Blog

Home / Blog / Single Post

Maternal And Neonatal Practices in Rural Areas Assignment.

Maternal & Neonatal Practices in Rural Areas Assignment.

Globally, there has been a considerable decline in under-five and infant mortality during last four decades.
However, neonatal mortality rates remain unchanged
especially in developing countries.[1,2] In India,
government, bilateral and multilateral agencies have
made several efforts in the area of maternal and child health welfare. The introduction of government schemes like Janani Suraksha Yojana, Chiranjeevi Scheme,
Propagation of Emergency Obstetric Care (EmOC),
Implementation of Integrated Management of Childhood and Neonatal Illness, etc. has resulted in an increase in institutional delivery and decrease in infant and child
mortality rates. Maternal & Neonatal Practices in Rural Areas Assignment.But there is no significant difference in
neonatal mortality rates, as evidenced by analysis of infant and child mortality rates over the past decade.

ORDER A CUSTOM-WRITTEN PAPER HERE

Even though the primary causes of neonatal deaths are
estimated to be preterm birth (28%), severe infections (26%), birth asphyxia and injuries (23%), tetanus (7%), congenital anomalies (7%) and diarrhoea (3%), with
Low Birth Weight contributing to large proportion of neonatal deaths[3]; studies show evidence about contribution of care practices immediately following
delivery to newborn’s risk of morbidity and mortality[4]. Maternal & Neonatal Practices in Rural Areas Assignment.

Studies on newborn care in some communities show that
the knowledge and practice of basic newborn care for instance prevention of hypothermia, feeding of colostrums and exclusive breast-feeding are lacking; even awareness regarding care seeking on the identification of life threatening signs has been found to be very low.[5] Despite implementation of proven cost-
effective solutions such as promoting antenatal tetanus toxoid immunization, skilled attendance during delivery, immediate and exclusive breast-feeding, and clean cord care; there has been relatively little change in neonatal mortality rate (NMR).[6]

The World Health Organization recommends improving essential newborn care practices at birth in order to reduce neonatal morbidity and mortality.[7] Two Lancet
series, on newborn health and maternal health propose key evidence-based interventions and packages which, if implemented to scale, could greatly contribute to saving
maternal and newborn lives in low income countries.
These interventions emphasize strengthening the
continuum of maternal, newborn and child care during the antenatal, natal and postnatal phase.[2, 8]

With this background we were interested in assessing practices of women in relation to care during pregnancy, delivery and for newborn. Maternal & Neonatal Practices in Rural Areas Assignment.Aims and Objectives are,
 To study the maternal care in terms of Antenatal,
Intranatal and Postnatal care practices.
 To assess newborn care practices of mothers in rural
areas. Maternal & Neonatal Practices in Rural Areas Assignment.

Materials and Methods

It was a Cross sectional study which was done during August 2012 to April 2013. Gandevi block of Navsari
district was selected for this study purposively. Three Primary Health Centres (PHC) out of six in Gandevi block were randomly selected for this study. Mothers having
one child in the age group of 12-23 months from these randomly selected PHCs were enrolled in this study.

Percent distribution of mothers who have not received even a single TT vaccine during last pregnancy was taken
for calculation of sample size. This was taken because it had lowest prevalence among all other variables in this study. According to DLHS-3 Gujarat, (2007-2008)
percentage of mothers who have not received even a
single TT vaccine was 31.4%. An allowable error of 20%
was taken to calculate the sample size. Maternal & Neonatal Practices in Rural Areas Assignment.Considering a
10% of non-response, the sample size came out to be
240; however in the present study 243 children were
covered. This was calculated by using formula, 4PQ / L2,
where, P = prevalence of No TT taken, Q = 1-P and L = allowable error.

We have randomly selected two sub-centres from each
selected PHC. So we have selected 40 mothers randomly
from each selected sub-centres. Verbal consent of
mothers of all the children was taken prior to study.
Those mothers who denied participating in the study were excluded.

A structured questionnaire was constructed and pretested on a group of nonparticipating mothers, and adjustments to the questions were incorporated accordingly. The pretested questionnaire was used to collect information from mothers with children between 12 and 23 months of age. Maternal & Neonatal Practices in Rural Areas Assignment.

Statistical Analysis

Data was collected and entered in MS Office XL sheet and
statistical analysis was done by using the EPI Info 6 software.

Results

Mean age of the study population at time of first child birth was 22.05 (± 3.08) years. At the time of first child birth, 39 (16%) mothers were ≤19 years. Majorities were
Hindus and belongs to OBC caste. Higher secondary & above education was seen more commonly among mothers as compared to the fathers. Most common occupation among fathers was skilled work followed by labour, business, and agricultural work while majority of the mothers were housewives.

Table-1: Distribution according to Socio-demographic
characteristics of mothers

Characteristics (N=243)

N (%)

Mother’s Present

Age (Years)

≤ 19

2 (0.8)

≥ 20

241 (99.2)

Mother’s Age at the Time

of 1st child birth (Years)

≤ 19

39 (16.0)

≥ 20

204 (84.0)

Religion

Hindu

234 (96.3)

Muslim

9 (3.7)

Caste

General

13 (5.3)

58 (23.9)

10 (4.1)

OBC

162 (66.7)

Total families

BPL families

43 (17.7)

APL families

200 (82.3)

ORDER A CUSTOM-WRITTEN PAPER HERE

Table-2: Distribution of study population according to education
and employment

Characteristics (N=243)

Mother

Father

Education

Illiterate

11 (4.5)

10 (4.1)

Primary*

43 (17.7)

51 (21.0)

Secondary**

84 (34.6)

105 (43.2)

Higher secondary & above***

105 (43.2)

77 (31.7)

Employment

Labourer

14 (5.8)

96 (39.5)

Agriculture

0 (0.0)

4 (1.6)

Skilled worker

13 (5.3)

132 (54.3)

Business

0 (0.0)

11 (4.5)

Housewife / Stays at home

216 (88.9)

0 (0.0)

Figure in the parenthesis indicates percentage; * Primary education:
education up to 8th standard; ** Secondary education: education up to 10th
standard; *** Higher secondary & above: 12th standard completed & more

Table-3: ANC and intranatal care practices of mothers under study

Characteristics (N=243)

N (%)

Adequate ANC check-up ( ≥ 3 ANC check-ups ) Maternal & Neonatal Practices in Rural Areas Assignment.

