SUBMITTED BY:

MRS. UMI DEVI KANGJAM

I YEAR M.SC(NURSING),

Obstetrics and Gynecological Nursing

2009-2011 BATCH

SARVODAYA COLLEGE OF NURSING,

BANGALORE -560079

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / UMI DEVI KANGJAM,
I YEAR M.SC(NURSING),
SARVODAYA COLLEGE OF NURSING, 11/2 AGRAHARA, DASARAHALLI,NEAR RAHEJA APARTMENTS,MAGADI ROAD
BANGALORE-560079.
2. / NAME OF THE INSTITUTION / Sarvodaya College Of NursingBangalore- 560079.
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc nursing,
(obstetric and gynaecological Nursing)
4. / DATE OF ADMISSION OF THE COURSE / 27-05-2009
5. / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE KNOWLEDGE ON HOME CARE MANAGEMENT OF PRETERM BABIES AMONG WOMEN IN SELECTED HOSPITALS, BANGLORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET.”
6. / BRIEF RESUME OF THE WORK
6.0 INTRODUCTION
6.1 NEED FOR THE STUDY
6.1.1 STATEMENT OF THE STUDY
6.2 REVIEW OF LITERATURE
6.3 OBJECTIVES OF THE STUDY
6.3.1 OPERATIONAL DEFINITIONS
6.3.2 ASSUMPTION
6.3.3 HYPOTHESIS
6.3.4 SAMPLING CRITERIA
(I) INCLUSION CRITERIA
(II) EXCLUSION CRITERIA
(III) DELIMITATION / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / MATERIALS AND METHODS
7.1Sources of data: Data will be collected from women who are having preterm babies in selected hospitals, Bangalore.
7.2Method of data collection: Interview Method
7.3Does the study require any investigations of interventions to be conducted on the patients or other human being or animals? No
7.4Has ethical clearance been obtained from your institution?
YES. Ethical committee’s report is here with enclosed.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMAFOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MRS.UMI DEVI KANGJAM, I YR M.SC (NURSING)
SARVODAYA COLLEGE OF NURSING, 11/2 AGRAHARA DASARAHALLI,NEAR RAHEJA APARTMENTS,MAGADI ROAD
BANGALORE-560079.
2. / NAME OF THE INSTITUTION / Sarvodaya College Of NursingBangalore- 560044.
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc nursing,
(obstetric and gynaecological nursing)
4. / DATE OF ADMISSION OF THE COURSE / 27-05-2009
5. / TITLE OF THE STUDY / “A STUDY TO ASSESS THE KNOWLEDGE ON HOME CARE MANAGEMENT OF PRETERM BABIES AMONG WOMEN IN SELECTED HOSPITALS, BANGLORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”

6. BRIEF RESUME OF THE INTENDED WORK:—

6.0 INTRODUCTION:—

The health of a nation is the wealth of the nation. Today’s children are tomorrow’s adults. Birth is a major challenge to the newborn to negotiate successfully from intrauterine to extra uterine life. Newborn baby is considered to be tiny and powerless, completely dependent on others for life. Within one minute of birth the normal newborn adapts from a dependent fetal existence to an independent one; capable of breathing and carrying on life process. Thus these first hours are crucial because multiple organ systems are making the transition from intrauterine to extra uterine functions8.

The duration of normal pregnancy is usually nine months or 40 weeks. Any baby born before 37 completed weeks is called a preterm (premature) baby. The more preterm, more are the chances of complications and less the probability of survival. It goes without saying better the maturity better the survival. In India about 10 percent of babies are born premature. The incidence of prematurity is around 5 percent in the more developed countries.11

More than 1 million infants die each year because they are born too early. Worldwide, the pre-term birth rate is estimated at 9.6% - representing about 12.9 million babies. According to the White Paper, the highest pre-term birth rate in the world is found in Africa, North America and Asia as 11.9%, 10.6% and 9.1% respectively (Oct 5th, 2009)9.

