INTRODUCTION:

“The future destiny of a Child is always the work of the Mother”

The birth of an infant is one of the most awe-inspiring and emotional events that can occur in one’s lifetime. After 9 months of anticipation and preparation, the neonate arrives amid of flurry of excitement. Immediately after birth the newborn must make rapid adjustment to successfully adapt to life outside the womb.

Health statistics show that worldwide about 4 million newborn babies die each year; another 4 million babies each year are stillborn; most die in late pregnancy or labour and most newborn deaths occur in developing countries. The same statistics show that about two-thirds of deaths in the first year of life occur in the first month of life. Eighty-five percent of newborn deaths are due to three main causes: infection, birth asphyxia, and complications of prematurity and low birth weight (LBW).

In India, an estimated 26 millions of children are born every year. As per census 2011, the children (0-6 years) accounts 13% of the total population in the country. An estimated 15.5 lakhs children die every year before completing 5 years of age. However, 79% of under-five child mortality takes place within one year of the birth which accounts nearly 11.6 lakhs infant deaths whereas 56% of under-five deaths take place within first one month of life accounting to 8.7 lakhs neonatal deaths every year in the country

Most maternal and neonatal deaths in developing countries happen at home, beyond the reach of health facilities. India contributes about 1 million new born and infant deaths to the global burden, and its infant mortality is 43/1000 live births globally. In India it is 53/1000 live births, in Karnataka 45/1000 live births, a high rate that has not declined much in the recent past.

Common danger signs in newborn require immediate care and accounts for high morbidity, These danger signs include poor or no sucking, lethargy or drowsiness, rapid or difficulty breathing, hypothermia and hyperthermia, yellow color of the palms and soles, abdominal distension, bleeding from umbilical cord, diarrhea loose stools or bloody stools, convulsion and vomiting. Most of the signs of illness in newborns are non-specific. Nurse need to know the danger signs of sick newborn. A nurse can explain these signs to mother or family member in a simple language so as to enable them to identify the danger signs and to seek early and prompt medical help.

WHO, 2003 Globally 4 million newborns die every year before they reach the age of one month. The primary causes of neonatal death are sepsis (52%) (which includes pneumonia, meningitis, neonatal tetanus and diarrhea), birth asphyxia (20%), prematurity (15%) and others (13%). However, the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) approach has attempted to provide a standard case definition of various neonatal morbidities.

UNICEF, 2011 MDG4 (Millennium Development Goal four), national leaders committed to reduce levels of child mortality in their countries to two-thirds by 2015. Between 1990 and 2009, child mortality has reduced globally from 89 to 60 per 1000 live Births. India has the highest number of births in the world and also accounts for over 20% of all child deaths.

Sample Registration Survey (SRS 2011) India has persistently high rates of newborn mortality over three lakh a year and accounts for 29 per cent of all first-day deaths globally. Figures, reported that Madhya Pradesh has the highest burden of early newborn deaths at 32, followed closely by Uttar Pradesh and Orissa (30). Kerala is the leader in reducing neonatal mortality by a wide margin, while Tamil Nadu, Delhi and Maharashtra too have bucked the national rate of 24.

According to SRS September, 2013 In Punjab infant mortality rate was 28. Newborn survival has become an important issue to improve the child health status and for achieving the millennium developmental goals. Neonatal health and survival is enhanced by providing essential newborn care such as cleanliness, thermal protection, 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.

As a nurse, the investigator has a pivotal role in creating awareness among postnatal mothers about how to identify the symptoms and bring about modification in order to prevent further complications of neonatal warning signs. As the incidence of neonatal warning signs is increasing, the investigator felt that learning package was an effective teaching strategy to impart knowledge to postnatal mothers regarding neonatal warning signs. So the researcher choose the study to assess the knowledge of postnatal mothers regarding neonatal warning signs.

OBJECTIVES:

1. To assess the pre test knowledge regarding neonatal warning signs among postnatal mothers in control group and experimental group.

2. To assess the post test knowledge regarding neonatal warning signs among postnatal mothers in control group and experimental group.

3. To compare the pre test and post test effect of knowledge regarding neonatal warning signs among postnatal mothers in control group and experimental group.

4. To find out the association between posttest knowledge regarding neonatal warning signs among postnatal mothers and selected socio demographic variables in control group and experimental group.

HYPOTHESIS:

H₀: The post test mean knowledge score regarding neonatal warning signs among postnatal mothers in experimental group was not significantly higher than post test mean knowledge score in control group.

