DISSERTATION ON
TO COMPARE THE KNOWLEDGE AND PRACTICE ON POSTNATAL CARE AMONG POSTNATAL MOTHERS IN SELECTED URBAN
AND RURAL AREAS AT CHENNAI
M.SC (NURSING) DEGREE EXAMINATION BRANCH – IV COMMUNITY HEALTH NURSING
COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE, CHENNAI – 03.
A dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,
CHENNAI – 600 032.In partial fulfillment of the requirement for the degree of MASTER OF SCIENCE IN NURSING
JULY 2011
TO COMPARE THE KNOWLEDGE AND PRACTICE ON POSTNATAL CARE AMONG POSTNATAL MOTHERS IN SELECTED URBAN
AND RURAL AREAS AT CHENNAI
Approved by Dissertation committee on ____________________
PROFESSOR IN NURSING RESEARCH
Dr.Mrs.P.MANGALA GOWRI, M.Sc (N), Ph.D., ____________________
Principal,
College of Nursing, Madras Medical College, Chennai – 03.
CLINICAL SPECIALITY GUIDE
Dr.Mrs.P.MANGALA GOWRI, M.Sc (N), Ph.D., ____________________
Principal,
College of Nursing, Madras Medical College, Chennai – 03.
Medical Expert
Dr. K.JAYAKUMAR, MBBS., DPH., ____________________
Director,
Institute of Community Medicine, Madras Medical College,
Chennai – 03.
A dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI – 600 032.
In partial fulfillment of the requirement for the degree of MASTER OF SCIENCE IN NURSING
JULY 2011
CERTIFICATE
This is to certify that this dissertation titled, “A study to compare the knowledge and practice of postnatal care among postnatal mothers in selected urban and rural areas at Chennai”, is a bonafide work done by Mrs.T.Ramani Bai, College of Nursing, Madras Medical College, Chennai - 60003, submitted to the Tamil Nadu Dr.M.G.R.Medical University, Chennai, in partial fulfillment of requirements for the award of the degree of Master of Science in Nursing, Branch - IV, Community Health Nursing under our guidance and supervision during the academic period from 2009 to 2011.
Dr.Mrs.P.MANGALA GOWRI, M.Sc (N)., Ph.D.,
Principal, College of Nursing, Madras Medical College,
Chennai - 60003.
Dr.R.KANAGASABAI, M.D., Dean,
Madras Medical College, Chennai - 60003.
ACKNOWLEDGEMENT
My heartfelt gratitude is articulated to the ALMIGHTY for lavishing his blessings and grace for the physical and mental health given to complete this dissertation successfully.
The dissertation work was conducted with the assistance of many professional experts. The investigator is whole heartedly indebted to her research advisors for their comprehensive assistance in various form.
I wish to express my gratitude to Dr.R.Kanagasabai, M.D, Dean, Madras Medical College, Government General Hospital, Chennai, for his encouragement to conduct the study.
It is my longest desire to express my profound gratitude and exclusive thanks to Dr. Mrs. P.Mangala Gowri M.Sc (N), Ph.D., Principal, College of Nursing, Madras Medical College, Chennai. It is a matter of fact that without her esteemed suggestions, high scholarly touch, and piercing insight at every stage of the study, this work could not been presented in the manner in which it has been made.
It’s a pleasure and privilege to show my heartfelt gratitude and undebtness to Ms.Jenette Fernandes M.Sc (N), Reader, College of Nursing, Madras Medical College, Chennai, and Mrs. P.Sornam M.Sc (N) Reader, College of Nursing, Madras Medical College, Chennai for their valuable and skillful guidance, thought provoking stimulation, encouraging critical evaluation, untiring efforts, support and timely help, inspite of their busy schedule, they continually motivated me for the successful completion of this dissertation.
I would like to express my special thanks to Dr.Mrs..Kanagagmbujam, M.Sc (N) M.Phil, Professor, MIOT College of Nursing, Mugalivakkam for validated the contents of the tool of my study.
I also put forth my sincere thanks to Mrs.S.Aruna, M.Sc Reader, SRMC College of Nursing, Porur, for validated the contents of the tool of my study.
It is my pleasure and privilege to express my deep sense of gratitude to Dr.Porgai Pandian, Director of Health Services for permitting me to conduct this study.
I wish to extend my gratitude and special credits to Mr.A.Venkatesan, M.Sc (Stat)., PGDCA, Lecturer in Statistics for his valuable guidance and helping the statistical analysis of the data, which is the core of the study.
I am thankful to the Librarian Mr.Ravi, M.A., B.L., L.Sc, College of Nursing, Madras Medical College, Chennai -3 who helped me to avail library facility.
Taking this opportunity, I would like to pen down the pride, of support and encouragement of my husband and my beloved loving children throughout this study.
My fondest thanks are expressed from my heart to my dear most colleagues for all their support, guidance and help given to me during my study period.
I am very obliged to Kamalam computers, Razyaa Graphics, and A1 Xerox centre for their kind co-operation to complete my dissertation in time by getting photocopies, computerizing and binding my dissertation papers.
In conclusion, I would like to express my sincere thanks to each and everyone who have helped me to complete this study.
TABLE OF CONTENTS
Chapter No Contents Page No
I. INTRODUCTION 1.1 Need for the study 1.2 Statement of the problem 1.3 Objective
1.4 Operational definitions 1.5 Hypothesis
1.6 Assumptions 1.7 Delimitations
1 5 6 7 7 8 8 8 II. REVIEW OF LITERATURE
2.1 Literature related to the study 2.2 Conceptual framework
9 20
III. RESEARCH METHODOLOGY
3.1 Research Approach 3.2 Research Design 3.3 Setting of the study 3.4 Population
3.5 Sample 3.6 Sample size
3.7 Sampling Technique
3.8 Criteria for sample selection 3.9 Variables
3.10 Development of the instrument 3.11 Description of the tool
3.12 Score procedure
24 24 24 24 24 25 25 25 25 26 26 26
Chapter No Contents Page No 3.13 score interpretation
3.14 Testing of tool (validity, reliability) 3.15 Pilot study
3.16 Data collection procedure 3.17 Plan for data analysis 3.18 Statistical Method 3.19 Ethical Clearance
27 28 28 29 29 29 30 IV. DATA ANALYSIS AND INTERPRETATION 32
V DISCUSSION 43
VI. SUMMARY, CONCLUSION, AND RECOMMENDATIONS
48
BIBLIOGRAPHY
APPENDICES
LIST OF TABLES
Table No Title Page
No 1. Statistics of postnatal mothers in urban and rural 6
2. Statistics of neonates in urban and rural 7
3. Score interpretation of knowledge 27
4. Score interpretation of practice 27
5. Statistical method 30
6. Description of demographic data postnatal mothers 33
7. Level of knowledge between urban and rural mothers 38
8. Level of practice between urban and rural mothers 39
9. Correlation of knowledge and practice among urban and rural mothers
40
10. Association between level of knowledge and demographic variables among urban and rural
41
11. Association between level of practice and demographic variables among urban and rural
42
LIST OF FIGURES
Figure No Title Page
No 1. Schematic representation of conceptual frame work 23
2. Schematic representation of research design 31
3. Distribution of urban and rural postnatal mothers according to their age
34
4. Distribution of urban and rural postnatal mothers according to their educational status
35
5. Distribution of urban and rural postnatal mothers according to their type of family
36
6. Distribution of urban and rural postnatal mothers according to their parity
37
LIST OF APPENDICES
Appendices No Title
I. Structured questionnaire in English
II. Structured questionnaire in Tamil
III. Certificate of content validity
IV. Certificate of Approval in Ethics Committee
V. Permission letter Urban and Rural
VI. Self instructed module
CHAPTER - I INTRODUCTION
We know that birth takes a woman from one place in her life to another. The birth of a child certainly does change her viewpoint of herself and I believe her viewpoint of the world.”
