INTRODUCTION:

“The future destiny of the child is always the work of the mother” - Napolean Bonoparte

A healthy start of life is vital in establishing the foundation of an healthy and fruitful nation. They constitute about 40 percent of the total population. Neonatal period is refers to first 28 days of life which is further divided into early and late neonatal period. Early neonatal period refers to first 7 days of life while late neonatal period ranges from 7^th day to 28^th day of life. These neonates are the most valuable constituents of the world are most delicate and highly susceptible to develop infections, so appropriate care must be given to newborn during neonatal period.¹

Neonates are the most valuable assets to their parents after a period nine months expectation. To become a mother for the first time is wonderful and exciting feeling for any women in her life can become an annoying and heartbreaking experience for her by the illness of neonate. Once she comes to know that she is going to be a mother, she starts preparing for motherhood and waits patiently and expectantly for her baby it is the time when we can impart her education for healthy outcome of pregnancy.²

The majority of newborns enter the world healthy. But sometimes, these neonates develop conditions requiring medical examinations and treatment. Newborns are particularly susceptible to certain diseases, much more so than other age group of children and adults because of their immune systems aren't adequately developed to protect from the bacteria, viruses, and parasites that cause these infections³.

Neonatal infection is the single important cause of neonatal deaths. Newborn babies especially the low birth weight babies have higher risk of developing infections. Practices like exclusive breastfeeding, no prelacteal feeds, keeping the cord clean and dry, proper hand washing by caregivers before and after the handling baby, maintaining personal hygiene and general cleanliness, appropriate immunization can be effective in prevention of infections in neonates.⁴

Every year there was about 4 million neonates die within first four weeks of life, out of these 98percent are in developing countries. Neonatal deaths contribute to 40 percent of all childhood deaths and more than 50 percent of infant mortality. The largest number of neonatal deaths i.e. 1.4million per year occurs in South East Asia region. Major causes of these deaths in this region are low birth weight (<2.5kg), infections and asphyxia.In developing countries, this problem is more prevalent even in healthy full term and normal-birth-weight infants.⁵

The report released at the National Conference on Child Survival and Development in New Delhi, claims that of the approximately 26 million children born in India each year and 1.2 million die during the first four weeks due to neonatal infections. That’s 30% of the 3.9 million global neonatal death.⁶

Neonates are at much higher risk for developing infections than older children and adults because of their immature immune system–especially premature infants, where 1 out of every 250 will be diagnosed with sepsis. Sepsis is one of the major leading causes of death in the first few months of a newborn’s life. Infections can contribute up to 13-15% of all deaths during the neonatal period with the mortality rate reaching as high as 50% for infants who are not getting treatment timely. The combination of an immature and slow responding immune system increases the risk of infection in the neonate. Other reason for the increased risk is the antibodies, which help in protecting mothers from infections, could not cross the placental barrier to the foetus up to approximately 30 weeks of gestation. The antibodies present at birth take time to reach optimum levels and thus also affects the protection provided.⁷

According to a report, ‘levels and trends in child Mortality 2014’ Globally 2.8 million babies died within the first month of life, which represent about the 44% of all under five deaths. Around two thirds of neonatal deaths occur in just 10 countries one of them is India accounting for more than a quarter of these deaths. Most of these deaths could be easily prevented with simple, cost effective interventions before, during and after birth. Evidence shows that initiation of breastfeeding with in half an hour after birth reduces the risk of neonatal death by 44%.⁸

India is 2^nd highest populated developing country dividing into 29 states and 7 union territories dividing into 466 districts. Approximately more than 74 percent of population resides in rural areas lacking basic care.¹⁵ though most of mothers are delivering at home by choice or inaccessibility to basic health care facilities or even fundamental care. So most of the babies born outside of the hospital are obviously out of mind of the health professionals, so neglected by them leading to increase in neonatal death and disabilities. To maintain the wellbeing of neonates, providing health education to mothers who are basic care giver to their neonates can help in resolving the problem.⁹

A study was conducted on neonatal sepsis, one of the major health problem throughout the world, state that every year an estimated 30 million newborns acquire infection and 1-2 million of these die, the findings of the study showed that clean and safe delivery, early and exclusive breast feeding, strict post natal cleanliness following adequate hand washing and aseptic technique during invasive procedure may reduce the incidence of neonatal sepsis and infections. Prompt use of antibiotic according to standard policy can save the neonates life from the septicemia.¹⁰

A prospective study was conducted on Neonatal Conjunctivitis in Christian medical college; Ludhiana over a period of one year reveals the incidence of Conjunctivitis was 7.2 percent. Out of these 91.6 percent developed conjunctivitis was in the first week of life after the birth.¹¹

