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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 1-12

Nursing intervention sessions to improve newly mothers’ home care practices for their newborns in slum areas in Cairo


Department of Community Health Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt

Date of Submission11-Mar-2020
Date of Decision25-Mar-2020
Date of Acceptance08-Apr-2020
Date of Web Publication18-Nov-2020

Correspondence Address:
Rasmia Abd El-Sattar A.M Baih
Department of Community Health Nursing, Faculty of Nursing, Ain Shams University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_9_20

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  Abstract 


Background Neonatal health is the key to child survival. Improving neonatal home care practice may substantially improve survival of newborn babies in the first month of life.
Aim The study aims to assess the effect of nursing intervention sessions on improving newly mothers’ home care practices for their newborns in slum areas in Cairo.
Setting The study was conducted at three Maternal and Child Health Centers that are attached to slum areas in Cairo Governorate, which are Al-Zawya Al-Hamra, El-Khusus, and El Wailya in El-Abassia area.
Patients and methods A purposive sample was recruited, consisting of 162 postnatal primipara mothers and their alive newborns. The tool for data collection is newly mothers’ interviewing questionnaire (pre/post), which included (a) demographic characteristics; (b) newly mothers’ knowledge and the reported practice (pre/post) regarding breast feeding, thermal control, skin care and hygienic, safe cord care, and safety measures practices; and (c) the nursing intervention sessions for newborn’s home care practice. The results of the study revealed that mothers’ ages ranged from 18 to 40 years, and the mean of age was 23.3±5.6 years. Most of the studied mothers (87.7%) lived in flat, and 54.3% of them were living in one room, with 48.1% of them having moderate ventilation. Moreover, there are marked improvements in all aspects of mothers’ home care practice after implementation of the nursing intervention (paired t=3.708).
Conclusion The study concluded that the implementation of nursing intervention sessions regarding newly mothers’ home care practices had a positive effect on improving newly mothers’ reported practices.
Recommendations The study recommends that intervention classes for newly mothers should be conducted on a regular basis to discuss and teach them different aspects of home care practices for their newborn and replication of this study with a larger sample of different slums areas with longitudinal follow-up, so that the results could be generalized.

Keywords: home care, mothers, newborn, nursing intervention, practices, slums areas, unplanned


How to cite this article:
Baih RSA. Nursing intervention sessions to improve newly mothers’ home care practices for their newborns in slum areas in Cairo. Egypt Nurs J 2020;17:1-12

How to cite this URL:
Baih RSA. Nursing intervention sessions to improve newly mothers’ home care practices for their newborns in slum areas in Cairo. Egypt Nurs J [serial online] 2020 [cited 2020 Dec 3];17:1-12. Available from: http://www.enj.eg.net/text.asp?2020/17/1/1/300785




  Introduction Top


Global neonatal mortality rates have significantly declined over the past two decades. Although these improvements are multifactorial, children are at the greatest risk of dying during the neonatal period (the first 28 days of life), with an average rate of 18 neonatal deaths per 1000 live births globally in 2017 (Hug et al., 2018). Neonatal mortality is a significant health problem worldwide, particularly in developing countries. Neonatal fatality in the first 28 days of life represents nearly two-thirds of infant death internationally and nearly 40% of deaths of children under the age of 5 years. Nearly 65% of the neonatal fatality happens in the first week of life, frequently at home, highlighting the need for early appropriate home care. Almost 99% of the four million neonatal deaths happen yearly in the developing countries and nearly half of them at home far from the health care system (Ceber et al., 2013; Arlington et al., 2017).

Research estimates suggest that 36% of newborn deaths are owing to serious infections (e.g. pneumonia, septicemia, tetanus, and diarrheal diseases), 28% are owing to complications of prematurity, 23% are from birth asphyxia, and another 7% are attributed to major congenital anomalies. However, most deaths and adverse sequelae of complications are preventable with prompt and appropriate treatment and/or referral practices, emphasizing the importance of home care practices during neonatal period (Agossou et al., 2016).

