https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/144 Sun, 13 Nov 2016 09:14:27 +0000 Address for Correspondence: Dr Housne Ara Begum, Institute of Health Economics, University of Dhaka, Dhaka-1000, Bangladesh, email:drhousne@gmail.com           Characteristics Mother’s age (yrs) <20 21-25 26-30 31-35 >35 Mean (SD) Education of Mothers Illiterate Primary SSC HSC Graduation Residence of Parents Urban Rural Family income (Taka) > 3000 3000-7000 7001-15000 < 15000   To estimate the level of knowledge, mothers were asked questions on breast feeding, maintenance of body temperature, skin care, care of umbilical stump, eye care, immunization, early detection of serious diseases, social beliefs and source of information. Scores were given as 1 (for appropriate answer) or 0 (for inappropriate answer). Then they were computed and recoded and grouped in three categories as excellent, optimum, and poor. Only 5.8% mothers had excellent knowledge on neonatal care, 55.3% mothers had optimum knowledge, and 39% mothers had a poor knowledge. Level of practice of the respondent mothers on neonatal care was also calculated by following the same method. Only 5.5% of the mothers had an excellent performance whereas 71.8% mothers performed poorly. Regarding breast feeding, 10.5% of the respondent mothers told breast feeding should be initiated within 6 hrs, 10.5% of the respondent mothers told about feeding colostrum, 95.5% of the mothers told exclusive breasting should be up to 6 months where as 4.3% answered none. As regards ritual or traditional practices kajol, homeopathic drugs, breast milk, oil and similar items were used for treating various eye problems. Match box, iron sticks, brooms, shoes, scissors were mentioned by 46.5% of the respondents as materials to ward off evil spirit. For source of information for neonatal care, 96.8% of the mothers got suggestion and information from relatives and guardians. Only around 5% mothers got information from books, radio, TV and posters. Discussion This study revealed that less than half (42%) of the respondents knew how to care for the neonates. Many newborn deaths can be avoided by interventions that have important preventive effects like thermal protection. Simple measures such as a warm room for delivery, immediate drying of the baby and skin-to-skin contact with the mother can prevent loss of body warmth.4 In a study on the care of 62 normal newborns at four levels of institutions, the majority being at the University Teaching Hospital in Lusaka, it was seen at discharge after an average of 14 hours, half the babies had a body temperature below 36°C, i.e. mildly hypothermic. In another study, a significant decrease in body temperature was observed between 30 and 120 minutes post-partum.5 In this study, only 23.5% of the respondents kept neonates attached to mother with head covering. Neonates can easily loose body temperature. About one fifth of the temperature is lost through head. Although most neonates are adequately covered, their heads remain uncovered. Often they become hypothermic which goes unnoticed, resulting in mortality. Interestingly 22.5% respondents knew that shaving off hair is harmful but around 65% respondents told that they shave off their neonate’s hair. These practices make neonates more vulnerable to hypothermia. Those in favor of cutting hair of neonates argue that it is impure. Offering neonates anything other than breast milk makes them more prone to infection. In this study most of the mothers (91%) were in favor of breast feeding after birth. Some of them offered honey, sugar, misri (locally produced crystallized sugar), cow’s/goat’s milk as first feed. It indicates very few mothers were practicing early feeding of breast milk. When questioned about hypoglycemia, only 19 (29.2%) stated that the mother should increase the feeding frequency. Thirty subjects (46.2%) recounted the belief about “weak milk”. On the topic of contraception, 27 (41.5%) had proper knowledge on how to avoid a new pregnancy during lactation. Hugo et al.6 found that very few mothers had the knowledge of formulas for artificial milk. Same findings were shown in this study. Regarding the human milk substitutes, only 7 subjects (10.8%) knew that artificial formulas were made from cow or soybean milk. And 37 (56.9%) acknowledged the impact of the cost of the artificial formulas on the household income. Data on potential risk factors for omphalitis were collected during a community-based, umbilical cord care trial in Nepal during 2002–2005. Handwashing was associatedwith fewer infections and needs to be promoted by community-based healthworkers.7 More than half (54%) of the respondents thought that the umbilicus of the new born should be kept dry and nothing applied to it. Interventions introduced in both developed and developing countries to reduce exposure of the cord to infectious pathogens include clean cord cutting, hand-washing before and after handling the baby.8 During a study on pregnancy in a poor rural tropical area, a high prevalence of neonatal fever and umbilical cord infection was detected.9 It was found that 94% mothers thought oil massage was good for neonates and 87% of the respondents practiced so. Most of them used mustard oil. They did not know that it could be harmful for the tender skin of the infants. Twice-daily application of mustard oil for 7 days resulted in sustained delay of barrier recovery. Mustardoilisusedroutinelyinnewborncare throughout South Asia, having toxic effects on the epidermal barrier that warrant further investigation.10,11 Conclusion The study revealed that almost half of the respondent mothers were unaware of proper neonatal care. Many of them had not only inadequate knowledge but also maintained some rituals or traditional attitudes that proved to be unhealthy and even injurious to neonates. The mothers had a fair knowledge regarding need for immunization but a poor knowledge regarding the prevention of diseases. The health planners and policy makers should look into this important issue. Only educational interventions may significantly reduce neonatal morbidity and mortality and improve the overall health situation of infants. References 2.   AlecMercer, Hossain M, Fariha K, Nafisa H, Huq L, Nowsheruddin, Larson C. Level and determinants of neonatal mortality in rural areas of Bangladesh served by large NGO programme; ICDDR,B Neonatal Report 2005. 4.   WHO 1996. Essential newborn care. WHO/FRH/MSM/96.13. 6.   Hugo I, Borges M, Rodrigues S, Maria S. Knowledge of newborn healthcare among pregnant women: basis for promotional and educational programs on breastfeeding. Sao Paulo Med Journ 2001; 119(1): 35-39. 8.   Mullany, Luke C. Armstadt G, Tielsch J. Role of antimicrobial applications to the umbilical cord in neonates to prevent bacterial colonization and infection: a review of the evidence. Pediatric Infectious Disease Journ 2003; 22(11): 996-1002. 10.Darmstadt G.L, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, Elias PM. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatri 2002; 91(5): 546. 2026 Ibrahim Medical College. All rights reserved.