A cross sectional study was conducted to know mothers’ knowledge and explore the danger signs, health care seeking behaviours in Wardhana district, India, states that approximately 67.2 percent mothers knew at least one newborn danger sign. Majority of mothers (87.4%) responded that the sick child should be immediately taken to the doctors but only 41.3 percent of sick newborns got treatment and 46.1 percent received no treatment. Mothers’ state the reason for not taking their newborns to the doctors even in the presence of danger signs and symptoms were because of ignorance of parents, their belief in supernatural causes, home remedy, and absence of responsible person at home. The present study reveals the presence of gap between mother’s knowledge and their health seeking behavior for sick newborn.¹²

When women acquire the knowledge before or during pregnancy on how to prevent neonatal infections through simple hygiene practices, such hand washing and particularly adapting the hygienic behaviour to prevent it. The awareness of women’s knowledge on hand washing, not sharing drinking glass and not kissing young children on the mouth appeared to be generally acceptable. These are the preventable practices give the awareness to the mothers to prevent the neonatal infection.¹³

OBJECTIVES:

Objectives of the study was to:

· Develop the tool for assessing the knowledge of primigravida mother regarding prevention of selected neonatal infections

· develop a planned teaching programme regarding of prevention of selected neonatal infections

· Assess the existing knowledge of primigravida mothers regarding prevention of selected neonatal infections.

· Administer the planned teaching programme on prevention of selected neonatal infections among primigravida mothers.

· Determine the effectiveness of planned teaching programme regarding prevention of selected neonatal infections among primigravida mothers.

· Find out the association between level of knowledge of primigravida mothers and their demographic variables.

HYPOTHESIS:

H1: there is significant difference between pretest and posttest knowledge of primigravida mothers regarding prevention of selected neonatal infections.

H2: There was a significant association between post-test knowledge scores of primigravida mothers with their selected demographic variables.

REVIEW OF LITERATURE:

A review of literature pertaining to the present study is aimed at assess the effectiveness planned teaching programme on neonatal infections.

Shankar MJ, et al, (2008) conducted a study on incidence of neonatal sepsis in India that was 30 per 1000 live-births. Based on the onset, neonatal sepsis classified into two major categories: early onset sepsis and late onset sepsis which usually present with respiratory distress and pneumonia within 72 hours of age and late onset sepsis that usually presents with septicemia and pneumonia after 72 hours of age. Clinical feature of sepsis and blood culture is the fundamental standard for the diagnosis. It include practical septic screen for the diagnosis of sepsis and some suggestions for antibiotic use have been included in the protocol.¹⁴

Karkar S. et al, (2010) another epidemiological survey study conducted on neonatal conjunctivitis caused by Chlamydia trachomatis in tertiary care centre at New Delhi. The aim of study was to determine the cause of neonatal conjunctivitis and clinical epidemiological correlation of Chlamydia ophthalmic neonatrum. The 58 newborns with signs and symptoms of conjunctivitis were preterm and Chlamydial trachomatis infection was diagnosed in 18 neonates. Thus, it was concluded that Chlamydial trachomatis was the most common cause of neonatal conjunctivitis and routine screening and treatment of genital chlamydial trachomatis infection in pregnant women with early diagnosis and treatment of neonatal chlamydial conjunctivitis may be a effective modality considered for its prevention and control.¹⁵

Vural G., et al (2006) A comparative case control study was conducted in Turkey to compare the incidence of omphalitis among three groups selected, for each using a different type intervention for newborn cord care as povidane-iodine for first, dry care for second and topical human milk for other and concluded that the cultural practice of applying human milk to the umbilical cord stump have no adverse effect and is associated decreased time of cord separation than with the use of antiseptic.¹⁶

Manju Rahi.et.al, (2010) a study was conducted on newborn care practices along with cord care practices among 82 mothers at an urban slum of Delhi. The main aim of the study was to find out the newborn care practices including immediate care given after birth, cord care and breast-feeding practices in that urban slum of Delhi. The study finding shows that 38 (82.6%) of home deliveries was commonly bathing the baby immediately after birth. They used finger to clean the air passage in most of the home deliveries 29 (63%) and about 28 (61%) of home delivered newborns were not weighed at birth. The use of clip, band or sterile thread to tie the cord and no application to the cord was significantly higher in institutional or hospital deliveries. The study interprets that there is a need to educate mothers on clean delivery practices and early neonatal care.¹⁷

Mahmood A. et, al (2008) A Study was conducted in Gujranwala on the infection control practices in the delivery room and the nursery so the ongoing high rate of neonatal sepsis can be controlled. Certain observations were made regarding break in infection practices and specimens to interrupt the chain of infection and to remove the source and reservoir of infections in the delivery room and the nursery environment. The rate of neonatal sepsis drastically reduced after the implementations of the control measure the rate was declined from (63/1000) to (14/1000) over the next 3 months.¹⁸

RESEARCH METHODOLOGY:

Research approach:

Research approach is plans and the procedures for research that span the steps from broad assumptions to detailed methods of data collection, analysis and interpretation. It helps the researcher to know what data to be collect and how to analyze it and suggest the possible conclusion to be drawn from the data. In this research the investigator wished to assess the knowledge of primigravida mothers, after the planned teaching programme on prevention of neonatal infections. The research approach adopted for present study was an quantitative evaluative survey approach that helps to explain the effect of independent variable on the dependent variable.