A newborn’s body undergoes many changes, which begin at birth and continue throughout the neonatal period. The first and the most important change is to start breathing. Other changes are regulating the body temperature, feeding, and developing the ability to fight infections. The early week and month of the newborn’s life are a time of great threat. Nearly half of all newborn fatalities happen in the first 7 days, and although the risk of mortality decreases as time passes, every newborn needs careful care during the first month of life (Devkota and Bhatta, 2011; Abebe et al., 2019).Improving neonatal home care practice may substantially improve survival of newborn babies in the first month of life. The WHO guidelines for crucial newborn home care practices encompass early and exclusive breastfeeding, hygienic care, cord care, thermal control, skin care, and recognition of danger signs that are clearly associated with major causes of neonatal mortality, particularly serious neonatal infection (Grover and Chhabra, 2012).

The definition of slum areas varies from a country to another depending upon the socio-economic conditions and geographical factors of the society. Within the Egyptian context, slums have been known as ‘Ashwaiyyat,’ which literally means ‘disordered’ or ‘haphazard.’ It refers to informal areas suffering from the problems of accessibility, narrow streets, absence of vacant land and open spaces, very high residential densities, and insufficient infrastructure and services (World Bank, 2008; United Nations, 2018).

The basic characteristics of slums areas are dilapidated and poor housing structures, poor ventilation, over-crowding, faulty alignment of streets, inadequate lighting, paucity of safe drinking water, water logging during rains, absence of toilet facilities, and nonavailability of basic physical and social services. Moreover, living conditions in slums are usually unhygienic and in contrary to all norms of planned urban growth and are important factors in accelerating transmission of various diseases, especially to newborn babies (El-Zanaty and Associates and Macro International, 2015). Furthermore, inadequate availability of quality health services, poor health seeking and practicing behaviors by the families, and poor adherence to health care medical advice are considered the main barriers toward reducing neonatal mortality (UNICEF and Informal Settlements Development Facility, Egypt, 2013).

World Cities Report released in 2016 stated that the population of slum habitants in developing world progressively increased from 689 million to a massive 880 million in 2014. It also stated that a quarter of the world’s total urban population lives in slums. Health is a matter of interest particularly for people living in the slum areas of any province or in any country. The restricted health care resources at their disposal make their lives liable to hazards in case of diseases and their handling. Problems of shelter, housing, sanitation, water, social security, education, health, and livelihoods of high-risk groups like children, and women, in addition to their particular needs are the most remarkable areas where urban poverty demonstrates a great risk. Community health problems and social matters have emerged as factors that lower the quality of life. The poor sanitary situations in the overpopulated urban neighborhoods and the inappropriate waste disposal were adequate for infectious diseases spread like tuberculosis, pneumonia, and diarrheal diseases (Zaman et al., 2018).

Based on the national map of slums areas approved by the Prime Minister, the numbers of urban slums areas in Egypt are 226 settlements in 27 governorates, reaching a proportion of 37.5% of total urban area. Sohag Governorate occupied the highest percentage of slums areas, reaching 69.9% of the city, and the lowest percentage of urban slums areas was of 2.5% in Port Said (ISDF, 2012).

In Cairo Governorate, slum areas constitute 19.8% of total urban area of 92 904.8 acres. The number of urban slum areas to be developed in this governorate is 17 areas that suffer from deterioration in construction environment, and lack of services and infrastructure in some of them. The total area of these unplanned settlements is 6598.57 acre, which are Al-Petrol St. and Sheikh Mansour St. in El-Marg; Al-Ebageyah in Al-Khalifa; Ezbet Abu Hasish in Hadaeq El-Qobba; Abu Leila and Ahmed Khalil in Al-Zawya Al-Hamra; Sweqat Al-Wahayd in Manshyet Nasser; Kotsika in Torah; Ezbet Khakrallah and Dar Al-Salam Island in Dar El Salam; Al-Khabiry and EzbetNafea in Maadi; Al-Assal in Shoubra; and Souq Al-Nil, Taqsim Mecca and SouqEspico in Al-Salam Awal (Egypt’s Strategy for Dealing with Slums, 2014).

The mother plays an important role as a member of the health care delivery team of their newborn babies. Mothers have three essential roles for caring of their newborn babies, which are protecting them from harm, promoting their emotional as well as their physical health, enforcing boundaries to ensure their safety, and optimizing their development (John et al., 2013). The newborn’s mother is the key person who takes care and fulfills the needs of the newborn either physiological or psychological. Therefore, it is essential to apply instructional programs that appreciate mothers to have the correct knowledge, home care practice, and attitude to raise their healthy children. Correspondingly, nurses should determine the level of mothers’ knowledge about their newborns’ home care practice. This helps them in their planning process of mothers’ educational needs for better well-being, growth, and development of their newborns, and prohibiting newborn’s illness and fatality as well (Aziz and Lee, 2014).


