Antenatal education for expectant mothers results in sustained improvement in knowledge of newborn care

The Influence of Educational, Environmental and Social Factors in the Decision to Attend Prenatal Lectures among Pregnant Women in Romania

Introduction: Prenatal and postnatal education is an essential compound of prenatal care that prepares and facilitates the acquisition of women's skills, necessary for positive experiences during pregnancy, childbirth and postnatal period. Material and method: We conducted a prospective study that included pregnant women who attended prenatal courses. They were asked to fulfil a questionnaire about course topics, utility and impact on birth preparations. The pregnant women included in this group planned to give birth at Bucur Maternity, Saint John Clinical Hospital, Bucharest, Romania. Results:A number of 205 pregnant women answered the online questionnaire over a period of two months. Their age range was between 25 and 35 years (40.98%). Among them, 74.15% had higher education, 85.37% of them were from urban areas, 82.44% were primiparous and 63.41% intended to have natural birth. There has been a growing interest for natural birth among pregnant women in their first pregnancy (68.05%) and also for participating in pre- and postnatal education courses, which was influenced by the level of completed education (65.66% of pregnant women with higher education wanted to give birth naturally). Topics of interest for most pregnant women are mentioned too. Conclusion:In our study, the majority of participants were aware of the importance to get accurate information about the prenatal period, birth, childbirth and the next period, as well as the care of the new-born from specialized courses, provided by medical staff.

Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings

Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families’ use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families’ use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programmes that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.

Effect of education on the readiness levels of primigravida women to hygienic care practices of the newborn with the use of QR code

The researcers planned this study to determine the effect of the education on the hygienic care of the newborn with the use of QR Code on readiness levels of primigravida women to hygienic care practices of the newborn. A total of 68 primigravida women constituted of this interventional study. After the intervention group completed their education on newborn care, mobile application and QR codes were introduced to the pregnant women. The control group received routine newborn care training. It was observed that the education of hygienic care to the newborn, which was provided to pregnant women with the use of QR Code, was effective on their readiness to care. Pediatric nurses can provide QR code supported training to prepare pregnant women for the hygienic care of the newborn.

Using a Global Health Media Project Video to Increase Knowledge and Confidence in the Mothers of Admitted Neonates in Rwanda: A Prospective Interventional Study

INTRODUCTION

In resource-limited settings, the ratio of trained health care professionals to admitted neonates is low. Parents therefore, frequently need to provide primary neonatal care. In order to do so safely, they require effective education and confidence. The evolution and availability of technology mean that video education is becoming more readily available in this setting.

AIM

This study aimed to investigate whether showing a short video on a specific neonatal topic could change the knowledge and confidence of mothers of admitted neonates.

METHODS

A prospective interventional study was conducted in two hospitals in Kigali, Rwanda. Mothers of admitted neonates at a teaching hospital and a district hospital were invited to participate. Fifty-nine mothers met the inclusion criteria. Participants were shown 'Increasing Your Milk Supply, for mothers' a seven-minute Global Health Media Project video in the local language (Kinyarwanda). Before and after watching the video, mothers completed a Likert-based questionnaire which assessed confidence and knowledge on the subject.

RESULTS

Composite Likert scores showed a statistically significant increase in knowledge (pre = 27.2, post = 33.2, p < 0.001) and confidence (pre = 5.9, post = 14.2, p < 0.001). Satisfaction levels were high regarding the video content, language and quality. However, only 10% of mothers owned a smartphone.

DISCUSSION

We have shown that maternal confidence and knowledge on a specific neonatal topic can be increased through the use of a short video and these videos have the potential to improve the quality of care provided to admitted neonates by their parents in low-resource settings.

What topics should we teach the parents of admitted neonates in the newborn care unit in the resource-limited setting - a Delphi study

BACKGROUND

In resource-limited settings, such as Rwanda, health care profession (HCP) to neonate ratios are low, and therefore caregivers play a significant role in providing care for their admitted neonates. To provide such Family Integrated Care, caregivers need knowledge, skills, and confidence. The objective of this study was to identify consensus from key stakeholders regarding the priority topics for a "parental neonatal curriculum."

METHODS

A three-round Delphi-study was conducted. During Round-1, face-to-face interviews were undertaken and responses coded and categorized into themes. In Round-2, participants were presented with Round-1 feedback and asked to provide additional topics in respective themes. In Round-3, respondents were asked to rank the importance of these items using a 9-point Likert scale.

