Research work

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MOTHER’S KNOWLEDGE, ATTITUDES AND PRACTICES (KAPs) ON
THE CARE OF NEWBORN IN MARIDI PAYAM, MARIDI COUNTY,
WESTERN EQUATORIA STATE,
SOUTH SUDAN
By Oyet Charles Okech
(2014)
Title page

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CERTIFICATION STATEMENT AND DECLARATION
Certification Statement
I the undersigned, certify that this dissertation is the work of the candidate carried out during his
studies under my direct supervision. I have read and hereby recommend for examination, the
dissertation entitled “Mothers’ Knowledge, Attitudes and Practices (KAPs) on the Care of
Newborn, Maridi Payam, Maridi County,”
……………………………………
Manana David
Date…../………../2014
Declaration
I Oyet Charles Okech declare that this dissertation is my own work and it has never been presented
to any other institution for similar or any other award.
…………………………………
Oyet Charles Okech
Date………/…………./2014

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ACKNOWLEDGEMENT
First of all I am grateful to Almighty God for his abundant grace, blessings and unconditional love
that enabled me to carry out this study.
In addition my special thanks go to the following;
 Mr. Vundru Dominic, head of research department, for his guidance in research
methodology
 The Principal- Mr Patrick Taban, and Mrs. Ayakaka Margaret- Head of midwifery
department, for their expert guidance, suggestions, encouragement, and support, and help
rendered to me throughout this study
 My Supervisor- Mr. David Manana, for his guidance, support and supervision during this
study
 My study respondents for their wholehearted participation in the study, without them my
study would be an incomplete one.
Finally I extend my sincere thanks to everyone who helped me directly or indirectly in the
successful completion of this study.
May God Bless You All!
Oyet Charles Okech

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DEDICATION
This work is dedicated to my mother, Ayaa Olga Dario and Dad Okech Michael Okot, in
appreciation for their efforts and the tough times they went through in raising me.

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Table of Contents
Title page......................................................................................................................................... i
CERTIFICATION STATEMENT AND DECLARATION.....................................................ii
ACKNOWLEDGEMENT...........................................................................................................iii
DEDICATION.............................................................................................................................. iv
List of tables............................................................................................................. vi
List of figures.......................................................................................................... vii
List of Acronyms ................................................................................................... viii
Definition of Terms & Concepts.............................................................................. ix
ABSTRACT................................................................................................................................... x
CHAPTER ONE: INTRODUCTION......................................................................................... 1
1.3 Justification ..........................................................................................................2
1.6 Background to the Study Area............................................................................3
CHAPTER TWO: LITERATURE REVIEW............................................................................ 4
2.1 Knowledge on the care of the newborn ...............................................................4
2.2 Attitudes/believes on the care of the newborn.....................................................5
2.3 Mother’s Practices on the care of the newborn ...................................................6
CHAPTER THREE: METHODOLOGY ................................................................................ 12
3.1 Introduction........................................................................................................12
3.6 Data Analysis Method........................................................................................13
CHAPTER FOUR: RESULTS................................................................................................. 14
CHAPTER FIVE: DISCUSSION............................................................................................. 25
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS ........................................ 30
6.1 Conclusion .........................................................................................................30
6.2 Recommendations..............................................................................................30
REFERENCES............................................................................................................................ 31
APPENDICES............................................................................................................................. 37
APPENDICESNDIX I: INTRODUCTORY LATTER........................................................... 37
APPENDIX II: CONSENT FORM........................................................................................... 38
APPENDIX III: QUESTIONNAIRE........................................................................................ 39
APPENDIX IV: MAP OF MARIDI COUNTY........................................................................ 44

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List of tables
Table 1: Showing Maridi Payam Bomas with Total Population .................................................... 3
Table 4.1: Participants by Marital status....................................................................................... 15
Table 4.2: Respondent by Parity................................................................................................... 15
Table 4.3: Respondent by Age group ........................................................................................... 15
Table 4.4: Complications immediately after birth ........................................................................ 17
Table 4.5: Place of care when the baby sick................................................................................. 17
Table 4.6: Preferred Place of delivery .......................................................................................... 18
Table 4.7: Assistance during Delivery.......................................................................................... 19
Table 4.8: Status of Instrument Used to cut the cord.................................................................... 20
Table 4.9: Materials Used To Tie the Cord .................................................................................. 20
Table 4.10: Time of Initiating Breastfeeding................................................................................ 21
Table 4.11: Cleaning Of Breasts before Feeding.......................................................................... 22
Table 4.12: Daily Breastfeeding Practices.................................................................................... 22
Table 4.13: Immunizing the Newborn after Delivery................................................................... 23

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List of figures
Figure 4.1: Respondent by Education level .................................................................................. 14
Figure 4.2: Respondent by Religion ............................................................................................. 14
Figure 4.3: Awareness of the need to attend ANC clinic ............................................................. 16
Figure 4.4: ANC Attendance among respondents. ....................................................................... 16
Figure 4.5: Number of ANC clinic visits per respondent ............................................................. 16
Figure 4.6: Complications babies had at birth .............................................................................. 17
Figure 4.7: Knowledge of symptoms of newborn illness ............................................................. 18
Figure 3.8: The Place Respondents would recommend others to deliver from............................ 19
Figure 3.9: Showing instruments used to cut the cord.................................................................. 20
Figure 4.10: Material Applied On the Cord Stump ...................................................................... 21
Figure 4.11: Giving Other Feeds after Birth................................................................................. 22
Figure 4.12: Time of initiating the first bath................................................................................. 23
Figure 4.13: Measures taken to protect Baby from falling sick.................................................... 24

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List of Acronyms
ANNW; Africa Newborn Network
C/S; Caesarean Section
CHD; Community Health Department
CHD; County Health Department
ENC; Essential Newborn Care
FGD; Focuses Group Discursion
HBPs; Health Belief and Practices
KAPs; Knowledge Attitude and Practices
KMC; Kangaroo Mother Care
KMC; Kangaroo Mother Care Method
MNCH; Maternal, Newborn, and Child health
MoH; Ministry of Health
NHT; National Health Training Institute
PHC; Primary Health Care
STC; Save the Children
SVD; Spontaneous Vaginal Delivery
TBA; Traditional Birth Attainder
V/E; Vacuum Extraction
VDCs; Village Development committees
WHO; World Health Organizatio

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Definition of Terms & Concepts
Mother: in this study are refers to any female parent or guardian of children.
Caretaker: In this study are refers to nay one who are looking after the newborn if the mother is
dead of absent.
Knowledge: the facts, information, understanding that a person has acquired through experience
or education. (Soanes, 2007)
Attitude: is a way of thinking about something or behaving towards something (Brooker, 2006)
Practice: the actual doing of something; action as contrasted with ideas. (Soanes, 2007)
Exclusive breast-feeding: refers to giving the infant only breast milk; no other liquid solids,
except vitamin or mineral drops and medicines up to 6 months.
Population: Is defined as group of individuals that share one or more characteristics from which
data can be gathered and analyzed (Nieswiadomy, 2008).
Bomas: refers to a village within the payam.
Payam: refers to the sub-county
Newborn: In this study newborn refers to an individual from birth to four weeks (28days) of age.
Newborn care: In this study this refers to care of the baby from birth to four weeks of age.
Assessment: In this study assessment refers to the critical analysis and evaluation or judgment of
status about mother/ caretaker.
Midwife: is a health care provider who is trained in the care of pregnant women and young infants.
Traditional birth attendant: -traditional women with ability to deliver pregnant women.

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ABSTRACT
A study on the care of the newborn in Maridi payam was carried out in Maridi in July 2014 with
the objective assessing Mother’s knowledge, attitudes and practices on the care of the newborn in
the community.
It was be cross sectional explorative study that involved both quantitative and qualitative data.
Cluster and convenience sampling techniques were used. Data was collected using interviewer
questionnaires and was analyzed manually.
The main findings of this study were that; the majority mothers in Maridi payam had adequate and
relevant knowledge in the care of the new born in the community. The majority of mothers in the
payam generally had a positive attitude towards newborn care services available at Maridi Hospital
and other health facilities in the payam despite the fact that the majority of them continued to
deliver from their homes.
It was then concluded that though most of the respondents in this study had satisfactory knowledge
and positive attitudes towards the recommended newborn care, they generally lacked the practical
application especially in; hospital deliveries, improper cord care and immunization.
It was then recommended that all pregnant women in Maridi payam encouraged to attend at least
4 ANC visits and to deliver from Hospital. The State Minister of Health should organise training
for all TBAs in Maridi payam and beyond since more mothers in this payam delivered at home
than hospital. All women of childbearing age should be educated more on proper neonatal care
including; proper cord are, prevention of neonatal hypothermia, early initiation of breastfeeding,
exclusive breastfeeding on demand at least 8 times a day and general hygiene. All newborns in
Maridi payam should be vaccinated with BCG as early as possible after birth and with OPV0 within
the first 14 days. Finally all health workers should include men in the campaigns to promote proper
care of the new born as substantial house hold heads in Maridi payam.

