RISK FACTORS: ANAEMIA AMONG ANTENATAL MOTHERS

RISK FACTORS: ANAEMIA AMONG ANTENATAL MOTHERS Anemia in pregnancy constitutes a major public health problem in developing countries. It is defined as reduction in the oxygen carrying capacity of the blood as a result of fewer circulating erythrocytes than normal or a decrease in the concentration of Haemoglobin (Hb) (Hoque et al., 2009). During pregnancy, there is an increase in amount of iron required to increase red cell mass, expand plasma volume and to allow growth of fetal-placental unit (Scholl, 2005). The deficiency occurs through reduced production or an increased loss of red blood cells. Anaemia in pregnant women in developing countries is generally presumed to be the result of nutritional deficiency. In Malaysia, the incidence of anaemia among pregnant mothers attending public antenatal clinics was reported to be 35% (Jamaiyah et al., 2007). Hadipour et al. (2010) reported a higher incidence of anaemia among Iranian pregnant women i.e. 51.4%. Iron deficiency anaemia is the most prevalent nutritional deficiency problem affecting pregnant women. Pregnant women are considered to be the most vulnerable group, since the additional demands that are made on maternal stores during this period exposes them to various latent deficiencies that manifest themselves as anaemia (Hoque et al., 2009). Increased iron requirements, low pre-pregnancy iron stores and continued inadequate dietary intakes of iron exacerbate this physiologic anaemia during pregnancy in many regions of this world (Christian et al., 2003). Brabin et al. (2001) reported a strong association between severe anaemia (OR 3.51, 95% CI: 2.05-6.00) and maternal mortality. Anaemia may result from both nutritional and nonnutritional factors, specifically besides iron, deficiency of micronutrients such as vitamins A, C and B-12 and folic acid may contribute to the development of anaemia. These nutrients may affect haemoglobin synthesis either directly or indirectly by affecting absorption and/or mobilization (Ramakrishnan et al., 2004). Systemic evaluation of the efficacy of antenatal iron supplementation is known to raise haemoglobin concentration, although it effects are influenced by dose and compliance level (Christian et al., 2003). Inability to meet the required level for iron and other vitamins either as a result of dietary or supplementary gives rise to anaemia (Idowu et al., 2007). According to the World Health Organization (WHO, 1998), anaemia should be considered when the hemoglobin level is below 11 g/dL. Anaemia ranges from mild, moderate to severe and WHO classifies the hemoglobin level for each of these types of anemia in pregnancy at 10.0 -10.9 g/dL (mild anemia), 7-9 g/dL (moderate anemia) and The effects of maternal anemia on the fetus were considerable and include the following: the prematurity rate among infants of anemic mothers was 18.1%, 3 times that of infants born to nonanemic mothers; the perinatal loss in the anemic mother was 13.1%, twice that of the nonanemic mother (6.8%); and the stillbirth rate among infants born to anemic mothers was 91.0/1000 compared with a rate of 15.7/1000 among infants born to nonanemic mothers. The findings indicate the seriousness of severe anemia in pregnancy. Etiological factors are considered since this will be the basis of rational therapy. Iron deficiency anemia may develop for several reasons. There is usually a dietary deficiency of iron, and there may also be a lowered absorption from the gut. Also, there may be excessive blood loss due to hookworm and menorrhagia, and there are the demands of repeated childbearing. Apart from hookworm infestation, insufficient dietary intake of iron was the principal cause of anemia among the women in the study with iron deficiency anemia. Among the women with megatoblastic anemia folic acid was the prime deficiency leading to this type of anemia. The anemia was aggravated by increasing malnutrition as demonstrated by diminished serum albumin and globulin concentration. The diagnosis of severe iron deficiency anemia was made by estimation of the hemoglobin concentration, supplemented in some cases by serum iron studies. Megaloblastic anemia in pregnancy can only be diagnosed with accuracy by a bone marrow smear. Consideration of the etiology of anemia in Malaysia led to a standard treatment among the pregnant women studies. The treatment approach is reviewed in detail. In Malaysia, pregnant women from a lower social-economic group indicated the prevalence of anaemia was 30-40%. Since then, Malaysia has had tremendous economic changes and is expected to have changes in the prevalence of anaemia as well. This study was conducted with the aim of identifying of risk factors that contributing anaemia among antenatal mothers such as sociodemografic data, prenatal care and maternal health status. 1.1 PROBLEM STATEMENT Anaemia still constitutes a public health problem in the world, especially in the developing countries (Royston Armstrong),1989,Abou Zahr Royston,1992).Nutritional anaemia is found more among rural mothers, where poor dietary intake and parasitic infections are more common. Many women start their lives with insufficient iron stores, but also, because of inadequate child spacing, they have little time to build up their iron levels between pregnancies (WHO,1975). The effect of anaemia in pregnancy has been shown to be associated with an increase risk of maternal and fetal morbility (Tasker,1958;Llewellen-,1965;Lourdeadin,1969;Baker,1978). However, risk factors such as anaemia in pregnancy can be controlled and monitored by good antenatal care and appropriate action, including referral, in accordance to the level of severity of the anaemia. In Malaysia, 30 to 40% of pregnant women and 25% of women from rural communities suffer from iron deficiency anaemia. The most common haematologic complication of pregnancy and is associated with increased rates of premature birth, low birth weight and perinatal mortality. According to Jamaiyah et al.(2007), found that the prevalence of anaemia during pregnancy is 35% and mostly of the mild type and more prevalent in the Indian and Malays. WHO estimates that more than half of pregnant women in the world have a haemoglobin level indicative of anaemia. ( Base on the many contradicting finding of this similar study, therefore the aim of this study is to determine the factors that contributing anaemia during pregnancy among mothers admitted at antenatal ward, Hospital Jeli, Kelantan. 1.2 Objectives 1.2.1 General objectives To determine factors associated with anaemia during pregnancy among mothers admitted at Antenatal Ward, Hospital Jeli, Kelantan. 