Journal Reading

Evaluation of the Knowledge and Attitude Changes of

Mothers in Neonatal Care

Presenter:
Dr. Aprian Ilhami

Moderator:
Dr. H. Azhari, Sp.OG(K)

DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY
Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG
Presented on Wednesday, October 18th, 2017
Introduction

• To determine the levels of knowledge

on newborn nutrition and care of the
mothers whose infants were born
through normal spontaneous vaginal
Objective
delivery or cesarean section at Bağcılar
Training and Research Hospital, and to
evaluate the change in these
knowledge levels with education.
 Methods
Information sources and search strategy Eligibility criteria

• Between January 2016 and September • Before being discharged they were
2016. informed by the doctor and
• Mothers, and their infants born at breastfeeding nurse about nutrition,
Bağcılar Training and Research Hospital, infant care, and the most common
Obstetric Unit mistakes.
• These forms were reapplied on the 15th
and 30th days in neonatal polyclinic
controls and the changes were
evaluated.
• The correct information was repeated
to the mothers who were detected to
have misinformation and wrong
attitudes in the evaluations in each
form application period.
 Study Outcomes

The frequency and duration

of the breastfeeding, infant
umbilical care, swaddling,
A total of 100 mothers and their bathing, sensitivity to
infants were included in the study.
pinning jewellery on the
No difference was determined in infants, and whether or not
Outcomes the nutrition rates of infants with
mothers receive
food other
than breast milk on the first day, information about infant
15th and 30th days care from a healthcare
organisation have changed
positively after the
education.
Methods
• Cross-sectional study
• Mothers, and their infants born at Bağcılar Training and Research
Hospital, Obstetric Unit between January 2016 and September
2016
• Questionnaire forms designed on the subject of infant nutrition,
infant care, and traditional practices were given to mothers right
after delivery
Methods
• The mothers’ information was evaluated by a doctor and breastfeeding
nurse after the questionnaire and the mothers were informed about
nutrition, infant care, and traditional practices
• The questionnaire forms were repeated on the 15th and 30th days in
the neonatal policlinic controls and the changes were evaluated.
• Mothers who were determined to have wrong information and attitudes
in the evaluations were supplied with the correct forms after the
application.
Methods
• A sample size, total of 100 mothers and their infants were
included in the study.
• The ethical approval of the study was obtained from the
hospital ethics committee (approval number: 2016-12).
Written consent was obtained from the mothers before the
study.
Methods

Statistical Analysis
• Number Cruncher Statistical System (NCSS) 2007 (Kaysville, Utah, USA)
program was used for statistical analyses.
• Descriptive statistical variables were used for quantitative variables in the
study data.
• The Friedman test was used for the evaluations and comparisons between the
variables and the Wilcoxon signed-rank test and the Spearman correlation test
were used in paired evaluations.
• The level of p<0.05 was accepted to be significant.
Results
Table 1. Distribution of descriptive characteristics

n %
Method of delivery
Vaginal 53 53.0
Cesarean Section 47 47.0
Gender Female 48 48
Male 52 52
Maternal educational level
Illiterate 17 17.0
Primary school 27 27.0
Secondary school 36 36.0
High school 13 13.0
University 7 7.0
Time of the first breastfeeding of the infant
Did not breastfeed 5 5.0
30 minutes 30 30.0
1 hour 40 40.0
Table II. Evaluations for breastfeeding, bathing and umbilical care

1st day 15th day 30th day P

n (%) n (%) n (%) 1st day-15th day 1st day - 30th day 15th day - 30th day
Form of nutrition other breastfeeding 15 (15.0) 10 (10.0) 9 (9.0) 0.060 0.132 0.058 0.317
1 (1.0) 99 (99.0) 100 (100) 0.001 0.001 0.001 0.317
First bathing time
As soon as discharged from the hospital 89 (89.0) 90 (90.0) 90 (90.0) 0.368 0.317 0.317 1.000
After the umbilical cord has fallen off 11 (11.0) 10 (10.0) 10 (10.0)
First bathing place
Bathtub 24 (24.0) 15 (15.0) 10 (10.0) 0.001 0.001 0.001 0.020
Plastic basin 51 (51.0) 15 (15.0) 15 (15.0)
On a bathtub net 25 (25.0) 70 (70.0) 75 (75.0)
Sleeping position
While breastfeeding 96 (96.0) 96 (96.0) 95 (95.0) 0.867 1.000 0.705 0.317
Lying position 4 (4.0) 4 (4.0) 5 (5.0)
Place of sleep
Crib 98 (98.0) 99 (99.0) 99 (99.0) 0.368 0.317 0.317 1.000
No Bed 2 (2.0) 1 (1.0) 1 (1.0)
Rail, guard 94 (94.0) 95 (95.0) 94 (94.0) 0.779 0.564 1.000 0.317
Sleeping environment
In the dark 49 (49.0) 58 (58.0) 56 (56.0) 0.084 0.018 0.040 0.739
Illuminated 31 (31.0) 26 (26.0) 29 (29.0)
Umbilical care 27 (27.0) 83 (83.0) 52 952.0) 0.001 0.001 0.001 0.001
Results The rates of bathing the infants with and
without a bathtub net were determined to
be high on the 15th and 30th days

The change in the sleeping positions of the

infants, the place of sleep, and the presence
of rails/guards around the crib on the 15th
day and the 30th day was not found to be
significant compared to the first day
Results The increase in the rates of sleeping in
the dark after receiving the education
was significant as well as the increase in
the umbilical care rates on the 15th and
30th days in comparison to the first day.

The results regarding the form of

nutrition other than breastfeeding, the
first bath, sleeping position, place and
environment of sleep and umbilical care
of the infants are presented in Table II.
Table III. Evaluation of primary care and traditional practices

1st day 15th day 30th day P

n (%) n (%) n (%) 1st day-15th day 1st day - 30th day 15th day - 30th day
Diaper changing tool
Wet wipes 90 (90.0) 89 (89.0) 88 (88.0) 0.607 0.783 0.589 0.317
Wet cotton 6 (6.0) 7 (7.0) 8 (8.0)
Washing 4 (4.0) 4 (4.0) 4 (4.0)
Cleaning of clothes
Soap powder 58 (58.0) 71 (71.0) 73 (73.0) 0.001 0.001 0.001 0.157
Detergent 42 (42.0) 29 (29.0) 27 (27.0)
Pacifer use 53 (53.0) 55 (55.0) 55 (55.0) 0.135 0.157 0.157 1.000
Reason for pacifier use
Sleep 6 (11.3) 7 (12.7) 7 (12.7) 0.368 0.180 0.257 1.000
Crying 37 (69.8) 40 (72.7) 40 (72.7)
Does not know 10 (18.9) 8 (14.5) 8 (14.5)
Swaddling 39 (39.0) 16 (16.0) 11 (11.0) 0.001 0.001 0.001 0.025
Reason for swaddling
Culture 13 (33.3) 9 (56.3) 5 (45.5) - 1.000 1.000 1.000
To make baby stay still 26 (66.7) 7 (43.8) 6 (54.5)
Pinning jewellery 3 (3.0) 3 (3.0) 4(4.0) 0.717 1.000 0.564 0.564
The use of face cover 71 (71.0) 68 (68.0) 65 (65.0) 0.034 0.180 0.034 0.083
Reason for covering the face
family education 5 (7.0) 3 (4.4) 3 (4.6) 0.135 0.180 0.180 1.000
Prevention of jaundice 22 (31.0) 20 (29.4) 20 (30.8)
prevention of dust 18 (25.4) 19 (27.9) 18 (27.7)
prevention of light 26 (36.6) 26 (38.2) 24 (36.9)
Receiving care information
Family 92 (92.0) 49 (49.0) 38 (38.0) 0.001 0.001 0.001 0.001
Internet 1 (1.0) 0 (0) 0 (0)
Results No significant change was determined on the 15th and
30th days compared to the first day in the diaper
changing tools for infants, pacifier use and its reasons,
and in the evaluation of covering the face while sleeping
and the reasons for covering the face.

After the education, the increase in washing the clothes

of the infant with soap powder, and the decrease in
swaddling were found to be significant.

No change was determined in the rates of pinning

jewellery to the infants’ clothes after the education.
• A significant increase was determined in the rates of mothers
receiving infant care information from the healthcare organisation on
the 15th and 30th days compared to the first day (Table III).

• The highest correlation between maternal educational levels and

post-education knowledge, and attitude and behaviour change was
seen in uneducated and primary school graduate mothers (r2=0.35).
Discussion

Strength Limitation
• The sample was similar in demographic but • The sample size calculation was not
different in educational level explained properly
• Need more participant
Conclusion

The frequency and duration

of the breastfeeding, infant
umbilical care, swaddling, Further research is required
bathing, sensitivity to to determine the initial
pinning jewellery on the knowledge of mothers about
There were very limited data
infants, and whether or not neonatal care and evaluate
on cerclage.
mothers receive information their knowledge, care and
about infant care from a attitude changes following
healthcare organisation have individual education.
changed positively after the
education.
CRITICAL APPRAISAL
Questions Answers Explanation
Study design, source? cross-sectional study “The study was conducted as a cross-sectional study
with mothers, and their infants....”

Bağcılar Training and “... and their infants born at Bağcılar Training and
Research Hospital, Research Hospital, Obstetric Unit between January
Obstetric Unit between 2016 and September 2016. ”
January 2016
and September 2016.
Inductive or deductive Inductive reasoning Questionnaire form collecting data  analyze 
reasoning? conclusion
CRITICAL APPRAISAL
Questions Answers Explanation
Were the criteria used to No • There is no explanation about included and excluded
select articles for inclusion criteria
predetermined, clearly
stated, and appropriate?

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 CRITICAL APPRAISAL
Questions Answers Explanation

Type of data, primary, secondary Primary From patient’s questionnaire form

or tertiary resources?

Group or ungroup data? Group Data “.. highest correlation between the maternal education
level and the post-education knowledge and attitude
change was determined in uneducated and primary school
graduate mothers ..”
Ad hoc or routine data? Ad Hoc Data was collected for some period of time during study.

Measures of Central Tendency, None We had planned to carry out, data permitting, cross-
Position and Dispersion sectional study.
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CRITICAL APPRAISAL

Questions Answers Explanation

Tables that was used to Descriptive tables Data were presented using tables
present results of this study

Graph used in this paper None

Quality of research data High quality 1. Good operational definition

2. Using assay method and valid measurement
technique
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CRITICAL APPRAISAL

Questions Answers Explanation

Bias Low risk of bias The ethical approval of the study was obtained from the hospital
ethics committee (approval number: 2016-12). Written consent
was obtained from the mothers before the study

Were studies selected and data Yes

extracted by 2 or more
individuals?
Yes
Were the results similar from
study to study?
None
Conflict of interest 23
 CRITICAL APPRAISAL

Questions Answers Explanation

Sample size calculation for mothers, and their infants born at Bağcılar Training and
this study Research Hospital, Obstetric Unit between January 2016 and
September 2016
Sampling technique Purposive A total of 100 mothers and their infants were included in the
study. No difference was determined in the nutrition rates of
infants with food other than breast milk on the first day, 15th
and 30th days. However, the breastfeeding rates obtained were
higher on the 30th day than on the 15th, with an interval of two
hours, and in general breastfeeding rates were low on the 15th
and 30th

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 CRITICAL APPRAISAL
Questions Answers Explanation

Statistical analysis • Number Cruncher Statistical System (NCSS) 2007 (Kaysville, Utah,
USA) program was used for statistical analyses.
• Descriptive statistical variables were used for quantitative
variables in the study data.
• The Friedman test was used for the evaluations and comparisons
between the variables and the Wilcoxon signed-rank test and the
Spearman correlation test were used in paired evaluations.
• The level of p<0.05 was accepted to be significant.
Error to conclude statistical None
analysis results
How was the presentation of Good Writers clearly explained background, methods and results in this
results in this paper? study.
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THANK YOU