MOTHER’S KNOWLEDGE, ATTITUDES AND PRACTICES (KAPs) ON

THE CARE OF NEWBORN IN MARIDI PAYAM, MARIDI COUNTY,

WESTERN EQUATORIA STATE,

SOUTH SUDAN

By Oyet Charles Okech

(2014)

Title page

i

ii

CERTIFICATION STATEMENT AND DECLARATION

Certification StatementI the undersigned, certify that this dissertation is the work of

the candidate carried out during his studies under my direct

supervision. I have read and hereby recommend for examination,

the dissertation entitled “Mothers’ Knowledge, Attitudes and Practices

(KAPs) on the Care of Newborn, Maridi Payam, Maridi County,”

……………………………………

Manana David

Date…../………../2014

DeclarationI Oyet Charles Okech declare that this dissertation is my own

work and it has never been presented to any other institution for

similar or any other award.

…………………………………

Oyet Charles Okech

Date………/…………./2014

iii

ACKNOWLEDGEMENTFirst of all I am grateful to Almighty God for his abundant

grace, blessings and unconditional love that enabled me to carry

out this study.

In addition my special thanks go to the following;

Mr. Vundru Dominic, head of research department, for his

guidance in research methodology

The Principal- Mr Patrick Taban, and Mrs. Ayakaka Margaret-

Head of midwifery department, for their expert guidance,

suggestions, encouragement, and support, and help rendered

to me throughout this study

My Supervisor- Mr. David Manana, for his guidance, support

and supervision during this study

My study respondents for their wholehearted participation in

the study, without them my study would be an incomplete one.

Finally I extend my sincere thanks to everyone who helped me

directly or indirectly in the successful completion of this

study.

May God Bless You All!

Oyet Charles Okech

iv

v

DEDICATIONThis work is dedicated to my mother, Ayaa Olga Dario and Dad

Okech Michael Okot, in appreciation for their efforts and the

tough times they went through in raising me.

vi

Table of ContentsTitle page.....................................................iCERTIFICATION STATEMENT AND DECLARATION.......................iiACKNOWLEDGEMENT..............................................iiiDEDICATION....................................................iv

List of tables.......................................viList of figures.....................................viiList of Acronyms...................................viiiDefinition of Terms & Concepts.......................ixABSTRACT.......................................................xCHAPTER ONE: INTRODUCTION......................................1

1.3 Justification.....................................21.6 Background to the Study Area.....................3CHAPTER TWO: LITERATURE REVIEW.................................4

2.1 Knowledge on the care of the newborn..............42.2 Attitudes/believes on the care of the newborn.....52.3 Mother’s Practices on the care of the newborn.....6CHAPTER THREE: METHODOLOGY....................................12

3.1 Introduction.....................................123.6 Data Analysis Method.............................13CHAPTER FOUR: RESULTS........................................14CHAPTER FIVE: DISCUSSION.....................................25CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS...................30

6.1 Conclusion.......................................306.2 Recommendations..................................30REFERENCES....................................................31

vii

APPENDICES....................................................37APPENDICESNDIX I: INTRODUCTORY LATTER.........................37APPENDIX II: CONSENT FORM.....................................38APPENDIX III: QUESTIONNAIRE...................................39APPENDIX IV: MAP OF MARIDI COUNTY.............................44

List of tablesTable 1: Showing Maridi Payam Bomas with Total Population......3Table 4.1: Participants by Marital status.....................15Table 4.2: Respondent by Parity...............................15Table 4.3: Respondent by Age group............................15Table 4.4: Complications immediately after birth..............17Table 4.5: Place of care when the baby sick...................17Table 4.6: Preferred Place of delivery........................18Table 4.7: Assistance during Delivery.........................19Table 4.8: Status of Instrument Used to cut the cord..........20Table 4.9: Materials Used To Tie the Cord.....................20Table 4.10: Time of Initiating Breastfeeding..................21Table 4.11: Cleaning Of Breasts before Feeding................22Table 4.12: Daily Breastfeeding Practices.....................22Table 4.13: Immunizing the Newborn after Delivery.............23

viii

List of figures

Figure 4.1: Respondent by Education level.....................14Figure 4.2: Respondent by Religion............................14Figure 4.3: Awareness of the need to attend ANC clinic........16Figure 4.4: ANC Attendance among respondents..................16Figure 4.5: Number of ANC clinic visits per respondent........17Figure 4.6: Complications babies had at birth.................17Figure 4.7: Knowledge of symptoms of newborn illness..........18Figure 3.8: The Place Respondents would recommend others to deliver from..................................................19Figure 3.9: Showing instruments used to cut the cord..........20Figure 4.10: Material Applied On the Cord Stump...............21Figure 4.11: Giving Other Feeds after Birth...................22Figure 4.12: Time of initiating the first bath................23Figure 4.13: Measures taken to protect Baby from falling sick. 24

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List of Acronyms

ANNW; Africa Newborn Network

C/S; Caesarean Section

CHD; Community Health Department

CHD; County Health Department

ENC; Essential Newborn Care

FGD; Focuses Group Discursion

HBPs; Health Belief and Practices

KAPs; Knowledge Attitude and Practices

KMC; Kangaroo Mother Care

KMC; Kangaroo Mother Care Method

MNCH; Maternal, Newborn, and Child health

MoH; Ministry of Health

NHT; National Health Training Institute

PHC; Primary Health Care

STC; Save the Children

SVD; Spontaneous Vaginal Delivery

TBA; Traditional Birth Attainder

V/E; Vacuum Extraction

VDCs; Village Development committees

WHO; World Health Organizatio

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Definition of Terms & Concepts

Mother: in this study are refers to any female parent or guardian

of children.

Caretaker: In this study are refers to nay one who are looking

after the newborn if the mother is dead of absent.

Knowledge: the facts, information, understanding that a person

has acquired through experience or education. (Soanes, 2007)

Attitude: is a way of thinking about something or behaving

towards something (Brooker, 2006)

Practice: the actual doing of something; action as contrasted

with ideas. (Soanes, 2007)

Exclusive breast-feeding: refers to giving the infant only breast

milk; no other liquid solids, except vitamin or mineral drops and

medicines up to 6 months.

Population: Is defined as group of individuals that share one or

more characteristics from which data can be gathered and analyzed

(Nieswiadomy, 2008).

Bomas: refers to a village within the payam.

Payam: refers to the sub-county

Newborn: In this study newborn refers to an individual from birth

to four weeks (28days) of age.

Newborn care: In this study this refers to care of the baby from

birth to four weeks of age.

xi

Assessment: In this study assessment refers to the critical

analysis and evaluation or judgment of status about mother/

caretaker.

Midwife: is a health care provider who is trained in the care of

pregnant women and young infants.

Traditional birth attendant: -traditional women with ability to

deliver pregnant women.

xii

ABSTRACT

A study on the care of the newborn in Maridi payam was carried

out in Maridi in July 2014 with the objective assessing Mother’s

knowledge, attitudes and practices on the care of the newborn in

the community.

It was be cross sectional explorative study that involved both

quantitative and qualitative data. Cluster and convenience

sampling techniques were used. Data was collected using

interviewer questionnaires and was analyzed manually.

