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Table of Contents
ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 14-19

Newborn care in Urban slums: A missed opportunity


1 Associate Professor, Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
2 Medical Officer, NHPC, Faridabad, Haryana, India
3 Assistant Professor, Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
4 Professor, Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India

Date of Web Publication30-Aug-2018

Correspondence Address:
Agrawal Deepika
Associate Professor, Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.240195

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  Abstract 


Introduction: Neonatal mortality and morbidity are the greatest challenges in the current health care scenario. Majority of neonates die because mothers fail to identify danger signs of illness, and inappropriate or delayed care seeking. Objective was to find out the awareness among mothers regarding newborn care, essential newborn care practices and health care seeking behaviour in Urban slums.
Methodology: A cross sectional study was done among the study population of Urban slums, Bhangel, Noida which is the field practice area of Urban Health Training Centre, Department of Community Medicine, SMS&R, Greater Noida. Duration of the study was from 1st March to 31st August 2014. All mothers with infants less than 3months of age approaching the Urban Health Training Centre, Bhangel were taken as study subjects. Prevalidated semi structured questionnaire was used for interviewing mothers. Informed consent was taken from them about the participation in this study. Data was analysed using SPSS 17.0 version.
Result and conclusion: Most of the mothers lacked awareness regarding newborn danger signs and essential newborn care practices. The common reasons behind harmful practices were lack of awareness, traditional and cultural taboos and lack of free time for those mothers who were working.

Keywords: Neonatal care, awareness, danger sign, breast feeding


How to cite this article:
Deepika A, Kumari RP, Neha T, Manish C. Newborn care in Urban slums: A missed opportunity. J Integr Health Sci 2016;4:14-9

How to cite this URL:
Deepika A, Kumari RP, Neha T, Manish C. Newborn care in Urban slums: A missed opportunity. J Integr Health Sci [serial online] 2016 [cited 2022 Dec 4];4:14-9. Available from: https://www.jihs.in/text.asp?2016/4/2/14/240195




  Introduction Top


Neonatal, infant and under five mortality rates are considerably higher among urban poor as compared to urban averages and as worse as their rural counterparts in India.[1] A critical appraisal revealed that the health delivery system is entirely rural based and has ignored the rapidly growing urban community. Presently, the performance of urban maternal and child health (MCH) centres in India is far from satisfactory which is required to meet the maternal and child health needs of urban poor in minimal well defined quality assured health care facility.[2] Furthermore, the public healthcare delivery system is practically non-existent in urban slums due to which the slum population is lagging behind in all the major goals and objectives related to maternal and child health. With achievement in reducing infant mortality rate (IMR) from 72 in 2011 to 43 in last 15 years, we have not been able to reduce neonatal mortality rate (NMR) significantly.[3] Early identification of newborn danger signs by caregivers with prompt and appropriate referral serves as backbone of the program aiming at reduction in neonatal mortality.

Neonates and young infants often present with non-specific symptoms and signs that indicate severe illness. These signs might be present at or after delivery or in a newborn presenting to hospital or may develop during hospital stay. The aim of initial management of a neonate presenting with these signs is stabilization and preventing deterioration. WHO has recognized ten danger signs [4] which include not feeding well, convulsions, drowsy or unconscious, fast breathing (60 breaths/min), grunting, umblicus red/draining pus, severe chest indrawing, raised temperature > 37.5°C, hypothermia < 35.5°C and central cyanosis.

Hence, the present study was undertaken to find out awareness of mothers regarding newborn danger signs, essential newborn care practices and their health care seeking behaviour in Urban slums of Noida.


  Methodology Top


A cross sectional study was done among the study population of Urban slums, Bhangel, Noida. These slums are the catering population for the Urban Health and Training Center of Department of Community Medicine, at Noida. All mothers with infants less than 3 months of age approaching the Urban Health Training Center, Bhangel were taken as study subjects. Duration of the study was from 1st March to 31st August 2014. A total of 300 mothers approached the center, out of which 200 mothers fulfilled the inclusion criteria and were included in the study.

Inclusion criteria:

  • All mothers with infants less than 3 months of age.
  • Residents of slum in Bhangel for more than 6 months.
  • Willing to participate in the study.


Exclusion criteria:
  • Mother with infants more than 3 months of age.
  • Recently shifted to Urban slums of Bhangel.
  • Not willing to participate in the study.


