PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
SUBMITTED BY:
MRS. UMI DEVI KANGJAM
I YEAR M.SC(NURSING),
Obstetrics and Gynecological Nursing
2009-2011 BATCH
SARVODAYA COLLEGE OF NURSING,
BANGALORE -560079
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME
OF
THE
CANDIDATE
ADDRESS
AND UMI DEVI KANGJAM,
I YEAR M.SC(NURSING),
SARVODAYA COLLEGE OF NURSING, 11/2
AGRAHARA, DASARAHALLI,NEAR
RAHEJA APARTMENTS,MAGADI ROAD
BANGALORE-560079.
2.
NAME OF THE INSTITUTION
Sarvodaya College Of Nursing Bangalore- 560079.
3.
COURSE OF STUDY AND SUBJECT
1st Year M.Sc nursing,
(obstetric and gynaecological Nursing)
4.
DATE OF ADMISSION OF THE COURSE
27-05-2009
5.
TITLE OF THE TOPIC
“A STUDY TO ASSESS THE KNOWLEDGE ON
HOME CARE MANAGEMENT OF PRETERM
BABIES
AMONG
WOMEN IN SELECTED
HOSPITALS, BANGLORE WITH A VIEW TO
DEVELOP AN INFORMATION BOOKLET.”
6.
7.
BRIEF RESUME OF THE WORK
6.0 INTRODUCTION
6.1 NEED FOR THE STUDY
6.1.1 STATEMENT OF THE STUDY
6.2 REVIEW OF LITERATURE
6.3 OBJECTIVES OF THE STUDY
6.3.1 OPERATIONAL DEFINITIONS
6.3.2 ASSUMPTION
6.3.3 HYPOTHESIS
6.3.4 SAMPLING CRITERIA
(I) INCLUSION CRITERIA
(II) EXCLUSION CRITERIA
(III) DELIMITATION
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
MATERIALS AND METHODS
7.1
7.2
7.3
7.4
Sources of data: Data will be collected from women who are having preterm babies in
selected hospitals, Bangalore.
Method of data collection: Interview Method
Does the study require any investigations of interventions to be conducted on the patients or
other human being or animals? No
Has ethical clearance been obtained from your institution?
YES. Ethical committee’s report is here with enclosed.
2
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE CANDIDATE AND MRS.UMI DEVI KANGJAM,
YR M.SC (NURSING)
ADDRESS
I
SARVODAYA COLLEGE OF
NURSING, 11/2 AGRAHARA
DASARAHALLI,NEAR RAHEJA
APARTMENTS,MAGADI ROAD
BANGALORE-560079.
2.
NAME OF THE INSTITUTION
Sarvodaya
College
Of
Nursing
Bangalore- 560044.
3.
1st Year M.Sc nursing,
COURSE OF STUDY AND SUBJECT
(obstetric and gynaecological nursing)
4.
DATE
OF
ADMISSION
OF
THE 27-05-2009
COURSE
5.
“A STUDY TO ASSESS THE
KNOWLEDGE ON HOME CARE
MANAGEMENT OF PRETERM
BABIES AMONG WOMEN IN
SELECTED HOSPITALS,
BANGLORE WITH A VIEW TO
DEVELOP AN INFORMATION
BOOKLET”
TITLE OF THE STUDY
3
6. BRIEF RESUME OF THE INTENDED WORK:—
6.0 INTRODUCTION:—
The health of a nation is the wealth of the nation. Today’s children are
tomorrow’s adults. Birth is a major challenge to the newborn to negotiate successfully
from intrauterine to extra uterine life. Newborn baby is considered to be tiny and
powerless, completely dependent on others for life. Within one minute of birth the
normal newborn adapts from a dependent fetal existence to an independent one; capable
of breathing and carrying on life process. Thus these first hours are crucial because
multiple organ systems are making the transition from intrauterine to extra uterine
functions8.
The duration of normal pregnancy is usually nine months or 40 weeks. Any
baby born before 37 completed weeks is called a preterm (premature) baby. The more
preterm, more are the chances of complications and less the probability of survival. It
goes without saying better the maturity better the survival. In India about 10 percent of
babies are born premature. The incidence of prematurity is around 5 percent in the more
developed countries.11
More than 1 million infants die each year because they are born too early.