1.2.2 Specific objectives 1. To determine the haemoglobin level for mothers who admitted at antenatal ward ,Hospital Jeli, Kelantan 2. To determine factors associated with anaemia mothers. 1.3 Benefit of study Knowledge on factors associated anaemia during pregnancy among mothers such as factors social demographic, prenatal care of maternal status and maternal nutrition of the mothers. To prevent and reduce the prevalence of low birth weight among infants and to prevent maternal and prenatal mortality. 1.4 Conception frame work Figure 1: factors that contributing with anaemia Anemia in pregnancy constitutes a major public health problem in developing countries. (Brabin et al.2001). This conceptual framework describe those maternal factors that may influence anaemia among antenatal mothers. The important factors are the socio demographic data such as the age of mother, race, parity, education level of mothers, Occupation of mothers, Occupation of father and number of dependent. Perinatal care variables that were studied were access to antenatal booking, number of visit to antenatal clinic ,parity,Period of Gestation (POG) ,vitamin and iron supplements, family planning and eating taboos. Maternal health factors such as past medical history, Big baby, APH, placenta praevia, hyperemesis , Hb level ,Multiple pregnancy and others were included in this study to determine the factors that contributing anaemia mothers. CHAPTER 2 LITERATURE REVIEW 2.1 Definition of anaemia in pregnancy In pregnancy , anemia has a significant impact on the health of the fetus as well as that of the mother. The physiologic expansion of the plasma volume is detactable as early as 6 to 8 weeks gestationan (Wood Ronneberg, 2006). The world health organization (WHO) defines anemia in pregnancy as haemoglobin concentration of less than 11.0g/dl. WHO estimates that more than half of pregnant women in the world have a haemoglobin level indicative of anemia ( Iron is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport. Iron equilibrium in the body is regulated carefully to ensure that sufficient iron is absorbed in order to compensate for body losses of iron. While body loss iron quantitavely is as important as absorption in terms of maintaining iron equilibrium, it is a more passive process than absorption. Consistent errors in maintaining this equilibrium lead to either iron deficiency or iron overload. Iron balance is achieved largely by regulation of iron absorption in the proximal small interstine. Either diminished absorbable dietary iron or excessive loss of body iron can cause iron deficiency. Decrease absorption usually is due to an insufficient intake of dietary iron is an absorbable form. It si support by Ladewig et al.(2006), found that the common anemia of pregnancy are due to either to insufficient haemoglobin production related to nutritional deficiency in iron or folic acid during pregnancy. Anemia is the most common haematologic complication of pregnancy and is associated with increased rates of premature birth, loe birth weight and perinatal mortality. According to Allen (2000), iron deficiency anemia is a factor that can cause preterm birth and low birth weight and can effect the neonatal health status. Haemoglobin values drop during the second trimester of pregnancy because of the dilution of the blood caused by plasma increases and this physiologic anemia is normal. During the third trimester, haemoglobin levels generally return to pre pregnancy levels because of increased absorption of iron from the gastrointestinal tract. Generally, a women is considered anemia if her haemoglobin is less than 11 g/dl during the first and third trimester or less than 10.5 g/dl during the second trimester (Cunningham et al., 2001). In malaysia, ion deficiencies always happen in malay and Indians pregnant women because their particular eating habits of different races. It support study done by mohanambal et al.(2002), found that iron deficiency was sees in Malays and Indians, no iron deficienciency was seen among the Chinese. 2.2 Factors associated with anemia 2.2.1 socio- demographic factors Malaysian infant mortality diffentials, because socioeconomic development has very clearly had a diffential impact by ethnic group. The Chinese rates of infant mortality are significantly lower than the Malay or Intdian rates. Low socioeconomic level was the most important risk factor for anaemia among antenatal mothers. And was independent of other factors, including those related to production and nutrition, health service and prinatal care. It is support by Sohl Moore (2000), reported that there are clear genetic and constituonal influences that act on foetal growth, it is estimated that 40% of birth weight is due to heredity and the remaining 60% to environmental factors. According to kennedy et al.(1998) and Ecob and Smith (1999), among the socio-economic factors are income, education, occupation, household leadership and gender differences related to roles within the family. It support the findings studies by Tuntiserance et al. (1999), studied a cohort of 1797 pregnant women visiting antenatal clinics, they found that significantly factors between socio-economic indicators and pregnancy outcomes. The indicators were family socio-economic status, maternal education, maternal occupation, family income and work exposures, while the pregnancy outcomes were base on anaemia mothers. Age of mother Maternal age is an important and dependent risk factor for adverse pregnancy outcome(Delbaere et al.,2007). Epidemiological studies suggest that there is a trend in developing nations to delay the age of the first pregnancy. Maternal age > 35 years for first pregnancy is associated with low birth weight, intra uterine growth retardation and prematurity. It is supports the finding study by Ann et al. (2007) that have same conclusion that increasing maternal age to be associated with low birth weight and anaemia during delivery. Educational level of mother Educational level of mother are linked to certain prenatal risk factors such as anaemia and to proven detrimental to birth outcomes . this can help intervention workers to identify the at risk mother. Early identification can result in focused programs administered directly to the individuals most likely to benefit (Wasser, 1995). According to Currie and moretti (2003) started that the effect of maternal education on birth weight I the US with a policy increasing the supply of colleges when the mother was teenager. The rationale is that the opening of a college reduces the cost of higher education in a way that is uncorrelated with the unobservable term correlating both education and health. Family income Family income is generally considered a primary measure of a nations financial prosperity. Income or poverty status had a statistically significant effect on anaemia mothers and both low birth weight and the mortality rate. According to Duncan and Brooks-Gunn (1997), found the effects of income or poverty status and a number of pregnancy-related health services on birth outcomes for white and black women also found that for whites but not for blaks. Prenatal care of mothers Antenatal care is the clinical assessment of mother and fetus during pregnancy, for the purpose of obtaining the best possible outcome for the mother and child. Antenatal care traditionally involves a number of routine visits for assessment, to a variety of healthcare professionals, on a regular basis throughout the pregnancy. Number of children (parity) Parity was determined to all the number of previous pregnancies resulting in either live birth or still births after 22 weeks of gestational age. Maternal parity and age were significantly positively associated with anaemia mothers. Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased. The mother must increase her production of red blood cells and, in addition, the fetus and placenta need their own supply of iron, which can only be obtained from the mother. In order to have enough red blood cells for the fetus, the body starts to produce more red blood cells and plasma. It has been calculated that the blood volume increases approximately 50 per cent during the pregnancy, although the plasma amount is disproportionately greater. This causes a dilution of the blood, making the haemoglobin concentration fall. This is a normal process, with the haemoglobin concentration at its lowest between weeks 25 and 30. The pregnant woman may need additional iron supplementation, and a blood test called serum ferritin is the best way of monitoring this. Many women are anaemic during pregnancy. A recent study by the Anaemia Working Group found that about one-third of pregnant Malaysian women are anaemic. (Dr. Milton Lum , 2009).Anaemia occurs because there is increased demand for iron and vitamins in pregnancy. The mother has to produce more red blood cells for herself and the foetus. More plasma is also produced.The blood volume increases by about 50% during pregnancy with a disproportionate increase in plasma. This leads to a dilution of the blood with the haemoglobin falling. The haemoglobin is at its lowest level between 24 and 30 weeks of pregnancy. Poor diet: If the diet is low in iron and vitamins, especially folic acid, there is a risk of anaemia as these are the raw materials needed to produce sufficient numbers of red blood cells. Vegetarians who have a strict diet may not get enough iron or vitamin B12 in their food. Family history: Some women whose family members have anaemia because of inherited genes are at increased risk. Chronic conditions like kidney or liver failure, and cancer increases the risk. Chronic blood loss from some parts of the body due to ulcers, haemorrhoids, etc, may lead to iron deficiency anaemia. 2.3 Regulation of iron transfer to the fetus Transfer of iron from the mother to the fetus is supported by a substantial increase in maternal iron absorption during pregnancy and is regulated by the placenta .Serum ferritin usually falls markedly between 12 and 25 wk of gestation, probably as a result of iron utilization for expansion of the maternal red blood cell mass. Most iron transfer to the fetus occurs after week 30 of gestation, which corresponds to the time of peak efficiency of maternal iron absorption. Serum transferrin carries iron from the maternal circulation to transferrin receptors located on the apical surface of the placental syncytiotrophoblast, holotransferrin is endocytosed, iron is released, and apotransferrin is returned to the maternal circulation. The free iron then binds to ferritin in placental cells where it is transferred to apotransferrin, which enters from the fetal side of the placenta and exits as holotransferrin into the fetal circulation. This placental iron transfer system regulates iron tran sport to the fetus. When maternal iron status is poor, the number of placental transferrin receptors increases so that more iron is taken up by the placenta. Excessive iron transport to the fetus may be prevented by the placental synthesis of ferritin. 2.4 Effect of anemia on maternal mortality and morbidity The major concern about the adverse effects of anemia on pregnant women is the belief that this population is at greater risk of perinatal mortality and morbidity. Maternal mortality in selected developing countries ranges from 27 (India) to 194 (Pakistan) deaths per 100000 live births. Some data show an association between a higher risk of maternal mortality and severe anemia, although such data were predominantly retrospective observations of an association between maternal hemoglobin concentrations at, or close to, delivery and subsequent mortality. Such data do not prove that maternal anemia causes higher mortality because both the anemia and subsequent mortality could be caused by some other condition. For example, in a large Indonesian study, the maternal mortality rate for women with a hemoglobin concentration 2.5 Maternal anemia and birth weight The relation between maternal anemia and birth weight has been reviewed more extensively elsewhere in this issue. In several studies, a U-shaped association was observed between maternal hemoglobin concentrations and birth weight. Abnormally high hemoglobin concentrations usually indicate poor plasma volume expansion, which is also a risk for low birth weight. Lower birth weights in anemic women have been reported in several studies. In a multivariate regression analysis of data from 691 women in rural Nepal, adjusted decrements in neonatal weight of 38, 91, 187, and 153 g were associated with hemoglobin concentrations à ¢Ã¢â‚¬ °Ã‚ ¥20, 90-109, 70-89 and 2.6 Maternal iron deficiency anemia and duration of gestation There is a substantial amount of evidence showing that maternal iron deficiency anemia early in pregnancy can result in low birth weight subsequent to preterm delivery. For example, Welsh women who were first diagnosed with anemia (hemoglobin 2.7 Maternal anemia and infant health An association between maternal anemia and lower infant Apgar scores was reported in some studies. In 102 Indian women in the first stage of labor, higher maternal hemoglobin concentrations were correlated with better Apgar scores and with a lower risk of birth asphyxia. When pregnant women were treated with iron or a placebo in Niger, Apgar scores were significantly higher in those infants whose mothers received iron. A higher risk of premature birth is an additional concern related to the effect of maternal iron deficiency on infant health; preterm infants are likely to have more perinatal complications, to be growth-stunted, and to have low stores of iron and other nutrients. In the Jamaican Perinatal Mortality Survey of >10000 infants in 1986, there was an à ¢Ã¢â‚¬ °Ã‹â€ 50% greater chance of mortality in the first year of life for those infants whose mothers had not been given iron supplements during pregnancy, although the iron status of these infants and their mothers was not assessed. Apart from this survey, there is little known concerning the effects of maternal iron status during pregnancy on the subsequent health and development of the infant. 