A Study to Asses the Knowledge and Practice Among Primipara Mothers Related to Essential

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“The Nation walks on the feet of little children.” -Jawaharlal Nehru

Children all our future and our most precious resources. Health of the future children’s depends on the nurturing practice adopted by the family.1 The first few days of life is a period of transition occurring all of a sudden from parasitic fetal life (intra uterine environment) to a completely independent (extra Uterine life). The process of birth and adaptation to the new surroundings depend upon number of adjustments on the part of the newborn baby especially.2

The first four weeks of life constitute the “neonatal period”. The ideal basic needs for any new born includes breathing, warmth, cleanliness, and feeding mothers milk. Then all new born babies’ requires essential new born care to minimize the illness and maximize their growth and development. Clearly, essential care of new born will help to prevent many newborn emergencies, example umbilical cord may be the most common source of neonatal sepsis and also of tetanus infection, and good cord care could dramatically reduce the risks of these serious conditions. Breast feeding has a significant protective effect against infections, early breast feeding and the baby kept close to the mother reduce the risk of hypothermia, as well a hypoglycemia.3

Nearly 50% of all infant deaths occur during the neonatal period. Half of this death occurs in the first Seven days due to pre-maturity, neonatal tetanus, birth asphyxia and infections, which can be prevented by proper and timely care of the new born (CSSM -1992 and family welfare-1992).4

Cleanliness at delivery reduce the risk of infection for the mother and baby, especially neonatal sepsis and tetanus, clean illness requires mother, families and health professionals to avoid harmful traditional practices and prepare necessary material.3 In 1993, 42% (1.7 million) of newborn death due to infections (neonatal tetanus sepsis, meningitis pneumonia, diarrhea). Two third of those infections were related to the birth process. Neonatal tetanus causes more than half a million of these deaths (14% of the total). But babies may still die of other bacterial infection. Caused by lack of hygiene at birth and during the newborn period without precaution of hygiene are particularly at risk.5 WHO in its studies stated that 1/3 neonatal deaths occur due to the improper care or due to infections e.g.

Pneumonia, tetanus, neonatal diarrhea etc., most new born deaths can be avoided by both preventure measures

(such as clean delivery) and by effective management of complications (management of infection) and other daily care also have important preventive effects ( breast feeding eye care etc.,)4

6.1 NEED FOR THE STUDY

“Children are one third of our population and all of our future”.

Select panel for the promotion of Child Health, 1981

In India infant mortality rates are still high compared to developed countries, one million new born infants die every year because of infection which often entered body via the umbilicus, fifty percent of the infant deaths occur during the first four week. Umbilical cord infections are a major cause of neonatal deaths and it occurs due to poor aseptic practices.4

Two third of the baby’s in our country are born at home and are at higher risk of developing sepsis. Babies born in hospital may also develop infection at home after discharge from the hospital. The commonest sources of infection in the community are unhygienic practice during delivery at home which include delivery in dark dirty room, cord cut with any available sharp instrument and the baby wrapped in old dirty cloths and other practices that increase the risk of infection include harmful applications to the cord, discarding colostrums and use of prelacteal feeds numerous visitors, who could be carries of infection are another source of infection for the babies. Unhygienic practices at birth are also responsible for infections and deaths both of the baby and mother. The introduction of five cleans at delivery which include clean surface, clean hands, clean blade, clean cord tie and clean cloths have contributed to the reduction of neonatal infections.6

Due to the unhygienic practice where cutting the umbilical cord improper observation about bleeding and the cord may lead to neonatal complications like neonatal tetanus and neonatal septicemia. Neonatal tetanus due to application of animal dung to the umbilical stump after delivery may cause increase the infant mortality rate. Untreated neonatal sepsis is life threatening and therefore its early identification and treatment is essential.7

