RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Ms.Rani G. Umman.
Ist Year MSC Nursing, Koshys College of Nursing, No.31/1, Hennur Bagalur Road, Kadusonnappanahalli, Kannnur Post, Bangalore – 562149.
2. / NAME OF THE INSTITUTION / Koshys College of Nursing
3. / COURSE OF THE STUDY AND SUBJECT / MSC Nursing
Child Health Nursing
4. / DATE OF ADMISSION TO THE COURSE / 28-10-2011.
5. / TITLE OF THE TOPIC / A study to assess the effectiveness of structured teaching programme on knowledge regarding selected minor ailments of new born and its management among antenatal mothers in selected antenatal clinics, Bengaluru.

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“CHILDREN ARE A GIFT FROM THE LORD;

THEY ARE A REAL BLESSING”

BIBLE [PSALMS 127:3]

Kids lighten up our life and home with their soulful laughter, childish talk and unlimited energy. It is difficult to see them sick in the bed.1

The period from birth to 28 days of life is called neonatal period and the infant in this period is termed as new born baby. They are at risk for various health problems even though they born with average birth weight. The morbidity and mortality rate in newborn are high. They need optimal care for improved survival.2

Newborns are often prone to a wide range of diseases and health issues due to their weak immune systems and underdeveloped body organs. Thus, it becomes important to conduct frequent medical examinations to detect and reduce the common health problems in a newborn baby.3

As the newborn baby gets used to the outside world, his/her body will undergo many changes and experience a variety of reactions to new situations. In a new parent, even the smallest problem can cause anxiety. Fortunately, many conditions are common and can be treated at home.4

Selected minor ailments which create anxiety to the mother are diarrhoea, napkin rashes, infantile colic, erythema toxicum neonatorum and neonatal jaundice.2

In India diarrhoeal disease is a major Public health problem. Diarrhoea is defined as the passage of loose, liquid or watery stools. Breast fed infants passes 2 to 6 times golden yellow sticky, semi loose stools due to high content of lactose. The intake of large quantities of glucose water, unhygienic feeding practices, over feeding, bottle feeding and under feeding are the causes of diarrhoea in new born babies. Acute infective diarrhoea should be treated with intravenous fluids and systemic antibiotics.2

Diarrhea is found to be a commonest cause of mortality among the newborns. UNICEF proposed a target by 2015 to reduce the mortality rates among these high risk groups by 2/3rd from 93 infants & newborns of every 1000 dying before the age of 5 in 1990 to 31 of every 1000 in 2015.5

The attack of screaming with flexion of thighs and flushing of face with frowning may occur in the newborn in the evening regularly after few days of birth. This unexplained crying spells may present for minutes or hour. It is due to intestinal colic. Temporary relief may occur by holding the baby against skin, patting, kissing, prone position, etc. Home remedies can be used to relief colic.2

Napkin rash is commonly found in artificially fed babies. It can occur in prolonged wet nappies or lack of cleanliness. Perianal skin may become red, indurate and excoriated. It is often found following diarrhoea or fungal infection or due to use of nylon or water tight plastic napkins. It can be prevented by immediate change of soiled napkins and drying the area. It can be managed by keeping the area dry and exposed to air or sunlight and application of coconut oil or bland ointment or antifungal cream. It is seen in 25% of the infants wearing diaper.2

Erythema toxicum neonatorum (also known as "Erythema toxicum and Toxic erythema of the newborn") is a common rash in neonates. It appears in up to half of newborns carried to term, usually between 2-5 days after birth. Erythema toxicum is characterized by blotchy red spots on the skin with overlying white or yellow papules or pustules. These lesions may be few or numerous. The eruption typically resolves within a few days.6

Jaundice is the visible manifestation of hyperbilirubinemia. The clinical jaundice in neonate appears on face at a serum bilirubin level of 5mg/dl. About 60% term neonates and about 80% preterm neonate have bilirubin level greater than 5mg/dl in the first week of life.2

