6

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SOBANA A.R

M.Sc NURSING, 1st YEAR

OBSTETRICS AND GYNAECOLOGICAL NURSING

YEAR 2010-12

DHANWANTARI COLLEGE OF NURSING

No.41/3, VINAYAK NAGAR, HESSARGHATTA ROAD,

CHIKBANAVAR,

BANGALORE – 560 090.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.

Name of the Candidate and Address

Mrs. SOBANA A R.

I year M.Sc , Nursing,

DHANWANTARI college of nursing, bangalore - 560 090.

2.

Name of the Institution

Dhanwantari college of nursing, bangalore – 560 090

3.

Course of Study and subject

M.Sc. (Nursing)

Obstetric and gynaecology nursing

4.

Date of Admission Course

01/06/2010

5.

TITLE OF THE TOPIC

KNOWLEDGE OF THE MOTHERS REGARDING CARE OF LOW BIRTH WEIGHT BABIES

5..1

STATEMENT OF THE PROBLEM

“A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATIONAL BOOKLET ON KNOWLEDGE OF MOTHERS REGARDING CARE OF LOW BIRTH WEIGHT BABIES IN SELECTED HOSPITALS AT BANGALORE, KARNATAKA.”

6.BRIEF RESUME OF INTENDED WORK

6.1. INTRODUCTION :

Today’s healthy children are tomorrow’s healthy citizens. The health of a child is basically placed in the hands of parents as children nourish under the care of their mothers .Parenthood is one of the precious gift in the human life from which one can realize happiness, contentment & constant motivating force of the life. Aspirants’ parents have a lot of expectations regarding appearance, activities, growth and development of their offspring.

Healthy development of children is an investment in national development and productivity so the problem of this important group needs special care and attention. Little wonder that development of awareness of the new born care and lessening of infant mortality rates

As Nehru said (1960) that children’s are the future of tomorrow’s India. To give them happy healthy children, we must safeguard their total health right from the beginning.

Common complications of low birth weight babies is continuously like respiratory difficulties, body temperature regulations, digestion problem, renal function, infection and circulatory disorder. The causes of LBW baby is due to maternal diseases, recurrent urinary tract infection, and low nutritional status.1

An increasing no of studies across the global over the past 2-3 decades have witnessed prevalence rate Low birth weight baby as one weighing less than 2.5 kg at birth , irrespective of gestational age and the term , ‘Premature’ be used only for infants less than 37 weeks after beginning mother’s last menstrual period(WHO)2

New born less than 2500 gm at birth are termed as low birth weight . Low birth weight are broadly of two clinical types. First are those who are born before 37 weeks ( pre term ,low birth weight ), pre term baby is expected to have less in weight secondary category of low birth infants those babies who have intrauterine growth retardation. These babies are undernourished for given gestation( dates). They are, therefore called small for gestation age ( Ghai O. P 2002)3

Low birth weight is a major public health problem in many countries ( i.e. birth weight less than 2500 gm ). The incidence about 30 % of babies born in India are low birth weight as compared to 4% in some developed countries. In countries where the proportion of low birth weight is high, the majority of suffering from foetal growth retardation. Maternal malnutrition and anemia appear to be significant risk factors in the occurrence. Among the other causes of low birth weight is short maternal stature , very young age ,smoking, less birth interval are all associated factors . The birth weight is an indicator which gives us an idea about the quality of life, the socio economic status, health awareness ,nutritional status of the community. The birth weight in all population groups is the single most determinants of the chances of new born to survive and experience normal growth and development4

Infant mortality rate is related to illiteracy particularly female illiteracy . Mothers can save the lives of their infants if they can recognize the illness and apply prompt remedial measures for common health problems even at home . Mother is guardian of the child’s health .Mothers role is highlighted because she is the child’s initial protector during the period of 1/5 most rapid physical growth. Health promotion of the infants is done by the fulfillment of physical and physiological needs.5

Low birth weight babies can be managed at the time of antenatal period .Many mothers go on to enjoy near normal life if their babies were properly managed. Early intervention is important ,especially for the management of feeding, handling, cleanness, prevent from the infection. Mothers knowledge about their care of baby reflects the health and nutritional status of the baby.

Nurses play the significant role in empowering the mother of LBW with reliable method of management. Planned teaching and counseling of mothers of LBW babies by nurses may help the mother to get relieved of their worries and to join hands with the nurses in care of low birth weight babies.

6.2 NEED FOR STUDY:

A country’s destiny lies in its future

A future that relies on coming generation

Made up of children and youth.

These children rely on us to give them opportunities.

To grow and lead healthy lives.