2.8 Benefits of iron supplementation on maternal iron status There is little doubt that iron supplementation improves maternal iron status. Even in industrialized countries, iron supplements have been reported to increase hemoglobin, serum ferritin, mean cell volume, serum iron, and transferrin saturation. These improvements are seen in late pregnancy, even in women who enter pregnancy with adequate iron status. When compared with unsupplemented pregnant women, differences in iron status due to supplementation usually occur within à ¢Ã¢â‚¬ °Ã‹â€ 3 mo of the time supplementation begins. Supplementation can reduce the extent of iron depletion in the third trimester. However, for women who enter pregnancy with low iron stores, iron supplements often fail to prevent iron deficiency. The benefits of iron supplementation on maternal iron status during pregnancy become even more apparent postpartum. This is illustrated by a Swedish study in which all pregnant women who did not take iron supplements had less than sufficient iron stores in late pregnancy compared with 43% of supplemented (200 mg Fe/d) women. Use of nutritional supplements Intake of iron supplements during pregnancy was also found to have a protective effect with anaemia in pregnancy. This is consistent with the findings of some other studies on iron supplementation and pregnancy outcome (Hesss et al.,2001). Iron supplementation during pregnancy protects a women from becoming anaemic because the required amounts may not be supplied from dietary intake during this period. Controlled trials of iron supplementation during pregnancy have consistently demonstrated positive effects on maternal iron status at delivery. The prevalence of low hemoglobin or hematocrict is reduced: serum ferritin, serum iron and almost every other measure of maternal iron status, including bone marrow iron, are increased in comparison with controls (Mohamed, 1998). Malaysia has gone a long way towards improving the nutritional status of the population. Malnutrition has been defined as a pathological state resulting from a relative or a absolute deficiency or excess of one or more essential nutrients, it can comprise four forms-under-nutrition, over-nutrition, imbalance and specific deficiency (Park, 20000. Antenatal booking Antenatal booking is a an assessment of the physical, social, psychological and emosional state of the pregnant women. The main purpose of the booking visit to obtain a comprehensive history, establish the gestational age and identify maternal and ftal risk factors. Baseline investigations are performed. According to Adesina et al. (2003), stated that early antenatal booking and good control in pregnancy are strongly advocated as means of achieving good pregnancy outcome. It support by Tayie and Lartey (2008), found that early antenatal care was associated with pregnancy outcomes. Number of visits to antenatal clinics Antenatal clinic (ANC), refer to pregnancy related services provided between conception and delivery consisting of monitoring health status mother and her pregnancy. ANC was expected to ontain of mother to get anaemia and preterm delivery rete, a higher average birth weight and decreased neonatal mortality. According to Kost et al.(1998), antenatal clinic (ANC) visits could possibly be seen as indicator of the mothers sense of responsibility to her unborn baby. Visit to ANC services could also have a positive influence on the attitude of the mother, will impact on birth-outcomes. Total numbers of ANC visits for the current pregnancy were categorized as >4 visit and 4 ANC visits with an appropriate health care provided (World health organization,2004) ANC visits as part of primary health care to early detection and treatment of probable problem areas, and contribute to the quality of the birth outcome. ANC has been associated with improved maternal and perinatal outcome, but there is no agreement on the most effecting timing of visit antenatal mother. In Malaysia, the frequency of ANC visit depends on the gestational such as 0-28 week every one mont, 28-36 week every 2 week and 36-4- week every 1 weeks. Antepartum haemorrhage (APH) vagina bleeding is an important factor predictor of adverse effects anemia mothers. About 50% of women who bleeding in last half of pregnancy have placenta praevia or abruptio placenta. When ever the bleeding occurs at the beginning of pregnancy, however the cause is often unknown ( Valero de Bernabe et al.,2004). CHAPTER 3 METHODOLOGY 3.1 Study Location This study were carried out at the antenatal ward, Hospital Jeli, Kelantan. 3.2 Study Design A cross-sectional study design were done in antenatal ward, Hospital Jeli, Kelantan from period of January until March 2011. 3.3 Sampling 3.3.1 Sampling population All mothers who admitted to antenatal ward, Hospital Jeli, Kelantan during the period of January until March 2011 were included in the study. 3.3.2 Sampling frame A list of all antenatal mothers who are admitted at antenatal ward Hospital Jeli, Kelantan during the period of January March 2011 were obtained. 3.3.3 Sampling Method Simple random Sampling, where all antenatal mothers who fulfil inclusion criteria were selected. 3.3.4 Sample Size The minimum sample size required in this study was 30. Data were collected by using close and open ended questionnaires and recode review of admission registered at antenatal ward, Hospital Jeli, Kelantan. In this study, all antenatal mothers who admitted were choosing by Universal sampling. 3.3.5 Inclusion Criteria Mothers who are willing to participate study All The citizen mothers 3.3.6 Exclusion criteria Mothers whos refuse to participate in this study Non citizen mothers Mothers who not understand Malay and English language. 3.4 Research Instrument An interviewer administered questionnaire was developed with two sections: Section A (demographic data) Factors socio demographic (Maternal age, races, education level, family income, employment status, employment status of husband , Hb level and number of dependents. Section B (prenatal care of mothers) Period of gesational , antenatal booking, antenatal clinics ,parity, nutritional supplements,. Section C ( Maternal Health Status) Factors of maternal health status (past medical history, big baby, infection during pregnancy, Ante partum hemorrhage and hyperemesis during pregnancy. 