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CHAPTER ONE: INTRODUCTION
1.1 Background information
Child rearing practices depend on the traditional beliefs and practices. Healthy beliefs and
practices lead to a healthy child upbringing. According to Save the Children (2004) the newborn
child is extremely vulnerable unless it receives appropriate basic care, also called essential
newborn care. When normal babies do not receive this essential care, they quickly fall sick and
too often they die. For premature or low birth weight babies, the danger is even greater.
Approximately four million global neonatal deaths that occur annually, out of which 98% occur in
developing countries. Most of the newborns die at home under the cared of their mothers, relatives
and or traditional birth attendants. In Nepal, for instance approximately 90% of birth occurs at
home. In 2005, the infant mortality rate in Nepal was 64 per 1000 live and the neonatal mortality
rate was 39 per 1000 live births. In addition to the direct causes of death, many newborns die
because of their mother’s poor health or because of lack of access to essential care. Sometimes the
family may live hours away from a referral facility or there may not be a skilled provider in their
community (Save the children, 2004).
In sub-Sahara Africa each year at least 1.16 million babies born. This region has highest risk of
newborn death and the slow progress in reducing mortality and morbidity. More than two thirds
of these babies could be saved with lower cost, low skill action, most of which are already in policy
but do not reach the poor (ANNW, 2009).
The greatest obstacle to quality Maternal, Newborn, and Child Health (MNCH) in South Sudan is
a lack of skilled MNCH care providers, culture and mother knowledge on newborn care. The infant
and child mortality rates are estimated at 102 and 235 deaths per 1,000 live births, respectively.
Meanwhile, more than one in four children under the age of five is malnourished and only
approximately 10% of children are fully vaccinated. (Brett et al, 2011)
This study therefore explored the knowledge, attitudes and practices that influence the care of the
newborn among mothers/caretakers in Maridi community.

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1.2 Statement of the Problem
The fact that only a few Mothers deliver from Maridi hospital means that the majority deliver from
their homes often with the help of unskilled birth attendants. These newborns are often subjected
to unhygienic delivery practices arising from traditional beliefs and taboos that put their survival
at risk in Maridi payam and Maridi County in general.
1.3 Justification
It was anticipated that this study would identify the gaps in the knowledge, attitude and practices
on the care of the newborn and recommend ways of bridging the identified gaps to improve
neonatal survival in Maridi Payam.
1.4 Research Question
What cultural beliefs and practices influence the care of newborn in Maridi payam?
1.5 Study Objectives
1.5.1 Broad objective
This study sought to identify the household practices that influence newborn care and survival in
Maridi County
1.5.2 Specific objectives were;
1) To assess the Mothers’ knowledge on the care of the newborn
2) To assess the Mothers’ attitudes and beliefs towards the care of the newborn.
3) To assess the Mothers’ practices in the care of the new born.

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1.6 Background to the Study Area
Maridi payam is one of the six payams in Maridi County of Western Equatorial State of South
Sudan. This Payam subdivided in to 5 Bomas with an estimated population of 49,454 people.
Maridi payam is a peri-urban area inhabited by several ethnics groups of which the Zande are the
majority. Other tribes include; Moru, Avokaya and Baka. Their cultural beliefs and practices on
the care of the newborn differ according to their ethnicity.
Table 1: Showing Maridi Payam Bomas with Total Population
S/No Bomas Population
1. Maridi town 19,186
2. Mabirindi 6,519
3. Mboroko 8,567
4. Modobow 5,096
5. Nagbaka 10,086
Total 49,454

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CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction
In this chapter the researcher reviewed publications and studies on the care of the newborn in line
with the study objectives. It is divided into three study themes of knowledge, attitudes and practices
that influence the care of the newborn.
2.1 Knowledge on the care of the newborn
Newborn care aims at ensuring that the baby is made comfortable, is able to feed and facilities are
available to help parents with the attachment process. It is also important to ensure that the baby
is protected from airway obstruction, hypothermia, injuries, and infections (Myles, 2003).
Hygiene and aseptic conditions may be unknown or very difficult to achieve in many poor
communities. People may not be aware of the environmental dangers of infection and may not
make much effort in combating them, this pervasive acceptance of unhygienic conditions may
extend to cord care, drying and wrapping of the newborn etc (Parlato et al., 2004).
According to BBC Media Action’s South Sudan (2012), found that the majority of women who
were or had been pregnant did know that they should attend some form of antenatal care (ANC)
more than once. However, they were not clear about what ANC really entailed. Many felt that
having a TBA check the position of a baby in the last months of pregnancy was adequate and were
not aware of any specific number of times that they should attend ANC. Many women felt that
they were unable to plan regular ANC check-ups due to responsibilities at home and a lack of
money.
According Tarimo (2000) & Chibwana et al, (2009) mothers and caregivers in Tanzania and
Malawi did not have inadequate knowledge regarding the causes and treatment of conditions such
as sepsis and malaria. However they had knowledge of danger signs such as fever in infants. In
another study conducted in a rural community in northern India to assess household knowledge
that can affect neonatal health among 200 caregivers, it was reported that caregivers identified
illness among neonates in the form of continuous crying (Awasthi et al., 2008).
Panul & Deadihic, (2007) defined a healthy newborn as one born at term (between 38 to 42 weeks
of gestation), and cries immediately after birth. The period from birth to 28 days of life was referred

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to as neonatal period and the infant in this period is termed as neonate or newborn. The morbidity
and mortality rate in newborn are high and hence the need for optimal for improved survival.
According to Padiyath et al, (2010) the study done in India found that older and educated women
with higher social economic status were significantly associated with higher knowledge scores for
right neonatal care practices. In another study to assess the mothers' knowledge and practices of
basic newborn care given at home in Obstetric University Hospital in Tanta City revealed that
mothers' knowledge and practices were within good and satisfactory in most of the studied items
related to newborn care giving at home except breast feeding Helmy, & Bahgat (1998).
A study conducted among postnatal mothers in southern India revealed that the knowledge of
mothers was inadequate in areas of umbilical cord care (35%), thermal care (76%) and vaccine
preventable diseases. However 19% of them still practiced oil instillation into nostrils of newborns
and 61% of them administered gripe water to their babies (Asif et al, 2010).
2.2 Attitudes/believes on the care of the newborn
In Malawi Demographic and Health Survey it was reported that many prevailing cultural and social
norms and practices were known to be barriers to improving survival and health of newborns in
Malawi concerning newborn care (Malawi National Statistics Office, 2004).
An epidemiological study was carried out in Yaounde, Cameroon, revealed that 98% of mothers
breastfed their children. However 2% of mothers who did not breast-feed their children because
of the belief that milk flow was not enough or the infant’s refusal to suckle as the main reason
(Pascale, et al., 2007).
A study conducted to determine behavior’s related to immediate care of newborn in Kailali district,
Nepal showed that most people were unaware of importance of immediate care of newborn and
many unsafe behaviors did exist based on deep-seated traditional beliefs (Gurong, 2008).
Another study in Nepal reported that newborn babies were considered dirty as they came out of
their mother’s womb, hence almost all newborn babies were bathed within the first hour of birth.
The same study revealed that colostrum was regarded as dirty milk in some communities, and as
a result babies were fed with cow or goat milk immediately after birth for the popular belief that it
will make the baby become more intelligent (Yadav, 2007).