Worldwide, the pre-term birth rate is estimated at 9.6% - representing about 12.9 million
babies. According to the White Paper, the highest pre-term birth rate in the world is
4
found in Africa, North America and Asia as 11.9%, 10.6% and 9.1% respectively (Oct
5th, 2009)9.
The rate of premature birth is rising. According to the March of Dimes, about
12% of babies born in the USA are born pre-term. Among the babies born pre-term 84%
are born between 32-36 weeks of gestation, about 10% are born between 28 and 31
weeks of gestation, and about 6% are born at less than 28 weeks of gestation .13
At the recent Annual Conference of the Neonatology Forum (NNF) on 17th and
18th November 2007 in Bangalore, leading members of the 300 participants decided to
take on a mission to save newborns in the state of Karnataka. It states that Karnataka
would come next with a neonatal mortality of above 40 per thousand live births.10
According to White Plains, 60% of all neonatal deaths and 68% of the world’s
burden of perinatal death occur in Asia. Almost 98% of these deaths occur in developing
countries and most are caused by infectious diseases such as sepsis, complication of
prematurity and birth asphyxia. Between 40% to 70% of all neonatal deaths occur among
those weighing less than 2500gm at birth.2
In the India multicentric Neonatal Health Research Initiative (NHRI) study, the
causes of neonatal deaths as per verbal autopsy were respiratory distress syndrome
(57%), low birth weight (51%), prematurity (29%) and jaundice (4%).15
Preterm birth is a growing National health crisis, according to the March of
Dimes. More than a half million babies are born to soon each year, and the rate continues
to rise. Birth defects and preterm birth are the leading causes of infant death. About 8%
5
of babies born premature had a birth defect, according to the research by a team of
investigator March of Dimes.14
Approximately 70% of neonatal mortality and 75% of morbidity results from
prematurity. Most pre-term birth occur after premature rupture of membranes.
Prematurity accounts for the largest numbers of admission to an NICU. The highest
incidence is in lower socio –economy group.
The National Rural Health Mission (NRHM) in India has set the objective of
reducing IMR to 30 per 1,000 live births by 2012. Achieving this objective will require a
reduction in newborn deaths of over 50 per cent in less than a decade.24
6.1 NEED FOR STUDY:—
Babies who are born preterm or small for gestational age are often at higher risk
for morbidity and mortality then are full term babies with normal birth rate. Preterm
births account for 75% of deaths that occur in the perinatal period (Goldenberg et al.
2008).16
Every year nearly 40% of all under 5 child deaths are among newborn infants.
The majority of neonatal deaths (75%) occur during first week of life, and those deaths
between 25% to 45% occur within the first 24 hrs. Prematurity and low birth weight
account for 30% (WHO Geneva, 2008).
About 91% of neonatal deaths occur in developing countries. Out of that 27%
are due to prematurity. Most deaths occurring during the first 48hrs after birth result from
6
respiratory distress. Pre-term birth occurs in approximately 7% of life births of white
Infants. Pre-term infant deaths account for 80% to 90% of infant mortality in the first
year of life. (NVSS, 2009)1
Each year in India over 1 million newborns die before they complete their first
month of life, accounting for 30% of the world’s neonatal deaths. Neonatal mortality is
higher in rural areas at 49 per 1000 life births. The neonatal mortality rate varies
considerably among Indian states. Orissa and Madhya Pradesh have the highest neonatal
mortality rate of 61 and 59 per 1000 life birth respectively.3
Conducted a neonatal morbidity study in 7015 neonates born at the All India
Institute of Medical Sciences Hospital, New Delhi. The incidence of low birth weight
babies was 26.7%; one seventh (13.5%) of the series were preterm (less than 37 weeks),
while 6.6% were 'small-for-dates'. Birth asphyxia of varying severity developed in 5.9%
infants. Respiratory distress syndrome was diagnosed in 5.7 per 100 live-births; most
being due to hyaline membrane disease (33.5%), which affected 14.1% of preterm babies.