3.5 Definition of study variables The dependent variable: Antenatal mother The independent variables socio demographic factors Age Ethnicity Educational level Primary school Secondary school Tertiary level Occupational of mothers Housewive Professional Non professional Occupational of husband Professional Non professional Agriculture forestry Montly family income. It is divided to 3 categories; 1000-2500 >2500 Hb level of mother during admission Mild anemia ( 10.0 10.9 g/dL ) Moderate anemia (7.0 9 g/dL) Severe anemia ( Number of dependents ii. Prenatal care of mothers Number of children (parity) all the numbers of previous pregnancies resulting in either live births or still births after 22 weeks of gestational age. Number of visits to antenatal clinics that divided to 3 categories 0-4 visit 5-7 visit Above 8 visit Gestational age of mother Time measured from the first day of the womens last menstrual cycle to the current date. Use of nutritional supplements such as iron, folic acid, multivitamin and others iii. Maternal Health status Past medical history -Gestational Diabetic Mellitus (GDM) -Pregnancy Induced Hypertension (PIH) -Thalasaemia Infection Ante Partum Haemorrhage -Placenta praevia -Placenta abruptio Hyperemesis 3.6 Definition of terms 1. Anaemia: Anaemia is a lack of red blood cells, which can lead to a lack of oxygen carrying ability, causing unusual tiredness. Human resource management: Tesco Human resource management: Tesco The aim of the assignment is to evaluate strategic human resource management of Tesco Plc with reference to theory and practical approach, to study their Human Resource Management functions and evaluate the contribution of approaches and organisational structure. Human resource management is the process of acquiring, appraising, training, and compensating employees and of attending to their health and safety, and fairness concerns. HRM functions include a wide range of activities, and key among them is the responsibility of human resources. This includes deciding what staffing needs the company has and whether to hire employees or use independent contractors, recruiting and training of the employees, ensuring they always give high performance and ensuring personnel management practices to confirm laws and regulations. HRM activities also include managing employee benefits and compensation, personnel policies and employee records. TRADITIONAL DEFINITION Human resource management is the moulding of the human resources in such a fashion that the goals of the organisation are met and at the same time the need satisfaction of all the employees at all levels is attained to the highest possible degree. MODERN DEFINITION Human Resource (Personnel) Management is the planning, organizing, directing and controlling of the procurement, development, compensation, integration, maintenance, and separation of human resources to the end that individual, organizational and societal objectives are accomplished.- Edwin B. Flippo CONTEMPOPARY DEFINITION Human resource management (HRM) is the effective management of people at work. HRM examines what can or should be done to make working people more productive and satisfied.- John M. Ivancevic NATURE OF HRM Human resource management is a process of bringing organizations and people together in order to meet each others goals. Some of its features are as following: Pervasive force- Human resource management is pervasive in nature. Action oriented- Human resource management focuses on performance rather than written rules and procedures. Employees problems are solved through rational policies. Individual oriented- It helps employees in developing their potential full. It allows them to give their best efforts to the organization. It motivates them through systematic process of recruitment, selection, training and development with fair wage policies. People oriented- HRM is about people at work, as individuals as well as groups. It puts people on their assigned jobs to produce good results. Future oriented- HRM does help an organization to meet its goal in the future by preparing motivated and competent employees. Development oriented- HRM helps in developing full potential of the employees. Integrating mechanism- HRM helps in building and maintaining strong relations between people working at different levels in an organization. Comprehensive function- HRM is concerned a decision which can have an impact on the staff. Auxiliary- The purpose of the HR department is to advise and assist the operating managers to do work related to personnel more efficiently and effectively. NATURE OF HRM IMPORTANCE OF HRM People have always been the center of the organizations, and their importance is increasing in todays knowledge based industries. Success of an organization depends on knowledge, skills and abilities of the employees, especially as it helps to establish core competencies over its competitors. HRM helps an organization and its people to reach their goals at following level: Enterprise Level: Organizations can attract and retain best of the people in the organization if it has good human resource practices. Planning in advance helps the company to know what type of people it requires in short, medium and long term. It helps in training the employees for challenging roles, developing right attitude towards the company, promoting a spirit of team among employees and developing commitment and loyalty through reward schemes. Individual Level It helps in building teams and promotes team spirit among employees. It allows growth opportunities to people who have capabilities and potential to rise. It generates compassion and commitment in people towards their jobs. Society Level: Society as a whole is good beneficiary of human resource practices. It helps in generating employment opportunities. It puts talents to the best use. Companies that have good HRM policies stay ahead of their competitors and produce excellent results. National Level: Effective use of human resource results in better exploitation of physical, natural and financial resources. People with proper attitude and values and right skills help the nation to get ahead and compete with the best of countries. TESCO- COMPANY BACKGROUND Tesco was founded in 1919 by Jack Cohen. He started his new business venture by selling surplus groceries from a stall in the east end of London. On the first day, he made  £1 profit from  £4 of sales. Tesco has come a long way since then and is the fourth largest food retailers in the