  Significance of study Top


The newborn health challenges faced in slum areas in Egypt are more formidable than that experienced by any other country. According to the Egyptian Demographic and Health Survey (2014), the rate of newborn’s fatality in Egypt constitutes 14/1000 newborns, whereas neonatal mortality in poorest areas in Egypt is 23/1000 newborns (UNICEF Children in Egypt, 2015). This means that the rate of newborn’s fatality in the poorest areas is nearly double the rate of newborn’s fatality in whole Egypt. There is a lack of national studies that have examined the knowledge and reported home care behaviors toward newborns within delivered mothers in slums area despite high neonatal mortality rate. The present study is intended to assess the effect of nursing intervention sessions among newly mothers’ home care practices for their newborns at unplanned slum areas in Cairo.


  Aim Top


This study aims to assess the effect of nursing intervention sessions on newly mothers’ home care practices for their newborns within slums areas in Cairo.

Research hypothesis

The research team hypothesized that the implementation of nursing intervention sessions on newly mothers may improve their home care practices for their newborns in slum areas in Cairo.


  Patients and methods Top


Research design

A quasi-experimental research design was used to conduct this study.

Technical design

Settings

The study was conducted at three Maternal and Child Health (MCH) centers that are attached to slum areas in Cairo Governorate, which were selected from one MCH center from each slum area (the first one in the list of the urban slums areas in Cairo after arranging their names alphabetically), including the following:
  1. Al-Zawya Al-Hamra area in Cairo.
  2. El-Khusus in Al Qalyubiyah (great Cairo).
  3. El Wailya in El-Abassia area in Cairo.


Each area has one MCH centers affiliated to Ministry of Health and Population.

Sampling

A purposive sample consisted of 162 postnatal mothers and their alive newborns who received care from these three MCH centers, irrespective of the maternal age or mode of delivery. The inclusion criteria were postnatal primipara mothers and their newborn babies who visited the MCH centers for their first postnatal follow-up of thyroid screening test and child immunization 4 weeks after delivery. The exclusion criteria were cases where either the mother or newborn had abnormal health conditions during delivery or postnatal period and those who had multiple births and neonatal deaths.

Tool and technique of data collection

Newly mothers’ interviewing questionnaire: it was developed by the researchers (pre/post format). It was written and adapted into colloquial Arabic language for field administration to assess the studied newly mothers’ knowledge and reported practice regarding neonatal home care practices. It included three parts:
  1. Part I: it concerned demographic characteristics of the studied newly mothers:
    1. Characteristics of the studied newborns regarding their birth weight, sex, methods and place of delivery, specialized home care providers, and newborns’ health problems.
    2. Characteristics of the studied mothers regarding their age, level of education, working state, sources of information received related to home care practice of their newborn, and family’s housing condition parameter.
  2. Part II: it concerned newly mothers’ knowledge about home care practice during the postnatal period regarding the following:
    1. Exclusive breastfeeding.
    2. Ensuring baby is kept warm.
    3. Skin care.
    4. Umbilical stump care.
    5. Detection of health problems and danger signs.
  3. Part III: it concerned mothers’ reported home care practices regarding the following:
    1. Breastfeeding practice.
    2. Thermal control practice.
    3. Skin care and hygienic practice.
    4. Safe cord care practice.
    5. Safety measures practice.


The scoring system was as follows: a corrected response for each item of the part II (newly mothers knowledge) and part III (newly mothers’ reported practice) was scored 1 for correct answer and 0 for the incorrect answer. After summing the total items, if the total score was more than or equal to 50% for each part II and part III (knowledge and the reported practice of the studied newly mothers, respectively), it was considered as satisfactory, whereas less than 50% was considered as unsatisfactory.

The nursing intervention sessions for newborn’s home care practice was prepared according to the need assessment of the studied newly mothers.

Tools validity and reliability

  1. The study tool was reviewed by five jury experts in community health nursing to confirm its content validity for clarity, relevance, comprehensiveness, understanding, applicability and ease for implementation before its use.
  2. The Cronbach’s α test was used to assess the reliability of the questions pertaining to knowledge, which was 0.68, and the reliability of the questions relating to reported practices was 0.74.