H₁: The post test mean knowledge score regarding neonatal warning signs among postnatal mothers in experimental group was significantly higher than post test mean knowledge score in control group. (p<0.05 level of significance)

MATERIALS AND METHODS:

Research approach- Quantitative approach was used in the study.

Research design- Non equivalent pre test- post test control group design.

Research setting- Postnatal mothers in postnatal wards of selected hospitals Civil hospital, Ankur super speciality kids hospitals, Chawla nursing home of Jalandhar, Punjab.

Population- All postnatal mothers in selected hospitals of Jalandhar, Punjab.

Target population- It consisted of postnatal mothers in selected hospitals Civil hospital, Ankur super speciality kids hospital, Chawla nursing home of Jalandhar, Punjab.

Sample and sampling technique- Sample was postnatal mothers and convenient sampling technique was adopted to select sample in the study.

Sample size- The sample size comprised of 60 postnatal mothers. i.e. 30 in control group and30 in experimental group

Criteria for sample selection

Inclusion criteria:

Postnatal mothers who were:

1. Available in selected hospitals at the time of data collection.

2. Willing to participate in the study.

3. Able to understand Punjabi/ Hindi language.

Exclusion criteria:

Postnatal mothers who were:

1. Sick during the period of data collection.

2. Health professionals.

Variables:

Independent variable- Structured teaching program regarding prevention of neonatal warning signs.

Dependent variable- Knowledge regarding neonatal warning signs among postnatal mothers.

Selection and development of tool:

A tool is a vehicle that could obtain data pertinent to the study and at the same time it adds to the body of general knowledge in the Discipline.

Selection and development of Tool was done, based on the objectives of the study.

Section A: Socio-demographic variables regarding neonatal warning signs.

Section B: Self structured knowledge questionnaire to assess the knowledge of mothersregarding neonatal warning signs.

Section C: Structured teaching programme regarding neonatal warning signs.

Description of tool:

The tool was constructed to assess the knowledge regarding neonatal warning signs among postnatal mothers.

Tool was comprised of 3 sections:

Section A: This section included Socio-demographic variables that consisted of 10 items for obtaining information about selected background factors such as age of mothers, educational level, occupation, family income(per month), religion, number of children, type of delivery, place of delivery, type of family, place of residence.

Section B: This section consisted of 27 items of Self structured knowledge questionnaire for testing level of knowledge of postnatal mothers regarding neonatal warning signs.

Section C: This section consisted of nStructured teaching programme to provide knowledge regarding neonatal warning signs.

At the end of the teaching group will be able to:-

· Introduce Neonatal warning signs

· Define Neonatal warning signs

· Enlist Neonatal warning signs

· Elaborate alter thermoregulation

· Describe Neonatal Jaundice

· Enumerate Diarrhea

· Describe vomiting

· Discuss asphyxia

· Elaborate convulsion and poor sucking

Criterion Measures:

Criterion measures used in this study were as follows:

Assessment of knowledge:

There were total 27 items to assess the knowledge regarding neonatal warning signs among postnatal mothers. The maximum score was 27 and minimum 0.

Criterion measure for knowledge:

S.no	Level of knowledge	Score
1	Good	19-27
2	Average	Oct-18
3	Poor	00-09

Content validity of tool:

In this study content of tool was validated determined by various experts regarding opinion on the relevance of items. These experts were from the specialty of Child Health Nursing. The suggestions were incorporated after consultation with the research supervisor. The self structured knowledge questionnaire was finalized with 27 items for assessment of knowledge regarding neonatal warning signs among postnatal mothers. The self structured knowledge questionnaire translated into Hindi by language experts for the purpose of data collection.

Pilot study:

The pilot study was conducted on the minimum of 10% of the target population. The pilot study was started on 9/2/15 and end on 18/2/15. It was conducted on 12 postnatal mothers 6 in each experimental group and in control group.

Reliability of tool:

It is the degree of consistency or accuracy with which an instrument measures the attribute it is designed to measure. Reliability was obtained by test retest method and was calculated by Karl’s Pearson co-efficient of co-relation formula. The reliability of tool was 0.672, which indicated reliability.

