an assessment of knowledge on newborn care practices among hospital delivered postnatal mothers

CRANFIELD UNIVERSITY

ADERSH S.U.

AN ASSESSMENT OF KNOWLEDGE ON NEWBORN CARE

PRACTICES AMONG HOSPITAL DELIVERED POSTNATAL

MOTHERS

CRANFIELD HEALTH

M.Sc Clinical Research

Academic Year: 2010/2011

MSc - Thesis

CRANFIELD UNIVERSITY

CRANFIELD HEALTH

MSc Thesis

Academic year 2010-2011

ADERSH S.U.

AN ASSESSMENT OF KNOWLEDGE ON NEWBORN CARE

PRACTICES AMONG HOSPITAL DELIVERED POSTNATAL

MOTHERS

Academic Supervisor: Dr. Lincy Jaison

Industrial Supervisor: Dr. Hazeena.K.R.

September 2011

INSTITUTE OF CLINICAL RESEARCH [INDIA]

CAMPUS: BANGALORE

This thesis is submitted in partial fulfilment of the requirements for the

degree of Master of Science

© Cranfield University, 2011. All rights reserved. No part of

This publication may be reproduced without the written

Permission of the copyright holder

AKNOWLEDGEMENT

First and foremost I thank almighty God wholeheartedly for helping me successfully complete

the undertaken dissertation work.

I place on record my deep sense of gratitude to Dr. Lincy Jaison, Lecturer, ICRI, Bangalore for

her well planned and efficient guidance throughout this work.

I would like to express my sincere thanks to Dr. Pravina Koteshwar, Principal, ICRI, Bangalore

for her constant encouragement throughout the tenure of this work.

I express my thanks to all other staffs, especially Mr. Narasimha Murthy of ICRI, Bangalore for

their overwhelming support, which influence me for the successful completion of my project.

All staffs of Nurul Islam Medical Science (NIMS), Trivandrum, Kerala, especially Dr. Hazeena

K.R., Dr. Sheeja Madhavan and Mr. Alakeshan require greater level of appreciation for their

kind support and patience without which I wouldn’t have completed my project. I also thank all

participants of my study with my heart.

Over whiling encouragement extended by my parents has greatly influence the successful

completion of this project. I also thank them in this occasion.

Finally I thank all my friends, who helped me a lot for the completion of this work and I thank

them for their priceless help.

ABSTRACT

Background:

Developing countries account for more than 95% of the neonatal deaths occur in the world. Most

of these deaths occur at home, sometime due to the lack of care. Knowledge on newborn care

determines the attitude and the practice of newborn care. This study aimed to assess the level of

knowledge on newborn care among hospital delivered postnatal mothers in a private hospital in

Trivandrum, Kerala.

Methods:

A descriptive study was carried out in the neonatal division of paediatric department of NIMS

hospital in Trivandrum district of Kerala during May and August, 2011. Pre-validated

questionnaires were administered to the participants to assess their knowledge.

Results:

A total of 88 mothers were participated in the study. Majority of the participants were in the age

group of 25 – 30 years old (59.1%). All of them had at least preliminary (high school) education

with 48 (54.5%) graduates. Most of them were unemployed with 66 (75%) housewives. Most

participants had a monthly income of 2500 – 5000 Indian rupees. While 71.6% had normal

vaginal delivery, caesarean section was recorded in 28.4% cases. There were 64.8% primipara

cases and 35.8% multipara cases.

Irrespective of all demographic groups, the participants had only low level of knowledge

(41.2%) on newborn general care which includes newborn bathing, sleeping, travelling,

temperature etc. It was found that participants had moderate level of knowledge (71.63%) on

newborns’ health condition. The level of participants’ knowledge on newborns’ feeding was

found moderate (77.7%).

Conclusion:

Mothers had a moderate level of knowledge on newborn care practices. However individual

score to general care practices was found to be low. Awareness programs and community based

interventions are required to improve people’s knowledge about newborn care. Good knowledge

makes good attitude, good attitude is responsible for good practice.

TABLE OF CONTENTS

I. CHAPTER ONE – INTRODUCTION- - - - - - - - - - - - - - - - - - - - - - - 7

1.1 RATIONALE- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -12

1.2 LITERATURE REVIEW- - - - - - - - - - - - - - - - - - - - - - - - 13

1.3 AIMS AND OBJECTIVES- - - - - - - - - - - - - - - - - - - - - - - 21

II. CHAPTER TWO – METHODOLOGY- - - - - - - - - - - - - - - - - - - -22

2.1 STUDY METHOD- - - - - - - - - - - - - - - - - - - - - - - - - - - - - 22

2.2 STUDY DURATION- - - - - - - - - - - - - - - - - - - - - - - - - - - -22

2.3 STUDY POPULATION- - - - - - - - - - - - - - - - - - - - - - - - - -22

2.4 SELECTION CRITERIA- - - - - - - - - - - - - - - - - - - - - - - - 22

2.4.1. INCLUSION CRITERIA- - - - - - - - - - - - - - - - - -22

2.4.2. EXCLUSION CRITERIA- - - - - - - - - - - - - - - - - 23

2.5 STUDY SITE- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 23

2.6 DATA COLLECTION- - - - - - - - - - - - - - - - - - - - - - - - - - 23

2.7 THE QUESTIONNAIRE- - - - - - - - - - - - - - - - - - - - - - - - -23

2.8 ETHICS- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -24

2.9 STATISTICAL ANALYSIS- - - - - - - - - - - - - - - - - - - - - - -24

3.0 PROCESS FLOW- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -25

III. CHAPTER THREE – RESULTS- - - - - - - - - - - - - - - - - - - - - - - - - - - - - 26

IV. CHAPTER FOUR-DISCUSSION- - - - - - - - - - - - - - - - - - - - - - - - - - - - - 39

V. CHAPTER FIVE-CONCLUSIONS- - - - - - - - - - - - - - - - - - - - - - - - - - - -43

5.1 FUTURE WORK- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 45

REFERENCES- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -46

APPENDICES

APPENDIX-A ………………………………………………………………..... I (46)

APPENDIX-B ………………………………………………………………… II (51)

APPENDIX-C …………………………………………………………………XI (56)

APPENDIX-D ………………………………………………………………...XIII (61)

APPENDIX-E ………………………………………………………………… XVI (62)

APPENDIX-E …………………………………………………………………XVII (63)

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List of tables:

Table No Title of tables Page Number

1

Age Group Frequency

Distribution

28

2

Education Group Frequency

Distribution

29

3

Occupation Group Frequency

Distribution

30

4 Monthly Income Group

Frequency Distribution

31

5

Type of Delivery Group


32

6 Parity Group Frequency

Distribution

33

7

Newborn General Care

Knowledge

34

8

Newborn Health Knowledge

35

9

Newborn Feeding

Knowledge

36

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List of Figures:

Figure No. Title of the figure Page Number

1 Neonatal Deaths in India 16

2 Age Group Frequency

Distribution

28

3 Education Group Frequency

Distribution

29

4 Occupation Group


30

5 Monthly Income Group


31

6 Type of Delivery Group


32

7 Parity Group Frequency

Distribution

33

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CHAPTER 1 INTRODUCTION

Neonatal mortality or death is one of the major causes of concern with newborns all

over the world, especially developing and under developed countries. Despite some

remarkable improvements in neonatal health in recent years, the high mortality rates remain

unchanged in many countries [1]. Of the 10 million babies born every year, approximately 4

million infants die during first week, 8 million during first year and around 10 million within

5 years of their life [2]. 99% of these deaths occur in the third world or developing countries,

Asia and Africa contributing two third of those [3]. Out of the 3.9 million deaths occurring

worldwide, it is estimated that about 1.17 million (30%) deaths occur in India [4], where most

of these deaths taking place at home due to lack of proper care. According to United Nations

Children’s Fund, one in five infants who die within one month after birth is an Indian. Almost

fifty percent of the neonatal deaths occurring within 5 years happen before first 28 days. In

the past two decades, there has been a decline in neonatal mortality, between 1.7% and 2.3%

[5], and it is due to the vigorous efforts of government as well as non-government

organizations. However, the actual figures would be much higher, since most of the deaths

occur in homes and major part of it remains unreported and it requires a new system to figure

this out.

