PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION PROPOSAL
TOPIC: A DISCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF ANTENATAL MOTHERS REGARDING NEONATAL TATENUS, ITS PREVENTION AND MANAGEMENT IN SELECTED GOVT HOSPITALS AT TUMKUR ,WITH VIEW TO DEVELOP AN HEALTH INFORMATION GUIDE SHEET.
SUBMITTED BY
MS. SONSY JOE
1st YEAR M.Sc. NURSING,(2011-2013)
OBG NURSING,
SHRIDEVI COLLEGE OF NURSING, TUMKUR-572 106
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGLORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF
SUBJECS FOR DISSERTATION
1 / NAMEAND ADDRES OF THE CANDIDATE / Ms.SONSY JOEFIRST YEAR M.Sc NURSING
SHRIDEVI COLLEGE OF NURSING
TUMKUR-572106
KARNATAKA.
2 / NAME OF THE
INSTITUTION / SHRIDEVI COLLEGE OF NURSING,
TUMKUR
KARNATAKA.
3 / COURSE OF STUDY AND SUBJECT / FIRST YEAR M.Sc. NURSING,
OBG NURSING.
4 / DATE OF ADMISSION
TO COURSE / 01-10-2011
5 / TITILE OF THE TOPIC / A DISCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF ANTENATAL MOTHERS REGARDING NEONATAL TATENUS,ITS PREVENTION AND MANAGEMENT IN SELECTED HOSPITALS AT TUMKUR ,WITH VIEW TO DEVELOP AN HEALTH INFORMATION GUIDE SHEET.
6. BRIEF RESUME OF THE INTENTED WORK
INTRODUCTION
“Safe practices, saves life”
A new life begins at moment of fertilization, Good health depends on a part a safe environment practices or techniques that control or prevent transmission of infection helps to protect persons and health care workers from disease. In all health care settings are at risk for acquiring infections because of lower resistant to infectious micro organisms. By practicing infection prevention and control techniques, the nurse can avoid spreading micro organisms. Health care workers can protect themselves from contact with infectious material or exposure to a communicable disease by having knowledge of the infectious process and appropriate barrier protection. (1)
Baby is a marvel of mothers creation so mother have to learn how to take care of it. The hall mark nursing is to promote quality of life. Although this particular case occurred in an infant whose mother did not have adequate protection against tetanus (The mother apparently was not vaccinated), other (Such as infants, the elderly, or the immune -compromised) may be at risk because of poor protective antibody titers against tetanus. Infection by other micro organisms present in soil is also possible. Prudent health practices indicate that care be exercised in the use of any topical agent that is applied to a wound or otherwise abnormal skin surface because of the potential for contamination, infection or systematic absorption. This advice is particular relevant to those with weakened immune systems, who are at increased risk for such infections.
Neonatal Tetanus is an important endemic infection, in India. Behaviour such as hand washing, delivery practices, traditional birth customs and interest in immunization, are all important factors affecting the disease incidence. (2)
District are being classified in to three categories depending on neonatal tetanus incidence rates, immunization coverage levels in pregnant women with two doses or a booster dose of tetanus toxoid vaccine and proportion of clean deliveries by trained personnel. (2)
Till recently the tetanus neonatorum accounted for 6.5% of deaths in infancy in India. Every year nearly 230-280 thousand infants used to die with in first month of life due to neonatal tetanus, effective implementation of public health measures have reduced the incidence of tetanus neonatorum contamination and infection of the umbilical stump of the time of cutting the cord is an important cause. The condition is limited to domicilary midwifery, as untrained dais use un clean, sharp weapons to cut the umbilical cord. The first symptom being seen about the 7th day, Therefore tetanus is known as “8th day disease” and its most common in Punjab. In any country where hygiene is poor, neonatal tetanus may be common. (3)
Neonatal tetanus or “tetanus neonatorum” is a tetanus infection of the new born baby. The infection is usually caught from another infected person or else in the environment and enters the body through a wound such as the umbilical stump of the circumcised region. (11)
The preventive measures in the areas of high risk are being accelerated to reduce the number of cases. In areas considered at low risk, the surveillance system is being sensitized to ensure that no case is missed. A district classification has therefore been suggested so that area-specific action oriented measures could be taken and the progress monitored. (2)