RESULTS

Ten, 36 and 40 stakeholders participated in Rounds-1, - 2 and - 3 respectively, including parents, midwives, nurses and physicians. Twenty and 37 education topics were identified in Rounds-1 and -2 respectively. In Round-3 47 of the 57 presented outcomes met pre-defined criteria for inclusion in the "parental neonatal curriculum."

CONCLUSION

We describe a "parental neonatal curriculum," formed using robust consensus methods, describing the core topics required to educate parents of neonates admitted to a newborn care unit. The curriculum has been developed in Rwanda and is relevant to other resource-limited settings.

Perspective of pregnant women regarding antenatal preparation: A qualitative study

BACKGROUND

Antenatal Education programs have been recommended for pregnant women to help them during gestation, childbirth and development of parenthood. Evidence on the perspectives and expectations of pregnant women regarding antenatal education in hospital settings, specifically in developing countries is still scarce. In-depth understanding is a key issue to organize interventions.

AIM

Identify experiences, needs and expectations of a group of pregnant women regarding antenatal education.

METHODS

A qualitative study was conducted. Data were collected through semi-structured interviews at the antenatal clinic of a public maternity teaching hospital in the southeastern region of Brazil. The interviews were recorded, transcribed verbatim and thematic analysis was performed. Twenty-two pregnant women were recruited following the logic of purposive sampling.

FINDINGS

All the participants reported they would like to receive guidance on non-pharmacological techniques for pain management during labor. The participants reported barriers to performed physical exercise; however, they also said that if they were encouraged by healthcare professionals they would exercise. According to the majority, the exercises should be of low intensity, and the improvement of general wellbeing was the most commented benefit. Also participants said that antenatal education meetings should be linked to antenatal consultations to facilitate participation. According to some participants, knowledge about antenatal education was acquired in conversations with other women, from lay media, and some reported a lack of guidance during antenatal consultation.

CONCLUSION

The participants of our study reported they would like to participate in antenatal education groups to receive guidance on non-pharmacological techniques to use during labor and childbirth.

Gaps in the knowledge and skills of Portuguese mothers associated with newborn health care

Objectives:

assess mothers’ parenting knowledge and skills associated with the parental competence health promotion and monitoring for newborns and infants aged up to six months and determine the key characteristics of mothers who are better prepared for parenting.

Method:

cross-sectional study conducted in three health centers belonging to a Local Health Unit in the Northern Region of Portugal. Data was collected using clinical interviews conducted with pregnant women or mothers with a child aged up to six months. The tool used contained 21 child health promotion and monitoring indicators associated with different assessment moments: pregnancy, 1st/2nd week, 1st/2nd month, 3rd/4th month, and 5th/6th month.

Results:

we assessed the knowledge and skills of 629 women. Learning needs were identified for each of the indicators. The mothers who were better prepared for parenting tended to have a higher level of schooling, resided with the child’s father, had other children, had planned pregnancy, and intended to breastfeed.

Conclusions:

the results showed that knowledge and skills were lacking for each of the periods assessed by this study. First-time single mothers whose pregnancy was unplanned and who did not prepare themselves for parenthood may be considered a vulnerable group.

Changing Knowledge and Practices of Mothers on Newborn Care through Mother Class: An Intervention Study in Indonesia

Poor knowledge and practices of newborn care may contribute to high neonatal mortality. This study aims to analyze the effect of prenatal education, namely 'mother class', on knowledge and practices of newborn care among mothers in Tangerang Selatan District, Indonesia. An intervention study with a quasi-experimental design was conducted. Using a questionnaire, 427 mothers were interviewed: an intervention group (n = 214) that attended mother class and a control group (n = 213) that had not. A home visit followed the intervention to assess newborn care practices. Mother class used Maternal and Child Health Handbook as the main reference material. Attending mother class significantly increased knowledge of breastfeeding initiation and hepatitis B immunization (p < 0.05). Mothers in the intervention group had the likelihood of practicing good newborn care compared with the control group (odds ratio: 1.812; 95% confidence interval: 1.235-2.660). Mother class improves knowledge and newborn care practices and strengthens interactions between mothers and health care providers.

