INTRODUCTION:

Today’s children are tomorrow’s citizen. A well developed child contributes to the national welfare so children are the world’s most valuable asset and their wellbeing indicates the standard of living of the country. Children’s health reflects the national health and wealth. They constitute about 40 percent of the total population.⁽¹⁾

The period after childbirth is a critical time for the health of mother and her baby. With the joy of getting a child, most families tend to believe that nine months of added care and anxiety have come to an end. Nevertheless, the truth is that the first year after delivery are the most vulnerable days for the mother and child, demanding an extreme care during this time. Motherhood’ is the most beautiful experience in life without which a woman is incomplete

Mother is the true owner and care taker of her baby. The best and most precious gift the mother can give to the baby is the gift of health.The health and survival of the infant depends upon the health status of the mother and her awareness, education and skills in mother craft. The mother is more receptive to advice concerning herself and her baby during antenatal period than any other time.⁽¹⁾

In India, over 2.1 million children die annually before reaching their fifth birthday. The statistics are most shocking among infants. While around 4 million children die within the first 28 days of life across the planet annually. Infant mortality rate in Jharkhand is 49, 45 per 1,000 live births in Orissa — much higher than India's national estimates of 39 per 1,000.⁽²⁾

Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR, B hospital showed that the proportion of children with stunting, underweight, and wasting.⁽³⁾

Health and adequate nutrition are fundamental rights of every infant. But unfortunately, not every state has given it due importance. An exception to this is Mizoram where infant health indices are better than the rest. Its IMR is low at 34.1% and it has nearly 67% women breastfeeding within an hour of delivery. Compared to that, Chhattisgarh and Madhya Pradesh come across as the worst with IMR as high as 70.8% and 69.5 %⁽⁴⁾.

The World Health Organization recommends exclusive breastfeeding for the first six months of life and continued breastfeeding along with adequate complimentary foods for two years or beyond to reduce infant mortality linked to under nutrition, acute respiratory infection, diarrhoea and other infectious diseases. Breastfeeding also contributes to the health of mothers.⁽⁴⁾

NEED FOR THE STUDY:

Children don't have a vote but the future depends on them. Indian government could do well to concentrate on infant health indices that are poor to say the least. Infant health has been drastic in India since a long time and the health care takers are still struggling to bring it on track. Many policies have been on papers but they hardly reach the needy, and the main culprit is lack of awareness among Indian mothers regarding the proper care of their children. The best means to improve the infant health is to increase the awareness of their perfect care among their prominent care takers that is mothers.⁽⁵⁾

Infant health in India shows drastic figures. Delhi ranks 9th (out of 29 states) in infant mortality rate, it is a pathetic 19th in exclusive breastfeeding (that is only 34.5% of women breastfeed exclusively for 6 months) and 22nd in initiating breastfeeding within the first one hour. Only 29.9% children in Delhi are given ORS during diarrhoea.⁽⁶⁾

According to the National Family Health Survey-3, percentage of underweight children increases from about 16% to 30% by the time they are 6 months. That would mean action would have to take place during pregnancy, so that mothers receive adequate care and nutrition, women are supported at birth for safe delivery and beginning of breastfeeding within 1 hour, and exclusive breastfeeding is ensured for the first six months of life.⁽⁷⁾

The World Health Organization (WHO) estimates that 4 million children die during the neonatal period each year, with most deaths occurring in developing countries. Infections are the single most important cause of neonatal mortality. It is estimated that 3,00 000 infants die annually from tetanus, and a further 4,60,000 die because of severe bacterial infections, of which umbilical cord infections are an important precursor. Although increasing access to tetanus toxoid immunization during pregnancy must remain a priority, high rates of umbilical cord infection and sepsis can occur in areas free of tetanus, attributable to unhygienic delivery or immediate postpartum care practices that lead to contamination of the umbilical stump.⁽⁷⁾