Learning never ends in the life rather it continues throughout the life period. There is always something to learn. The birth of a child, heralded by its shrill cry, is something every parent looks forward to. For the construction of a strong building a strong foundation is needed. A child can never remain stable if he is built on the sand of inadequate and improper practice and who have been reared by mother having inadequate knowledge 6

Low birth weight is the most prevalent and dominant factor for infant mortality and childhood development disorders, making it an important target for improvement efforts. Research has shown that LBW results from interactions between the biological determinants of the mother and the foetus; the parents’ social milieu and the effectiveness of medical care during the preconception, prenatal period, and those interactions are complex and poorly understood. (Thompson Lindsay A.et, a, 2005).7

In spite of consistent efforts to improve the quality of maternal and child health ,more than 20 million Low birth weight babies (LBW) are ban every year throughout the world. Half of all Perinatal &1/3 of all infants deaths are directly or indirectly related to low birth weight babies It is generally acknowledged that the etiology of LBW is multifactorial. Most of an knowledge of the factors which affect the birth weight of the offspring has been derived from hospital based studies which are associated with inherent babies . It has been emphasized that a community based retrospective study would leep to define exact role of various factors affecting birth weight. With this background & fortified by the fact that limited number of community based retrospective studies are available .This study was undertaken to define the extent of LBW problem in an urban area & investigate the maternal factors associated with this condition.8

According to WHO estimated Low birth weight babies at birth, continues to remain a major public health problem in India, where most pregnant women have little or no antenatal care. The magnitude of low birth weight infant in developing world id enormous out of a total of 22 million such infants in the world, 21 million belong to developing countries. In developing countries intra-uterine growth retardation (IUGR) accounts for over 2/3 of all low birth weight. The aim is to reduce low birth weight pregnancy from the present level of 30% to 10% by 2000A.D.2

INCIDENCE OF LOW BIRTH WEIGHT BABY IN GLOBALLY.

Countries

percentage

Year

United states

12 %

2007-2008

India

30%

2008

Nepal

21.6%

2008

INCIDENCE OF LOW BIRTH WEIGHT BABY IN STATES.

States

Percentage

Year

Kolkata

28.6%

2008

Ahmadabad

61.2%

2008

Punjab

21.3%

2008

Karnataka

23%

2009

According to a study by the Ministry of Health of the Union Government, 30 per cent of the infants born in India were Low Weight Babies, 10 per cent were less than 2 kg, three per cent weighed less than 1.5 kg, and 0.7 per cent weighed less than one kg. The mortality rate among the low birth weight babies is unacceptably very high. As mothers, mostly in rural areas are illiterate so they are not utilizing the healthcare facilities which are available in the hospital so this leads to intra-uterine growth retardation and then low birth weight babies9

Reduction in infant mortality is a priority goal for all the nations and also for both WHO and UNICEF. Nearly 75% of all diseases in India are due to non-immunization, malnutrition and contamination of water. Mother’s knowledge is very essential to recognize the common health problems. If mother’s about recognition of disease is correct, then they can treat the disease occurring in their children appropriately. If knowledge is inadequate, then their infant’s lives can be endangered.10

This study was conducted in rural area of Ballabhgarh (Haryana) and shows knowledge of mothers and the facts. This could be due to the poor literacy status of the mother. This problems increases if the registration of pregnancy is late . Low birth weight of the babies continue to remain a major public health problem in India. This study indicates how outcome of low birth weight babies. Mothers knowledge regarding maternal age ,parity, pregnancy, complications, premature rupture of membrane , mode of delivery and foetal death. Low birth weight and gestational age and intra uterine growth how to maintain. If mothers have complete knowledge then conclusion can be made. Researcher emphasized that the mother were trained for care of low birth weight babies by informed education with regular reinforcement method on routine visit.11

The study was conducted at Government Medical College and Hospital, Chandigarh during April 2007 to March 2008. A total of 200 neonates delivered in the health facility were included randomly for investigating some maternal risk factors of LBW and their respective mothers were interviewed using pre-designed interview schedule. The overall proportion of LBW was 23.8% among all study subjects studied (of which 47.8%; were preterm and 52.2% were SGA). Proportions of LBW were significantly higher (P<0.05) among neonates of mothers below 20 years of age (50.0%), poorly educated (32.6%), belonging to family with income less than Rs. 2000 per capita, (28.9%), poorly nourished with pre-pregnancy weight less than 45 kg (50.0%) than those of mothers aged 26 – 30 years (16.3%), educated up to 12 years or more (12.5%), belonging to family with income between Rs.2000-7000 (19.8%), and well nourished with pre-pregnancy weight 56 kg or more (15.2%) respectively Findings of the present study suggest the need of population based interventions in conditions of improving maternal education and socio-economic status. Also, elderly and multi-gravid mothers should be given special care and they should be imparted health education for adopting contraception and proper ANC care for reducing LBW12

Nurses are the responsibility for health promotion of the baby in different stages of the development and to guide the paret for child care. They are the significant care providers to assist the parent to understand the different aspects of growth and development and to meet the needs of infants during development state. Education plays an important role in helping the people to achieve optimum health through their own efforts .Most of the structured teaching programme showed that they were very effective . Hence , the investigator felt that STP is an effective teaching method for this present study.