Why do children die at their early stages? There are many causes of neonatal deaths.

Complications during pregnancy, poor health condition of mother, lack of proper care during

pregnancy, filthy conditions during delivery, critical conditions after birth and improper

newborn care are some of the major causes of neonatal mortality. Children also die due to

premature birth, severe malformation, obstetric complications, or because of infections

caused by harmful practices at home. It is estimated that around one percent of infants being

born with major congenital anomalies around the world and it is found more common in

developing and poor developed countries than in developed countries [6]. Even though it is

not scientifically proved, low birth weight is also one of the causes of neonatal death.

Infections are the major cause of infant mortality after one week of birth. Infants get infected

either from hospitals due to various complications or from the home. The later one is the

main reason of infection in many countries. There are many ways an infant acquires infection

at home. Unhygienic environment conditions, improper cord care practices, poor feeding

practices etc can cause infections like sepsis, tetanus, diarrhoea etc., to infants leading to

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death [6]. Children are the asset of a good society and it is the moral responsibility of all of

us, not just the parents or birth attendants, to provide proper care to the infants and protect

them.

Proper parenting is very import for an infant and it is a very difficult and complex job

as well. Infants need a special care and parents must be prepared and trained well for proper

newborn care. Proper care provided to children is not only crucial for infants but it is also

important for maternal health. Parents’ knowledge, attitude and practice towards the newborn

care have a vital role in the way they treat and care their infants. Care given to the children is

not just important for their physical health, but it determines and shape their mind and

character. Proper knowledge about newborn care is the base of proper newborn care. It is

basically parents’ own responsibility to attain this knowledge and they must gain it before

they deliver their baby. Newborn practices are largely depended and related to newborn

knowledge. Good newborn knowledge will lead to positive attitude towards newborns and it

reflects in their practices. Lack of proper newborn care knowledge is the main reason behind

large infant mortality rates in developing countries. Inadequate knowledge results from many

problems in these countries, some of them being finance, illiteracy, early marriage and child

bearing as well as lack of experience [7]. Government and the society has critical role in

taking care of these issues and they must handle it proper for a healthier society.

Recent decline in neonatal mortality rate is the result of the essential newborn care

being provided to the newborns and it showed that essential newborn care has a vital role in

improving the health of newborns. Essential newborn care is a wide ranging interventional

strategy designed and developed with the aim to improve newborn’s health and it is

administered before conception, during pregnancy and delivery, after birth as well as during

the postnatal period [8]. It is applicable to all those who deal with newborns – parents,

relatives, birth attendants etc – and should be practiced accordingly. An essential newborn

care programme comprises of three major components (8, 9). The first one includes basic

antenatal or pregnancy cares, labour or delivery cares and postnatal cares. The next is the

early detection of the dangerous signs and symptoms or problems and consultation of medical

practitioners. The final is the adequate treatment given to the newborns for various

conditions, such as birth asphyxia, sepsis etc. Every human should get these facilities

irrespective of their socio-economical status in order to reduce the mortality rates and

improve the health of newborns.

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There are number of interventions in the essential newborn care practice and all of

them are important and should be practiced in a proper way for better results [10]. It includes

prevention of infection through clean delivery and hygienic cord care, thermal protection by

keeping the baby warmth, ensuring proper breathing and resuscitation methods, early and

exclusive breast feedings, immunization, treatment of newborn illness, eye care practices, and

providing special care to immature and low birth weight infants. These interventions are

clinically proved and found effective in reducing newborn deaths at their early periods and

reducing and managing many diseases. Administrating these interventions in a proper way

would help in reducing the high infant mortality rates to a larger extend.

People often start thinking about the baby care only after he/she has been brought to

home from hospitals and take it in a much lighter way. This attitude leads to poor care

practices causing many complications. Actually proper newborn care must be initiated from

the conception period itself. Antenatal care has an important role in determining the health

and growth of the infants. Adequate diet, proper immunizations, breast feeding counselling,

nutrient intake, detection and treatment of infections and diseases, preparing for delivery etc

are some of the normal antenatal care practices [9]. Special care is necessary in conditions

such as HIV, syphilis etc and obstetric and neonatal complications. Proper medical care must

be sought in these situations. Good maternal health is very important for the good health of

newborns. Skilled attendance during labour and delivery is also important as antenatal and

neonatal care. Every year there are considerable numbers of newborns die due to the lack of

skilful birth attendants. It is the responsibility of birth attendants to ensure clean delivery.

They must be trained for handling deliveries, preventing hyperthermia and to ensure

immediate breast feeding. They must provide special care in special conditions like birth

asphyxia, low birth weight etc. For babies born with low birth weights, special care such as

special warmth, assisted feeding, kangaroo mother care, special hygiene and cord care can be

provided as applicable and the birth attendants should be ready for that. The chance for

infants getting infected during delivery is very high and in order to prevent this, proper

hygienic measures should be taken before the commencement of delivery. Birth attendants

should keep their hands and other contacts with umbilical cord clean and hygienic to prevent

such infections.

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Early and exclusive breast feeding is an important mean of newborn care. Breast milk

is very important for infants and it is the best known food for newborns. It provides all

nutrients and other elements required for the growth and development of children. Breast

milk has proven anti-infective properties [10]. Breast milk provides immunity power to infant

against various pathogens – bacteria, viruses – before the baby gets immunity through

vaccination. Breast milk contains antibodies that fight against the harmful microorganisms

present in the baby’s body which have come from the mother’s body. The newborn must be

feed within one hour after birth. Birth attendants should ensure proper positioning and

attachment during the initial feeding. Babies should be feed exclusively with breast milk for

six months and there is no need to provide with any additional feeds or liquids. Additional

feeding or supplements will never help the infants in any ways and there is no evidence to

support these supplements helping babies for growth or development. Lactating mothers

should take additional food to produce sufficient milk for her baby.

Thermal care is an important component of essential newborn care. Newborn has a

normal body temperature of 36.5 – 37.50C. When newborn’s body temperature rises above

37.50C, the condition is called hyperthermia and when the temperature goes beyond 36.5

0C, it

is called hypothermia. Both hyperthermia and hypothermia are equally dangerous to

newborns. Newborns should keep warmth in order to prevent hypothermia. Newborns are

more prone to hypothermia even at normal environmental temperature, if they are not well

protected or can happen even because of baby bathing. Hypothermia lead to various

complications and even can cause death. Always keep the baby and surroundings dry and

warmth to keep the newborn away from hypothermia. Newborn’s temperature variations can

be recognized by touching baby’s feet and body. Rise in baby’s temperature is also important

as hypothermia. Increased exposure to warm and hot conditions can cause hyperthermia in

newborns. Infants should keep away from hot sun and other warm situations, undressed and

cooled.

Management of newborn illness is important in any newborn care programmes. All

signs and symptoms must be recognized, diagnosed and treated as early as possible. Only

professional and skilful help must be sought to deal with newborn’s health. Immunizing the

baby through vaccination help the baby keep away from many diseases and infections. Babies

must be immunized with recommended vaccines at right time. BCG is a common vaccine for

all population which is being administered soon after birth. It helps to avoid and prevent

tuberculosis related complications. All babies must be vaccinated with hepatitis B vaccine

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and it is ensured by national immunization programmes in all countries. OPV is another

recommended vaccine. OPV helps to acquire early immunity against a variety of diseases and

a single dose of OPV is given at birth or 2 weeks after birth.

Knowledge is the basis of all activities and it is same in case of newborn care as well.

This study aims to assess the level of knowledge of a given population of mothers regarding

essential newborn care. This study also aims to evaluate the possible relationship between

various demographic variables such as age, education, parity etc. of tested population with

the newborn care knowledge. This study hopes to give a picture on the state of level of

knowledge of a particular population with different demography in the state of Kerala, where

lowest neonatal mortality rates are reported in India.