The infant mortality rate (0-1year) is 64 / 1000 live births in Bagalkot, 45 in Belgaum, 53 in Bellary, 67 in Bijapur,69 in Dharwad and 66 in Gadag and 67 in Gulbarga. Neonatal mortality constitute almost three quarters of total infant mortality.⁽⁸⁾ Severe infections, asphyxia, preterm birth causes 86 percent of newborn deaths.⁽¹³⁾In developing countries 560 000(14.1%) and 290 000(7.2%) neonatal death occurs due to Neonatal tetanus and Sepsis and incidence of neonatal conjunctivitis is about 3.1 per 1000 live births⁽⁸⁾

A prospective survey study was carried out to identify healthy and harmful practices in Neonatal care in rural Karnataka, using quantitative data from a following mothers through their experience of pregnancy and the postnatal period; and qualitative data from in depth interviews and focus group discussions conducted with mothers, grandmothers and birth attendants. It explored local newborn care practices and beliefs. Findings show that many potentially harmful newborn care practices are being carried out in the study area, such as unhygienic cord cutting, delayed breastfeeding and early bathing. Some are more amenable to change than others, depending on the strength of the underlying beliefs, and acceptability of alternative care.⁽⁹⁾

A child’s birth is a rebirth of mother. The process of birth takes only few hours but it is the most hazardous period of life, since it is associated with largest number of death as compared to any other phase of life. The mother’s timely behavior in seeking care for her sick child is a critical factor for reducing mortality. Such seeking behavior will not take place unless the mother recognize signs and symptoms of illness, interpret the possible severity of conditions and take an action to seek care in timely manner.⁽⁹⁾

So there is a need to plan implement a teaching programme on knowledge regarding specific neonatal infections and their prevention among primigravida mothers. This can reduce high risk of infant mortality rate in the country.

OBJECTIVES OF THE STUDY:

1. To assess the knowledge of primi Para mothers on Infant care.

2. To assess the practice of primi Para mothers on Infant care.

3. To evaluate the effectiveness of Structured teaching programme on Knowledge and practice of primi Para mothers on Infant care.

4. To find the correlation between knowledge and practice regarding Infant care.

5. To determine the association between knowledge of primi para mothers with selected demographic variables.

6. To determine the association between practices of primi-para mothers with selected demographic variables.

OPERATIONAL DEFINITIONS:

1. Assess:

Refers to the statistical measurement of level of knowledge and practice on infant care among primi para mothers.

2. Effectiveness:

It refers to the quality of being or able to bring an effect or efficient of structured teaching programme in promoting the knowledge and practice of infant care among primi para mothers.

3. Knowledge:

Refers to the awareness of primi para mothers on infant care.

4. Practice:

It refers to the way of caring the infant by the primi para mothers by providing warmth,feeding, basic hygiene and identifications of danger sign and seeking help from health personals whenever required.

Primi para mothers:

Refers to a woman who has given birth for the first time.

5. Infant care:

It is the basic activities carried out by a primi para mother for the upbringing of her child satisfactorily in physical, physiological, psychological, social, economical and spiritual dimension to maintain optimum feeling of wellbeing in her child by providing warmth, feeding, basic hygiene and identification of danger signs, and seeking help from health personnel whenever required.

Variables:

Dependent variable:

The outcome of interest. The variable that is hypothesized to depend on or caused by another variable. In this study the Knowledge of primi para mothers on infant care was considered as dependent variable.

Independent Variable:

The variable that is believed to cause or influence the dependent variable.²¹

In this study the structured teaching programme on Infant care was considered as independent variable.

Extraneous Variables:

These are the variables other than independent variables, which can influence the dependent variable.

Assumptions:

It refers to the beliefs that are held to be true, but have not necessary to be proven²¹. The present study was assumed that:

1. Primi para mothers may differ in their knowledge and practice on Infant care.

2. Primi para mothers will have some knowledge on Infant care

Limitations of the study:

The study was limited to the Nurses working in selected paediatric hospitals at Bangalore.

