RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MRS CHANDNI .C.SRI LAKSHMI COLLEGE OF NURSING,
# 127/1, SRI GANDADAKAVAL, MAGADI MAIN ROAD, VISHWANEEDAM POST, SUNKADAKATTE, BANGALORE-91.
2 / NAME OF THE INSTITUTION / SRI LAKSHMI COLLEGE OF NURSING,
# 127/1, SRI GANDADAKAVAL, MAGADI MAIN ROAD, VISHWANEEDAM POST, SUNKADAKATTE, BANGALORE-91.
3 / COURSE OF STUDY AND SUBJECT / M.Sc., NURSING I YEAR
OBSTETRICS AND GYNECOLOGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 15.05.2010
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING ON KNOWLEDGE AND PRACTICE PRGARDING NEWBORN CARE AMONG POSTNATAL MOTHERS IN SELECTED HOSPITALS AT BANGALORE, KARNATAKA.’’
6
6.1
6.2
6.2.1
6.2.2
6.2.3
6.2.4
6.3
6.4
6.5
6.6
6.7
7.0
7.1
7.2
7.2.1
7.2.2
7.2.3
7.2.4
7.2.5
7.2.6
7.2.7
7.2.8
7.2.9
7.2.10
7.2.11
7.2.12
7.2.13
7.2.14
7.3
7.4
8.0 / BRIEF RESUME OF THE INTENDED WORK :
INTRODUCTION:-
“The Newborn is the very spring of life and hope…..! The newborn baby is our most prized possession and we would certainly like to give it the best neonatal care that possibly we can”
Neonatal care is very important because, at the moment of birth, numerous physiologic adaptations begin to take place in the newborn’s body. Because of these dramatic changes, newborns require close observation to determine how smoothly they are making the transition to extra uterine life. Newborns also require care that enhances their chances of making the transition successfully. It also aims at reducing the mortality and morbidity rate and also reduces the risk of infection in neonate.1
Nearly 27 million babies are born in India each year; this accounts for 20% of global births. Of these, 1.0 million die before completing the first four weeks of life. This accounts for nearly 25% of the total 3.9 million neonatal deaths worldwide. The current neonatal morality rate of 39 per 1000 live births (NFHS03; 2005-06) accounts for nearly two-thirds of infant mortality and half of under-five mortality rates.2
About 40% of the neonatal deaths occur on the first day of life, almost half within three days and nearly three-fourth in the first week. The rate of neonatal mortality varies widely among the different states ranging from 11 per 1000 live births in Kerala to about 48 in Uttar Pradesh. The states of Uttar Pradesh, Madhya Pradesh and Bihar together contribute to over half of all newborn deaths in India in 2000.2
Almost 60% of deliveries occur at home and only 46.6% of these are attended by skilled birth attendants (doctors, nurses and midwives). It is documented that states with higher institutional births (e.g. Kerala) have lower neonatal mortality as compared to those with lower institutional births (e.g. Uttar Pradesh). The NMR declined rapidly in the 1980s- from 69 in 1980 to 53 in 1990. However, in recent years, the rate of fall of NMR has showed some slackening-from 48 in 1995 to 60 per 1000 live births in 2009-10. This slow declining trend is a cause for concern. Most of the Government programs (ARI, Diarrheal Disease Control, and immunization) in the last decade have focused on infants and children beyond neonatal period. In addition, most of the focus for essential newborn care was directed to limited government facilities. This has resulted in the decline of IMR bur NMR remained almost static.3
There are important rural-urban and socioeconomic differences in the NMR. The NMR in rural areas is about one and a half times of that in urban areas (42.5 vx.28.5 per 1,000 live births). Similarly, the NMR among the poorest 20 percent of the population is more than double the NMR of the richest 20%-48.5 versus 22 per 1,000 live births. Globally, infections, asphyxia and prematurity are the leading causes of neonatal deaths. A similar pattern is seen in India where they contribute to 33, 21 and 15 percent of the total neonatal deaths respectively. A large proportion of neonatal mortality is contributed by infections, a largely preventable cause. The incidence of neonatal tetanus, formerly a major cause of mortality, has declined dramatically.3
The main philosophy of care is that mothers and babies should stay together. A newborn baby can be whirlwind of activity and excitement to every mother’s life and lack of knowledge regarding neonatal care may bring plenty of stress to mothers. As a health worker we are having an important role in providing accurate information regarding neonatal care to the postnatal mothers.1
NEED FOR THE STUDY:-
“You are a child of the universe no less than the moon and stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should”
-MAX EHRMANN