Giving birth is both exhausting and emotional. After the birth, the mother may feel tired and with her hormones once again changing, very emotional. Physically, she may feel sore, especially if she had stitches.
Postnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother Less frequently used is the term puerperium.
Biologically, it is the time after birth, a time in which the mother's body, including hormone levels and uterus size, returns to pre pregnancy conditions. Lochia is post-partum vaginal discharge, containing blood, mucus, and placental tissue.
The period after delivery, for at least 6 weeks is also very crucial for the mother’s healthy recovery and protection from any complications. This is called the puerperium and during this time, the various changes that occurred during pregnancy revert back to the non-pregnant state.
In the Hindu culture, the puerperium was traditionally considered a period of relative impurity due to the processes of childbirth, and a period of confinement of 10 days was recommended for the mother. During this period, she was exempted from usual household routine and religious rites. The father was purified by a ritual bath after visiting the mother in confinement. In the event of a stillbirth, the period of impurity for both parents was 24 hours.
Hennaing a woman after she gives birth is a traditional way to deter disease, depression, and poor bonding with her infant. The action of applying henna to a mother after childbirth, particularly to her feet, keeps her from
getting up to resume housework. A woman who has henna paste on her feet must let a friend or relative help her care for older children, tend the baby, cook and clean! This allows her to regain her strength and bond with her new baby. She is also comforted by having friends who care about her well-being, and is helped to feel pretty again. It’s a comfort to have feet beautified when you haven’t seen them for several months.
In a traditional Indian home, confinement serves to keep a new mum and her baby within a room or in a particular section of the house for an extended period after delivery.
They may be helped by a special assistant traditionally known as a dai or (increasingly common) a maid. Traditionally, the dai prepares special meals for the new mum, massages and bathes her and her baby, and does the laundry.
The confinement period is laced with many restrictions in food and movement. But in the end, it is all about helping the new mum relax and regain her energy. The confinement period varies according to the region in India. In most of north, west and south India, confinement stretches to about 40 days after the baby is born. In the east, especially in the north-eastern states, the concept of confinement is not practised rigorously.
It is not unusual for some new mums to avoid the confinement period as they feel they do not require it. She may end it early to get back to work.
Or she may extend it to receive more help and care. Restrictions are followed by different families in varying degrees. It is believed that following these restrictions helps a mother avoid health problems such as rheumatism, arthritis, headaches and body pains later in life.
Bathe only in warm water that has been boiled with neem leaves. It is believed the leaves are a natural antiseptic, and lukewarm water can soothe tired, aching muscles. Cover the head with a scarf, keep the windows closed, wear socks and remain in bed as long as possible (to prevent chills and allow the mother to rest in the initial days). Avoid air-conditioners and fans. This is
done to avoid excessive temperature fluctuations, which some believe can cause her to catch a cold.
No reading and no watching TV (too tiring). No shouting, crying, or engaging in conversation for too long (too stressful). No bending over at the waist (to prevent back injuries). No cooking or doing housework of any kind.
Staying in the room or the confinement area in the house (generally believed to help her avoid infections).
Both mother and baby receive massages during confinement. The dai massages the mother and the baby daily with oils (ghee in north India, mustard oil in the east and coconut oil in the south). She rubs the mother's abdomen and binds it with a long cloth to tighten up the lax muscles. Massage is believed to help the new mum relax and get back into shape.
The dai massages the baby too. It is supposed to be good for his bones and overall development. Initially, the baby may cry during a massage, but he gradually settles down and learns to enjoy it. In some families, atta (dough) is rubbed over the baby's forehead and body to remove excessive hair.
After the massage and bath, the dai usually applies kajal on the baby's forehead to ward off the "evil eye". During confinement, she will be put on a special diet. The aim of this diet is to boost her immunity and strength. Eat warm foods and avoid the ones that are considered "cool", such as cucumber, cabbage and pineapple. It is believed that such "cooling" foods can cause rheumatism and arthritis later in life.
Eat gourds such as bottle guard and tori which are believed to increase the milk supply. Eat paan (betel leaves) after every meal. Increase the amount of ghee in the diet; it is supposed to help regain strength and aid muscle repair. Avoid fruits, aerated drinks and juices. Substitute green and red chillies with black pepper in the meals. Stay away from "windy" foods such as onions and jackfruit as they are traditionally believed to cause colic in the baby.
Morbidity indicators are more reliable pointers of community health than mortality indicators. Although community data regarding patterns of childhood
morbidity in India is limited due to poor reporting system, hospital data identifies four major causes of post-neonatal morbidity in Indian children - Acute respiratory tract infections (-30%), Malnutrition (-25%), acute diarrheal diseases (-20%) and vaccine preventable diseases e.g. tuberculosis & measles (-20%). Many of these problems are inter-related and co-exist in the same child seeking health care.
Mortality indicators are relatively better defined and documented. It is estimated that -30-40% of all deaths in India occur during childhood, of which 50% occur in first five years, 33% in first year, 20% in first month and 10% in first week of life.
Last century has witnessed a sharp fall in 1MR (204 in 1911 to 57 in 2006), predominantly due to declining post-neonatal mortality rate after better control of exogenous factors e.g. infection and malnutrition. Neonatal mortality rate, which is mainly related to biological factors e.g. low birth weight, birth asphyxia and congenital malformations etc. continues to be high in most parts of our country. Interestingly, Neonatal mortality rate is higher in males (?biologically fragile sex), while perinatal mortality rate is higher in females due to socio-cultural neglect.