Neonatal hyperbilirubinemia occurred in 5.9%, most of whom were premature.21
Preterm birth is the major cause of neonatal mortality in developed countries.
Premature birth is a serious health problem. Premature babies are at increased risk for
newborn health complications, such as breathing problems, and even death. The shorter
the term of pregnancy, the greater the risk of mortality and morbidity for the baby due to
the related prematurity. Prematurity is a major reason why babies are born sick and suffer
disabilities. It is the number one cause of newborn death (Klebu, March of Dimes
7
volunteer, Nov 2009). Most premature births are caused by spontaneous preterm labor,
either by itself or following spontaneous premature rupture of the membranes (PROM)19.
The Mother Kangaroo Method is an important model of cost-benefit ratio
which improves the survival rate and quality of life of premature infants. The continuous
skin to skin contact helps the infant maintain adequate body temperature and stimulate
the development of a close emotional bond between mother and child. Love, warmth and
maternal lactation are the essence of the Mother Kangaroo Method20. In a study of three
continuous hours of Kangaroo care for preterm babies, it is found that apnoea,
bradycardia, and periodic bleeding were absent during Kangaroo care. Regular breathing
increased for babies receiving Kangaroo care compared to babies receiving standard
NICU care (Ludington- Hoe et al).18
By recognizing the susceptibility of the premature baby from its immunological
system’s vulnerability, mothers prevent infections with visit restriction, utensil care and
vaccination. Restricting visitors is a measure that contributes to prevent infections. Thus
parents must prevent their child from coming into contact with people with a cold or flu.
They must explain to the visitors that they will have plenty of time to visit the child as it
is staying at home, so they do not need to gather together. Some of the home measures to
prevent home infections of preterm babies were hygiene habits at home such as general
cleaning, and care for the newborn such as hand washing to change the baby’s clothing
and hygiene during food preparation. (BALBINO)25
8
6.1.1
STATEMENT OF THE PROBLEM:—
“A study to assess the knowledge on home care management of preterm
babies among women in selected hospitals, Bangalore with a view to develop an
information booklet”.
6.2
REVIEW OF LITERATURE:—
The literature for the present study is organized or presented under the
following headings:1. Studies related to incidence on preterm babies.
2. Studies related to home care management of preterm babies.
Studies related to incidence:-
In a random sample of 4,719 women who gave birth in Western Australia, the
incidence of preterm birth was highest amongst women who binged (9.5%) or drank
heavily, even if the mother stopped drinking prior to the second trimester (13.6%),
compared with less than 6% in women who did not drink during pregnancy. There was a
2.3-fold increased odds of preterm birth in women who drank heavily in early pregnancy
but then stopped after taking into account maternal smoking, drug use, socioeconomic
status and maternal health. Researchers suggest that a possible reason why this occurs is
because the cessation of alcohol consumption before the second trimester may trigger a
metabolic or inflammatory response resulting in preterm birth. There was no evidence of
an increased likelihood of preterm birth at low levels of alcohol consumption.7
9
The incidence of preterm births in India is estimated to be 11–14%. In a
database of 1,45,623 live births collected from 18 hospitals, 14.5% of babies were
premature (NNPD 2002–03). This means that India has an annual incidence of 3 to 4
million preterm live births which is a huge number. Even in developed countries, there is
often uncertainty of incidence of prematurity and incomplete recording of gestational
assessment. The incidence of preterm births in most developed countries has been about
9–12%.5
The study correlates the mode of breech delivery to the immediate neonatal
outcome in preterm breeches. Among 9816 deliveries the incidence of breech deliveries
was 3.95% and the incidence of preterm breech deliveries was 1.9%. Totally 112 (69%)
patients delivered vaginally and 50 (31%) underwent caesarean section. Between 30-36.6
weeks gestation the incidence of birth asphyxia was higher in the vaginal group. In this
group the take home baby rate after vaginal delivery was 81% as compared to 86% in
caesarean group.6
Studies related to home care management:An article was written on the effectiveness of the kangaroo position or direct
skin contact as a method for obtaining an adequate temperature of the newborn (WHO
1986). Results shown that for a 2000 gms baby, in an environment at room temperature,
direct skin contact is much better than the warmth provided by a thermal blanket,
incubator with hot water mattress, or a common incubator. The kangaroo position allows
babies to be isolated from infections and mother to keep close watch.