world after Wal-Mart of the USA, Carrefour of France and Home Depot of the USA. Tesco PLC is listed on the LSE, with the symbol TSCO. It is listed on NASDAQ and Irish Stock Exchange as well. Today it is operating 5,008 stores worldwide of which 2,545 stores are in the UK, and employing over 472,000 people worldwide of which 287,669 are in the UK. Not only Tesco has managed to monopolise the food sector, it has also diversified into a number of other sectors, some of which are insurance, mobile networks, clothing and electronics. However this assignment will focus on the retail sector in the United Kingdom. Albeit that Tesco has 2,545 stores locally, it is considered as operating in global environment. Apart from the United Kingdom, Tesco has stores in six other European countries; Poland, Hungary, Czech Republic, Slovakia, Republic of Ireland and Turkey. Furthermore, it also operates in Asia, and has stores in Malaysia, China, Korea, Thailand, Japan and Taiwan. Tesco requires people across a wide range of both store-based and non-store based jobs:- In store, checkout staffs, stock handlers, supervisors and many specialists such as bakers and pharmacists are needed. For distribution depots it requires people skilled in stock management and logistics. Head office provides the infrastructure that helps to run Tesco efficiently. In the head office, main roles include human resources, legal services, marketing, information technology, property management and accounting. FUNCTIONS OF HRM IN TESCO PLC RECRUITMENT AND SELECTION Recruitment involves attracting the suitable applicant to apply for the vacancies. Tesco advertises for the jobs in different ways. The process varies upon the type of job available. Tesco, first of all, looks at its internal Talent Plan to fill a vacancy. In this process, its current employees who are looking for a move, either at the same level or on promotion, are listed. If it can not find suitable people in this Talent Plan, Tesco advertises the post internally over its intranet for two weeks. For recruitments from outside the organisation, Tesco advertises vacancies through its website www.tesco-careers.com or through display boards in stores. Applications for the managerial positions are made online. Applicants who are chosen, have an interview followed by attendance at an assessment centre for the final stages of the selection process. People who are looking for store based jobs with Tesco can submit their CV at the store or can register through Jobcentre Plus. The store prepares a waiting list of people applying and calls them as jobs become available. For jobs that are hard to fill or are specialised in nature, such as pharmacists and bakers, Tesco goes for external advertising through following mediums: Through radio and television Through website and offline media By placing advertisements on Google or in magazines. Tesco seeks the most cost effective way of attracting right applicants. Tough it is expensive to advertise on radio and television, it is necessary to ensure that right people get to know about the vacancies. Tesco makes it easy for the applicants to find out about the available jobs and has a simple application process. An applicant can find about management jobs, head office jobs and local jobs, through Tescos website. There is an online application form for applicants to submit directly. Skills required There are six work levels within the organisation and each level requires particular skills and behaviours. Level 1 These are frontline jobs and include working directly with customers, various in-store tasks such as filling the shelves with stock. Candidate should have the ability to work accurately with enthusiasm and should be able to work in a team. Level 2 This includes leading a team of employees who are involved in dealing directly with the customers. Candidate should have the ability to manage resources, set targets and constantly work manages and motivates others. Level 3 This includes running an operating unit. It requires management skills that include planning, setting targets and reporting. Level 4 These are supporting operating units and requires good knowledge of the business, ability to lead others and skills to analyse and make decisions. Level 5 People working at this level are responsible for working of Tesco as a whole and should have ability to take major decisions and to lead others. Level 6 This includes the top level management of Tesco PLC which is responsible for Tescos performance. This level requires from candidates an excellent overview of retailing and ability to lead the whole organisation. This framework of Tesco describes the skills and behaviours required at each job and every level of in the company. This helps the candidates to understand whether they possess the right skills and knowledge to carry out their roles. SELECTION Selection involves choosing the most suitable people from those who have applied for a particular job. Screening candidates is an important part of the selection process. This process makes sure that people selected for the interview are best fit with the job requirements. In the first stage of screening, selectors will carefully look at each applicants CV. A well written and positive CV helps Tesco assess whether an applicant matches the specifications required for a particular job. The company also provides a tool called job type match on its webpage. It helps people to let them know where they might fit within the organisation. Candidates who pass screening have to attend an assessment centre. The assessment centres are held in stores and are run by managers. They help to provide consistency in the process of selection. Applicants are given various tasks, this includes working in teams or problem solving exercises. These involve examples of the problems they might have to face at work. Candidates who get approved by the internal assessment centres then have an interview. Line managers take part in the interview to make sure that the candidate fits job requirements. TRAINING Training means acquisition of skills and knowledge by a person for carrying out particular jobs and tasks. The benefits of training employees in an organisation are as follows: It motivates them by increasing their sense of ownership in the organisation. Training makes the employees more productive, organised and flexible. They are able to meet the needs of external and internal customers. Training makes them more effective by imparting new skills and abilities in areas such as decision making. Tescos business image helps Tesco grow. This is because customers are more confident in the competence and knowledge of staff. Tescos training and development module is flexible and