RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA
SYNOPSIS
FOR REGISTERATION OF SUBJECT FOR DISSERTATION

1.

NAME OF THE CANDIDATE

LATHA.U.S

2.

NAME OF THE INSTITUION

DIANA COLLEGE OF NURSING

NO.68 CHOKKANAHALLI, JAKKUR

3.

COURSE OF STUDY AND

POST BANGALORE-64

SUBJECT

MASTER OF SCIENCE IN NURSING

PAEDIATRIC NURSING SPECIALITY

4.
C

DATE OF ADMISSION TO

28.6.2008

COURSE
5.

TITLE OF THE TOPIC

Effectiveness of Self Instruction Module on

Home Management of Low Birth Weight
Babies Among Postnatal Mothers at Selected
Hospital, Bangalore.

6. Brief Resume of the Intended Work

Introduction
Birth of a healthy new born baby is one of the finest gifts of nature. The
process of birth takes only in few hours but it is the most hazardous period of life
since it is associated with largest no of deaths a compared to any other phase of life.
According to W.H.O expert committee on maternal and child health aspect of
the low birth weighing less than 2.500 grams at birth is classified as low birth weight
irrespective of the period of gestation.
About 25 to 35 percent of babies in India are low birth weight as opposed to
about 5 to 7 percent of new born in the west. In India alone 6 to 8 millions low birth
weight infants are born annually (Meharban Singh, 2005).
Main causes of low birth weight babies are common in women belonging to
poor socio-economic status, under nutrition, chronic and acute systemic maternal
disease, and antepartum hemorrhage, and cervical incompetence, emotional stress in
physical exertion or trauma. Babies with congenital malformations are likely to be
delivered prematurely. (Meharban Singh, 2004).
Low birth weight babies are small in size with thin, gelatinous, shining and
pink skin. They have abundant lanugo, Ear cartilage is deficient. They have poor
muscle tone with sluggish automatic reflexes and slow or Ineffective sucking and
swallowing efforts, brest nodule is small or absent. (O.P GHAI, 2003).
The indications for hospitalization of a low birth weight babies include birth
weight less than 1,800 gram, neonate who is not able to take feeds from mothers or by
katori or a sick neonate. The principles of management of low Birth weight neonate in
he hospital is temperature maintenance, providing fluids, prevention of infection.
(Piyush Gupta, 2004).

