6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“A baby is something you carry inside you for nine months,
in your arms for three years and in your heart till the
day you die.”
Mary Mason.
Birth is the most important determine of perinatal, neonatal and post neonatal outcome. The birth weight of an infant is the single most important determined of its chance of survival, health growth and development. The average weight of newborn varies from 2 to 3.1 Kg. WHO has defined LBW as one whose birth is less than 2500 gm irrespective of the gestational age1.
Global incidence of LBW according to WHO (1995-2000) states that Bangladesh has the highest incidence of 30 percent and India ranks second with 26%. The rates in other countries are: Pakistan – 21%, Sri Lanka – 17%, Singapore – 8%, USA – 8%, UK – 8%, Thailand – 7%, China – 6%, Switzerland – 6%, and Sweden –4%. Globally, more than 20 million infants are born with low birth weight. The number of low birth weight babies is concentrated in two regions of the developing world. Whereas 72% of LBW infants are born in developing countries2.
These infants may suffer from infections, weakened immunity, learning disabilities, impaired physical development and, in severe cases, die soon after birth.3
In assessing the preventable causes of death; poor diet, and physical activities accounts for an estimated 3, 00,000 deaths per year globally. For proper growth and development and to prevent health problems such as obesity and amnesia young people should begin healthy eating early in life4
The birth weight of infant is dependent on the length of the gestational intrauterine growth of the fetus. LBW can result from a problem of birth or intrauterine growth retardation or a combination of the two. Infant born at relatively mature gestation (32-36 wks.) are still at higher risk of death during infancy compared to term infant.5
The health and survival of the newborn baby depends upon the health status of the mother and her awareness, education & skill in mother craft. Mother is the best primary health workers. She has the advantages of instinct concern and inters to look after her baby. Mother looks after her baby with love, affection and sense of sacrifice. Early involvement of the mother in the care of her baby is the best way to promote and encourage. She is the best person to identify minor development deviations as early evidence of disease process because she is constantly and closely watching her baby6.
6.1. NEED FOR THE STUDY:
“Before you were born I carried you under my heart. From the moment you arrived in this world until the moment I leave it, will always carry you in my heart.”
Mandy Harrison
In the developed countries, the proportion of LBW among newborns is low and approximately two-thirds of LBW are pre-term babies. In the developing countries, the proportion of LBW is high and in a majority of cases, this is attributable to IUGR. Out of an estimated 22 million low birth weight babies born worldwide annually, where the India accounts for about 7-10 million.7
According to WHO reports about 50% of children in the age group of 1 year old in developing countries die during the 1st month of life, and 97% of all infant deaths occur in developing countries.8
Deshmukh D. Mahesh (1999) stated that reason for the high acceptance of home based care were the huge unmet need of neonatal care in villages, involvement of traditional birth attendants, health education, good quality, of care of village health worker resident in the village.9
One of the components of the maternal child health care of LBW baby is the part of the global strategy for “Health for all by the year of 2000” the proportion of the infants born with a LBW as one of the global indicator with which to monitor progress. The target reduction in the incidence of LBW to less than 10%. 10
Further may low birth weight were born in hospital and also discharge before they could gain normal weight and to be care at home. The health and survival of low birth weight babies depends upon mothers awareness, education and skill in mother craft. Mother is the best and primary health worker. Mothers look after her newborn with love, affection and sense of sacrifice. Early involvement of mother in the care of her low birth weight newborn is the best way to identify the problem and treat them immediately. Nurses should play an important role in educating the mothers regarding the basic knowledge and skills pertaining to care of low birth weight newborns, which will help to reduce the infant mortality.11
Pregnancy-related complications claim the lives of an estimated 5,15,000 children worldwide every year, with most of these deaths occurring in the developing world.2 Internationally, each year, more than 20 million children born are low birth weight babies, and an estimated 2,00,000 newborns die as a result of low birth weight. In Sub-Saharan Africa, 10,000 children’s die each year due to low birth weight causes. In Africa, children’s mortality has been identified between 84 to 2000 per 1,00,000 live births.3 low birth weight causes one to one and a half million deaths each year. The majority of the cases are clustered in India, Brazil, Afghanistan, Sri Lanka, Thailand and China. 12
Based on the above statistics and personal experience of the investigator during practice in the field of nursing services, found that post natal mothers does not have adequate knowledge about the care of low birth weight babies, hence the investigator felt to impart teaching progarmme on home care management of low birth weight babies which may help them to improve the quality of care among low birth weight babies.13
6.2. REVIEW OF LITERATURE:
Review of literature is an important part of the scientific research projects. The researcher almost never conducts a study in an intellectual vacuum. Almost all the studies are conducting within the context of an existing knowledge base. Researcher usually conducts the literature review to familiarize themselves with that knowledge base. A literature review involves the systematic identification, location, scrutinizing and summary of written materials that contain information on a research problem14.