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RATIONALE AND HYPOTHESIS OF THE STUDY

India accounts for 20% of global births with approximately 27million babies being born

every year. Unfortunately nearly 1 million of those die with various reasons before they

complete first month of their life and it is about 25% of the total neonatal deaths (3.9 million)

occurring worldwide. India has to look more into the neonatal healthcare and invest more if

the millennium development goals have to be achieved. There is an urgent requirement of

more research works to study and make interventions on the newborn health sector. There

have been few studies and interventions carried out in India and it must surely have an

important role in India’s marginal decline in the neonatal deaths and the improvement in

neonatal healthcare, which has been happening for two decades. This study was conducted in

a place (Kerala) where lower neonatal mortalities occurring in India. Kerala’s total neonatal

mortality rate is very low (11) compared to the national average (40). Kerala stand top in the

literacy chart. People of Kerala are educated and possibly this should have an effect on the

newborn care as well. In India high institutional births are occurring in Kerala. Present study

was designed to assess the level of knowledge of postnatal mothers on newborn care. This

study also intended to find out the difference in the knowledge level when the participants are

grouped according to age, education, occupation, type of deliver, parity etc.

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REVIEW OF LITERATURE

Newborn caring is a phenomenal task and as far as India is concerned, it is a

herculean task with more than 25 million births every year. More than 5% (≈1.3 million) of

them die before the completion of first month of their life with various reasons and it

accounts for the 25% of total newborn deaths happening in the world. An endeavour to

reduce the number of infants dying at their earlier periods has been initiated from the

government level with the help of health professionals and as a result of this the rates have

been declining marginally since few years. Overall neonatal survival and the rates indicate

the different statuses – growth, social, economical etc – of a society. India, being a

developing country should consider its neonatal deaths with serious since 96% of the total

global neonatal deaths occur in developing countries.

Neonatal Mortality Rate (NMR) is the number of neonatal deaths per 1000 live births.

Current neonatal mortality rate of India is 44. Neonatal mortality rate has a considerable

difference between rural and urban areas. Neonatal mortality rate in rural areas is 49 per 1000

live births, while it is 27 per 1000 live births in urban areas [11]. There is also variation in

neonatal mortality rates among different states of India, varying from Orissa (61 per 1000

live births) to Kerala (10 per 1000 live births). According to India’s National Family Health

Survey of 1992-93 periods [12] which estimates various aspects of maternal and infant

health, there is a 34% decline in overall neonatal mortality rate between 19981 and 1990.

However the rate is still high compared to the global rate. The results show that an estimated

88 out of 1000 die during first year of life, an estimated 121 die before completing 5 years

after birth. Overall decline in child mortality is not promising for neonatal health. The decline

is high for overall child mortality but it is very low for neonatal mortality. More girls die than

boys in India. The average female mortality of India is 40% higher than male mortality and

this is very high in Northern states than the Southern states. Another major finding of this

survey is different demographic characters have significant effect the infant mortality. An

example to this is neonatal mortality decreases with increase in parity. Mortality rates are

high in primipara cases than in multipara cases as newborn care knowledge increases with

higher birth orders. This report also provides solutions and management plans to reduce

mortality rates as well as tips to essential newborn care practices.

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There are many causes of neonatal deaths in India and it varies between regions and

demography. However except few studies and surveys, there haven’t been any direct

measures to find out the major causes of neonatal deaths in India either in the government or

non-government level. According to a study for the Million Death Study Collaborators [12]

which examines the different causes of neonatal and child deaths occurring in India in 2002-

03 period, infants die at their earlier period because of three major reasons – prematurity and

low birth weight, neonatal infections and birth trauma and birth asphyxia. Prematurity and

low birth weights accounts for the death for 0.33 million neonatal deaths in India, while

various neonatal infections causes 0.27 million infant deaths and another 0.19 million babies

die because of birth asphyxia and birth trauma. All these cause 20% more mortality among

boys than in girls. Neonatal infections and the resulted mortalities are high throughout India;

it is more among poorer states than in the richer sates. Infections of the central nervous

system, pneumonia and neonatal sepsis are the major types of infections that cause more

neonatal deaths in India. There are notable differences between all causes of neonatal

mortality among different geographical areas. The neonatal mortality due to prematurity and

low birth weights are found to be highest in Western states (NMR=14.5) and lowest in

Northern states (NMR=8.3).

Diarrhoea (0.30 million deaths) and Pneumonia (0.37 million deaths) accounts for

50% of total neonatal deaths occurring between 1-59 months. 36% more girls die than boys

between ages 1-59 months with various reasons. Two third of the total deaths of girls

between ages 1-59 months is due to pneumonia and diarrhoea. Like any other major causes

pneumonia and diarrhoea accounts for more neonatal deaths in poorer states than in richer

states. Neonatal mortality due to neonatal infections is four times higher in central regions

(NMR = 14.5) than that of southern regions (3.8). Pneumonia causes four time deaths in

Central India (NMR=18.0) than in South India (NMR=4.7) while diarrhoea causes three

times more deaths in Central India (NMR=14.5) than that of West India (NMR=4.9). 5 times

more girls die (NMR=2009) due to pneumonia in Central India than in the South Indian boys

(NMR=4.1) and the mortality due to diarrhoea is four times higher (NMR=17.7) than in the

boys in the West (4.1).

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Fig 1: Causes of neonatal deaths in India, by region, at age 0 – 4 years:

Source: Causes of neonatal and child mortality in India: nationally representative mortality

survey, For the Million Death Study Collaborators, Published in final edited form as: Lancet.

2010 November 27; 376(9755): 1853–1860.

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Results of a study by R.S. Goyal from Indian Institute of Health Management

Research, Jaipur, India, which was based on the verbal autopsies done in the mortality cases

occurred during the year 2007, in 700 villages in 7 districts of Uttar Pradesh in India, showed

that 10% of all neonatal deaths occurred within 30 minutes after birth [14]. 60% of all deaths

found to be occurred during the first week after birth. Mothers of diseased children were

included in this particular study and a total of 348 neonatal mortality cases out of 14,655

births in the year 2007 were taken. All these deaths were grouped into different categories. It

includes:

i. Due to inadequate antenatal care

ii. Due to the lack of awareness or knowledge about the danger signs of pregnancy and

the poor management of it

iii. Due to the lack of knowledge and awareness about the danger signs during labour and

delivery, and the poor management of these complications.

iv. Due to poor knowledge and practice about essential newborn care and the lack of

management of newborn’s illnesses.

Additional to this more than 50% of mothers reported problems regarding newborn feeding.

Nearly 40% of neonates died due to feeding complications and due to the lack of proper

medical assistance for this. Of the 348 cases studied 30.7% experienced difficulty in

breathing followed by drawing chest (23.6%), fast breathing (23.3%), unconscious or

unresponsive (22.7%), grunting (21%), cold to the touch (13.8%), fever (10.3%), abdominal

distension (9.2%), flaring of the nostrils (8.3%), stiff and arched backward (8.3%), yellow

palm or soles (7.8%), vomiting (7.5%), discharge from the umbilical cord stump (4.3%),

cough (3.4%), bulging of the fontanel (2.3%), and convulsion (2%).

A study was conducted in Uttar Pradesh, in 2005 by AH Baqui, GL Darmstadt et al.

The objective of the study was to assess the rate, timing and causes of the neonatal deaths in

rural India, where more neonatal deaths occur in India [14]. Verbal autopsy interviews were

used to investigate 1048 deaths occurred in Uttar Pradesh among different districts. The

results were analysed and it was identified that there were 430 still births, which comprises of

41% of all deaths that included in the study. 32% of the total deaths occurred on the first day

of birth. 50% of deaths were reported within 3 days of life and 71% occurred during first

week. Birth asphyxia (31%) and preterm birth or prematurity were the primary cause of

mortality of neonates during the first day of life. Other leading causes of death during first

week were preterm birth (30%), and pneumonia or sepsis (25%).