The main findings of this study were that; the majority mothers

in Maridi payam had adequate and relevant knowledge in the care

of the new born in the community. The majority of mothers in the

payam generally had a positive attitude towards newborn care

services available at Maridi Hospital and other health facilities

in the payam despite the fact that the majority of them continued

to deliver from their homes.

It was then concluded that though most of the respondents in this

study had satisfactory knowledge and positive attitudes towards

the recommended newborn care, they generally lacked the practical

application especially in; hospital deliveries, improper cord

care and immunization.xiii

It was then recommended that all pregnant women in Maridi payam

encouraged to attend at least 4 ANC visits and to deliver from

Hospital. The State Minister of Health should organise training

for all TBAs in Maridi payam and beyond since more mothers in

this payam delivered at home than hospital. All women of

childbearing age should be educated more on proper neonatal care

including; proper cord are, prevention of neonatal hypothermia,

early initiation of breastfeeding, exclusive breastfeeding on

demand at least 8 times a day and general hygiene. All newborns

in Maridi payam should be vaccinated with BCG as early as

possible after birth and with OPV0 within the first 14 days.

Finally all health workers should include men in the campaigns to

promote proper care of the new born as substantial house hold

heads in Maridi payam.

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CHAPTER ONE: INTRODUCTION

1.1 Background informationChild rearing practices depend on the traditional beliefs and

practices. Healthy beliefs and practices lead to a healthy child

upbringing. According to Save the Children (2004) the newborn

child is extremely vulnerable unless it receives appropriate

basic care, also called essential newborn care. When normal

babies do not receive this essential care, they quickly fall sick

and too often they die. For premature or low birth weight babies,

the danger is even greater.

Approximately four million global neonatal deaths that occur

annually, out of which 98% occur in developing countries. Most of

the newborns die at home under the cared of their mothers,

relatives and or traditional birth attendants. In Nepal, for

instance approximately 90% of birth occurs at home. In 2005, the

infant mortality rate in Nepal was 64 per 1000 live and the

neonatal mortality rate was 39 per 1000 live births. In addition

to the direct causes of death, many newborns die because of their

mother’s poor health or because of lack of access to essential

care. Sometimes the family may live hours away from a referral

facility or there may not be a skilled provider in their

community (Save the children, 2004).

In sub-Sahara Africa each year at least 1.16 million babies born.

This region has highest risk of newborn death and the slow

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progress in reducing mortality and morbidity. More than two

thirds of these babies could be saved with lower cost, low skill

action, most of which are already in policy but do not reach the

poor (ANNW, 2009).

The greatest obstacle to quality Maternal, Newborn, and Child

Health (MNCH) in South Sudan is a lack of skilled MNCH care

providers, culture and mother knowledge on newborn care. The

infant and child mortality rates are estimated at 102 and 235

deaths per 1,000 live births, respectively. Meanwhile, more than

one in four children under the age of five is malnourished and

only approximately 10% of children are fully vaccinated. (Brett

et al, 2011)

This study therefore explored the knowledge, attitudes and

practices that influence the care of the newborn among

mothers/caretakers in Maridi community.

2

1.2 Statement of the Problem

The fact that only a few Mothers deliver from Maridi hospital

means that the majority deliver from their homes often with the

help of unskilled birth attendants. These newborns are often

subjected to unhygienic delivery practices arising from

traditional beliefs and taboos that put their survival at risk in

Maridi payam and Maridi County in general.

1.3 JustificationIt was anticipated that this study would identify the gaps in the

knowledge, attitude and practices on the care of the newborn and

recommend ways of bridging the identified gaps to improve

neonatal survival in Maridi Payam.

1.4 Research Question

What cultural beliefs and practices influence the care of newborn

in Maridi payam?

1.5 Study Objectives

1.5.1 Broad objective

This study sought to identify the household practices that

influence newborn care and survival in Maridi County

1.5.2 Specific objectives were;

1) To assess the Mothers’ knowledge on the care of the newborn

2) To assess the Mothers’ attitudes and beliefs towards the care

of the newborn.

3

3) To assess the Mothers’ practices in the care of the new born.

4

1.6 Background to the Study AreaMaridi payam is one of the six payams in Maridi County of Western

Equatorial State of South Sudan. This Payam subdivided in to 5

Bomas with an estimated population of 49,454 people. Maridi payam

is a peri-urban area inhabited by several ethnics groups of which

the Zande are the majority. Other tribes include; Moru, Avokaya

and Baka. Their cultural beliefs and practices on the care of the

newborn differ according to their ethnicity.

Table 1: Showing Maridi Payam Bomas with Total Population

S/

No

Bomas Population

1. Maridi town 19,186

2. Mabirindi 6,519

3. Mboroko 8,567

4. Modobow 5,096

5. Nagbaka 10,086

Total 49,454

5

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CHAPTER TWO: LITERATURE REVIEW

2.0 IntroductionIn this chapter the researcher reviewed publications and studies

on the care of the newborn in line with the study objectives. It

is divided into three study themes of knowledge, attitudes and

practices that influence the care of the newborn.

2.1 Knowledge on the care of the newbornNewborn care aims at ensuring that the baby is made comfortable,

is able to feed and facilities are available to help parents with

the attachment process. It is also important to ensure that the

baby is protected from airway obstruction, hypothermia, injuries,

and infections (Myles, 2003). Hygiene and aseptic conditions

may be unknown or very difficult to achieve in many poor

communities. People may not be aware of the environmental dangers

of infection and may not make much effort in combating them, this

pervasive acceptance of unhygienic conditions may extend to cord

care, drying and wrapping of the newborn etc (Parlato et al.,

2004).

According to BBC Media Action’s South Sudan (2012), found that

the majority of women who were or had been pregnant did know that

they should attend some form of antenatal care (ANC) more than

once. However, they were not clear about what ANC really

entailed. Many felt that having a TBA check the position of a

baby in the last months of pregnancy was adequate and were not

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aware of any specific number of times that they should attend

ANC. Many women felt that they were unable to plan regular ANC

check-ups due to responsibilities at home and a lack of money.

According Tarimo (2000) & Chibwana et al, (2009) mothers and

caregivers in Tanzania and Malawi did not have inadequate

knowledge regarding the causes and treatment of conditions such

as sepsis and malaria. However they had knowledge of danger signs

such as fever in infants. In another study conducted in a rural

community in northern India to assess household knowledge that

can affect neonatal health among 200 caregivers, it was reported

that caregivers identified illness among neonates in the form of

continuous crying (Awasthi et al., 2008).

Panul & Deadihic, (2007) defined a healthy newborn as one born at

term (between 38 to 42 weeks of gestation), and cries immediately

after birth. The period from birth to 28 days of life was

referred to as neonatal period and the infant in this period is

termed as neonate or newborn. The morbidity and mortality rate in

newborn are high and hence the need for optimal for improved

survival.