  • A pre-tested semi structured questionnaire was used for interviewing mothers which included the socio-demographic details, the newborn care practices (colostrum feeding, exclusive breast feeding, immunization etc), awareness regarding danger signs of the neonatal period (inability to feed/poor suckling, yellow soles, letharginess/drowsiness, seizures, fast breathing, hypothermia, red or pus draining from umblicus, fever with severe chest indrawing), health problems during neonatal period (neonatal jaundice, delayed fall of umbilical cord, episodes of fever and diarrhoea) and health care seeking behaviour of mothers in cases of sickness in infants. The awareness was arbitrarily graded as follows-

    1. Mostly aware- mothers who knew more than five out of the ten danger signs
    2. Partially aware- mothers who knew two to five out of the ten danger signs
    3. Not aware- mothers who knew less than two out of the ten danger signs


    Those mothers who had initiated immunization within three months of delivery were taken as positive for immunization practice. Similarly, those mothers who had taken professional medical advice for their sick infants were taken as positive for health care seeking behaviour.

    Ethical consideration: Study got prior approval from institutional research and ethical committee. Informed verbal consent was taken from mothers about the participation in this study.

    Data Analysis: Data was analysed using appropriate statistical softwares such as Microsoft Excel and SPSS 17 version.


      Result Top


    [Table 1] shows the socio demographic profile of the mothers included in the study. Majority of the mothers were in the age-group of 20-29 years (85%). 60% were just literate while almost all were housewives (92%). Most of the mothers were a part of nuclear families (83%) and three- fourths of the subjects belonged to upper-lower and lower-middle class (75%).
    Table 1: Socio-demographic distribution of study subjects

    Click here to view


    [Table 2] describes the levels of awareness regarding danger signs, the various essential new born care practices followed, the health problems encountered by the newborns and the health care seeking behaviour patterns of the study group. Only 10% of the mothers were mostly aware of the danger signs and half of the total study subjects were not aware at all. Data for essential new born care practices revealed that 90% of the mothers fed their infants with colostrums, 75% had initiated immunisation and only 60% were feeding the newborns exclusively on breast milk. Majority of the newborns had a delayed fall of umbilical cord (90%) while other health problems ranged between 20-30%. Approximately half of the mothers sought professional advice for health problems experienced by their babies (55%).
    Table 2: Description of awareness regarding danger signs, and newborn care practices among the study subjects.

    Click here to view


    The study revealed a significant relationship between the place of delivery and the awareness levels for danger signs among mothers. The mothers who had delivered at home had lesser awareness as compared to those who went for institutional delivery (72% vs 42% for no awareness and 28% vs 58% for partially or mostly aware in home delivery and institutional delivery respectively, P<0.02) [Figure 1].
    Figure 1: Relationship between place of delivery and level of awareness

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    Level of education of mothers also showed a significant effect on exclusive breast feeding. Most of the mothers who were graduates or above, practised exclusive breast feeding as compared to a lower number of illiterate mothers practising the same (82% and 32% respectively, P<0.002) [Figure 2].
    Figure 2: Relationship between education and exclusive breast feeding

    Click here to view



      Discussion Top


    The awareness among mothers about danger signs in newborn, was found to be low with 50% mothers not having any awareness at all. In a similar study done in rural Wardha by Dongre et al.,[5] 67.2% mothers knew about at least one danger sign. This shows that awareness was poorer in slums as compared to villages in India. A study done in Trivandrum by Accamma et al.,[6]also revealed mean knowledge scores of 57.1% among mothers of newborns. Our findings are echoed by another study done in Karamsad, Gujarat by Nimbalkar et al.[7] regarding knowledge about neonatal danger signs (50% of the mothers had no knowledge). In other studies done in South east Nigeria and rural Uganda by Ekwochi et al.[8] and Sandberg et al.[9], the awareness levels among mothers for three or more signs was poor. In general, the mothers lacked appropriate and accurate knowledge of danger signs in newborn and the awareness was found to be poorer in slums as compared to villages. The levels of awareness were also found to be significantly associated with the place of delivery, awareness being more in institutional deliveries as compared to home deliveries.

    In this study, almost 90% of the mothers fed colostrum which is more than the proportion of mothers feeding colostrum in urban slums of Lucknow (43.5%).10 Exclusive breast feeding was carried out by 60% of the mothers in our study while in a study done by Nimbalkar et al.[7] in urban slums of Anand, Gujarat, only 6.5% mothers practiced exclusive breast feeding as compared to 85.6% in villages. Practice of colostrum feeding was found to be quite high in slums.

    Approximately 30% of infants in our study suffered from various health problems and almost 90% gave history of delayed fall of umbilical cord. However, only half of the mothers of such babies sought a doctor’s advice for the health problems. In another study by Dongre et al. in peri-urban Wardha,[11] 37.5% infants suffered from health problems which is almost similar to our findings. But, the health care seeking behaviour of mothers of these sick neonates was much better (93%) as compared to the Noida slums. In another study by Dongre et al. in rural Wardha,[5] only 41.8% mothers of sick newborns sought treatment from doctors. In the study by Nimbalkar et al. in Anand, Gujarat,[7] health care seeking behaviour of mothers was poor. NM Srivastav et al.,[12] in their study in slums of urban Lucknow also found 56.8% neonates suffering from illness and more than a quarter of them did not receive qualified medical care.