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Newborn care in India is in the edge of an immense expansion as maternal and child

health services integrated into Global Child Survival and Safe Motherhood (CSSM)

programme. The main aim of this programme is to ensure essential newborn care, proper

management of diarrhoea, various newborn infections, vitamin A prophylaxis and

immunization [15]. According to CSSM, the essential newborn care components include

special care to neonates with asphyxia, prevention of infections, prevention of infections and

earlier and exclusive breast feeding. This programme initiated an effort for the training of

traditional birth attendants with the aim to ensure every delivery is being attended by trained

and skilful attendants in India. National Neonatology Forum (NNF) is another major body

which has a special interest in neonatal care. It is NNF is a purely academic, non-

governmental organization formed in 1980. It has been playing an important role in neonatal

care and development area in India since its formation. NNF represents more than 1500

paediatricians in India, both from government and private sectors.

A study conducted by Padiyath MA, et al., on postnatal mothers in a tertiary care

hospital in South India during April – July 2009 had the aim to assess the knowledge and

attitude of neonatal care practices [16]. Data from 100 neonatal mothers were collected.

Various demographic characters of mothers such as age, educational status, occupation, type

of family, average monthly income etc were collected with the aim to know the socio-

economical status of the participants. Standard validated questions were asked to participants

which was the main tool to assess the knowledge and attitude towards newborn care. The

analysed results showed that mothers had comparatively less knowledge in the areas of

umbilical cord care (35%), vaccine preventable diseases (43%) and thermal protection (76%).

It was revealed that 19% of the participants still practice oil instillation into newborn’s

nostrils and most of the mothers gave the reason for this as it protects the newborn from

cough and cold. It was found out that 61% of the participant mothers administer gripe water

to their babies. Most of them believed that gripe water helps the newborn for proper

digestion. Few of them gave reason for this practice as it is a remedy for stomach pain. Most

of them had the opinion that vaccination is good for newborn’s health but a majority of them

did not know the actual purpose of vaccination. Most of them were only aware about Polio

and Hepatitis vaccines. It was identified that those who had higher educational qualifications

were more aware about the proper vaccination than the less educated. This study indicates

that awareness and attitude has an important role in essential newborn care especially for

those who belong to lower educational and socio-economical status.

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It is widely accepted and proved through various studies and researches that parents’

knowledge and practice towards proper newborn care has a directly proportional correlation

to the infant survival and growth. However the results of a study conducted in the centre

villages of a rural municipality in the Cagayan valley region in Philippines opposed this

general opinion [7]. This study was conducted by Carnate IV and colleagues and the major

purposes of this study was to determine health condition of newborns under the care of their

parents, the level or extent of parents’ knowledge and attitude towards essential newborn

care, significant difference in the knowledge and attitude of newborn care among and

between various demographic characteristics such as age, educational status, economical

status etc. The method used in the study was normative and correlation types of descriptive

research. Data were collected from 100 parents (biological or surrogate) and their infants. It

was found that the level of knowledge of various essential newborn care practices – nutrition

and feeding, medication, motor and language development and hygienic care – was generally

low. However a majority of the newborns are having proper nutrition, adequate general and

medical care. These results show that there are no significant correlation between newborn

care practices and the parents’ level of knowledge.

There was a study conducted in the Angoche, Mogincual and Monapo districts of

Nampula province in Mozambique in July 2008 by Arnaldo C and et al., as part of the Save

the Children campaign [17]. This study was aimed to assess the good knowledge, attitude and

practice toward newborn care among women of these areas. It was a survey based study

where 637 women who were pregnant in the last 12 month before the commencement of the

survey. It was found that more than 70% of the participants had their deliveries at home. Only

19% of women took their babies for post-partum check up to health centres within 3 days.

About 50% of babies were not either weighed or it is unsure that they were weighed or not.

Around one third of children were born with low birth weights. Under age of 6 months,

exclusive breast feeding was practiced by only 27% of mothers and it is as low as 10% in

some districts. It was found in one district that about 24% of infants were given with

traditional medicines and water under one month. It was relatively low about the knowledge

about the various danger signs in children. Only 55% and 44% of participants were only

aware about the danger signs and the proper management of fever and bleeding respectively,

in children. Irrespective of the socio-economic status most of the participants were aware

about the mother-to-child transmission of HIV. However knowledge about the prevention of

transmission of HIV from mother to child is found to be very poor.

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According to a study by Penfold S., et al., which was conducted in Southern Tanzania

between June and October 2007 with an aim to describe newborn care practices

quantitatively in the largely populated 5 districts of Southern Tanzania, only 41% of the total

participants had the opportunity to deliver their babies with proper health facilities with the

assistance of skilful birth attendants [18]. Nearly 57% of participants had their deliveries at

home and only 40% of them had the assistance of skilled birth attendance. 50% of

participants who had their deliveries at home reported that they dried their babies after birth

and one third of them reported that they wrapped up their babies within 5 minutes of delivery.

Most of them had made necessary preparations of delivery for cleaning, drying etc. More

than 95% of the participants reported that they used a clean razor blade to cut the umbilical

cord. 10% of them reported that they dipped their babies in cold water immediately after birth

and around a two third bathed their babies within 6 hours of delivery. 28% of them had put

something on the cord in order to dry it. It was also found out that skin-to-skin contact

between mother and child was very rare after delivery. Another major finding of the study

was, more than 80% of participants breast fed their babies within 24 hours after birth, but

breastfeeding within one hour was found in only 18%. Exclusive breast feeding was only

practiced by less than 50% of participants within 3 days of delivery. These finding suggests

an urgent need to encourage deliveries with proper health facilities, skilful attendants of home

deliveries, immediate and exclusive breastfeeding and delayed bathing to improve newborn

health.

A study conducted in Western Nepal on home delivery and newborn care practices

suggests the requirement of a community based intervention to encourage and facilitate

families to ensure skilled attendance and hygiene practices during and after delivery. This

study was conducted by Sreeramareddy CT et al., of the Manipal College of Medical

Sciences, among urban women in western Nepal with an aim to assess home delivery and

essential newborn care practices [19]. It was a cross sectional survey based study, carried out

during January and February 2007 in the immunization clinics of Pokhara city in Western

Nepal where only home delivered mothers were included. A total of 240 mothers participated

in this survey. It was found that only 6.2% of mothers delivered with the assistance of skilled

birth attendants and 15.8% deliveries occurred without any form of assistance. In more than

90% of deliveries the umbilical cord was cut using a new or boiled blade. It was reported that

mustard oil was applied to the umbilical cord in 22.1% of cases. Newborns were wrapped

immediately after birth in 45.8% cases and 97.1% of newborns were wrapped within 30

minutes. More than 90% of the newborns were bathed immediately after birth. Initial

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breastfeeding within one hour was found in 57.9% cases and 85.4% of newborns were

breastfed within 24 hours. An important finding of this study was 51% of participants had

their deliveries at home because it was a precipitate labour. 25.7% of participants gave

preference as the reason for home delivery followed by convenience (21.4%), lack of

transportation facilities (18%) and the lack of escort (11%).

There have been only few studies conducted on breast feeding practices. A study

conducted in the north of Jordan assessed the knowledge, attitude and practice of newborn of

post natal mothers [20]. It was a cross sectional study conducted by Khassawneh M. et al, of

Jordan University of Science and Technology carried out during July 2003 to August 2003.

A total of 344 women with children of 6months to 3 years of ages were participated in this

study. Analysed results showed that full breast feeding was reported in 58.3% cases. 30.3%

of participants reported mixed feeding and 11.4% reported infant formula feeding.

Approximately one third of those who reported full breast feeding reported full and exclusive

breastfeeding for 6 – 12 months and in two third of cases breastfeeding was continued for

more than one year. It was found that unemployed women were more likely to breastfeed

their babies fully, compared to employed women. More breastfeeding practices are reported

in those who had normal vaginal deliveries compared to those who had caesarean delivery.

Most of the participants had a positive attitude towards breastfeeding, but short maternity

leaves and the work nature found to have a negative impact on it.

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AIM AND OBJECTIVES

AIM:

The aim of this study is to assess the level or extent of knowledge on newborn care practices

among postnatal mothers.