Indira Shekar Rao.M, 2002 classifies at risk babies as babies weighing 1,500 to
2,000 grams, active at work with no signs of illness, main ting proper body
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temperature, with good sucking, ability to feed. All the mothers who delivers such
babies can be trained at home regarding feeding, warm , monitoring for dangers signs
, immunization, spacing, follow up and screaming . This can bring about 50%
reduction if neonatal mortality rate.
Home management is important because low birth weight babies have a higher
risk of dying before their first birthday and other suffer from recurrent infections or
neurological and development problems. Good progonis in growth and development
problems of such babies is purely dependant on the effectiveness of home
management (Behrman R& Shiono. P, 1995).
The nurse should give health education on home management of low birth
weight babies like maintenance of temperature, feeding, prevention of infection,
recognize danger signs, immunization and follow up and screening. (Piyush Gupta,
2004.
6.1 Need for the study
Every pregnancy is considered to be a precious pregnancy for the mother. The birth of
an infant is an event filled with wonder and joy for most of the families. (Jacinth
Christy Joy, 2004).
New born babies are not mini adults because they have anatomical and
functional immaturity of various body organs at different stages of life. They rapidly
develop life threating medical emergencies due their physiological instability. New
born babies are like flowers, they can rapidly wither following an acute illness but are
endowed with tremendous recuperative capabilities and when tended with care,
compassion and due concern for their physiological handicaps, they bloom back to life
with equal case, (Vishwanathan, J. Etal, 1995).
Home management is important because low birth weight babies have a higher
risk of dying before their first birthday and other suffer from recurrent infections or
neurological and development problems. Good prognosis in growth and development
problems of such babies is purely dependant on the effectiveness of home
management. (Behrman.R. & Shiono.P, 1995)
According to Indira Shekar rao, 2002, survival of the low birth weight babies
can be strengthened by training of personnel involved in health care delivery system,
reorientation of medical education and strengthening of the neonatal units. It is
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universally accepted that improved survival of low birth weight can be successfully
achieved by training education others and family members and home based care.
Bang Abhay, 2002 says that more than half of the child death could be
prevented if a new module home based neonatal care is tried.
Mothers are the natural custodian of the new born who care for their babies
with love, affection and with sense of commitment. They are the one who first notice
any change in babies condition or behavior. But due to ignorance, they fail in their
role and hence arises the need for sum education and support from health personnel.
(Jacinth Christy Joy, 2004.)
Ravikumar. M and Bhat B.V, 1995 conducted a study to find out early neonatal
mortality in a tertiary care hospital and found that early neonatal mortality rate was
26.6/1000 live birth. In their study, they concluded that health education to the mother
on new born care would significantly reduce early neonatal death.
According to Helen Yeo, 1992 the needs of the small require carefully
management in order to maximize their potential both in present and future. Their
needs encompass respiratory status, thermal environment, nutritions, observation,
skin integrity, positioning stimulation, parental environment.
The investigator, during her past experience as nice nurse, has observed the
recurrent readmission of low birth weight babies due to infection and with other health
problems. She has also observed lack of confidence and knowledge in caring for such
babies among the mothers and parental anxiety regarding prognosis of the child.
The need for early discharge due to unaffordability of the parents, busy ward
routine has barred the communication of home management of low birth weight
babies to the mother by any mean. The poor parental knowledge on home
management has resulted in poor child raring practice, frequent hospitalization and an
increase in mortality and morbidity rate.
The high cost of neonatal care at tertiary level and unaffordabitly of the parents
due to poor per capital income has necessitated the urged to prevent rehospitaliztion
through proper health education programme. These facts sensitized the investigator to
do a study to assess the knowledge of mothers on home management of low birth
weight babies.
6.2 Review of Literature
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The review of the related literature is an essential aspect of scientific, the study
has been organized under the following headings;
1. Literature related to low birth weight babies.
2. Literature related to home management of low birth weight babies.
3. Literature related to self-instructional module on home management of low
birth weigh babies.
1. Literature Related To Low Birth Weight Babies
According to NWEP- Pakistan, in his explanatory module on risk
factor for low birth weight in public hospitals at Peshawar, identified his risk
factors for small for gestational age babies as gestational age of less than 37
weeks, and maternal age below 2o years. Increased the incidence among tribal
area with presentation of anemia and the mothers having previous history of
abortions and miscarriage were also found to be significant independent
factors.
Prozialec et.al., (2000) in their article, in the article of Evaluation in a family
case management programme determining outcomes for low birth weight
deliveries, documented that a positive association was shown between the
early entry and increased use of prenatal services to improved birth out comes
in the subsequent programme.
Naran Anil and Sandesh Kiran (2002) did a survey to set the limit for
identifying low birth weigh babies. They observed that when birth weight
2,300 gram was used as limit for low birth weight. It constituted 29-46 of total
infants in India. He observed that babies between 2,000-2,500 gram are mostly
term and do not suffer significant in mortality and morbidity when compared
with babies weighing more the 2,500 grams. He recommend that if 2,000
grams is taken as a limit for low birth weight babies. Only 10% infant would
require special care. Therefore the neonatalogists recommended the use of
2,000 grams as the limit for identifying low birth weight babies.
2. Literature Related To Home Management Low Birth Weight Babies.
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Short et.al, 1996, in his experimental study on swaddling the preterm babies found, as
swaddling the preterm well in flexed position stimulated the position of the baby in
the uterus, it promoted hypertonicity, quieting behavior and more eye hand mouth coordination.
Rao Nagaraj, M. Etal, (1998) in their descriptive study in primary care of the new
born, reported that umbilical infection is more common in the first three days after
delivery. He suggested that washing hands before handling and feeding the baby
prevents 50% of infection.
Child Survival Safe Mother hood 1998, article on low birth weight discussed that the
risk of infection is higher in low birth weight babies and he emphasized that hand
washing with soap and water for at least four minutes before handling the baby is the
most effective method of prevention infection personnel with skin infection,
respiratory infection.
Sinclair J.C, 2000 in his experimental study conducted in Cocharne on servo control
for maintaining abdominal skin temperature at 36 C in low birth weight babies,
determined the effects of death and other important clinical out because targeting body
temperature rather than air temperature. He observed that there was a very important
reduction in death rate of low birth infants attributable to servo control of abdominal
skin temperature at 36 C.
Hopkins John, 2001, in his comparative study conducted in Bangladesh on the effect
of exclusive breast feeding on babies born small at birth observed that if such babies
are exclusive breast fed had significantly better chances for catch up growth compared
to small infants given other fluids or foods during first six months which only had
detrimental effect.
Ramnathan.K, Paul.V.K, Deorari, A.K Etal, 2001