Among neonatal deaths, three fourths occur during the first week of life, while 25－45% occur within the first 24 hours after birth. The majority occur at home. A strategy that promotes universal access to antenatal care, skilled birth attendants and early postnatal care has the potential to contribute to sustained reductions in maternal and neonatal mortality and morbidity.
Information on the effectiveness of these complementary community- based approaches for reducing maternal and neonatal mortality and morbidity is needed to frame policy for their inclusion in public health programmes.
Further, the relative value of preventive or promotive and treatment interventions is unclear. Therefore a systematic review for the purpose of determining whether home visits for postnatal care by community health workers can reduce maternal and neonatal mortality and morbidity and stillbirths in resource-limited settings with poor access to health facility- based care
NEED FOR THE STUDY
According to National Family Health Survey – III (2006), Current perinatal mortality rate in India is 48.5/1000 live births, with wide geographic variations. Despite the declining trends during recent years, it is still much higher than that in most developed countries (15-20/1000).
According to latest National Family Health Survey – III (2004-2006), current IMR in India is 57/1000 live births, much higher than that in developed countries (<10/1000). Within India too, IMR differs widely in urban vs. rural population (42 & 62 respectively) and from state to state – being lowest in Kerala (15), moderate in Maharashtra (37) and highest in Uttar Pradesh (73).
Infancy includes two crucial phases of human life ― neonatal and post-neonatal period, with diverse child health problems. Infant mortality rate denotes addition of neonatal mortality rate (NMR) and post-neonatal mortality rate (PNMR), which may be computed separately.
Current neonatal mortality rate and perinatal mortality rate in India is 39/1000 and 18/ 1000 live births, respectively.
According to the World Health Organization, in its World Health Report 2005, poor maternal conditions account for the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis. Most maternal deaths and injuries are caused by biological processes, not from disease, which can be prevented and have been largely eradicated in the developed world - such as postpartum hemorrhaging, which causes 34% of maternal deaths in the developing world but only 13% of maternal deaths in developed countries
Estimates published in 2001
suggest that about 38% of all under-5 mortality occurs in the neonatal period and accounts for 4 million deaths worldwide each year. Ninety-nine per cent of global neonatal mortality occurs in developing countries.It is widely recognized that lowering neonatalmortality is vital for achieving further reductions in infant and child mortality.
Hogan et al., 2010,
cognizing the necessity of postnatal care, the government of Tamilnadu has mandated at least 3 PNC visits for each mother.Data of the NFHS 3 showed that PNC given by Tamilnadu within 2 of birth, is 87.2% and 91.3% receive PNC within 42s days. Tamilnadu is one of the topmost states other than Kerala and Goa with regard to care given during the postnatal period.
The same study said approximately 25%-85% of postpartum women experience the “blues” for a few days. Between 7%-17% may experience clinical depression, with a higher risk among those women with a history of clinical depression. Rarely, in 1in 1000 cases, women experience a psychotic episode, again with a higher risk among those women with pre-existing mental illness.
The investigator has witnessed the postnatal mothers in the postnatal wards in the primary health centres, urban health post during her clinical experience and noted that the mothers were ignorant about postnatal care (including mother and newborn). Even though the Government implement many programmes, the mothers have lack of knowledge regarding postnatal care.
Therefore there is a need to identify the knowledge, practices of postnatal care among postnatal mothers. Therefore, investigator felt that there is necessity to conduct study on postnatal mothers knowledge and practices and compare them with urban and rural areas.
Table-1: Statistics of Postnatal mothers in urban and rural areas in 2010
Area Postnatal infections
Postnatal hemorrhages
Breast abscess
Breast engorgement
Peuperal psychosis
Peuperal depression
Urban 4 5 100 105 30 5
Rural 15 10 123 95 10 3
Table-2:
Statistics of Neonates in urban and rural areas in 2010
Area Neonatal infections Neonataljaundice ARI Weight loss Neonatal sepsis Fever
Urban 115 45 40 58 70 105
Rural 120 55 48 24 25 136
Statement of the problem:
To compare the knowledge and practice on postnatal care among postnatal mothers in selected urban and rural areas in Chennai.
Objectives:
¾ To assess the knowledge of postnatal care among postnatal mothers residing in urban and rural area.
¾ To assess the practice of postnatal care among postnatal mothers residing in urban and rural area.
¾ To correlate the knowledge and practice regarding postnatal care among postnatal mothers residing in urban and rural areas.
¾ To associate the knowledge and practice with their selected demographic variable.
Operational Definitions:
Knowledge:
IT refers to awareness of postnatal care on the following factors diet, personal hygiene, exercise, newborn care, breast-feeding, immunization, family welfare
Practice:
It refers to activities performed by the postanatal mothers during their postnatal period.
Postnatal care:
It refers to care or the activities performed by the mother during 6weeks after delivery of the baby.
Postnatal mothers:
It refers to the mothers who delivered an alive baby by vaginal birth.
Hypothesis
There is a significant relationship between the knowledge and practice of postnatal care among postnatal mothers residing urban and rural areas.
Assumption:
The postnatal mothers in urban area will have adequate knowledge and practice regarding postnatal care than postnatal mothers of rural area.
Delimitation:
The study is delimited to a period of 4 weeks.
The practice regarding postnatal care is assessed by structured interview method.
CHAPTER – II
This chapter deals with Review of Literature and Conceptual Framework.
PART – I
REVIEW OF LITERATURE
It deals with selected studies which are related to the objectives of the study. The reviewed literatures are presented under the following headings into two parts.
Section – A : Literature on Knowledge and practice on Postnatal care Section – B : Literature regarding diet
Section – C : Literature regarding Breast feeding Section – D : Literature regarding Exercise Section – E : Literature regarding Newborn care
Section – A: Literature on knowledge and practice on postnatal care Ghosh. R, Sharma A.K., (2010)
conducted a study Intra- and inter- household differences in antenatal care, delivery practices and postnatal care between last neonatal deaths and last surviving children in a peri-urban area of India. The paper concludes that to improve child survival general education and awareness regarding safe delivery should be increased. Continuing cultural stigmas and misconceptions about birth practices before, during and after childbirth should be an important part of the awareness campaigns.Khan. Z, Mehnaz. S et al (2009)
conducted a study to determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers, Aligarh, India. Although breast- feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 501 of the babies and feeding was delayed beyond 24 hours in 81 of the cases. Several mothers hadbreastfeeding problems. Barriers to utilization of available services leads to hazardous perinatal practices in urban slums.
