Teaching Programme Promotes Awareness on IMNCI [Integrated Management of Neonatal and Child Hood Illness] Among Trained Nurses

 

Anu Rani A Augustine, Mohammed Siraj. P, Prashanth. K,  Shomiya Shaju, Shilpa G.S.* and Uma Rani J.

Department of Child Health Nursing, Yenepoya Nursing College,

Yenepoya University, Derelakatte, Mangalore, 575018, Karnataka

. *Corresponding Author Email: shilparashi9997@gmail.com

 

ABSTRACT:

Integrated management of neonatal and child hood illness is very essential for effective management of children during illness. The aim of the study was to determine the effectiveness of teaching programme on knowledge regarding IMNCI among trained nurses. The research design selected for the study was quasi experimental pre test post test design. Thirty Five Trained nurses were considered as sample for the study. Convenience sampling technique was used for sample selection. The instrument used for the study was self administered structured knowledge questionnaire. The planned teaching programme was administered soon after pre-testing. Then the post test was conducted after one week. The findings revealed that the mean post test knowledge score was significantly higher than that of pre test score. The calculated ‘t’ value (11.86) was greater than the table value at 0.05 level significance. The study concluded that teaching programme on IMNCI was effective in imparting knowledge among the trained nurses.

 

KEYWORDS: IMNCI (Integrated management of neonatal and child hood illness), trained nurses, knowledge.

 


 

INTRODUCTION:

Over the last 3 decades the annual number of deaths among children less than 5 years of age has decreased by almost a third. Every year more than 10 million children die in developing countries before they reach their fifth birthday. Seven in 10 of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhoea, measles, malaria, or malnutrition - and often to a combination of these illnesses1.

 

In India, common illnesses in children under 3 years of age include fever (27% ) , acute respiratory infections (17% ), diarrhoea (13% ) and malnutrition (43%) – and often in combination2. Infant Mortality Rate continues to be high at 68/1000 live births and Under Five Mortality Rate at 95/1000 live births per year. Neonatal mortality contributes to over 64% of infant deaths and most of these deaths occur during the first week of life. Mortality rate in the second month of life is also higher than at later ages3.

Approximately 28% of all deaths of newborns and 23% of all infant deaths in the world occur in India.4 Many of these deaths could be prevented by greater access to and use of high quality healthcare in combination with improved newborn and infant care practices in families5.

 

India adapted the Integrated Management of Childhood Illness (IMCI) strategy,6 Aiming to reduce its newborn and infant mortality burden and renamed the revised strategy Integrated Management of Neonatal and Childhood Illness (IMNCI)7

 

Implementation of IMNCI started in India in 2003. By June 2010, it had been implemented in 223 of India’s 640 districts and more than 200000 workers had been trained. Evaluating the effect of this strategy was identified as a priority for research in the Lancet’s newborn series a priority shared by the Ministry of Health of India8.Evaluations of community based newborn care interventions, showed 30-61% reductions in neonatal mortality.9,10

 

Providing quality care to sick children in these conditions is a serious challenge. So The Government has taken the initiative to provide quality care with effective strategies that are based on a holistic approach through IMNCI (Integrated management of neonatal and child hood illness).  Many of the nurses lack their knowledge on IMNCI. These views stemmed to the development of this present study.

 

The aim of the study was to determine the effectiveness of a structured teaching programme on knowledge regarding IMNCI among trained nursing staff.

 

MATERIALS AND METHODS:

Identification of the knowledge base requires the development and recognition of concepts and theories.11The conceptual framework for the present study was developed on the basis of Ludwig Von Bertalanffy General system model.12

 

The research design incorporates the basic methodological strategies in research study.13 One group pre test- post test design was carried out in a selected Nursing College. Totally, 35 samples were selected using convenience sampling technique. Out of 35 samples, 10 samples were MSc. Nursing students and rest 25 were Post Basic Nursing students. Baseline Proforma and structured knowledge questionnaire on IMNCI were used to collect the data, which consisted of two parts. These includes

 

1. Section A:

Baseline Proforma which comprises of age, sex, education, religion, Experience etc.

2. Section B:

Structured questionnaire with 30 items ware used to assess the knowledge on IMNCI. The score is interpreted as follows

 

91-100 % : Excellent knowledge

81-90% : very good knowledge

71-80 %: good knowledge

61-70% : average knowledge

50-60% : poor knowledge

< 50% :very poor knowledge

 

An informed consent was taken from the subjects for their full co-operation and given assurance of confidentiality. The Pre-test knowledge questionnaire was administered and the planned teaching programme was administered soon after pre-testing. After one week post-test was conducted using the same questionnaire. The data was analysed by using descriptive and inferential statistics.

 

RESULTS:

Analysis of pre-test and post test knowledge score regarding “IMNCI” (table.1) showed that 85.71% of trained nurses had very poor knowledge regarding “IMNCI”, 11.42 % had poor knowledge and 2.85 % had average knowledge and none of them had good to excellent knowledge. But the analysis of post-test knowledge score regarding “IMNCI” showed an improvement in knowledge level. 2.85 % of trained nurses had very poor knowledge regarding “IMNCI”, 8.57% had poor knowledge, 48.5 7% had average knowledge, 11.42 % had good, 20% had very good and 8.57 % had excellent knowledge on “IMNCI”.