Hypotheses:

H1. There will be significant correlation between the knowledge and practice of primi para mothers on Infant care.

H2. There will be significant difference of knowledge before and after implementing structured teaching programme.

H3. There will be significant difference of practice before and after implementing structured teaching programme.

H4. There will be significant association between knowledge on Infant care with selected demographic variables of primi para mothers.

H5. There will be significant association between practices on Infant care with Infant care selected demographic variables of primi para mothers.

METHODOLOGY:

Methodology is the most important part of any research study. It includes various steps that are generally adopted by the researcher in studying the research problem along with the logic behind them.^{( 10)}

The present study was aimed at assessing the effectiveness of structured teaching programme on knowledge and practice on Infant Care among Primi para mothers.

This chapter deals in detail with the methodology adapted for the study. It also describes the rationale for research approach, research design, setting of the study, population, sample, sampling technique, and sample size, method of data collection, development of tool, ethical consideration, validity, pilot study, reliability and plan for data analysis.

Research Approach:

Research approach is the most significant part of any research. The appropriate selection of research approach depends on the purpose of the study.⁽¹¹⁾

An evaluative approach was considered as the appropriate measure to evaluate the effectiveness of structured teaching programme on knowledge and practice of Infant Care among Primi para mothers. An evaluative research approach is generally applied where the primary objective is to determine the extent to which a given strategy meets the desired result.

Research Design is the plan, structure and strategy of investigation of answering the research question or it is the overall plan of or blue print that researcher selects to carry out the study.⁽¹²⁾

R O₁XO₂

O₁ = Pre test for the assessment of knowledge and practice on Infant Care among primipara mothers.

X = Implementation of Structured teaching programme on Infant Care.

O₂= Post test to assess the effectiveness of Structured teaching programme on Infant Care among primipara mothers.

Variables:

Independent Variable: Structured teaching programme on Infant care.

Dependent Variable: Knowledge and practice on infant care among primi para mothers at selected paediatric hospitals.

Population:

Population is a complete set of persons or objects that possess a common characteristic that is of interest to the researcher.⁽¹³⁾

The target population of the present study was Primi para mothers in selected pediatric hospitals at Bangalore.

Sample:

Sample is a subset of population, selected to represent the population.^{( 14)}

In present study the sample consists of 40 Primi para mothers in selected pediatric hospitals at Bangalore.

Sampling Technique:

Sampling is a process of selecting the portion of the population to represent the entire population.⁽¹⁴⁾

Convenient Sampling Technique was used to select the sample for the present study

Sample Size:

40 Primi para mothers in selected paediatric hospitals at Bangalore were considered as sample for the present study.

Setting of the Study:

Research setting refers to the physical location and condition in which the data collection for study takes place.⁽¹⁵⁾

The present study was conducted in selected children hospitals at Bangalore.

Criteria for Sample Selection:

The following criteria were set by the researcher for the selection of sample.

Inclusion Criteria:

The study includes the Primi para mothers who are:

· Available in the pediatric units.

· Willing to participate in the study.

Exclusion Criteria:

The study excludes the Primi para mothers who are:

· Available in the pediatric units but possess more than one child.

· not able to understand English or kannada.⁽¹⁶⁾

RESULTS:

Analysis is categorizing, ordering, manipulating and summarizing of the data to obtain answers to the research questions.

Section I. Analysis and interpretation of socio demographic characteristics of mothers.

Section II. Analysis and interpretation of knowledge scores of mothers on infant care.

Section III.Analysis and interpretation of practice scores of mothers on infant care

Section IV. Evaluation of the effectiveness of the STP on knowledge and practice on infant care among primipara mothers.

Section V. Analysis and interpretation of data to find out the correlation between knowledge and practice scores.

Section VI. Analysis and interpretation of data to find out the association between the knowledge and practice scores with selected socio demographic variables.

SECTION 1: Analysis and interpretation of socio demographic characteristics of mothers.