The proportion babies who are breast fed is high in all regions of the world but there are wide variations in the duration of breast, feeding, sub-optimal breast feeding practice are still the norm in most countries, failure to give newborn infants colostrums is a common example of bad practice, lack of exclusive breast-feeding substantially increase the risk of poor newborn and childhood outcome.5

2 Neonatal care is not available to most neonates in developing countries because hospital care is costly, “so there is a need of home based delivery and neonatal care”. The neonatal care needs even more special attention because births taking place in home, in unhygienic conditions, due to ignorance, poverty and illiteracy among rural women.8

Promoting health at home and within the wider community plays and essential part in the reduction of children’s morbidity and mortality rate. WHO’S report states that integrated approach, good feeding practice, immunization, improved hygiene and the healthy development of children will help to reduce the child mortality rates. So investigators felt that it is necessary, to conduct study on primipara mothers, knowledge, practice care related to essential news born care.4

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process. It is used by investigator in the activities involved in identifying and searching for information and gaining insight in the problem selected for the study.9

Literature review is presented under the following headings

 Prevention of hypothermia  Establishment of breast feeding  Prevention of infection

Review of literature is on prevention of hypothermia

A comparative study conducted on the effect of timing of initial bath on newborns temperature. The study was conducted on 80 healthy full term newborns. 40 neonates were bathed at one hour of age and 40 bathed at 2 hours of age. There was no significant difference noted in temperature between two groups before the bath or at 10,20 or 60 minutes after bath. It shows that healthy full term newborns with auxiliary temperature > or = 36.80 C ( 98.20 F) can be bathed after one hour of age when appropriate care is taken to support thermal stability.10

A study conducted on , The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda. The aim of the study was to elcidate the impact of bathing on the prevalence of hypothermia among newborn babies exposed to the skin to skin (STS) care technique before and after bathing. The results showed bathing of newborns in the first hour after delivery resulted in a significantly increased prevalence of hypothermia. There was no neonatal mortality by this method they have concluded, bathing newborn baby’s

3 shortly after birth increased the risk of hypothermia despite the use of warm water and STS care for thermal protection of the newborn.11

A study conducted on, Skin to skin treatment of neonatal hypothermia. This study was shown that the skin-to skin (STS) care also called kangaroo care, an intervention in which the unclothed diapered infant is place on the mothers bare chest, be used to promote thermo regulation instead of using separation and a warmer, STS care has been recognized as a way to facilitate maternal – infant attachment and promote thermo regulation. The finding of the study concluded that the use of STS care as an alternative to traditional re-warming and the use of STS care in the treating of mild hypothermia in the low-risk infant.12

Review literature on Establishment of breast feeding

A study conducted on, An maternal attitudes and trends in initiation of new born feeding- in lady Hardinge Medical College, New Delhi in India. In this study 305 of the mothers were primipara and 297 multipara 95.01% of the mothers indicated inclinations about breast feeding 47.37% of the mothers who knew about breast feeding had been instructed by the doctors at some stage lastly the study was concluded that clearly, better health education is called for regarding the early initiation of breast feeding and the importance of the colostrums to new born weaning practices.13

A study conducted on, The first six months growth and illness of exclusively and non exclusively breast fed infants in Nigeria. The objectives of the study to compare the growth and illness pattern of infants who were exclusively breast feds for six months with those of infants commenced on complimentary feeding before the age of six months and ascertain reasons for the early introduction of complimentary feeding. They concluded that exclusive breast feeding supported adequate growth during the first six months of life for most of the infants studied. Early introduction of complimentary foods did not provide any advantages in terms of weight gain in our environment; it was frequently associated with illness episodes and growth faltering. Many mothers however require support, encouragement and access to health care providers to breast fed exclusively for the first six months of life.14

A study conducted on, Breast feeding and health promotion of child survey results in Molise region in Italian, the aim of this study is to compare initiation and duration rates of breast feeding in Molise region ( Italy ) to those targeted from world health organization ( WHO ) and to examine factors associated with infant health. They concluded although we meet WHO goals regarding breast feeding initiation, we don’t about breast feeding duration, yet. Moreover the leading factors negatively link to infant health, are not widely recognized. It is therefore necessary to promote the whole infant health either supporting predominantly breast feeding, especially in some ASL, or providing better knowledge about risk factors.15