The rate of premature birth is rising. According to the March of Dimes, about 12% of babies born in the USA are born pre-term. Among the babies born pre-term 84% are born between 32-36 weeks of gestation, about 10% are born between 28 and 31 weeks of gestation, and about 6% are born at less than 28 weeks of gestation.13

At the recent Annual Conference of the Neonatology Forum (NNF) on 17th and 18th November 2007 in Bangalore, leading members of the 300 participants decided to take on a mission to save newborns in the state of Karnataka. It states that Karnataka would come next with a neonatal mortality of above 40 per thousand live births.10

According to White Plains, 60% of all neonatal deaths and 68% of the world’s burden of perinatal death occur in Asia. Almost 98% of these deaths occur in developing countries and most are caused by infectious diseases such as sepsis, complication of prematurity and birth asphyxia. Between 40% to 70% of all neonatal deaths occur among those weighing less than 2500gm at birth.2

In the India multicentric Neonatal Health Research Initiative (NHRI) study, the causes of neonatal deaths as per verbal autopsy were respiratory distress syndrome (57%), low birth weight (51%), prematurity (29%) and jaundice (4%).15

Preterm birth is a growing National health crisis, according to the March of Dimes. More than a half million babies are born to soon each year, and the rate continues to rise. Birth defects and preterm birth are the leading causes of infant death. About 8% of babies born premature had a birth defect, according to the research by a team of investigator March of Dimes.14

Approximately 70% of neonatal mortality and 75% of morbidity results from prematurity. Most pre-term birth occur after premature rupture of membranes. Prematurity accounts for the largest numbers of admission to an NICU. The highest incidence is in lower socio –economy group.

The National Rural Health Mission (NRHM) in India has set the objective of reducing IMR to 30 per 1,000 live births by 2012. Achieving this objective will require a reduction in newborn deaths of over 50 per cent in less than a decade.24

6.1 NEED FOR STUDY:—

Babies who are born preterm or small for gestational age are often at higher risk for morbidity and mortality then are full term babies with normal birth rate. Preterm births account for 75% of deaths that occur in the perinatal period (Goldenberg et al. 2008).16

Every year nearly 40% of all under 5 child deaths are among newborn infants. The majority of neonatal deaths (75%) occur during first week of life, and those deaths between 25% to 45% occur within the first 24 hrs. Prematurity and low birth weight account for 30% (WHO Geneva, 2008).

About 91% of neonatal deaths occur in developing countries. Out of that 27% are due to prematurity. Most deaths occurring during the first 48hrs after birth result from respiratory distress. Pre-term birth occurs in approximately 7% of life births of white Infants. Pre-term infant deaths account for 80% to 90% of infant mortality in the first year of life. (NVSS, 2009)1

Each year in India over 1 million newborns die before they complete their first month of life, accounting for 30% of the world’s neonatal deaths. Neonatal mortality is higher in rural areas at 49 per 1000 life births. The neonatal mortality rate varies considerably among Indian states. Orissa and Madhya Pradesh have the highest neonatal mortality rate of 61 and 59 per 1000 life birth respectively.3

Conducted a neonatal morbidity study in 7015 neonates born at the All India Institute of Medical Sciences Hospital, New Delhi. The incidence of low birth weight babies was 26.7%; one seventh (13.5%) of the series were preterm (less than 37 weeks), while 6.6% were 'small-for-dates'. Birth asphyxia of varying severity developed in 5.9% infants. Respiratory distress syndrome was diagnosed in 5.7 per 100 live-births; most being due to hyaline membrane disease (33.5%), which affected 14.1% of preterm babies. Neonatal hyperbilirubinemia occurred in 5.9%, most of whom were premature.21

Preterm birth is the major cause of neonatal mortality in developed countries. Premature birth is a serious health problem. Premature babies are at increased risk for newborn health complications, such as breathing problems, and even death. The shorter the term of pregnancy, the greater the risk of mortality and morbidity for the baby due to the related prematurity. Prematurity is a major reason why babies are born sick and suffer disabilities. It is the number one cause of newborn death (Klebu, March of Dimes volunteer, Nov 2009). Most premature births are caused by spontaneous preterm labor, either by itself or following spontaneous premature rupture of the membranes (PROM)19.

The Mother Kangaroo Method is an important model of cost-benefit ratio which improves the survival rate and quality of life of premature infants. The continuous skin to skin contact helps the infant maintain adequate body temperature and stimulate the development of a close emotional bond between mother and child. Love, warmth and maternal lactation are the essence of the Mother Kangaroo Method20. In a study of three continuous hours of Kangaroo care for preterm babies, it is found that apnoea, bradycardia, and periodic bleeding were absent during Kangaroo care. Regular breathing increased for babies receiving Kangaroo care compared to babies receiving standard NICU care (Ludington- Hoe et al).18

By recognizing the susceptibility of the premature baby from its immunological system’s vulnerability, mothers prevent infections with visit restriction, utensil care and vaccination. Restricting visitors is a measure that contributes to prevent infections. Thus parents must prevent their child from coming into contact with people with a cold or flu. They must explain to the visitors that they will have plenty of time to visit the child as it is staying at home, so they do not need to gather together.Some of the home measures to prevent home infections of preterm babies were hygiene habits at home such as general cleaning, and care for the newborn such as hand washing to change the baby’s clothing and hygiene during food preparation. (BALBINO)25

6.1.1 STATEMENT OF THE PROBLEM:—

“A study to assess the knowledge on home care management of preterm babies among women in selected hospitals, Bangalore with a view to develop an information booklet”.