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According to results of study which conducted on traditional beliefs as influencing factors on
breast-feeding performance in Turkey it found that more than 30% of the mothers believed that
colostrum should not be given to the newborn, and others believed that breast milk could harm
their babies, (HIzel et al., 2006). Another study by Ergenekon-ozelci (2006) showed that the
mothers generally had a positive attitude towards breast-feeding. However colostrum was usually
perceived negatively. No woman was found to feed her infant exclusively by breast-feeding.
According to Hake-Brooks & Anderson (2008) mothers' perception of the skin-to-skin contact in
the kangaroo-carrying position had improved with the majority of them practicing it more
competently and confidently than mothers whose babies were under conventional incubator care.
Most mothers were happy because they felt that the kangaroo method was safe, and did not
separate them from their infants.
A study on mother’s attitudes towards immunization in Western Nigeria revealed that almost
97.6% mothers who attended antenatal clinic thought their child should be immunized. However
8.2% of the respondents believed that immunization caused fever while 5% believed it causes
deformity while others believed that local herbs were good substitutes for immunization
(Adeyinka, 2008). Another study conducted in Aweil East and North counties in northern Bahr-
el-Ghazal region to determine attitude toward immunization revealed that most mothers had good
knowledge and attitudes towards immunization and said it protected against diseases such as polio
and measles. However two mothers did not like immunizations, especially the polio vaccine,
because complained that it made children sick. One mother said that the child’s father was against
immunization because it was against their culture (Cyprian et al, 2011).
2.3 Mother’s Practices on the care of the newborn
A survey was carried out in the immunization clinics of Pokhara city of western Nepal revealed
that 90% of deliveries took place at home. However information about reasons for delivering at
home and newborn care practices in urban areas of Nepal is lacking (Sachdev, 2006).
There are marked variations in patterns of newborn care and interventions. Knowledge on what is
needed for optimal newborn care is lacking in many cases. Modern hospital practices as well as
traditional practices neglect the basic needs of newborns, these basic needs include: warmth,

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cleanliness, breast milk, safety and vigilance. Other interventions such as: thermal protection,
breast-feeding, eye care (to reduce blindness), have essential preventive effects (WHO, 2006).
The World Health Organization (WHO, 1996) recommends the following essential newborn care
interventions:
 Clean childbirth and cord care in order to prevent infection
 Thermal protection in order to prevent and manage newborn hypo/hyperthermia
 Early and exclusive breastfeeding which should be started within 1 hour after child birth
 Initiation of breathing and resuscitation to facilitate early asphyxia identification and
management
 Eye care for the prevention and management of ophthalmia neonatorum
 Immunization: at birth with Bacilli Calmette-Guerin (BCG) vaccine, Oral Poliovirus
vaccine (OPV) and Hepatitis B virus (HBV) vaccine
 Identification and management of the sick newborn
 Care for the preterm and/or low birth weight newborn
 The study focused specifically on practices such as clean child birth, Early and exclusive
 breastfeeding, immunization of BCG and OPV, recognition and management of the sick
newborn
There should be clean cord care procedures which are crucial in infection prevention. The
Umbilical cord should be cut with a clean (sterilized) blade and tied with clean (sterilized)
Materials, and no substances should be put on the cord stump (WHO, 1996).
Sometimes blades of grass, bark fibres, reeds or fine roots are used to cut the cord. This is Harmful
because these materials often harbour tetanus spores from the soil and thus increase the risk of
neonatal tetanus. Materials such as threads, strips of cloth and strings are used to tie the cord
(Woodruff et al., 1984).
The cord stump remains the major means of entry for infections after birth. Principles of clean
cord stump care stipulate keeping the cord dry and clean and nothing is applied anything on it,
neither at home nor in the health facility. The stump will dry and mummify if exposed to air
without any dressing, binding or bandages. It will remain clean if it is protected with clean clothes

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and is kept from urine and soiling. No antiseptics are needed for cleaning. If soiled, the cord can
be washed with clean water and dried with clean cotton or gauze. Local practices of putting various
substances on the cord stump - whether in health facilities or homes - should be carefully examined
and discouraged if found harmful and substituted with acceptable ones (WHO, 2006).
If the umbilical stump becomes red, drains pus with the redness extending to the skin around it,
the baby stops suckling well, is sleepy, does not wake up or is having difficulty breathing, this may
be a sign of serious infection. The mother or caretaker should seek help from a health facility. The
baby must be referred immediately to the hospital for proper treatment (WHO, 2006).
In the Sylhet District of Bangladesh, among the substances that were applied on the cord stump,
after cord cutting; turmeric was the most common. Umbilical stump care revolved around bathing,
skin massage with mustard oil and heat massage on the umbilical stump.
Mothers were the principal provider for skin and cord care during the neonatal period. Unhygienic
cord care practices are prevalent in the study area. (Alam et al., 2008).
According to NSO, UNICEF& MIC (2006 & 2008) in Malawi most newborns and mothers do not
receive postnatal care (PNC) services from skilled health care providers during the critical first
few days after delivery. The result also established that only four percent of newborns received
post natal care the first week after delivery. Community based study conducted in Sudan indicated
that 54.2% of mothers initiated breastfeeding after one hour from delivery and 39.7% of them
initiated breastfeeding during from two hours to 24 hours and only 6.0% of the mothers initiated
breastfeeding after one day (Haroun, 2008).
Mriso et at (2008) in their study on understanding home based neonatal care practices in rural
Tanzania reported that the majority of detrimental practices to newborns during the neonatal period
included delay in providing warmth after delivery and bathing newborns soon after birth.
A study by Mesko et al (2003) found that major obstacles to accessing newborn care were “the
need to wait and watch” and preference to treat illness within the community. Similar findings
were also found in India where traditional medicines were used for treatment of neonatal

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conditions such as bulging fontanelle, chest in-drawing and rapid breathing (Ogunlesi &
Oufowora, 2010).
According to Zulfia et al., (2009) the material used for cutting cord in urban slums included; a new
blade in 59.9% of the cases but by traditional objects such as the edge of a broken cup in 40.3%
of the cases. In addition the results showed that 50% of the home deliveries were attended by
Trained Birth Attendants and 40% were attended by untrained birth attendants.
Culturally, most African communities practice mixed feeding instead of exclusive breastfeeding.
In most circumstances, primary health practitioners advised mothers according to formal
guidelines without being adequately aware of the mothers’ preferences, skills and home
circumstances (Bland et al., 2002).
A study conducted among the rural poor in western Uttar Pradesh, to identify factors influencing
newborn care showed that nearly all newborns were left wet and naked on the floor until the
placenta was delivered and bathed immediately after birth. Very few birth attendants
washed their hands with soap before assisting the delivery. It also revealed that they used new
blade dipped in hot water to cut the cord but used unsterilized cord ligature (Sethi et al., 2005).
Early contact (immediately after birth) between the mother and the baby, according to the WHO
(1999), has a beneficial effect on breast-feeding. Early suckling provides the baby with colostrum
that offers protection from infection, gives important nutrients, and has a beneficial effect on
maternal uterine contractions. Khadduri et al. (2007), state that most women breastfed their babies,
but initiation within 1 hour of birth and colostrum feeding were not common.
The baby's skin and gastrointestinal tract are colonized with the mother's microorganisms, against
which she has antibodies in her breast milk. Important factors in establishing and maintaining
breast-feeding after birth include:
• giving the first feed within one hour of birth,
• correct positioning that enables good
• attachment of the baby,
• frequent feeds,

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• no prelacteal feeds or other supplements, and
• Psychosocial support for breast-feeding mothers.
Babies have a wide range of behaviors following spontaneous delivery and are not all ready to
feed at the same time. A skilled person can help to facilitate the process by ensuring correct
positioning and attachment. A healthy baby has no need for large volumes of fluid any earlier than
they become available physiologically from the mother's breast. There is no evidence to support
the practice of providing supplementary feeds of water, glucose or formula. Traditional prelacteal
feeds should be strongly discouraged although harmless rituals may be allowed so long as they do
not delay breast-feeding. Every birth attendant should also know the importance of unrestricted
feeding and the ways to support breast-feeding mothers. Mothers should be instructed about the
need for an adequate diet to sustain lactation. They should be helped and encouraged if they have
difficulties breast-feeding (WHO, 1996).
Another study conducted in Haryana, India revealed that 75 percent of newborns were given
prelacteal feeds of honey, tea and diluted milk, and babies are often not breastfed during the first
3 days. They were often given sweetened water; this presumes that colostrum was discarded
(Bhandari et al., 2003). In contrast Li Salami., (2006) reported that 82% of the mothers in Edo
State, Nigeria practiced breastfeeding, 66% supplemented with corn gruel and glucose water, and
14% used herbal brew. Only 20% practiced exclusive breastfeeding.
A survey conducted in Aweil East and North counties in northern Bahr-el-Ghazal region showed
that most mothers (94%) breastfed their babies within one hour of birth and 6% gave cow milk
immediately after birth. 82% of them breastfed on demand especially during daylight, and 69%
breastfed 2-3 times at night (Cyprian, 2005)
The preterm infants on KMC have been found to have reduced rates of severe morbidity compared
to those on conventional care. Low birth weight infants on Kangaroo Mother Method (KMM) had
a significantly lower rate of morbidity than the control group (Sachdev, 2006& Sloan, 1994).

