ARC Journal of Nursing and Healthcare

AUTHOR DETAILS

Sushila Devi Bhandari,Saraswati Sharma, Paudyal

Associate professor,
Nepalese Army Institute of Health Sciences,
College of Nursing, Bhandarkhal, Sanobharyang, Kathmandu,
[email protected]

KEYWORDS

Knowledge, New born, Newborn Care, Postnatal Mothers, Practice

INTRODUCTION

Globally 4 million newborn die every year before they reach the age of one month. Out of them 1.5 million newborn die in four countries of South Asia including Nepal (WHO, 2006).Approximately 3.4 million newborn die within the first week of life. Of these deaths, 66% occur during the 1st 24 hours. Late death i.e.; after 24 hours, still occur 34 % and may be prevented if mothers have knowledge about newborn care including dangers sign of newborn (Thakur, 2012).

Clean cord care is one of the essential newborn care practices recommended by the World Health Organization to reduce morbidity and mortality amongst the World’s newborns. Despite this, cord infections are still prevalent in developing countries because of the high rates of unhygienic cord care practices (Opara, Jaja, Dotimi, & Alex Hart, 2011).

The care the newborn receives depends a lot on the knowledge, skills and attitude of the mother. The primigravida mothers are supposed to be lacking in knowledge, practices and attitude of newborn care (Yadav, 2013).

Comparing data with result of 2006 under-five mortality rates have declined over the past, but the neonatal mortality rates still remains high.ie; IMR- 48/1000 live birth and NMR 33/1000 live birth (NDHS,2011). Awareness and attitude of postnatal mothers towards neonatal care has lots of lacunae especially in those who belong to the lower socio- economic status. There is scope for improvement by providing better care and health education for antenatal mothers (Monebenimp, Mireille, Chelo, Pascal, Christopher, & Charles, 2013).

Neonatal health and survival is enhanced by providing essential newborn care such as cleanliness, thermal protection, and initiation of breathing, early and exclusive breastfeeding, eye care, immunization, and management of newborn illness. Mothers are the key person for providing newborn care in Nepal (Shrestha, Gautam, & Silwal, 2013). So that study was conducted to assess the knowledge and explore the practice of postnatal mother regarding new born care.

METHODS AND MATERIALS

This study was descriptive cross sectional study. Purposive sampling technique was used to select the sample as well as study site. After getting permission from hospital and informed verbal consent from each respondent, face to face interview was conducted with 75 postnatal mothers admitted in post natal ward of MahendraAsarsa Hospital,Chitwan, Nepal from August 2014 to November2014.Both primi and multi gravid postnatal mothers were included in the study to explore knowledge on newborn care and practice was observed in 30 post natal mothers.

Semi- structured interview schedule was used for face to face interview to assess the knowledge and observation check list was used to assess the practice of mothers regarding new born care. Respondents were assured that the information provided by them waskept confidential and their name was not disclosed in report.

RESULTS

Among 75 postnatal mothers,majority of group 70.7% belong to 20-27 years of age, and minority 2.7% belong to age of 35 years and above. Majority 60 % of respondents resides at rural areas. Concerning the ethnicity,62.7% were Janajati-disadvantaged group followed by 37.7% upper cast and 89.3 % of respondents were Hindu followed by 9.3% Buddhist. Regarding educational status 46.7 % of respondents have studied up to Higher-Secondary Level and 2.7 % have got no education.Majority 74.7% of respondent’s family income has between Rs 10000 – 15000 per month. Among 75respondents, 46.7 % are engage in agriculture and65. 3% of respondents lived in joint family. Most of the respondents 65.3 % were primi-para. Majority of the respondents97.3 % have attended antenatal Clinic and majority of them 66.7 % have visited Antenatal clinic for 4 times.

Majority, 85.3% of respondents said that newborn means the baby up to 28 days. Regarding average weight of newborn 74.7 % of respondents answered the baby should be of 3000 -3500 grams to be of normal weight. About sleep need of newborn 41.3 % of respondents stated that newborn need 20-22 hrs of sleep per day.

Majority 56 % of respondents answered that secretion in respiratory tract will lead to aspiration pneumonia and 5-3 % answered Jaundice.Majority of respondents 94.7 % have heard about physiological jaundice. And out of them 60.6 % said that it will appear within 24 hours of birth and 18.3 % said 6-8 days of birth. And 45.1 % of respondents said it will disappear between 2-4 days and 38 % said it will take 4-6 days.

Majority 98.7% of postnatal motherssaid newborn should be first fed with mother’s milk/ colostrum. Regarding breast feeding frequency 54.7 % answered she fed newborn whenever it needs.Majority 88% of respondents have heard about (Exclusive Breast Feeding) EBF. Out of 66 respondents hearing about EBF, 72.7 % said it means feeding baby only mother’s milk for 6 months.

Majority of respondents, 89.3 % answered that cord should be observed for cord bleeding/ discharge, redness and for swelling around cord. Regarding, keeping cord clean majority 56.3 % of respondents answered that it should be kept clean to prevent infection.