According to Padiyath et al, (2010) the study done in India found

that older and educated women with higher social economic status

were significantly associated with higher knowledge scores for

right neonatal care practices. In another study to assess the

mothers' knowledge and practices of basic newborn care given at

home in Obstetric University Hospital in Tanta City revealed that

8

mothers' knowledge and practices were within good and

satisfactory in most of the studied items related to newborn care

giving at home except breast feeding Helmy, & Bahgat (1998).

A study conducted among postnatal mothers in southern India

revealed that the knowledge of mothers was inadequate in areas of

umbilical cord care (35%), thermal carea (76%) and vaccine

preventable diseases. However 19% of them still practiced oil

instillation into nostrils of newborns and 61% of them

administered gripe water to their babies (Asif et al, 2010).

2.2 Attitudes/believes on the care of the newbornIn Malawi Demographic and Health Survey it was reported that many

prevailing cultural and social norms and practices were known to

be barriers to improving survival and health of newborns in

Malawi concerning newborn care (Malawi National Statistics

Office, 2004).

An epidemiological study was carried out in Yaounde, Cameroon,

revealed that 98% of mothers breastfed their children. However 2%

of mothers who did not breast-feed their children because of the

belief that milk flow was not enough or the infant’s refusal to

suckle as the main reason (Pascale, et al., 2007).

A study conducted to determine behavior’s related to immediate

care of newborn in Kailali district, Nepal showed that most

people were unaware of importance of immediate care of newborn

and many unsafe behaviors did exist based on deep-seated

traditional beliefs (Gurong, 2008).

9

Another study in Nepal reported that newborn babies were

considered dirty as they came out of their mother’s womb, hence

almost all newborn babies were bathed within the first hour of

birth. The same study revealed that colostrum was regarded as

dirty milk in some communities, and as a result babies were fed

with cow or goat milk immediately after birth for the popular

belief that it will make the baby become more intelligent (Yadav,

2007).

According to results of study which conducted on traditional

beliefs as influencing factors on breast-feeding performance in

Turkey it found that more than 30% of the mothers believed that

colostrum should not be given to the newborn, and others believed

that breast milk could harm their babies, (HIzel et al., 2006).

Another study by Ergenekon-ozelci (2006) showed that the mothers

generally had a positive attitude towards breast-feeding. However

colostrum was usually perceived negatively. No woman was found to

feed her infant exclusively by breast-feeding.

According to Hake-Brooks & Anderson (2008) mothers' perception of

the skin-to-skin contact in the kangaroo-carrying position had

improved with the majority of them practicing it more competently

and confidently than mothers whose babies were under conventional

incubator care. Most mothers were happy because they felt that

the kangaroo method was safe, and did not separate them from

their infants.

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A study on mother’s attitudes towards immunization in Western

Nigeria revealed that almost 97.6% mothers who attended antenatal

clinic thought their child should be immunized. However 8.2% of

the respondents believed that immunization caused fever while 5%

believed it causes deformity while others believed that local

herbs were good substitutes for immunization (Adeyinka, 2008).

Another study conducted in Aweil East and North counties in

northern Bahr-el-Ghazal region to determine attitude toward

immunization revealed that most mothers had good knowledge and

attitudes towards immunization and said it protected against

diseases such as polio and measles. However two mothers did not

like immunizations, especially the polio vaccine, because

complained that it made children sick. One mother said that the

child’s father was against immunization because it was against

their culture (Cyprian et al, 2011).

2.3 Mother’s Practices on the care of the newbornA survey was carried out in the immunization clinics of Pokhara

city of western Nepal revealed that 90% of deliveries took place

at home. However information about reasons for delivering at home

and newborn care practices in urban areas of Nepal is lacking

(Sachdev, 2006).

There are marked variations in patterns of newborn care and

interventions. Knowledge on what is needed for optimal newborn

care is lacking in many cases. Modern hospital practices as well

11

as traditional practices neglect the basic needs of newborns,

these basic needs include: warmth, cleanliness, breast milk,

safety and vigilance. Other interventions such as: thermal

protection, breast-feeding, eye care (to reduce blindness), have

essential preventive effects (WHO, 2006).

The World Health Organization (WHO, 1996) recommends the

following essential newborn care interventions:

Clean childbirth and cord care in order to prevent infection

Thermal protection in order to prevent and manage newborn

hypo/hyperthermia

Early and exclusive breastfeeding which should be started

within 1 hour after child birth

Initiation of breathing and resuscitation to facilitate

early asphyxia identification and management

Eye care for the prevention and management of ophthalmia

neonatorum

Immunization: at birth with Bacilli Calmette-Guerin (BCG)

vaccine, Oral Poliovirus vaccine (OPV) and Hepatitis B virus

(HBV) vaccine

Identification and management of the sick newborn

Care for the preterm and/or low birth weight newborn

The study focused specifically on practices such as clean

child birth, Early and exclusive

breastfeeding, immunization of BCG and OPV, recognition and

management of the sick newborn

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There should be clean cord care procedures which are crucial in

infection prevention. The

Umbilical cord should be cut with a clean (sterilized) blade and

tied with clean (sterilized)

Materials, and no substances should be put on the cord stump

(WHO, 1996).

Sometimes blades of grass, bark fibres, reeds or fine roots are

used to cut the cord. This is Harmful because these materials

often harbour tetanus spores from the soil and thus increase the

risk of neonatal tetanus. Materials such as threads, strips of

cloth and strings are used to tie the cord (Woodruff et al.,

1984).

The cord stump remains the major means of entry for infections

after birth. Principles of clean cord stump care stipulate

keeping the cord dry and clean and nothing is applied anything on

it, neither at home nor in the health facility. The stump will

dry and mummify if exposed to air without any dressing, binding

or bandages. It will remain clean if it is protected with clean

clothes and is kept from urine and soiling. No antiseptics are

needed for cleaning. If soiled, the cord can be washed with clean

water and dried with clean cotton or gauze. Local practices of

putting various substances on the cord stump - whether in health

facilities or homes - should be carefully examined and

13

discouraged if found harmful and substituted with acceptable ones

(WHO, 2006).

If the umbilical stump becomes red, drains pus with the redness

extending to the skin around it, the baby stops suckling well, is

sleepy, does not wake up or is having difficulty breathing, this

may be a sign of serious infection. The mother or caretaker

should seek help from a health facility. The baby must be

referred immediately to the hospital for proper treatment (WHO,

2006).

In the Sylhet District of Bangladesh, among the substances that

were applied on the cord stump, after cord cutting; turmeric was

the most common. Umbilical stump care revolved around bathing,

skin massage with mustard oil and heat massage on the umbilical

stump.

Mothers were the principal provider for skin and cord care during

the neonatal period. Unhygienic cord care practices are prevalent

in the study area. (Alam et al., 2008).

According to NSO, UNICEF& MIC (2006 & 2008) in Malawi most

newborns and mothers do not receive postnatal care (PNC) services

from skilled health care providers during the critical first few

days after delivery. The result also established that only four

percent of newborns received post natal care the first week after

delivery. Community based study conducted in Sudan indicated that

14

54.2% of mothers initiated breastfeeding after one hour from

delivery and 39.7% of them initiated breastfeeding during from

two hours to 24 hours and only 6.0% of the mothers initiated

breastfeeding after one day (Haroun, 2008).