243 (100)

ANC check-up by skilled health professionals

243 (100)

TT injection received

243 (100)

Iron supplements received

243 (100)

Iron supplements consumed for ≥ 3 months

177 (72.8)

Mothers eligible for

government schemes (N=88)

Janani Suraksha Yojana

benefit taken

69 (78.4)

Place of

Delivery

Government hospital

16 (6.6)

Private hospital

165 (67.9)

Trust/NGO hospital

60 (24.7)

Home delivery

2 (0.8)

Type of

Delivery

Normal

193 (79.4)

Caesarean section

50 (20.6)

Post natal care

practices

Infant seen by health

provider in first 24 hours

243 (100)

Table-4: Birth profile of living children and thermal care practices
for newborn babies

Characteristics (N=243)

N (%)

Sex of the child

Male

125 (51.4)

Female

118 (48.6)

Birth weight

<2.5 47 (19.3) ≥2.5 196 (80.7) Time to drying & wrapping of baby ≤ 15 min 121 (50.2) 16-30 min 110 (45.6) > 30 min

10 (4.2)

Time to bathing

of baby

< 24 hour 92 (37.8) ≥ 24 hour 151 (62.2) Bath given by Health professional 84 (34.6) Family members/Relatives 132 (54.3) Dai 27 (11.1) Temperature of water to bath the baby Warm water 243 (100) Shreyash J Gandhi, et al. Newborn care practices in rural areas International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 11 (Online First) Table-5: Newborn care practices regarding neonatal massage Newborn Care Practices N (%) Neonatal massage done (N=243) Yes 240 (98.8) No 3 (1.2) What was used for massage* Johnson baby oil 98 (39.9) Dabar red oil 54 (21.9) Coconut oil 32 (13.0) Butter with gram flour 29 (11.9) Figaro olive oil 16 (6.5) Cotton seed oil 9 (3.6) Mustard oil 4 (1.6) Himalaya oil 4 (1.6) Massage advice by (N=240) Family members 214 (89.1) Health professionals 15 (6.3) Dai 11 (4.6) * Multiple responses Table-6: Pre-lacteal feeding & colostrum feeding practices Infant feeding Practices N (%) Practices of pre- lacteal feeds (N=243) Yes 78 (32.1) No 165 (67.9) Type of pre- lacteal feeds (N=78) Gripe water 35 (44.9) Janam ghutti 21 (26.9) Honey 17 (21.8) Plain/boiled/sugar water 3 (3.8) Animal milk 2 (2.6) Practices of colostrums (N=243) Yes 221 (90.9) No 22 (9.1) Reasons for discarding colostrums (N=22) Milk is not coming out of breast for the first 3-5 days 9 (40.9) Low birth weight baby 8 (36.4) LSCS delivery 2 (9.1) Baby was hypothermic & kept in radiant warmer 3 (13.6) Figure-1: Newborn care practices for care of umbilical cord Figure-2: Breastfeeding practice All the mothers under study had adequate ANC check-up (≥ 3 ANC check-up) by skilled health provider and received TT vaccination during pregnancy. Iron supplements for 90 days or more during pregnancy was not consumed by around 30% mothers. Many mothers had not availed benefit of Janani Suraksha Yojana. Almost all mothers had institutional delivery; majority had utilized private hospital. All the infants were seen by health provider in first 24 hours of delivery. It was found that male and female children were almost in equal proportion. It was found that 19.3% of babies had birth weight of less than 2.5 kg. Regarding thermal care practices, half of the mothers reported that the baby was dried and wrapped within 15 minutes of delivery. More than one third of babies were bathed in less than 24 hours of birth. All the babies were bathed in warm water. Most of the mothers had put substances on the umbilical cord. Most common application on the cord was disinfectant powder/ointment. Other substances were ash, cow dung and coconut oil. Body massage to newborns was practiced by almost all mothers; substances mostly used included Johnson baby oil and Dabar red oil. Other substances that used were Coconut oil, Butter with gram flour, Figaro olive oil, Cotton seed oil, Mustard oil and Himalaya oil. Family members had advised neonatal massage in majority of the mothers. Massage was done by family members in majority of babies followed by Dai. In this study, one third of the infants had received pre-lacteals feeds. Among infants who had received pre-lacteals, most common feed was Gripe water, followed by Janam ghutti and Honey. In this study, 90.9% mothers fed colostrums to their child. About asking the reasons for not giving colostrums, out of 22 mothers, majority replied that milk is not coming out from breast for the first 3-5 days and because of LBW baby. This study depicted that, around half of the mothers initiated breast-feeding within one hour of birth. Proportion of mothers who had initiated it after 24 hours was 9.9%. Majority of mothers (93.0%) were giving breast-feeding on demand. Only one third of the mothers had given exclusive breast-feeding to their baby for 6 months. (Figure 2) Discussion Improving newborn survival is a major priority in child health today. Specific programs for enhancing the maternal and child health have been in place since the early 1950s till date, like the MCH program, immunization, ORS for the control of diarrheal disease, anemia, and vitamin A prophylaxis program, CSSM, and RCH II. In present study, it was found that all the mothers under study had adequate ANC check-up (≥ 3 ANC check-up) by skilled health provider. In contrary to this, In NFHS-3 study for Gujarat revealed that among mothers during their last delivery, 55.8% had 3 ANC visits.[9] In present study only 72.8% mothers had consumed iron supplements for 90 days or more during pregnancy. In contrary to this finding, in NFHS-3 study for Gujarat revealed that 28.9% of pregnant mothers had consumed IFA for 90 days or more in rural areas.[9] Present study found that majority of mothers (99.2%) had institutional delivery. In NFHS-3 study for Gujarat in rural area, 39% mothers had institutional delivery. In present study 79.4% were normal deliveries, while 20.6% were Caesarean section. In NFHS-3 study for Gujarat in rural area, 5.5% were caesarean deliveries.[9] In present study, it was found that all the infants were seen by health provider in first 24 hours of delivery. According to DLHS-3 for Gujarat, 57.2% infants had received health check-up within 24 hours of birth.[12] In present study, it was found that 19.3% of babies had birth weight of less than 2.5 kg, similar findings were observed in NFHS-3 study.[12] In present study, regarding thermal care practices, 50.2% women reported that the baby was dried and wrapped within 15 minutes of delivery. More than one third (37.8%) of babies were bathed in less than 24 hours of birth. All the babies were bathed in warm water. S. Barnett et al found that 59% of the infants were wiped, and 64% were wrapped immediately after delivery. About 44% of newborns were bathed immediately after birth.[14] In present study, most of the mothers (93.4%) had put substances on the umbilical cord. Most common application on the cord was disinfectant powder/ ointment (94.5%). Other substances were ash, cow dung and coconut oil. Afsheen Ayaz et al found that 58% women used some application on the umbilical cord which included ointment (33%), ghee (saturated oil) Maternal & Neonatal Practices in Rural Areas Assignment. (27%), coconut oil (19%), mustard oil (9.5%) , some also applied substances like surma (locally made kohl), clove oil, turmeric and talcum powder on umbilical stump.[13] In present study, Body massage to newborns was practiced by almost all (98.8%) mothers; substances mostly used included Johnson baby oil (39.9%) and Dabar red oil (21.9%). Afsheen Ayaz et al found that body massage to newborns was practiced by nearly 89% of women; substances mostly used included mustard oil (73%) and ghee (15%).[13] Present study depicted that 32% of the infants had received pre-lacteals feeds, most common feed was Gripe water (44.9%). I.I. Meshram et al found that 45% children had received pre-lacteal feeds.