Registration for Dissertation
Bangalore City College of Nursing
2010
Rajiv Gandhi University of Health Sciences
Bangalore, Karnataka
A Study to evaluate the effectiveness of structured teaching programme regarding care of a newborn babies among prime para mothers in selected village at kodasonnapapana halli PHC Bangalore.
Synopsis proforma for Registration of subject for Dissertation
N.SUMALATHA
Bangalore City College of Nursing
Bangalore - 43
Synopsis
Proforma for Registration of Subjects for
Dissertation
1.Name of the candidate & Address : Miss N. sumalatha
1st year M.Sc [Nursing],
Bangalore City College of Nursing,
160, Chelikere Main Road,
Banaswadi Outer Ring Road,
Kalyanagar Post,
Behind BTS Bus Depot,
Bangalore - 560 043.
2.Name of the Institution : Bangalore city college of nursing
3.Course of the Study & Subject : 1st year M.Sc [Nursing]
Community health nursing
4.Date of Admission : 10-10-2009
5.Title of the topic
A Study to evaluate the effectiveness of structured teaching programme regarding care of a new born babies among primi para mothers in selected village at kodasannappanna halli PHC Bangalore.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
The new born health challenges 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 world wide, almost 30% occur in India. Global under five mortality rates have declined over the past four decades, but the neonatal mortality rates still remains high. Although the neonatal mortality rate {NMR} shows a decreasing trend, compared to 25% reduction in the neonatal deaths in 1980s the decline in 1990s was only 15%. Irrespective of urban-rural differences in NMR , neonatal deaths are a bane of the poorest .The major causes of neonatal deaths globally were estimated to the complications of pre-maturity [28%], birth asphyxia and injuries [23%] , tetanus[7%], congenital anomalies[7%] and diarrhea [3%].A recent study was done by Baqui Et al [2006] in rural uttarpradesh, showed that out of 618 neonatal deaths, 32% deaths were on the day of birth, 50% occurred during the first 3 day of life and 71% were during the first week. Despite a plethora of health institutions, over 50% births amongst the urban poor continue to occur in home settings and under the supervision of birth attendants1.
There is an evidence the improvement of personal health improve the general health to promote the newborn babies among primi para mothers by giving planned health education. Care of the newborn babies health aims at the promotional maintenance at the highest degree of physical mental and social well being of primi para mothers while public health officials have been aware of regarding care of a newborn babies problems interest should be developed to the primi para mothers2.
Nearly 50% of all infant death occurs 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 timely care of the newborn. On the Dec 1948 the U.N. General assembly adopted the universal declaration of human rights. Section25 of the declaration states “mother-hood and child-hood are entitled to special care and assistance.
The concept of participate of the mother in the care of the neonate’s needing special care under close supervision of the trained and experienced neonatal team of nurses and pediatricians becomes extremely relevant and worthy of a critical appraisal, such type of an approach ensures establishment of new born care units at minimal an affordable cost. It is practical and may not require the cumbersome administrative sanctions at higher levels of the government3.
Rooming in technique is the recent technique used to increase the child survival. Mother plays a key role in identifying minor development deviations and early evidence of the disease process because she is constantly and constantly closely watching her baby. So she the basic knowledge and skills pertaining to child nutrition [feeding, immunization environmental sanitation, personal hygiene and other common problems in children]4.
Jawaharlal once said “the nation’s works on the feet of little children the children of today ought to have sound health in order to build a healthy nation. Health in the words our late Prime Minister indiragandhi is starting the point of all welfare and the nation depends and health of individuals
The mother is the higher level of worker not in terms of training or qualification but in experience love and the special knowledge of her won children, the range of integrated services she provides and permanent presence she brings to her child life.
Perhaps the most important again, which is hardly, discussed results after the discharge from the hospital. It is an improved care at home of infants graduating from such units. The experience of nursing by the mother in the hospital under supervision provides the confidence and opportunity to learn the appropriate and suitable ways of looking after such infants. It also ensures a follow up and after. Care by the team from the neonatal unit.