Soltani MS, Sakouhi. M, et al (2009)
conducted a study Evaluation of mother’s knowledge in pre and postnatal preventive care in the Tunisian Sahel. Health education on preventive care received by the mothers helps increase knowledge and probably practices as well. The increase in mothers' knowledge happens with appropriate initial and continued training in health education, provided by health professionals and with the reinforcement of educational activities during each contact with the mother both during her pregnancy and in periods where she is not pregnant.Kumar D., Goel N.K., et al (2008)
conducted a study to assess existing gap between awareness and practice levels of lactating mothers in urban slum, Chandigarh. Wide gaps exist between awareness and practices related with MCH due to non-adoption of knowledge into actual practice, except some selected components lacking in both knowledge as well as practice. Need for bridging the existing gaps avoiding socio-cultural barriers and misconceptions prevailing in the community and by promoting and protecting healthy MCH care practice.Khaddiro R.et al (2008)
conducted a study to determine household knowledge and practices of newborn and maternal health in Haripur District, Pakistan. After delivery, mothers often maintained low fluid intake but otherwise reported healthy nutritional practices. Knowledge of some danger signs in newborn was common, but timely action upon recognition was not common. Although the findings illustrate some beneficial practices, many reported practices are harmful to the newborn.Sinivastava, N.M. et al (2008)
conducted a study to assess symptom – specific care seeking practices for newborns in northern India. Instruction about care of the perineum and breasts, the possibility of postpartum depression, resumption of sexual intercourse, contraception, diet and exercise is appropriate in the postpartum. Period. The mother may also benefit from discussions about how to obtain practical support at home. Potentialbiomedical problems that may arise during this period include mastitis, late uterine hemorrhage, late endometritis, thyroiditis and incontinence.
Murira, N, et al (2007)
study conducted on the role of the midwife in perineal wound care following childbirth. A wide variety of practices are carried out in this area. However, some current practices may not be beneficial to the promotion of wound healing. Midwives must realize the relevance of their care and potential impact, both positive and negative, of advocated treatment in wound healing. It is important that midwives recognize the need for research based practice and that an adult is set up nationally to evaluate the efficacy of treatment and practice.Sarma. S, Rempel. H (2007)
conducted a study Household decisions to utilize maternal health care in rural and urban India. The data show that the level of schooling mothers have attained has a significant, positive effect on decisions to register and utilise these healthcare services in both rural and urban areas. The findings demonstrate that the health status of women and children in India can be improved significantly by strengthening IEC (Information, Education and Communication) efforts on the demand side and reducing access barriers on the supply side.Zhao. FM, Guo SF, et al (2006)
conducted a study to understand the perception on roles of gender and decision-making regarding family affairs among married women and its impact on the utilization of perinatal care. Perception of gender role was not a predictor for antenatal care utilization, but it was predictive of institutional delivery. Education was quite a significant predictor on perinatal care utilization. Efforts should be strengthened to improve women's awareness and to increase their perception on gender role in the families so that more women could achieve quality perinatal care.Eberhard-Gran. M, Nordhagen. R, et al (2006)
conducted a study postnatal care in a cross cultural and historical perspective knowledge. The resemblance between different cultures is striking. Many postnatal customs from rural societies that were common before 1950 have disappeared. Thefocus on rest and help in the household for the mother after delivery has been reduced. We need more knowledge about the impact of different kinds of postnatal care on the mother's wellbeing.
Shaw (2005),
A Quasi – experimental study was conducted to find out the effectiveness of planned teaching programme on episiotomy and self perennial care among primi gravidae women in Kasthuriba Hospital Manipal.The findings of the study showed that there was a significant difference between experimental and control group with regard to knowledge in the post test and there was an increased ability to perform self perineal care among primi gravidae mother.
Section- B: Assessment of Diet
Kulakac. O, Oncel. S et al (2007)
conducted a study, the study was to identify the changes employed mothers of infants aged 0-24 months made in their nutrition with the aim of increasing their milk production and extending their breastfeeding period. Mothers need to be informed about the factors that increase and decrease milk production and affect infant colic, and should be encouraged that they can successfully breastfeed without increasing their consumption of sweets or avoiding dried legumes and some vegetables.Neera Gupta et al, (2007)
study was conducted on local dietary practices and belief regarding specific properties of food, which should be consumed or avoided during breast feeding, using a survey method in urban Lucknow. In some places, dietary restrictions are continued for a long time up to seven months after delivery, leading to depletion of nutrients in the maternal body and also their tradition does not recommending leafy vegetables. Same time they considered Green leafy vegetables is very difficult to digest and disturb the quality of breast milk. Other food items restricted during lactation were salty and sour foods ; groundnuts, curds, mango, tamarind, eggs and ladies finger etc.Holroyd. E, Twinn. S, Yim. TW., (2006)
conducted a study, to identify Chinese women's cultural beliefs and behaviors related "doing the month". The analysis highlighted a wide range of issues for thesepredominantly middle class women which included special postpartum dietary beliefs and behaviours including the avoidance of hot and cold food, the restorative powers of food, wind and water prohibitions, food prescriptions and prohibitions during breast feeding. It is concluded that health professionals working with Chinese women need further awareness of the cultural significance of adherence to post natal practices and their fundamental links to the health status of post partum women, and family relationships.
Santos-Torres. MI, V.Isquez-Garibay. E, (2006)
conducted a study, to identify food taboos among nursing mothers who participated in a breast-feeding support programme. Finding an association among food taboos, mother’s characteristics, and demographic variables. A supportive approach and efficient communication, taking into account mother's characteristics, might reduce the gap between scientific recommendations and nutritional practices of mothers willing to nurse their infants.Strucitaska. M et al (2006),
conducted a study Vegetarian diets of breastfeeding women in the light of dietary recommendations. The literature review concerning selected nutritional and health aspects of applying different vegetarian diets by breastfeeding women was presented. The low intake of docosahexaenoic acid (DMA) was also characteristic in this group.Additionally the endogenous metabolism OHA is inhibited due to high proportion of linoleic vs. linolenic acid considered that lactating women on vegetarian diet should have a greater nutritional knowledge in order to avoid deficiencies which would adversely affect mother's and her child's health.
Savino. F, Bermond S et al (2005)
conducted a study Food intakes in breast feeding mothers. The study was conducted to verify the adequacy of lactating mother's diet in comparison with the Italian recommended daily assumption levels of nutrients (LARN 1996) for this category. Mothers are not informed enough about their alimentation during lactating period.Pediatricians must improve their knowledge about this subject and give the mothers the information they need to achieve the recommended food requirements.