During clinical posting, investigators have found some lack of knowledge and doubts among mothers looking after their low birth weight babies. Thus, the need was felt to access the knowledge so that further steps can be advocated to give this group better opportunity to care for their babies. The investigator also came across high morbidity among low birth weight babies due to lack of knowledge among mothers regarding child care and management. So the investigator felt the need to find out their knowledge and promotes the health care of low birth weight babies so that infant mortality and morbidity can be reduced.

6.3 REVIEW OF LITERATURE:

Review of literature is a key step in research process. Nursing research may be considered as a continuing process in which knowledge gained from earlier studies is an integral part of research in general. In review of literature a researcher analysis existing knowledge before delving into a new study and when making judgment about application of a new knowledge in nursing practice. The literature review is an extensive, systemic, and critical review of the most important published scholarly literature on particular topic.

A study was conducted on cause of low birth weight. It was found that low birth weight is caused by intra-uterine growth restriction (I.U.G.R), short gestation or both. The incidence of pre-term birth <37 completed weeks of gestation is fairly similar worldwide, generally ranging between 7 and 16% of total births and W.H.O. estimates, is the direct cause of neo-natal deaths. Attempts to prevent low birth or pre-term birth in populations have been largely ineffective. This is one of the most challenging and frustrating problem in public health. Radhakrishnan New Field committee.16

A study was conducted on the effectiveness of early Kangaroo mother care before stabilization of low birth weight infants as compared with conventional method of care. The findings revealed that the mean birth weight was 1514.8 gm for KMC and 1471.8 gm for CMC. And the mean gestational age was 32.42 and 31.59 weeks for KMC and CMC cases respectively. The study showed that 22.5% of KMC and 38% CMC babies died during the study. The majority occur during the first 12 hours of life.17

A study was conducted on low birth weight is a weight of less than 2500gm at birth, very low birth weight is weight is less than 1500gms/ mature births occurs before and of 27 weeks of pregnancy. More than 60% of low birth weight babies are pre term, the earlier, baby is born, the less develop its organ will be, the less it is likely to weight and the its greater its risk for many problems. Small for date babies may be full term but are underweight. There low birth weight results, atleast partly, from slowing or temporary halting of growth in the womb.18

This study was conducted on knowledge of families in NICU The study was conducted in the Kaunas Perinatal Center. The sample consisted of 181 parents and 37 nurses. The NICU Family Needs Inventory was used for data collection. The instrument included five dimensions of needs. The study resulted that importance of the needs by parents was prioritized on the basis of the knowledge given to them on the needs as following: assurance, proximity, information, support, and comfort, and by nurses assurance, information, proximity, support, and comfort. The needs for assurance, proximity, and information were significantly more important for parents as compared with nurses. Needs for support were significantly more important for nurses. Conclusion forty-seven (83.9%) items (out of 56) were identified as important by parents and 49 (87.5%) items by nurses. Both parents and nurses identified the same 7 items within the group of 10 most important.19

A study was conducted to test an educational intervention designed to improve lactation knowledge, attitudes and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support. Quasi-experimental, time-series, pre-tests/post-tests was carried out. Convenience sample of 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU (n=19 and 13, respectively). Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses.20

A study was conducted to evaluate the efficacy of an educational-behavioural intervention program (i.e., Creating Opportunities for Parent Empowerment) that was designed to enhance parent-infant interactions and parent mental health outcomes for the ultimate purpose of improving child developmental and behaviour outcomes. A randomized, controlled trial was conducted with 260 families with preterm infants. All participants received 4 intervention sessions of audiotape and written materials. Infants in the Creating Opportunities for Parent Empowerment program had a 3.8-day shorter NICU length of stay (mean: 31.86 v/s. 35.63 days) and 3.9-day shorter total hospital length of stay (mean: 35.29 v/s. 39.19 days) than did comparison infants. It was found that Knowledge regarding the LBW amongst the parents is very necessary as compared to normal baby. A reproducible educational-behavioural intervention program for parents that commences early in the NICU can improve parent mental health outcomes, enhance parent-infant interaction, and reduce hospital length of stay.21