10
A study to determine the effects of kangaroo care (KC) (skin-to-skin contact)
on breastfeeding status in mother-preterm infant dyads from postpartum through 18
months. The control group received standard nursery care; in the intervention group,
unlimited KC was encouraged. A subsample of 66 mothers and their preterm infants (3236 completed weeks gestation, 1,300-3,000 g, 5 minute Apgar > or = 6) who intended to
breastfeed. Breastfeeding status at hospital discharge and at 1.5, 3, 6, 12, and 18 months
as measured by the Index of Breastfeeding Status. KC dyads, compared to control dyads,
breastfed significantly longer23.
In an observational study, there were total 81 babies eligible for Kangaroo
Mother Care with birth weight of 1363.4gms and gestation of 30.5weeks. KMC was
provided by father in 24 cases. The duration of KMC given by father was 2.8 hours per
day. Mean temperature of baby during KMC was 36.9degree celsius. No baby suffered
hypothermia or hyperthermia during KMC.26
A study in India on the effect of massage with oil on preterm babies growth
showed that a four week daily regiment resulted in significant weight gain. In this
randomized controlled trial, 62 preterm neonates weighing less than 3.3 pounds were
assigned to 3 groups- massage with oil, massage without oil and no massage. Subjects in
the oil- massage group gained an average of 0.8 pounds. Subjects in the massage- only
and no- massage group gained an average of 0.638 pounds and 0.627 pounds
respectively. It is found that oil application may have a potential to improve weight gain.4
11
The use of human milk for premature and other high risk infants either by
direct breast feeding and / or using the mother’s own expressed milk is recommended by
the American Academy Of Padiatrics. Feeding human milk to preterm infants provide
nutritional, gastrointestinal, immunological, developmental, and psychological benefits
that may impact their long term health and development. Human milk is advocated as the
nutrition for preterm baby because it provides substances not supplied in formula.22
6.3 OBJECTIVES OF THE STUDY:—
1. To assess the knowledge regarding home care management of preterm babies among
women.
2. To identify the association between knowledge regarding home care management of
preterm babies and selected variables.
3. To develop information booklet on home care management of preterm babies.
6.3.1
OPERATIONAL DEFINITIONS:—
1. KNOWLEDGE— Refers to the awareness of women regarding home care
management of preterm babies as assessed by the responses to items of the knowledge
questionnaires.
12
2. HOME CARE— It refers to the care that can be practiced in home setting to maintain
temperature, improve weight gain, infection prevention by the mother.
3 .PRETREM BABIES— Refers to the babies born before 37 weeks of gestation with
birth weight of less than 2 kg.
4. WOMEN— It refers to the women who are having preterm babies.
5. INFORMATION BOOKLET— It refers to an organized written materials which
contain about the meaning, causes, clinical manifestations, and home care management of
preterm babies.
6.3.2 ASSUMPTION:—
The women may have lack of knowledge regarding home care management
of preterm baby.
6.3.3 HYPOTHESIS
There is no significant association between knowledge and selected demographic
variables of women regarding homecare management of preterm babies.
13
6.3.4
SAMPLING CRITERIA:—
INCLUSION CRITERIA
 Who are willing to participate in the study.
 Who are available at the time of data collection.
 Who can read and speak Kannada or English.
EXCLUSION CRITERIA
 Women who had still births or neonatal deaths.
6.3.5
DELIMITATION
 The study is delimited to Vanivillas Hospital and Sri Lakshmi Hospital,
Bangalore.
 The study is delimited to 4 weeks.
7. MATERIALS AND METHODS:—
7.1
SOURCE OF DATA
Data will be collected from women who are having preterm babies in selected hospitals,
Bangalore.