Knowledge of postnatal mothers on essential newborn care practices at the Kenyatta National Hospital: a cross sectional study

Introduction

Of the 130 million babies born yearly, nearly 4 million die in the neonatal period. Kenya Demographic Health Survey (KDHS) 2014 places neonatal mortality rate at 22 deaths per 1,000 live births, well above the Sustainable Development Goal (SDG) 3 that aims to reduce these mortalities to at least 12 deaths per 1000 live births by 2030. The aim of the study was to assess maternal knowledge on selected components of essential newborn care: breastfeeding, cord care, immunisation, eye care and thermoregulation.

Methods

A hospital based cross-sectional study was conducted on 380 postnatal mothers in Kenyatta National Hospital. Interviews were conducted using structured pretested questionnaires. A score of one was given for correct response and zero for incorrect. Data were analysed using SPSS version 18.

Results

Modes of thermoregulation identified included kangaroo care (7%), warm room (4%) and warm clothing (93%). Almost all mothers knew of breastfeeding on demand, exclusive breastfeeding and colostrum use. Only 17.8% of mothers identified Bacillus Calmette-Guérin (BCG) and Oral Polio Vaccine (OPV) were birth vaccines. Only 4 mothers knew no substances should be applied to the cord. In logistic regression, factors significantly associated with poor knowledge included lack of education on newborn care during pregnancy, incomplete (less than 3) or no antenatal visits with an odds ratio (OR) of 3.3 (95% confidence interval (CI), 1.5 to 7.4 ), 2.5(1.5 to 4.2), 5.1(1.3 to 19.3) and p values of 0.003, 0.001 and 0.018 respectively.

Conclusion

Knowledge gaps existed regarding cord care, eye care, and immunization. Mothers had good knowledge on breastfeeding practices. Those who fail to fully attend antenatal clinics should be targeted for newborn care education.

Effects of Essential Newborn Care Training on Fresh Stillbirths and Early Neonatal Deaths by Maternal Education

BACKGROUND

Infants of women with lower education levels are at higher risk for perinatal mortality.

OBJECTIVES

We explored the impact of training birth attendants and pregnant women in the Essential Newborn Care (ENC) Program on fresh stillbirths (FSBs) and early (7-day) neonatal deaths (END) by maternal education level in developing countries.

METHODS

A train-the-trainer model was used with local instructors in rural communities in six countries (Argentina, Democratic Republic of the Congo, Guatemala, India, Pakistan, and Zambia). Data were collected using a pre-/post-active baseline controlled study design.

RESULTS

A total of 57,643 infants/mothers were enrolled. The follow-up rate at 7 days of age was 99.2%. The risk for FSB and END was higher for mothers with 0-7 years of education than for those with ≥8 years of education during both the pre- and post-ENC periods in unadjusted models and in models adjusted for confounding. The effect of ENC differed as a function of maternal education for FSB (interaction p = 0.041) without evidence that the effect of ENC differed as a function of maternal education for END. The model-based estimate of FSB risk was reduced among mothers with 0-7 years of education (19.7/1,000 live births pre-ENC, CI: 16.3, 23.0 vs. 12.2/1,000 live births post-ENC, CI: 16.3, 23.0, p < 0.001), but was not significantly different for mothers with ≥8 years of education, respectively.

CONCLUSION

A low level of maternal education was associated with higher risk for FSB and END. ENC training was more effective in reducing FSB among mothers with low education levels.

Perceptions, practices, and traditional beliefs related to neonatal jaundice among Egyptian mothers: A cross-sectional descriptive study

Neonatal jaundice (NNJ) is one of the most common neonatal disorders worldwide. It is still a main cause of avoidable brain damage, physical and mental impairment, and probable death in newborns.We aimed to assess perceptions, practices, and traditional beliefs among Egyptian mothers toward NNJ that may contribute to delayed presentation and inappropriate management of hyperbilirubinemia.This descriptive, cross-sectional study was conducted from January to May 2015. We interviewed 400 Egyptian mothers who gave birth in <1 month before the study using a structured questionnaire. Participants were recruited from outpatients of Cairo University Teaching Hospital.This study revealed unexpected moderate knowledge and attitude scores of Egyptian mothers in most domains with a mean of 6.6 and 20.6, respectively, although the majority of them were illiterate or had low educational attainment. In terms of knowledge, 52.3% of participants had adequate knowledge about NNJ in the aspects of awareness, risk factors, management, and complications. Almost all participants exhibited moderate (89.8%) and high levels (10%) of positive attitudes toward NNJ. Maternal sociodemographic factors influenced knowledge level, attitudes, and behaviors related to NNJ in Egypt. Working mothers and those residing in urban areas were significantly more knowledgeable (P = 0.023 and 0.021, respectively), and attained higher attitude scores (P < 0.001 and P < 0.001, respectively) than housewives and rural ones. Moreover, significantly higher attitude scores (P < 0.001) were attained by those who had completed their university [22.3 (SD = 3.1)] or postgraduate education [22.2 (SD = 3.6)].The majority of Egyptian mothers have a satisfactory level of knowledge and attitudes related to NNJ. However, cultural beliefs and traditional infant care practices still have an impact on mothers regardless of their educational level.