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A study conducted on the impact of newborn bathing on the prevalence of neonatal hypothermia
in Uganda revealed that bathing newborn babies shortly after birth increased the risk of
hypothermia. On the other hand the use of warm water and skin-to-skin care for thermal protection
of the newborn reduced the risk of hypothermia (BergstrAqm et al., 2005).
The WHO (1996) stipulates that BCG should be given as soon after birth as possible in all
populations at high risk of tuberculosis infection, and a single dose of OPV should be given at
birth or two weeks after birth (this is recommended to increase early protection). Hepatitis B
vaccine (HBV) should be integrated into national immunization programmes in all countries by
1997. Where perinatal infections are common it is important to administer the first dose as soon
as possible after birth.
Newborns are more likely to survive if delivery is clean, that is if actions are taken to help prevent
infection. Ensuring a clean delivery implies:
• That all those attending to the mother and newborn wash their hands with soap and water
before during and after delivery.
• The perineal area of the vagina is washed before each examination and before delivery,
and no foreign material is introduced into the vagina (the examiner’s hand only when
necessary).
• Delivery surface is clean, or at a minimum, birth doesn’t occur on the bare floor.
(Parlato et al., 2004).
According to the WHO (1996), many newborn problems can be prevented by the interventions
described above. However, when a disease occurs, many deaths can be avoided if the signs are
recognized early and the newborn managed effectively.

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CHAPTER THREE: METHODOLOGY
3.1 Introduction
This Chapter presents the description of the methodological approach that was used in collecting
and analyzing the data. The following sub-topics are covered in this chapter: research design, target
population, sampling methods Data collection instruments (tools), and data collection procedures
and data analysis methods.
3.1 Study Design
This was a cross-sectional explorative study that employed both quantitative and qualitative study
approaches
3.2 Sampling Procedures
The sampling method used was cluster and convenience sampling technique. The 5 bomas in
Maridi payam formed 5 clusters from which 10 mothers or caretakers of newborns per cluster were
drawn by convenience sampling to make a total of 50 mothers.
3.3 Study Population
The study population was 50 mothers and caretakers of newborn babies in Maridi payam.
3.4 Data Collection Tools
A structured interview questionnaire was used to collect data from respondents. Each questionnaire
consisted of 2 main parts namely;
Part A: That was used to assess the demographic data (age, educational status, occupation, family
income, religion, type of family birth history, birth weight, area of residence).
Part B: That was used to assess the knowledge, attitudes and practices of newborn care among
mothers and caretakers in Maridi payam.
3.5 Data Collection Methods
Data collection was by face to face interview guided by the questionnaire.

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3.6 Data Analysis Method
Both quantitative and qualitative data were analyzed manually.
3.7 Pretesting Methodology
A pre-test was carried out in a one boma out of the five in Maridi payam before the actual study.
3.8 Quality Control
All filled questionnaires were checked daily for completeness and consistency of the responses to
eliminate possible errors.
3.9 Ethical Considerations
Relevant permissions and approval was sought from NHTI and Maridi county authorities before
the study. Every participant [mothers] was briefed about the study in order to gain her informed
consent to participate.
3.10 Dissemination of the Study Findings
The findings of the study will be submitted to the Head of Midwifery Department of NHTI for
marking after which copies will be disseminated to the Maridi County Health department (CHD)
and Maridi hospital.

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CHAPTER FOUR: RESULTS
Introduction
This chapter presents the finding of this study as detailed below according to the study objective. In this 50
mothers were interviewed about their knowledge attitudes and practices on the care of the newborn in
Maridi Payam.
4.1 DEMOGRAPHIC CHARACTERISTICS OF THE STUDY POPULATION
Figure 4.1: Respondent by Education level
From the above figure; 56% of the respondents interviewed stopped in primary level, 10% of them were
secondary school leavers and the remaining 34% of them had not gone to school at all.
Figure 4.2: Respondent by Religion
0%
10%
20%
30%
40%
50%
60%
Primary Secondary Nerver went to schoo
Percentage
Educational level
4%
96%
religion of the respondent
muslim
christian

15
According to the figure above, most of the respondents (94%) of were Christians in various denominations
e.g. Catholic, Episcopal Church of South Sudan. The remaining participants were Muslims.
Table 4.1: Participants by Marital status
Marital status Numbers of respondents Percentage
Married 37 74%
Not married 13 26%
Total 50 100
From the table above, the majority (74%) of the participants were married. The rest were either divorced,
widowed or single
Table 4.2: Respondent by Parity
Parity Frequency Percentage
Prime parity 15 30%
Multiparty 35 70%
Total 50 100
According to the above table, the majority (70%) of the respondents were multipara (had ever delivered
more than one child). The rest were prime para (mothers with only one child).
Table 4.3: Respondent by Age group
Age group Frequency Percentage
15-20yrs 16 36%
21-25yrs 14 28%
26-30yrs 10 20%
31-35yrs 8 16%
36-40yrs 2 4%
Total 50 100%
From the above table, the age group with highest fertility rate was 15-20years-just because this age group
had more mothers participating in this study. The age group with the least number of children was 36-40
years
4.2 MOTHER’S KNOWLEDGE ON THE CARE OF THE NEWBORN

16
Figure 4.3: Awareness of the need to attend ANC clinic
According to the figure above, the majority (94%) of the mothers were aware of the importance of attending
ANC checkup. However 6% of them were not aware at all.
Figure 4.4: ANC Attendance among respondents.
The figure above, shows that 96% of the respondents attended ANC clinic during pregnancy. Only 4% of
them did not attend ANC. Maridi Hospital ANC clinic is the only one providing the care to women in
Maridi Payam.
Figure 4.5: Number of ANC clinic visits per respondent
Yes
96%
No
4%
ANC Attendance
88
12%
Awareness of the need to attent ANC clinic
Yes
No

17
In the above figure, about 20% of respondent visited ANC clinic more than 4 times. 34% of them visited 4
times, which the minimal number is recommended by World Health Organization (WHO). 38% of
respondents visited ANC only 3 times. The rest of mothers visited ANC 2 or less times.
Table 4.4: Complications immediately after birth
Complications immediately after birth Frequency Percent (%)
Yes 14 28 percent
No 36 72 percent
Total 50 100%
From the table shown above, majority (72%) of respondent recalled that their baby didn’t have any
complication after birth while 28% of them said their babies were born with complications as illustrated in
figure 4.6 below.
Figure 4.6:
Complications babies had at birth
According to the figure above, out of 14 respondents whose babies were born with complication, 64% of
them remembered that their babies delayed to cry, 29% of the babies had inability to suckle and 7% of them
had difficulty in breathing.
Table 4.5: Place of care when the baby sick.
Where to take baby for treatment when sick Frequency Percent (%)
Take to Hospital 38 76%
Take to clinic 8 16%
Treated home with traditional drugs 4 8%
Total 50 100%
According to the table above, majority (76%) of participants reported that sought medical care in Maridi
Hospital whenever their children fell sick. 16% of them took their sick children to clinics or bought drugs
and treated at home. However, 8% of them used traditional remedies if the condition was not severe.
0%
10%
20%
30%
40%
50%
60%
70%
delay to cry
difficulty to breath
inabilty to suckle
Complications babies had at birth