[10] In this study, the colostrum were fed by 90.9% mothers. I.I. Meshram et al found that 15.1 % babies had not received colostrum.[10] About asking the reasons for not giving colostrum, out of 22 mothers, 9 mothers (40.9%) replied that milk was not coming out from breast for the first 3-5 days, 8 mothers (36.4%) had not given colostrum because of LBW baby, 3 mothers (13.6%) had not given colostrum because baby was hypothermic and kept in radiant warmer whereas 2 mothers (9.1%) had not given because of LSCS. Saxena D et al found that 11.22% mothers had not given colostrum to their child. Most common reason was custom (53%) not to give colostrum, followed by harmful for baby (26.1%) and mother's illness (3.5%).[11] This study depicted that 56.4% mothers of 12-23 months children initiated breast-feeding within one hour of birth, while 90.1% initiated it within one day of birth. NFHS-3 study for Gujarat revealed that 30.0% mothers of under five children initiated breast-feeding within one hour of birth, while 58.0% mothers initiated breast-feeding within one day of birth.[9] I.I. Meshram et al found that 22% infants had received breast-feeding within one hour of birth while 64% had received it within 24 hours of birth.[10] Maternal & Neonatal Practices in Rural Areas Assignment. Even though the higher rates of early initiation of breastfeeding and exclusive breast-feeding were observed, there was low awareness of the benefits of exclusive breastfeeding. Creating an awareness of the advantages of exclusive breastfeeding by grass-root level workers will further strengthen and support this common practice in rural communities. In majority of cases, correct practices regarding newborn care was observed among mothers and this should be promoted through improved coverage with existing health services. Community based health workers have a major role to play in the eradication of harmful newborn care practices and the sustenance of good practices and also prove to be a link between families and health system. Maternal & Neonatal Practices in Rural Areas Assignment. No investment in global health has a greater return than saving the life of a child. With sufficient resources and political resolve, we can ensure a healthy start, and a promising future, for children everywhere." Melinda Gates, Bill and Melinda Gates Foundation. Newborn care practices shows the importance given to the wellbeing of the newborn and raising a child well [1]. Newborns are valuable treasure to the nation. Realizing the importance of child development, United Nations declared 1979 as the International Year of the Child [2] and World Health Organisation (WHO) proposed a theme on World health day during 2003 as "Healthy environment for children" and 2005 as "Make every mother and child count" to focus the attention of planners, policy makers, administrators, health and social scientists on various problems faced by children [3]. Neonatal mortality has been declining worldwide. Neonatal Mortality Rate (NMR) is reduced by 28% in last two decades from an estimated 32 deaths per 1000 live births (year 1990) to 21 deaths (year 2011) [4]. Globally, around 86% of neonatal deaths are due to pneumonia, diarrhoea, and preterm births. To prevent newborn and maternal infection, clean delivery practices and appropriate treatment should be adopted. Birth asphyxia causes 23% of newborn deaths and can largely be prevented by improved care during labour and delivery [4]. Social determinants for child mortality include early marriage and childbirth at a very young age, less spacing between births and low literacy level among women, in particular those belonging to the urban poor and rural settings. Under National Rural Health Mission (NRHM), there are a number of focused interventions for improving care of the new-born, which include focus on improving access to Skilled Birth Attendance (SBA) and Emergency Obstetric Care for all women in rural areas. On the demand side, Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram have managed in overcoming many traditional barriers to institutional deliveries [5]. Several programmes have been implemented by Government of India along with WHO and UNICEF to improve the health status of newborns. Many customs are prevalent in India which affects health status of the new-borns. Understanding of the community and traditional newborn care practices is necessary to implement the effective programme for promotion of newborns health. For the effective child health care delivery, information regarding newborn care is important. This study was done to describe selected newborn care practices in rural area of Puducherry. Aims and Objectives 1. To study the newborn care practices in a rural area of Puducherry. Abstract Background: Globally, around 86% of neonatal deaths occurred are due to infections and preterm births. To prevent newborn infection, clean delivery and newborn carepractices should be adopted. Understanding of the community and traditional new-born care practices is necessary to implement the effective programme for promotion of newborns health. Objectives: To study the new-born care practices and its determinants in a rural area of Puducherry, India. Methodology: A cross sectional study done in Bahour commune from 1st April 2012 to 31st June 2012. Information regarding background details and new-born care practices were recorded in semi-structured questionnaire by house to house visit. Total of 136 infants born during Jan-March 2012 were enrolled. Data were presented as percentages, ratios and Chi-square test was used to find association among variables. p-value<0.05 was considered statistically significant. Results: Among 136 newborns, 46.3% were male and 53.7% were female. Around 65% newborns were breastfed within an hour after birth and 5.9% were prelacteally fed. Maternal & Neonatal Practices in Rural Areas Assignment.There was significant difference between male and female newborns in terms of wrapping after birth and day of first bath (p value 0.04 and 0.007 respectively). Out of 37 mothers who belonged to poor socio-economic status, 24.3% mothers practiced application on cord with significant association (p=0.03). Majority (70.6%) of mothers gave bath to their newborn's on third day or beyond. In the present study, mothers age at marriage and day of first bath to newborn's was significantly associated (p=0.02). Conclusions: The overall practices like giving pre-lacteal feed; application on umbilical cord and giving bath immediately after bath of newborn are still practiced in the study area. Therefore, faulty newborn care practices need to be addressed. *Corresponding author: Vijayalakshmi S, Mahatma Gandhi Medical college and Research Institute, Pondicherry, Puducherry, India, Tel:9788942682; E-mail: vijilakshmi121@gmail.com Received August 05, 2014; Accepted September 05, 2014; Published September 07, 2014 Citation: Vijayalakshmi S, Patil R, Datta SS (2014) Community-based Study on Newborn Care Practices and its Determinants in Rural Pondicherry, India. J Neonatal Biol 3: 158. doi:10.4172/2167-0897.1000158 Copyright: © 2014 Vijayalakshmi S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Journal of Neonatal Biology ISSN: 2167-0897 Journal of Neonatal Biology Citation: Vijayalakshmi S, Patil R, Datta SS (2014) Community-based Study on Newborn Care Practices and its Determinants in Rural Pondicherry, India. J Neonatal Biol 3: 158. doi:10.4172/2167-0897.1000158 Pge 2 of 5 Volume 3 • Issue 5 • 1000145 J Neonatal Biol ISSN: 2167-0897 JNB an open access journal 2. Maternal & Neonatal Practices in Rural Areas Assignment.To find out the determinants of newborn care practices. Materials and Method This was a Community based cross sectional study done in the rural area of Pondicherry. As per convenience, child born to mothers during Jan-March 2012 were enrolled for the study through Anganwadi registers from Bahour Commune during April-June 2012. Total 136 newborns were included in the study. Information regarding background details and newborn care practices were recorded in semi-structured questionnaire. The investigator interviewed the mother/husband in local language using a pre-designed proforma. Each infant-mother was interviewed for about 40 minutes. Mothers were informed through phone prior to visit and then house to house visit was done. Statistical Analysis The data was entered and analysed using Microsoft Excel and were presented as percentages and ratios. Chi-square test and Fisher's exact p test were used to find association between the variables. p-value<0.05 was considered as statistically significant. Results Total 136 newborn's mothers participated in the study. Among 136 newborn's, 63(46.3%) were male and 73 (53.7%) were female. Table 1 shows the socio-demographic profile of the study newborns in rural Puducherry. Majority of the newborns (94.9%) belonged to Hindu families. According to modified B.G. Prasad's Classification for socio-economic status [6], 51 (37.5%) newborns belonged to lowermiddle class followed by 37 (27.2%) newborns in poor class. Total 97 (71.3%) mothers were educated up to 12th standard and 18 (13.2%) were graduate. Out of 136 mothers, 114 (83.8%) were housewives. Family background of the study newborns is shown in Table 2. It was observed that parents of 16 (11.8%) newborns had history of consanguineous marriage. The mean age for marriage of mothers of study newborn was 21.9 ± 3.1 years. Out of 136 newborns, 73 (53.7%) belonged to nuclear families. Only 22 (16.2%) mothers had more than two living children. It was observed that, out of 136 newborns, one male child was delivered at home by a trained dai while remaining 135(99.3%) were delivered at institution by doctor/nurse/ANM. Only three (2.2%) female newborns were found to have low birth weight (<2500 gm). There was no significant difference found between male and female newborns in terms of history of birth in this present study (Table 3). It was observed that, out of 136 newborns, 128 (94.1%) were wrapped immediately after birth. Total 19 (14%) children had a history of application over umbilical cord by sweet flag (vasambu) Characteristics N (%) Religion Hindu 129 (94.9) Christian 6 (4.4) Muslim 1 (0.7) Socio-economic status Upper high 3 (2.2) High 18 (13.2) Upper middle 27 (19.9) Lower middle 51 (37.5) Poor 37 (27.2) Education level of mother Illiterate 21 (15.5) Upto 12th std 97 (71.3) Graduate and above 18 (13.2) Education level of father Illiterate 8 (5.9) Upto 12th Std 92 (67.6) Graduate and above 36 (26.5) Occupation of mother Housewife 114 (83.8) Business/Service 15 (11) Labourer/Fisherwoman/Farmer 7 (5.1) Occupation of father Labourer/Fisherman/Farmer 82 (60.3) Business/Service 53 (39) Unemployed 1 (0.7) Table 1: Socio-demographic profile of study infants (N=136). Characteristics N (%) H/O consanguineous marriage Yes 16 (11.8) No 120 (88.2) Mothers age at marriage (in years) <18 8 (5.9) 18 to 22 88 (64.7) 23 to 27 30 (22) ≥ 28 10 (7.4) Type of family Nuclear 73 (53.7) Joint 63 (46.3) Number of living children ≤ 2 114 (83.8) >2 22 (16.2) Table 2:Maternal & Neonatal Practices in Rural Areas Assignment. Family background of new-borns (N=136). Characteristics Male (n=63) Female (n=73) Total Order of birth 1 28 (44.4) 30 (51.7) 58 (42.6) 2 24 (38.1) 31 (56.4) 55 (40.4) ≥ 3 11(17.5) 12 (52.2) 23 (17) Birth interval* (N=78) ≤ 24 months 5 (14.3) 7 (16.3) 12 (15.4) 25-36 months 27 (77.1) 32 (74.4) 59 (75.6) > 36 months 3 (8.6) 4 (9.3) 7 (9) Place of delivery Home 1 (1.6) 0 1(0.7) Institutional 62 (98.4) 73 (100) 135 (99.3) Birth attendant Doctor/ nurse/ANM 62 (98.4) 73 (100) 135 (99.3) Trained dai 1 (1.6) 0 1 (0.7) Mode of delivery Normal 50 (79.4) 57 (78.1) 107 (78.7) Caesarean section 12 (19) 15 (20.5) 27 (19.8) Assisted 1 (1.6) 1 (1.4) 2 (1.5) Birth weight (in grams) 1500-2499 0 3 (4.1) 3 (2.2) ≥ 2500 63 (100) 70 (95.9) 133 (97.8) (Figures in parenthesis indicate percentages) *For mothers having children 2 or more than 2 Table 3: Birth history of new-borns (N=136). Citation: Vijayalakshmi S, Patil R, Datta SS (2014) Community-based Study on Newborn Care Practices and its Determinants in Rural Pondicherry, India. J Neonatal Biol 3: 158. doi:10.4172/2167-0897.1000158 Pge 3 of 5 Volume 3 • Issue 5 • 1000145 J Neonatal Biol ISSN: 2167-0897 JNB an open access journal (52.6%), oil (42.1%) or ghee (5.3%). In the present study, bathing of 96 (70.6%) newborns was delayed till third day or more. However, seven (5.1%) newborns were bathed on the first day of birth itself. There was significant difference between male and female newborns in terms of wrapping after birth and day of first bath (p value 0.04 and 0.007 respectively). However, no significant difference was observed between male and female newborns as far as cloth used for wrapping, application on umbilical cord stump and type of cord application is concerned (Table 4). Table 5 shows the association of socio-demographic variables of the study children with newborn care practices in the present study. Among the illiterate mothers, 19 (90.5%) mothers wrapped their newborn after birth, 5 (23.8%) mother’s practiced application on umbilical stump, and 52 (71.2%) mothers gave bath to their newborns on third day or beyond. There were no significant association between newborn care practices and mothers’ education. Out of 37 mothers who belonged to poor socio-economic status, 9 (24.3%) mothers practiced application on cord. Significant association was observed between application on umbilical stump and socioeconomic status of mothers (p=0.03).Majority (70.6%) of mothers gave bath to their newborns’ on third day or beyond. Seventy four (77.1%) mothers aged ≤ 22 years gave bath to their newborns’ on third day or beyond. In the present study, mothers age at marriage and day of first bath to newborns’ was significantly associated (p=0.02). However, no significant association was observed between newborn care practices and mothers occupation, type of family and birth order of newborn in the present study (Table 5). Discussion The present study aimed at assessing the newborn care practices in a rural area of Puducherry. This study described the essential newborn care given during birth examined their association with sociodemographic variables. According to Census 2011 [7] 80% males and 79% females are literate. In the present study, majority (67.6%) of the mothers were educated upto 12th standard and 26.5% mothers were graduate; this shows that female literacy rate is high in the study area. Out of total women, 83.8% were housewives and only 11% were doing service/ business.Maternal & Neonatal Practices in Rural Areas Assignment. It stresses the fact that women at a larger scale are still working within the household. The institutional delivery rate is extremely low at national level. Unless the pace of change accelerates, it will take until 2025 for half of all rural births to be institutional and mid-century before 75% coverage is reached [8]. There was a slow increase in institutional delivery rate in India, without the sign of acceleration in achieving the national goal of 80% coverage in 2015 [8].

ORDER A CUSTOM-WRITTEN PAPER HERE

In present study, 99.3% deliveries were conducted in institutions and only one (0.7%) woman delivered at home by a trained dai due to delay in accessing the nearby health facility. Similar finding was reported in District Level Household Survey-3 (DLHS-3) conducted in Pondicherry with institutional delivery rate of 99.4% and in Tamil Nadu with 94% [8]. In contrast, according to DLHS-3 [8], the institutional delivery rate in India was 47% and as per National Family Household Survey-3 (NFHS-3) for rural areas in India, the rate was 31.1% [9]. Studies conducted in other states also showed lower level of institutional delivery compared to our study [10-12]. This suggests, there was an effective health education given to women regarding the place of delivery during antenatal visits, availability of facilities and good transport in present study area. According to the present study, mode of delivery was observed to be normal vaginal delivery (78.7%). The percentage of mothers who had caesarean section was 19.8% which was higher as compared to the NFHS-3 report for India (7%) [9]. Similar observations were noted in studies conducted in Gujarat (15.3%) and Haryana (16%) [10,11]. The reason for increased caesarean section in the study area was due to increased awareness and readiness towards complications related to delivery among the mothers and their families. As per Integrated Management of Neonatal and Childhood Illness Guidelines, the newborn should be quickly dried and wrapped in the warm and clean cloth immediately after delivery to prevent heat loss from the body [13]. In the present study, it was observed that, 94.1% newborns were wrapped immediately after birth. Similar observations were reported from Chandigarh [14], Bangalore [15] as well as from South Nepal [16] with of 93.8%, 90.1% and 82.8% new-borns respectively being wrapped immediately after birth. Indicators Male (n=63) Female (n=73) Total p value Wrapping immediately after birth 0.04 Yes 62 (98.4) 66 (90.4) 128 (94.1) No 1 (1.6) 7 (9.6) 8 (5.9) Cloth used for wrapping (n=128) 0.13 New/ washed 53 (85.5) 55 (83.3) 108 (84.4) Not properly washed 9 (14.5) 11(16.7) 20 (15.6) Application on umbilical cord 0.16 Yes 6 (9.5) 13 (17.8) 19 (14) No 57 (90.5) 60 (82.2) 117 (86) Type of cord application (n=19) 0.26 Sweet flag (Vasambu) 2 (33.3) 8 (61.5) 10 (52.6) Oil 4 (66.7) 4 (30.8) 8 (42.1) Ghee 0 1 (7.7) 1 (5.3) Day of first bath 0.007 1st day 2 (3.2) 5 (6.8) 7 (5.1) 2nd day 23 (36.5) 10 (13.7) 33 (24.3) ≥ 3rd day 38 (60.3) 58 (79.5) 96 (70.6) (Figures in parenthesis indicate percentages) Table 4: Care given to newborns after birth (N=136). Citation: Vijayalakshmi S, Patil R, Datta SS (2014) Community-based Study on Newborn Care Practices and its Determinants in Rural Pondicherry, India. J Neonatal Biol 3: 158. doi:10.4172/2167-0897.1000158 Pge 4 of 5 Volume 3 • Maternal & Neonatal Practices in Rural Areas Assignment. Issue 5 • 1000145 J Neonatal Biol ISSN: 2167-0897 JNB an open access journal Application on umbilical cord of newborn is a custom followed in many parts of India and majority of them use cow dung as the application which is a common cause of neonatal tetanus and neonatal death. Our study reported that 14% children had a history of application over umbilical cord stump, either by sweet flag (52.6%), oil (42.1%) or ghee (5.3%). Other studies also reported similar practices of application on umbilical cord, the percentages ranged from 10% to 50% [12,17-20]. Common applicant used were turmeric powder, oil and ghee with the percentage of 83%, 15.8% and 12% respectively [12,17,19]. In the present study, significant association was observed between socio- economic status and application on umbilical cord. Mothers who belonged to poor class practiced application on umbilical cord stump as compared to middle/high class mothers. According to WHO and UNICEF report on newborn care, bathing should be avoided immediately after birth in order to prevent hypothermia and for a normal newborn bathing should be started on second day [13]. There is a common belief of people that the mother and her newborn are polluted due to the delivery process, so bath should be given immediately after birth [21]. In the present study, bathing of (70.6%) infants was delayed till third day or more. However, 5.1% infants were bathed on the first day of birth itself. In contrary, studied conducted in Bangladesh, Uttar Pradesh, Haryana, Chandigarh and West Bengal reported that 76.1%, 67%, 56.5%, 40% and 17.6%infants respectively were given first bath immediately after birth [19,22,23]. Pre-lacteal feeding is almost universal in India. Present study observed that percentage of newborns who were given pre-lacteal feed was only 5.9%. Among them 62.5% were given animal’s milk as prelacteal feed and 37.5% new-borns were given honey water. Studies from South Nepal [16] and Pakistan [17] reported that the percentage of newborns that were given pre-lacteal feeds was 44%, 55.6% and 87.6% respectively, which were higher compared to the present study. Studies from other parts of India also reported the practice of giving prelacteal feeds [15,20,24,25]. Colostrum is a thick, yellow secretion from the breast during initial two to three days after delivery. It provides a concentrated source of energy for the newborn which is easily digestible and also offers protection against childhood illnesses. In the present study, 2.2% newborns did not receive colostrum even after two days of birth. Similar observations were reported from two studies conducted in Bangalore [15,20].Maternal & Neonatal Practices in Rural Areas Assignment. However, studies from other regions of India and other countries also showed even higher percentage of mothers discarding colostrum for first two days [12,15,24,26]. According to Infant and Young Child Feeding Practices (2006) guidelines in India, it is recommended that initiation of breastfeeding should begin immediately after birth. In the present study initiation of breastfeeding within one hour after birth was 64.7% and within 24 hours was almost 97%. Initiating breastfeeding within one hour was similar to DLHS-3 [8] findings for Pondicherry rural area (67.2%) and other studies conducted in Uttar Pradesh and rural wardha [12,25]. However, our observations are more than the national and Tamil Nadu figures as per DLHS-3 [8] and NFHS-3 [9]. Mothers belonging to high socio-economic class families had better knowledge related to initiation of breastfeeding. Findings in regard to initiation of breastfeeding in the present study was higher than studies reported from other states of the country and this could be attributed to high level of female literacy, effective antenatal advices to mothers and frequent postnatal visits by healthcare providers leading to increased knowledge regarding early initiation of breastfeeding and the importance of colostrum. IMNCI recommends on-demand breastfeeding or feeding 8 times or beyond to the newborn [13]. In the present study it was observed that, majority of the mothers breastfed their newborns on demand (80.1%), similar to the observations made by Joseph et al. [15] in Bangalore (87%). Conclusions On the whole, the results of our study indicated that most of the mothers were having good child care practices. Practices like giving pre-lacteal feeds, application of substances on the cord, giving bath to the baby immediately after birth are less prevalent in our study. Even New-born care practices Mothers’ education Mothers’ Occupation Socio-economic status Illiterate (n=21) Literate (n=115) p value Housewife (n=114) Working (n=22) p value Poor (n=37) Middle/High (n=99) p value Wrapping after birth Yes No 19 (90.5) 2 (9.5) 109 (94.8) 6 (5.2) 0.44 107 (93.9) 7 (6.1) 21 (95.5) 1 (4.5) 0.77 35 (94.6) 2 (5.4) 93 (93.9) 6 (6.1) 0.88 Application on umbilical stump Yes No 5 (23.8) 16 (76.2) 14 (12.2) 101 (87.8) 0.15 16 (14) 98 (86) 3 (13.6) 19 (83.4) 0.96 9 (24.3) 28 (75.7) 10 (10.1) 89 (89.9) 0.03 First bath given on 1st Day 2nd Day ≥ 3rd Day 1 (4.8) 4 (19) 16 (76.2) 6 (5.2) 29 (25.2) 80 (69.6) 0.82 5 (4.4) 28 (24.6) 81 (71) 2 (9.1) 5 (22.7) 15 (68.2) 0.65 0 7 (18.9) 30 (81.1) 7 (7.1) 26 (26.3) 66 (66.6) 0.13 New-born care practices Type of family Birth order Mothers age at marriage Nuclear (n=73) Joint (n=63) p value 1 (n=58) ≥ 2 (n=78) p value ≤ 22 (n=96) >22 (n=40) p value Wrapping after birth Yes No 70 (95.9) 3 (4.1) 58 (92) 5 (8) 0.34 56 (96.6) 2 (3.4) 72 (92.3) 6 (7.7) 0.29 91 (94.8) 5 (5.2) 37 (92.5) (7.5) 0.60 Application on umbilical stump Yes No 12 (16.4) 61 (83.6) 7 (11.1) 56 (88.9) 0.37 6 (10.3) 52 (89.7) 13 (16.7) 65 (83.3) 0.29 16 (16.7) 80 (83.3) 3 (7.5) 37 (92.5) 0.16 Day of first bath 1st Day 2nd Day ≥ 3rd Day 5 (6.9) 16 (21.9) 52 (71.2) 2 (3.2) 17 (27) 44 (69.8) 0.53 1 (1.7) 15 (25.9) 42 (72.4) 6 (7.7) 18 (23.1) 54 (69.2) 0.29 3 (3.1) 19 (19.8) 74 (77.1) 4 (10) 14 (35) 22 (55) 0.02 Table 5: Association of socio-demographic variables and newborn care practices (N=136). Citation: Vijayalakshmi S, Patil R, Datta SS (2014) Community-based Study on Newborn Care Practices and its Determinants in Rural Pondicherry, India. J Neonatal Biol 3: 158. doi:10.4172/2167-0897.1000158 Pge 5 of 5 Volume 3 • Issue 5 • 1000145 J Neonatal Biol ISSN: 2167-0897 JNB an open access journal though the overall practices like giving pre-lacteal feed; application on umbilical cord and giving bath immediately after bath of newborn are still practiced in the study area. The present scenario can be improved through enhancing Information Education and Counselling activities, training of health workers and mothers focusing on newborn health care practices. Strengths This was a community based, house to house survey done to know the traditional newborn care practices prevailing in the community. Therefore, faulty newborn care practices are addressed to improve the health status of the newborn. To reduce recall bias due to time delay, the information regarding birth was obtained from discharge slip and other details were cross checked with their husband. Limitations This study focused mainly few determinants that determine newborn care practices. Further study need to be done to provoke the reason for the faulty practices prevailed in the community. References 1. Park K (2013) Park’s Textbook of Preventive and Social Medicine. (22ndedtn). Banarsidas Bhanot, Jabalpur, India. 2. Maternal & Neonatal Practices in Rural Areas Assignment.UNICEF (1979) Year of the child UNICEF. New York, USA. 3. WHO (2013) The World Health Day themes. Geneva, Switzerland. 4. WHO (2011) Neonatal mortality rate. Geneva, Switzerland. 5. NRHM (2012) Special initiatives in India. New Delhi, India 6. Sharma R (2013) Revision of Prasad’s social classification and provision of an online tool for real-time updating. South Asian J Cancer 2: 244 7. Government of India (2011) Provisional Population Totals: Office of the Registrar General and Census Commissioner, India. 8. International Institute for Population Sciences (2008) District Level Household and Facility Survey-3. Mumbai, India. 9. International Institute for Population Sciences, Macro International (2006) National Family Health Survey-3. Mumbai, India. 10. Bhanderi DJ, Mukherjee SM, Gohel MK, Christian DS (2009) An evaluation of the utilisation of reproductive and child health services provided by government to the rural community of Anand District, Gujarat. Indian J Public Health 53: 250-252.

References

1.Bhalotra S, Arulampalam W. Sibling Death Clustering in India :
State Dependence vs . Unobserved Heterogeneity. IZA Discussion
Paper No. 2251. 2006.
2.Tinker A, Ten Hoope-Bender P, Azfar S, Bustreo F, Bell R. A
continuum of care to save newborn lives. Lancet 2005;365:822–5.
3.Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When?
Where? Why? Lancet. 2005;365:891–900. Maternal & Neonatal Practices in Rural Areas Assignment.
4.Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, De Bernis
L. Evidence-based, cost-effective interventions: how many
newborn babies can we save? Lancet 2005;365:977-88.
5.Bang AT, Paul VK, Reddy HM, Baitule SB. Why do neonates die in
rural Gadchiroli, India? (Part I): primary causes of death assigned
by neonatologist based on prospectively observed records. J
Perinatol 2005; 25:S29–S34.
6.Dutta AK. Home-based newborn care how effective and feasible.
Indian Pediatr 2009;46:835-40.
7.Marsh DR, Darmstadt GL, Moore J, Daly P, Oot D, Tinker A.
Advancing newborn health and survival in developing countries: a
conceptual framework. J Perinatol 2002;22:572-6.
8.Campbell OM, Graham WJ; Lancet Maternal Survival Series
steering group. Strategies for reducing maternal mortality: getting
on with what works. Lancet 2006;368:1284-99.
9.National Family Health Survey (NFHS) -3 state reports: Gujarat.
Indian Institute for Population Sciences. Mumbai. 2005-06.
Available from: URL: http://www.rchiips.org/nfhs/NFHS-
3%20Data/gujarat_state_report_for_website.pdf
10.Meshram II, Laxmaiah A, Venkaiah K. Impact of feeding and
breastfeeding practices on the nutritional status of infants in a
district of Andhra Pradesh, India. Natl Med J India 2012;25:201-6.
11.Saxena D. Socio demographic profile of Breast-Feeding Mothers in
Urban Slums of Surat city [dissertation]. South Gujarat University,
Surat. 2004.
12.District Level Household & Fecility Survey (DLHS-3): Gujarat.
2007-08. Available from: URL: Maternal & Neonatal Practices in Rural Areas Assignment.
http://www.rchiips.org/pdf/rch3/report/GJ.pdf
13.Ayaz A, Saleem S. Neonatal Mortality and Prevalence of Practices
for Newborn Care in a Squatter Settlement of Karachi, Pakistan : A
Cross-Sectional Study. PLoS ONE 2010;5:e13783.
14.Barnett S, Azad K, Barua S, Mridha M, Abrar M, Rego A, et al.
Maternal and newborn-care practices during pregnancy,
childbirth, and the postnatal period: a comparison in three rural
districts in Bangladesh. J Health Popul Nutr 2006;24:394-402. Maternal & Neonatal Practices in Rural Areas Assignment.

ORDER A CUSTOM-WRITTEN PAPER HERE

Materials and Methods

Statistical Analysis

Data was collected and entered in MS Office XL sheet and
statistical analysis was done by using the EPI Info 6 software.

Results

Table-1: Distribution according to Socio-demographic
characteristics of mothers

Characteristics (N=243)

N (%)

Mother’s Present

Age (Years)

≤ 19

2 (0.8)

≥ 20

241 (99.2)

Mother’s Age at the Time

of 1st child birth (Years)

≤ 19

39 (16.0)

≥ 20

204 (84.0)

Religion

Hindu

234 (96.3)

Muslim

9 (3.7)

Caste

General

13 (5.3)

58 (23.9)

10 (4.1)

OBC

162 (66.7)

Total families

BPL families

43 (17.7)

APL families

200 (82.3)

ORDER A CUSTOM-WRITTEN PAPER HERE

Table-2: Distribution of study population according to education
and employment

Characteristics (N=243)

Mother

Father

Education

Illiterate

11 (4.5)

10 (4.1)

Primary*

43 (17.7)

51 (21.0)

Secondary**

84 (34.6)

105 (43.2)

Higher secondary & above***

105 (43.2)

77 (31.7)

Employment

Labourer

14 (5.8)

96 (39.5)

Agriculture

0 (0.0)

4 (1.6)

Skilled worker

13 (5.3)

132 (54.3)

Business

0 (0.0)

11 (4.5)

Housewife / Stays at home

216 (88.9)

0 (0.0)

Table-3: ANC and intranatal care practices of mothers under study

Characteristics (N=243)

N (%)

Adequate ANC check-up ( ≥ 3 ANC check-ups ) Maternal & Neonatal Practices in Rural Areas Assignment.

243 (100)

ANC check-up by skilled health professionals

243 (100)

TT injection received

243 (100)

Iron supplements received

243 (100)

Iron supplements consumed for ≥ 3 months

177 (72.8)

Mothers eligible for

government schemes (N=88)

Janani Suraksha Yojana

benefit taken

69 (78.4)

Place of

Delivery

Government hospital

16 (6.6)

Private hospital

165 (67.9)

Trust/NGO hospital

60 (24.7)

Home delivery

2 (0.8)

Type of

Delivery

Normal

193 (79.4)

Caesarean section

50 (20.6)

Post natal care

practices

Infant seen by health

provider in first 24 hours

243 (100)

Table-4: Birth profile of living children and thermal care practices
for newborn babies

Characteristics (N=243)

N (%)

Sex of the child

Male

125 (51.4)

Female

118 (48.6)

Birth weight

<2.5 47 (19.3) ≥2.5 196 (80.7) Time to drying & wrapping of baby ≤ 15 min 121 (50.2) 16-30 min 110 (45.6) > 30 min

10 (4.2)

Time to bathing

of baby

ORDER A CUSTOM-WRITTEN PAPER HERE

References

1. Bhalotra S, Arulampalam W. Sibling Death Clustering in India :
State Dependence vs . Unobserved Heterogeneity. IZA Discussion
Paper No. 2251. 2006.
2. Tinker A, Ten Hoope-Bender P, Azfar S, Bustreo F, Bell R. A
continuum of care to save newborn lives. Lancet 2005;365:822–5.
3. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When?
Where? Why? Lancet. 2005;365:891–900. Maternal & Neonatal Practices in Rural Areas Assignment.
4. Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, De Bernis
L. Evidence-based, cost-effective interventions: how many
newborn babies can we save? Lancet 2005;365:977-88.
5. Bang AT, Paul VK, Reddy HM, Baitule SB. Why do neonates die in
rural Gadchiroli, India? (Part I): primary causes of death assigned
by neonatologist based on prospectively observed records. J
Perinatol 2005; 25:S29–S34.
6. Dutta AK. Home-based newborn care how effective and feasible.
Indian Pediatr 2009;46:835-40.
7. Marsh DR, Darmstadt GL, Moore J, Daly P, Oot D, Tinker A.
Advancing newborn health and survival in developing countries: a
conceptual framework. J Perinatol 2002;22:572-6.
8. Campbell OM, Graham WJ; Lancet Maternal Survival Series
steering group. Strategies for reducing maternal mortality: getting
on with what works. Lancet 2006;368:1284-99.
9. National Family Health Survey (NFHS) -3 state reports: Gujarat.
Indian Institute for Population Sciences. Mumbai. 2005-06.
Available from: URL: http://www.rchiips.org/nfhs/NFHS-
3%20Data/gujarat_state_report_for_website.pdf
10. Meshram II, Laxmaiah A, Venkaiah K. Impact of feeding and
breastfeeding practices on the nutritional status of infants in a
district of Andhra Pradesh, India. Natl Med J India 2012;25:201-6.
11. Saxena D. Socio demographic profile of Breast-Feeding Mothers in
Urban Slums of Surat city [dissertation]. South Gujarat University,
Surat. 2004.
12. District Level Household & Fecility Survey (DLHS-3): Gujarat.
2007-08. Available from: URL: Maternal & Neonatal Practices in Rural Areas Assignment.
http://www.rchiips.org/pdf/rch3/report/GJ.pdf
13. Ayaz A, Saleem S. Neonatal Mortality and Prevalence of Practices
for Newborn Care in a Squatter Settlement of Karachi, Pakistan : A
Cross-Sectional Study. PLoS ONE 2010;5:e13783.
14. Barnett S, Azad K, Barua S, Mridha M, Abrar M, Rego A, et al.
Maternal and newborn-care practices during pregnancy,
childbirth, and the postnatal period: a comparison in three rural
districts in Bangladesh. J Health Popul Nutr 2006;24:394-402. Maternal & Neonatal Practices in Rural Areas Assignment.

Single Blog

Blog

Maternal And Neonatal Practices in Rural Areas Assignment.

Tips and Tricks from our Blog

What Doctors Arent Always Taught: How to Spot Racism in Health Care

VTEs Tied to Immune Checkpoint Inhibitor Cancer Treatment

The Curious Case of Three Fingers and Four iPhones

bscinnursing.com

Contacts

Company

Resources

Follow Us