Many parents doubt whether they will recognize if the baby is sick. When the mothers have no experience with babies, being told that a sick baby behaves differently from a well baby is of little comfort. If everything about the baby seems unfamiliar, it is hard to have confidence that the mother can and will recognize changes that indicate the baby is ill. Besides, healthy babies can cry for a couple of hours each day.7

Expecting parents are responsible for making healthy decisions for the sake of their baby, but some newborn health problems aren’t preventable. Discovering that the newborn has a health problem can be devastating, but learning about some common complications and their treatments in advance may help the mother to manage them.8

Even the wisest parents can’t read their babies mind and babies don’t have the words to tell their parents about what’s wrong with them.9

Bringing anew babyhome from the hospital is a very exciting time. It can also be pretty nerve-racking, especially for first-time moms. Rest assured that the baby is probably perfectly healthy. But keep in mind that there are some common conditions that the baby may experience. Most are nothing to worry too much about, but knowing what to expect can help the mother determine whether your baby might need medical attention.10

Newborn babies keep their parents on their toes! There is always something to keep mom or dad in a state of worry.11

6.1 NEED FOR STUDY

A newborn baby makes his entrance into the world with immature bodily systems. As the child begins his/her outside life, he/she'll eat, cry and need diaper changes as you would expect. New parents are not always prepared for the bumps in the road that come along with having a new baby-including tummy troubles.12

The knowledge regarding various developmental variations and physiological conditions and their evolution is important for giving proper advice, guidance and assurance to the mothers. Most mothers observe their babies carefully and are often worried by minor physical peculiarities, which may be of no consequences.13

Neonatal health problems are frequently found ranging from minor physical or physiological peculiarities to the serious life - threatening illness. Minor problems should not be ignored lightly without adequate assessment of conditions. Early diagnosis and management of the serious problems help to overcome life-long disability and to reduce neonatal morbidity and mortality.2

A study was undertaken in August and September 2010, to assess the knowledge mothers regarding home-based management of diarrhoea in rural area of Aligarh. The overall prevalence of diarrhoea was 32%. Only 26% knew about the correct method of preparation of Oral Rehydration Salt solution. Only 36% of the mothers knew about home available fluids, out of which salt sugar solution was the choice in majority of cases. The study highlighted that the knowledge of mothers is not adequate and it emphasizes the need for improving the knowledge of mothers which may lead to substantial decrease in morbidity and mortality due to diarrhea.14

As per an article published in the Indian Journal of paediatrics, incidence of infantile colic is about 5-19% and a recent study from Brazil revealed that 80.1% of mothers reported that their infant had colic.15

It has been reported that the incidence of erythema toxicum neonatorum in India is20%, in USA it was between 30-70% of newborns and in spain it was 25%.16

A longitudinal study was conducted to study the incidence and types of morbidity in the first year of life among 194 newborns in a birth cohort in northern part of Karnataka state in India. They were assessed at the time of enrolment and monthly follow up was done till they attained one year of age. This study revealed that commonest morbidities during infancy were diarrhoea 42.8% and skin diseases (21.6%). Incidence of disease in infancy highlights the need to improve and plan health programmes.17

A descriptive study was conducted to determine the factors affecting child mortality in Bangladesh. The result showed that the mother’s education has a greater impact on the child’s mortality than any other factors. Literacy and IMR* are inversely proportional. Thus it was a motivation for the investigator to conduct this study.18

A retrospective, nationwide study was conducted to investigate the frequency, etiology, and current management strategies for diarrhea in newborn. In Italy among 5801 subjects observed in neonatal intensive care units during 3 years. Thirty-nine cases of diarrhea (36 acute, 3 chronic) were identified. The occurrence rate of diarrhea was 6.72 per 1000 hospitalized newborn. Etiology was defined in 29 of 39 newborn (74.3%). In 19 of 39 patients (48.7%), rehydration was performed exclusively by the enteral route. The study concluded that diarrhea in neonates is a challenging clinical condition due to the possible heterogeneous etiologies and severe outcomes. So specific guidelines are advocated in order to optimize management of diarrhea in this particular setting.19

