Awareness and Health Care Seeking behaviour for Newborn Danger Signs among Mothers in Rural area of a district in Maharashtra. Presenter : Dr. Abhijeet Golhar Guide: Dr. B.S. Garg Coguide: Dr. Abhishek Raut

INTRODUCTION Neonatal deaths accounts for almost two thirds of all deaths in the first year of life and 40 per cent of deaths before the age of five. Early identification of Newborn danger signs by caregivers with prompt and appropriate health care seeking serves as backbone of the programs aiming at reduction in neonatal mortality. The present study was conducted to find out the effect of community based health education strategy, on early identification of newborn danger signs by caregivers health care seeking behaviour of families with sick newborn

OBJECTIVES To develop a community based health education strategy for improving the health care seeking behaviour of families with sick newborns. To assess the effect of the community based health education strategy on health care seeking behaviour of families with sick newborns.

MATERIAL AND METHODS: Study design: Quasi-experimental study Need assessment and Development of Health Education Material (A triangulated research design of quantitative and qualitative (FGD) Implementation of health education strategy (ASHA, AWW, VHND,CBO-SHGs, KPs, VHNSC) Endline survey(180 Mothers with Infant 0-11months of age in each PHC) PHASE III- 1 Year PHASE I -2 Month Baseline survey (180 Mothers with Infant 0-11months of age in each PHC) Intervention arm(PHC Anji) Control arm(PHC Waifad) Study population PHASE II -2 Month PHASE IV-2Month

MATERIAL AND METHODS Sample size: We calculated sample size for 20% improvement in awareness of at least three newborn danger signs from 15% to 35% with 95% confidence and 80% power using ‘STATCALC’ module under EPI7 software; this comes as 83.Considering a design effect of 2 for cluster sampling technique, it comes as 166. It was decided to use 30 clusters with 6 households in each cluster for intervention and control PHC areas separately. Therefore the total number of mothers with children 0-11 months of age needed was 180 in each PHC separately.

MATERIAL AND METHODS Ethical Consideration: The study was initiated after taking approval from the Institutional Ethical Committee. Informed consent was taken from the mother of the children 0-11 months of ageafter explaining them the purpose of the study. Data entry and analysis: The data was collected and entered in the computer by using Epi-Info version 7 and analysed subsequently using frequency, proportions and appropriate statistical test (Z test for proportion) and the content analysis of qualitative data was done manually.

Results: Table 1.1 Socio Demographic features of mothers of children (0- 11 months): Base line characteristics Intervention area Control area Baseline n=180% % Age in years Education Illiterate Primary Secondary Higher Sec Graduate Type of family Nuclear Joint

2) Knowledge of mothers regarding newborn care Table 2.1: Knowledge regarding cleaning the child after birth Knowledge regarding cleaning Intervention area Control area BaselineEndline p value BaselineEndline p value n%n%n%n% Correct Incorrect Total

Table 2.2 Knowledge regarding wrapping of child after birth Knowledge regarding wrapping in clothes Intervention area Control area BaselineEndline p value BaselineEndline p value n%n%n%n% Correct Incorrect Total

2.3: Knowledge regarding Initiation of breastfeeding after birth Figure 2.3

2.4: Knowledge regarding First bath to child after birth Figure 2.4

Table 2.5: Knowledge regarding weighing of child after birth Knowledge regarding weighing Intervention area Control area BaselineEndline p value BaselineEndline p value n%n%n%n% Correct Incorrect Total

3.1: Knowledge of mothers regarding newborn Danger Signs Newborn Danger Sign Intervention area Control area BaselineEndline p value BaselineEndline p value n%n%n%n% Fever Cold, Cough, vomiting Rapid/difficult breathing or pneumonia Poor sucking Jaundice

3.1: Knowledge of mothers regarding newborn Danger Signs Newborn Danger Sign Intervention area Control area BaselineEndline p value BaselineEndline p value n%n%n%n% Low body temperature Convulsions Lethargy/ unconscious Pus draining from umbilicus Not gaining weight

3.2: First contact point of treatment for sick children First contact point for treatment Intervention areaControl area BaselineEndlineBaselineEndline n%n%n%n% Doctor Home remedy Vaidu/Faith healer Self-treatment with medicine

Findings from Focus Group Discussion: When asked about the perception regarding newborn danger signs. Majority of the respondents for FGD identified, dudh pit nahi (poor sucking), sardi, khokla (cold, cough), hagwan (loose stool), susta padne/ beshuddha padne (lethargy/ unconsciousness), tap (fever), zatke yene (convulsion) as newborn danger signs. In the presence of these danger signs, caregivers initially prefer to go to ASHA, ANM or sometimes Anganwadi workers (AWWs) of that village or give home treatment for one day or two. If relief was not there then for treatment of newborn danger signs, private health care providers were preferred.

Strengths and Limitations of study: Strengths Used a community based health education strategy for behaviour change. Used a control area to assess the effect of health education strategy in comparative manner and significant improvement was observed. Limitations The control area and intervention area for the study were not selected randomly.

Conclusion: In conclusion community based health education and community mobilization is an effective means to promote behaviour change for care seeking and for improvement of knowledge regarding newborn danger signs at community level.

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