Factors associated with post-natal anxiety among primiparous mothers in Nepal

BACKGROUND

In Nepal, new mothers are fatigued by childcare responsibilities because of lack of knowledge and preparation for their new role. Knowledge deficit and adherence to traditional health practices place infants at risk. Some cultural practices for the care of newborns may cause tetanus, hypothermia or other life-threatening illnesses. Maternal education, previous experience of newborn care, economic status, relationship problems with husband or mothers-in-law and dissatisfaction with social relations are the variables of interest for this study.

AIMS

To examine the association between socio-demographic variables and post-natal anxiety among primiparous mothers in Nepal.

DESIGN

The study was designed as a correlational study.

SETTING

A major maternity hospital in Kathmandu, Nepal.

PARTICIPANTS

The sample were 216 primiparous mothers who were followed at 5-6 weeks after delivery.

METHODS

Three instruments were used for data collection: a demographics questionnaire, the Newborn Care Knowledge Questionnaire and the State-Trait Anxiety Inventory for Adults.

RESULTS

The mothers' knowledge of newborn care, general educational level and income were inversely related to maternal anxiety, that is, mothers with a lower educational level and socio-economic status demonstrated a higher level of post-natal anxiety. Poor relationships with husbands or mothers-in-law and low social support presented potential for the development of anxiety and depression during post-partum period.

CONCLUSION

Maternal education, socio-economic status and knowledge of newborn care were major factors of post-natal anxiety. On the other hand, women with low income and education, poor relationships with their husbands or mothers-in-law, and insufficient social support are vulnerable to the development of moderate to severe anxiety.

HEALTH POLICY

Policy implications from these results indicate the need for support and funding from the Ministry of Health for education for women at hospitals, which must work together to offer newborn care education during the ante-natal and post-natal periods.

Inadequate knowledge of neonatal danger signs among recently delivered women in southwestern rural Uganda: a community survey

BACKGROUND

Early detection of neonatal illness is an important step towards improving newborn survival. Every year an estimated 3.07 million children die during their first month of life and about one-third of these deaths occur during the first 24 hours. Ninety-eight percent of all neonatal deaths occur in low- and middle-income countries like Uganda. Inadequate progress has been made globally to reduce the amount of neonatal deaths that would be required to meet Millennium Development Goal 4. Poor knowledge of newborn danger signs delays care seeking. The aim of this study was to explore the knowledge of key newborn danger signs among mothers in southwestern Uganda.

METHODS

Results from a community survey of 765 recently delivered women were analyzed using univariate and multivariate logistic regressions. Six key danger signs were identified, and spontaneous responses were categorized, tabulated, and analyzed.

RESULTS

Knowledge of at least one key danger sign was significantly associated with being birth prepared (adjusted OR 1.7, 95% CI 1.2-2.3). Birth preparedness consisted of saving money, identifying transportation, identifying a skilled birth attendant and buying a delivery kit or materials. Overall, respondents had a poor knowledge of key newborn danger signs: 58.2% could identify one and 14.8% could identify two. We found no association between women attending the recommended number of antenatal care visits and their knowledge of danger signs (adjusted OR 1.0, 95% CI 0.8-1.4), or between women using a skilled birth attendant at delivery and their knowledge of danger signs (adjusted OR 1.2, 95% CI 0.9-1.7).

CONCLUSIONS

Our findings indicate the need to enhance education of mothers in antenatal care as well as those discharged from health facilities after delivery. Further promotion of birth preparedness is encouraged as part of the continuum of maternal care.