Mriso et at (2008) in their study on understanding home based

neonatal care practices in rural Tanzania reported that the

majority of detrimental practices to newborns during the neonatal

period included delay in providing warmth after delivery and

bathing newborns soon after birth.

A study by Mesko et al (2003) found that major obstacles to

accessing newborn care were “the need to wait and watch” and

preference to treat illness within the community. Similar

findings were also found in India where traditional medicines

were used for treatment of neonatal conditions such as bulging

fontanelle, chest in-drawing and rapid breathing (Ogunlesi &

Oufowora, 2010).

According to Zulfia et al., (2009) the material used for cutting

cord in urban slums included; a new blade in 59.9% of the cases

but by traditional objects such as the edge of a broken cup in

40.3% of the cases. In addition the results showed that 50% of

the home deliveries were attended by Trained Birth Attendants and

40% were attended by untrained birth attendants.

Culturally, most African communities practice mixed feeding

instead of exclusive breastfeeding. In most circumstances,

15

primary health practitioners advised mothers according to formal

guidelines without being adequately aware of the mothers’

preferences, skills and home circumstances (Bland et al., 2002).

A study conducted among the rural poor in western Uttar Pradesh,

to identify factors influencing

newborn care showed that nearly all newborns were left wet and

naked on the floor until the placenta was delivered and bathed

immediately after birth. Very few birth attendants

washed their hands with soap before assisting the delivery. It

also revealed that they used new blade dipped in hot water to cut

the cord but used unsterilized cord ligature (Sethi et al.,

2005).

Early contact (immediately after birth) between the mother and

the baby, according to the WHO (1999), has a beneficial effect on

breast-feeding. Early suckling provides the baby with colostrum

that offers protection from infection, gives important nutrients,

and has a beneficial effect on maternal uterine contractions.

Khadduri et al. (2007), state that most women breastfed their

babies, but initiation within 1 hour of birth and colostrum

feeding were not common.

The baby's skin and gastrointestinal tract are colonized with the

mother's microorganisms, against which she has antibodies in her

breast milk. Important factors in establishing and maintaining

breast-feeding after birth include:

• giving the first feed within one hour of birth,

16

• correct positioning that enables good

• attachment of the baby,

• frequent feeds,

• no prelacteal feeds or other supplements, and

• Psychosocial support for breast-feeding mothers.

Babies have a wide range of behaviors following spontaneous

delivery and are not all ready to feed at the same time. A

skilled person can help to facilitate the process by ensuring

correct positioning and attachment. A healthy baby has no need

for large volumes of fluid any earlier than they become available

physiologically from the mother's breast. There is no evidence to

support the practice of providing supplementary feeds of water,

glucose or formula. Traditional prelacteal feeds should be

strongly discouraged although harmless rituals may be allowed so

long as they do not delay breast-feeding. Every birth attendant

should also know the importance of unrestricted feeding and the

ways to support breast-feeding mothers. Mothers should be

instructed about the need for an adequate diet to sustain

lactation. They should be helped and encouraged if they have

difficulties breast-feeding (WHO, 1996).

Another study conducted in Haryana, India revealed that 75

percent of newborns were given prelacteal feeds of honey, tea and

diluted milk, and babies are often not breastfed during the first

3 days. They were often given sweetened water; this presumes that

17

colostrum was discarded (Bhandari et al., 2003). In contrast Li

Salami., (2006) reported that 82% of the mothers in Edo State,

Nigeria practiced breastfeeding, 66% supplemented with corn gruel

and glucose water, and 14% used herbal brew. Only 20% practiced

exclusive breastfeeding.

A survey conducted in Aweil East and North counties in northern

Bahr-el-Ghazal region showed that most mothers (94%) breastfed

their babies within one hour of birth and 6% gave cow milk

immediately after birth.  82% of them breastfed on demand

especially during daylight, and 69% breastfed 2-3 times at night

(Cyprian, 2005)

The preterm infants on KMC have been found to have reduced rates

of severe morbidity compared to those on conventional care. Low

birth weight infants on Kangaroo Mother Method (KMM) had a

significantly lower rate of morbidity than the control group

(Sachdev, 2006& Sloan, 1994).

A study conducted on the impact of newborn bathing on the

prevalence of neonatal hypothermia in Uganda revealed that

bathing newborn babies shortly after birth increased the risk of

hypothermia. On the other hand the use of warm water and skin-to-

skin care for thermal protection of the newborn reduced the risk

of hypothermia (BergstrAqm et al., 2005).

18

The WHO (1996) stipulates that BCG should be given as soon after

birth as possible in all populations at high risk of tuberculosis

infection, and a single dose of OPV should be given at birth or

two weeks after birth (this is recommended to increase early

protection). Hepatitis B vaccine (HBV) should be integrated into

national immunization programmes in all countries by 1997. Where

perinatal infections are common it is important to administer the

first dose as soon as possible after birth.

Newborns are more likely to survive if delivery is clean, that is

if actions are taken to help prevent infection. Ensuring a clean

delivery implies:

• That all those attending to the mother and newborn wash

their hands with soap and water before during and after

delivery.

• The perineal area of the vagina is washed before each

examination and before delivery, and no foreign material is

introduced into the vagina (the examiner’s hand only when

necessary).

• Delivery surface is clean, or at a minimum, birth doesn’t

occur on the bare floor.

(Parlato et al., 2004).

According to the WHO (1996), many newborn problems can be

prevented by the interventions described above. However, when a

disease occurs, many deaths can be avoided if the signs are

recognized early and the newborn managed effectively.

19

20

CHAPTER THREE: METHODOLOGY3.1 Introduction

This Chapter presents the description of the methodological

approach that was used in collecting and analyzing the data. The

following sub-topics are covered in this chapter: research

design, target population, sampling methods Data collection

instruments (tools), and data collection procedures and data

analysis methods.

3.1 Study Design

This was a cross-sectional explorative study that employed both

quantitative and qualitative study approaches

3.2 Sampling Procedures

The sampling method used was cluster and convenience sampling

technique. The 5 bomas in Maridi payam formed 5 clusters from

which 10 mothers or caretakers of newborns per cluster were drawn

by convenience sampling to make a total of 50 mothers.

3.3 Study Population

The study population was 50 mothers and caretakers of newborn

babies in Maridi payam.

3.4 Data Collection Tools

21

A structured interview questionnaire was used to collect data

from respondents. Each questionnaire consisted of 2 main parts

namely;

Part A: That was used to assess the demographic data (age,

educational status, occupation, family income, religion, type of

family birth history, birth weight, area of residence).

Part B: That was used to assess the knowledge, attitudes and

practices of newborn care among mothers and caretakers in Maridi

payam.

3.5 Data Collection Methods

Data collection was by face to face interview guided by the

questionnaire.

3.6 Data Analysis Method

Both quantitative and qualitative data were analyzed manually.

3.7 Pretesting Methodology

A pre-test was carried out in a one boma out of the five in

Maridi payam before the actual study.

3.8 Quality Control

All filled questionnaires were checked daily for completeness and

consistency of the responses to eliminate possible errors.