Table 1: Frequency distribution of primipara mothers according to their socio demographic characteristics. N = 40

Socio-Demographic variables	No of respondents(f)	% of respondents
Age (in years)
18-22	22	55.00
23-27	14	35.00
28 &above	4	10.00
Educational status
No formal education	2	5.00
Primary	12	30.00
Secondary	6	15.00
PUC	10	25.00
Diploma or/and graduation	8	10.00
Post Graduation	2	5.00
Occupation
House wife	10	25.00
Coolie	16	40.00
Government employee	6	15.00
Private employee	8	20.00
Family Income(monthly)
Rs. 1000/--Rs.2000/-	2	5.00
Rs.2001/--Rs.4000/-.	24	60.00
Rs.4001/--Rs.6000/-.	6	15.00
Rs.6001/--and above	8	20.00
Place of Residence
Urban	18	45.00
Rural	22	55.00
Source of Information
News paper	4	10.00
Mass media	10	25.00
Magazine	6	15.00
Others	20	50.00
Gestational age at the time of data collection
Below 3 months	1	2.5
3-5 months	19	47.5
6-8 months	13	32.5
8 months and above	7	17.5

Section II: Analysis and interpretation of knowledge scores of mothers regarding infant care.

This section deals with percentage distribution, mean and standard deviation of sample’s overall knowledge levels and knowledge in specific areas related to infant care in pre test and post test.The knowledge of sample on Infant Care was assessed by using a structured interveiw schedule, with 28 items on knowledge and 32 items on practice on Infant Care.

TABLE 2: Percentage distribution of knowledge levels of Primipara mothers on Infant Care in pre test and post test=N = 50

Levels of knowledge	Pre test		Post test
Levels of knowledge	Frequency	Percentage	Frequency	Percentage
High knowledge	00	00	12	30
Average knowledge	16	40	28	70
Low knowledge	24	60	__	__

TABLE 3: Mean and standard deviation of pre test and post test knowledge scores of Primipara mothers regarding Infant Care-

N = 50

	Pre test		Post test
	Mean	Standard deviation	Mean	Standard deviation
Knowledge regarding Infant care	16.2	2.85	22.45	2.13

Table 3 represents the mean and standard deviation of pre test and post test knowledge scores of Primipara mothers regarding Infant Care. It clearly demonstrates that the mean of knowledge score in pre test was increased from 16.2 + 2.85 to 22.45 + 2.13 in post test.

Section III: Analysis and interpretation of practice scores of primipara mothers regarding infant care.

TABLE 4: pre-test and post test practice scores of primipara mothers. N=40

Level of practice	Pre test		Post test
Level of practice	Frequency	Percentage	Frequency	percentage
High	00	00	15	37.5
Average	13	32.5	23	57.5
Low	27	67.5	02	05

Table 4 reveals, in pre-test 13(32.5%) subjects had average level of practice and 27(67.5%) had average level of practice regarding infant care. Whereas in post test 15(37.5%) of subjects demonstrated a high level practice, 23 (57.5%) had average and 2(5%) subjects had low level of practice regarding infant care.

SECTION –IV: Testing hypothesis for evaluating effectiveness of structured teaching programme.

TABLE 6: Comparison of knowledge scores of Primipara mothers before and after structured teaching programme on Infant Care-N = 40

Mean Difference	Standard error of difference	Paired ‘t’ test value
		Calculated value		Table Value
07.3	2.23	19.07	2.26

(Table value of ‘t’ for 39 df at 0.05 level of significance is 2.26)

Table 6 reveals that the overall mean difference was 7.3 with paired ‘t’ value 19.07. Thus it was revealed that the post test mean score was significantly higher than the pre test mean score. The table value of paired‘t’ test at 39 degree of freedom and at 0.05 level of significance is 2.26. Since the calculated value was higher than the table value, the research hypothesis H₂ was accepted. Hence there was a significant difference between the pre test and post test scores on Infant Care.