 

Table.1 Analysis of pre-test and post test knowledge score regarding “IMNCI” among the trained nurses.    N=35

Level of knowledge

Score

PRE TEST Frequency and percentage

POST TEST Frequency and percentage

Excellent

91-100%

0

3 (8.57%)

Very good

81-90%

0

7 (20%)

Good

71-80%

0

4 (11.42%)

Average

61-70%

1 (2.85%)

17( 48.57%)

Poor

50-60%

4(11.42%)

3 (8.57%)

Very poor

Below50%

30 (85.71%)

1 (2.85%)

 

Table.2 Comparison of pre- test and post –test knowledge scores                    N= 35

Knowledge score

Mean

Standard deviation

Mean difference

t- value

PRE TEST

12.14

2.46

7.63

11.86*

POST TEST

19.77

2.61

df (34) = 1.697; *Significant, p<0.005

 

The paired ‘t’ test (table.2)was used to find the effectiveness to teaching program on IMNCI. The findings revealed that the calculated ‘t’ value (11.86) was greater than the table value (1.697) at 0.05 level of significance. Hence it is concluded that there is significant gain in knowledge of trained nurses regarding “IMNCI” after the teaching program.

 

DISCUSSION:

The study was conducted to evaluate the teaching program on knowledge of trained nurses on IMNCI. The pre test result showed lack of knowledge on IMNCI. Teaching program was administered after the pre test. The result of post test data showed gain in knowledge. Thus it is indicated that a regular teaching program is necessary to update the knowledge of trained nurses.

 

An interventional study conducted in Pakistan showed that community interventions in the antenatal and neonatal period resulted in a 15% (95% confidence interval 4% to 24%) reduction in neonatal mortality rate14.

 

In a study the Community health workers were trained to conduct postnatal home visits and women’s group meetings; physicians, nurses, and community health workers were trained to treat or refer sick newborns and children; supply of drugs and supervision were strengthened. The perinatal and post-neonatal mortality rates were significantly lower in the intervention clusters (table 3). Whereas the effect of the intervention on perinatal mortality rate was seen only among home births, the intervention led to a reduction in post-neonatal mortality rate both among home births (adjusted hazard ratio 0.73, 0.63 to 0.84) and among facility births (0.81, 0.69 to 0.96)15.

The limitations of the study were, it was confined to a specific geographical area which is a limits the generalization of the findings. Hence the study findings could be generalized only to that population which fulfilled the criteria in the study. The study has used convenience sampling and so that the researcher has not given equal opportunity to participate in the study.

 

IMPLICATIONS

The present healthcare delivery system emphasizes more on preventive rather than the curative aspect. The study implies that health personnel have to be properly trained. Nursing curriculum should be such that it prepares the prospective nursing students to assist the client and community in aspects of health care. Cost effective production of health care measures by the nursing staff should be encouraged. Necessary administrative support should be provided to conduct such activities and the nurse has to encourage further studies regarding the regular practice of IMNCI.

 

CONCLUSION:

Surveys reveal that many sick children are not properly assessed and treated by the health providers, and their parents are poorly advised. An integrated approach is needed to manage sick children to achieve better outcomes. So the nurses are need to be aware of the strategies of IMNCI. Thus the study concludes that it was evident where structured teaching program on IMNCI improved the knowledge of trained nurses.

 

REFERENCES:

1.       World Health Organization. World Health Report 1999 making a difference. Geneva: WHO; 1999.

2.       Murray CJ, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases injures, and risk factors in 1990 and projected to 2020. Geneva: World Health Organization; 1996.

3.       Marlow DR, Redding BA. Textbook of paediatric nursing. 6th ed. New York: W. B. Saunders Company; 1998.

4.       United Nations Children’s Fund. Levels and trends in child mortality: report 2010. Estimates developed by the UN Inter-Agency Group for Child Mortality Estimation. Unicef, 2010.

5.       Darmstadt GL, Bhutta ZA, Cousens SN, Adam T, de Bernis L, Walker N. Evidence-based, cost-effective interventions that matter: how many newborns can we save and at what cost? Lancet2005;365:977-88.

6.       World Health Organization. IMCI adaptation guide, version 5. WHO, 1998.

7.       World Health Organization. Integrated management of neonatal and childhood illnesses. WHO, 2003.

8.       Martines J, Paul VK, Bhutta ZA, Koblinsky M, Soucat A, Walker N, et al. Neonatal survival: a call for action. Lancet 2005; 365:1189-97.

9.       Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, et al. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet 2008; 371:1936-44.

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11.     Park K. Textbook of preventive and social medicine. 17th ed. Jabalpur: Banarsidas Bhanot Publishers; 2002.

12.     Gillies, Dee Ann (1982). Nursing management a systems approach. Philadelphia: W. B. Saunders Company, 56-74.

13.     Polit DF, Hunlger BP. Nursing research principles and methods. 6th ed.Philadelphia: J. B. Lippincott Company; 2000.

14.     Bhutta ZA, Soofi S, Cousens S, Mohammed S, Memon ZA, Ali I, et al. Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster randomised effectiveness trial. Lancet 2011; 377:403-12.

15.     Nita Bhandari, Sarmila Mazumder, Sunita Taneja, Halvor Sommerfelt, Tor A Strand, Effect of implementation of Integrated Management of Neonatal and ChildhooIllness (IMNCI) programme on neonatal and infant mortality: cluster randomised controlled trial. British Journal of Medicine. March 2012;344

 

 

 

Received on 21.10.2013           Modified on 25.11.2013

Accepted on 05.12.2013           © A&V Publication all right reserved

Int. J. Adv. Nur. Management 2(2): April- June, 2014; Page 79-81