Review of literature consists of:
1. Study related to the knowledge on home care management of low birth weight babies
WHO, (2002) has explained that LBW babies require extra warmth over a longer period of time. KMC keeps the baby warm, promotes feeding, and increases mother’s confidence. KMC is suitable for LBW infants with no medical problem or after they have been corrected when clinical sign are stable.15
A study was conducted to assess 120 mothers knowledge about care of low birth weight babies in selected hospital of Pune on different aspects of care of low birth weight babies and it was found mothers knowledge regarding different aspects of care was only 20%. Knowledge related to different aspects of skin care and thermoregulation was least only 22%.16
A study conducted on assessment of birth weight pattern in Karnataka at the coastal areas of Udupi taluk between July 2002 to 2006 showed that 2308 (51.3%) boys and 2190 (48.9%) girls were recorded. Eighty percent were weighed between 2500 and 3400 gm; 13.3% had low birth weight of under 2500 gm; and 0.4% had very low birth were of under 1500gm. The mean birth weight was 2823gm- 2850gm for boys and 2765.4gm for girls. The mean birth weight increased with increased parity lowest birth weight occurred among first births. 17
A study was conducted on low-birth-weight babies and risk factors in the Command Hospital Bangalore three thousand one hundred delivered live newborns were studied for the incidence of low birth weight babies and associated risks many 40% of babies delivered were low birth weight babies and their mothers knowledge was only 20% related to care of children in home when assessed by questionnaire method. 18
A study was conducted to determine the feasibility and acceptability of kangaroo care in a tertiary care hospital in India. Among 89 neonatal fourty four babies were randomized to the KMC group and 45 to the conventional method of care. there was significant reduction in KMC vs CMC group of hypothermia 79 percentage of mothers felt comfortable during the KMC and 73% felt they can give KMC by their own in home so mothers should be taught about care of children in home especially care of low birth weight babies. 19
A co relational study of infant rearing practices and common health problems in infants with selected mothers and related variables in an urban slum in Mumbai revealed that 78% of mothers gave daily bath, 21% on alternative days and 1% bathed their babies twice a week; 55% breastfed immediately after birth, 11% on second day and 35% on the third day. Breast milk supplement was a common practice among majority (53%). Between 3-6 months of age, 89% of them started weaning. The common health problems among infants were respiratory (77%), gastrointestinal (58%) and skin problems (16%). The mother related variables like education, family income, and common health problem were found to be non-significant. 20
A study was conducted to assess the knowledge and practice of mothers regarding complimentary feeding revealed that 93.33% of mothers had average knowledge (<50%) regarding complimentary feeding. It was also found that there was no significant relationship between mothers knowledge and also there was no correlation between knowledge of mothers and complimentary feeding.21
A study was conducted to assess the knowledge regarding breastfeeding among mothers in a selected community of Karnataka revealed that literate mothers (77%) had more knowledge the illiterate (75%) mothers. Mothers with two or more children (85%) had more knowledge than mothers with single child (81%). Regarding advantages of breastfeeding illiterate mothers (75%) had more knowledge than literate mothers (65%). There was no association between mothers knowledge and educational status. 22