A study was conducted on mothers knowledge regarding risk factors of low birth weight babies , analyzed with the help of descriptive statistics categorisation of knowledge score was done in order to classify the subject into high, medium, low knowledge group on the basis of quartile values. The incidence of low birth weight can be reduced by provision of high quality pre natal care and broad public information activities aimed at pregnant women and their families. Majority of term low birth weight can be prevented by providing health education about risk factors of low birth weight and prevention of low birth weight.22

This study was conducted on the association of socio-economic status and the development of intrauterine growth retardation was analyzed in a two year prospective study. The study group consisted of 34 patients having small-for-gestational-age newborns. The control group consisted of those 68 women having normal term birth. Significant differences were found in the Body Mass Index, smoking habits during pregnancy, education, and poverty status. The difference in age was expressed, but not significant. There were no significant differences among alcohol and caffeine consumption, family status, household crowding and employment.: Beside the effective medical prenatal care the importance of education and social support is emphasised.23

A study was conducted on the traditional practices have become a part and parcel of our lifestyle. They are readily available at the door steps of the people. They are cheap and affordable and can be utilized by large segment of our community. Mothers are using remedial measures according to their knowledge, culture, customs and believes. Some of them are good for the health of the infants. Government of India emphasized self care in the health care of the people.24

A study was conducted on low birth weight infants which has a high risk of morbidity and mortality in the pre natal period. In our country where almost 70 – 80 % birth takes place at home and peripheral hospital. Researcher emphasize low birth weight babies were trained by informal education, taking accurate birth was problem due to unavailability of weighing scale and trained personnel. There is constant search for new method to detect low birth weight babies so that early instituted.25

6.4 STATEMENT OF THE STUDY:

“A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATIONAL BOOKLET ON KNOWLEDGE OF MOTHERS REGARDING CARE OF LOW BIRTH WEIGHT BABIES IN SELECTED HOSPITALS AT BANGALORE, KARNATAKA.”

6.5 OBJECTIVES OF THE STUDY:

1. To assess the knowledge of mothers regarding care of low birth weight babies before administration of informational booklet.

2. To assess the knowledge of mothers regarding care of low birth weight babies after administration of informational booklet.

3. To find the association between pre-test knowledge level with selected socio- demographic variables.

6.6 HYPOTHESIS:

Ho1 – There will be a significant difference between pre test and post test knowledge score.

Ho2- There will be significant association between knowledge level and selected socio -demographic variables.

6.7 OPERATIONAL DEFINITIONS.

· Effectiveness: It refers to improvement in the knowledge of mothers by informational booklet regarding care of low birth weight babies.

· Evaluate: It refers to impact of informational booklet on mothers.

· Informational booklet: It is one of the best teaching strategy and refers to systematically organized teaching to mothers regarding care of low birth weight babies.

· Knowledge: It refers to the correct response of the mothers as elicited by self administered knowledge questionnaire on care of low birth weight babies.

· Mothers: The mothers whose babies weighs less than 2500 gms and admitted in the hospital.

· Low Birth Weight Babies : It refers to neonates born prematurely or at term weighing less than 2,500gms.

· Health: “Health is a state of complete physical , mental and social well being and not merely an absence of harmful effects of Television watching.

6.8 ASSUMPTIONS :

1.Mothers will have limited knowledge regarding care of low birth weight babies.

2.Informational booklet is effective in improving the knowledge of mothers regarding care of low birth weight babies.

6.9 DELIMITATION :

1.This study is limited to selected mothers who can read Kannada.

2. This study is limited to mothers of low birth weight babies of selected hospitals at Bangalore.

3.This study is limited to 50 samples.

6.10 VARIABLES :

Independent variable: informational booklet.

Dependent variable: Knowledge of mothers regarding care of low birth weight babies.

7. MATERIALS AND METHODS:

7.1.: RESEARCH APPROACH:

Evaluative research approach.

7.1.1: SOURCE OF DATA:

Information will be collected by means of self administered questionnaire regarding care of low birth weight babies among mothers.

7.1.2: RESEARCH DESIGN:

A research design selected for present study is quasi experimental.

7.1.3: SETTING OF THE STUDY :

The study will be conducted in selected hospitals at Bangalore.

7.1.4: POPULATION :

The Target Population of the present study includes normally delivered Mothers ( 19-35 Yrs ) who are having low birth weight babies in selected hospitals at Bangalore.

7.2 METHOD OF DATA COLLECTION:

Data will be collecting from the postnatal mother by structured interview schedule

7. 2.1: SAMPLING PROCEDURE:

The samples will be selected by simple random sampling technique.