Sims LS et al (2005)
conducted a study Dietary status lactating women relation of nutritional knowledge and attitudes to nutritional intake.This research suggests that nutrition education programs should adopt, as a primary goal, that of instilling positive attitudes about nutrition and demonstrating to learners that "nutrition is important". Once such attitudes have been formulated, ability to learn and comprehend nutritional facts and concepts will be facilitated, thus resulting in improved dietary intake of crucial nutrients.
Section - C: Breast Feeding
Lacneash mohan Agarwal, et al (2008)
A descriptive study conducttd on knowledge and attitude of mothers related to breast feeding and weaning practices. The study documented that 50% of the mothers said that colostrums was good for the baby. Among the 40 mothers 20% did not know about colostrums while 10% stated that it was bad for the baby. Majority of the mothers (75%) stated that breast milk had substances to protect against disease. But majority of the mothers had a wrong notion that top milk used for infant feeding should be diluted.Gracy. M. (2007),
A longitudinal survey was conducted on knowledge on breastfeeding among medical professionals in Israel. This indicated that physicians have a positive disposition towards breastfeeding but their knowledge is somewhat low. It seems awareness is lacking to the importance of continuous support and practical guidance beginning before birth and continuing until 3 months or more in postnatal period.Philipps, H (2007),
conducted a descriptive study on knowledge, attitude and practice of breast feeding among 50 postnatal mothers using a structured questionnaire in a selected private hospital Kerala. The finding of the study revealed that majority of the mothers (82%) had the knowledge that breast milk was the best baby food. Out of the 50 mothers, (64%) had the knowledge that breast milk contained protective substances. Knowledge about the high content of nutrients in colostrums was identified by the 60 percentages of the mothers. Only 10 of the mothers had knowledge regardingthe antenatal preparation of breast feeding. Majority of the mothers (86 – 100%) had positive attitudes towards breast feeding and all the mothers expressed their liking to breast feed their babies.
Chaudhary, N, (2006),
conducted a descriptive study on breast feeding and culture and states that breast feeding is the most appropriate means of nourishing infants. In human societies the choice, duration, and mode of lactation, are governed by various prohibitions or beliefs. Infant feeding habits are transformed by major social changes, such as women working outside the home, female emancipation or the emergence of a consumer society, although physicians and healthy systems do not always notice this. Most cases of inadequate milk production are due to social causes.Hence, when promoting breast feeding, in addition to argue on the basis of scientific knowledge, physicians must take into account the changes in the social context.
Crow, K, et al (2006),
A qualitative study was conducted to assess barriers to breast feeding and reasons for combination feeding among low - income Latin women and their families. The study concluded that four main domains were identified first was mothers desire to ensure their babies get both the healthy aspects of breast milk and vitamins. Second was breast feeding can be a struggle, breast feeding is natural but can be painful, embarrassing, and associated with breast changes and diet restrictions. Third reason was breast feeding not in mother’s control, mothers want to breast feed, but things happen that cause them to discontinue breast feeding and fourth reason was related to family and cultural beliefs.Yildirim, G. Sahin, N.H., (2006)
A qualitative study was conducted to evaluate the knowledge of breast feeding issues among post partum women who had participated in a prenatal program at the Rio de Janeiro Federal University Teaching Hospital. So the study noted that the mothers have adequate knowledge about breast feeding, issues like the best moment for the first feeding, the importance of colostrums, and nutritional aspects for nursing mothers.Mc. Crea, B. Hally (2005),
An evaluative study was conducted to know the prevalence of exclusive breast feeding and the reasons for water supplementation, and investigate whether water is necessary in the humid climate of Colombo. The result was in such a way that 60% of mothers introduced supplementary fluids within the first 4 months, because of advice from grandmothers or relatives. 45% had introduced water and 70% of mothers who gave supplementary fluids were aware of the importance of exclusive breast feeding. The study was concluded that a majority of mothers supplemented breast milk with water or other fluids during the first 4 months.Section – D: Exercise
Borello – France et al (2007),
describe the teaching and practice of pelvic floor exercise before and after delivery. Among the women who were thought, 68% performed pelvic floor muscle exercise after delivery and 63%still performing the exercise later delivery. Results revealed tremendous potential for the improvement of pelvic floor muscle exercise, education and targeting at risk women in the peripartum period.
Neiminen, K, (2006),
A qualitative study was conducted to review the existing evidence on the impact of pelvic floor exercise on the occurrence and role in the treatment of stress urinary incontinence in the perinatal period.The analysis indicates that pelvic floor exercise are a safe and highly effective measure in the prevention of occurrence and treatment of stress urinary incontinence, both ante partum and post partum. The performance in the in patient setting during early puperium can allow proper physiotherapeutic instruction and supervision. The study findings revealed that peripartum pelvic floor exercise as a preventive method of urinary incontinence on a regular basis.
Whit ford et al (2006),
conducted a study using postnatal postal questionnaire to 257 women during 6-12 months after delivery. One hundred and sixty three woman responded 63.4%. They concluded the pelvic floor exercise after delivery they practice and were relieved from the incontinence of urine.Section – E: Newborn
Ahmed AS, Ahmed J, et al (2010),
conducted a study on maternal recognition of neonatal illnesses at home compared to assessment by community health workers (CHWs) during routine household surveillance for neonatal illness in rural Bangladesh. Maternal recognition of neonatal illnesses at home was poor in two rural areas in Bangladesh. Interventions need to be designed to improve maternal recognition, and routine post-natal assessment by CHWs at home may be an essential component of community- based newborn care to improve care-seeking for newborn illness.Willis JR, Kumar V, et al (2009)
conducted a study to assess the gender differences in perception and care-seeking for illness of newborns in rural Uttar Pradesh, India. Households with female newborns used cheaper public care providers whereas those with males preferred to use private unqualified providers perceived to deliver more satisfactory care. These results suggest that, during the neonatal period, care-seeking for girls is neglected compared to boys, laying a foundation for programmes and further research to address gender differences in neonatal health in India.Baqui. A, Williams. EK, et al (2008)
conducted a study to assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme. The effect on mortality remained statistically significant when excluding babies who died on the day of birth.The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level, A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.
Afroza S, (2007),
conducted a study on neonatal sepsis, which is one of the major health problems throughout the world. The findings of the study showed that clean and safe delivery, early and exclusive breast feeding, strict postnatal cleanliness following adequate hand washing and aseptic technique during invasive procedure might reduce the incidence of neonatal sepsis.Prompt use of antibiotic according to standard policy is warranted to save the newborn lives from septicemia.
