Asian Journal of Nursing Education and Research 4(3): July-September 2014

www.anvpublication.org ISSN- 2231-1149 (Print)

2349-2996 (Online)

RESEARCH ARTICLE

A Study to Assess the Essential Newborn Care Practices among Primipara

Mothers at Government District Hospital, Tumkur, Karnataka, India
Shivaleela P. Upashe
Department of Nursing, College of Medical and Health Sciences, Post Box No: 395,
Wollega University, Nekemte, Ethiopia.
*Corresponding Author Email: spupashe@gmail.com

ABSTRACT:
Background: An estimated 3.1 million neonates die each year globally, and 99% of these deaths occur in low-income
countries Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can
be delivered in communities as well as facilities. The present study was designed to assess the practices on essential
newborn care among primipara mothers at District Hospital, Tumkur, Karnataka, India.

Methodology: The data were collected on practices of primipara mothers of new born baby’s. It is believed that mothers
were the first nurse who take care and meet the primary needs of the new born babies during wellness and illness. Sample
size was 100 primipara mothers. Simple random sampling technique was used to draw the sample. The data collection was
done by interview method, using structured questionnaire which includes 40 questions of practices regarding essential new
born care with scoring pattern of one for each correct answer and zero for incorrect response.

Results: The results of the study were indicating about above 28% of mothers had good practice, 62% mothers had
moderate practice and below 10% of mothers had poor practice related to essential new born care.

Conclusions: The in-depth qualitative studies are needed to explore the reasons for different traditional practices. The
high-risk traditional newborn care practices like delayed wrapping, bathing immediately after birth, mustard oil massage,
applying cow dung, ash, herbal mixture on the umbilical stump, pre lacteal feeding and discarding colostrums need to be
addressed by culturally acceptable community-based health education programmes. Improving newborn care and newborn
health outcomes in India will likely require a multifaceted approach.

KEY WORDS: Primipara, Newborn, Practices, Scoring, Tumkur.