7. 2.2: SAMPLE SIZE:

Sample would consist of 50 mothers.

7. 2.3: CRITERIA FOR SELECTION OF SAMPLE :

INCLUSION CRITERIA

1.Mothers of selected hospitals at Bangalore.

2.Mothers who are available at the time of data collection.

3.Mothers who are willing to participate in the study.

7.2.4: TOOLS INTENDED TO BE USED :

The tool will be in the form of self- administered knowledge questionnaire.

The tool consist of two sections namely section A and section B.

Section A consist of information related to socio-demographic characteristics.

Section B consists of questions related to knowledge of mothers regarding care of low birth weight babies.

7.2.5: DATA COLLECTION METHOD:

The data will be collected from the mothers by using self-administered knowledge questionnaire after obtaining permission from higher authorities or correspondent to conduct main study. On day first pre test will be conducted to the respondents ,the informational booklet will be administered on the same day. The post test will be conducted to the same respondents after seven days of administration of informational booklet to evaluate the effectiveness of informational booklet.

7.3: DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Yes, the study administering informational booklet on care of low birth weight babies among mothers of selected hospitals in Bangalore.

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3 ?

Yes, prior to study, the ethical clearance will be obtained from ethical committee.

8. LIST OF REFERENCE:-

1.Dutta D.C. Text book of Obstetric. New central agency 4th edition. 2000 : 490-95.

2. World health organization. 2000.

3. Ghai O.P. Essential of Paediatrics. Essential of Paediatric. 4th edition. Sagar publication New Delhi .2001:115-157.

4.Parthsarthi. Text book of Paediatric. 2nd edition Jaypee :61-63.

5. Nair N .Sreeku Maran. Socio demographic and maternal determinants of low birth weight .Indian journal of Paediatric. 2000. Vol 67: 9-14.

6..Kapoor . S.K. Traditional practices in community. Journal of Paediatric. 1998:4-8

7.Thompson Lindsey.Regional variation rates of low birth weight babies. Indian Journal of Paediatric. 2005. Vo1 l 16 P 164-167.

8. Deshmukh I.S. Low birth weight and associated maternal factors in an urban area. Indian Journal of Pediatric. Vol 35. 1998:33-35.

9. www.ezinearticles.com

10.Ministry of health and family welfare operational guidelines for management of neonatal childhood illness http:// 29 june 20.2006.htm.

11. UNICEF INDIA .Interagrated Management of Neonatal and childhood illness. www://india/health 369.htm .

12. Kapoor. S.K et al. Incidence of low birth weight in rural Ballabhgarh. Indian Journal of Pediatric. 2006 .Vol 38:271-274.

13. P. Kaur Incidence of low birth weight in PGI Chandigarh. National family health survey.2008:32.

14. T. Bang Abhay. Low birth weight, preterm and neonates. Health action. Journal of Prenatology. 2006 Vol 25:17-19.

15. Worku B, Kassie A. Effectiveness of kangaroo mother care. International Journal of Obstetric. 2006 Aug: 525-530

16. MR .Incidence of low birth weight baby. International Journal of obstetric. 2005. 5(22): 445-46.

17. Vaskelyte A. et al. Assessing needs of families with low birth weight babies. International Journal of Pediatric. 2009.45 (4) 320-26.

18. Bernaix.LW et al. Success of lactation education programme on NICU nurse’s knowledge and attitude. Journal of obstetric Gynecology Neonatal Nursery. 2008 Jul-Aug 37 (4):436-45.

19. Melnyk B M. Reduction preterm infants’ length of stay and improving parents’ mental health outcomes with the creating opportunities for parents empowerment NICU program .International Journal of Pediatric Nursing. 2006. 118 (5) :1414-27.

20. Vidhulata B. Risk factors of low birth weight babies. Journal of Obstetric and Gynecology. 2003: 46-50.

21. Mészáros G, Novák T, Rigó A, Nyári T, Pál A, social background of small for gestational age infants. International Journal of community.2001:34-36

22. Singh Meharban .traditional Practices Indian Journal of Paediatrics.2001. Vol 40 Pp: 88-95

23. Small C.C et al Calf circumference as an alternative to birth weight babies. Journal of Paediatric. Vol 38 2001:275-276.

9.

signature OF THE Candidate

10.

remarks of the guide

11.

name and designation

m.muthukannu, M.Sc

Nursing, Asst. professor, dhanwantari nursing college

12.

head of the department

m.muthukannu

13.

signature

14.

Remarks of the principal

14.1

SIGNATURE

PAGE

1