Community health education at student-run clinics leads to sustained improvement in patients' hepatitis B knowledge

While student-run clinics are often important healthcare safety nets for underserved populations, their efficacy for improving patient health knowledge has not been thoroughly explored. From September 2011 to April 2012, we assessed patients' retention of hepatitis B virus (HBV) knowledge after receiving student-led education at two student-run HBV screening and vaccination clinics. Patient education was provided by trained first and second-year medical, nursing, and pharmacy students, aided by a script and interpreters. Patient knowledge of HBV was evaluated at three points: before education, after the initial visit, and at one-month follow-up. Student-led education produced improved knowledge of HBV transmission, prevention, and management, which was retained 1 month after education for 52 patients tracked through time. Mean scores on an HBV knowledge survey improved from 56.4 % (SD = 15.2 %) at baseline to 66.6 % (SD = 15.1 %) after education, and 68.3 % (SD = 15.2 %) after one month. There was a statistically significant difference between the first and second (paired T test, p < 0.001) and the first and third tests (paired T test, p < 0.001), but no difference between the second and third tests (paired T test, p = 0.45). Multivariate analysis demonstrated that retention was correlated with patient educational background but independent of patient age, gender, income, primary language and number of years lived in the United States. Our study suggests that trained health professional students can effectively impart health knowledge that is retained by patients for at least 1 month. These results warrant consideration of student-led educational sessions at SRCs as a promising community health education model.

Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda

BACKGROUND

Mothers who attend antenatal care late miss the opportunity of early detection of HIV and STDs, malaria and anaemia prophylaxis, health education and treatment or prevention of complications. Whereas many women in Mulago hospital make their first antenatal care visit after 20 weeks of gestation, the reasons for coming late are not documented. The objectives were to determine the gestation age at which pregnant women make their first antenatal care visit and the reasons for late coming.

METHOD

The study was conducted in June 2012 among women with a gestation age of more than 20 weeks on their first antenatal care visit. We collected data on gestation age (from weeks of amenorrhea or based on ultrasound scan) and reasons for coming late.

RESULTS

Four hundred women participated in the study. Their mean age was 25.2 years with a standard deviation of 5.2 years. The majority of the participants were Catholics (n = 126, 31.5%), they lived in a distance of greater than five kilometers from the hospital (n = 201, 50.3%) and had attained secondary education (n = 220, 55.0%). The mean of their weeks of amenorrhea was 27.9 (± 4.6) weeks. The results showed that 291 (72.7%) of the study participants did not know the right gestation age at which a pregnant woman should start attending antenatal care. One hundred and ten (27.5%) agreed that they did not have money for transport to bring them to the hospital while 37 (9.3%) thought that they had to pay for the antenatal care services. Two hundred thirteen (53.3%) reported that they did not have any problem with their current pregnancy and so they saw no reason to come early for antenatal care, even though some of these knew the right gestation age at which they should make their first antenatal care visit.

CONCLUSION

Pregnant women who come late for antenatal care in Mulago hospital, Uganda are not well-informed about the right gestation age at which they should make their first antenatal care visit and/or of the importance of early attendance at antenatal care.

Barriers to neonatal care in developing countries: parents' and providers' perceptions

AIM

Hospital care and advanced medical technologies for sick neonates are increasingly available, but not always readily accessible, in many countries. We characterised parents' and providers' perceptions of barriers to neonatal care in developing countries.

METHODS

We interviewed parents whose infant was hospitalised within the first month of life in Cambodia, Malaysia, Laos and Vietnam, asking about perceived barriers to obtaining newborn care. We also surveyed health-care providers about perceived barriers to providing care.

RESULTS

We interviewed 198 parents and 212 newborn care providers (physicians, nurses, midwives, paediatric and nursing trainees). Most families paid all costs of newborn care, which they reported as a hardship. Although newborn care is accessible, 39% reported that hospitals are too distant; almost 20% did not know where to obtain care. Parents cited lack of cleanliness (46%), poor availability of medications (42%) or services (36%), staff friendliness (42%), poor infant outcome (45%), poor communications with staff (44%) and costs of care (34%) as significant problems during prior newborn care. Providers cited lack of equipment (74%), lack of staff training (61%) and poor infrastructure (51%) as barriers to providing neonatal care. Providers identified distance to hospital, lack of transportation, care costs and low parental education as barriers for families.

CONCLUSIONS

Improving cleanliness, staff friendliness and communication with parents may diminish some barriers to neonatal care in developing countries. Costs of newborn care, hospital infrastructure, distance to hospital, staffing shortages, limited staff training and limited access to medications pose more difficult barriers to remedy.