Neonatal tetanus is one of the causes of avoidable morbidity and mortality. In the past this disease was over looked by the health services of many developing countries, but recently the extent and magnitude of neonatal tetanus has become clearer and shown. It is a very serious health problem in the developing countries. The results of community-based surveys show that neonatal tetanus mortality rates rage from less than 5 to more than 60 per 1000 lives births, these deaths represents between 23% and 72 % of all neonatal deaths. The results so far suggest that this disease claims the lives of over half a million new born children every year.(4)
Communicable diseases are more influencing in our country, because of over population and also lack of knowledge to people about communicable disease. In these communicable diseases tetanus is one of the bacterial infectious disease. It is an acute disease induced by the exotoxin of clostridium tetani and clinically characterized by muscular rigidity which persists through out illness punctured by painful paroxysmal spasm of the voluntary muscles. Especially the masseters (lock jaw) the facial muscles. The muscles of the back and neck (opisthotonous) and those of the lower limbs and abdomen.(5)
6.1 NEED FOR THE STUDY
Tetanus is an acute, often fatal, disease caused by an exotoxin produced by clostridium tetani. It occurs in new born infants born to mothers who had not have sufficient circulating antibodies to protect the infant passively, by Tran placental transfer. To assess the effectiveness of tetanus toxoid, administered to women of child bearing age or pregnant women, to prevent cases of and deaths from neonatal tetanus. Randomised or quasi randomised trials evaluating the effects of tetanus toxoid in pregnant women or women of child bearing age on neonatal cases and deaths. Available evidence supports the implementation of immunization practices on women of child bearing age or pregnant women in communities with similar or higher levels of risk of neonatal tetanus to the two study sites. (6)
The neonatal tetanus rates as a percentage of all neonatal deaths for the rural agricultural and rural agricultural and rural cattle and horse raising areas were higher (60% and 73%) than for the urban slums (45%). The village barber circumcises male infants on or before the 7th day of life. Therefore the total ratio of male deaths to female deaths was 1.6 most males died during the last 3 weeks at the 1st month which can be attributed to circumcision. Overall most deaths occurred between 4-19 days. None of the mothers interviewed had been vaccinated with a tetanus toxoid during pregnancy which greatly contributed to the neonatal tetanus mortality rate. (14)
According to “WHO” is a worldwide occurrence. It is a health problem in India. It is more prevalent in rural areas than in urban areas. Tetanus causative agent is clostridium tetani mainly it is present in the soil, cow dung and environment. Tetanus may occure after any injury. The spores bearing organism in the body introduced by applying various talcum powders.mainly due to lack of knowledge and negligence. Behaviour such as handwashing, delivery practices, traditional births, customes and interest in immunization are all. Important factors affecting the disease incidence. Prior national program an estimated 3.5 lakhs children died annually due to neonatal tetanus cases were overted.(7)
In late 2005, Nepal demonstrated through surveys that it has reached the WORLD HEALTH ORGANIZATION criterion for having eliminated neonatal tetanus i.e., neonatal tetanus cases occurred at a rate of less than 1 per 1000 live births in every district. Neonatal cases had decreased substantially by 1999, but the final push was provided through the national TT supplemental immunization activities in 2000-2004 which raised the proportion of children protected at birth against tetanus to above 80%. It is likely that a number of cases still occur without being reported, particularly in rural areas.(8)
The diagnosis at death due to neonatal tetanus was made on the basis of the flowing criteria. The child cries and sucks during the first two days after birth. Failure to such between the 3rd to 14thday after birth. In the urban and rural samples in the 2 regions, 23,566 house holds were visited, representing 12% of the tatal population in these areas. A total study population 9623 live births and 206 neonatal deaths were reported, 140 males (68%) and 66 females (32%). In the total study population 66 deaths from neonatal tetanus deaths represent 32% all neonatal deaths. The mean age at onset of the disease was 6 days. 77% of the neonatal tetanus cases and 55 % of deaths due to other causes were delivered by untrained staff. In the study area nearly 90% of all deliveries occur at home.(9)
One of the most encouraging signs at our times in the awakening of the mother to the needs and rights of children, since mother is the first teacher of the child, mother has to play a key role in the treatment of the child while cleanliness to the umbilical cord, as they do not require any hospitalization and are totally preventable and curable.