3.9 Ethical Considerations

22

Relevant permissions and approval was sought from NHTI and Maridi

county authorities before the study. Every participant [mothers]

was briefed about the study in order to gain her informed consent

to participate.

3.10 Dissemination of the Study Findings

The findings of the study will be submitted to the Head of

Midwifery Department of NHTI for marking after which copies will

be disseminated to the Maridi County Health department (CHD) and

Maridi hospital.

23

CHAPTER FOUR: RESULTS

Introduction This chapter presents the finding of this study as detailed below

according to the study objective. In this 50 mothers were interviewed

about their knowledge attitudes and practices on the care of the

newborn in Maridi Payam.

4.1 DEMOGRAPHIC CHARACTERISTICS OF THE STUDY POPULATION

Figure

4.1: Respondent by Education levelFrom the above figure; 56% of the respondents interviewed stopped in

primary level, 10% of them were secondary school leavers and the

remaining 34% of them had not gone to school at all.

Figure 4.2: Respondent by Religion

24

Primary Secondary Nerver went to schoo

0%10%20%30%40%50%60%

Educational level

Perc

enta

ge

4%

96%

religion of the respondent

muslimchristian

According to the figure above, most of the respondents (94%) of were

Christians in various denominations e.g. Catholic, Episcopal Church of

South Sudan. The remaining participants were Muslims.

Table 4.1: Participants by Marital status Marital status Numbers of respondents PercentageMarried 37 74%Not married 13 26%Total 50 100

From the table above, the majority (74%) of the participants were

married. The rest were either divorced, widowed or single

Table 4.2: Respondent by Parity Parity Frequency PercentagePrime parity 15 30%Multiparty 35 70%Total 50 100

According to the above table, the majority (70%) of the respondents

were multipara (had ever delivered more than one child). The rest

were prime para (mothers with only one child).

Table 4.3: Respondent by Age group Age group Frequency Percentage15-20yrs 16 36%21-25yrs 14 28%26-30yrs 10 20%31-35yrs 8 16%36-40yrs 2 4%Total 50 100%

25

From the above table, the age group with highest fertility rate was

15-20years-just because this age group had more mothers participating

in this study. The age group with the least number of children was 36-

40 years

4.2 MOTHER’S KNOWLEDGE ON THE CARE OF THE NEWBORN

Figure 4.3: Awareness of the need to attend ANC clinicAccording to the figure above, the majority (94%) of the mothers were

aware of the importance of attending ANC checkup. However 6% of them

were not aware at all.

26

88

12%

Awareness of the need to attent ANC clinic

YesNo

Yes96%

No4%

ANC Attendance

Figure 4.4: ANC Attendance among respondents.The figure above, shows that 96% of the respondents attended ANC

clinic during pregnancy. Only 4% of them did not attend ANC. Maridi

Hospital ANC clinic is the only one providing the care to women in

Maridi Payam.

Figure 4.5: Number of ANC clinic visits per respondentIn the above figure, about 20% of respondent visited ANC clinic more

than 4 times. 34% of them visited 4 times, which the minimal number is

recommended by World Health Organization (WHO). 38% of respondents

visited ANC only 3 times. The rest of mothers visited ANC 2 or less

times.

Table 4.4: Complications immediately after birth Complications immediately after birth

Frequency Percent (%)

Yes 14 28

27

percentNo 36 72

percentTotal 50 100%From the table shown above, majority (72%) of respondent recalled that

their baby didn’t have any complication after birth while 28% of them

said their

babies

were born

with

complications as illustrated in figure 4.6 below.

Figure 4.6: Complications babies had at birth According to the figure above, out of 14 respondents whose babies were

born with complication, 64% of them remembered that their babies

delayed to cry, 29% of the babies had inability to suckle and 7% of

them had difficulty in breathing.

Table 4.5: Place of care when the baby sick.

Where to take baby for treatment when sick Frequency Percent (%)Take to Hospital 38 76%Take to clinic 8 16% Treated home with traditional drugs 4 8%

28

delay to cry

difficulty to breath

inabilty to suckle

0% 10%

20%

30%

40%

50%

60%

70%

Complications babies had at birth

Total 50 100%

According to the table above, majority (76%) of participants reported

that sought medical care in Maridi Hospital whenever their children

fell sick. 16% of them took their sick children to clinics or bought

drugs and treated at home. However, 8% of them used traditional

remedies if the condition was not severe.

Diarrhea

Fast breathing

Crying

High tempreture

Vomiting

Not breastfeeding

0%15%30% 16%

3%

17% 33%9%

21%

Knowledge of symptoms of newborn illness

Perc

enta

ge

Figure 4.7: Knowledge of symptoms of newborn illnessThe figure above shows the mother’s knowledge on how to recognize

signs and symptoms of a sick baby 33% of the respondents reported high

fever, 21% of them said failure to breastfeed and 17% of them

mentioned excessive crying. Other signs mentioned included; fast,

breathing, diarrhea and vomiting.

4.3 MOTHER’S ATTITUDES ON THE CARE OF THE NEWBORN

Table 4.6: Preferred Place of delivery

Preferred Place of delivery Frequency PercentageHome 32 64%

29

Hospital 18 36%Total 50 100%

From the table above, it is clear that majority (64%) of participants

preferred to deliver from home while 36% of them delivered from the

hospital. Their reasons for preferring to deliver at home included;

Presence of the TBA with in the community

Abrupt onset of labour,

Long distance from home to hospital

Demand for money by Midwives demand at Maridi hospital maternity.

Those who preferred to deliver from Hospital gave the following

reasons;

Getting medication

Better management of prolonged labor

Better management of bleeding during labour

Management of complications like the baby’s failure to breath at

birth

Cleaner delivery environment in hospital.

94%

6%

The Place Respondents would recommend others to deliver from

30

Figure 3.8: The Place Respondents would recommend others to deliver fromAccording to above figure most of the respondents (94%) would

recommend others to deliver in the hospital. Only 6% of them would

recommend different place.

4.4 PRACTICES ON THE CARE OF THE NEWBORN

Table 4.7: Assistance during DeliveryAssistance during time of

labor

Frequency (%)

TBA 19 38%

Midwifes 18 36%

Mother 8 16%Doctor 2 4%Husband 2 4%Deliver alone 1 2%Total 50 100%

According to above table, 38% of the mothers delivered at home

assisted by TBA. 36% of them delivered from hospital with the help of

midwifes. 16% of them reported that they were helped by their mothers.

The rest were either assisted by their husbands or delivered alone.

31

Scissor

32%

Razorblade 60%

Others 8%

Intrument used to cut the cord

Figure 3.9: Showing instruments used to cut the cordThe above figure shows that 60% of the respondents reported the use of

a razorblade for cutting the cord. 32% of them said that scissors

were used while 8% of them used other instrument i.e. like knife,

Table 4.8: Status of Instrument Used to cut the cordWas instrument used to cut the cord

clean?

Frequency %

Yes 26 52%No 24 48%Total 50 100%

Approximately 52% of respondents used clean instruments to cut the

cord. However 48% of them said there were not sure if the instruments

used to cut the cord were clean.

