RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING
MANAGEMENT OF LOW BIRTH WEIGHT (LBW) BABIES AMONG
POSTNATAL MOTHERS IN SELECTED COMMUNITY AT
PROFORMA FOR REGISTRATION OF SUBJECT FOR
S.L.E.S COLLEGE OF NURSING, CHINTAMANI.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 NAME OF THE Ms. SWATHI.S
STUDENT M.Sc NURSING STUDENT
S.L.E.S COLLEGE OF NURSING,
2 NAME S.L.E.S COLLEGE OF NURSING,
OF INSTITUTION CHINTAMANI. -563125
3 COURSE OF THE M.Sc NURSING
STUDY COMMUNITY HEALTH NURSING.
4 DATE OF
ADDMISSION TO 25-08-2011
5 TITLE OF TOPIC “A STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON
KNOWLEDGE REGARDING MANAGEMENT OF
LOW BIRTH WEIGHT (LBW) BABIES AMONG
POSTNATAL MOTHERS IN SELECTED
COMMUNITY AT CHIKKABALLAPUR(dist)”
6 BRIEF RESUME OF INTENDED WORK:
“There is no indicator in human biology, which tells us so much about the past
events and the future trajectory of life, as the weight of infant at birth.”
– V. Ramalingaswami.
Motherhood is a beautiful and joyous experience to a woman. The health of the mother
during pregnancy is important to give birth to a healthy baby. The best and most precious gift
a mother can give her baby is the gift of health1.
The healthy newborn is born at term, cries immediately after delivery and establishes
satisfactory rhythmic pulmonary respiration. In India reports of various studies shows birth
weights of mature newborn varying between 2.5 to 3.9 kgs with a mean of 2.7 kgs2.
WHO has defined the term “low birth weight” as birth weight less than 2500grams. As
per the definition babies with birth weight of less than 2500 grams are classified as low birth
weight irrespective of the duration of the gestational period. Newborns with birth weight (for
gestational age) of less than 10th percentile are categorized as “small for date” (SFD). Thus
the term low birth weight includes preterm babies (those born before 37 weeks of gestation) as
well as full-term babies who are small for date due to intrauterine growth retardation3.
Survival of LBW newborn during first month of life is determined by stressors of
intrauterine life, problems faced during delivery as well as by adjustment to new environment.
Birth weight is the single most important marker of adverse perinatal, neonatal and infantile
outcome. Over 80 percent of all neonatal deaths occur among the LBW babies. LBW infants
have 2-3 times increased risk of mortality due to infection compared to normal birth weight
babies. The common problems associated with premature babies are hypothermia respiratory
distress syndrome, difficulty in feeding because of weakness, more susceptible to infection,
greater likelihood of contracting jaundice.4
Majority of the problems associated with Low birth weight newborn can be prevented by
providing education to the mother’s regarding the identification of problems associated with
LBW and care of LBW newborn.4
Low birth weight is one of the important causes for the high infant mortality rate in
developing countries. In India during the year 1991, the IMR was 80 per 1000 live births &
neonatal mortality rate (NMMR) was 51 per 1000 live births.LBW babies have been reported
to lag behind their heavier counterpart in development for the rest of their lives.
The incidence of low birth weight in the country is estimated to be around 40%. The basis
for this has mainly come from hospital based data; the data shows a wide range from 2.7% to
40%. In rural India, almost 90% of deliveries occur at domiciliary level and are conducted by
traditional birth attendants weighing them soon after birth poses a considerable challenge.
However, the need for this information is essential for planning purposes a well as for
management of newborns.5
While some low birth weight babies may be perfectly healthy how birth weight due to
restricted growth can negatively affect a child’s growth and susceptibility to disease through
out life. Premature birth and low birth weight are both major causes of neonatal death.5
6.1 Need for the study
Low birth weight newborns forms a paediatric priority because they have less chance
of survival than babies weighing 2500 gm. Half of the prenatal and one third of infant
mortality are due to the low birth weight. Low birth weight may lead to serious physical and
mental handicap in those who survive. Incidence of LBW newborns in India is estimated to be
5-7 percent in some of the industrially advanced countries6
A birth weight of less than 2500 gm is considered less favourable for the survival
and wellbeing of a newborn and hence the weight of 2500 gm is being used as cut-off point.
Low birth weight is a major public health problem in all developing countries including
India8. Birth weight is the critical determinant for survival in the neonatal period and for the
future growth and development of the newborn.7
In India about 25-35 percent of babies are born with low birth weight. Over 80
percent of neonatal deaths and 50 percent of infant deaths occur among low birth weight
neonates. A LBW newborn may face problems like hypothermia, increased chance to acquire
infection due to lack of immunity and LBW newborns are at high risk of having problem with
feeding which later can lead to malnutrition10. Hence it is important to educate the mother
about the problem and how to manage the newborn with such problems.8
Babies born with normal or above average birth weight already have a healthy start. Risk
of childhood illness, learning and developmental disorders are less in a normal newborn when
compared to low birth weight newborn. Babies are more susceptible to infant mortality, birth
defects other physical and mental difficulties throughout their lives. Infant mortality has
decreased during the last few years but the rate of low birth weight increased. It is predicted
that LBW infants are almost 2.4 times likely to die during their first four weeks of life than
normal birth weight newborns. Thus educating the mother is very useful in reducing the
More than 95% of low birth weight babies are born in developing countries. However
data collection for low birth weight is difficult because babies are not weighed at birth in many
countries. Nearly 4 million babies die in the first month of life and premature birth are major
causes. Half of all low birth weight babies are in south-central Asia, where 27% of infant are
born below 5.5 pounds low birth weight levels in sub-subsaharan.11
Africa are around 15% and the Caribbean has a level of 14% north America averages 8%
while Europe has the lowest prevalance.11
A mother’s prenatal care is a key factor in preventing preterm birth and low birth weight
infants, proper nutrition and weight gain, as well as avoiding alcohol and cigarettes can
prevent LBW. Preventing LBW may also include micronutrient supplementation and
preventing and a treating diseases such a malaria and HIV/AIDS in pregnant women.11
Low birth weight babies need care in a neonatal intensive care unit and usually need a
temperature controlled bed and special food, potentially through a tube into the stomach.
These interventions are costly and can be difficult if not impossible to obtain in developing
countries. A process called kangaroo mother care, where the mother straps the baby to her,
providing continuous skin-to-skin contact, has been shown to provide some of the warmth,
stimulation and protection from infection that a newborn needs to survive.11
In parental education, particularly the mothers are strongly responsible to improve
the healthcare of newborns. Education enables the mother to acquire greater knowledge and
better newborn care practices. Mother is an important primary care provider and therefore, her
education and access to information will help her, on care of her LBW newborn. As newborns
constitute the most important and vulnerable segment of our population, mother represents the
most important health worker as far as newborns health is concerned. Health education inputs
for mother should be therefore strengthened. Even today the mortality and morbidity in LBW
newborns is high and it is mainly due to the causes that can be prevented.12
The researcher felt the need to identify the needs of mothers and educate them on
care of LBW newborns, so as to improve the care of LBW newborns and to promote normal
and healthy growth and development and thereby reduce LBW newborns mortality and
6.2 REVIEW OF LITRATURE
A study was conducted to determine the feasibility and acceptability of
kangaroo care in a tertiary care hospital in India. Among 89 neonatal forty-four babies were
randomized to the KMC group and 45 to the conventional method of care. There was
significant reduction in KMC v/s CMC group of hypothermia (10/44 v/s 21/45, p<0.01),
higher oxygen saturation (95.7 v/s 94.8%, p<0.001) and decreased respiratory rates (36.2 v/s
40.7, p<0.01). There were no statistically significant differences in the incidence of
hyperthermia, sepsis, apnoea, onset of breastfeeding, and hospital stay in two groups. Seventy-
nine percent of the mothers felt comfortable during the KMC and 73% felt they would be able
to give KMC at home.12
A study on the assessment of newborn babies’ temperature by human touch was
conducted at AIIMS, New Delhi. Fifty healthy term neonates were assessed by three
pediatricians for skin temperature to the nearest ±0.05°C at three body sites, that is, mid-
forehead, abdomen and dorsum of right foot by touch. The predicted temperatures at different
sites were compared with simultaneously recorded temperatures at the same sites with the help
of electronic thermometers. Rectal temperatures were also recorded in all the babies with
rectal thermometer to compare the variation between the core and skin temperatures. There
was a good correlation between the skin temperature of the babies as perceived by touch and
values recorded with the help of electronic thermometer. All the hypothermia babies were
correctly picked up by all the observers. It was recommended that health professionals and
mothers should be explained the importance of evaluating the core and peripheral skin
temperature by touch for early identification of babies under cold stress in order to prevent
occurrence of life-threatening hypothermia.13
A study was conducted on the implications of kangaroo care for growth and
development in pre-term infants. The study consists of 74 pre-term infants below the weight of
1600 g. These babies were consecutively allocated to kangaroo care unit or standard care for
24 times within 7 days. There was a higher weight gain (10.2 g/day) and shorter hospital stay
A study was conducted on twenty very low birth weight infants and to compare the
clinical effects of breast and bottle feeding. Five breast feedings and five bottle feedings for
each infant were observed. Weights before and after feeding were recorded. The results
showed that weight gain during breastfeeding session was less (median, no gain v/s 31 gm; p <
0.001) probably because of low intake and may require more lactation counseling or
supplementation of the feeding15.
A study was conducted to determine whether transition from tube to oral feeding can
be accelerated by the early introduction of oral feeding among 29 preterm infants at Texas.
Infants were randomized to an intervention and control group. The intervention group was
initiated to oral feeding 48 hours after achieving full tube feeding and followed a structured
protocol. Feeding performance was assessed. The results showed that infants in the
experimental group were compared with control counterparts when introduced to oral feeding
significantly earlier (31.1±1.3 v/s 33.7±0.7 weeks) and attained all oral feeding significantly
earlier (34.5±1.6 v/s 36.0±1.5 weeks). The transition time from full tube feeding to all oral
feeding was 26.8±12.3 days for the control group. Early introduction of oral feeding
accelerates the transition time from tube to oral feeding16
A study was conducted to investigate changes in nutritive sucking pattern behavioral
state and neurobehavioral development of preterm infants from the 34 weeks post-
conceptional age to term 66 preterm infants with a gestational age between 24 and 34 weeks at
birth. A feeding procedure was administered at 34 and 40 weeks PCA with the behavioral
assessment score at 40 weeks PCA. Results showed there were significant differences in
number of sucks (p<0.001), intensity of sucking pressure (p< 0.001), and average time
between sucks (p<0.001) from 34 weeks PCA to term with maturation. It was noted that the
pre-term infants were significantly more alert during the sucking protocol from 34 weeks to
A study was designed to quantify the pre-term babies’ response to routine childhood
immunization. A total of 69 pre-term babies were put into two groups of less than 32 weeks
and between 32 and 35. According to this gestational age, within each group the babies were
randomly placed into one of three schedules for immunization with DTP and oral polio
vaccine at 3, 4 and 5 months; 3, 4, 5 and 18 months; and 3, 4, 10 months. Antibodies were
measured before and after immunization. Children had adequate immunity to all four
infections. So it was concluded that no correction needs to be made for prematurity when
initiating routine immunization in premature infants18.
A study was conducted to describe current immunization practices for premature and
low birth weight infants and certain risk factors for poor immunization status. The study
revealed that at each age infants weighing less than 1500 gm at birth had lower up to date
immunization than other infants. At age 6 months, 52% to 65% of infants weighing less than
1500 g were up to date at each of 3 health maintenance organizations compared with 69% to
73% of those weighing 1500 to 2500 g and 66% to 80% of premature infants weighing more
than 2500g. The data suggested that infants born prematurely are vaccinated at levels
approaching that of general population but levels of vaccination for very low birth weight
infants lag slightly behind19.
A correlation study of infant rearing practices and common health problems in infants
with selected mother-related variables in an urban slum in Mumbai revealed that 78% of
mothers gave daily bath, 21% on alternative days and 1% bathed their babies twice a week;
fifty-five percent breastfed immediately after birth, 11% on second day and 35% on the 3rd
day. Breast milk supplement was a common practice among majority (53%). Between 3-6
months of age, 89% of them started weaning. The common health problems among infants
were respiratory (77%), gastrointestinal (58%) and skin problems (16%). The mother-related
variables like education, family income, and common health problem were found non-
A study was conducted to assess the knowledge regarding breastfeeding among
mothers in a selected community of Karnataka revealed that literate mothers (77%) had more
knowledge than illiterate (75%) mothers. Mothers with two or more children (85%) had more
knowledge than mothers with single child (81%).Regarding advantages of breast feeding
illiterate mothers (75%) had more knowledge than literate mothers (65%).There was no
association between mother’s knowledge and educational status21.
A study was conducted to assess the knowledge and practice of mothers regarding
complementary feeding revealed that 93.33% of mothers had average knowledge (<50%)
regarding complementary feeding. It was also found that there was no significant relationship
between mothers knowledge and practice and also there was no correlation(r=0) between
knowledge of mothers and their practice regarding complementary feeding22.
A study was conducted on 763 neonates to evaluate the effectiveness of home based
neonatal care in the management of LBW in Godchiroli village India. Intervention included
were healthcare, breast feeding and prevention and management of infections. After this
intervention the case fatality rate among pre-term babies decreased by 69.5% in LBW
neonates; the CF rate decreased by 58%; the decrease was most pronounced (67%) in the
neonates weighing 2000 to 2499 gms but in the <1500gm groups it remained high at 40% in
spite of a 42.2% decrease23.
A study to evaluate the effectiveness of planned teaching regarding assessment of
LBW infants in terms of knowledge and skills of nursing personnel working in neonatal care
unit in a selected hospital of Delhi. The study results showed that the mean post-test
knowledge score (44.47) and skill score were significantly higher than the mean pre-test
knowledge scores and skill scores (17.91) (p<0.01). There was a significant positive
coefficient of correlation (0.41) between post-test knowledge score and skill score (p<0.05).
Thus the PTP was effective in enhancing knowledge as well as skill of nursing personnel
regarding assessment of LBW infants24.
A study to explore the feasibility of using motivational interviewing to promote
sustained breast feeding was conducted at three western rural community hospitals. The study
samples included 73 primiparous breastfeeding mothers ranging between the ages of 19 and
38. The study revealed that the motivational interviewing group (M=98.1 days, SD =75.2)
breast fed longer than the comparison group (M=80.7 days SD=71.9). However the difference
was not significant (t (69) =0.991, p=.325), Cohen’s d=0.24. It was concluded as a strategy to
test a comprehensive intervention plan25.
A study to evaluate the effectiveness of a parent-focused intervention programme
(COPE) on infant cognitive development and maternal coping was conducted with 42 mothers
of low birth weight premature infants hospitalized in a NICU with follow-up at 3 months and
6 months. COPE mothers received the four phase educational behavioural programme that
began 2-4 days post-birth and continued through 1 week following discharge from NICU.
Comparison mothers received audio taped information during the same four timeframes.
Results indicated that COPE infants had significantly higher mental development score at 3-
months corrected age (M=100.3) than did the comparison26.
6.3 PROBLEM STATEMENT
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE REGARDING
MANAGEMENT OF LOW BIRTH WEIGHT (LBW) BABIES AMONG
POSTNATAL MOTHERS IN SELECTED COMMUNITY AT
1. To determine the level of knowledge of postnatal mothers regarding management of low
birth weight babies
2. To evaluate the effectiveness of structured teaching programme on management of low
birth weight babies.
3. To find the association between pre-test & post-test knowledge scores with selected
Assess: estimate the size or quantity of.
Assess: It refers to knowledge level of mothers regarding the factors affecting &
management of low birth weight babies
Knowledge: awareness or familiarity or a person’s range of information.
Knowledge: In this study it refers to the correct response of mothers of LBW newborns to the
knowledge item in a structured teaching programme on the care of LBW newborns & expressd
in term of knowledge scores.
Mothers: A female parent.
Mothers: It refers to individuals who are having newborn babies whose birth weight is less
Structured teaching Programme: It is a planned teaching an learning process between the
investigator and study subject that helps for knowing about factors affecting and management
of LBW newborns
Low birth weight: Any newborn or neonate weighing less than 2500gm at birth irrespective
of gestational age. In this study it refer to those newborn whose weight at birth was less than
2500gms irrespective of gestational age.
A1: level of knowledge among postnatal mothers of low birth weight babies regarding
management of low birth weight babies differs from one mother to an other mother.
A2: Structure teaching programme influences level of knowledge among postnatal mothers of
Low birth weight babies regarding Management of low birth weight babies.
A3 : socio-demographic variable contribute to the level of knowledge among postnatal mothers
. regarding Management of low birth weight babies
A4: mass media influences the level of knowledge among postnatal mothers of low birth
weight babies regarding Management of low birth weight babies
The study is delimited to:
Study is delimited to postnatal mothers who are not having low birth weight babies
Study is delimited to mothers who are not willing to participate in study.
Study is delimited to mothers who are previously sensitized with the similar study.
Study is delimited to mothers who are not able to communicate in kannada &
H1: there will be significant difference between pre- test & post- test knowledge score of
mothers following administration of structured teaching programme regarding management of
low birth weight babies.
H0: There will be no significant difference between pre test & post test knowledge score of
mothers after administration of structured teaching programme regarding management of low
birth weight babies.
6.8.1 Dependent variable:- . The variable that is hypothesized to depend on or caused by
6.8.2 Independent variables: -. It refers to the variable that is believed to cause or influence
the dependent variable.
In this study the independent variable is structured teaching programme(STP)
6.8.3 Extraneous variable: Some demographic variables like age, education, occupation
etc are extraneous variables .
MATERIAL AND METHOD
Source of data: - Data will be collected from the mothers in a selected community at
7.1 Method of data collection
7.1.1 Research design: Quasi experimental one group pre-test & post-test design.
7.1.2 Setting of the study: the study will be conducted in a selected community at
7.1.3 Population: Postnatal mothers with low birth weight babies & mothers who
meet the inclusion criteria.
7.2 METHOD OF DATA COLLECTION
The purpose of the study will be explained to involve the participants in the study.
Structured interview schedule will be adopted by the researcher to collect the data from the
subjects. The tool for data collection will be prepared and after validation by the experts the
further refinement of the tool will be done. Pilot study will be conducted before the main
study. Pre-test to subjects will be conducted and STP will be implemented. Post-test
assessment will be done after 7 days of the implementation of the Structured teaching
programme. This will be followed by Analysis.
7.2.1Sample size: 40 samples are selected for the study.
7.2.2 Sampling technique: Convenient sampling.
7.2.3 Sampling criteria
Mothers who are willing to participate.
Mothers who can communicate in Kannada or English.
Mothers who are having low birth weight babies.
Mothers who are previously not sensitized with similar studies.
Mothers who are not willing to participate.
Mothers who are not able to communicate in Kannada or English.
Mothers who are not having low birth weight babies
Mothers who are previously sensitized with similar studies
7.2.4 Tools of data collection
A structured interview schedule will be used by interviewer as a method for data collection.
Tool consist of
Section A- demographic data of subject
Section B- management of low birth weight babies.
7.2.5 DATA ANALYSIS AND INTERPRETATION
Descriptive and inferential statistics like mean, median, standard deviation, paired ‘t’
test, correlation, coefficient and chi-square will be used for data analysis and presented in the
form of tables, graphs and diagrams.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION
TO BE CONUCTEDC FROM OTHER CLIENT OR ANIMAL.IF SO DESCRIBE
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
Prior to the study permission will be obtained from the concerned authority to
conduct the study and also from research committee of S.L.E.S College of nursing chintamani,
the purpose of study will be explained to the respondent.
8. List of References
1. Singh M. Care of newborn. 6th ed. New Delhi: Sagar Publications; 2004.
2. Dawn CS. Textbook of obstetrics, neonatology and reproductive and child health education.
16th ed. Kolkata: Dawn Books; 2004.
3. Gurav BR, Kartikeyan S, Jape RM. Low birth weight babies. [Online]. Available
4. Premature babies. India Parenting. [Online]. Available from:
5. Google search on Low birth weight
6. Trivedi CR, Maralankar DV. Epidemiology of LBW in Ahmedabad. Indian
Journal of Paediatrics;53:795-800.
7. Sarma KVR. When the baby weighs low. Health Action 1996 Sep;13-14
8.Das KB, Mishra NR, Mishra PO, Bhargava V, Prakash A. Comparative outcome of low
birth weight babies. Indian Pediatrics 1993 Jan;30(1):15-21.
9. Ghai OP. Essential paediatrics. 5th ed. New Delhi: Mehta Publishers; 2001.
10. Demography, health and nutrition
11. Pubmed search on Low birth weight
12. Kadam S, Binoy S, Kanbur W, Mondkar AJ, Fernandez A. Feasibility of kangaroo mother
care in Mumbai. Indian J Paediatrics 2005 Jan;72(1):35-8.nutrition. 134
13. Singh M, Rao G, Malhotra AK, Deoralr AK. Assessment of newborn baby’s temperature
by human touch. A potentially useful primary care strategy.Indian Paediatrics 1992
14. Dodd VL. Implications of kangaroo care for growth and development in preterm infants.
JOGNN 2005 Mar-Apr;34(2():218-28.
15. Bier BJ, Ferguson A, Andersen L, Solomon E, Voltas C, Oh V. Breastfeeding of very low
birth weight infants. The Journal of Paediatrics;123(5):773-8.
16. Simpson C, Schanler RJ, Lau C. Early introduction of oral feeding in pre-term infants.
Paediatrics 2003 Jan-Feb;15(1):1-5.
17. Cooper BM, McGrath JM, Bilker W. Nutritive sucking and neurobehavioural
development. MCN 2000 Mar-Apr;25(2):64-70.
18. Conway S, James J, Balfour A. Smithells R. Immunisation of the pre-term baby. J Infect
19. Daris RL, Rubanowice D, Shinefield HR, Lewis N, Gu D, Black SB, et al. Immunisation
levels among premature and low birth weight infants and risk factors for delayed up-to-
date immunisation status. JAMA 1999 Aug 11;282(6):547-52.
20. Sr. Edith. A correlational study of infant rearing practice and common health problems in
infants with selected mother-related variables in an urban slum.The Nursing Journal of
India 1998 Mar;589(3):59-60.
21. Sreevani R, Prashanthi N. A study to assess the knowledge regarding breastfeeding among
mothers in a selected community. Nurses of India 2004 Aug;5-7.
22. Joji I. A study to assess the knowledge and practice of mothers regarding complementary
feeding. Nurses of India 2005 Nov;12-4.
23. Abhay T. Low birth weight and pre-term neonates. Can they be managed at home by
mother and a trained village health worker? Health Action 2006 Apr;18-20.
24. Kumari S. Planned health education and safe motherhood. The Nursing Journal of India
25. Wilhelm SL, Stephans MB, Hertzog M, Rodehorst K, Gardner P. Motivational
interviewing to promote sustained breastfeeding JOGNN 2006;35(3):340-4.
.26. Melnyk BM, Gillis LA, Feenstein NF, Eileen F, Czarniak JS, Hust D, et al. Improving
cognitive development of LBW premature: A pilot study of the benefit of early NICU
Intervention with mothers. Research in Nursing and Health 2001;(24):373-89.
9. Signature of the candidate
10. Remarks of the guide
11. Name and designation of (in block letters)
PROF .S . NARASIMHA PRASAD
11.3 Co-guide (if any)
PROF .S . NARASIMHA PRASAD
12 12.1 Head of the department
13. 13.1 Remarks of the Chairman and Principal