18
Figure 4.7: Knowledge of symptoms of newborn illness
The figure above shows the mother’s knowledge on how to recognize signs and symptoms of a sick baby
33% of the respondents reported high fever, 21% of them said failure to breastfeed and 17% of them
mentioned excessive crying. Other signs mentioned included; fast, breathing, diarrhea and vomiting.
4.3 MOTHER’S ATTITUDES ON THE CARE OF THE NEWBORN
Table 4.6: Preferred Place of delivery
Preferred Place of delivery Frequency Percentage
Home 32 64%
Hospital 18 36%
Total 50 100%
From the table above, it is clear that majority (64%) of participants preferred to deliver from home while
36% of them delivered from the hospital. Their reasons for preferring to deliver at home included;
 Presence of the TBA with in the community
 Abrupt onset of labour,
 Long distance from home to hospital
 Demand for money by Midwives demand at Maridi hospital maternity.
Those who preferred to deliver from Hospital gave the following reasons;
 Getting medication
16%
3%
17%
33%
9%
21%
0%
5%
10%
15%
20%
25%
30%
35%
Percentage Knowledge of symptoms of newborn illness

19
 Better management of prolonged labor
 Better management of bleeding during labour
 Management of complications like the baby’s failure to breath at birth
 Cleaner delivery environment in hospital.
Figure 3.8: The Place Respondents would recommend others to deliver from
According to above figure most of the respondents (94%) would recommend others to deliver in the
hospital. Only 6% of them would recommend different place.
4.4 PRACTICES ON THE CARE OF THE NEWBORN
Table 4.7: Assistance during Delivery
Assistance during time of labor Frequency (%)
TBA 19 38%
Midwifes 18 36%
Mother 8 16%
Doctor 2 4%
Husband 2 4%
Deliver alone 1 2%
Total 50 100%
94%
6%
The Place Respondents would recommend others to deliver from

20
According to above table, 38% of the mothers delivered at home assisted by TBA. 36% of them delivered
from hospital with the help of midwifes. 16% of them reported that they were helped by their mothers. The
rest were either assisted by their husbands or delivered alone.
Figure 3.9: Showing instruments used to cut the cord
The above figure shows that 60% of the respondents reported the use of a razorblade for cutting the cord.
32% of them said that scissors were used while 8% of them used other instrument i.e. like knife,
Table 4.8: Status of Instrument Used to cut the cord
Was instrument used to cut the cord clean? Frequency %
Yes 26 52%
No 24 48%
Total 50 100%
Approximately 52% of respondents used clean instruments to cut the cord. However 48% of them said there
were not sure if the instruments used to cut the cord were clean.
Table 4.9: Materials Used To Tie the Cord
Material used for tied cord Frequency %
Cord ligature 26 52%
Thread 19 38%
Cloths 5 10%
Total 50 100%
Scissor
32%
Razorblade
60%
Others
8%
Intrument used to cut the cord

21
From the table above, 52% of the mothers said cord ligature was used for tying the cord. 38% of them used
threads for tying the cord and the rest used cloths.
Figure 4.10: Material Applied On the Cord Stump
According to the figure above, the majority (56%) of respondent applied ash on the cord stump. 22% of
them applied herbs. About 18% of them did not apply anything to the cord as instructed from the hospital.
Only 4% of mothers said they apply cooking oil to the cord stump.
Table 4.10: Time of Initiating Breastfeeding
After Birth First Breastfeed Newborn Respondent /Frequency (%)
After 1hrs 37 74%
30 min-1hr 6 12%
Within 30 minutes 4 8%
Immediately 3 6%
Total 50 100%
From the table above: majority (74%) of the respondents reported that they initiated breastfeeding after 1
hour of birth. While only 6% of them initiated breastfeeding immediately after delivery and the rest said
they started breastfeeding between 30 minutes to 1 hour.
0% 5% 10% 15% 20% 25% 30% 35%
Diarrhea
Fast breathing
Crying
High tempreture
Material Applied On the Cord Stump

22
Figure 4.11: Giving Other Feeds after Birth
According to the figure above, 60% of the respondents gave fluid to newborns after birth. Fluids given
include sugar and salt mixed in water. 38% of them gave breast milk only and 2% of the newborn were
given other feeds.
Table 4.11: Cleaning Of Breasts before Feeding
Cleaning of breasts before breastfeed Frequency Percentage
Yes 43 86%
No 07 14%
Total 50 100%
According to the table above, the majority (86%) of the respondents cleaned their breasts before
lactating, however 14% did not clean their breasts before breastfeeding. Out of those who cleaned
breasts before breastfeeding, 65% used wash their breast with water first before breastfeeding.
35% of them only clean their breasts with baby towel or cloth before breastfeeding.
Table 4.12: Daily Breastfeeding Practices
Number of times mothers
breastfed newborns in a day
Frequency %
On demand 8 times and above 45 90%
Less than 8 times in 24hrs 8 8%
Other (specify) 1 2%
Total 50 100%
From the table above, majority (90%) of the participants said they breastfeed their babies on demand at
least 8 times a day. However the rest breastfed less than 8 times a day.
0%
10%
20%
30%
40%
50%
60%
70%
Breast milk Fluid Formula
feeds
Series1 38% 60% 2%
Percentage

23
Figure 4.12: Time of initiating the first bath
From the figure above, 52% of the respondents had their babies bathed after 24 hours. 38% of them had
their babies bathed immediately after delivering and 10% of them delayed the bathing but was done within
24 hours of birth.
Table 4.13: Immunizing the Newborn after Delivery
Was your baby immunized immediately after birth Frequency Percentage
Yes 6 12%
No 44 88%
Total 50 100%
According to the table above, the majority (88%) of the mothers said their babies were not immunized with
BCG and OPV0 either on the day of delivery nor within two weeks after delivery. However 12% of them
said their babies were vaccinated before discharge from hospital. Most of mothers whose babies were not
immunize within 2 weeks had delivered at home and they had to wait till after 6 weeks for DPT1 and OPV1.
Some of them said they delivered in hospital but when vaccines were out of stock and therefore their babies
could not be immunized.
0%
20%
40%
60%
Immdiately
after birth
After 24hrs Within 24hrs
percentage

24
Figure 4.13: Measures taken to protect Baby from falling sick
Majority (42%) of the respondents said they protected babies from becoming ill by practicing good hygiene.
50% of them said sleeping under mosquito net, good nutrition, keeping the newborn warm prevented illness.
The rest did not know what to do to protect babies from becoming sick.
0%
10%
20%
30%
40%
50%
Hygiene Net Good
nutrition
Providing
warm
Don't knows
Percentage
Measures taken to protect Baby from falling sick

25
CHAPTER FIVE: DISCUSSION
5.0 INTRODUCTION
This chapter discusses the findings of this study as detailed below based on the study objectives.
It discusses the study findings and their significance especially in relation to what has already
been published. It is divided into three main sections i.e. mother’s knowledge, attitudes and
practices on the care of the newborn in Maridi payam.
5.1 MOTHER’S KNOWLEDGE ON THE CARE OF THE NEWBORN
Results of this study have shown that the majority (94%) of the mothers were aware of the
importance of attending ANC checkup. This finding is similar to what was reported by BBC Media
Action’s South Sudan (2012), who established that the majority of women in their study knew that
they should attend some form of antenatal care (ANC) more than once. This study also established
that only about 20% of respondent visited ANC clinic more than 4 times and 34% of them visited
4 times. These findings revealed that mothers in Maridi payam were more informed about the
need and frequency of attending ANC clinic than what was reported by BBC Media Action (2012)
The majority (72%) of respondents in this study reported that their babies didn’t have any
complication after birth while 28% of them said their babies were born with complications.
Complications reported included delay to cry, inability to suckle and difficulty in breathing.
Most respondents (76%) in this study sought medical care from Maridi Hospital whenever their
children fell sick while 16% of them took their sick children to clinics or bought drugs and treated
at home. This is better health services seeking behavior than what was reported by Tarimo (2000)
and Chibwama et al. (2009). The good health services seeking behavior seem to have been enhance
by their good knowledge of the symptoms of childhood illness such as high fever reported by 33%
of the respondents, failure to breastfeed by 21% of them and excessive crying by 17% of them.
Other signs mentioned included; fast breathing, diarrhea and vomiting. This findings were similar
to those reported by Awasthi et al, (2008), Tarimo (2000) and Chibwana et al, (2009).
It was then concluded that the majority mothers in Maridi payam had adequate and relevant
knowledge in the care of the new born in the community. This included knowledge of the need for
and the frequency of attending ANC, knowledge about the complications of childbirth as well as
symptoms and signs of illness in the newborn.