There is a famous proverb which says that, “Prevention is better than cure”. The investigator found that it is better to educate the mothers before they face these probable minor ailments in their new born babies. All the above said studies revealed that brief antenatal education increases mothers’ understanding of selected minor ailments of newborn and its management. Thus the investigator came to the conclusion that similar educational programs could reduce the neonatal morbidity and mortality rate As the antenatal mothers are resting with a peace of mind and are eagerly waiting for a newcomer, this teaching programme will be accepted by them and will be more effective. So the investigator selected antenatal mothers as the sample population for her study.

6.2 REVIEW OF LITERATURE:

A review of literature is an essential aspect of scientific study. It involves the systematic identification, location, scrutiny and summary of written materials that contains information on a research problem. It broadens the views of the investigator regarding the problem under investigation, helps in focusing on the issues specifically concerning the study.20

A literature review helps to lay the foundation for a study, and can also inspire new research ideas. A literature review also plays a role at the end of the study, when researchers are trying to make sense of their findings.21

Here review of literature related to this study has been discussed under the following headings:

1.  STUDIES AND LITERATURE RELATED TO INCIDENCE AND ETIOLOGY REGARDING MINOR AILMENTS IN NEW BORN.

2.  STUDIES AND LITERATURE RELATED TO KNOWLEDGE OF MOTHERS REGARDING THE COMMON MINOR AILMENTS OF NEWBORN.

3.  STUDIES AND LITERATURE RELATED TO KNOWLEDGE OF MOTHERS REGARDING THE MANAGEMENT OF COMMON MINOR AILMENTS OF NEWBORN.

1.  STUDIES AND LITERATURE RELATED TO INCIDENCE AND ETIOLOGY OF MINOR AILMENTS OF NEW BORN

A cross sectional epidemiological survey was conducted to detect whether source of water influences the occurrence of diarrhoea. The objectives of the study was to know the incidence of morbidity and mortality due to diarrhoea, to identify the relationship of occurrence of diarrhoea with source of drinking water and to study the treatment practices in diarrhoea among 7141 under five children in the Karnataka region of kaveri basin. The result showed that nearly 7% of children experienced diarrhoea in the past two weeks and 4% had an attack of diarrhoea in the last 24 hours. Incidence of diarrhoea was significantly higher amongst 1-3 years male children. The source of drinking water did not influence the incidence of diarrhoea. Use of ORS was low (12.7%). It was reported that 31% of mothers stopped breast-feeding and 15% of mothers stopped oral fluid during diarrhoea. Thus the study concluded that the overall under five-mortality rate in the area was 6.5 per 1000 children and of these one third deaths could be attributed to diarrhoea.22

A study was conducted to determine the prevalence and severity of diaper dermatitis among 3-9 months old neonates who are exclusively using Chinese cloth diapers in five in land cities of China. During each home visit, researchers documented the presence and severity of diaper dermatitis using a visual dermatological scale and conducted transepidermal water loss (TEWL)* and PH measurements. The result showed that diaperdermatitis was rare in the buttocks and genital area of the children (<20%) but was common in the perianal and intertriginous regions (50-70%). TEWL and PH* were mildly higher in babies with diaper dermatitis than in those without diaper dermatitis in the genital and buttocks area. This study concluded thatdiaperdermatitis is common in children who use traditional Chinese cloth diapers, especially in the perianal and intertriginous regions.23

A longitudinal study was conducted to determine the incidence of nappy rash and the factors associated with developing the rash during the first four weeks of life in a United Kingdom (UK). The data are derived from self-completed questionnaires of parents in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). The result of the study showed that the incidence of nappy rash was 25%. The researcher concluded disposable nappies give little protection and the likelihood of nappy rash increases with intercurrent illness and early introduction of cereals.24