      Conclusion and Recommendations Top


    In this study, the mothers of infants less than 3 months lacked appropriate awareness about neonatal danger signs, with half of the mothers completely unaware (50%), partial awareness being 40% and awareness for more than half of the danger signs to be only 10%. Awareness of neonatal danger signs was affected significantly by place of delivery with mothers delivering in an institution found more aware than their counterparts opting for home delivery. Essential newborn care practices like colostrum feeding (90%), exclusive breast feeding(60%), initiation of immunization (75%) had shown an improvement over the previous findings and also the national averages. However, health care seeking behaviour among mothers for neonatal health problems was only 55%. Rest of the mothers mostly relied upon home remedies.

    Though the overall scenario for newborn care practices has shown some improvement from the past, yet urban slums are far behind their rural counterparts in terms of health. There is a need to establish a proper health infrastructure specifically meant for slums with dedicated grass root level workers devoted to generating mother and child health related awareness, to actually make the Sustainable Development Goals[13] achievable. Though the Government has taken newer initiatives and the problems of slums has finally caught the attention of health authorities in the form of Mission Indradhanush[14] and NUHM,[15] still the road seems to be long. Concerted inter and intra-sectoral co-ordination and streamlined efforts are required to hit the bull’s eye.



     
      References Top

    1.
    India Newborn Action Plan. Ministry of Health and Family Welfare, Government of India. September 2014.  Back to cited text no. 1
        
    2.
    National Urban Health Mission. Ministry of Health and Family Welfare, Government of India. May 2013.  Back to cited text no. 2
        
    3.
    India- National Family Health Survey (NFHS3), 2005-6. Key Findings. International Institute for Population Sciences, Mumbai.  Back to cited text no. 3
        
    4.
    Problems of neonate and young infant. Pocket book of hospital care for children. Guidelines for the management of common childhood illnesses. 2nd. WHO 2013.  Back to cited text no. 4
        
    5.
    AR Dongre, PR Deshmukh, BS Garg. Perceptions and health care seeking about newborn danger signs among mothers in rural Wardha. Indian Journal of Paediatrics. 2008;75(4):325-9  Back to cited text no. 5
        
    6.
    Oommen Accamma, Vatsa Manju. Mothers awareness regarding danger signs of neonatal illnesses at a selected hospital in Trivandrum. International Journal of Nursing Care. 2013;1(2):1-6  Back to cited text no. 6
        
    7.
    Archana S Nimbalkar, Vivek V Shukla, Ajay G Phatak, Somashekhar M Nimbalkar. Newborn care practices and health seeking behaviour in urban slums and villages of Anand, Gujarat. Indian Paediatrics. 2013;50:408-10  Back to cited text no. 7
        
    8.
    Ekwochi U, Ndu IK, Osuorah CD, Amadi OF, Okeke IB, Obuoha E, Onah KS, Nwokoye I, Odetunde OI, Obumneme-Anyim NI. Knowledge of danger signs in newborns and health seeking practices of mothers and care givers in Enugu state, South-East Nigeria. Italian journal of pediatrics. 2015 Mar 21;41(1):18.  Back to cited text no. 8
        
    9.
    Jacob Sandberg, Karen Odberg Pettersson, Gustav Asp, Jerome Kabakyenga, Anette Agardh. Inadequate knowledge of neonatal danger signs among recently delivered women in south-western rural Uganda: A community survey. PLOS One. 2014;9(5):1-8.  Back to cited text no. 9
        
    10.
    Gupta P, Srivastava VK, Kumar V, Jain S, Masood J, Ahmad N, Srivastava JP. Newborn care practices in urban slums of Lucknow city, UP. Indian Journal of Community Medicine. 2010 Jan 1;35(1):82-5.  Back to cited text no. 10
        
    11.
    Amol R Dongre, Pradeep R Deshmukh and Bishan S Garg. Awareness and health care seeking for newborn danger signs among mothers in peri-urban Wardha. Indian Journal of Pediatrics. 2009;76:691-3  Back to cited text no. 11
        
    12.
    Srivastava NM, Awasthi S, Mishra R. Neonatal morbidity and care seeking behaviour in urban Lucknow. Indian Pediatrics. 2008;45(3):229-32  Back to cited text no. 12
        
    13.
    14.
    15.
    NUHM-Government of India-National Health Misssion http://nrhm.gov.in/nhm/nuhm.html  Back to cited text no. 15
        


        Figures

      [Figure 1], [Figure 2]
     
     
        Tables

      [Table 1], [Table 2]



     

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