6.2 REVIEW OF LITERATURE:—

The literature for the present study is organized or presented under the following headings:-

  1. Studies related to incidence on preterm babies.
  2. Studies related to home care management of preterm babies.

Studies related to incidence:-

In a random sample of 4,719 women who gave birth in Western Australia, the incidence of preterm birth was highest amongst women who binged (9.5%) or drank heavily, even if the mother stopped drinking prior to the second trimester (13.6%), compared with less than 6% in women who did not drink during pregnancy. There was a 2.3-fold increased odds of preterm birth in women who drank heavily in early pregnancy but then stopped after taking into account maternal smoking, drug use, socioeconomic status and maternal health. Researchers suggest that a possible reason why this occurs is because the cessation of alcohol consumption before the second trimester may trigger a metabolic or inflammatory response resulting in preterm birth. There was no evidence of an increased likelihood of preterm birth at low levels of alcohol consumption.7

The incidence of preterm births in India is estimated to be 11–14%. In a database of 1,45,623 live births collected from 18 hospitals, 14.5% of babies were premature (NNPD 2002–03). This means that India has an annual incidence of 3 to 4 million preterm live births which is a huge number. Even in developed countries, there is often uncertainty of incidence of prematurity and incomplete recording of gestational assessment. The incidence of preterm births in most developed countries has been about 9–12%.5

The study correlates the mode of breech delivery to the immediate neonatal outcome in preterm breeches. Among 9816 deliveries the incidence of breech deliveries was 3.95% and the incidence of preterm breech deliveries was 1.9%. Totally 112 (69%) patients delivered vaginally and 50 (31%) underwent caesarean section. Between 30-36.6 weeks gestation the incidence of birth asphyxia was higher in the vaginal group. In this group the take home baby rate after vaginal delivery was 81% as compared to 86% in caesarean group.6

Studies related to home care management:-

An article was written on the effectiveness of the kangaroo position or direct skin contact as a method for obtaining an adequate temperature of the newborn (WHO 1986). Results shown that for a 2000 gms baby, in an environment at room temperature, direct skin contact is much better than the warmth provided by a thermal blanket, incubator with hot water mattress, or a common incubator. The kangaroo position allows babies to be isolated from infections and mother to keep close watch.

A study to determine the effects of kangaroo care (KC) (skin-to-skin contact) on breastfeeding status in mother-preterm infant dyads from postpartum through 18 months. The control group received standard nursery care; in the intervention group, unlimited KC was encouraged. A subsample of 66 mothers and their preterm infants (32-36 completed weeks gestation, 1,300-3,000 g, 5 minute Apgar > or = 6) who intended to breastfeed. Breastfeeding status at hospital discharge and at 1.5, 3, 6, 12, and 18 months as measured by the Index of Breastfeeding Status. KC dyads, compared to control dyads, breastfed significantly longer23.

In an observational study, there were total 81 babies eligible for Kangaroo Mother Care with birth weight of 1363.4gms and gestation of 30.5weeks. KMC was provided by father in 24 cases. The duration of KMC given by father was 2.8 hours per day. Mean temperature of baby during KMC was 36.9degree celsius. No baby suffered hypothermia or hyperthermia during KMC.26

A study in India on the effect of massage with oil on preterm babies growth showed that a four week daily regiment resulted in significant weight gain. In this randomized controlled trial, 62 preterm neonates weighing less than 3.3 pounds were assigned to 3 groups- massage with oil, massage without oil and no massage. Subjects in the oil- massage group gained an average of 0.8 pounds. Subjects in the massage- only and no- massage group gained an average of 0.638 pounds and 0.627 pounds respectively. It is found that oil application may have a potential to improve weight gain.4

The use of human milk for premature and other high risk infants either by direct breast feeding and / or using the mother’s own expressed milk is recommended by the AmericanAcademy Of Padiatrics. Feeding human milk to preterm infants provide nutritional, gastrointestinal, immunological, developmental, and psychological benefits that may impact their long term health and development. Human milk is advocated as the nutrition for preterm baby because it provides substances not supplied in formula.22

6.3 OBJECTIVES OF THE STUDY:—

1. To assess the knowledge regarding home care management of preterm babies among women.

2. To identify the association between knowledge regarding home care management of preterm babies and selected variables.