TABLE 7: Comparison of practice scores of Primipara mothers before and after intervention of structured teaching programme on Infant Care.-N = 40

Mean Difference	Standard error of difference	Paired ‘t’ test value
		Calculated value	Table value
08.66	2.4	17.49	1.96

(Table value of ‘t’ for 39 df at 0.05 level of significance is 2.26)

Table 7 reveals that the overall mean difference was 08.66 with paired ‘t’ value 17.49. Thus it was revealed that the post test mean score was significantly higher than the pre test mean score. The table value of paired‘t’ test at 39 degree of freedom and at 0.05 level of significance is 2.26. Since the calculated value was higher than the table value, the research hypothesis H₃ was accepted. Hence there was a significant difference between the pre test and post test practice scores on Infant Care.

Section VI: Association between pretest knowledge scores and selected socio demographic variables.

Table 8: Association between knowledge scores and selected socio demographic variables

SL. NO	Socio demographic variables	Df	Chi-square value	Table value	Level of significance
1.	Age	1	3.523	3.84	0.05
2.	Educational status	1	12.2	3.84	0.05
3.	Occupation	1	7.29	3.84	0.05
4.	Place of residence	1	6.532	3.84	0.05
5.	Source of information regarding health	1	2.434	3.84	0.05

Table no. 8 depicts the association between socio demographic variables of sample and their knowledge scores. For age the calculated χ²value was 3.523 and table value of χ² at 5% level of significance with degree of freedom 1 is 3.84. As the calculated value was less than the table value the research hypothesisrelated to Age of the sample and pre test knowledge score was accepted. Hence no significant relationship was observed between the Age of the primipara mothers and their knowledge score on infant care.

The calculated χ²value was 12.2 and table value of χ² at 5% level of significance with degree of freedom 1 is 3.84. As the calculated value was more than the table value the research hypothesis related to Educational status of the sample and pre test knowledge score was rejected. Hence significant association was observed between the Educational status of the primigravida mothers and their pre test knowledge score on selected Neonatal infections and their prevention.

DISCUSSION:

Section I:

Analysis and interpretation of socio demographic characteristics of mothers.

Section 1 reveals that, out of 40 subjects, 22(55%) of the subjects belong to 18-22 years, and 4(10 %) were 28 and above years of age. Only 2(5%)of the subjects had no formal education, 12(30%) up to primary education, and 2(5%) of the subjects had post graduation.10(25%)of the subjects, were housewives, 16(40%) were coolie, 6(15%) were government employee, and remaining 8(20%) of the subjects were private employee. 2(5%) subjects had an income of Rs.1000/--Rs2000/-, and most of them, 24(60%) had income between Rs. 2001/--4000

Majority-22 (55%) of subjects were staying in rural area and remaining 18(45%) were in urban area. 4(10%) subjects were getting information from news paper, followed by 10(25%) subjects were getting from mass media,6(15%) were getting from magazine and 20(50%) were getting from others like friends, neighbours, relatives, etc.

Section II:

Analysis and interpretation of knowledge scores of mothers regarding infant care. In pre test 16 (40%) of the Primipara mothers had average knowledge only and remaining 24(60%) had low knowledge. Post test scores compared to pre test scores showed an observable increase in the knowledge of Primipara mothers as 12 (30%) of them had high knowledge and remaining 28(70%) had average knowledge. The mean of knowledge score in pre test was increased from 16.2 + 2.85 to 22.45 + 2.13 in post test.

Section III:

Analysis and interpretation of practice scores of mothers regarding infant care. In pre-test 13(32.5%)subjects had average level of practice and 27(67.5%) had average level of practice regarding infant care. Whereas in post test 15(37.5%) of subjects demonstrated a high level practice, 23 (57.5%) had average and 2(5%) subjects had low level of practice regarding infant care. In pre-test the mean and standard deviation was 18+ 3.24, whereas in post test it increased to 25.66+3.14.