in their experimental study

conducted in AIIMS New Delhi, on kangaroo mother care in low birth weight
infants, analyzed the effect of Kangaroo mother care on breast feeding rates, weight
gain and length of hospitalization. They observed that kangaroo mother care managed
6

babies had better weight gain, earlier hospital discharge higher exclusive breastfeeding than the control group.
Hopkin John, 2001, in his experimental study conducted in Ivan Hoe on role of zinc in
prevention of infection in low birth weight babies observed that zinc provided
substantial reduction in infectious diseases in low birth weight babies. He also found
that low birth weight infants had low zinc concentration in their blood and zinc
supplementation lowered the mortality rate.
Joshi Swati, 2002, in her article feeding in the low birth weight new born, Stated
that the composition of low birth weight and preterm mothers milk is suited to
increased requirement of certain nutrients of the preterm babies. Milk of suck mothers
contained higher content of protein, sodium, fatty acids, energy, calcium, magnesium,
zinc, copper, iron, Ig and other host defense factors. Such babies are fed at higher
volumes of 180-200 mi\kg\day may catch up growth.
Menon Janaki, 2002, in her descriptive study on relactation in mothers of high risk
infants has observed that reward of breast feed and relactation is possible even in
most unlikely of setting. Delayed initation of breast feed in an infant born with birth
weight 700 gram showed steady weight gain on exclusive breast feed.
Garman et.al, 2004, in their descriptive study conducted in Vermant to assess the
parents behavior on development low birth weight babies observed that low quality
parental behavior resulted in difficult temperament in small infant.
Sudha, Sujath 2002, In their prospective study on mortality and morbidity in 307 high
risk infants whose birth weight was less than 2000 grams found that, babies less than
2000 grams were hospitalized frequently and showed border line intelligent Quatient
at six years of age.
Camel T Collins, Phillip Ryan, Caroline, Andrew Jmcphee, Susan Petersen, 2004, In
their randomized controlled trial study on effects of bottles, cups and dummies on
breast feed in preterm infants, evaluated the dummies do not affect breast feed in
7

preterm infants. Cup feeding significantly increases the likely hood that the baby will
be fully breast feed at discharge time. But has no effect on any breast feed and
increases the length of hospital stay.
Meharban Singh, 2004, Stated that the low birth weight babies should be kept isolated
in one room and unnecessary visits by relatives should be avoided, strict hand washing
with soap and water before picking the baby or feeding the baby, should be properly
washed and sun dried.
Nursan Dede Cinar And Tuncay Muge Filiz, 2006,

They conducted study on

neonatal thermoregulation investigated the cold stress and hypothermia may have
serious metabolic consequences for all new borns there may be devastating and may
increase both morbidity and mortality rates among preterm.
Nea, Joffe And Jan Hall, 2006, investigated that low birth weight babies being
transported in car seats are at risk of suffering episodes of apnea, bradycardia, and
oxygen desaturation. To help minimize these risk, the authors have begun the process
of implementing car seat oxygen saturation testing in their own unit as well as
informing a car seat manufacturer of the need to avoid respiratory instability in these
vuleranable infants and to improve the babys sitting position while in the car seat.
Leanne Monterosso And Linda Kristjanson, 2006, Conducted study on Neuro motor
development and physiologic effects of position in very low birth weight infants,
analyzed that the prone position is physiologically more beneficial for the preterm
infants than supine and lateral positions.
Em Mc Call, Fa Alderdile, Hl Halliday, Jg Jenkins, S.Vohra, 2008, In their
comparative study on Interventions to prevent hypothermia at birth in preterm and or
low birth weight infants, analyzed that skin to skin care was shown to be effective in
reducing the risk of hypothermia when compared to conventional incubator care for
infants of 1,200 to 2,199 grams birth weight. The Tran warmer mattress kept infants
less than 1,500 grams significantly warmer and reduced the incidence of hypothermia
and admission to NICU.
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3. Literatures Related To Self- Instructional Module on Home Management of Low