Osrin D. et al, (2006)
conducted a Cross sectional retrospective study in Nepal to A determine home based newborn care practices, The findings of study showed that health promotion interventions most likely to improve newborn health in this setting include increasing attendance at delivery by skilled service provider, improving information for families about basic prenatal care, promotion of clean delivery practices, early cord cutting and wrapping of the baby and avoidance of early bathing.Trotter S (2006),
conducted a review on neonatal skin care. The aim of the study is to inform midwives about the potential dangers of chemical ingredients used in personal care products and to suggest simpler skincare regimes. It revealed that these irritants caused conditions like eczema, asthma and related allergies. There are suggestions given on alternative cleaning agents with procedure to use with them.Vural G And Kisa S (2006),
conducted a case control study in Turkey to compare the A incidence of omphalitis among three groups, each using a different type of newborn cord care; Povidoneiodine, dry care and topical human milk. They concluded that the cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics.Bang AT, Bang RA et al (2006)
conducted a study Burden of morbidities and the unmet need for health care in rural neonates - a prospective observational study in Gadchiroli, India. Nearly half of the neonates in rural homes developed high risk morbidities ten times the neonatal morbidity rate and needed health care but practically none received it. The magnitude of care gap suggests an urgent need for developing home-based neonatal care to reduce neonatal morbidities and mortality.Bank AT, Bang RA (2005)
conducted a study Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Home-based neonatal care, including management of sepsis, is acceptable, feasible, and reduced neonatal and infant mortality by nearly 50%among our malnourished, illiterate, rural study population. Our approach could reduce neonatal mortality substantially in developing countries.
PART – II
CONCEPTUAL FRAME WROK
Polite and Hungler (2002) states that conceptual frameworks are inter related concepts on obstructions that are assembled together in some rational scheme by virtue of relevance to a common theme. It is a device that helps to stimulate research and the extension of knowledge by providing both directing and imetus. A framework may served as a spring for a scientific advancement.
The conceptual framework of my study is based on Pender’s Health Promotion Model.
Health promotion is directed at increasing a client’s level of well being. The health promotion model describes the multidimensional nature of persons as they interact within their environment to pressure health.
The model focuses on the following three areas 1. Individual characteristics and experiences 2. Behaviour specific knowledge and affect 3. Behavioural outcomes.
The health belief model notes that each person has unique personal characteristics and experiences that affect subsequent actions.
The set of variables for behavioural specific knowledge and affect have important motivational significance. These variables can be modified through nursing action. Health promoting behaviour is the desired behavioural outcome. Health promoting behaviours should result in improved health, enhanced functional ability and better quality of life at all stages of development.
This model addresses the importance of postnatal care among postnatal mothers. According to the model by the identification of the cognitive
perceptual factors of the postnatal mothers, and modifying factors, it provides a way for improving the action.
Health promotion is made for looking organizing framework and for looking the increasing level of well being,
The model is divided into 3 major components.
They are
1. Cognitive perceptual factors, 2. Modifying factors
3. Behavioural factors.
Cognitive perceptual factors
In the present study, the investigator assessed the knowledge and practice of postnatal mothers regarding postnatal care in various aspects such as meaning of postnatal care, diet, personal hygiene, exercise, family welfare, new born care. Each individual is uniquely expressed by her own pattern of cognitive perceptual factors.
Modifying factors
The modifying factors such as age, education, income, type of family, parity occupation. These factors change the behaviour of the postnatal mother.
Behaviours
Health related behaviour is the outcome of the model and is directed toward attaining the positive health outcomes and experiences through the lifespan.
In the present study likelihood of action depends on cues such as participation in postnatal health education at the time of discharge, well baby clinic and follow up at family planning OP.
Cues to action in the present study is through individual health education, mass media campaign, advices from relatives friends, health care providers, receiving messages through pamphlets, booklets, photographs. In this way the knowledge can be provided and gradually change the practice of the mothers.
34
FIGURE-1: SCHEMATIC REPRESENTATION OF CONCEPTUAL FRAMEWORK
Cognitive perceptual factors Modifying factors Participation in health promoting behaviour
NEGATIVE FACTORS
♦ Unawareness regarding knowledge about postnatal care.
♦ Negative attitude towards postnatal care practices.
POSITIVE FACTORS
♦ Maintaining proper diet, personal hygiene, exercise, family welfare and newborn care
♦ Adequate awareness and practices
Demographic Variables
♦ Age
♦ Educational Status
♦ Income
♦ Type of Family
♦ Parity
♦ Occupation
Interpersonal characteristics
♦ Relatives
♦ Friends
♦ Neighbours
♦ Health care providers Situational Factors
♦ Access to health care
♦ Availability of resources
Likelyhood attending in health promoting behaviour by
postnatal mothers.
♦ Participation in postnatal health education at the time of
discharge, well baby clinic and follow up at family planning OP.
Cues to action
♦ Individual health education
♦ Mass media campaign
♦ Advices from relatives friends, neighbours health care providers
Likelyhood engaging un healthy dietary practices Improper personal hygiene, less exercise, not following
family planning method, poor newborn care Inadequate
awareness and unfavourbale
practices
Adequate awareness and
favourable practices
MODIFIED PENDER’S HEALTH PROMOTION MODEL
CHAPTER – III METHODOLOGY
This chapter deals with the methodology adopted for the study and includes the description of research, sampling technique, sample size, description of the tool, pilot study, and method of data collection and statistical methods.
3.1 RESEARCH APPROACH
A research approach tells the researcher as to what data must be collected and the method of analysis. In the present study a descriptive approach was used as it is appropriate to accomplish the objectives of the study.
3.2. RESEARCH DESIGN
Descriptive design was used to evaluate the knowledge and practice among postnatal mothers regarding postnatal care.
3.3 SETTING OF THE STUDY
The study was conducted at urban area of Elango Nagar and Rural area of Madambakkam. The Elango Nagar urban health post comes under Chennai corporation. The Elango Nagar covers population 54922. The Madambakkam rural area comes under Medavakkam upgraded primary health centre. It is a sub centre of Medavakkam. It contains 18665 population.
3.4 POPULATION
The target population of this study was 50 postnatal mothers in urban Elango Nagar area and 50 postnatal mothers in Rural Madambakkam subcentre area.
3.5. SAMPLE
The sample for the present study comprised of postnatal mothers those who are multigravida.
SAMPLE SIZE
A total of 100 postnatal mothers, 50 from urban area at Elango Nagar and 50 from Rural area at Madambakkam.
3.7. SAMPLING TECHNIQUE
The sampling technique used for the study was non randomized convenience sampling technique.
3.8 CRITERIA FOR SAMPLE SELECTION Inclusion Criteria
1) Women who are multigravida delivered alive baby normally by vaginal birth.
2) Women who have completed 15 days after delivery.
3) Women who are able to speak, and understand Tamil only.
4) Women who are willing to participate.
Exclusive criteria
1) Women who are primigravida delivered alive baby normally by vaginal birth.
2) Women who are less than 15 days completed after delivery.
3) High risk mothers and sick child.
4) Mothers who had abortions.
3.9 VARIABLES Independent variables
The demographic variables are age, religion, educational status, occupation, Income, type of family, age at marriage, age at first child, source of information.
Dependent variables
The study variables are postnatal mothers and postnatal care
3.10 DEVELOPMENT OF THE INSTRUMENT
A structured interview schedule was developed based on the objectives of the study. Various sources of literature and opinions from the subject experts who obtained to ascertain the effectiveness and to bring about the correct items in the questionnaire all these helped in the ultimate development of the tool.
3.11. DESCRIPTION OF THE TOOL
The instrument used for data collection was an structured interview schedule This was developed based on the objectives of the study and through review of literature.
Part I : It was not scored but data were categorized for descriptive analysis
Part II : It consists of 20 multiple choice questions which was prepared to assess the knowledge of postnatal mothers. The question were related to postnatal care regarding general information, diet, personal hygiene, exercise, family welfare, newborn care.
Part III : It consists of 24 multiple choice questions which was prepared to assess the practice of postnatal mothers. The questions were related to postnatal care regarding diet, personal hygiene, exercise, newborn care.
3.12. SCORE PROCEDRURE
Part I : It consists of demographic data which includes age, educational status, income, type of family, parity.
Part II : It consists of 20 multiple choice questions. Postnatal mothers were interviewed and the answers were written against each question for each correct answer one mark will be given and zero for wrong answer. The total score is 20.
Part III : It consists of 24 multiple choice questions for evaluation of practice of postnatal care among postnatal mothers. For each correct answer one mark will be given and zero for wrong answer. The total score is 24.
3.13. SCORE INTERPRETATION Part – II
The instrument of Part – II consist of 20 multiple choice questions regarding assess the knowledge of general information of postnatal care, diet, personal hygiene, exercise, family welfare, newborn care.
Table – 3: The Score Were Interpreted as Follows
Title Inadequate knowledge
Moderately adequate knowledge
Adequate knowledge Total No. of
questions 0 -10 11 -15 > 15
Score < 50% 51 – 75% > 75%
Part – III
The instrument of Part – III consists of 24 multiple choice questions regarding assess the practice of postnatal mothers diet, personal hygiene, exercise, newborn care.
Table - 4: The overall level of practice was graded as follows
Title Poor Good Excellent
Total No. of items 0 -12 13 – 18 > 18
Score < 50% 51 – 75% > 75%
3.14. TESTING OF TOOL Validity
The tool was evaluated by 3 experts for content validity. The experts includes one professor from the community medicine department at Madras Medical College and 2 nursing experts specialized in community health nursing. Suggestions were considered and modifications of tool were done according to the opinion of experts. Translation of tool was done by language experts. Translation of tool was done by language experts and retranslation to English was done and validity was confirmed.
Reliability
The tool was submitted to 3 experts in the field of nursing, statistics and the dissertation committee of the college of nursing the reliability of assessment scale was established by the test retest method score (R= 0.81) is highly valuable. The study was feasible and practicable.
3.15. PILOT STUDY
The pilot study was conducted in Elango Nagar Health post area. Formal permission was obtained from the authorities prior to the pilot study.
The pilot study was done for a period of 5 days with 10 samples using convenient sampling technique. The selected sample was informed about the purpose and need for the study was informed that the information provided by them will be kept confidential and there after their written constant were taken.
After conducting the pilot study the researcher found that the questionnaire would take 20 – 30 minutes for collecting data from each sample.
As per the experience gained from this study, the researcher made changes in the tool and also gain confident to do this study. It was found that the study was feasible, the concerned authorities and the women were found to be cooperative and showed interest in participating in the study, and the questionnaire were relevant. The time and cost of the study were within the researcher’s limit. The participants were not included for main study.
3.16. DATA COLLECTION PROCEDURE
The formal approval was obtained from the Director of Health Service and corporation health officer at Chennai. The data was collected for four weeks in the month of December 16th to January 15th among postnatal mothers those who are multigravida completed 15 days after delivery, the sample for the study were identified and selected on sample selection criteria by using non randomized convenience sampling technique.
Initial rapport was established and the purpose of the study was explained to the sample subject. After obtaining the informed consent the interview was conducted among them.
The data was collected between 9am to 2pm, in that period about 4 -6 samples were interviewed in the less distraction place. For each postnatal mothers the time to complete the interview is about 20 – 30 minutes. After finishing the interview, the researcher clarifies the doubts raised by the women as well as relatives.
3.17. PLAN FOR DATA ANALYSIS
The data analysis was planned to include both descriptive statistics and inferential statistics. Frequency and percentage distribution mean and standard deviation were used to describe demographic variables. Frequency and percentage distribution were used to assess the knowledge of postnatal mothers. Chi square test is used to find out the association between knowledge and selected demographic variables. Chi square test is used to identify the level of knowledge of postnatal mothers with their selected demographic variables and associate the practice of postnatal mothers with their selected demographic variables.
3.18. STATISTICAL METHODS
The statistical methods used for nalysis were nunebr, perecentage, mean standard deviation chi –square, Karl pearsons’s correlation and students unpaired t-test
TABLE – 5: Statistical Method
S.No Data Analysis Methods
1. Descriptive statistics
Number percentage, mean, standard deviation
2. Inferential
statistics Chi –square test, Karl Pearson’s correlation Pearson’s correlation students impaired t-test
3.19. ETHICAL CLEARANCE:
The investigator followed all the ethical guidelines, which were issued by institutional research ethical committee. After a thorough review of the study topic and its inclusions the ethical committee at Madras Medical College approved by the study for its further proceeding. And also permission was obtained from Director of Public Health and Corporation of Chennai.
F F IG I GU UR RE E- -2 2 : : S SC C H H EM E M AT A TI I C C R R E E P P RE R ES S EN E N TA T AT TI IO ON N OF O F R R ES E S E E A A R R C C H H D D E E SI S I GN G N
Research approach (Quantitative approach)
Research Design (Descriptive Approach)
Target Population
(Urban and rural postnatal mothers)
Accessible population
(Postnatal Mothers Elango Nagar and Madambakkam)
Sample
(Postnatal Mothers those who are multigravida)
Sample Size
(50 urban 50 rural postnatal mothers)
Sampling Technique (Convenience sampling technique)
Tool
(Structure interview questionnnaire)
Tool
(Structure interview questionnnaire)
Analysis and Interpretation (Descriptive and Inferential Statistics)
Findings of the study
CHAPTER- IV
DATA ANALYSIS AND INTERPRETATION
This chapter deals with the analysis and interpretation of the data collected from knowledge and practice of 50 postnatal mothers from urban and 50 postnatal mothers from rural regarding postnatal care. The collected data was tabulated, organized, analysed and interpreted on the basis of the objective of the study and presented into eight sections mentioned below;
I) Distribution of samples according to demographic variables.
II) Knowledge of postnatal mothers.
III) Practice of postnatal mothers
IV) Correlate the knowledge and practice of postnatal mothers among urban and rural.
V) Association between the level of knowledge of postnatal mothers with their selected demographic variables.
VI) Association between the practice of postnatal mothers with their selected demographic variables.
SECTION–I: DESCRIPTION OF DEMOGRAPHIC DATA OF THE POSTNATAL MOTHERS
Table – 1
Distribution of Demographic Data of Postnatal Mothers according to their baseline status (n=100)
Postnatal Mothers Urban Rural Demographic Variable
n % n %
Hindu 37 74.0% 40 80.0%
Christian 8 16.0% 6 12.0%
Religion
Muslim 5 10.0% 4 8.0%
Housewife 42 84% 38 76%
Occupation
Unskilled worker 8 16% 12 24%
Rs.3001 -4000 34 68.0% 29 58.0%
Rs.4001 -5000 10 20.0% 21 42.0%
Income
>Rs.5000 6 12.0% 0 0.0%
15 -20 yrs 2 4.0% 7 14.0%
21 -25 yrs 41 82.0% 42 84.0%
Age at Marriage
26 -30 yrs 7 14.0% 1 2.0%
21 -25 yrs 42 84.0% 45 90.0%
Age at Child Birth
26 -30 yrs 8 16.0% 5 10.0%
Health care providers 32 64.0% 34 68.0%
Family members 16 32.0% 12 24.0%
Source of Knowledge
Friends 2 4.0% 4 8.0%
Ab
45
Distribution of Age
78% 76%
22% 24%
0%
20%
40%
60%
80%
100%
Urban Rural
21-25 years 26-30 years
The above figure shows that higher proportion of postnatal mothers among the urban (78%) and rural (76%) belongs the age group of 21-25 years
46
6% 8%
50% 50%
32% 32%
12% 10%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Non formal education
Primary education
Secondary education
Higher Secondary
education Distribution of Educational Status
The above figure shows that half of the proportion of urban and rural postnatal mothers were educated upto primary school.
47
78%
22%
60%
40%
0%
20%
40%
60%
80%
1 2
Distribution of Type of Family
Nuclear family Joint family
The above figure shows that more than half of the Urban (78%) and rural (60%) postnatal mothers belong to nuclear family.
48
88%
12%
84%
16%
0%
20%
40%
60%
80%
100%
1 2
Distribution of Parity
Second Third
The above figure shows that majority of the urban (88%) and rural (84%) of postnatal mothers belong to second prity.
SECTION – II: ASSESSMENT OF KNOWLEDGE AMONG URBAN AND RURAL POSTNATAL
MOTHERS REGARDING POSTNATAL CARE Table – 7: Distribution of level of knowledge between the urban and rural mothers
Urban Rural
Knowledge No. of Postnatal
mothers Percentage No. of Postnatal
mothers Percentage
Inadequate 33 66.0% 42 84.0%
Moderate 17 34.0% 8 16.0%
Adequate 0 0.0% 0 0.0%
The above table depicted that higher proportion of urban (66%) and rural (84%) postnatal mother had inadequate knowledge where as 34% of urban postnatal mothers had moderate knowledge regarding postnatal care.
SECTION – III: ASSESSMENT OF LEVEL OF PRACTICE AMONG URBAN AND RURAL POSTNATAL MOTHER
Table – 8: Distribution of level of practice between the urban and rural mothers
Urban Rural
Practice No. of Postnatal
mothers Percentage No. of Postnatal
mothers Percentage
Poor 31 62% 40 80%
Moderate 19 38% 10 20%
Good 0 0% 0 0%
The above table depicted that higher proportion of urban (62%) and rural (80%) postnatal mother had poor practice where as 38% of urban postnatal mothers had moderate practice regarding postnatal care.
SECTION –IV: CORRELATION OF THE KNOWLEDGE AND PRACTICE OF POSTNATAL CARE AMONG POSTNATAL MOTHERS IN URBAN AND RURAL
Table-9: Correlation between knowledge and practice score
Mean + SD Karl Pearson Correlation Coefficient
Knowledge Score 9.52+2.09 Urban
Practice Score 7.42+1.97
R=0.51, P=0.01*
Knowledge Score 11.82+2.24 Rural
Practice Score 9.58+2.33
R=0.42, P=0.01*
The above table shows that the postnatal mothers in urban have better knowledge that of the practices which is significant (r=0.51, P=0.0*) and postnatal mothers in rural have better knowledge than that of the practices which is also significant (r=0.42, P-=0.01*). There is a positive correlation between knowledge and practices score. It means knowledge increases their practices also increases.
SECTION-V: ASSOCIATION BETWEEN THE LEVEL OF KNOWLEDGE OF POSTNATAL MOTHERS WITH THEIR SELECTED DEMOGRAPHIC VARIABLES.
Table-10: Association between level of knowledge and demographic variables among urban and rural
Urban Rural
Inadequate Moderate Inadequate Moderate n % n %
Pearson chisquare
test
n % n %
Pearson chisquare
test
21 -25
yrs 29 74.3% 10 26.7% 35 92.1% 3 7.9%
Age
26 -30
yrs 4 36.3% 7 63.7%
χ2=5.51 P=0.02 DF=2,
significant 7 58.3% 5 41.7%
χ2=7.73 P=0.01**
DF=2, significant Second 32 72.7% 12 27.3% 37 88.1% 5 11.9%
Parity
Third 1 16.7% 5 83.3%
χ2=7.39 P=0.01**
DF=2,
significant 5 62.5% 3 37.5%
χ2=3.84 P=0.05*
DF=2, significant The above table reveals that there is a significant association between the age and the level of knowledge. Among both the urban and rural postnatal mothers majority of them who were as the age group of 26-30 years had a moderate knowledge of postnatal care. As the age increases the knowledge of the postnatal mothers also increases.
There is a significant association between the parity and the level of knowledge. Among both the urban and rural postnatal mothers majority of them who had more than two children also had a moderate knowledge of postnatal care. As the parity increases the knowledge of the postnatal mothers also increases.