New born care, it is the study that refers to knowledge regarding different aspects of neonatal care such as care of eyes, care of umbilical cord, body care, mummification, breastfeeding, rooming in, management of minor disorders and neonatal infections, kangaroo mother care etc.,
A healthy infant born at (between 38 to 42 weeks) should have an average birth weight for the country (about 2500 gms), cries immediately following birth, established independent rhymathic respiration and quickly adapts to the new atmosphere is called as new born.3
Annually, there are approximately 3.7 million neonatal deaths and 3.3 million stillbirths worldwide. 1 approximately 38% of deaths among children younger than 5 years of age occur during the first 28 days of life, and 75% of the neonatal deaths occur within the first 7 days 1-3 without a major reduction in neonatal deaths in the first 7 days birth, achievement of the United Nations; Millennium Development Goal 4-a reduction in mortality by two thirds among children younger than 5 years of age 2 – is unlikely to be realized.3
Neonatal mortality in developing countries is one of the most important problems that need immediate attention in order to achieve millennium development goals. About 4 million newborns die in the world every year, 90% of them in the developing world. Most of these deaths are prevented by simple interventions in the community. However in most of the target countries the implementation of essential newborn care is practicing.4
A cross sectional study was carried out through a written survey to 228 postpartum mothers in a large teaching hospital in Connecticut. It was to identify mothers who were less trusting with regard to vaccines. 29% of mothers worried the vaccines would not work, 11% were worried the doctor would give the wrong vaccines and 8% worried that “they” are experimenting when they give vaccines. Mothers reported that the most important reasons to vaccinate were to prevent diseases in the baby (74%) and in society (11%) knowledge of mothers about vaccination was poor. For example 33% correctly matched chickenpox with varicella vaccine. Mothers who were planning to breast feed were primiparas or had an income less than 40000 Although 70% wanted information’s about vaccines during pregnancy. Only 18% reported receiving such information’s during prenatal care.4
A cross sectional study was conducted regarding Maternal knowledge on newborn care among 446 mother from 5 hospitals in Puttalam district of Srilanka by random sampling. More than 90% of mothers knew about feeing on demand, the advantages of colostrum and the duration of exclusive breast feeding. Except for few conditions mothers demonstrated a satisfactory knowledge in recognizing danger signs of newborn. Primipara women with delayed antenatal booking visits were more likely to have poor knowledge.5The study concludes that mother had a satisfactory knowledge about breast feeding and recognition of danger signs. But the knowledge about care of umbilical cord was very poor. Maternal education by vedio assisted teaching place more emphasis on first time mothers, unemployed women and those with delayed booking visits.5
A study was conducted regarding the impact of essential newborn care interventions at the house hold level among the postnatal mothers by using a structured questionnaire in 2002 and 2004. In total 3325 mothers with children aged less than one year in 2002 and 3110 mothers in 2004 and from ten sub districts in Jodhpur were interviewed during each survey. The result showed that proportion of newborns dried and wrapped immediately after birth increased from 14% in 2002 to 55% in 2004, 76.2% of the newborns were put to the mother’s breast within one hour of birth compare to 38.6% in 2002, Newborn checkup within 24 hours of delivery increased from 14.4% in 2002 to 27.3% in 2004. Postnatal checkups of mothers by trained providers within 3 days of delivery loss from 2.4% in 2002 to 27.3% in 2004. Knowledge of mothers on at least three postnatal danger signs increased by 17.2% and on at least three postnatal danger signs also showed in increased 16%. Essential newborn care practices such as wrapping the baby immediately after birth. Initiation of breast milk within one hour of birth and early postnatal newborn checkup, improved in the interventions area. The study concludes that increased community awareness help in improving maternal and newborn care practices at house hold level.6
Every newborn requires basic care which has to be provided by the mother at home. It has been observed by various studies on the newborn care in the communities that the knowledge and the practices of simple care are lacking. There is an urgent need for the improvement of care seeking behavior of the mothers by behavior change communication so that people accept the services provided by the government. Mother and baby should be considered as a single unit to formulate strategies for improvement of neonatal care.6