Operation of the study

Ethical considerations

Informed consents were taken before the interview with mothers. Confidentiality of information was maintained. Participation was voluntary and respondents were free to withdraw from the study at any time.

Administrative design

An official permission to carry out the study was obtained by submission of an official letter issued by the Dean of the Faculty of Nursing, Ain Shams University, to the Director of each MCH center. The title and the aim of the study have been illustrated. Moreover, the main data items and the expected outcome from implementation of the study were included in this letter.

Pilot study

A pilot study was carried out in December 2016. It was conducted on 10% of the total study sample, involving 16 mothers and their newborn babies to assess the clarity and applicability of the study tools. Simple modifications in the form of rephrasing were done for the study tools according to the obtained results from the pilot. Mothers and their newborn babies included in the pilot study were included in the study.

Field work

A review of national-related and international-related references was carried out to get acquainted with the various aspects of the research problem and to develop data collection tools. The actual fieldwork was carried out from January 2017 up to the end of March 2017 for data collection. Each mother was assessed and interviewed individually for 10–20 min using the study tools. Data collection was done in a separate room belonging to each MCH center. The researchers conducted the implementation phase of the nursing intervention in two sessions for 30 min. Patients were divided into subgroups, and each of them consisted of 6–10 patients and nursing intervention was implemented for each group separately (3 days/week). The nursing intervention sessions include home care knowledge and practice regarding feeding, thermal control, skin care, hygienic care, umbilical stump care, and detection of danger signs and safety measures. Several educational methods were used, such as group discussion, role play, demonstration, and re-demonstration. Moreover, visual aids were used such as posters, handouts, and booklets. The instructions were implemented in colloquial Arabic language.

Evaluation phase

The study tools were used in the first week after delivery at the time of thyroid screening test and 4 weeks later after the implementation of the nursing intervention sessions at the time of immunization to evaluate the effect of the nursing intervention on the studied newly mothers.

Statistical analysis

Data entry and analysis were done using SPSS, version 16. The collected data were organized, revised, stored, tabulated, and analyzed using the number and percentage distribution. Statistical analysis was done by computer. Proper statistical tests were used to determine whether there was a significant difference or not.
  1. Percentage.
  2. Mean degree.
  3. SD.
  4. Paired t test.



  Results Top


[Table 1] clarifies that the mean birth weight of the studied newborn was 3050±515.2 g, and more than three-quarters (79%) of them were full-term newborns. Regarding the method of delivery, more than two-thirds (71.0%) of them were delivered by normal delivery, and 90.7% of them were delivered in hospital, whereas only 9.3% of them were delivered at home. Moreover, as shown in [Figure 1], it was found that 56.8% of the studied newborns were females and 43.2% of them were males.
Table 1 Number and percentage distribution of the studied newborn according to their characteristics (N=162)

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Figure 1 Percentage distribution of the studied newborns according to their sex.

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[Figure 2] represents that mothers and mother’s mother were the most common caregivers of the studied newborns, representing 50.8 and 30.5%, respectively.
Figure 2 Percentage distribution of the studied newborns according to their specialized home care providers (n=162).

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[Figure 3] represents that abdominal distension was the most common health problems, which represents 75.9% of the studied neonates followed by oral moniliasis, which represents 69.7% of them. However, only 19.7 and 21% of them had vomiting and impetigo, respectively.
Figure 3 Percentage distribution of the studied newborns according to their health problems.

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The demographics characteristics of the studied mothers as listed in [Table 2] showed that their ages ranged from 18 to 40 years, with a mean of 23.3±5.6 years, and 40.1% of them were 18–20 years old. Their educational level was as follows: 45.7% of them were illiterate, 42% of them could read and write, 8.6% of them had obtained middle education, and only 4.3% of them were graduated from university and higher education. Meanwhile, 51.9% of them were working and 48.1% were not working.
Table 2 Number and percentage distribution of the studied newly mothers according to their characteristics (N=162)