structured, which caters to each individual employee needs. This allows the company to identify the potential customers and who have desire to do a bigger and different role to take part in training and develop their skills and leadership capabilities. Tesco follows two types of training methods for the training purpose of its employees. These methods are on the job training and off the job training. On the job training methods include: Shadowing: In this method, a new employee is shown how to do a particular work by an employee who is already working there for a long time and has got good knowledge and skills for that work. Coaching: In this method a designated colleague helps trainees and inspires them to find solutions for the problems they face. Mentoring: In this method, an experienced member of staff acts as an advisor for the new entrants. Job rotation: In this method the trainee is given full responsibilities on a temporary basis. On the job training is directly relevant to the work of the employees and they get to know the people in their area and feel part of a team. The advantages of on the job training methods are as follows- It is costs much less than the off the job training methods. Managers can keep a check on the progress of employees and can help if a problem arises. The employee works during training. Hence, this method of training is more productive. The employee can apply what he/she has learned while working. This results in a better learning. In areas such as team building, organisation and planning or communications, off the job training methods are more appropriate. It involves attending qualified Tesco training staff or external courses run by professional training organisations. At the A Level Options programme detailed induction training is provided from day one. It helps in developing new recruits into managers. This makes new employees meet other trainees and learn about the company and the business objectives extensively. With this kind of elaborate training schedule, they are able to develop the first level management position while working as a Team Leader DEVELOPMENT Development focuses on the growth of the person and extending his/her abilities. Tesco takes the responsibility for training and development of its staff. Primarily, the trainee is responsible for his/her development. The trainee and the manager, both contribute to the programme. The contribution is shown in the following table: TRAINEE LINE MANAGER Identifies and agrees development needs Helps to put together the personal developmental plan Attends workshop and development days Coaching and guiding the trainee as per the developmental plan. Collects evidence of achievements Reviews performance regularly. This he does to ensure that the trainee gets the best from the training Uses the feedback he receives to improve performance and review his development plans Provides feedback Employees of Tesco are encouraged to ask certain strategic questions about themselves in order to assess their ability and skills regarding progress. These questions are:- Do I know how? Can I do it now? What are my current skills? What do I need to achieve a higher position? Options programme Options programme of Tesco provides a long term strategy for development. The employees PERSONAL DEVLOPMENT PLAN includes: Activity plans A learning log A plan, do, review checklist. This is done to monitor when plans are completed. This enables trainees analyse their own progress. Long lasting competencies are produced with the help of personal development. Employees become more productive, positive and valuable to the organisation in the long term. It is a known fact that recruiting new staff costs more than retaining existing staff, therefore for an organisation like Tesco, retaining staff is of prime importance. Development also helps to increase the level of motivation amongst the employees. According to motivation theorists, if employees are given the support to grow their abilities, skills to perform their jobs well and greater responsibility, they become more effective. Tesco needs to ensure that it has the right calibre of staff to build its management team of the future. It requires a staff who can be flexible and who can adapt to change. THE BENEFITS OF TRAINING AND DEVELOPMENT All businesses, for financial and non-financial reasons, have to monitor and evaluate the costs and benefits of their training and development activities. The business needs to be aware if the investment of its time and money in selection and training of the employees producing any improvements. An employee needs to be given positive and structured feedback on their progress. This gives them a direction and much of confidence. This is reflected in their behaviour while dealing with customers and inspires higher customer confidence in Tesco. The tools of Tesco for monitoring and evaluation of training and development includes: Scheduled tasks Timetables Measures Checklists Employees are able to assess themselves by setting aims in Activity Plans, Recording Outcomes, Personal Development Plans and in Learning Logs. Activity plans need to have SMART objectives: Specific- This describes exactly what needs to be done Measurable- It has a target that can be measured against. Achievable- This is possible within the trainees current skills, role and experience. Realistic- It is achievable within the time and resources available. Time framed- it has a clear deadline. 360 DEGREE APPRAISALS Tesco also uses 360 degree method of performance appraisal. It involves taking feedback from all the people concerned with the employee in the organisation. In other words, all the stakeholders of the organisation who are in contact with the employee assess the persons performance and give feedback for the same. Apart from 360 degree appraisal, Tesco uses a more informal approach to development. In this approach, employees are asked to write down three that according to them they are good at and three things that they believe they could do better. The employee can make out the actions that he/she should continue to do and the bring improvement to the areas they could do better. Managers and trainees hold a weekly informal session and more formal four weekly sessions in order to track progress against their personal development plans. The feedback is carefully recorded and scored. Trainees are given a colour coded development rating: REWARDS AND BENEFITS It is important for an organisation that its people feel rewarded for the work they do. Tesco offers a wage rate that is higher than minimum salaries across all its businesses internationally. Tesco focused on its core rates and even in tough financial year, its pay competitiveness