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M.Sc. Nursing Dissertation Protocol submitted to - Rajiv Gandhi

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					      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.

                           By

                  MRS. HELEN METILDA

                  M.Sc NURSING 1ST YEAR

                        2009-2011



                  Under the Guidance of



           HOD, Department of Obstetric Nursing

                    KTG College of Nursing

                     Hegganahalli Cross

                     Vishwaneedam Post

                       Magadi Road

                       Bangalore –91



                                 1
            RAJIV GANDHI UNIVERSITY OF HEALTH
            SCIENCES,KARNATAKA, BANGALORE

                            ANNEXURE – II

            PROFORMA FOR REGISTRATION OF SUBJECT
                    FOR DISSERTATION

1.   NAME OF THE CANDIDATE AND   MRS. HELEN METILDA
     ADDRESS:                    I YEAR M.Sc.NURSING,
                                 KTG COLLEGE OF NURSING
                                 HEGGANAHALLI CROSS
                                 VISHWANEEDAM POST
                                 MAGADI ROAD
                                 BANGALORE-91

2.   NAME OF THE INSTITUTION:    KTG COLLEGE OF NURSING
                                 HEGGANAHALLI CROSS
                                 VISHWANEEDAM POST
                                 MAGADI ROAD
                                 BANGALORE-91


3.   COURSE OF STUDY AND         M.Sc NURSING
     SUBJECT:                    COMMUNITY HEALTH NURSING


4.   DATE OF ADMISSION TO THE    15-05-2009
     COURSE:
5.
     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”.




                                   2
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




                                                    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

trained.2



    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




                                            4
   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




                                           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



                                              6
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



                                           7
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




                                        8
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

               Attendants.

         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.



6.5   HYPOTHESIS;

      H1: More than 50 percent of TBAs will have high knowledge regarding newborn

      care.

      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

      sector

      ● 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
      TBAs.



                                              9
7     ASSUMPTIONS;

      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.




6.8   DELIMITATIONS

      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
      present study.

      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.


                                              10
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.
          ILL.
          Having sensory problems.
         

                                                11
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

      among TBAs.



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-

      30days.



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?

                                        ---Yes.---



                                                 12
7.4   HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
      INSTITUTION IN CASE OF 7.3

      Yes, Permission was obtained from the institutional ethical committee.




                                             13
8.   LIST OF REFERENCES:

       1. Directorate of economics and statistics. Status of schedule tribes, Karnataka
          2003.
       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
          2001.
       6. National Research Centre on Equines: Annual Report 2002-2003 in Karnataka;
          2003.
       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-
          63.
       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
          2000 January.




                                          14
9.   SIGNATURE OF THE CANDIDATE


                                       Helen Metilda


10. REMARKS OF THE GUIDE               The study is suitable and feasible




11. NAME AND DESIGNATION OF THE Chandrakala .A
     GUIDE




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
     PRINCIPAL




                                  15
        RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
                     CURRICULAM DEVELOPMENT CELL
              CONFORMATION FOR REDISTRATION OF SUBJECTS FOR

                                    DISSERTATION


Registration number                  :

Name of the candidate                :

Address                              :
      .
Name of the institution              :

Course of study and subject          :
       .
Date of admission to course          :

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                 :

Signature of the guide               :

Co-guide name                        :

Signature of co-guide                :

HOD name                             :

Signature of HOD                     :

Principal Name                       :       Mr. Biju Ramachandran

Principal Mobile No                  :       09845144754

Principal E-mail ID                  :       bijuramnair@rediffmail.com

Remarks of the Principal             :
       .
Principal signature                  :




                                               16

				
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