Though the government administrates tetanus toxoid vaccine to the mother through the various MCH programmes in all over India but still, especially in slums and certain remote areas the mothers are unaware of the importance of tetanus toxoid vaccination which leads to increase the incidence of neonatal tetanus.
Health education is the process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health regarding neonatal tetanus. Hence the investigatore has planned to take up a study to impart and knowledge to mothers of the children with regard to selected Neonatal tetanus in selected areas of TumkurDirstict.
6.2 REVIEW OF LITERATURE
The purpose of review of literature is to obtain comprehensive knowledge base and in department of information from previous studies.
J Ambe (2010)Astudy was conducted by while cord care practices vary from place to place, some of can be harmful to the new born, with the help of medical students during their rural posting, a structured questionnaire was administered to 400 mothers with particular reference. The traditional practices of cord care in this area include application of hot fermentation (31.5%), use of rag and lantern (19.5%) use of powder (6.5%) and red sand (3.5%) use of Vaseline (9.5%) as ash/charcoal (9.3%). These practices are often harmful, because these substances are often contaminated with bacteria and spores, thus increasing risk of infection. Very few mothers / care givers use saline water (2.0%) use spirit (8.5%) while in a few the cord is left alone today on its own (1.5%). This will go a long way in reducing the morbidity and mortality in the newborn.(13)
Dikici B. et al. (2009) The study to describe neonatal tetanus in Turkey aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the pediatric infectious diseases ward of Dicle university hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may be contribute to the elimination of the disease in Diyarbakir patient were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the decade efforts including appropriate health education of the masses, ensurement of access to antenatal services and increasing the rate of tetanus immunization among mothers still should be made our region to achieve the goal of neonatal tetanus elimination. (14)
Roper M.H. et al. (2008) Maternal and neonatal tetanus are important causes of maternal and neonatal mortality, claiming about 1,80,000 lives world wide. Although easily prevented by maternal immunization with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical cord care practices, maternal and neonatal tetanus persist as public-health problems in 48 countries. The ultimate goal of this initiative is the world wide elimination of maternal and neonatal tetanus. Since tetanus spores cannot be removed from the environment sustaining elimination will require improvement to presently inadequate immunization and health-service infrastructures, and universal access to those services. (15)
Ogunlesi T.A. et al (2007)A study was conducted by neonatal tetanus at the close of the 20th century in Nigeria. Thus records of neonates admitted between 1996 and 2000 into the Wesley Guild hospital. Ilesa, were analyzed of 3051 total neonatal admissions, 162 (5.3%) had Neonatal Tetanas. The majority (66.7%) of them delivered at home or churches and others at either private clinics or primary health centres. Overall, the case fatality rate was 43.8%, though it was significantly higher among babies whose mothers had neither clinic based ANC [odds ratio or = 2.62 ; 95% confidence interval (CI) = (1.33-5.18)] nor antenatal tetanus toxoid vaccination (or = 2.41; 95% CI= 1.17-5.03). (16)
Rachel A Haws (2007) A study was conducted by studies employing more than one biologically possible neonatal health. Intervention and reporting neonatal morbidity or mortality out comes were included. We found studies that implemented packages at interventions and reported neonatal health outcomes. Intervention appeared largely bundled out of convenience or funding requirements, rather than based on anticipated synergistic effect, like service delivery mode or cost effectiveness data. The foundation more guiding effective implementation of public health programmes addressing neonatal health.(17)