INTRODUCTION:
The period from birth to 28 days of life is called as neonatal India account for 27% of the global burden of the neonatal
period and the infant in this period is termed as neonate or deaths each year. It is recognized that to reduce infant
newborn baby. The healthy newborn infant born at term, mortality rate, health problems that occur during first month
between 38 to 42 weeks, cries immediately after birth, of life must be addressed as a high priority2.
establishes independent rhythmic respiration, quickly
adapts with the extra-uterine environment, has an average WHO reported that 6.9 million children under the age of
birth weight and no congenital anomalies1. In India, infant five died in 2011. It also reported that a child's risk of dying
mortality is still high compared to developed countries. One is highest in the neonatal period, the first 28 days of life.
million neonates die every year in our country. Neonatal Safe childbirth and effective neonatal care are essential to
deaths account for 63.7% all infant deaths in India. prevent these deaths. 43% of child deaths under the age of
five take place during the neonatal period, more than three
million babies die every year in their first month of life and
Received on 09.06.2014 Modified on 22.07.2014 a similar number are still born. Within the first month, one
Accepted on 30.07.2014 © A&V Publication all right reserved quarter to one half of all deaths occurs within the first 24
Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 370-375 hours of life, and 75% occur in the first week. The 48 hours
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immediately following birth is the most crucial period for conducting the study and the investigators feasibility with
newborn survival. This is when the mother and child should the setting. The present study was conducted at post natal
receive follow-up care to prevent and treat illness3. ward of the hospital.
Worldwide; about eight newborn babies die every minute.
Every year more than four million babies die during first Ethical Consideration and Clearance
week of life due to inadequate care by mothers/ care givers. Ethical clearance and permission was obtained from District
India accounts for 27% of global neonatal deaths and 30% Health Hospital and Aruna College of Nursing, Karnataka,
of neonatal mortality in the state of Uttar Pradesh (UP). India. Each participant (primipara mothers) was notified
Thus, nearly 10% of all global neonatal deaths take place in about the purpose of the study, the right to refuse for
this state of India. The characteristics of this part of India participation in the study, and anonymity and
are very similar to several other Indian states as well as confidentiality of the information. Primipara mothers were
large sections of Bangladesh, Southern Nepal and Pakistan4. assured that they will not be penalized for not participating
Substantial progress has been made towards achieving and that their responses to the questions would have no
Millennium Development Goal 4. The number of under- effect on their care.
five deaths worldwide has declined from more than 12
million in 1990 to 7.6 million in 2010. It was estimated that METHODOLOGY:
nearly 21,000 children under five were dying every day in The descriptive with cross sectional study was carried out at
2010 and about 12,000 were dying per day in year 20115. Post-natal Ward of Government District Hospital, Tumkur,
Karnataka, India to assess the practices on essential
Irrespective of urban-rural differences in NMR, neonatal newborn care among primipara mothers. The simple
deaths are a bane of the poor. The major causes of neonatal random sampling technique was adapted while selecting the
deaths globally are estimated to be complications of subjects to meet the study objectives8. Data was collected
prematurity (28%), sepsis and pneumonia (26%), birth by using a structured questionnaire as a tool to assess the
asphyxia and injuries (23%), tetanus (7%), congenital essential newborn care practices of primipara mothers.
anomalies (7%) and diarrhea6. Promotion of essential Informed consent was obtained from all the primipara
newborn care practices is one strategy for improving mothers, who were interviewed.
newborn health outcomes and to minimize the illness and
maximize their growth and development. The World Health Inclusion and Exclusion Criteria
Organization has defined essential newborn care to include In Inclusion Criteria which includes all the primipara
clean delivery and clean cord care, thermal protection, mothers who are available at the time of data collection,
keeping newborn warm, kangaroo mother care, early and those who are having communication with same common
exclusive breastfeeding, eye care, immunization, care for language English/ Kannada and mothers who are willing to
the low birth weight newborns, and management of participate. Exclusion Criteria, which excludes Nullipara
newborn illness7. mothers or infertile women, those mothers who are not
communicate with same, common language English /
The good essential newborn care practices immediately Kannada and Primipara mothers those who are not willing
after delivery play a major role in causing neonatal to participate.
morbidities and mortalities. Essential new born care
practices were outlined to decrease the neonatal morbidity Socio-demographic Profile of the Respondents
and mortalities8. These good practices include clean cord Socio-economic factors such as family income, educational
care, thermal care, kangaroo mother care and initiating status of the mother, occupation of the mother etc. and
breastfeeding immediately after birth (within 1 hour). The socio-demographic factors such as age, religion, type of
traditional practices like applying cow dung on the family, residence, type of delivery, weight of the newborn
umbilical stump, oil instillation into nose etc also contribute baby etc. were recorded.
to newborn’s risk of morbidity and mortality9. Therefore it Assessment of Practices on Essential Newborn Care
is necessary for the mother and her family to understand Practice scoring was done depending on the responses to
these aspects of childbirth and newborn care practices and the questions given by primipara mothers and represented
be prepared to react for the potential dangers signs10. as follows, Score ‘1’ for correct response and ‘0’ for wrong
Therefore, the present study was designed to assess the response. To assess the practices of primipara mothers
practices of essential newborn care among primipara about newborn care includes following domains, which
postnatal mothers. includes practices about maintenance of body temperature,
establishment of breast feeding, prevention of infection,
MATERIALS AND METHODS: immunization and growth and development.
Study Area
The study was conducted at Government District Hospital, Data Analysis
Tumkur and it is 500 bedded hospital with medical, The collected data was coded, tabulated, and analyzed by
surgical, emergency, pediatric unit, neonatal intensive care using descriptive statistics (mean, mean percentage,
unit, post natal ward, labor room, operation theatre and standard deviation) and inferential statistics (chi-square) to
outpatient departments. The criteria for selection of the find out the association between demographic variables and
setting were the availability of the subjects, feasibility of
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practice score. The total score was calculated and data was Practices of Primipara Mother’s Related to the Essential
analyzed by using Statistical Package for Social Sciences Newborn Care
(SPSS) version 13.0. The practices of primipara mother’s regarding the care of
the newborn baby’s was assessed related to the maintenance
RESULTS: of body temperature, establishment of breast feeding,
Socio-Demographic Data prevention of infection, immunization and growth and
A total of 100 primipara mothers were participated in the development. According to the total score obtained by each
study. Maternal age ranges between 18 to 30 with an subject, practices was classified into good practice (>80%),
average of 23.18±4.98. Most of the mothers, 46% were moderate practice between (40 to 80%) and poor practice
Hindus, 34% were Christian, and 20% mothers were (<40). Table 1 gives the distribution of practice level. Our
Muslims. Among them 48% mothers had completed pre study indicates that 62% had moderate practice level, 28% of
university course (PUC) and above level of education, 32% them had good practice level and 10% had poor practice level.
were elementary level of education and 20% mothers were
Table 1: Level of practices of respondents regarding newborn care
illiterates. Out of 100 mothers, 50% were employee, 30% Level of practice Sample frequency ( % )
mothers were house wives and 20% were laborers. Monthly Good (>80%) 28
income of the family, 45% mothers had the income range Moderate (40 to 80%) 62
between Rs 2000-4000, 40% mothers had the income above Poor (<40%) 10
Rs 4000 and 15% mothers had the monthly income less Total 100
than Rs 2000. Regarding type of family, 40% were belongs Table 2 represents overall mean practice score of mothers
joint family, whereas 50% mothers were belongs to nuclear regarding essential newborn care was 26.62 with a standard
family and only 10% mothers were belongs to extended deviation of 2.32 and score range between 12.36. The mean
family. Regarding residence, 60% mothers belongs to rural practice score for the sample same found to be 70% with
area and 40% mothers belong to urban area. Regarding type standard deviation variables of 2.32. In the present study
of delivery, 50% mothers were belongs to normal delivery 28% sample had a good and 62% sample had a moderate
and 50% mothers were belongs to caesarean section. practice, this constitute a 90% of the sample with
Regarding weight of the baby, 11% baby’s were 2- 2.5 kg satisfactory or higher level practice but need a refinement
and 79% baby’s were 2.5-3 kg and 10% baby’s were 10% of the sample had a poor practice, indicating that
belongs to 3-3.5 kg9.. mother’s need a detailed demonstration on newborn care
practices.