Infancy is the basis of man’s life. Healthy Child-hood. Our children inherit their future from us and their best equipment to meet the challenges a head depends on a healthy body, an inquiring mind and a stable personality. Every new born has the right to the possible conditions for its growth and development especially because children are assess for the nations development. As rightly remarked by W.H.O.A healthy child is nation’s pride5.
The traditional perception is that women wife/ mother has almost total responsibility for her children Gandhiji has stated “there is a no school equal to a decent home and no teachers equal to hones, virtuous parents. In any society it is the mother who is held totally responsible for caring for the child.
The care that is required to grow from infancy into a healthy adolescence was not knows to the community in the earlier days. Today, the facilities available for child-care are numerous and there are educational programmes to guide the community. The developed countries are aware of the need for comprehensive child health and they are successful in building up the health of the child population but the developing countries need to strive hard to attain the goal of optimum health for children.
The mother has a pivotal role to play in the life of her infant. To appreciate the palge of the mother in rearing her child the words of Sir. Johnson Spencer the author of the famous “one-thousand-families-survey” are worth recalling. He said in the study of these families and attempting to correlate their environment with health of the children these emerged one dominating factor the capacity of the mother. If she failed her children suffered. If she coped with life skillfully and with pluck, she was a safe guard to their health. In spite of lapses and failure, the mother stood out as the corner stone of the family structure and remained the chief guardian of the child welfare. Thus the mother is presented as the custodian of the child health.
Each year, millions of women, newborns, and children die from preventable causes, while the interventions that could save their lives are widely known, they are often not available to those most in need. A look at the statistics worldwide shows that each year:
· More than 60 million women deliver at home without skilled care.
· About 530,000 women die from pregnancy related complications, with some 68,000 of those deaths resulting from unsafe abortion.
· About 4 million babies die within the first month of life (the newborn period), and more than 3 million die as still births.
· Over 10 million children under the age of 5 die.
· Moreover, nearly all (99 percent) maternal, newborn, and child deaths occur in low-and middle-income countries.
6.1 NEED FOR THE STUDY
The neonatal mortality rate in our country is 5-6 times higher as compared to that of the developed nations. The NMR has been forming an increasing proportion of IMR over the years and currently accounts for more than 60% of the infant deaths6.
The neonatal mortality rate has declined from 66.7 in 1982 to 50 at the national level but several states are still a bone the national average and only three states have neonatal mortality rate of less than 40, which is the national goal for 2000 ad.
Care practices immediately after delivery play a major role n cause in neonatal morbidities and mortalities. Essential new born care practices were outlined to decrease the neonatal morbidity and mortalities.
The traditional practices like applying cow dung on the umbilical stump oil installation in to nose etc also contribute to new born risk of morbidity and mortality. The purpose of the study is to assess knowledge of prime para mothers regarding the new born care.
It is very common practice in India to bath the new born immediately after birth. This puts the new born at risk of hypothermia which gets worse with the lack of adequate drying and warm clothes.
The government of India launched the CSSM programme in 1992. In this programmed the new born has been given a separate special status with the emphasis on clean and safe delivery, prevention and management of asphyxia, provision of warmth and adequate feeding7.
Low birth weight, birth asphyxia, birth trauma and infections are responsible for majority of the death in the community. In areas with low NMR over 60% of the neonatal deaths occur amongst low birth weight babies and neonatal tetanus contributes to 30% of the neonatal deaths.
During the data collection the investigator observed that the average neonatal death rate was 7-10 per month in selected PHC Bangalore. The common cause for death is pre-maturity. They are also associated with septicemia and cardiac arrest.