Research Design:

Research design is the researcher’s overall plan for answering the research questions or testing the research hypothesis. The research design specifies the plan of action that the researcher adopts to develop information that is accurate, objective and interpretable.

The research design includes the overall plan for addressing a research question, along with specification for enhancing the integrity of the study. In present study, the researcher has adopted pre–experimental one group pre test post test only design. The study was intended to find out the knowledge regarding common neonatal infections among primigravida mothers in Govt Doon Medical College and Hospital, Dehradun.

Instrument:

Self Developed Structured Questionnaire and was in two parts. First parts consist of demographic data and second structured questionnaire. The tool was used after testing its validity by 7 experts and reliability was tested by split half technique r=0.918 p, 0.005.

It included 9 items of demographic variables and 37 items related to knowledge regarding common neonatal infections which are further grouped in sub sections.

Table 1: areas of assessment and number of items

Sl. No.	Section	Knowledge aspect	No of item
1	A	General care	12
2	B	Opthalmia neonatrum	5
3	C	Umbilical cord infection	4
4	D	Oral Thrush	4
5	E	Pyoderma	5
6	F	Neonatal sepsis	7
Total			37

Data collection:

Prior permission was obtained from concerned authorities and consent was taken from samples too. The data was collected from 50 primigravida mothers at Govt. Doon Medical College and Hospital Dehradun, by using self structured questionnaire.

RESULT:

The collected data was entered in a master sheet for tabulation and statistical processing. The data is analyzed and interpreted using descriptive and inferential statistics based on objectives and hypothesis formulated for present study. The finding are presented under the following headings-

Table 2: Percentage wise distribution of demographic variables

S. No.	Age	Frequency	Percentage
1	Age in years
	18- 22 years	24	48%
	23- 27 years	18	36%
	28- 32 years	07	14%
	33- 37 years	01	2%
2	Religion
	Hindu	34	68%
	Muslim	11	22%
	Christian	02	4%
	Any other	03	6%
3	Education
	Primary education	16	32%
	Secondary education	19	38%
	Graduation	11	22%
	Post graduation	04	08%
4	Monthly income
	Less than 5000	02	4%
	5001 to 10000	31	62%
	10001 to 15000	13	26%
	More than 15000	04	8%
5	Area of living
	Rural area	27	54%
	Urban area	23	46%
6	Type of family
	Nuclear family	23	46%
	Joint family	27	54%
7	Registered in ANC clinic
	Yes	32	64%
	No	18	36%
8	Previous knowledge about neonatal care
	Yes	28	56%
	No	22	44%
9	Source of information
	Mass media	05	10%
	Family and friends	26	52%
	Health personnel	15	30%
	Any other	04	8%

MAJOR FINDINGS OF THE STUDY WERE:

· The majority of respondents 24 (48%) comes under age group 18-22 years.

· The majority of respondents 34 (68%) are Hindu.

· The majority of respondents 19 (38%) comes under secondary education

· Occupational status depict that the majority of respondents 41 (82%) were housewife.

· Monthly income depict that the majority of respondents 31 (62%) had monthly income between 5001-10000.

· Area of living depict that the majority of respondents 27 (54%) residing in rural area.

· Type of family shows that majority of respondents 27 (54%) belong to the joint family.

· The majority of respondents 32(64%) were registered in ANC clinic.

· The majority of respondents 28 (56%) had somewhat knowledge regarding neonatal care

· The majority of respondents 26 (52%) has source of information family and friends.

Level of Knowledge about Prevention of Common Neonatal Infections:

The knowledge score of the primigravida mothers indicates that majority of primigravida mothers i.e. 27(54%) has inadequate knowledge, 23(46%) has moderately adequate knowledge while 0% mother has no adequate knowledge about prevention of neonatal infections in pre-test.

The knowledge score of primigravida mothers in post-test shows 48(96%) primigravida mother has adequate knowledge and 2(4%) having moderately adequate knowledge and none of the primigravida mother had inadequate knowledge. Thus it can be interpreted that the increase in knowledge is as result of planned teaching programme on prevention of neonatal infections.