26
5.2 MOTHER’S ATTITUDES ON THE CARE OF THE NEWBORN
This study found out that the majority (64%) of the respondents preferred to deliver from home
but assisted by an untrained birth attendant. Their reasons for preferring to deliver at home
included; presence of the TBA with in the community, abrupt onset of labour, long distance from
home to hospital, and demand for money by Midwives demand at Maridi hospital maternity.
However 36% of them had given birth from the hospital. Those who preferred to deliver from
Hospital gave the following reasons; getting medication, better management of prolonged labor,
better management of bleeding during labour, management of complications like the baby’s failure
to breath at birth and a cleaner delivery environment in hospital. This findings however were better
that what was found in western Nepal where 90% of the deliveries took place at home (Sachdev,
2006). Unlike in Malawi, cultural and social norms and practices do not appear to be barriers to
improving survival and health of newborns in Maridi payam (Malawi National Statistics Office,
2004).
It was also established that most of the respondents (94%) would recommend others to deliver in
the hospital. Only 6% of them would recommend different place. This finding reflects a positive
attitude to hospital delivery despite that the majority of the mothers still deliver from their homes
It was then concluded that the majority of mothers in Maridi payam generally had a positive
attitude towards newborn care services available at Maridi Hospital and other health facilities in
the payam despite the fact that the majority of them continue to deliver from their homes.
5.3 MOTHERS’ PRACTICES ON THE CARE OF THE NEWBORN
Place of delivery and Birth attendant
This study revealed that the majority (60%) of the mothers delivered from home than in hospital
to the ratio of almost 2:1. Out of those who delivered from home 38% were assisted by TBAs,
16% of them were assisted by their mothers. The rest were either assisted by their husbands or
delivered alone. This finding is better than what was established by (Sachdev, 2006), where 90 %
the deliveries took place at home in western Nepal.
5.3.1 Prevention and management of Neonatal Hypothermia

27
This study established that 52% of the respondents bathed their newborns after 24 hours. 38% of
them bathed their babies immediately after birth. This immediate bathing of the newborns carries
with it a risk of neonatal hypothermia as reported by BergstrAqm et al. (2005) and Mriso et al.
(2008). There is therefore need to teach about the need to delay bathing of newborns as
recommended by WHO (2006), Parlato et al. (2005) and Mriso et al. (2008) in order to minimize
the risk of neonatal hypothermia. There is also need to promote the Kangaroo Mothercare Method
(KMM) in preventing and managing neonatal hypothermia as recommended by Sachdev (2006),
Sloan (1994) and Hake-Brooks and Anderson (2008).
5.3.2 Cord Care
60% of the respondents in this study reported the use of a razorblade for cutting the cord. 32% of
them said that scissors were used while 8% of them used other instruments e.g. knife.
Approximately 52% of respondents thought a clean instrument was used to cut the umbilical cord.
However 48% of them said there were not sure if the instruments used to cut the cord were clean.
52% of the mothers said cord ligature was used for tying the cord. 38% of them used threads for
tying the cord and the rest used pieces of cloths. The majority (56%) of respondent applied ash on
the cord stump. 22% of them applied herbs. 4% of mothers said they applied cooking oil to the
cord stump. Only 18% of them did not apply anything to the cord as instructed from the hospital.
These findings were similar to what was reported by Zulfia et al., (2009), Sethi et al. (2005) and
Awasthi et al. (2008). However principles of clean cord stump care recommend keeping of the
cord dry and clean and ensuring that nothing is applied on it, either at home or in the health facility.
To sum clean cord care procedures are crucial in infection prevention in the newborn (WHO,
1996).
5.3.3 Breastfeeding Practices
Findings of this study indicate that only 6% of the respondents initiated breastfeeding immediately
after delivery. 20% of them initiated breast feeding between 30 and 60 minutes. However the
majority (74%) of them initiated breastfeeding after 1 hour of birth. A good proportion (60%) of
respondents gave fluid e.g. sugar salt solution newborn as the first feed. This is slightly better than
what was reported by Haroun (2008) about initiation of breastfeeding in Sudan where 54.2% of

28
mothers initiated breastfeeding after one hour from delivery and 39.7% of them initiated
breastfeeding between 2 and 24 hours. 38% of the respondents gave breast milk as the first feed to
their newborns while 2% gave formula feed as the first feed. The reasons for giving formula feed
and sugar salt solution included; insufficient or lack of breast milk. This is similar to what Bhandari
et al. (2003) found out in Haryana, India, where 75% of newborns were given prelacteal feeds of
honey, tea and diluted milk. However early contact between the mother and the baby, according
to the WHO (1999), has a beneficial effect on breast-feeding. For instance early suckling provides
the baby with colostrum that offers protection from infection, gives important nutrients, and has a
beneficial effect on maternal uterine contractions. Important factors in establishing and
maintaining breast-feeding after birth include: giving the first feed within one hour of birth, correct
positioning that enables good, attachment of the baby, frequent feeds, no prelacteal feeds or other
supplements, and psychosocial support for breast-feeding mothers Khadduri et al. (2007). Mothers
therefore should be instructed about the need for an adequate diet to sustain lactation. They should
be helped and encouraged if they have difficulties during breast-feeding (WHO, 1996).
This study also established that the most (86%) of the respondents cleaned their breasts before
lactating, however 14% did not clean their breasts before breastfeeding. Out of those who cleaned
breasts before breastfeeding, 65% washed their breast with water before breastfeeding. 35% of
them only cleaned their breasts using a baby towel or cloth before breastfeeding. In addition this
study found out that most 90%) of the respondents breastfed their babies on demand at least 8
times a day, which is the recommended practice. The rest (10%) of them breastfed less than 8
times a day. This is similar to what was reported by in Aweil East and North by Cyprian (2005).
5.3.4 Immunization status of the newborns in Maridi payam
The immunization status of children whose mothers were interviewed was worrying as most of
(88%) them reported that babies were missed BCG and OPV0. Only 12% of them said their babies
were immunized with BCG and OPV0 before discharge from hospital. Most of the newborns who
missed the first vaccines were delivered at home. Some of them reported that they delivered in
hospital but vaccines were out of stock the and therefore their babies could not be immunized
before discharge. Missing BCG and OPV0 was also reported from Pokhara city of western Nepal
where 90% of deliveries took place at home (Sachdev, 2006). In contrast the WHO (1996)
recommended that BCG be given as soon as possible after birth in all populations, and a single

29
dose of OPV should be given at birth or within two weeks after birth. This calls for more
immunization campaigns targeting all babies who are delivered at home while ensuring that all
those born at the health facilities receive BCG and OPV0 before they are discharged.
5.3.3 Other measures of preventing neonatal illnesses.
Most respondents in this study new and practiced some preventive measures against illness among
the newborns. For instance 50% of them slept under mosquito nets and kept the newborn warm as
a way of preventing illness. 42% of the respondents suggested that good hygiene as a prevention
measure against neonatal illness. The rest did not know what to do to protect babies from becoming
sick. According to Parlato et al. (2004) newborns are more likely to survive if delivery is clean,
that is if actions are taken to help prevent infection. Ensuring a clean delivery implies: clean and
gloved hands, clean perineal area and clean delivery surface (Parlato et al., 2004). These infection
prevention measures are similar to what was recommended by recommended by (WHO, 1996 and
2006).
It was then concluded that though respondents in this study had satisfactory knowledge and
positive attitudes towards the recommended newborn care, they generally lacked the practical
application especially in hospital deliveries, improper cord care and immunization.