14
7.2 METHOD OF DATA COLLECTION:-1. RESEARCH APPROACH— Exploratory approach
2. REASERCH DESIGN— Descriptive study.
3 .SETTING— It is selected in Vanivillas Hospital, and Sri Lakshmi Hospital,
Bangalore.
4. POPULATION--- All women who delivers a preterm baby.
5. SAMEPLE---- Women having preterm babies
6. SAMEPLE SIZE— 60
7. SAMEPLING TECHNIQUE— Convenient Sampling technique
8. METHOD OF DATA COLLECTION— Interview method
9. TOOL FOR DATA COLLECTION — Structured questionnaire
10. METHOD OF DATA ANALYSIS AND INTERPRETATION— The researches will
use appropriate statistical technique for data analysis and present in the form of tables and
diagrams.
 Knowledge will be analyzed by frequency and percentage distribution.
 Level of knowledge will be analyzed by mean and standard deviation.
 Association between demographic variables and knowledge on home care
management of preterm babies will be analyze by chi square test.
11. DURATION OF THE STUDY— 4 weeks.
12. VARIABLES—
Research Variable
 Dependent variables: - knowledge on home care of preterm babies.
15
Demographic variables:I.
II.
Age.
Educational qualification
III.
Occupation
IV.
Types of family
V.
Income
VI.
Parity
VII.
VIII.
IX.
Previous history of preterm babies
Previous source of information
Baby born at -
 PROJECTED OUTCOME— The information booklet will enhance the women’s
knowledge on home care management of preterm babies. The women will develop
skills and practice in caring preterm babies at home.
7.3 Does the study require any investigation or intervention to be conducted on
patient or other animal?
—No
7.4 Has ethical clearance been obtained from your institution?
— Yes, ethical committee clearance is enclosed herewith.
16
8.0 LIST OF REFERENCES:—
1) Adele Pillitteri. Maternal and Child Health Nursing 6th edition. Philadelphia.
J.B. Lippincott Williams & Wilkins. 2009. 711-712..
2) Hans Troedsson and Jose Martines. Introduction to Meeting. The Journal of
Perinatology. 2002; 22,35-39. Available from URL: www.harpnet.org/doc/int
3) Kumar D, Verma A, Sehgal UK. Neonatal Mortality in India. From Rural and
Remote Health 7( Online ) 2007; 833. Available on URL: www.rrh.org.au.
4) Jyoti Arora, Ajay Kumar and Siddharth Ramji. Massage with oil improves
weight gain in preterm babies. Published in Indian Pediatrics. Nov. 17.2005;
Vol.42.AvailablefromURL:www.ultimatewatermassage.com/research_health/
massage_research_preterm_babies.htm.
5) Chellani Harish. Prematurity- An Unmet Challenge. Journal of Neonatology.
YearVol.21(2).AvailablefromURL:www.indianjournals.com/ijor.aspx?target=
ijor.jn and vol=21 and issue=2 and article =editorial.
6) HS Warke, RM Saraogi and SM Sanjanwalla. Should a Preterm Breech Go for
Vaginal Delivery or cesarean section. Journal of Post Graduate Medicine.
Year 1999. Vol. 45(1) 1-4. Available from URL:
www.jpgmonline.com/article.asp?issn=0022 – 3859, year=1999
Vol.=45;issue=1 spage=1/epage=4;aulast=Warke.
7) Medical News . Heavy and Binge drinking during pregnancy increases risk of
preterm birth. 21 January 2009 Available from URL:
www.news.medical.net/news/2009/01/21/45180.aspx.
17
8) Shrestha M,Singh R,Upreti D Quality of care provided to newborn by nog.
Personnel at BP koirala Institute of Health Sciences. Katmandu University
Medical Journal(2009). Vol.7 No.3(27).231-237.Available From
URL:www.kumj.com.np/ftp/issue/27/231-237.pdf.
9) Elizabeth Lynch.Global death toll:1 million premature babies every
year.March of Dimes Foundation.4oct.2009. 914-997-4286.Available from
URL www.eurekalert. Org/pub-release/ 2009-10/modf-gdt100209.php.