Hence research hypothesis was as there was a highly significant increase in knowledge level among primigravida mothers after implementing planned teaching programme on prevention of common neonatal infections.

Comparison of Pre Test and Post Test Knowledge Scores of Mother:

Table 3: Comparison of Pre Test and Post Test Knowledge Scores of mother N = 50

Know ledge aspects

Mean

Mean %

S D

Enhan

cement

t Value

Inf erence

Pre test

15.78

42.64

6.03

44.37%

21.

Post test

32.22

87.01

2.64

The overall value was as mean 15.58, mean percentage 42.10%, S.D 6.21 in pre-test, for post test it was like this mean 33.05, mean percentage 89.32%, S.D12.52; enhancement in knowledge was 47.22% t-value 21.56 at df 49 shows significant association and thus research hypothesis was accepted.

Association of pre test knowledge scores of mother with selected demographic variables:

In order to find out association with knowledge score and their demographic variable annova test and independent t test was used .The finding shows that obtained annova value for age in years, is (3.64 P value 0.0101); religion is (10.17 P value <0.0001); educational status is (10.41P value <0.0001); occupation, is (2.88 P value 0.045); monthly income is (2.98value p0.041); source of information, is ( 2.84 p value 0.00164) greater than the table value which indicate that there is significant association between level of knowledge with selected demographic variables. Hence the research hypothesis is accepted.

The obtained t value for area of living, is 1.27 value, p value 0.2067; type of family , is1.08 p value 0.2831; do you have any knowledge about neonatal care is (0.75pvalue 0.45) was lesser than the table value 2.00 which indicate that there is no significant association between level of knowledge with selected demographic variables. Hence the research hypothesis is rejected.

The obtained t value for educational status, is (3.32 P value 0.0017) greater than the table value which indicate that there is significant association between level of knowledge with selected demographic variables. Hence the research hypothesis is accepted.

CONCLUSION:

The study concluded that the structured teaching programme on knowledge regarding prevention of common neonatal infections was an effective method for providing knowledge regarding prevention of these infections. Findings of the studies showed that knowledge score of primigravida mothers were having less before the administration of the structured teaching programme. This study has a great implication in nursing practice, education, research and administration. The result of the study shows the great need for the health personnel to educate the primigravida mothers about prevention of common neonatal infections. Use of pre experimental design and small sample size executes limits to generalization of the result. On the basis of findings, it is recommended that a similar study may be replicate during a large number of participants and experimental design. More intervention studies should be carried out for improving the knowledge regarding prevention of common neonatal infections

RECOMMENDATION:

· The study can be replicated with a larger no of samples for better generalization.

· The study can be done with other neonatal infections too.

· A similar study can be conducted to find out the effectiveness of planned teaching programme among the staff working in hospital settings.

· A similar study can be done to evaluate the effectiveness of planned teaching programme on the knowledge and attitude of primigravida mothers regarding prevention of common neonatal infections

· A similar study can be conducted on health care providers to increase knowledge regarding prevention of common neonatal infections

· A similar study can be conducted on student nurses to increase knowledge regarding prevention of common neonatal infections

· A similar quasi experimental study can be done conducted to find out the effectiveness of planned teaching programme among the staff working in hospital settings

RESULT:

The data was tabulated analysed and interpreted using inferential and descriptive statistics methods.

Table 1 shows the major findings indicated that postnatal mothers according to their age majority 68% of the respondents were in the age group of 18-26 years. Higher percentages 58% of the respondents were multipara. Majority of respondent 76% were Hindu. 56% belongs to the rural area. Higher percentage 43% of respondent had primary education. Majority of respondent 88% were home maker and higher percentage of the respondents 91% does not have any previous health education on prevention on breast engorgement. There was no association found between the knowledge score and socio demographic variables of the study.

Table No 4: comparison of pre-test and post-test level of knowledge

Pertest		Posttest		DF	‘t’-Value
Mean	SD	Mean	SD	DF	‘t’-Value
11.02	3.58	19.48	2.79	49	30.34*

The data presented in the table no. 2 shows that the calculated’ value of pre-test and post-test of knowledge regarding prevention of breast engorgement were 30.34, which was higher than the table value at 0.05 level of significance. It reveals that there was a difference in the pre-test and post-test level of knowledge score regarding prevention of breast engorgement among postnatal mothers with caesarean section and the study result is significant.

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Received on 06.09.2021 Modified on 03.12.2021

Int. J. of Advances in Nur. Management. 2022; 10(1):71-76.

DOI: 10.52711/2454-2652.2022.00018

A study to assess the effectiveness of planned teaching programme on prevention of common neonatal infections among primigravida mothers, in Doon Female Hospital, Dehradun, Uttarakhand