4 Review literature on prevention of infection

A study conducted on Bacterial eye infection in neonates, a prospective study in a neonatal unit. One hundred and fifty four neonates with conjunctivits admitted into the neonatal unit at the Lagos University Teaching Hospital were microbiologically investigated. This was to determine the bacterial etiological agent (s) in neonatal eye infection and highlight some risk factors. The incidence of conjunctivitis in the newborn was 18 per 1000 live births. The study findings showed that the high incidence of bacterial eye infection should be minimized by the elimination of the risk factors and adaptation of stringent aseptic measures in the care of neonates.16

A study conducted on, Effect of home based neonatal care and management of sepsis on neonatal mortality in a field trail in rural India, neonatal care is not available to most neonates in developing countries because hospital are in access and costly. According to the data the base line mortality rate (1993-95) was similar, and in the intervention and the control area was 62 and 58 per100 live birth, respectively. In the third of intervention 93% of neonates received home based neonatal care, including management of sepsis, is acceptable, feasible, and reduced neonatal and infant mortality by nearly 50% among the malnourished, literatures, rural study population as per the research neonatal mortality can be reduced substantially in developing countries by applying this method.8

A study conducted on, Neonatal sepsis; it is one of the major health problems throughout world. Every year an estimated 30 million new born acquire infection and 1-2 million of these die. The finding of the study showed that clean and safe delivery, early and exclusive breast feeding, strict postnatal cleanliness following adequate hand washing and aseptic techniques during invasive procedure might reduce the incidence of neonatal sepsis, prompt use of antibiotic according to standard policy is warranted to save the newborn lives from septicemia.17

6.3 STATEMENT OF THE PROBLEM

“A study to assess the knowledge and practice among primipara mothers related to essential newborn care at District Hospital Tumkur.”

6.4 OBJECTIVES OF THE STUDY

 To assess the knowledge on essential newborn care among primipara mothers.

5  To assess the practice on essential newborn care among primipara mothers.

 To identify the association between the knowledge and practice on essential newborn care among primipara mothers.

 To determine the association between socio-demographic variables with knowledge and practice related to essential newborn care among, primipara mothers.

6.5 OPERATIONAL DEFINITIONS

Assess

It is organized systematic and continuous process of collecting data from

the primipara mothers related to essential newborn care.

Knowledge

It refers to the correct responses of the primipara mothers to the question

included in the structured interview schedule related to essential

newborn care.

Practice

It refers to the correct responses regarding activities of primipara mothers

related to the essential newborn care.

Primipara

Women having a first child.

Newborn /Neonate

Baby from birth to one month or from birth to (28 days) of age.

Essential Newborn Care (ENC)

It refers to the essential care provided to the baby by care giver or by the

mothers on warmth, feeding personal hygiene, care of the cord,

6 maintenance of temperature, immunization etc.,

6.6 ASSUMPTION

 Primipara mothers will not have more knowledge on essential newborn care.

 It is assumed that selected demographic variables have influences on primipara mother’s knowledge and practice about essential new born care.

 It is assumed that primipara mother’s responses to the interview schedule items will reflect their actual knowledge about newborn care.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

7.1.1. Types of study : Descriptive study.

7.1.2 Research design : Non experimental/descriptive design.

7.1.3 Setting of the study : The study will be conducted on the primipara mothers Admitted at District Hospital Tumkur.

7.1.4 Population : All primipara mothers who are having baby from birth to 28 days available in District Hospital, Tumkur.

7.1.5 Sampling Technique : Simple random sampling.

7.1.6 Sample size : 100.

7.1.7 Selected variables :Variables include in the present studies are demographic variables such as ;age, religion, education,occupation,income and type of family.etc.