Section IV:

Evaluation of the effectiveness of the STP on knowledge and practice regarding infant care primipara mothers. The overall mean difference was 7.3 with paired‘t’ value 19.07. Thus it was revealed that the post test mean score was significantly higher than the pre test mean score. The table value of paired‘t’ test at 39 degree of freedom and at 0.05 level of significance is 2.26. Since the calculated value was higher than the table value, the research hypothesis H₂ was accepted. Hence there was a significant difference between the pre test and post test scores on Infant Care.

The overall mean difference was 08.66 with paired ‘t’ value 17.49. Thus it was revealed that the post test mean score was significantly higher than the pre test mean score. The table value of paired‘t’ test at 39 degree of freedom and at 0.05 level of significance is 2.26. Since the calculated value was higher than the table value, the research hypothesis H₃ was accepted. Hence there was a significant difference between the pre test and post test practice scores on Infant Care.

SECTION – V: Analysis and interpretation of data to find out correlation between knowledge and practice scores.

Karl Pearson’s coefficient correlation was used to find the compute the correlation between knowledge and practice of primipara mothers regarding Infant care. The ‘r’ was found to be 0.052, hence a positive correlation was found between knowledge and practice scores of primipara mothers. Hence the research hypothesis H₁ was accepted.

Section VI: Association between knowledge and practice of primipara mothers regarding infant care and selected socio demographic variables.

The association between knowledge of primipara mothers regarding infant care and their selected socio demographic variables was tested by using chi square test at 0.05 level of significance. Findings revealed that significant association was found between the knowledge score of the primipara mothers and their attribute variables like Educational status, occupation, place of residence. The knowledge score regarding infant care was not found associated with remaining attribute variables like Age and Source of information.

The association between practice of primipara mothers regarding infant care and their selected socio demographic variables was tested by using chi square test at 0.05 level of significance. Findings revealed that significant association was found between the practice score of the primipara mothers and their attribute variables like educational status and place of residence. The practice score regarding infant care was not found associated with remaining attribute variables like Age, occupation and source of information regarding infant care.

Implications of the Study:

The findings of the study have implications on the nursing practice, nursing education, nursing administration, nursing research, primary health care and in general education.

1. Nursing Practice:

Health education is an important tool of healthcare agency. It is one of the most cost effective interventions. It is concerned with promoting health as well as reducing morbidity and mortality rate. The extended and expanded roles of professional nurse have emphasized more about the preventive and promotive aspects of the health.

Primary prevention is one of the important components of nursing. Nurses have a major role in preventive aspects than the curative aspects. STP developed for this study will help the nurses in organizing educational programmes.

The gap between the existing and expected levels of knowledge of primipara mothers indicate that there is high need of education regarding “Infant care”. This will help them to improve their knowledge and practices and use the knowledge in identifying risk factors and preventing the incidence of infant mortality and morbidity.

From the present study it was found that STP was very effective teaching method. The investigator as a nurse felt the need that nurses should act as key persons to educate primigravida mothers so that they could learn to protect their infants.

2. Nursing Education:

The curriculum is responsible for preparing the future nurses. There it should emphasize on preventive and promotive health practices. The learning experience of the students should give more emphasis on teaching the population who are at risk.

Workshops, seminars and conferences can be conducted to educate the student nurses regarding infant care and their prevention so that they could disseminate their knowledge to the primipara mothers in both areas in community and clinical settings. The student nurses should be given opportunities during his/her training to plan and conduct health education for primipara mothers visiting the hospital and in the community area.

The study emphasizes significant short term in-service education programmes for nurses and peripheral health workers related to health education for rural people regarding infant care.

3. Nursing Administration:

· The nursing administrators should take active part in health policy making, developing protocols, standing orders related to designing health education programmes and strategies for primipara mothers on infant care.

· The nursing administrator can mobilize the available resource personnel towards the health education of primipara mothers on infant care.

· The nurse administrator should take interest in providing information and plan and organize educational programme for nursing students to motivate them in conducting teaching programmes on infant care.