Majority 72% of respondents answered newborn should be bathed after 24 hours of birth, 88 % of respondents answered clean cotton cloth is used to clean newborn eye.

Regarding oil massage, majority 89.3 % of respondents said it improves blood circulation, keeps skin healthy and prevent from cold, 5.3 % said it helps to increase body weight.

Regarding the maintenance of body temperature 56% of respondents said that newborn can be kept warm by covering head and chest with cotton cloth and keeping baby with mother. Regarding ways to assess body temperature majority 45.3 % said by touching the forehead, 33.3 % said by touching abdomen.Asking about Kangaroo Mother Care 74.7 % of respondents said they have heard about it. Out of 56 respondents 82.1% said it means skin to skin contact of baby with mother like Kangaroo and rest 14.3% said keeping baby near mother.

While asking about the immunization, cent percent knew about it. Regarding time for 1st immunization majority of respondents 44% answered 45 day of birth, 26 % replied immediately following birth, 20% said don’t know and remaining 10% said within 1 month of birth.

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Figure 1. Level of knowledge of respondents on newborn care

Figure 1 shows that 41.3 % have moderate knowledge, 38.7% of respondents have good knowledge, and 20.0 % have poor knowledge related to newborn care.

Above table shows the association between knowledge of new born care and various demographic variables. There is no any association between Knowledge about newborn care and age of the respondents (p=0.1). There was approximately equal number of respondents who had the knowledge of newborn care in the variation of age group. The proportion of knowledge of respondents residing in urban and rural are not significantly different (p=0.21). The proportion of knowledge is significant to the religion (p=0.005). Likewise, the proportion of knowledge of newborn by occupation is significantly associated (p=0.027). Literacy status (p=.702), parity (0.15) and income (0.232) were also insignificant.

Over viewing the practice of mother in newborn general hygiene, reveals 3.33 % of mothers practice washing hand before touching the newborn. Majority of mothers 93.3% keeps their newborns eye clean. About 83.33 % of newborns umbilical cord was clean. Majority of mothers 63.33 % wash hands before handling stump and wash and clean napkins after each motion. About 66.66% mothers wash and clean napkins after each motion. About 83.33 % practice to dry the napkins under direct sunlight. And about 60 % of mothers, wash newborn’s genitals after each defecation with wet cloth.

Regarding breast feeding practices 93.3 % of mothers keep their breast clean before feeding. About 86.66 % of mothers position while feeding was appropriate. Minority of mothers ie: 20 % support breast with fingers below and the thumb above while feeding. Majority of mothers ie: 73.33% support the head of baby while feeding. About 66 % of mothers burp the baby after feeding and 60% practice exclusive breast feeding.

Concerning practice related toward maintenance of body temperature of newborn, all of the newborn 100 % was properly wrapped, wore a cap or head was covered and they were kept warm according to room temperature. Minority of mother’s 6.6 % practice Kangaroo Mother Care.

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Figure 2. Level of practice of respondents on newborn care

Figure 2 shows that 73.3% of respondents have adequate practice, 26.7 % have inadequate practice related to newborn care.

DISCUSSION

This present study mainly focuses to find out the knowledge and practice of newborn care among postnatal mothers. Mothers are the first hand care giver to their newborn so; their knowledge and practices were explored. This study reported that most of the mothers have adequate practice regarding newborn care.

This study found that 41.3 % have moderate knowledge, 38.7% of respondents have good knowledge, and 20.0 % have poor knowledge related to newborn care. Those who have poor knowledge regarding post natal care need further education. This finding isinconsistence with study done by Reza & Hassan, 2013. It had found that 78.5% had moderate, 13.3% had a good knowledge & 8.2% had poor knowledge regarding newborn care. Another study done by Castalino, Nayak& D’Souza, 2014 states majority 76.6 % of mothers had good knowledge.

Some of the findings of the present study are similar to the previous study. In this present study 73.3% of respondents have adequate practice, 26.7 % have inadequate practice related to newborn care, which is supported by previous study conducted by Shrestha, Gautam, &Silwal, 2013, 2013 which states, comparing knowledge with practice regarding newborn care, practice looks better in many areas.

On observation only 3.33 % mothers wash their hand before handling their baby; this may be due to lack of knowledge on importance of washing hand. Therefore education intervention regarding newborn care should be provided during the period of antenatal visit.

CONCLUSION

Majority postnatal mothers have knowledge on colostrums feeding, eye care, oil massage, cord care and exclusive breast feeding. Regarding practice most of the mothers have adequate practice on newborn care except hand washing and kangaroo mother care. Therefore educational intervention regarding neonatal care is required during the period of antenatal visit. It is a small scale hospital based study therefore large scale hospital base as well as community based study should be carried out to explore the real scenario.

The authors are grateful to MahendraAdarsa Hospital, Chitwan for providing opportunity to collect the data. The authors are also thankful to all post natal mothers who participated in this study.