7 7.1.7 Sampling criteria

Inclusion criteria

 All the primipara mothers who are available at the time of data collection.

 Those who are having communication with same common language English / Kannada.

 Mothers who are willing to participate.

Exclusion Criteria

 Nullipara mothers or infertile women

 Those mothers who are not communicate with same Common language English / Kannada.

 Primipara mothers those who are not willing to participate

7.2 METHODS OF DATA COLLECTION

7.2.1. Data Collection Technique : Sructured Interview Schedule

7.2.2. Tools for Data Collection : Structured Questionnaire 7.2.3. Methods of Data Analysis And Interpretation : The researcher will use appropriate and inferential statistics for data

8 analysis and present in the form of tables, graphs and diagrams.

7.2.4. Duration of study : 6 weeks

7.3 Does the study require any investigations or interviews to be conducted on patients or other human beings or animals?

7.4 Has ethical clearance has been obtained from your institution?

Permission will be obtained from ethical committee’s reports.

9 8. REFERENCES

1. National Neonatology forum. Essential Newborn care. The nurses journal of India 2007 Nov; 6 (1).

2. Achar ST. Paediatrics. Ist edition. Madras (India); orient Longman; 1977.

3. AIIMS New Delhi. Essential Newborn care. Module VII, Nightingale Nursing Times 2007 Aug; 3 (5); 66-67.

4. Park K. “Text book of Preventive and Social Medicine” 18th edition. Bhanot publication; 2005.

5. Essential Newborn care http://www.google.com

6. National Neonatal forum. Prevention of Infection in the Newborn. The nursing journal of India; 2004 Nov: XCV (11) 243-45.

7. Rashid H Marchant, Mumtaz Sharif. Prevention of Neonatal sepsis. The journal of Obstetrics and Gynecology India July 2004; 55 (4) 313-317.

8. Bang AT, Bang RA, Baitule SB, Reddy MH, Desmukh MD. “Effective of home based neonatal care and management of sepsis on neonatal mortality; field trail in rural India” Lancet (1999) Dec-4; 354 (9194)- 61.

9. Poilit DF, Hungler BP. “Text book of nursing research principles and methods” Lippincott publications; 2005.

10. Varda KE, Behnke RS. “The effective of timing of initial bath on Newborns temperature” Journal of Obstetrics and Gynecology neonatal nurse; 2000: 29(1): 27-32.

11. Bergstron A, Byaruhanga R, Okong P. The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda. Indian journal of Paediatrics 2005 Oct; 94 (10): 1462-7.

12. Galligaman. Skin to skin treatment of neonatal hypothermia. MCN AMJ maternal child nursing. 2006 Sep-Oct; 31 (5); 298-304; Quiz 305-6.

10 13. Kumari S, Saili A, Jain S, Bhargava U, Gandhi G, Seth P. maternal attitudes and trends in initiation of newborns feeding in Lady Hardinge Medical College, New Delhi in India, Indian journal of Paediatrics 1998 Nov-Dec; 55 (6); 905-11.

14. Onayada AA, Abiona TC, Abayani IO, Makanjoula RO. “The first six month growth and illness of exclusively and non exclusively breast fed infants in Nigeria. East Africa medical journal 2004 March; 81(3): 146-53.

15. Selvaggi TM, Santilli T, Palombi E, Vichi M, Simeone R, Vendemiati A, et al., breast feeding and health promotion of child; survey in molise region; Minerva Peadiatric 2005 April; 57(2): 91-103.

16. Iroha EO, Kesah CN, Egri-okawaji MT, Odugbemi TO. Bacterial eye infection in neonates, a prospective study in neonatal unit, West Africa journal medical 1998 July-Sep; 17(3): 168-72.

17. Afroza S. neonatal sepsis-a global; problem: an overview. Mymensingh medical journal. 2006 Jan:15(1): 108-14.