30
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
6.1 Conclusion
It was then concluded that the majority mothers in Maridi payam had adequate and relevant
knowledge in the care of the new born in the community. This included knowledge of the need for
and the frequency of attending ANC, knowledge about the complications of childbirth as well as
symptoms and signs of illness in the newborn. The majority of mothers in the payam generally had
a positive attitude towards newborn care services available at Maridi Hospital and other health
facilities in the payam despite the fact that the majority of them continued to deliver from their
homes. Finally, though respondents in this study had satisfactory knowledge and positive attitudes
towards the recommended newborn care, they generally lacked the practical application especially
in; hospital deliveries, improper cord care and immunization.
6.2 Recommendations
In view the above the following measures are the recommended way forward;
 The Midwives at Maridi Hospital should encourage all pregnant women attending ANC at
Maridi Hospital to deliver from hospital for neonatal outcomes.
 The recommended number of not less than four ANC visits per pregnancy should be
promoted though health education during ANC visits and other gatherings by the midwife.
 The State Minister of Health should organize training for all TBAs in Maridi payam and
beyond since more mothers in this payam delivered at home than hospital.
 All women of childbearing age should be educated more on proper neonatal care including;
proper cord are, prevention of neonatal hypothermia, early initiation of breastfeeding,
exclusive breastfeeding on demand at least 8 times a day and general hygiene by the health
workers.
 Health workers see all newborns in Maridi payam should be vaccinated with BCG as early
as possible after birth and with OPV0 within the first 14 days.
 All health workers should include men in the campaigns to promote proper care of the new
born as substantial house hold heads in Maridi payam.

31
REFERENCES
Adeyinka D., Oladimeji O., Adeyinka F., & Aimakhu C., 2008. Uptake of Childhood
Immunization Among Mothers Of Under-Five In Southwestern Nigeria. The Internet Journal of
Epidemiology. Volume 7 Number 2.
http://ispub.com/IJE/7/2/3255
Accessed on 1/06/2014
Awashi S., Verma T., Agarwal M., 2006. Danger signs of neonatal illnesses perception of care givers
and health workers amongst mothers in India, Bull World Health Organization; 84(10):819-245.
Asif P., Mohamed B., Vishnu B., Ekambaram M., 2010. Knowledge attitude and practice of
neonatal care among postnatal mothers, Current Pediatric Research; Vol. 14 Issue 2, p147.
http://connection.ebscohost.com/c/articles/74462996/knowledge-attitiude-practice-neonatal-
care-among-postnatal-mothers
Accessed on 31/05 /2014
BergstrAqm A., Byaruhanga R., Okong P., 2005. The impact of newborn bathing on the prevalence
of neonatal hypothermia in Uganda: a randomized, controlled trial, Act Pediatric 2005 Oct;
94(10): 1462-7.
http://14.139.159.4:8080/jspui/bitstream/123456789/9166/1/Mamtha%20kumari%20yadav%20
OBG.pdf.
Accessed 1/06/2014
Brett D., Nelson M., Maya F., Melody J., Eckardt, Roy A., Margaret T., Genevieve P., Sarah B.,
El-BashirA., MPH, Emily K., Ghirmai E., Thomas F., Burke, 2011. Innovative package for
frontline maternal, newborn and child health workers in South Sudan,
http://www.southsudanmedicaljournal.com/archive/november-2011/innovative-package-for-
frontline-maternal-newborn-and-child-health-workers-in-south-sudan.htm

32
Bhandari N., Bahl R., Mazumdar s., Martines J, Black R., Bhan M., 2003. Effect of community-
based promotion of exclusive breastfeeding on diarrhoeal illness sand growth,: a cluster
randomized controlled trial. Lancet.
Bland R.M., Rollins N., Coutsoudis A., & Coovadia H., 2002. Breastfeeding Practices in an Area
of high HIV Prevalence in rural South Africa. Act Pediatrics Scandinavia, 91, 704-711.
Brooker C., 2006. Churchill Livingstone’s dictionary of nursing. (19th ed). UK: Elsevier.
Chibwana A., Mathanga D., Chinkhumba J., Campbell CH., 2009, Social- Cultural predictors of
health-seeking behavior for febrile under five children in Mwanza – Neno district, “Malawi.
Malaria Journal; 8:219.
www.malariajournal.com/content/8//219
Accessed 5/06/2014
Cyprian O., 2011. Knowledge, attitudes and practices of caretakers of malnourished children in
Aweil East and North counties, South Sudan
http://www.southsudanmedicaljournal.com/archive/february-2011/knowledge-attitudes-and-
practises-of-caretakers-of-malnourished-children-in-aweil-east-and-north-counties-south-
sudan.html
Accessed 30/05/2014
Ergenekon-ozelci P., Elmaci N., Ertem M., Saka G., 2006. Breastfeeding beliefs and practices
among migrant mothers in slums of Diyarbakir, Turkey. Eur J Public Health 2006 Apr; 16(2):143-
148.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3439284/
Accessed 20/04/2014
Gurong G., 2008. Practice on immediate care of new born in the communities of Kalilali district
Nepal. Med Coll J; 10(1):41-4.
www.rguhs.ac.in/cdc/onlinecdc/uploads/05_N006_31351.doc
Accessed 5/06/2014
Hake-Brooks S., Anderson G., 2008. Kangaroo care and breast feeding of mother-preterm day 0-
18 months: a randomized controlled trail. Neonatal network, 27(3):151-9.

33
Haroun H., Mahfouz M., Ibrahim B., 2008. Breast feeding indicators in Sudan: A case study of
Wad Medani town. Sudanese Journal of public health; 3(2): 81C90Sudanese Journal of Public
Health:; 3 (2)
Helmy F., Bahgat S., 1998. Newborn care giving by primipara and multipara mothers at home in
Tanta City . J Egypt Public Health Assoc.; 73(5-6):501-18.
http://www.ncbi.nlm.nih.gov/pubmed/17217021
Accessed 1/06/2014
HIzel S., Ceyhum G., Tanzer F., Sanli C., 2006. Traditional beliefs as forgotten influencing factors
on breast-feeding performance in Turkey. Saudi Med J; 27(4):511-518.
www.ncbi.nlm.nih.gov/pubmed/16598330
Accessed20/03/2014
Li Salami., 2006. Factors influencing breastfeeding practices in Edo state, Nigeria African
Journal of Food, Agriculture, Nutrition and Development search 2,o11,936 article,
http://www.oalib.com/paper/1333040#.U4raBt4dxdh
Accessed 1/06/2014
Mesko N., Osrin D., Tamang S., 2003. Care for perinatal illness in rural Nepal”a descriptive study
with cross sectional and qualitative components. BMC International Health and Human Rights;
3:3.
www.midwiferyjournal.com/article/S0266-6138(13)00081-8/references
Accessed on 20/ 05/ 2014
Mrisho M., Schellenberg A., Mushi A., Obrist B., Mshinda H., Tanner M., 2008. Understanding
home-based neonatal care practice in rural southern Tanzania. Trans. R. Soc. Trop. Med. Hyg.
2008;102:669-678
http://www.ncbi.nlm.nih.gov/pubmed/18513769
Accessed 2/06/2014

34
Myles a text Book of Midwives, 2003. 14th
Edition Elsevies British library publication pp No:736-
739
National Statistical Office (NSO), and ORC Macro 2005. Malawi demographic and health
survey 2004. Calverton, Maryland: NSO and ORC Macro;
www.mamaye.org/sites/default/.../mamaye-refsheet-factsheet-malawi.doc.
Accessed 4/06/2014
National Statistical Office and UNICEF. Malawi Multiple Indicator Cluster Survey 2006. Final
Report. Lilongwe, Malawi: National Statistical Office and UNICEF, (2008).
www.childinfo.org/files/MICS3_Malawi_Final Report_2006_eng.pdf
Accessed 20/04/2014
Nieswiadomy, M. R. 2008. Foundations of Nursing Research (6 th. Ed.). U.S.A: Pearson
Ogunlesi T., & Oufowora B., 2010. “Predictors of Mortality in Neonatal Septicemia in an under
source setting. Journal of the National Medical Association; 102(10):915-
.http://www.medcol.mw/commhealth/mph/dissertations/Triza%20Kakhobwe%20Hara_MPH_T
hesis_approved.pdf
Accessed 1/05/2014
Panul D, &Deadihic Nursing Jaypee Brothers Medical Publishers LTD New Delhi, 2007. Pag 66
Parlato R., Darmstadt G., Tinker A., 2004. “Qualitative Research to Improve Newborn Care
Practices Saving Newborn Lives Tools for Newborn Health. Washington DC
Pascale K., Laure N., Enyong O., 2007. Factors Associated with Breast feeding as Well as the
Nutritional Status of Infants (0-12) Months: An Epidemiological Study in Yaounde, Cameroon.
Pakistan Journal of Nutrition, 6 (3): 259-263.
http://etd.aau.edu.et/dspace/bitstream/123456789/2360/1/104
Accessed 23/05/2014
Padiyath M., Bhat V., Ekambaram M., 2010. Knowledge, attitude and practices of neonatal care
among postnatal mothers. Cur Pediatric Res.; 14(2):147-152.