R S Oruamabo (2007) A study was conducted by the 130 million babies born annually globally, 4 million (3.1%) die within the first 4 weeks of life. In Nigeria, Of the 5 million babies born annually 240000 (4.8%) die within the first 4 weeks of life. Globally tetanus accounts for 7% of these neonatal deaths, but accounts for up to 20% in Nigeria, one of 27 countries that account for 90% of the global burden of the disease. One of the oil producing states at Nigeria 30-50 patients with neonatal tetanus are admitted annually, most of them are full term normal sized babies 9-11 this review highlights some of the reasons for the persistently high incidence of NNT in Nigeria and examines options for reduction within the context of millennium development.(18)
Gitta SN, et al. (2006)A study was by risk factors neonatal tetanus. To understand the reasons for this high incidence, a study was conducted to identify neonatal tetanus risk factors. During March-May 2004, a matched case control. Study was conducted in the Busoga region for a 2 year study period (2002-2003). A total 24 cases at Neonatal Tetanas (according to the WHO case definition) were identified from hospital records and 96 community controls (children who survived the neonatal period) were selected. These findings underscore 2 doses of tetanus toxoid during pregnancy. Implementation of these measures might help eliminate. Neonatal tetanus from the Busoga region of Uganda. (19)
Basu (2006) A study was conducted by the neonatal tetanus a preventable disease, remains an important cause of infant mortality in developing countries such as India. Clinical data of neonatal tetanus in North Bengal, India and determine the risk factors for mortality. The overall mortality was 66.3%. The group who survived had a significantly greater mean body weight on admission, later onset of the disease and were hospitalized early. Although over 7 years improvement was observed in admissions for Neonatal Tetanus, maternal literacy and the economic status of families, there is a persisting lack of awareness regarding antenatal care and deliveries are still conducted unhygienic ally by untrained persons.(20)
Bhuttaza et al (2005)A study was community based interventions for improving perinatal and neonatal health outcomes in developing countries. Infant and under 5 child hood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. But this may be unattainable without halving newborn deaths, which now compare 40% at all under 5 deaths. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health. The review offers compelling support for using research to identify the most effective measures to save new born lives. It also may facilitate dialogue with policy makers about the importance of investing in neonatal health.(21)
Abhay T Bang MD (2005) A study was neonates die in rural Gadchirali. India primary causes of death assigned by neonatologist based on prospectively observed records in the first year (1995 to 1996) of the field trial in Gadchirali, India. Trained village health workers observed neonates in 39 villages by attending home deliveries and making eight home visit during 0 to 28 days. A total of 763 neonates were observed of whom 40 died (NMR 52.4/1000) the primary causes of death were sepsis/pneumonia 21 (52.5%), asphyxia 8 ( 20%), prematurely <32 weeks 6 (15%), hypothermic 1( 2.5%) and other / not known 4 (10%) most of the rematurity or asphyxia deaths occurred during the first 3 days of life. The infections causes a larger proportion of deaths in neonates in the community compared to the reported proportion in hospital based studies.(22)
Demicheli (2005) A study was conducted by vaccines for woman to prevent neonatal tetanus. To assess the effectiveness of tetanus toxoid, administered to women of child bearing age or pregnant women to prevent cases of deaths from neonatal tetanus randomized or quasi – randomized trails evaluating the effects of tetanus toxoid in pregnant women or women of child bearing age of number of neonatal tetanus cases and deaths. In preventing deaths at UTO 14 days the RR was 0.38 ( 95% CI 0.27 to 0.55) and vaccine effectiveness was 80%. Another study involving 3641 children asseswsed the effectiveness of tetanus diphtheria toxoid in preventing neonatal mortality after on or two doses. The RR was 0.68 vaccine effectiveness was 32% in preventing deaths and vaccine effectiveness 62%. Available evidence support the implementation of immunization practices on women of child bearing age or pregnant women in communities with similar or higher levels of risk of neonatal tetanus to the two study sites. The review of studies assessing vaccinating women of child bearing age showed fewer. Cases of NT when two or three doses were used, but no potential adverse effects were assessed. Administrative and operational aspects also need to be of good quality for vaccination programme to be effective.(23)