OBJECTIVES:

Primary Objective:

To determine the level or extent of parents’ knowledge on essential newborn care,

particularly in the aspects of General Care, Newborn health care and Newborn

feeding.

Secondary Objective:

To determine the significant differences in the parents’ newborn care knowledge

when they are grouped according to various demographic variables such as age,

educational status, occupation, monthly income, parity etc.

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CHAPTER 2: METHODOLOGY

Study Method:

The method used in this study was a descriptive, normative and correlation type of research.

The normative aspect used was to determine and describe mother’s various demographic

characteristics and their knowledge on newborn care. Significant relationship between

mothers’ knowledge on newborn care and their demographic characteristics was determined

using the correlation aspect. Pre-validated questionnaire were used to assess the knowledge

of mothers.

Study Duration:

This study was carried out for a period of four months, from May 2011 to August 2011.

Actual data collection lasted for one month during which data from participants were

collected.

Study Population:

A total of 88 mothers participated in this study. Women who delivered in the respected study

site during the study period were included in the study. Nearly 100 deliveries occurred in the

hospital where the study was carried out, out of which 88 were selected based on inclusion

and exclusion criteria.

Selection Criteria:

Inclusion Criteria:

Mothers of infants aged 0 – 28 days.

Those who were retained in the hospital.

Those who were willing to participate in the study.

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Exclusion Criteria:

Mothers who gave birth for more than one month before the commencement of

study.

Those who did not read or understand either English or Malayalam.

Sick mothers and those who lost their babies.

Study Site:

This study was carried out in the neonatal division of Paediatric Department of Nurul Islam

Medical Science (NIMS), a private hospital in Trivandrum, the southern district of Kerala of

South India.

Data Collection:

Data collection was initiated after necessary permissions were obtained from the hospital and

the concerned departments. Questionnaires were the main medium of data collection.

Relevance of the questions used was approved by a neonatologist before it was administered

to the participants. Participants were given with the proper instructions to fill the questions

along with the detail of the study. Participants were approached through hospital nurses and

proper information was already given to them. Participants were told to ask if they come

across any problems while filling the questionnaire. Participants various demographic

profiles were collected in the demography session included in the questionnaire. Filled

questionnaires were collected with the help of hospital nurses. Answer keys to the questions

were given to those who completed the questionnaire, so that they could rate their knowledge

by themselves. The collected data were used for further statistical interpretations.

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The questionnaire:

Questionnaire was the main tool for data collection. Questions in the questionnaire were pre-

validated by a paediatrician for its relevance. The entire questionnaire was divided into two

parts – demographic variables as well as knowledge assessment questions. The formal part

was used to record participants various demographic characteristics such as age, education,

occupation, monthly income, type of delivery, parity etc. The later was the main session to

assess the knowledge of the mothers. The questionnaire consisted of both closed end and

open end questions. The knowledge questions were categorized into three – general care,

newborn health and newborn feeding. A total of 20 questions were included in the

questionnaire plus the demographic session. Instructions to fill the questionnaire were also

included in the questionnaire.

Ethics:

There weren’t any ethical requirements as there were no ethical issues involved. So there

were no ethical permissions were taken. Verbal consents were collected from those who

participated in this study. The study was conducted with the permission of the hospital and

concerned departments.

Statistical Analysis:

The data collected using questionnaire were analysed statistically using Statistical Package

for Social Sciences (SPSS) Version 17.0. Scoring of the questions was done for statistical

analysis. A score of one was given to the correct answer and a score of zero to the wrong

ones. Frequency counts, percents, means and standard deviations were the descriptive

statistics used. Demographic information and participant education was calculated using Chi-

square test of significance. Mean knowledge difference among demographic variables and

between various aspects of newborn care knowledge was calculated using Student t test.

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Process Flow:

SPSS

Study Location: NIMS, Trivandrum, Kerala

Sample Population: 88 Post Delivery Women

Data Collection

Statistical Analysis & Data Interpretation

Result

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CHAPTER 4: RESULTS

A total of 88 postnatal mothers were participated in the study. Participants were aged

between 20 to 35 years old. Majority of them were in the age group of 25 – 30 years old,

followed by 27.3% in 20 – 25 and 13.6% in 30 – 35 years old. Among them 48 participants

(54.5%) were graduates and 39 participants (44.3%) had higher secondary education. One of

the participant mothers had only completed high school. Most of the mothers were

unemployed. A total of 66 (75%) were housewives, 12 (13.6%) government employees and 8

(9.1%) corporate or private employees. About 2.3% of participants had other forms of

occupation apart from the aforementioned occupations. Majority of the participants belonged

to families which had a monthly income ranging from 2500 – 5000 Indian rupees. 71.6% had

normal vaginal delivery and caesarean section was recorded in 28.4% cases. It was the first

delivery for most of the mothers. 64.8% of the mothers were primipara.

The information collected via questionnaire was divided into the following categories.

They are:

1. Demographic Information

2. Knowledge on newborn care.

The responses to knowledge on newborn were divided into three areas of newborn care and

they are

1. General Newborn care

2. Newborn’s health conditions and

3. Newborn Feeding.

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4.1 FREQUENCY DISTRIBUTION

Age Group Frequency Distribution

Figure: 2

TABLE: 1

AGE GROUP FREQUENCY PERCENT VALID

PERCENT

CUMULATIVE

PERCENT

20 – 25 24 27.3 27.3 27.3

25 – 30 52 59.1 59.1 86.4

30 - 35 12 13.6 13.6 100.0

Out of 88 postnatal mothers included in the study, 24 were belonged to 20 – 25 years of age

group, 52 to 25 – 30 years and 30 – 35 years of age.

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Education wise Frequency Distribution

FIGURE: 3

TABLE: 2

EDUCATION FREQUENCY PERCENT VALID

PERCENT

CUMULATIVE

PERCENT

PRIMARY - - - -

HIGH SCHOOL 1 1.1 1.1 1.1

HIGHER

SECONDARY

39 44.3 44.3 45.5

GRADUATION 48 54.5 54.5 100.0

Of 88 mothers included, 12 were graduates and 39 had higher secondary education. Only one

of them had only high school education.

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Occupation wise Frequency Distribution

FIGURE: 4

TABLE: 3

OCCUPATION FREQUENCY PERCENT VALID

PERCENT

CUMULATIVE

PERCENT

GOVERNMENT

EMPLOYEE

12 13.6 13.6 -

PRIVATE/CORPORATE

EMPLOYEE

8 9.1 9.1 22.7

HOUSE WIFE 66 75.0 75.0 97.7

OTHERS 2 2.3 2.3 100.0

Among the participants unemployed were more. House wives constituted about 75% of the

total participants followed by 13.6% of government employees and 9.1% of corporate or

private employees. 2.3% of them did not belong to either of the aforementioned groups.

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Income wise Frequency Distribution

FIGURE: 5

TABLE: 4

INCOME RANGE

(RUPEES) FREQUENCY PERCENT VALID

PERCENT

CUMULATIVE

PERCENT

1000 – 2500 7 8.0 8.0 8.0

2500 – 5000 64 72.7 72.7 80.7

>5000 17 19.3 19.3 100.0

Most of the participants (72.7%) reported to have a monthly income ranging between 2500 –

5000 Indian rupees. About 19.3% of them had a monthly income of more than 5000 rupees.

A monthly salary of 1000 – 2500 rupees was recorded in only 8% of cases.

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Frequency Distribution – Type of Delivery

FIGURE: 6

TABLE: 5

TYPE OF

DELIVERY FREQUENCY PERCENT VALID

PERCENT

CUMULATIVE

PERCENT

Normal Vaginal 63 71.6 71.6 71.6

Caesarean 25 28.4 28.4 100.0

Normal vaginal delivery was recorded in 63 participants (71.6%) and Caesarean section in 25

participants (28.4%).