4. Nursing Research:

Nurses should come forward to take up unsolved questions in the field of infant care to carryout studies and publish them for the benefit of patients, public and nursing fraternity. The public and private agencies should also encourage research in this field through materials and funds.

Limitations of the Study:

· The study is limited to primipara mothers attending the hospital.

· The study did not assess the attitude of primipara mothers on infant care

· The study did not use any control group.

· Small number (40) subjects limits generalization of the study.

RECOMMENDATIONS:

On the basis of the findings of the study following recommendations have been made:

· A similar study can be replicated on a large sample to generalize the findings.

· A study can be conducted by including additional demographic variables.

· A comparative study can be conducted between rural and urban settings.

· An experimental study can be undertaken with control group for effective comparison of the result.

· A study can be carried out to evaluate the efficiency of various teaching strategies like SIM, pamphlets, leaflets and computer assisted instruction on infant care

· A study on demonstration of infant care strategies among primipara mothers.

· A study can be conducted specifically on minor ailments and home care of infants among primipara mothers.

REFERENCES:

1. Trends in Pediatric Nursing, New Born and Infant care. HS3T1 Pediatric Nursing. Indira Gandi National Open University School of Health Sciences. March 2001. Unique Press Pvt. Ltd, NOIDA.

2. Park’s text book of preventive and social medicine 16^th edition. Jabalpur, India M/s. Banarsidas Bhanot. 2001.

3. Deorar AK, Chellani H, Carlin JB. Clinico-epidemiological profile and preditor of fevero illness in young infant <60 days reporting to a hospital in north india. Journal of the Indian Academy of pediatrics October 2007; 4(10) : 739.

4. Merchant RM and Sharif M. The neonatal titanus due to application of cow-dung to the umbilical stump causes septicemia. The Journal Of Obstetrics And Gynecology India. July 2005; 55 (4) : 313-317.

5. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999 December; 354 (9194) : 1955-61.

6. Jali MV. Xth Annual conference of National Neonatology Forum Karnataka state chapter. NEOCON 2006 September; 23-24: PP-8.

7. Burns N, Groove SK. Understanding Nursing research. 2^ndedition, Philadelphia (USA): Harcort publishers: 1995.

8. Talbot. Nursing research. 2^nd edition. Philodelphia: W.B. Saunders company; 1995.

9. Sasaki Y, Ali M, Kakimoto K, Saroeun O, Kanal K, Kuroiwa C.. Predictors of exclusive breast-feeding in early infancy.2008 Dec; 25(6):463-9.

10. Ergenekon-ozelci P, Elmaci N, Ertem M, Saka G. Breastfeeding beliefs and practices among migrant mothers in slums of Diyarbakir, Turkey. Eur J Public Health 2006 Apr; 16(2):143-148.

11. HIzel S, Ceyhum G, Tanzer F, Sanli C. Traditional beliefs as forgotten influencing factors on breast-feeding performance in Turkey. Saudi Med J 2006 Apr; 27(4):511-518.

12. Sasaki Y, Ali M, Kakimoto K, Saroeun O, Kanal K, Kuroiwa C.. Predictors of exclusive breast-feeding in early infancy. 2008 Dec; 25(6):463-9.

13. Usfar AA, Iswarawanti DN, Davelyna D, Dillon D. Food and personal hygiene perceptions and practices among caregivers whose children have diarrhea: 2008 Nov;78(11):1019-22

14. Abdella, Tree JW. Elements of Research in Nursing 2^nd edition. London: Mosby company; 1982.

15. Basvanthappa BT. Nursing research. New Delhi : Jaypee Brothers; 1998.

16. Kerlinger FN. Foundation of Behavioral Research. New York : Hold International Edition; 1973.

Received on 09.11.2017 Modified on 19.02.2018

Int. J. Nur. Edu. and Research. 2018; 6(3): 271-278.

DOI: 10.5958/2454-2660.2018.00064.9