2. Study related to structured teaching programme on home care management of low birth weight babies.
A study was conducted on 763 neonates to evaluate the effectiveness of home based neonatal care in the management of low birth weight babies in Godchiroli village India. Intervention included were health care, breastfeeding and prevention and management of infections. After this intervention the case fatality rate among pre-term babies decreased by 69.5% in low birth weight neonates; the cumulative frequency rate decreased by 58%, the decrease was most pronounced (67%) in the neonates weighing 2000 to 2499 gms but in the < 1500 gm groups it remained high at 40% in spite of a 42.2 % decrease. 23
A study to assess the effectiveness of planned health education for motherhood in primigravida women was conducted at Mangalore. Fifty samples were selected randomly out of which 25 primigravida were kept in the experimental groupand 25 primigravida in the control group. Health education was provided to the study group. It was found that the post-test mean difference was 21.24; SD 5.22 and t value 20.34. The post-test score was significantly higher than the pre-test score and when comparing with control group the difference mean was 0.60 and SD 0.16 and t-1.33. Itwas lesser than 1.711 at 0.05 level of significance.24
A study to evaluate the effectiveness of planned teaching regarding assessment of LBW infants in terms of knowledge and skills of nursing personnel working in neonatal care unit in a selected hospital of Delhi. The study results showed that the mean post-test knowledge score (44.47) and skill score were significantly higher than the mean pre-test knowledge scores and skill scores (17.91) (p<0.01). There was a significant positive coefficient of correlation (0.41) between post-test knowledge score and skill score (p<0.05). Thus the PTP was effective in enhancing knowledge as well as skill of nursing personnel regarding assessment of LBW infants.25
A study to explore the feasibility of using motivational interviewing to promote sustained breast feeding was conducted at three western rural community hospitals, UK . The study samples included 73 primiparous breastfeeding mothers ranging between the ages of 19 and 38. The study revealed that the motivational interviewing group (M=98.1 days, SD =75.2) breast fed longer than the comparison group (M=80.7 29 days SD=71.9). However the difference was not significant (t (69)=0.991, p=.325), Cohen’s d=0.24. It was concluded as a strategy to test a comprehensive intervention plan.26
A study on the interventions to prevent hypothermia at birth in preterm and low birth weight babies was conducted at Queen’s University, UK. Trials using randomised allocation to test a specific intervention designed to prevent hypothermia. Six studies giving a total of 304 infants randomised were included; four comparisons to routine care were undertaken. Study revealed that plastic barriers were effective in reducing heat losses in infants < 28 weeks gestation (three studies n= 159; WMD 0.76°C; 95% C1 0.49, 1.03) but not in the 28 to 31 week group. Stockinet caps were not effective in reducing heat loses. Skin-to-skin care was shown to be effective in reducing the risk of hypothermia when compared to conventional incubator care for infants 1200 to 2199 gm birth weight (n=31; RR 0.09; 95% C1 0.0). 27
A study to examine early feeding of low birth weight babies with higher amounts of human milk and milk fortifiers could improve postnatal growth and maintain human milk production was conducted in selected hospital Argentina. A group of 100 low birth weight infants was compared with another randomized group of similar birth weight that was born previously. The studied group was fed with human milk and fortified with human milk fortifier when 100ml/kg/day was reached. The control group was not given human milk fortifier. The collection of human milk in the studied group was highly stimulated. The result showed early feeding with human milk and fortification with human milk fortifier improved enteral tolerance and diminished significantly the number of days needed to regain birth weight. Frequent extractions oh human milk increased the available amounts of milk and allowed relactation. At discharge the infants were fed on breast milk and formulas and their growth curves were adequate at the first year of post conception age.27