Table 2: Maximum score, mean, and standard deviation in related to the practice regarding essential newborn care.
Maximum possible score Maximum score Range of score Mean score Mean score(%) Standard deviation
40 0-40 12-40 26.62 70% 2.32

Table 3: Association between level of practice and selected demographic variables.

No Variables Practice Score P value Inference
Good Moderate Poor 2
1 Age of Mother
18-25 yrs 12 30 6 5.86
25-30 6 26 2 P>0.05 Not significant
30 and above 10 6 2
2 Religion
Hindu 13 29 4
Muslim 9 21 4 1.12 P>0.05 Not significant
Christian 6 12 2
3 Educational status
Illiterate 0 16 4
Elementary 12 16 4 10.78 P<0.05 significant
PUC and above 16 30 2
4 Occupation
House wife 15 12 3
Daily wages 4 9 7 12.61 P<0.05 significant
Employee 9 41 0
5 Family Income
Below Rs 2000 5 8 2
Rs 2000 – Rs 4000 12 23 5 3.15 P>0.05 Not significant
More than Rs 4000 11 31 3
6 Type of family
Nuclear 6 30 4
Joint 14 30 6 15.89 P<0.05 significant
Extended 8 2 0

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Association between Level of Practices and Selected 1st day of birth. A study conducted in Uganda, it was found
Demographic Variables that bathing of newborns in the first hour after delivery
Chi square test was done in order to determine the resulted in a significantly increased prevalence of
association between the overall Practice level of mothers hypothermia, defined as temperature <36.5°C, at 70 and at
about essential newborn care and selected demographic 90 min postpartum despite the use of warm water and the
variables. Findings are presented in table 3. application of the skin-to-skin method15.