Data collection procedure:

Data collection procedure of the study was carried out in the month of March 2015 in selected hospitals Civil hospital, Ankur Superspeciality Kids Hospital, Chawla nursing of Jalandhar, Punjab. Before collecting the data, investigator obtained permission from medical superintendent of hospitals. Data was collected from postnatal mothers and the sample size was 60 i.e 30 mothers in experimental group and 30 mothers in control group. The investigator had taken written informed consent from the mothers for participation in the study. Participants were assured that their responses would be kept confidential and used only for research purpose. Pre test knowledge of both groups was assessed by self structured knowledge questionnaire. A structured teaching programme on neonatal warning signs was given only to experimental group. Post test knowledge of both groups was assessed after seven days.

ETHICAL CONSIDERATION:

1. Ethical permission was taken from the Principal, S.G.L Nursing College, Semi Jalandhar, Punjab.

2. Written permission was obtained from the ethical clearance committee of S.G.L Nursing College, Semi, Jalandhar, Punjab.

3. Written permission was obtained from medical superintendent of selected hospitals of Jalandhar, Punjab.

4. Informed written consent was obtained from each postnatal mother.

5. Confidentiality and anonymity of each study sample was kept throughout the study.

Plan of data analysis:

Data analysis and interpretation of data was done according to the objectives of the study. Analysis was done by using descriptive and inferential statistic. Descriptive statistic used was Frequency, Percentages, Mean and S.D. Inferential statistics used were ‘t’ and ANOVA test.

MAJOR FINDINGS:

· 50% of postnatal mothers were between 26-30 years age group in experimental group and 47% were from 20-24 year age group in control group.

· 33% of postnatal mother were educated up to senior secondary in experimental group and 33% were qualified upto graduation in control group.

· 77% of postnatal mothers were unskilled both experimental group and 67% in control group

· 37% of postnatal mothers were having family income 15001and above in experimental group 30% in control group had monthly income upto Rs.5000.

· 50% of the mothers in were having two child and control group 47% were having only 1 child.

· 70% mothers in experimental group were had LSCS and 53% in control group were also had LSCS.

· 50% mothers in experimental group were had delivery at private hospital and 57% in control group were had delivery at government hospital.

· 70% of mothers in experimental group and in control group 63% were having nuclear family.

· 60% of mothers in experimental group and 73% in control group were belonging to Hindu religion.

· The pre test mean knowledge score of experimental group was 9.30 and post test was 17.63 and pre test knowledge score of control group was 10.73 and post test was 10.83.

· There was a significant increase in knowledge in experimental group than the control group. The calculated, t‟ value (20.159) is more than the table value so, the difference of post test mean knowledge score of experimental group was statistically highly significant at p<0.05.

· It was found significant association with the education level at the level of 0.05% level is 11.223, in occupation at the level of 0.05% level is 2.763, family income at the level of 0.05% level is3.221,place of delivery at the level of 0.05% level is 5.123 in experimental group.

· It was found significant association with the education level at the level of 0.05% level is 6.284 and in family income at the level of 0.05% level is 4.533 in control group.

ACKNOWLEDGEMENT:

My study is purely dedicated to my God and beloved parents.

REFERENCES:

1. Marlow DR. Redding BA. Text book of Pediatric Nursing. 6^thed. New Delhi: Elsevier publication 2007.

2. Integrated Management of Newborn and Childhood Illness: HEAT Module, http://labspace.open.ac.uk/mod/oucontent /view.php?id=452806

3. National health mission(NHM) ministry of health and family welfare: Government of india.2012,http://nrhm.gov.in/ nrhmcomponents/rmnch-a/child-healthimmunization.html

4. Gupta Piyush. Essential pediatric nursing.1^sted. New Delhi: A.P.Jain and co publication, 2004.

5. World Health Organization: Handbook IMNCI integrated management of neonatal and childhood illnesses. Geneva: WHO; 2003. WHO document WHO/FCH/CAH.

6. The vulnerable newborn: time we pay attention to them!. JNMA J Nepal Med Assoc Oct-Dec 2007;46(168): I-II.

7. Gurung G. Practices on immediate care of newborn in the communities of Kailali district: Nepal Med Coll J.Mar2008;10(1): 41-4.

8. United Nations Children’s Fund. State of the world’s newborns 2001. Washington, DC: Save the Children Publication; 2002.

9. SRS 2011, http://www.frontline.in/other/data-card/death-at-birth/article4749758.ece

10. SRS, September 2013. India Vital Statistics Division in New Delhi, Volume 48 NO.2.

Received on 22.09.2015 Modified on 19.10.2015

Int. J. Adv. Nur. Management 4(1): Jan. - Mar. 2016; Page 19-23

DOI: 10.5958/2454-2652.2016.00005.6