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Frequency Distribution – Parity

FIGURE: 7

TABLE: 6

PARITY STATUS FREQUENCY PERCENT VALID

PERCENT

CUMULATIVE

PERCENT

Primipara 57 64.8 64.8 64.8

Multipara 31 35.2 35.2 100.0

64.8% of the participants (57 mothers) were primipara and the rest (35.2%, 31 mothers) were

multipara.

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4.2 LEVEL OF KNOWLEDGE

Tested Level of Knowledge on Newborn Care According to Demographic

Characteristics:

The following tables show the influence of various demographic variables on newborn care

knowledge. Based on the percent score obtained, a description of level of knowledge has been

given.

The description pattern is:

100: Very High (VH)

80 – 99: High (H)

60 – 79: Moderate (M)

40 – 59: Low (L)

Less than 40: Very Low (VL)

TABLE: 7

1. GENERAL CARE KNOWLEDE

DEMOGRPHIC

CHARACTER

NUMBER MEAN

SCORE

PERCENT

SCORE

STD.

DEVIATION

DESCRIPTION

AGE

20 -25 24 2.33 46.6 1.373 L

25 – 30 52 1.98 39.6 0.980 VL

30 - 35 12 1.83 36.6 0.835 VL

> 35 - - - - -

EDUCATION PRIMARY - - - - - HIGH SCHOOL 1 4.00 80 - H HIGHER

SECONDARY 39 1.90 38 0.968 VL

GRADUATION 48 2.15 43 1.148 L

OCCUPATION GOVERNMEN

T EMPLOYEE 12 2.42 48.4 1.379 L

CORPORATE

EMPLOYEE 8 1.75 35 0.886 L

HOUSE WIFE 66 2.02 40.4 1.060 L OTHERS 2 2.50 50 0.707 L

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MONTHLY

INCOME

< 1000 - - - - - 1000 – 2500 7 2.43 48.6 1.272 L 2500 – 5000 64 2.02 40.4 1.061 L > 5000 17 2.06 41.2 1.144 L

TYPE OF

DELIVERY

NORMAL

VAGINAL

63

2.06

41.2

1.076

L CAESAREAN 25 2.04 40.8 1.136 L

PARITY PRIMIPARA 57 2.16 43.2 1.146 L MULTIPARA 31 1.87 37.4 0.957 VL

TOTAL 88 2.06 41.2 1.087 L

Various factors were scored and the maximum score can be obtained was 5. It further

shows that almost all mothers irrespective of their various demographic characteristics have

low level of knowledge on newborn general care practices (mean % score = 41.2%).

Responses to most of the general care questions, which include questions on newborns’

weight, length, temperature, bathing etc, were wrong.

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TABLE: 8

2. NEWBORN HEALTH KNOWLEDGE

DEMOGRPHIC

CHARACTER

NUMBER MEAN

SCORE

PERCENT

SCORE

STD.

DEVIATION

DESCRIPTION

AGE

20 -25 24 5.75 71.875 0.989 M 25 – 30 52 5.75 71.875 1.250 M

30 - 35 12 5.58 69.75 1.311 M

> 35 - - - - -

EDUCATION PRIMARY - - - - - HIGH SCHOOL 1 5 62.5 - M HIGHER

SECONDARY

39

5.69

71.125

1.195

M GRADUATION 48 5.77 72.125 1.189 M


T EMPLOYEE

12

5.75

71.875

0.965

M CORPORATE

EMPLOYEE

8

6.00

75

0.535

M HOUSE WIFE 66 5.68 71 1.291 M OTHERS 2 6.00 75 0.000 M

MONTHLY

INCOME

< 1000 - - - - -

1000 – 2500 7 5.71 71.375 0.756 M

2500 – 5000 64 5.73 71.625 1.250 M

> 5000 17 5.71 71.375 1.105 M

TYPE OF

DELIVERY

NORMAL

VAGINAL

63

5.68

71

1.242

M

CAESAREAN

25

5.84

73

1.028

M

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PARITY PRIMIPARA 57 5.77 72.125 1.225 M MULTIPARA 31 5.63 70.375 1.182 M

TOTAL 88 5.73 71.625 1.182 M

Various factors were scored and the maximum score that can be obtained was 8. All

of the participants had a medium level of knowledge on newborns’ health conditions. The

mean scores of participants when they grouped according to age, education, occupation,

monthly income, type of delivery and parity status was 5.69 (71.13%), 5.49 (68.63%), 5.86

(73.25%), 5.72 (71.5%), 5.76 (72%) and 5.7 (71.25%) respectively. The mean score of the

total participants was 5.73 (71.63%).

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TABLE: 9

3. NEWBORN FEEDING KNOWLEDGE

DEMOGRPHIC

CHARACTER

NUMBER MEAN

SCORE

PERCENT

SCORE

STD.

DEVIATION

DESCRIPTION

AGE

20 – 25 24 5.50 78.57 1.022

25 – 30 52 5.38 76.86 1.069

30 – 35 12 5.58 79.71 0.669

> 35 - - - - -

EDUCATION PRIMARY - - - - - HIGH SCHOOL 1 7.00 100 - HIGHER

SECONDARY

39

5.51

78.71

1.048

GRADUATION 48 5.35 76.43 0.956


T EMPLOYEE

12

5.67

81

1.231

CORPORATE

EMPLOYEE

8

5.63

80.43

1.188

HOUSE WIFE 66 5.41 77.29 0.944 OTHERS 2 4.50 64.28 0.707

MONTHLY

INCOME

< 1000 - - - - -

1000 – 2500 7 5.43 77.57 0.787

2500 - 5000 64 5.41 77.29 0.955

> 5000 17 5.59 79.88 1.278

TYPE OF

DELIVERY

NORMAL

VAGINAL

63

5.29

75.57

0.958

CAESAREAN 25 5.84 83.43 1.028

PARITY PRIMIPARA 57 5.56 79.43 1.018 MULTIPARA 31 5.23 74.71 0.956

TOTAL 88 5.44 77.71 1.004

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Various factors were scored and the maximum score can be obtained was 7. It further

shows that participants had a medium level of knowledge on newborns’ feeding with a mean

score of 5.44 (77.71%). The mean score of mothers were 5.49 (78.43%), 5.95 (80%), 5.30

(75.71%), 5.57 (79.57%) and 5.40 (77.14%) when they were grouped according to their age,

education, occupation, monthly income, type of delivery and parity status respectively.

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CHAPTER 5: DISCUSSION

Of the 3.9 million neonatal deaths occurring each year worldwide, 1 million (≈25%)

deaths are taking place in India [9]. The current neonatal mortality of India is 47.57 deaths

per 1000 live births. Even though there has been some decline in the neonatal deaths

occurring in the country, India still represents a quarter of the global neonatal deaths. It has

been found through a number of studies that infections are one of the three major causes of

neonatal deaths occurring in India along with prematurity and low birth weights and birth

asphyxia. Adequate and proper newborn care has a very important role in preventing infants

from dying because of the aforementioned as well with many other reasons. Inadequate and

improper newborn care practices cause many risks to infants and leads to morbidity and

mortality of infants. Lack of proper education and awareness regarding proper newborn care

is the major reason for many neonatal deaths occurring in India. Parents’ social, economical

and various other demographic characters have an important part in their knowledge and

attitude towards newborn protection and care and it reflects in their practices. Essential

newborn care is the new and broad term used to describe the early, sufficient and proper care

provided to the newborns. It describes about various care practices ranging from antenatal to

post natal periods.

The present study was conducted with an aim to assess the level of knowledge of

immediate delivered mothers (0 – 28 days). This study was carried out in a private hospital in

the Trivandrum district of Kerala, India for a period of one month. Women who admitted to

the neonatal division after delivery were approached and included into the study with their

verbal consent. Out of 98 post natal mothers approached 94 gave their consent to participate

in the study (response rate: 95.92%) and a total of 88 were selected based on the inclusion

exclusion criteria. The participants were aged between 20 to 35 years old and most of them

were educated. Among them 48 were graduates and 39 had education until higher secondary.