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As shown in [Table 3], 53.1% of the studied newly mothers listed family members as their main source of information in newborn care during the postnatal period. The next most important source listed by 27.2% of the studied newly mothers was follow-up visits during the postnatal period. Meanwhile, 23.5% of studied mothers’ derived information from media technology, such as magazines, newspapers, pamphlets, television, and the internet, and only 13% of the studied newly mothers listed friends and neighbors as their source of information.
Table 3 Number and percentage distribution of the studied newly mothers according to their sources of information received related to home care practice of their newborn (N=162)

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Concerning housing condition of the studied mothers, [Table 4] shows that 87.7% of the studied newly mothers lived in flat, and 54.3% of them lived in one room, with 48.1% of them having moderate ventilation. Moreover, it was found that most of studied mothers (87.7, 90.7, 97.5, and 97.5%) had separate bathroom, separate kitchen, electrical source of lighting, and source of water supply inside the house, respectively. In addition, 56.2% of the studied newly mothers were dependent on drain sewage disposal and 53.7% had moderate level of cleanliness, whereas 42.0 and 39.5% of them disposed the rubbish in streets and by burning, respectively.
Table 4 Number and percentage distribution of the studied newly mothers according to their family’s housing condition parameters (N=162)

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[Table 5] reveals marked improvements of newly mothers’ knowledge regarding all aspects of home care practices of their newborns before and after implementation of nursing intervention sessions (T=9.703), where more than half (63%) of them reported exclusive breastfeeding after implementation of nursing intervention sessions compared with 24.7% before implementation of the teaching sessions. Approximately three-quarters (76.5%) of the studied newly mothers ensured their newborn babies were kept warm after implementation of nursing intervention sessions compared with 38.3% before implementation of the nursing intervention sessions. Although skin care was known by more than one-third (40.7%) of studied mothers before implementation of the nursing intervention sessions, 39.5% of them reported poor knowledge after implementation of the nursing intervention. Regarding knowledge about hygienic and physical care, only 18.5% had reported poor knowledge after implementation of the nursing intervention sessions compared with 50.6% of the before implementation of the nursing intervention sessions. The percentage of studied newly mothers who knew care of the umbilical stump was 70.4% after implementation of the nursing intervention sessions, whereas only 29.6% of newly mothers did not know. Concerning detection of health problems and danger signs, the results revealed that there was marked improvements of studied mothers’ knowledge after implementation of nursing intervention sessions, with statistical significant differences, where 56.8% of them had satisfactory knowledge after implementation of nursing intervention sessions compared with 21% before implementation of the nursing intervention.
Table 5 Newly mothers’ knowledge regarding home care practices of their newborns before and after implementation of nursing intervention sessions (N=162)

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[Table 6] shows that, only 4.9% of the studied newly mothers did not exclusively breast fed their newborn babies after implementation of the nursing intervention compared with 59.3% before implementation of the nursing intervention sessions.
Table 6 Number and percentage distribution of the studied newly mothers according to their reported breastfeeding practices newborns before and after implementation of nursing intervention sessions (N=162)

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[Table 7] shows that there are marked improvements in newly mothers’ home care practice regarding all aspects of thermal control practice after implementation of nursing intervention sessions (paired t=3.708), where the majority of the studied newly mothers (88.9%) provided skin to skin care after implementation of nursing intervention sessions.
Table 7 Number and percentage distribution of the studied newly mothers according to their reported thermal control practice newborns before and after implementation of nursing intervention sessions (N=162)

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[Table 8] shows that washing hands before handling the baby, change solid diaper, and bathing the baby were satisfactorily practiced by 46.9, 35.8, and 53.1% of studied newly mothers after implementation of the nursing intervention, but also there were 53.1, 64.2, and 46.9% of them who did not satisfactorily practiced after implementation of the nursing intervention.
Table 8 Number and percentage distribution of the studied newly mothers according to their reported skin care and hygienic practices for newborns before and after implementation of nursing intervention sessions (N=162)

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Concerning mothers’ reported safe cord care practice, [Table 9] shows that the majority of the studied newly mothers did not clean the base around cord and clean the stump, representing 93.8 and 93.8%, respectively, before the nursing intervention compared with 58 and 49.4%, respectively, after the implementation of the nursing intervention sessions. There were statistical significant differences (t=9.037).
Table 9 Number and percentage distribution of the studied newly mothers according to their reported safe cord care practice newborns before and after implementation of nursing intervention sessions (N=162)

