Knowledge and attitude of postnatal mothers on essential newborn care practices at Marsabit county referral hospital.

Abstract

Introduction: Annually 2. 6 million neonates lose their lives within first month of life globally. 1 million of them die within first 24 hours of life. 80% of the deaths that occur in neonatal period are secondary to preventable causes: prematurity, asphyxia, sepsis, jaundice and anemia. Low and middle income economies carry the heaviest burden and Sub-Saharan Africa has the highest rate accounting to 38% of global neonatal deaths. Kenya’s neonatal mortality has been falling gradually from 39.3 deaths per 1000 live births in 1963 to 20.9 deaths per 1000 live births in 2017. To achieve international and national goals of ending preventable deaths of this population, further effort is needed. The WHO developed essential new-born care package (ENCP) which have proved to improve neonatal outcomes thereby reducing neonatal deaths. Identification of discrepancies in Knowledge and attitude early in the neonatal period has been linked to better neonatal Outcomes. OBJECTIVES: To assess the postnatal mother’s knowledge and attitude on ENCP at Marsabit County Referral Hospital and to determine socio demographic factors associated with Poor maternal knowledge on ENCP. METHODOLOGY: A cross-sectional study was conducted on postnatal mothers of neonates at Marsabit County Referral Hospital. The study subjects were interviewed using structured pretested questionnaires. A scoring system was used for closed ended questions. For open ended questions responses were summarized and descriptive statistics carried out. During analysis for factors associated with poor maternal knowledge on ENC the median score was used as a cut off to distinguish between adequate knowledge and inadequate knowledge. A five-point Likert scale was used to evaluate maternal attitude on various aspects of ENCP. Statistical analysis was performed using Stata version 15.1 (StataCorp, College Station, TX, USA). RESULTS: One hundred and seventy two (172) postnatal mothers were enrolled. 149 (87%) of the postnatal mothers knew their babies required vaccination after delivery, 93 (54%) knew vaccines prevent diseases while, 7 (4.1%) believed vaccines could be harmful to their babies. Regarding eye care, 51 (30%), 69 (40%), 51 (30%) of mothers were aware of eye discharge, reddening of the eye and swollen eye respectively as signs of eye infection. 10 (56%) of the mothers agreed other substances other than prescribed drugs could be applied to baby’s eye when there is discharge. Regarding thermoregulation, 147 (85%) and 23 (13%) of the postnatal mothers interviewed recognized warm clothing and kangaroo mother care as modes of thermoregulation and 111 (65%) of the mothers knew the baby should not be washed within 24 hours of delivery and 39 (23%) thought the baby could be washed minutes after delivery. 143 (83%) of the mothers knew the cord should be left uncovered, 124 (72%) of the mothers knew the code should be kept clean and dry. 143 (83%) of the mothers knew about the exclusive breastfeeding for 1st 6 months, 171 (99%) of the mothers fed their babies on colostrum, 147 (85%) of the mothers knew the baby should be breastfed minutes after delivery. 165 (96%) of the mothers knew about breastfeeding on demand. A total of 160 (93%) of the mothers were aware of any danger signs of the neonate’s serious illness. The mothers were able to consistency identify all the listed signs as important in suggesting neonate’s serious illness. Multivariate analysis showed that secondary education was associated with lower risk of having poor knowledge compared to primary education or no education. Multiparity as compared to primiparity was also associated with reduced risk of poor knowledge on ENCP adjusted risk ratio of 0.58. CONCLUSION: Knowledge gaps were noted in thermoregulation, eye care and immunization. The postnatal mothers had a negative attitude towards immunization but positive attitude towards other components of newborn care. Secondary education as compared to primary education and no formal education and multiparity as compared to primiparity was linked to reduced risk of poor knowledge on ENCP.