Recently the world health organization and UNICEF have declared that from 1-7th august of every year [1st Week] as “breast feeding week” and the slogan of 1996 was “breast feeding”. A community responsibility [ref manual BPNL New Delhi]. Today the government of India and state health authority strive to reduce the infant mortality rate and provide better health through various child health programmes and one among which is early breast feeding initiation through baby friendly hospital initiatives in celebrating the breast feeding week every year from 17th august to motivate mother to breast feed. In our developing world 3 million babies die during their 1st week of life8.
The study indicates that awareness and attitude of prime para mothers towards neonatal care has lots of lacunae especially in those who belongs to the lower socioeconomic status. There is scope for improvement by providing better care and health education for antenatal mothers at primary care level itself.
Hence we should perhaps more concerned with the new born care to decrease the infant mortality faced by over society with daily toll that it takes not only lives and illness but in terms of its effects for parents and relations and as well.
The above mentioned magnitude of mortality and morbidity due to saving new born life to prevented by imparting knowledge regarding new born care to the primi mothers and help them to take precautionary measures.
Health education is one of the strategies in the prevention of new born life’s. Keeping the above facts in view and the fact that health education has significant effects on the knowledge of the primi para mothers of prevention of save the life of newborn. The investigator intends to conduct a structured teaching programmed on creating awareness and prevention of new born mortality and morbidity which will help them to develop good health and protecting individually and also advancing the preventive measures to adopt by the primi mother by management by giving continuum of care for new born baby by primi mothers9.
6.2 REVIEW OF LITERATURE
To explore traditional neonatal beliefs and care practices and to assess the predictors for giving prelacteal feeds, a qualitative and quantitative study was conducted in low socioeconomic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth semi-structure interviews were conducted in July and August 2000; structured questionnaires were administered to 525 recently delivered women through November. Antenatal care coverage was common; a little over half of the women delivered at home with traditional birth attendants. Among the 387 women who reported at least one antenatal visit, most (78.6%) reported re10.
Receiving counseling on breastfeeding by their healthcare provider. A significant proportion woman (44.8%) reported giving lacteals; colostrum (41.7%) or animal/formula milk (3.1%), as the first feed. New borns were bathed immediately (82.1%) after delivery as the vernix was considered ‘dirty looking’ 78.5% and it was felt it should be removed. To foster muscle relaxation (80.2%) and strengthen the bones (43.0%), daily massage was universally practiced, mustard oil (75.9%) being the most frequently used lubricant11.
Risky feeding practices such as giving prelacteals (55.0%) or supplementary feeds (71.3%), or delaying first feed (30.9%) were common. During the neonatal period, breast milk was the preferred feed (98.6%); however, honey (28.7%), ghutti (27.8%) and water (11.8%) were also given in order to ‘reduce colic’ or ‘act as a laxative’, which were perceived health benefits mentioned by mothers and traditional birth attendants. Ethnicity and birth attendant at delivery were strong predictors for women who gave prelacteals12.
Mildred Kabasonga and Prossy Namatova work at Mulagao Hospital in Kampala, Uganda – a facility that averages between 18,000 and 22,000 births annually (almost 60 per day). Following their participation in the REDI and by working together, they have improved the quality of care for women giving birth in the midwifery-run labor ward, and strengthened the pre-service clinical practicum for midwifery and medical students at the same time. At this national teaching and referral hospital, they pursued and received funding from the Rockefeller Foundation to conduct short coursed to update the clinical skills and pre-service midwifery instructors. In addition, they advocated for and helped to establish a mandatory competency-based practicum for medical students13.
In Burkina Faso, regional experts Drs. Andre Bazie and Blami Dao have been the linchpins of many MNH / Burkina Faso activities – influencing policy dialogue with the Ministry of Health to adopt the modified World Health Organization (WHO) pantograph as part of the national policies, norms, and protocols for essential and emergency obstetric care: training a core group of 20 trainers representing all 10 regions of the country in use of the pantograph; and conducting knowledge from th Ouagadougou and Bubo Doulas’ national teaching Hospitals, as well as district chief medical officers from four districts14.