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As observed from [Table 10], there were marked improvements among studied newly mothers’ reported practices regarding safety measures (t=4.34).,where, all of the studied mothers (100, 100, and 100%, respectively) reported poor practices regarding detection of danger signs, care of chocking, and immunization during the first month before the nursing intervention compared with 64.2, 69.1, and 45.1%, respectively, after the implementation of the nursing intervention.
Table 10 Number and percentage distribution of the studied newly mothers according to their reported safety measures practice newborns before and after implementation of nursing intervention sessions (N=162)

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From [Table 11], it is clear that there was a statistically significant difference in newly mothers’ reported home care practices of their newborns before and after implementation of the nursing intervention (P=14.99), where, 76.0, 59.3, 55.6, and 80.2% had reported poor practices regarding breastfeeding, thermal control, hygienic care, and safe cord care practices, respectively, compared with 30.9, 37.7, 30.9, and 24.7%, respectively, after implementation of the nursing intervention. Moreover, there is marked improvements in mothers’ reported practices regarding safety measures (53.1% after implementation phase compared with only 16% before implementation of the nursing intervention).
Table 11 Newly mothers’ reported home care practices of their newborns before and after implementation of nursing intervention sessions (N=162)

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General characteristics of the studied sample

The characteristics are clarified in sampling and demographic data.


  Discussion Top


The present study was conducted to assess the effect of nursing intervention sessions on newly mothers’ home care practices for their newborns in slum areas in Cairo.

Concerning the characteristics of the studied newly mothers, the results of the current study revealed that the studied newly mothers’ ages ranged from 18 to 40 years, with a mean of 23.3±5.6 years, and more than one-third of them were in the age group 18–20 years. Concerning their educational level, it was found that nearly half of them were illiterate and more than half of them were not working (house wives). This may indicate that people’s beliefs in slums are not interested in education and they prefer early marriage. These findings were similar to the findings of Madhu et al. (2009), who studied breastfeeding practices and newborn care in rural areas in Indian stated that the majority of the mothers were between the ages of 21 and 25 years old (60%) and 15 and 20 years old (30%). Approximately 52% of the mothers were illiterate, and the majority of the mothers were housewives (69%) and mothers who were employed were 22%. The findings of the study were in contrast to the findings of Hadush et al. (2016), who assessed knowledge and practice of neonatal care among 290 postnatal mothers attending Ayder and Mekelle Hospital in Mekelle, Tigray, Ethiopia, 2013, and stated that, the mean age of studied mothers was 27.04±5.9 years, where, 53% were in the age group of 25–29 years, 16% were 30–34 years, and 6% were those between 35 and 39 years. Moreover, 48.28% of them were housewives. Regarding the level of education, it was found that, 46.8% of them were attending formal school education.

This study also showed that more than half of the studied newly mothers received information from family members, followed by follow-up visits during the postnatal period, whereas a few of them were seeking information from neighbors and friends. The researchers believe that this situation happens because mothers feel close and comfortable with blood relations. These results were similar to the study findings of Aziz and Lee (2014), who studied Malaysian primipara’s knowledge and practice on newborn care during the postnatal period and stated that the respondents were expected to seek information from family, friends, and health professionals to learn about their role and capabilities as new mothers. In contrast, Fathie et al. (2012), who assessed knowledge, attitude, practice, and problem of postnatal mothers related to their health care and breastfeeding, reported that 86% of the mothers depended on printed media as their primary source of information during pregnancy. However, this study found that only 23.5% of the respondents sourced for information through media technology, which includes magazines, newspapers, pamphlets, television, and the internet.

The results of the current study revealed that there was marked improvement in newly mothers’ reported practice regarding breastfeeding before and after implementation of the nursing intervention sessions. This might be owing to that successful breastfeeding practices in the community were attributed to the consistent efforts made by the health services in MCH centers and educating mothers during pregnancy, delivery, and postpartum periods on breastfeeding. Moreover, social, cultural, and religious aspects would also have contributed in promoting these practices. These results were consistent with the results of Senarath et al. (2011), who studied the effect of a hospital-based intervention in Sri Lanka on newborn care practices at home. They reported that 91.7 and 93.6% in the preintervention and postintervention samples of newborns, respectively, were exclusively breastfed at 28 days of life. In addition, the current study found that most newborns were breastfed and had given colostrum after implementation of the nursing intervention sessions, which was similar to that of results of Chaudhary et al. (2013) on factors affecting newborn care practices among their mothers in selected village development committees of Chitwan district, who found that all newborns were breastfed and had been given colostrum as first fed. Madhu et al. (2009) stated that exclusive breastfeeding should be continued for 6 months. It protects the child from malnutrition, infections, and helps the overall development of the child. To sustain high breastfeeding rates, we recommend that the training programs for health staff on breastfeeding should be continued, focusing on women at risk of discontinuation of exclusive breastfeeding.