10) UNICEF partners with Neonatology Forum for Newborn Survival Revolution
in Karnataka.Unicef. Available from URL www.unicef.org/india/resourses3761.htm.
11) Dr.Pradeep Kapoor. Premature baby.Associated
Content.sept30.2009.Avialable from URL
www.associatedcontent.com/article/2232991/premature- baby.html?Cat=52.
12) Alice Park.U.S.Gets a D on Preterm Birth Rates Says March of
Dimes.Yahoo!News.Nov20.Available from URL
www.news.yahoo.com/s/time/20091120/hl-time/08599194014000
13) When are most premature babies born?Premature Birth.March of
Dimes.2009.Available fromURL
www.marchofdimes.com/professionals/14332-1157.asp.
14) Heidelberg. Analysis of millions of US births shows association between birth
defects and preterm birth.Science News.May21.2008-11:08Available from
URLwww.esciencenews.com/article/2008/05/21/analysis.millions.us.birhs.sho
ws.association.between.birth.defects.and.preterm.birh.0
18
15) MKC Nair and Vishwas Mehta.Life Cycle Approach to Child Development.
Indian Pediatr Suppl. 2009: 46:S7-S11. Available from URL:
www.indianpediateics.net/suppl2009/sup-S7-S11.htm.
16) Gilliam Lim, Jacinth. Tracey, Nicole Boom, Sunita Karmakar, Joy Wang.
Hospital Cost for Preterm and Small for Gestational Age Babies in Canada.
Health care Quarterly. 12(4) 2009; 20-24. Available from
URL:www.longwoods.com/product.php?product id=21121 & cat=609 &
page=2.
17) National Prematurity Awareness Day – Nov. 17. The Banner .Com Available
from URL: www.the banner.com/articles/2009/11/06/news/news05.txt.
18) Blois Maria. “Birth. Care of Infant and Mother: Times Sensitives Issues.
“2007-08. P-108-132. Available From URL: www.indiseasemanagement.org.
19) Premature Birth. March of Dimes. Professionals & Researchers. Available
From URL: www.marchofdimes.com/professionals/14332-1157.asp
20) Hector Martinez. The Mother Kangaroo Method. Innovation for Development
& South Cooperation. Colombia. Available from URL: www.ideasonline.org.
21) Singh M. Deorari AK. Khajuria RC. Paul VK. A four years study on neonatal
morbidity in a New Delhi Hospital. Indian J Med Res 1991. June: 94: 186-92.
Available from URL: www.ncbi.nlm.nih.gov/pubmed/1937600.
22) Andi Dietz, Susan Greathouse , Jennifer Niemeyer. DHS. Available from
URL: www.oron.gov/DHS/ph/wic/docs/preterm.pdf
23) Hake-Brooks, Sara J, Anderson, Gene Cranstone. Making Medical Research
Available to everyone Home. National Library of Medicine. 2008 Vol.27(3) p
19
-151-9 available from URL:www.find-healtharticles.com/rec-pub_1855762kangaroo-care-breastfeeding-motther-preterm-infant-dyadx-0-18months.htm
24) Dr.AK Nigam et al.Community;Based Interventions that Improve Newborn
Health Outcomes:A Review of Evidence in South Asia.March 08.Available
From URL: www.nippcd.nic.in/mch/er/ermb.pdf.
25) Aisiane Cedraz Morais,Marinelva Dias Quirino,Mariza Silva Almeida.Home
Care of the Premature Baby.Aca paul.enferm.jan/feb.2009.Available from
URL:www.sceilo.br/pdf/ape/v22nl/en-a04v22nl.pdf.
26) Kanya Mukhopadhyay, Prof.Anil Narang, Praveen Kumar. Prematurre infants
need dads too. Kangaroo Mother Care Initiative.2004.28Oct.Available From
URL:www.kmcindia.org/healthcare/fact;immediate.html.
20
9.
Signature of Candidate
10.
Remarks of the Guide
Name and Designation
11.
(In block letter)
11.1 Guide
11.2 Signature
11.3 Head of the Department
.
12.
12.1 Remarks of the Chairman & Principal
12..2 Signature
21