Newborn mortality is one of the world’s most neglected health problems. It is estimated that globally four million newborns die before they reach 1 month of age and another four million are stillborn every year. Death during the neonatal period (the first 28 days of life) accounts for almost two –thirds of all deaths in the first year of life and 40% of deaths before the age of five.6
The global burden of neonatal death is estimated to be 5.0 million of which 3.2 million deaths occur during the first week of life. Each year, 26 million infants born in India. Of these, nearly 1.2 million die during the neonatal period, before completing 4 weeks of life, amounting to one quarter of all the neonatal deaths in the world. India, thus contributes 30% of the 3.9 million neonatal deaths worldwide. Global under five and infant mortality rates have declined over the past four decades, but high neonatal mortality rates have remained relatively unchanged. The primary causes of neonatal death are believed to be complications of prematurity (28%) sepsis and pneumonia (26%) birth asphyxia and injuries (23%) tetanus (7%), congenital anomalies (7%) and diarrhea (3%), with low birth contributing to a large proportion of deaths.6
We have also witnessed the negligence of proper care of neonates by the mothers in the Vanivilas hospital during our posting. As we interacted with the mothers we came to know that they are not having proper knowledge regarding the child care. So it is very essential to provide effective educations to the mothers regarding the newborn care.
Since the problems of availability of quality care to all, the neonate is multifaceted, the solution too have to be likewise. There is sufficient evidence to show that most of the basic neonatal care can be delivered at home through primary care in a highly cost-effective manner. Hence, to reduce neonatal mortality, strategies must be developed for safe home deliveries including essential neonatal care, besides devising means of proper care of the neonate in domestic settings and ensuring proper referral of only those neonates who cannot be managed at home. Many of the life-threatening conditions could be prevented or treated with low technology, improved labor and delivery care, and attention to the physiological needs of the newborn. The causes of neonatal mortality, the organization and coverage of delivery care, resuscitation, low birth weight, hypothermia, low technology warming, reducing infection, etc., are some important areas that have to be addressed.7
REVIEW OF LITERATURE :-
Review of literature refers to the activities involved in identifying and searching for information on a topic and developing an understanding of the state of knowledge on that point.
The review of literature of the present study has been done from published articles, text books, reports, and medline searches etc.,
Review of literature for the present study has been organised under the following headings.
Studies related to:
6.2.1 Incidence and prevalence of newborn care
6.2.2 Newborn care.
6.2.3 knowledge and attitude of postnatal mothers
regarding Newborn care.
6.2.4 Video assisted teaching on New born care among
Post- natal mothers.
Studies related to incidence and prevalence to newborn care:
A study was carried out regarding knowledge of 240 mothers regarding neonatal care in the immunization clinics of Pokhara City, in Western Nepal. Result revealed that, planned home deliveries were 140 (58.3%) and 100 (41.7%) were unplanned only 6.2% of deliveries had a skilled birth attendant present and 38 (15.8%) mothers give birth alone. Only 46 (16.2%) women had used a clean home delivery kit and only 92 (38.3%) birth attendants had washed their hands. The umbilical cord was cut after the expulsion of the placenta in 154 (64.2%) deliveries and the cord was cut using a new or boiled blade in 217 (90.4%) deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1%) deliveries. Only 100 (45.8%) newborns were wrapped within 30 minutes. Majority of the newborns were given a bath soon after birth. 16 mothers (10.8%) did not feed the baby with colostrum to their babies. Pre lacteal feeds were given to 37 (15.2%) newborns. Initiation of breast feeding were (57.9%) within 24 hours. In conclusion main reasons cited for delivering at home were ‘preference’ 925/7% ease and convenience (21.4%) for planned deliveries while precipitate labour (51%) lack of transportation (18%) and lack of escort during labour (11%) were cited for unplanned ones.8