35
www.pediatricresearch.info/yahoo_site_admin/.../19.176181814.pdf
Accessed 5/2014
BBC Media action’s., 2012."Maternal and child health in South Sudan
http://www.bbc.co.uk/mediaaction/publicationsandpress/research_health_south_sudan_page.htl
Sachdev, H.P.S., 2006. Kangaroo Mother Care method to reduce morbidity and mortality in low-
birth-weight infants. The WHO Reproductive Health
Save the Children 2004. Saving Newborn lives.
http://resourcecentre.savethechildren.se/sites/default/files/documents/1945.pdf Accessed
21/04/2014
Sethi V., Kashyap S.,Agarwal S. 2005. Contextual factors influencing newborn care
Amongst rural poor in western Uttar Pradesh Pakistan Journal of Nutrition. 4: 273-275
Shoaeib F., El-Barrawy M., 2005. Alcohol or traditional methods versus natural drying for
newborn’s cord care, J Egypt Public Health Assoc.; 80(1- 2):169-201.
www.biomedcentral.com/1471-2393/12/50/ Accessed 13/04/2014
Sloan, N.L, et al. 1994. Kangaroo mother method: randomized controlled trial of an alternative
method of care for stabilized low-birth weight infants. Lancet. Sep 17; 344(8925):782-5
Soanes C., 2007. Oxford English Mini Dictionary. 17th
Edition, United States: Oxford
University.
Tarimo D., Lwihula G., Minjas J., Bygbjerg C.,2000. Mothers' perceptions and knowledge on
childhood malaria in the holoendemic Kibaha district”, Tanzania: implications for malaria control
and the IMCI strategy. Trop Med Int Health. 2000; 5:179–84. www.biomedcentral.com/1472-
698X/6/7
The Africa newborn network, 2009. Addressing critical knowledge gap in newborn health”
http://www.healthynewbornnetwork.org/partner/africa-newborn-network
Access on 22/04/2014

36
World Health Organization (WHO), 2006, Neonatal & Perinatal Mortality; Country, Regional
and Global Estimates.
World Health Organization (WHO), 1996, Perinatal mortality; a listing of available information.
FRH/MSM.96.7. Geneva.
Yadav S., 2007. Newborn care: traditional practices in Nepal,
Archive.student.bmj.com/issues/07/09/life/308.pdf,
Accessed 23rd March 2014
Zulfia K., Saira M., Najam K., MohdA.A., Abdul R., 2009. Poor Perinatal Care Practices in Urban
Slums: Possible Role of Social Mobilization Networks.Indian J Community Med. Apr 2009; 34(2):
102–107.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781114/
Accessed 22/05/2014

37
APPENDICES
APPENDICESNDIX I: INTRODUCTORY LATTER

38
APPENDIX II: CONSENT FORM
I am Mr. Oyet Charles Okech is a third year student in NHTI-Maridi, am doing Diploma in
Midwifery. I pursue a study to assess the knowledge, attitude and Practices of mothers on
newborn care at maridi payam. Although the study will not benefit you directly, it will provide
health professionals with information, which may result in better care of newborn.
The study data will be kept secretly and your name will not be included in this study so that your
identity will not be revealed during or after the study to anyone. All the study data pertaining to
you will be stored in a secure place of the investigator and will not be shared with any person
without your permission.
Your participation in the study is voluntary and you are under no force to participate. You have
the right to refuse the study any time you wish to do so and they will be no payment for it. I kindly
request you to pay attention to me for just 10 minute.
I have read/heard what was explained on the consent form and was explained that the information
provided by me would be kept confidential and used only for the above mentioned study purpose.
I voluntarily consent to participate in the study.
Participant Signature /thumb……………………….. Date:………../…………./2014
I have explained the study to the above participant and sought her understanding of the informed
consent.
Researcher Signature…………………………… Date:………../…..……../2014

39
APPENDIX III: QUESTIONNAIRE
INSTRUCTIONS:
This questionnaire contains some questions section about care of newborn. I kindly requesting you to
listen to the questions asked by the interviewer carefully and provide the necessary information by
giving appropriate response. The information collected from you will be used only for the purpose
of the study and kept in confidential
Questionnaire on Mothers’ Knowledge, Attitudes and Practices on Care of the
Newborn
Section A. Demographic Characteristics
Questionnaire Number
Date of Interview
1. Age of Respondent
Age group Code Tick one
15-20 yrs 1
21-25yrs 2
26-30yrs 3
31-35yrs 4
36-40yrs 5
41-45yrs 6
46-50yrs 7
2. Address…………………………Boma 3. Parity…………………………………
4. Youngest child’s age……………………… 5. Sex of Baby…………………………..
6. Ethnicity/tribe…………………………….. 7. Respondent’s Religion………………
8. Marital Status of the respondent…………… 9. Level of Education…………………..
10. Occupation………………………………..
Chapter B. Mothers’ Knowledge on care of newborn

40
11. Are you aware that you are supposed to attend ANC clinic? Yes No
12. Did you attend ANC during pregnancy of your youngest child? Yes No
13. If yes where…………………………………………...
14. How many times
15. What advice did you receive from ANC clinic?
Advice Code Tick
Personal hygiene 1.
Nutrition during pregnancy 2.
Infant and child nutrition 3.
Care of cord 4.
Importance of hospital Delivery 5.
Importance of Immunization 6.
Importance of Breastfeeding 7.
How to identify sign of illness 8.
Advantage of ANC 9.
Family planning 10.
16. Are you on any family planning method? Yes No
17. If yes which methods?............................................................................
18. Did your baby have any complication immediately after birth? Yes No
19. If yes, what was baby suffering from?
Difficulty in Breathing 1
Jaundice 2
Bleeding 3
Inability to suckle 4
No. of Visits Code Tick one
1 time 1
2 times 2
3 times 3
4 times 4
Over 4times 5

41
Inability to urinate 5
Delay to cry 6
Other (specify) 7
20. What do you do when either you or your baby falls sick?
......................................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
21. How do you know when baby is sick?
Has diarrhea 1.
High body temperature 2.
Fast breathing 3.
Feels hot/cold 4.
Sweating 5.
Shivering 6.
Vomiting 7.
Chapter C: Mother’s Attitudes on Care of Newborn
22. Where did you deliver your last child from? ...................................................................
23. Who attended to you during delivery?.........................................................................................
24. Why did you choose to deliver at the above place?
…………………………………………………………………………………………………
…………………………………………………………………………………………………..
25. What is your comment about the place where you delivered from?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
26. Would you recommend other women to deliver from the same place? ..........................
Chapter D, Practice on Newborn Care
27. How did you deliver your last baby?

42
SVD 1
C/S 2
V/E 3
Other (specify) 4
28. What was used to cut the cord after delivery? ............................................................
29. Was the above mentioned material clean? Yes No
30. What material was used for tying a cord? ...................................................................
31. What was applied on the cord stump? .........................................................................
32. How was baby cleaned after delivery?
………………………………………………………………………………………..
33. What was used to wrap baby after delivery? ..............................................................
34. Approximately how long after delivery did you first breastfeed your baby?
35. What other feeds did you give to baby immediately after delivery?
Breast milk 1
Fluid 2
Formula feed 3
Other(specific) 4
36. Do you clean your breast before breastfeeding the baby? Yes No
37. If yes, what do you use to clean your breast before breastfeeding? ..............................
38. How often do you breastfeed baby in a day?
On demand 8times and above 1
Less than 8times in 24hrs 2
Don’t breastfeed 3
Other (specify) 4
Immediately 1
Within 30 minutes 2
30min-1hr 3
After 1hrs 4
Other (specify) 5

43
39. When did you start bathing the baby after birth?
Immediately after birth 1
After 24hrs 2
within 24hrs 3
40. What do you apply on the baby’s body after bathing?
………………………………………………………………………………………………
41. Was your baby immunized at birth? Yes No
42. If no to Q41, why?
……………………………………………………………………………………………
43. What traditional method of treatment newborn illness do you use?
44. What methods of preventing newborn illness do you practice in this community?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Thank you for answering the questions
Procedure Tick one
Enema 1
Herbal 2
Take traditional
healer
3

44
APPENDIX IV: MAP OF MARIDI COUNTY

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