One of the mothers had only high school education. A majority of the participants (75%)

were house wives. There were 12 (13.6%) government employees and 8 corporate or private

employees. 2 of them were neither corporate, government employees nor housewives. More

than 70% of the participants were belong to families whose monthly income is in the range of

2500 to 5000 rupees. 17 participants (19.3%) reported that they have a monthly income of

more than 5000 rupees. 7 mothers (8%) had a monthly income of only 1000 – 2500 rupees.

25 participants (28.4%) mothers had a caesarean delivery section while the rest 63 had

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normal vaginal delivery. For a majority of the participants it was the first delivery. 57

participants (64.8%) were primipara and 31 (35.2%) were multipara.

The knowledge on newborn care was categorized primarily into three aspects –

General care, Newborn health and Newborn feeding – for the ease of assessment. Regardless

of the various demographic profiles of participants, it was found that participants had a low

level of knowledge on general care (41.2%). Responses of participants to most of the

questions in this section were wrong irrespective of their age, education, occupation, monthly

income, type of delivery and parity status. Age group of 25 – 30 and 30 – 35 were found very

low in knowledge in this area with a mean percent score of 39.6% and 36.6% respectively. In

education group those with higher secondary education had very low level of knowledge with

38% mean score. Interestingly multipara mothers were also found with very low level of

knowledge (37.4% mean score). Apart from these all other groups had a low level of

knowledge with a mean percent score ranging between 40 and 59. This section included

general questions on newborns’ weight, length, bathing, temperature, travelling, sleeping etc.

Most of the mothers were unaware of the normal weight and height of newborns. Having low

birth weights as an important cause of newborn mortalities in India, mothers should aware of

the normal weight as well as height of newborns’ and must ask about their babies’ weight and

length to the concerned people. If the newborns were found with low birth weights adequate

medical care must be provided. Most of the mothers had a good knowledge on newborns’

bathing. Even though it was recommended that bathing of newborns 2-3 times a week is

sufficient, most of the mothers do bathe their infants every day. Newborns must not be bath

immediately after birth as they are easily susceptible to hypothermia. Majority of the mothers

had no idea about how to keep their newborns while travelling in a car or bus. Babies must be

faced or positioned backwards in the back seat when travelling in a car. Normally babies

sleep an average time of 16 – 18 hours a day and most of the participant mothers were not

aware about this. Overall the knowledge level of participants was poor and it needs

improvement.

A newborn’s health is very sensitive and it must be taken care very seriously. The

result of the present study shows that participants had a moderate level of knowledge on

newborns’ health condition with a mean percent score of 71.03. It indicates that participants

are more aware and vigil about newborns’ health conditions. But it is always better to keep

the baby away from diseases than giving special care after any diseases or problems occur.

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There were questions regarding common and dangerous diseases that are seen in infants such

as diarrhoea, jaundice, fever etc as well as questions on colic, cough, allergies, temperature

etc. regardless of the various demographic groups they belong, most of the participants had a

medium level of knowledge on newborns’ health conditions. In the age group category both

20 – 25 and 25 – 30 group category had equal level of knowledge with a mean percent score

of 71.88. In education category, a maximum score 72.13% was recorded among the

graduates. Housewives were found with a least score of 5.68 (mean % score: 71) and a

standard deviation of 1.291. Participants who hailed from families with monthly income of

1000 – 2500 and more than 5000 had equal level of knowledge with a mean percent score of

71.38. It was found that caesarean delivered mothers had more knowledge on newborns’

health conditions (mean % score: 73) than those who had normal vaginal delivery (mean

percent score: 71). Primipara mothers had comparatively more knowledge on newborn health

(mean % score: 72.13) than multipara mothers (mean % score: 7.38). Most of the mothers

aware that conditions like diarrhoea, jaundice, fever etc are dangerous and how to manage

them. But very few are aware of the actual cause of these illnesses. Diarrhoea is the main

illness that affects a majority of newborns. Unclean food and water and non-hygienic

conditions are responsible for diarrhoea in newborns. Oral Rehydration Solution (O.R.S.) is

the best remedy for diarrhoea in children. It helps the baby to regain the water content that

had lost from the body and prevent them from going to dehydration.

Feeding is an important procedure for infant. An infant receives necessary energy and

nutrition through feeding. Improper feeding is as dangerous as not feeding. Breast milk is the

best food for infants. It provides sufficient nutrition and energy to the newborn. Newborns

must be feed exclusively with breast milk for six months. Breast feeding not only provides

necessary factors for growth and development to the infants, but also it provides a close

physical and mental relationship or attachment with mother and children. The results of this

study show that the participant mothers had a moderate level of knowledge on newborn

feeding practices with a mean percent score of 77.71. Among all demography groups,

caesarean delivered mothers were found having more knowledge on newborn feeding with a

score 5.84 for a maximum score of 7 (mean percent score: 83.43) and with a standard

deviation of 1.028. Among age groups those who are in the age between 30 – 35 years old

had comparatively high level of knowledge with a mean percent score of 79.71 followed by

20 – 25 years of age (mean percent score: 78.57) and then 25 – 30 years of old (mean percent

score: 76.87). In education group one participant scored 7 out of 7 (mean percent score: 100)

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and interestingly she had got only high school education. Higher secondary education holders

exceed the graduates with a mean percent score of 78.71 where graduates got a mean percent

score of 76.43. In occupation category government employees stand top in the list with a

mean percent score of 81. Corporate or employees got the second position with a mean

average score of 80.43 followed by housewives (mean percent score: 77.29). Participants

those who belonged to the others category had a knowledge level of about 4.50 out of seven

(mean percent score: 64.28). In the monthly income wise category, those who had a monthly

income of more than 5000 rupees had comparatively more knowledge on newborn care with

a mean percent score of 79.88. Participants those who had a monthly income of 1000 – 2500

and 2500 – 5000 rupees array next two positions with a mean percent score of 77.57 and

77.29 respectively. Caesarean delivered mothers were recorded to have high knowledge on

newborn feeding with a mean percent score of 83.43 compared to normal vaginal delivered

mothers (mean percent score: 75.57). Primipara mothers had more knowledge on newborn

feeding (mean percent score: 79.64) than the multipara mothers (mean percent score: 74.71).

This study indicates that there is lack of proper knowledge towards various fields of

newborn care especially those who have lower socio-economic status. It was found in this

study that the level of knowledge is generally low with those who had low level of education

and low income except few cases.

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CHAPTER 6: CONCLUSION

This study concludes with an estimation of moderate level of knowledge on essential

newborn care with the participants included in the study. Participants had a low level of

knowledge on general care (mean score 41.2%) and moderate level of knowledge about

newborn health (mean score 71.63%) and newborn feeding (mean score 77.71%). Except few

odd cases, it was found that the knowledge level is low with those who belonged to lower

social, educational and economical status. As the number of people who belonged to lower

socio-economical class is high in India, these results obviously reflects and represents the

national status. This study indicates the requirement of an awareness programme on essential

newborn care – a programme that contains all the components of essential newborn care –

available to all the people irrespective of their socio-economical status. Although there are

number of initiatives taken in the government level, it is neither available to most of the

people nor they are aware about it. The only solution to this would be making all initiatives

and activities more public.

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FUTURE WORKS

The present study was conducted in a private hospital where people are given with

basic newborn care awareness, and this might have possibly affected the result of the

study. However this facility may not be available to those who deliver in government

hospitals and these populations should also be included if the actual picture has to be

viewed.

It would be great and very useful if the pregnant women’s knowledge level on

newborn care can be assessed as they are going to start practicing it in few months.

More field researches are required to assess the actual attitude and practice of people

towards newborn care and it has to be started from the low level of society.

An awareness programme or educational intervention on essential newborn care with

the cooperation of local administrative would be more useful with the participation all

people.

Making the benefits of national-international initiatives such as ‘Save the Children’,

available to more people.

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REFERENCES

1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, et al. Global, regional, and

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APPENDICES

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Appendix A: (Protocol)

ASSESSMENT OF NEWBORN CARE KNOWLEDGE OF

POSTNATAL (HOSPITAL DELIVERED) MOTHERS

Protocol Number: ANCKPM – 01

Protocol Version Date: 01-07-2011

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TABLE OF CONTENTS

PARTICULARS PAGE NO.