The findings presented in the table 3 shows that the In the present study, most of the mothers had a fairly good
calculated chi-square value at df=4 for age of the mother. practices in terms of maintaining body temperature mothers
(χ2 =5.88, P> 0.05), Religion (χ2 =1.12, P> 0.05) was not covered the whole body of their newborn baby with warm
significant at 0.05 level of significance. Further findings clothes, and they also practice bedding-in. some of the
shows that in the table 3 the educational status (χ2 =10.78, mothers were aware about Kangaroo method itself. These
P>0.05), Occupation (χ2 =12.61, P< 0.05) significant at 0.05 practices help to maintain neonate’s temperature, encourage
level of significance. It is interpreted that there is an breast-feeding and bonding. But more effort can be put into
association between educational status, occupation and their educating these women to prevent hypothermia in
level of practice regarding newborn care. So we may reject newborns.
the null hypothesis. The findings presented in the table 3
shows that the calculated chi-square value at df 4 for family The traditional practices, which are notable, are the use of
income, (χ2 = 3.15, P>0.05) was not significant at 0.05 level gripe water, glucose water, honey, discarding colostrums
of significance. It is interpreted that there is no association etc. It is believed that the alcohol in gripe water provides
between family income and their level of practice related to the soothing effect16, 17. In our study area, the initiation of
newborn care. Further findings in the table 3 shows that breast-feeding to the newborn baby’s was found to be >
computed chi-square value at df 4 for type of family 80% and all mothers were said that they have good practice
(χ2=15.89, P<0.05) is greater than the table value (9.49) at regarding establishment of breast-feeding and also they are
0.05 level of significance. It is interpreted that there is an aware about the importance of breast-feeding. Only some of
association between type of family and their level of the mothers which are from rural background were
practice regarding newborn care. discarding colostrums, using of glucose water, gripe water,
honey etc and which are the bad practices and it will intern
DISCUSSION: reduce the immunity of the babies.
Globally every year about 4 million die in the first 4 weeks
of life11. A similar number of babies are still born. Most Care of umbilical cord is always stressed since it can
neonatal deaths (99%) occur in low income and middle- function as the entry route for infections. Despite the efforts
income countries and about half of the deaths occur at to improve the cord practices, in many rural areas where
home. It is tragic that million of newborn die every year deliveries are conducted by untrained dhais. The World
specially when their deaths are so easily preventable. It is Health Organization recommends dry cord care (where
estimated that about 75% of neonatal deaths could be nothing is placed on cord stump unless indicated18. Various
avoided with simple, low cost tools that already exist such studies were done in developing countries have reported
as antibiotics for pneumonia and sepsis, sterile blades to cut that, the mothers applying substances like mustard oil,
the umbilical cords using knit caps and kangaroo care to coconut oil, turmeric powder, herbal mixture, ash, cow
keep babies warm, early initiation of breast feeding12. dung and antiseptic lotion etc. on the cord stump without
Newborn care practices at and immediately following any scientific knowledge19. The wrong practices followed
delivery can contribute to morbidity and mortality of by mothers without the basis of scientific knowledge have
neonates. A set of Essential Newborn Care (ENC) practices proved to be fatal to the life of the newborns. Our study
have been proven to reduce these risks9. The promotion of reveals that, least practice score was found in the aspect of
preventive newborn care practices through home visits by prevention of infection. About 62% of newborn mothers
community health workers and community mobilization has have moderate and only 28% of mothers have good level of
been shown to reduce newborn deaths in high mortality practices. Still 10% of the primipara mothers belongs to
settings in Asia13. rural area has poor practices regarding umbilical cord care
and this indicates that they need health education from the
It is a common practice in India to bath the newborn’s the health settings to prevent the umbilical cord infection
immediately after birth. This puts the newborn at risk of and to promote the newborn care. Our findings also
hypothermia which gets worse with the lack of adequate supported by the studies of Manju, (1999)20, Raman Vidya,
drying and warm clothes. The reason for this practice is the Rekha and Chandrasekhara, (1996)21, Deorari, (1996)22,
belief that the blood/fluid/vernix which stays on newborn’s Wondu Garoma, (2013)23 and Hill, (2000)24.
skin after birth is impure and has to be removed thoroughly.
World Health Organization (WHO) recommends that Providing immunization to the newborn bays is one of the
bathing of the newborn be postponed for at least 6 hours if important area. The present study reveals that, almost all the
not 2 to 3 days after delivery14. In this present survey, >70% mothers have good awareness about immunization practices
of mothers said that the first bath should be given after the and they are getting information from the hospital itself.
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