In the light of the study findings, it was noticed that most studied newly mothers improved their practice regarding all aspects of thermal control practices after implementation of the nursing intervention sessions. These findings were similar to the findings of Aziz and Lee (2014), who found that 74.1% of the studied mothers improved their thermal control practice during the postnatal period.

Concerning newly mothers’ hygienic practice, the results of the current study showed that most studied mothers did not wash their hands and did not change solid diaper and clothes before implementation of the nursing intervention. This may be attributed to the fact that changing the knowledge is the milestone for practice change. These results were in contrast to the results of Darmstadt et al. (2008), who studied neonatal home care practices in rural Egypt (Fayoum, Aswan, and Luxor) during the first week of life and mentioned that overall fewer than 10% of mothers washed their hands after diaper changes or before feedings. Most babies’ clothes were changed routinely after baths, but most mothers also changed their baby’s clothes independent of bathing, usually daily. All babies wore diapers, which were usually changed when soiled.

Application of safe cord care continues to be a common newly mothers’ home care practice in the first few days after delivery for their newborn babies. The findings showed that more than three-quarters of the studied mothers in slum area in Cairo did not apply alcohol on the cord stump, and the majority of them did not clean the base around the cord before implementation of the nursing intervention sessions with marked reduction in cord care faulty practice after implementation of the nursing intervention. This may reflect the importance of nursing intervention for improving neonatal cord stump care. These findings were similar to the findings of Mersha et al. (2018) who studied essential newborn care practice and its predictors among mother who delivered within the past 6 months in Chencha District, Southern Ethiopia, they stated that 52.9% of neonates received safe cord care, 71.0% received optimal thermal care, and 74.8% had good neonatal feeding, which showed mothers had good knowledge about neonatal care. Moreover, Darmstadt et al. (2008) studied the practices of rural Egyptian birth attendants during the antenatal, intrapartum, and early neonatal periods and stated that 55% of the studied sample did not apply alcohol to the cord and did not clean the base of the cord. Such a home malpractice may predispose the newborn to risk of neonatal tetanus.

Concerning newly mothers’ safety measures, the results of the current study showed that all studied newly mothers’ reported poor practices regarding detection of danger signs, care of chocking, and immunization during first month before the nursing intervention. This finding may be owing to nearly half of them were illiterate and received information from family members. Meanwhile, there were marked improvements after implementation of the nursing intervention. These findings were similar to the findings of a study by Saaka and Iddrisu (2014), titled ‘Patterns and Determinants of Essential Newborn Care Practices in Rural Areas of Northern Ghana.’ The mothers were tested in their knowledge regarding newborn danger signs, which included poor suckling or not able to breastfeed, fast breathing, care of chocking, hypothermia, fever, unconsciousness, convulsion, severe umbilical infection, redness of skin around the cord, and foul smelling discharge. They found that 77.2% of mothers were aware of one to three newborn danger signs, and 20.3%, representing less than a quarter of the mothers, were aware of at least four danger signs, whereas only 2.5% of the mothers were not aware of any of the danger signs in the newborn.


  Conclusion Top


Based on the results of the present study, the following could be concluded:

The implementation of nursing intervention sessions regarding newly mothers’ home care practices for their newborns in slums areas in Cairo had improved the newly mothers’ knowledge and reported practices. Therefore, the findings of the study comply with the research hypothesis.

Recommendations

Based upon the results of the current study, the following recommendations are suggested:
  1. Mothers’ classes should be conducted on regular basis to discuss and teach them different aspects of home care practices for their newborn.
  2. Availability of photographic booklets and flayers involving all mothers’ home care practices for their newborn.
  3. Replication of this study with a larger sample of different areas with longitudinal follow-up is recommended, so that the results could be generalized.
  4. Further studies should be conducted on different aspects related to mothers’ home care practices for their newborn babies.
[25]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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