3. To develop information booklet on home care management of preterm babies.

6.3.1 OPERATIONAL DEFINITIONS:—

1. KNOWLEDGE— Refers to the awareness of women regarding home care management of preterm babies as assessed by the responses to items of the knowledge questionnaires.

2. HOME CARE— It refers to the care that can be practiced in home setting to maintain temperature, improve weight gain, infection prevention by the mother.

3.PRETREM BABIES— Refers to the babies born before 37 weeks of gestation with birth weight of less than 2 kg.

4. WOMEN— It refers to the women who are having preterm babies.

5. INFORMATION BOOKLET— It refers to an organized written materials which contain about the meaning, causes, clinical manifestations, and home care management of preterm babies.

6.3.2 ASSUMPTION:—

The women may have lack of knowledge regarding home care management of preterm baby.

6.3.3 HYPOTHESIS

There is no significant association between knowledge and selected demographic variables of women regarding homecare management of preterm babies.

6.3.4 SAMPLING CRITERIA:—

INCLUSION CRITERIA

  • Who are willing to participate in the study.
  • Who are available at the time of data collection.
  • Who can read and speak Kannada or English.

EXCLUSION CRITERIA

  • Women who had still births or neonatal deaths.

6.3.5 DELIMITATION

  • The study is delimited to VanivillasHospital and SriLakshmiHospital, Bangalore.
  • The study is delimited to 4 weeks.

7. MATERIALS AND METHODS:—

7.1 SOURCE OF DATA

Data will be collected from women who are having preterm babies in selected hospitals, Bangalore.

7.2 METHOD OF DATA COLLECTION:--

1. RESEARCH APPROACH— Exploratory approach

2. REASERCHDESIGN— Descriptive study.

3.SETTING—It is selected in VanivillasHospital, and SriLakshmiHospital, Bangalore.

4. POPULATION--- All women who delivers a preterm baby.

5. SAMEPLE---- Womenhaving preterm babies

6. SAMEPLE SIZE— 60

7.SAMEPLING TECHNIQUE— ConvenientSampling technique

8. METHOD OF DATA COLLECTION— Interview method

9. TOOL FOR DATA COLLECTION— Structured questionnaire

10. METHOD OF DATA ANALYSIS ANDINTERPRETATION— The researches will use appropriate statistical technique for data analysis and present in the form of tables and diagrams.

  • Knowledge will be analyzed by frequency and percentage distribution.
  • Level of knowledge will be analyzed by mean and standard deviation.
  • Association between demographic variables and knowledge on home care management of preterm babies will be analyze by chi square test.

11. DURATION OF THE STUDY— 4 weeks.

12. VARIABLES—

Research Variable

  • Dependent variables: - knowledge on home care of preterm babies.

Demographic variables:-

  1. Age.
  2. Educational qualification
  3. Occupation
  4. Types of family
  5. Income
  6. Parity
  7. Previous history of preterm babies
  8. Previous source of information
  9. Baby born at -

PROJECTED OUTCOME— The information booklet will enhance the women’s knowledge on home care management of preterm babies. The women will develop skills and practice in caring preterm babies at home.

7.3Does the study require any investigation or intervention to be conducted on patient or other animal?

—No

7.4Has ethical clearance been obtained from your institution?

— Yes, ethical committee clearance is enclosed herewith.

8.0 LIST OF REFERENCES:—

1)Adele Pillitteri. Maternal and Child Health Nursing 6th edition. Philadelphia. J.B. Lippincott Williams & Wilkins. 2009. 711-712..

2)Hans Troedsson and Jose Martines. Introduction to Meeting. The Journal of Perinatology. 2002; 22,35-39. Available from URL:

3)Kumar D, Verma A, Sehgal UK. Neonatal Mortality in India. From Rural and Remote Health 7( Online ) 2007; 833. Available on URL:

4)4)Jyoti Arora, Ajay Kumar and Siddharth Ramji. Massage with oil improves weight gain in preterm babies. Published in Indian Pediatrics. Nov. 17.2005; Vol.42.AvailablefromURL: