A STUDY TO ASSESS THE KNOWLEDGE REGARDING NEW
BORN CARE AMONG TRAINED BIRTH ATTENDANTS WORKING
AT SELECTED PHC’S IN BANGALORE
M.Sc. Nursing Dissertation Protocol submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
MRS. HELEN METILDA
M.Sc NURSING 1ST YEAR
Under the Guidance of
HOD, Department of Obstetric Nursing
KTG College of Nursing
RAJIV GANDHI UNIVERSITY OF HEALTH
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT
1. NAME OF THE CANDIDATE AND MRS. HELEN METILDA
ADDRESS: I YEAR M.Sc.NURSING,
KTG COLLEGE OF NURSING
2. NAME OF THE INSTITUTION: KTG COLLEGE OF NURSING
3. COURSE OF STUDY AND M.Sc NURSING
SUBJECT: COMMUNITY HEALTH NURSING
4. DATE OF ADMISSION TO THE 15-05-2009
TITLE OF THE TOPIC:
“A STUDY TO ASSESS THE KNOWLEDGE
REGARDING NEW BORN CARE AMONG TRAINED
BIRTH ATTENDANTS WORKING AT SELECTED
PHC’S IN BANGALORE”.
6. BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR STUDY
Health of the future citizens depends on the care we are giving to our children
today. More than half of the infants’ deaths occur in newborn period. Most of these
deaths occur during first week of life. The major causes of these deaths are due to
birth asphyxia, hypothermia and infection. 1
Every year 70 percentage of neonatal deaths (almost 3 million) happens because
effective yet simple interventions do not reach those most in need. Coverage of
intervention is low, progress in scaling up in slow, and inequity is high, especially
for skilled clinical interventions. Situations vary between and within countries, and
there is no single solution to saving lives of newborn babies systematic scaling up of
neonatal care in countries is necessary. 2
In India infant mortality rates are still high compared to developed countries, one
million newborn infant die every year because of bacterial infection, which often
entered body via umbilicus, fifty percentage of infant death occur during the first
four week. Umbilical coed infection is major cause of neonatal death and it occurs
due to poor aseptic practices. 1
Due to the unhygienic practice while cutting the umbilical cord improper
observation about bleeding and the cord may lead to neonatal complications like
neonatal tetanus and neonatal septicemia. Neonatal tetanus due to applications of
animal dung to the umbilical stump after delivery because increase in infant
mortality rate. Untreated neonatal sepsis is life threatening and therefore its early
identification and treatment is essential. 3
Neonatal care is available to most neonates’ in developing countries because hospital
care is costly, so there is a need of home base delivery where trained birth attendants will
assist it most of the time.2
The study was conducted to identify healthy and unhealthy delivery practices in rural
UP especially in following 5 cleans. The result shows most of them are not followed 5
cleans during labour so they suggest the training should be given TBAs.4
Altafs states that usually TBAs are illiterate and has very little training in conducting
delivery. He concluded many of those are related to cultural and religion beliefs and are
reinforced by rituals and ceremonies TBAs are helpful in promoting the health and
wellbeing of mother and newborn.5
80% of Indian population lives in rural areas most deliveries will have to take place in
the house by trained dai. The trained dai in pivot of homecare should be adequately
TBA’s actually doing attend the majority of births. So TBA’s must trained in basic
first aid or case management as well as preventive care.3
Trained Birth attendants (TBA’s) integral component of maternal child health
interventions. Many of our programmes have incorporated services for delivery and there
are no alternative health providers willing to be available 24 hours a day. 7 days a week to
respond to delivery calls.5
In remote areas this situation has not changed significantly in India, today there are
142 districts spread out around the country identified by the ministry of health and family
welfare where less than 305 of deliveries are conducted by trained personnel this includes
trained TBA’s the challenge of making skilled attendants available at village level.4
The majority of births in rural Bangladesh are carried out in unhygienic conditions by
relatives and traditional birth attendants (TBA’s). This result in a high incidence of
maternal and infant mortality that could be reduced if childbirth were to occur in health
center or under the supervision of trained TBA’s.2
The trained birth attendants try to keep being with mother at the time of delivery
become close to the mother and she is in a position to give education to the mother and
family. To do this the TBA’s should have adequate knowledge regarding newborn care so
that they cannot only protect newborn from the dangerous like asphyxia, hypothermia and
infection but also can educate the mother in this regard. Hence the investigator felt a need
to assess knowledge of TBA’s regarding newborn care. And prepare self instructional
module based on their learning needs.5
6.2 REVIEW OF LITERATURE
Review of Literature is to ascertain what is already known in relation to problem of
interest, to develop a broad conceptual context into which, a problem will fit. It helps to
know methodology and research tools, especially research strategies and specific
procedures, measuring instruments and statistical analysis that might be productive in
pursuing the research problem and interpreting the result of study.6
A comparative study was conducted to compare the knowledge of Trained and
untrained TBA’s regarding care of newborn. 28 trained and 27 untrained TBA’s were
selected for the personnel study. The data were gathered by interview with the help of
structured questionnaire. Results revealed that Trained TBA’s have more knowledge
and more willing to disseminate health care information to mother with new infants’ than
untrained. TBA’s the mothers’ health practices were independent of the advice provided
by the two groups of TBA’s. Additionally, the mothers’ health practices equaled or
exceeded expected norm.7
A study was conducted to access the knowledge attitude and practices regarding
maternal & newborn care among TBAs in Battmore. USA. 93 TBAs were selected
randomly & were interviewed. The study reveled that 89% of TBA’s used clean cord
cutting instrument & 74% washed their hands before delivery & thermal care were low.
The study suggested that efforts should be made to define role of TBA’s so that they can
improve in providing essential newborn care.8
A survey was conducted on TBA’s in Krabi province, Thailand, to assess their
personal background, techniques and practices in delivery and beliefs and attitudes
towards midwifery 116 TBA’s were selected randomly and interviewed the study revealed
that more than half provided antenatal care at their own home but 85 percent
conducted delivery at the clients home. About eighty percent of the TBA’s claimed that
sterilization of instruments was performed. However, dressing of the umbilical card was
done inappropriately using various kinds of powders by about 40 percent. The study
suggested that knowledge of sterilization of instruments was inadequate indicating a need
to improve teaching in this area.9
A study was conducted to assess the management of newborn in a slum cum
resettlement colony (Area-1) and four villages (Area-2) of Delhi. They have selected 25
functioning TBAs who conducted 83.64% deliveries in area 1 and area 16.22% in area 2
was studied. Results showed that majority if TBAs did not have the concept of washing
A study was conducted by direct observation of traditional birth attendants. They lacked
with basic knowledge of safe obstetric practices. They suggested that to reduce IMR or
MMR TBA’s most be adequately trained.12
A study conducted to investigate the trained performing deliveries during intra-
natal period in rural area. The result was expect two areas that is maintenance of safety of
fetus and prevention of infection to mother and newborn. She suggested that hands
before conducting per vaginum (p/v) examinations or deliveries. 21 out of 25 used razor
blade to cut the umbilical cord of which 9 used a upside down was the commonest
(68%0 method neonatal resuscitation. All TBAs massaged and bathed the baby everyday.
18 out of 25 referred the baby to a health agency for immunization though they did not
know the exact schedule.10
An exploratory study was undertaken to understand how traditional birth attendants
were handling its problem of birth asphyxia in Haryana. They have selected 100 TBAs
randomly. Result showed that 70% of the participants used resuscitation procedure for
half hour, before giving up due to such prognostic features as a blue or pale color, the
absence of cord pulsation, no breathing, limpness and the absence of pulsation in the
anterior fontanelle. Knowledge of modern resuscitation equipment and procedures was
poor and referrals were made based on the proximity of the institution and not on the
quality of care available. The study recommended that, TBAs conducting more than 30
deliveries a year should be given a bag, mask and disposable mucus suction traps in
mouth to mouth resuscitation.11
The TBA’s should improve on:
01. Hand washing technique
02. Checking fetal movement and FHR
Per vaginal examination.13
6.3 STATEMENT OF THE PROBLEM:
“A STUDY TO ASSESS THE KNOWLEDGE REGARDING NEW BORN CARE AMONG
TRAINED BIRTH ATTENDANTS WORKING AT SELECTED PHC’S IN BANGALORE”.
6.4 OBJECTIVES OF THE STUDY:
1. To assess the knowledge regarding newborn care among Trained Birth
2. To find out the association between knowledge of newborn care among TBA’s
and selected socio-demographic variables.
3. To develop a self – instructional module on newborn care for TBA’s.
H1: More than 50 percent of TBAs will have high knowledge regarding newborn
H2: There will be significant association between knowledge regarding newborn care
and selected socio demographic variables.
6.6 OPERATIONAL DEFINITIONS
● TBAs: Who has undergone a training course conducted by the modern health care
● NEWBORN: Baby from birth to four weeks(28 weeks) of age.
● KNOWLEDGE: The level of understanding of TBA regarding newborn care to
range of information awareness or all that has been perceived or grouped by the TBA.
● NEWBORN CARE: Care of the baby from birth to four weeks of age.
● ASSESSMENT: The critical analysis and valuation or judgement of the status of
The study is based on the following assumptions
Selected socio-demographic variables have influence on TBAs knowledge
regarding newborn care.
TBAs will be willing to participate in the study.
Tool prepared by the investigator will be sufficient to collect the data.
The study is delimated to the TBAs undergone a training course conducted by the
modern health care sector.
Study period limited to 4 weeks.
6.9 PROJECTED OUTCOME
The present study will help the TBAs to learn regarding newborn care and hence to
decrease the neonatal mortality rate.
7.0 MATERIALS AND METHODS OF THE STUDY
7.1 SOURCE OF DATA
7.1.1 RESEARCH DESIGN : A Descriptive design will be adopted for conducting the
RESEARCH APPROACH: Survey approach will be used to this study.
7.1.2 SETTING OF THE STUDY: The study will be conducted in selected PHC’s in
Bangalore which is 2 km away from the college.
7.1.3 POPULATION: The accessible population for present study is the TBAs who are
residing in various areas of Bangalore.
7.2 METHOD OF COLLECTION OF DATA: The investigator will use questionnaire to
assess the knowledge regarding newborn care among TBAs interview will be conducted
between 9am to 2pm. Data will be collected from 5 samples per day. The duration of 30
minutes will be spent per each subject.
7.2.1 SAMPLING TECHNIQUE: simple random sampling technique will be used to select
the area and the purposive sampling technique will be used to select the subjects.
7.2.2 SAMPLE: A sample consists of subject of units that comprises the population for
present study. Sample size is 60 TBAs.
Selected variables: variables included in the study are
Dependent Variables: Knowledge of trained birth attendants regarding Newborn care
Socio demographic variables: Such as age, Marital Status, Religion, General
Education, Professional Education, Training, Work Experience
Criteria for Sample selection:
7.2.3 INCLUSION CRITERIA:
The study includes the TBAs who are
Available at the time of data collection at selected PHC’s in Bangalore.
Willing to participate in study.
Able to understand kannada.
7.2.4 EXCLUSION CRITERIA:
The study excludes the TBAs who are
Out of area at the time of data collection.
Having sensory problems.
7.2.5 INSTRUMENT INTENDED TO BE USED
The investigator planned to assess knowledge of TBAs through structured interview
technique with the help of structured interview. It consists of 2 sections namely section I
and section 2.