Table 4.9: Materials Used To Tie the CordMaterial used for tied cord Frequency %Cord ligature 26 52%Thread 19 38%

32

Cloths 5 10%Total 50 100%

From the table above, 52% of the mothers said cord ligature was used

for tying the cord. 38% of them used threads for tying the cord and

the rest used cloths.

Diarrhea

Fast breathing

Crying

High tempreture

0% 5% 10% 15% 20% 25% 30% 35%

Material Applied On the Cord Stump

Figure 4.10: Material Applied On the Cord Stump According to the figure above, the majority (56%) of respondent

applied ash on the cord stump. 22% of them applied herbs. About 18% of

them did not apply anything to the cord as instructed from the

hospital. Only 4% of mothers said they apply cooking oil to the cord

stump.

Table 4.10: Time of Initiating Breastfeeding After Birth First Breastfeed

Newborn

Respondent /Frequency (%)

After 1hrs 37 74%30 min-1hr 6 12%Within 30 minutes 4 8%

33

Immediately 3 6%Total 50 100%

From the table above: majority (74%) of the respondents reported that

they initiated breastfeeding after 1 hour of birth. While only 6% of

them initiated breastfeeding immediately after delivery and the rest

said they started breastfeeding between 30 minutes to 1 hour.

Figure 4.11: Giving Other Feeds after BirthAccording to the figure above, 60% of the respondents gave fluid to

newborns after birth. Fluids given include sugar and salt mixed in

water. 38% of them gave breast milk only and 2% of the newborn were

given other feeds.

Table 4.11: Cleaning Of Breasts before FeedingCleaning of breasts beforebreastfeed

Frequency Percentage

Yes 43 86%No 07 14%Total 50 100%According to the table above, the majority (86%) of the

respondents cleaned their breasts before lactating, however 14%

34

Breast milk Fluid Formula feeds0%

20%

40%

60%

Perc

enta

ge

did not clean their breasts before breastfeeding. Out of those

who cleaned breasts before breastfeeding, 65% used wash their

breast with water first before breastfeeding. 35% of them only

clean their breasts with baby towel or cloth before

breastfeeding.

Table 4.12: Daily Breastfeeding PracticesNumber of timesmothers breastfednewborns in a day

Frequency %

On demand 8 timesand above

45 90%

Less than 8 times in24hrs

8 8%

Other (specify) 1 2%Total 50 100%From the table above, majority (90%) of the participants said they

breastfeed their babies on demand at least 8 times a day. However the

rest breastfed less than 8 times a day.

Figure 4.12: Time of initiating the first bath

35

Immdiately after b...

After 24hrs Within 2...0%

10%20%30%40%50%60%

perc

enta

ge

From the figure above, 52% of the respondents had their babies bathed

after 24 hours. 38% of them had their babies bathed immediately after

delivering and 10% of them delayed the bathing but was done within 24

hours of birth.

Table 4.13: Immunizing the Newborn after Delivery Was your baby immunized immediately after

birth

Frequency Percentage

Yes 6 12%No 44 88%Total 50 100%

According to the table above, the majority (88%) of the mothers said

their babies were not immunized with BCG and OPV0 either on the day of

delivery nor within two weeks after delivery. However 12% of them said

their babies were vaccinated before discharge from hospital. Most of

mothers whose babies were not immunize within 2 weeks had delivered at

home and they had to wait till after 6 weeks for DPT1 and OPV1. Some of

them said they delivered in hospital but when vaccines were out of

stock and therefore their babies could not be immunized.

Hygiene Net Good nutrition

Providing warm

Don't knows

0%

10%

20%

30%

40%

50%

Measures taken to protect Baby from falling sick

Perc

enta

ge

36

Figure 4.13: Measures taken to protect Baby from falling sickMajority (42%) of the respondents said they protected babies from

becoming ill by practicing good hygiene. 50% of them said sleeping

under mosquito net, good nutrition, keeping the newborn warm prevented

illness. The rest did not know what to do to protect babies from

becoming sick.

37

CHAPTER FIVE: DISCUSSION5.0 INTRODUCTION

This chapter discusses the findings of this study as detailed

below based on the study objectives. It discusses the study

findings and their significance especially in relation to what

has already been published. It is divided into three main

sections i.e. mother’s knowledge, attitudes and practices on the

care of the newborn in Maridi payam.

5.1 MOTHER’S KNOWLEDGE ON THE CARE OF THE NEWBORN

Results of this study have shown that the majority (94%) of the

mothers were aware of the importance of attending ANC checkup.

This finding is similar to what was reported by BBC Media

Action’s South Sudan (2012), who established that the majority of

women in their study knew that they should attend some form of

antenatal care (ANC) more than once. This study also established

that only about 20% of respondent visited ANC clinic more than 4

times and 34% of them visited 4 times. These findings revealed

that mothers in Maridi payam were more informed about the need

and frequency of attending ANC clinic than what was reported by

BBC Media Action (2012)

The majority (72%) of respondents in this study reported that

their babies didn’t have any complication after birth while 28%

of them said their babies were born with complications.

38

Complications reported included delay to cry, inability to suckle

and difficulty in breathing.

Most respondents (76%) in this study sought medical care from

Maridi Hospital whenever their children fell sick while 16% of

them took their sick children to clinics or bought drugs and

treated at home. This is better health services seeking behavior

than what was reported by Tarimo (2000) and Chibwama et al.

(2009). The good health services seeking behavior seem to have

been enhance by their good knowledge of the symptoms of childhood

illness such as high fever reported by 33% of the respondents,

failure to breastfeed by 21% of them and excessive crying by 17%

of them. Other signs mentioned included; fast breathing, diarrhea

and vomiting. This findings were similar to those reported by

Awasthi et al, (2008), Tarimo (2000) and Chibwana et al, (2009).

It was then concluded that the majority mothers in Maridi payam

had adequate and relevant knowledge in the care of the new born

in the community. This included knowledge of the need for and the

frequency of attending ANC, knowledge about the complications of

childbirth as well as symptoms and signs of illness in the

newborn.

5.2 MOTHER’S ATTITUDES ON THE CARE OF THE NEWBORN

This study found out that the majority (64%) of the respondents

preferred to deliver from home but assisted by an untrained birth

attendant. Their reasons for preferring to deliver at home

included; presence of the TBA with in the community, abrupt onset

39

of labour, long distance from home to hospital, and demand for

money by Midwives demand at Maridi hospital maternity. However

36% of them had given birth from the hospital. Those who

preferred to deliver from Hospital gave the following reasons;

getting medication, better management of prolonged labor, better

management of bleeding during labour, management of complications

like the baby’s failure to breath at birth and a cleaner delivery

environment in hospital. This findings however were better that

what was found in western Nepal where 90% of the deliveries took

place at home (Sachdev, 2006). Unlike in Malawi, cultural and

social norms and practices do not appear to be barriers to

improving survival and health of newborns in Maridi payam (Malawi

National Statistics Office, 2004).

It was also established that most of the respondents (94%) would

recommend others to deliver in the hospital. Only 6% of them

would recommend different place. This finding reflects a positive

attitude to hospital delivery despite that the majority of the

mothers still deliver from their homes

It was then concluded that the majority of mothers in Maridi

payam generally had a positive attitude towards newborn care

services available at Maridi Hospital and other health facilities

in the payam despite the fact that the majority of them continue

to deliver from their homes.

5.3 MOTHERS’ PRACTICES ON THE CARE OF THE NEWBORN

40

Place of delivery and Birth attendant

This study revealed that the majority (60%) of the mothers

delivered from home than in hospital to the ratio of almost 2:1.

Out of those who delivered from home 38% were assisted by TBAs,

16% of them were assisted by their mothers. The rest were either

assisted by their husbands or delivered alone. This finding is

better than what was established by (Sachdev, 2006), where 90 %

the deliveries took place at home in western Nepal.

5.3.1 Prevention and management of Neonatal Hypothermia

This study established that 52% of the respondents bathed their

newborns after 24 hours. 38% of them bathed their babies

immediately after birth. This immediate bathing of the newborns

carries with it a risk of neonatal hypothermia as reported by

BergstrAqm et al. (2005) and Mriso et al. (2008). There is

therefore need to teach about the need to delay bathing of

newborns as recommended by WHO (2006), Parlato et al. (2005) and

Mriso et al. (2008) in order to minimize the risk of neonatal

hypothermia. There is also need to promote the Kangaroo

Mothercare Method (KMM) in preventing and managing neonatal

hypothermia as recommended by Sachdev (2006), Sloan (1994) and

Hake-Brooks and Anderson (2008).

5.3.2 Cord Care

60% of the respondents in this study reported the use of a

razorblade for cutting the cord. 32% of them said that scissors

were used while 8% of them used other instruments e.g. knife.

41

Approximately 52% of respondents thought a clean instrument was

used to cut the umbilical cord. However 48% of them said there

were not sure if the instruments used to cut the cord were clean.

52% of the mothers said cord ligature was used for tying the

cord. 38% of them used threads for tying the cord and the rest

used pieces of cloths. The majority (56%) of respondent applied

ash on the cord stump. 22% of them applied herbs. 4% of mothers

said they applied cooking oil to the cord stump. Only 18% of

them did not apply anything to the cord as instructed from the

hospital. These findings were similar to what was reported by

Zulfia et al., (2009), Sethi et al. (2005) and Awasthi et al.

(2008). However principles of clean cord stump care recommend

keeping of the cord dry and clean and ensuring that nothing is

applied on it, either at home or in the health facility. To sum

clean cord care procedures are crucial in infection prevention in

the newborn (WHO, 1996).

5.3.3 Breastfeeding Practices

Findings of this study indicate that only 6% of the respondents

initiated breastfeeding immediately after delivery. 20% of them

initiated breast feeding between 30 and 60 minutes. However the

majority (74%) of them initiated breastfeeding after 1 hour of

birth. A good proportion (60%) of respondents gave fluid e.g.

sugar salt solution newborn as the first feed. This is slightly

better than what was reported by Haroun (2008) about initiation

of breastfeeding in Sudan where 54.2% of mothers initiated

42

breastfeeding after one hour from delivery and 39.7% of them

initiated breastfeeding between 2 and 24 hours. 38% of the

respondents gave breast milk as the first feed to their newborns

while 2% gave formula feed as the first feed. The reasons for

giving formula feed and sugar salt solution included;

insufficient or lack of breast milk. This is similar to what

Bhandari et al. (2003) found out in Haryana, India, where 75% of

newborns were given prelacteal feeds of honey, tea and diluted

milk. However early contact between the mother and the baby,

according to the WHO (1999), has a beneficial effect on breast-

feeding. For instance early suckling provides the baby with

colostrum that offers protection from infection, gives important

nutrients, and has a beneficial effect on maternal uterine

contractions. Important factors in establishing and maintaining

breast-feeding after birth include: giving the first feed within

one hour of birth, correct positioning that enables good,

attachment of the baby, frequent feeds, no prelacteal feeds or

other supplements, and psychosocial support for breast-feeding

mothers Khadduri et al. (2007). Mothers therefore should be

instructed about the need for an adequate diet to sustain

lactation. They should be helped and encouraged if they have

difficulties during breast-feeding (WHO, 1996).

This study also established that the most (86%) of the

respondents cleaned their breasts before lactating, however 14%

did not clean their breasts before breastfeeding. Out of those

43

who cleaned breasts before breastfeeding, 65% washed their breast

with water before breastfeeding. 35% of them only cleaned their

breasts using a baby towel or cloth before breastfeeding. In

addition this study found out that most 90%) of the respondents

breastfed their babies on demand at least 8 times a day, which is

the recommended practice. The rest (10%) of them breastfed less

than 8 times a day. This is similar to what was reported by in

Aweil East and North by Cyprian (2005).

5.3.4 Immunization status of the newborns in Maridi payam

The immunization status of children whose mothers were

interviewed was worrying as most of (88%) them reported that

babies were missed BCG and OPV0. Only 12% of them said their

babies were immunized with BCG and OPV0 before discharge from

hospital. Most of the newborns who missed the first vaccines were

delivered at home. Some of them reported that they delivered in

hospital but vaccines were out of stock the and therefore their

babies could not be immunized before discharge. Missing BCG and

OPV0 was also reported from Pokhara city of western Nepal where

90% of deliveries took place at home (Sachdev, 2006). In contrast

the WHO (1996) recommended that BCG be given as soon as possible

after birth in all populations, and a single dose of OPV should

be given at birth or within two weeks after birth. This calls for

more immunization campaigns targeting all babies who are

delivered at home while ensuring that all those born at the

health facilities receive BCG and OPV0 before they are

discharged.

44

5.3.3 Other measures of preventing neonatal illnesses.

Most respondents in this study new and practiced some preventive

measures against illness among the newborns. For instance 50% of

them slept under mosquito nets and kept the newborn warm as a way

of preventing illness. 42% of the respondents suggested that good

hygiene as a prevention measure against neonatal illness. The

rest did not know what to do to protect babies from becoming

sick. According to Parlato et al. (2004) newborns are more likely

to survive if delivery is clean, that is if actions are taken to

help prevent infection. Ensuring a clean delivery implies: clean

and gloved hands, clean perineal area and clean delivery surface

(Parlato et al., 2004). These infection prevention measures are

similar to what was recommended by recommended by (WHO, 1996 and

2006).

It was then concluded that though respondents in this study had

satisfactory knowledge and positive attitudes towards the

recommended newborn care, they generally lacked the practical

application especially in hospital deliveries, improper cord care

and immunization.

45

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS

6.1 Conclusion

It was then concluded that the majority mothers in Maridi payam

had adequate and relevant knowledge in the care of the new born

in the community. This included knowledge of the need for and the

frequency of attending ANC, knowledge about the complications of

childbirth as well as symptoms and signs of illness in the

newborn. The majority of mothers in the payam generally had a

positive attitude towards newborn care services available at

Maridi Hospital and other health facilities in the payam despite

the fact that the majority of them continued to deliver from

their homes. Finally, though respondents in this study had

satisfactory knowledge and positive attitudes towards the

recommended newborn care, they generally lacked the practical

application especially in; hospital deliveries, improper cord

care and immunization.

6.2 Recommendations

In view the above the following measures are the recommended way

forward;

The Midwives at Maridi Hospital should encourage all

pregnant women attending ANC at Maridi Hospital to deliver

from hospital for neonatal outcomes.

46

The recommended number of not less than four ANC visits per

pregnancy should be promoted though health education during

ANC visits and other gatherings by the midwife.

The State Minister of Health should organize training for

all TBAs in Maridi payam and beyond since more mothers in

this payam delivered at home than hospital.

All women of childbearing age should be educated more on

proper neonatal care including; proper cord are, prevention

of neonatal hypothermia, early initiation of breastfeeding,

exclusive breastfeeding on demand at least 8 times a day and

general hygiene by the health workers.

Health workers see all newborns in Maridi payam should be

vaccinated with BCG as early as possible after birth and

with OPV0 within the first 14 days.

All health workers should include men in the campaigns to

promote proper care of the new born as substantial house

hold heads in Maridi payam.

47

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55

APPENDICES

APPENDICESNDIX I: INTRODUCTORY LATTER

56

APPENDIX II: CONSENT FORM

I am Mr. Oyet Charles Okech is a third year student in NHTI-

Maridi, am doing Diploma in Midwifery. I pursue a study to assess

the knowledge, attitude and Practices of mothers on newborn care

at maridi payam. Although the study will not benefit you

directly, it will provide health professionals with information,

which may result in better care of newborn.

The study data will be kept secretly and your name will not be

included in this study so that your identity will not be revealed

during or after the study to anyone. All the study data

pertaining to you will be stored in a secure place of the

investigator and will not be shared with any person without your

permission.

Your participation in the study is voluntary and you are under no

force to participate. You have the right to refuse the study any

time you wish to do so and they will be no payment for it. I

kindly request you to pay attention to me for just 10 minute.

I have read/heard what was explained on the consent form and was

explained that the information provided by me would be kept

confidential and used only for the above mentioned study purpose.

I voluntarily consent to participate in the study.

57

Participant Signature /thumb………………………..

Date:………../…………./2014

I have explained the study to the above participant and sought

her understanding of the informed consent.

Researcher Signature…………………………… Date:………../…..

……../2014

58

APPENDIX III: QUESTIONNAIREINSTRUCTIONS:

This questionnaire contains some questions section about care ofnewborn. I kindly requesting you to listen to the questions asked

by the interviewer carefully and provide the necessary information

by giving appropriate response. The information collected from you

will be used only for the purpose of the study and kept in

confidential

Questionnaire on Mothers’ Knowledge, Attitudes and

Practices on Care of the Newborn

Section A. Demographic CharacteristicsQuestionnaire

NumberDate of

Interview

1. Age of RespondentAge

group

Cod

e

Tick

one15-20

yrs

1

21-

25yrs

2

26-

30yrs

3

31-

35yrs

4

36- 5

59

40yrs41-

45yrs

6

46-

50yrs

7

2. Address…………………………Boma 3.

Parity…………………………………

4. Youngest child’s age……………………… 5. Sex of

Baby…………………………..

6. Ethnicity/tribe…………………………….. 7. Respondent’s

Religion………………

8. Marital Status of the respondent…………… 9. Level

of Education…………………..

10. Occupation………………………………..

Chapter B. Mothers’ Knowledge on care of newborn11. Are you aware that you are supposed to attend ANC clinic?

Yes No

12. Did you attend ANC during pregnancy of your youngest child?

Yes No

13. If yes where…………………………………………...

60

14. How many times

15. What advice did you

receive from ANC clinic?Advice Code TickPersonal hygiene 1.Nutrition during

pregnancy

2.

Infant and child

nutrition

3.

Care of cord 4.Importance of hospital

Delivery

5.

Importance of

Immunization

6.

Importance of

Breastfeeding

7.

How to identify sign

of illness

8.

Advantage of ANC 9.Family planning 10.

16. Are you on any family planning method? Yes

No

61

No. of

Visits

Code Tick one

1 time 12 times 23 times 34 times 4Over 4times 5

17. If yes which

methods?......................................................

......................

18. Did your baby have any complication immediately after birth?

Yes No

19. If yes, what was baby suffering from?Difficulty in

Breathing

1

Jaundice 2Bleeding 3Inability to

suckle

4

Inability to

urinate

5

Delay to cry 6Other (specify) 7

20. What do you do when either you or your baby falls sick?

..............................................................

..............................................................

..............................................................

..............................................................

..............................................................

..............................................................

..............................................................

................

21. How do you know when baby is sick?Has diarrhea 1.High body temperature 2.

62

Fast breathing 3.Feels hot/cold 4.Sweating 5.Shivering 6.Vomiting 7.

Chapter C: Mother’s Attitudes on Care of Newborn22. Where did you deliver your last child

from? ........................................................

...........

23. Who attended to you during

delivery?.....................................................

....................................

24. Why did you choose to deliver at the above place?

……………………………………………………………………………………………………………………………………………………………………

………………………………..

25. What is your comment about the place where you delivered

from?

……………………………………………………………………………………………………………………………………………………………………

………………………………

26. Would you recommend other women to deliver from the same

place? ..........................

63

Chapter D, Practice on Newborn Care27. How did you deliver your last baby?

SVD 1C/S 2V/E 3Other

(specify)

4

28. What was used to cut the cord after

delivery? ....................................................

........

29. Was the above mentioned material clean? Yes

No

30. What material was used for tying a

cord? ........................................................

...........

31. What was applied on the cord

stump? .......................................................

..................

32. How was baby cleaned after delivery?

………………………………………………………………………………………..

33. What was used to wrap baby after

delivery? ....................................................

..........

64

34. Approximately how long after delivery did you first

breastfeed your baby?

35. What other feeds did you give to baby

immediately after delivery?Breast milk 1Fluid 2Formula feed 3Other(specifi

c)

4

36. Do you clean your breast before breastfeeding the baby? Yes

No

37. If yes, what do you use to clean your breast before

breastfeeding? ..............................

38. How often do you breastfeed baby in a day?

On demand 8times and

above

1

Less than 8times in

24hrs

2

Don’t breastfeed 3Other (specify) 4

39. When did you start bathing the baby after birth?

65

Immediately 1Within 30

minutes

2

30min-1hr 3After 1hrs 4Other

(specify)

5

Immediately after

birth

1

After 24hrs 2within 24hrs 3

40. What do you apply on the baby’s body after bathing?

………………………………………………………………………………………………

41. Was your baby immunized at birth? Yes

No

42. If no to Q41, why?

……………………………………………………………………………………………

43. What traditional method of treatment newborn illness do you

use?

44. What methods of preventing newborn

illness do you practice in this

community?

……………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………

Thank you for answering the questions

66

Procedure Tick

oneEnema 1Herbal 2Take

traditional

healer

3

APPENDIX IV: MAP OF MARIDI COUNTY

67