still improved in many markets. In most developing countries, staffs give priority to good basic pay and being paid fairly for overtime. In Malaysia, where there is no legal minimum wage rate, a Tesco employee receives 30% more than the Poverty Line Index for households. Tesco also provide its employees a wide range of competitive benefits in line with local labour laws and regulations. Some of these benefits are from paying at least 75% of the medical expenses, prescription drugs, dental and vision coverage after 90 days employment in the US to providing tuition subsidies in South Korea. Tesco has formulated long term reward plans for all markets so that it has clear plans on how to invest in pay and develop benefits for its employees in each country. All management teams of Tesco share in the success of its business. They are growing through bonus schemes linked to profitability. In the year 2009, Tescos employees received  £98 million worth of free shares in its Shares in Success scheme. A pay out of  £144 million was shared between fifty five thousand employees in Tescos Save as You Earn share option scheme. Tesco offers a wide range of staff discounts throughout the group. In Thailand, Tesco introduced staff discounts linked to its own Tesco clubcard in which staff received higher rewards than its customers. Tesco UK won two awards for its pension schemes. At the 2009 financial Times Pension and Investment Scheme Management Awards, Tescos schemes were awarded Defined Benefit Pension Scheme of the Year and Trustee Excellence- Large schemes. These award recognise how the funds are invested, how it communicates with its staff, how well it carries out the administration of the scheme and strength of the governance. The scheme aims at providing people with an annual income after they retire. Tesco provides benefits on ill health and death, based on their pay and their service. This benefit is one of the ways to reward loyalty and also contribute in attracting and retaining its employees. COMMUNICATION Tesco wants employees to share their views on issues that affect and business, and communicate with them regularly through face to face briefing, store and depot forums, publications, intranet and staff question times. Tescos annual staff survey, called Viewpoint, is kept confidential and anonymous. Results are fed into local plans at office, depot and store level. All of Tescos employees are given right to join a trade union and it is important for both company and employees that they exercise their rights. Tesco has a leading partnership with Usdaw in the UK, and agreements with Katz in Hungary and Solidarity in Poland. Head Office staff of Tesco gains shop floor experience through annual programme called TWIST (Tesco Week In Store Together). In the peak shopping periods such as Christmas and Easter, all head office provide support to their store colleagues through a programme called Helping Hands. Whistle-blowing Tescos whistle blowing policy and helpline number is there in all the countries. Protector Line is a confidential telephone line and e-mail address for employees to report grievances and raise ethical issues. All the calls are invested properly and serious matters are reported to the CEO. The feedback is monitored by the compliance committee. The Group Audit committee reviews the numbers of call and the quality of investigation each year. It also reviews plans to ensure that the staff is well aware of the facility. In 2009, there were around 1,700 employment related calls to the helpline. There was an increase from the last year showing that employees are gaining confidence in the service. Most of the calls are related to personnel issues, commercial issues and security and trading law. Personnel issues are resolved through grievance procedures. In the autumn of the year 2009, Tesco launched a service called Every Comment Helps, in the UK. Customers can contact the company via free text messages, e-mails, free phone calls or a card commenting on the experience in store and stating whether it was good or bad. The messages are transferred to the manager who then decides whether a stock or display issue needs to be solved, or provides feedback to the member of the staff who has been commented on. BUSINESS STRATEGY Tesco with its well-established and consistent strategy for growth tends to solidify their core UK business and expand into new markets. The objective for the strategy is to broaden the scope of its business so that it delivers strong sustainable long term growth and following the customers into large expanding markets in UK, such as telecoms, non-food and financial services, and new markets abroad, initially in Asia and Central Europe and recently in United States. Tesco adopted the strategy of diversifying its business in 1997, and this strategy been the foundation of its success in recent years. The businesses in which Tesco entered over past twelve years now are competitive, have scales and in fact they are the market leaders in some of the markets outside UK. The Tesco group has been making good progress with this strategy. It has five elements, reflecting Tescos four established areas of focus, and also Tescos long term commitments on environment and community. The momentum that this strategy has given the business has allowed the group to continue to grow despite economic downturn. The objectives of the strategy are: To be successful as an international retailer To grow business in UK. The UK is Tescos biggest market and core of its business. Tescos aim is to provide its customers a wide range of choices with excellent value. To develop its retailing services including Tesco Personal Finance, Telecoms and Tesco.com To consider community before taking any decision. CONCLUSION Tesco is a large organisation with many job opportunities, including management, graduate, school leaver and apprentice posts. Tesco needs people with right skills and behaviour in order to support its growth and development. Tesco has detailed job descriptions, person specifications and clear organisational structures. It provides friendly way of applying for jobs and a consistent approach to recruitment and selection. Hence, it can manage its changing demand for staff. An essential element of Tescos continuing growth is an efficient and effective training and development of employees to compete in this increasingly commercial world. Tesco wants its employees to be flexible and committed in order to fulfil the needs of its expanding business. Tescos expansion depends upon retaining existing customers and attracting new ones. Its structured methods of training and development of new and existing employees provides a strong base for its continuing growth.