Section 1: deals with socio demographic data Such as age, Marital Status, Religion,
General Education, Professional Education, Training, Work Experience
Section 2: deals with items related to assessment of knowledge regarding newborn care
7.2.6 DATA COLLECTION METHOD
Prior permission will be obtained by the significant authorities and from the
subjects. The investigator conducts face-to-face interview the subjects in the study area by
using the structured interview. Interview will be conducted between 9 am to 5 pm
depending upon the availability of sample. The duration of the study period will be 20-
7.2.7 PILOT STUDY
6 samples will be selected and study will be conducted to banal out the feasibility.
7.2.8 DATA ANALYSIS PLAN
Descriptive statistics like mean standard deviation and frequency distribution and
inferential statistical like chi-square test will be used to analyze the collected data.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO
BE COLLECTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3
Yes, Permission was obtained from the institutional ethical committee.
8. LIST OF REFERENCES:
1. Directorate of economics and statistics. Status of schedule tribes, Karnataka
2. Park K. Text book of prevention and social medicine.18th edition, Jabalpur,
Banarsidas bhoot publication,2005.
3. Oladiran Idowa, Meer.E.Donal, Ojelade, A. David, Adenrian adenike and
trapley.L.John.Tetanus: continuing problem in the developing world. World
Journal of Surgery 2002: Octobe,26(10): Page no: 1282.
4. Dawn c s Text Book of Obstetrics & Neonatology sixth Edition, Kolkata; Dawn
Publish V 2003.
5. Littleton Lynnay, Maternal neonatal & woman health nursing 9th ed. Delmar
6. National Research Centre on Equines: Annual Report 2002-2003 in Karnataka;
7. Khanom K, Salahudin AK, An educational programme on immunization
behaviour parents. Bangladesh Medical Research council Bull; 2001 january:
9(1):: page no : 18-24.
8. Falle TY, Mollany Le, Thatte N, Khatry, Leclerq SC, Darmstadt GLO,
Department of international health, John Hopkins, Bloomberg School of Public
Health, 615 North wolfe street E 8646, Battimore, MD 21205, USA 2009 Feb.
9. Chongsuviv atwongv, Bocharkorn.L.Treetrong R. epidemiology unit, faclty of
medicine, prince of songkla university, hat yai, theland 19921 Dec.
10. Hayney MS, Love GD, Carlberg BM, Buck JM, Mullar D. Tetanus
seroprevalence among farmers. Journal Rural Healthy: 2003:19(2): Page no;62-
11. Feroz Ahm, Rahman Mh. A ten year retrospective study of Tetanus at a
teaching hospital in Bangladesh. Journal of Bangladesh college of Physician
and Surgeons. 2007:25(2): page no; 62-63.
12. Sibely LM et al TBA’s training effectiveness international journal of
gynecology and neonatology 83, 2003;121-122.
13. Sachita sahachoudhary. Internatal care by TBA. The nursing journal of India
9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE The study is suitable and feasible
11. NAME AND DESIGNATION OF THE Chandrakala .A
12 GUIDE NAME AND ADDRESS
13 SIGNATURE OF THE GUIDE
14 HEAD OF THE DEPARTMENT Chandrakala .A
15 SIGNATURE OF THE H.O.D
16 REMARKS OF THE PRINCIPAL The study is suitable and feasible
NAME & SIGNATURE OF THE Biju Ramachandran
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
CURRICULAM DEVELOPMENT CELL
CONFORMATION FOR REDISTRATION OF SUBJECTS FOR
Registration number :
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Name of the institution :
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Title of the topic : A study to assess the knowledge regarding
New born care among trained birth attendants
Working at selected PHC’S in Bangalore
Brief resume of the intended work : Attached
Signature of the student :
Guide Name :
Remarks of the guide :
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Co-guide name :
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HOD name :
Signature of HOD :
Principal Name : Mr. Biju Ramachandran
Principal Mobile No : 09845144754
Principal E-mail ID : firstname.lastname@example.org
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