1. Study Summary 49

2. Introduction 50

3. Study Aim and Objectives 50

4. Study Methodology

i. Study Setting 50

ii. Study Population 50

iii. Study Duration 50

iv. Sample Size 50

v. Eligibility Criteria 50

a. Inclusion criteria

b. Exclusion Criteria

vi. Procedure 50

vii. Statistical Analysis 50

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1. Study Summary

TITLE

Assessment of newborn care knowledge among postnatal

(hospital delivered) mothers

AIM To assess the level of knowledge on newborn care hospital

delivered postnatal mothers

OBJECTIVES

1. Primary Objective:

To determine the level or extent of parents’ knowledge on

essential newborn care, particularly in the aspects of

General Care, Newborn health care and Newborn

feeding.

2. Secondary Objective:

To determine the significant differences in the parents’

newborn care knowledge when they are grouped

according to various demographic variables such as age,

educational status, occupation, monthly income, parity

etc.

STUDY DESIGN Description, Normative and Correlation type of research.

STUDY SETTING NIMS (Nurul Islam Medical Science), Trivandrum, Kerala, India

STUDY DURATION 4 months

SAMPLE SIZE Women who deliver during the data collection period and those

who satisfy the inclusion-exclusion criteria will be selected.

ELIGIBILITY

CRITERIA

1. Inclusion Criteria:

Mothers of infants aged 0 – 28 days.

Those who are retained in the hospital.

Those who are willing to participate in the study.

2. Exclusion Criteria:

Mothers who gave birth for more than one month

before the commencement of study.

Those who do not read or understand either English

or Malayalam.

Sick mothers and those who lost their babies.

STATISTICAL

ANALYSIS

Chi Square and Student t Test

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2. INTRODUCTION

Neonatal mortality is one of the major worries concerning newborns all over the world.

Of the total neonatal deaths occurring in the world, 95% occur in the developing

countries. India accounts for 25% of total neonatal deaths occurring in the world with

around 2million deaths each year. Prematurity or low birth weight, birth asphyxia or

tremor and newborn infections are the major three causes of neonatal deaths occurring in

India. Most of these deaths can be avoided with the effective implementation of essential

newborn care. An essential newborn care programme comprises of three main

components – i) Antenatal, pregnancy, labour and delivery cares; ii) Early detection of

dangerous sign and availing medical assistance if necessary and iii) Proper treatment of

newborns with various illnesses and health issues. This study is aimed at assessing the

knowledge of hospital delivered mothers as early as after delivery before discharged to

home.

3. AIM & OBJECTIVES

AIM:

The aim of this study is to assess the knowledge on newborn care among postnatal

(hospital delivered) mothers in a private hospital.

OBJECTIVES:

i. Primary Objective:

To determine the level or extent of parents’ knowledge on essential newborn care,

particularly in the aspects of General Care, Newborn health care and Newborn

feeding.

ii. Secondary Objective:

To determine the significant differences in the parents’ newborn care knowledge

when they are grouped according to various demographic variables such as age,

educational status, occupation, monthly income, parity etc.

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4. STUDY METHODOLOGY

4.1. Study Setting:

The study will be conducted at Nurul Islam Medical Science (NIMS) Hospital

in Trivandrum, Kerala.

4.2. Study Population:

Women who deliver during the data collection period and those who satisfy

the inclusion-exclusion criteria will be selected.

4.3. Study Design:

Normative, correlation and descriptive type.

4.4. Study Duration:

Four months.

4.5. Eligibility Criteria:

4.5.1. Inclusion Criteria: Mothers of infants aged 0 – 28 days, Those who are

retained in the hospital and Those who are willing to participate in the

study

4.5.2. Exclusion Criteria: Mothers who gave birth for more than one month

before the commencement of study, Those who do not read or understand

either English or Malayalam and Sick mothers and Those who lost their

babies.

4.6. Study Procedure:

This is a questionnaire based study. Pre-validated questionnaires will be

provided to the selected participants along with the instructions to fill the

questionnaire. Filled questionnaires will be collected and answers with

explanation will be provided to those who completed the questionnaire. The

data obtained will be analysed then statistically.

4.7. Statistical Method:

Chi square and Student t test.

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Appendix B: (Questionnaire)

1. English:

NEW BORN CARE

Check for your response

1. Age:

20 – 25 years

25 – 30 years

30 – 35 years

35 and above

2. Educational Status:

Primary

High School

Higher Secondary

Graduate

3. Occupation:

Government Employee

Private/Corporate Employee

House Wife

Others

4. Monthly Income (Rs):

Less than 1000

1000 – 2500

2500 – 5000

More than 5000

5. Type of Delivery:

Normal Vaginal

Caesarean

6. Parity:

Primipara

Multipara

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INSTRUCTIONS FOR COMPLETING THE QUESTIONNAIRE

There are 30 questions and there is only one correct answer for each question

Check towards your most appropriate response

If you have any questions regarding the completion of this questionnaire please ask

GENERAL CARE

1. What is the average weight of a newborn:

a. 2 – 3 kg

b. 2.5 – 4 kg

c. 3 – 4.5 kg

d. 3.5 – 5 kg

2. What is the average length of the newborn:

a. 20 – 25 cm

b. 46 – 54 cm

c. 35 – 50 cm

d. 22 – 38 cm

3. When riding in the car, your baby will be the safest when:

a. facing backwards in the front seat

b. facing forward in the front seat

c. facing backward in the back seat

d. facing forward in the back seat

4. How often should you bathe your newborn?

a. Once a week

b. 2 or 3 times a week

c. Daily

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5. What is the average time does a baby sleep a day?

a. 8 – 10 hours

b. 16 – 18 hours

c. 18 – 20 hours

d. 20 – 22 hours

6. True or false: It's normal for your newborn to be coughing frequently

a. True

b. False

7. Which of the following is not a symptom of colic?

a. Nonstop crying

b. Excessive sleepiness

c. An enlarged stomach

d. Passing gas

8. A newborn has a fever if their temperature is at or above:

a. 36° Celsius

b. 38° Celsius

c. 37.5° Celsius

d. 40° Celsius

9. If your baby's skin gets yellow, he/she likely has:

a. Roseola

b. Thrush

c. Jaundice

d. a fever

10. Babies may cry when they:

a. are hungry

b. are tired

c. need their diaper changed

d. all of the above

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11. All are dangerous except:

a. Sneezing

b. Jaundice

c. Excessive Sleepiness

d. Poor Feeding

12. What is the main cause of Diarrhoea

a. Teething

b. Germs/Microbes

c. Unclean Food & Water

13. Which is the best remedy for Diarrhoea

a. O.R.S.

b. Antibiotics

c. Boiled Water

d. Cow’s Milk

14. Which is the best food for newborns:

a. Oatmeal

b. Breast milk

c. Mashed potatoes

d. Cow’s milk

15. True or False: Babies up to 4 – 6 months only be given with breast milk

a. True

b. False

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16. True or false: A nursing mother needs extra food to produce milk for her baby:

a. True

b. False

17. True or false: Most common illnesses--such as colds, flu, skin infections, or

diarrhoea--can be passed through breast milk:

a. True

b. False

18. What is the minimum age that a baby should be started on solid foods?

a. 6 to 8 weeks

b. 4 to 6 months

c. 1 to 2 years

19. True or False: Baby should be given honey, jaggery or butter at birth

a. True

b. False

20. True or false: Water should be boiled before it's mixed with infant formula

a. True

b. False

Thank you for participating!

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APPENDIX C: Malayalam:

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APPENDIX D: (Questionnaire Validation Certificate)

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APPENDIX E: (Hospital Certificate)

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APPENDIX F: (Certificate of Neonatologist)

an assessment of knowledge on newborn care practices among hospital delivered postnatal mothers

Documents

newborn care practices

good knowledge

newborn general care

practice of newborn

moderate level of knowledge

assessment of knowledge

low level of knowledge

peoples knowledge