Study to Assess the Knowledge on Essential Newborn Care among Primipara Mothers – A Case of Government District Hospital, Tumkur, Karnataka, India

 

Shivaleela P. Upashe

Department of Nursing, College of Health and Medical Sciences, Post Box No: 395, Wollega University,

Nekemte, Ethiopia.

 

ABSTRACT:

Background: Nearly 50% of all newborn 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. The present study was designed to assess the knowledge on essential newborn care among primipara mothers at District Hospital, Tumkur, Karnataka, India.

Methodology: The data were collected on knowledge of primipara mothers of new born baby’s. It is believed that mothers were the first nurse who take care and met the primary needs of the new born babies during wellness and illness. Sample size was 100 primipara mothers. Simple random sampling technique was used to draw the sample. The data collection was done by interview method, using structured knowledge questionnaire which includes 40 questions of knowledge regarding essential new born care with scoring pattern of one for each correct answer and zero for incorrect response.

Results: The results of the study were indicating about 25% of mothers had good knowledge, 64% mothers had moderate knowledge and 11% of mothers had poor knowledge related to essential new born care.

Conclusions: Further research warranted for improving the level of knowledge among primipara mothers related to essential newborn care. 

 

 

 

INTRODUCTION:

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 preventive 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.)¹. The newborn health challenge faced by India is more formidable than that experienced by any other country in the world. It is estimated that out of 3.9 million neonatal deaths that occur worldwide, almost 30% occur in India².

Global under –five mortality rates have declined over the past four decades, but the neonatal mortality rates still remains high³. Although the neonatal mortality rate shows a decreasing trend, compared to 25% reduction in the neonatal deaths in 1980s the decline in 1990s was only 15% (NHFS, 1998-99). The Major causes of neonatal deaths globally were estimated to be complications of prematurity (28%), sepsis and pneumonia (26%), birth asphyxia injuries (23%), tetanus (7%), congenital anomalies (7%) and diarrhea (3%)^2,4. 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 ⁵. 

The first four weeks of life constitute the “neonatal period”.  The ideal basic needs for any new born includes breathing, warmth, cleanliness, breast feeding. The good care practices immediately after delivery play a major role in causing neonatal morbidities and mortalities. Essential newborn care practices were outlined to decrease the neonatal morbidity and mortalities. 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 clean cord care could dramatically reduce the risks of these serious conditions. Initiating breast feeding immediately after birth (within 1 hour) 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 as hypoglycemia⁶.  Traditional wrong practices like applying cow dung, oil, ash, herbal mixture on the umbilical stump, oil instillation into the nose and also regarding breast feeding are also practiced, like baby is put to the breast after 3 days of delivery and discarding the 1^st milk colostrums etc also contribute to newborn’s risk morbidity and mortality^1,7. 

 

The perusal of the literature survey found that, there are no studies conducted at Tumkur, Karnataka, India. Therefore the present study was conducted to assess the knowledge and its relationship with essential newborn care among primipara mothers. The study also describes the association between socio-demographic variables with knowledge. The results so obtained from the study might be used to identify best knowledge, and to suggest areas that require improvement.

 

MATERIALS AND METHODS:

Study Area                                                                                                                                

The study was conducted at Government District Hospital, Tumkur and 500 beded hospital with medical, surgical, emergency, pediatric unit, neonatal intensive care unit, post natal ward, labor room, operation theatre and outpatient departments. The criteria for selection of the setting were the availability of the subjects, feasibility of conducting the study and the investigators feasibility with the setting. The present study was conducted at post natal ward of the hospital. 

 

Ethical Consideration and Clearance

Ethical clearance and permission was obtained from District Health Hospital and Aruna College of Nursing, Karnataka, India. Each participant (primipara mothers) was notified about the purpose of the study, the right to refuse for participation in the study, and anonymity and confidentiality of the information. Primipara mothers were assured that they will not be penalized for not participating and that their responses to the questions would have no effect on their care.

 

 

Methodology     

The descriptive with cross sectional study was carried out at Post-natal Ward of Government District Hospital, Tumkur, Karnataka, India to assess the knowledge on essential newborn care among primipara mothers. The simple random sampling technique was adapted while selecting the subjects to meet the study objectives⁸. Data was collected by using a structure questionnaire to assess the knowledge and of primipara mothers. Informed consent was obtained from all the primipara mothers, who were interviewed.

 

Inclusion and Exclusion Criteria

In Inclusion Criteria which includes all the primipara mothers who are available at the time of data collection, those who are having communication with same common language English/    Kannada and mothers who are willing to participate.  Exclusion Criteria, which excludes  Nullipara mothers or infertile women, those mothers who are not communicate with same, Common language English / Kannada and Primipara mothers those who are not willing to participate.

 

Socio-demographic Information

Socio-demographic information such as Age, Religion, Educational Status, Family Income, Occupation, Type of family, Residence etc. were recorded.

 

Assessment of Knowledge

Knowledge scoring was done depending on the responses to the questions given by primipara mothers and represented as follows, Score ‘1’ for correct response and ‘0’ for wrong response. To assess the knowledge of primipara mothers about new born care includes following domains, which includes knowledge about maintenance of body temperature, establishment of breast feeding, prevention of infection, immunization and growth and development. 

 

Data analysis

The collected data was coded, tabulated, and analyzed by using descriptive statistics (mean, mean percentage, standard deviation) and inferential statistics (chi-square) to find out the association between demographic variables and knowledge score. The total score was calculated and data was analyzed by using Statistical Package for Social Sciences (SPSS) Version 13.0. The data is presented in the form of tables and graphs.

 

RESULTS:

Socio-Demographic Data

A total of 100 primipara mothers were participated in the study. Maternal age ranges between 18 to 30 with an average of 23.18±4.98. Most of the mothers 46% were Hindus, 34% were Christian, and 20% mothers were Muslims. Among them 48% mothers had completed pre university course (PUC) and above level of education, 32% were elementary level of education and 20% mothers were ill literates. Out of 100 mothers 50% were employee, 30% mothers were house wives and 20% were coolies. About monthly income of the family 45% mothers had the income range between  Rs 2000-4000, 40% mothers had the income above Rs 4000 and 15% mothers had the monthly income less than Rs 2000. Regarding type of family 40% were belongs joint family, whereas 50% mothers were belongs to nuclear family and only 10% mothers were belongs to extended family. About residence 60% mothers belongs to rural area and 40% mothers belong to urban area. Regarding type of delivery 50% mothers were belongs to normal delivery and 50% mothers were belongs to caesarean section. Regarding weight of the baby 11% babys were 2-2.5 kg and 79% babys were 2.5-3 kg and  10% babys were belongs to 3-3.5 kg.

 

 

 

Table 1: Socio-demographic variables of the study (n=100).

 

 

Knowledge of Primipara Mothers’ Related to the Essential Newborn Care

The knowledge of primipara mothers regarding the care of the newborn baby’s was assessed related to the maintenance of body temperature, establishment of breast feeding, prevention of infection, immunization and growth and development.  According to the total score obtained by each subject, knowledge was classified into good knowledge (>80%), moderate knowledge (40 to 80%) and poor knowledge (<40). Table 2 gives the distribution of knowledge level. Our study indicates that 64% had moderate knowledge level, 25% of them had good knowledge level and 11% had poor knowledge level.

 

Table 2: Level of knowledge of respondents regarding Newborn care.

 

 

 

 

Table 3 represents overall mean knowledge score of mothers regarding essential new born care was 31.89 ±2.32 and score range 13-39.

 

Table 3: Maximum score, mean, and Standard deviation in related to the knowledge regarding essential new born care.

Maximum possible score	Range of score	Mean score	Mean score (%)	Standard deviation
40	13-39	31.89	79	2.32

 

Table 4 depicts the overall mean knowledge was found to be 31.89. The highest mean knowledge score of maintenance of body temperature was 97% and the least mean score percentage of prevention of infection 71%.  The establishment of breast feeding was 83%, immunization was 90% and the growth and development was 72% respectively.

 

Table 4: Domain (area) wise mean knowledge score of respondents.

 

Association between the level of knowledge and selected demographic variables

Chi square test was done in order to determine the association between the overall Knowledge level of mothers about essential newborn care and selected demographic variables. Findings are presented in table 5.

Table 5:  Association between level of knowledge and selected demographic variables.

 

 

 

The findings presented in the table 5 shows that the calculated chi-sqare value at df=4 for the age (x²=12.07. p<0.05) is higher than the table value (9.49) at 0.05 level of significance. It is interpreted that there was a significant association between age of the mother and their level of knowledge regarding newborn care. Same as educational status, occupation the chi-square value at df=4 (x² =14.15, 12.24, P<0.05) is higher than the table value (9.49) at 0.05 level of significance. It is interpreted that there was a significant association between educational status, occupation and their level of knowledge regarding newborn care. Further the findings in the table shows that the computed chi-sqare at df=4 type of family (x² =10.36,P<0.05). Furthermore, the findings in the table shows that the calculated chi-square value at df=4 for religion, income(x² = 2.96, x² =3.29, P<0.05) is lesser than that of table value (9.49) at 0.05 level of significance. The null hypothesis accepted, it is interpreted that there was no significant association between Religion, Family income  and their level of knowledge regarding newborn care.

 

DISCUSSION:

Four millions deaths occur globally in the first month of life. Under five mortality has decreased in the recent years but most of it is due to a decrease in the post neonatal mortality. India accounts for a quarter of neonatal deaths occurring globally. Newborn care practices at and immediately following delivery can contribute to morbidity and mortality of neonates. A set of Essential Newborn Care (ENC) practices have been proven to reduce these risks ⁹.

 

 

Distribution of mothers according to their age show that majority (48%) of them were in the age group 18-25 years and with education level of PUC (48%). Higher age was associated with higher scores and difference among the groups was found to be significant. This might also be due to the trend that women who belong to higher socio-economic status and the one with better education tend to get later age pregnancy. Higher percent of respondents classified as employee in occupation that is 50% and most of them found Hindu religion 46%. Majority of respondents belongs to nuclear family 50% and 45% with family income between Rs.2000 to 4000 and better neonatal care score also correlated with better occupation. This tells that more effort has to be put to educate the young mothers. Our study demonstrates that, higher socio-economic status correlated with better neonatal care score. This could be because of the educational status of the mothers from higher socio-economic class.

 

Maintaining the normal body temperature is extremely important in newborns because of their larger body surface area. A study done in rural India has proven that even when pregnant mothers have access to a trained birth attendant for delivery at home, thermal care is the component of essential newborn care which gets neglected¹⁰. In the present study we assessed knowledge of primipara mothers for the maintenance of body temperature of newborn baby and our findings shows that the overall mean Knowledge score found to be 79.93%. The highest mean percent of Knowledge score found in the aspect of maintenance of body temperature (97%). Care of umbilical cord is always stressed since it can function as the entry point for infections. Despite the efforts to improve the cord care practices, in many rural areas where deliveries are conducted by untrained dhais, guidelines for umbilical cord care are seldom followed. The World Helath Organization recommends dry cord care (where nothing is placed on cord stump unless indicated¹¹. Various studies done in developing countries have reported mothers applying substances like mustard oil, turmeric, cow dung, antiseptic lotion etc. on the cord stump without any scientific knowledge¹². The wrong practices followed by mothers without the basis of scientific knowledge have proved fatal to the life of the newborns. Our study reveals that least knowledge score found in the aspect of prevention of infection (71%) of newborn care. Our findings supported by the studies like Manju, (1999)¹³, Raman Vidya, Rekha, Chandrasekhara, (1996)¹⁴, Deorari, (1999)¹⁵ and Hill, (2000)¹⁶.

 

A result of the data establishes that the overall mean practice score found to be 70% in all the area of the essential newborn care.  Our findings also in agreement with supported by the studies like, Choudary, Rajendra Kumar Bajaj and Raj Kumar Gupta (2000)¹⁷, Mondlane, de Graca, and Ebrahim, (1989)¹⁸ and Parul Datta (1997)¹⁹. The present study shows a significant association between knowledge and practice with demographic variables like age of the mothers and knowledge (x²=12.07) only, educational status and knowledge. Type of family (x²=10.36, 15.89) knowledge. The above findings were supported by the studies conducted by Pridham and Chang, (1992)²⁰,  Rathore and Ramesh (1994)²¹ and Samudre Manisha (2002)²².

 

CONCLUSIONS:

As home delivery is common and hospital stays are short, the expansion of outreach education and care represents an effective way of reaching more mothers and babies and improving newborn care. The result of the study indicates that knowledge of primipara mothers towards essential new born care has lots of lacunae especially in those who belong to the lower socioeconomic and educational status. There is scope for improvement by providing better care and health education for primipara mothers at primary care level itself. The present study recommends further, a follow up study is needed to evaluate the knowledge of mother regarding newborn care, It is very vital to conduct a comparative study to find out similarities or differences b/w rural and urban mothers, the teaching and demonstration materials can be videotaped and can be encouraged in the outpatient department and ward of the hospital, Individual teaching can be given during prenatal counseling. Finally, health information regarding care of newborn should be given to improve the knowledge of the mother.

 

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Received on 19.02.2014           Modified on 18.03.2014

Accepted on 25.03.2014           © A&V Publication all right reserved