Birth Weight Babies.
Pinhate Muss, Gonclaves, And Foss, 1993, in their evaluative study on determine the
effect of BCG vaccination on Intra Uterine Growth Retardation, babies observed that
immunigenicity of BCG vaccines is similar in term infants who have Normal
abnormal Intra uterine growth. Hence BCG vaccination should not be delayed in Intra
Uterine Growth Retardation babies.
Kumar Rajesh And Aggarwal Arun.K 1996, In their no experimental study on
assessing the accuracy of maternal perception of neonatal temperature, reported that
mothers could correctly categorized 24.6% babies as very cold, 46.7% babies as
moderately cold and 32% of babies with cold stress by touching.
Blake.A , Stewart.A, Turcan.D, 2000, In their long term follow up study to assess the
emotional status of the mothers of low birth weight babies due to their prolonged
hospitalization observed that mothers underwent a stage of emotional crisis until the
parents had the child back at

home. They also observed that parents formed

satisfactory relationship with their children and they tended to be of over protective
and anxious.
According To O.P. Ghai, 2003, in Essential pediatrics, documented nutritional
requirement of low birth weight babies and method of feeding for low birth weight
babies, micro nutrient supplementation of low birth weight infants fed human milk.
Meharban Singh, 2004, Explained in Essential pediatrics for Nurses that home care
of low birth weight babies, the mother should be given detailed instructions to keep
the baby warm and mother should be trained to assess the temperature of baby by
touch.
Frank.M.Ringstedand Hellasamelsan, 2006, In their Ethnographic study on Early
home based recognition of anemia via general danger signs in children in a malaria
endemic community in north east Tanzania, assessed that the recognition of anemia
9

via general danger signs as the infant unable to breast feed, weak, sleeping all time,
convulsing, loosing consciousness, there will be actual of evolving moderate to severe
anemia.
Nirmala.P, Swrna Rekha and Maryam Washigton, 2006, conducted a study on
Kangaroo mother care; effect and perception of mothers and health personnel,
assessed no significant changes were observed all the physiological parameters during
kangaroo mother care and routine care. Perceptions of mothers and health personnel
were positive towards kangaroo mother care.
Statement of Problem: Effectiveness Of Self Instruction Module On Home
Management Of Low Birth Weight Babies Among Postnatal Mothers At Selected
Hospital, Bangalore.
6.3 Objective of This Study
1. To assess the knowledge on home management of low birth weight babies among
postnatal mothers before intervention.
2. To find the effectiveness self instructional module on home management of low
birth weight babies among postnatal mothers.
3. To find the association between post test knowledge scores of postnatal mothers
and their demographic variables.
Operational Definition
1. Effectiveness: Significant gain in the knowledge as determined by the statistical
difference in the pretest and post test knowledge scores on home management of low
birth weight babies among postnatal mothers.
2. Self Instructional Module: Refers to systematically organized series of content on
home management of low birth weight babies. It includes meaning, causes, sign and
symptoms, methods and techniques of home management of low birth weight babies.
3. Low Birth Weigh Babies: Refers to the new born whose birth weight is less than
2,000 gram regardless of gestational age.

10

4. Home Management: Refers to the rearing and caring practice of low birth weight
babies at home after discharge from the hospital.
5. Postnatal Mother: Refers to a woman admitted in postnatal ward and neonatal
intensive care unit and who had given birth to a baby weighing less than 2,000 grams.
Hypothesis
H1: There will significant difference between post test knowledge scores of postnatal
mother in experimental group and control group.
H2: There will significant association between post test knowledge scores of postnatal
mothers and their demographic variable.
Assumption
1. Mothers with low birth weight babies may have some knowledge on home
management of low birth weight babies.
2. Self instructional module may promote safe practices and better survival of low
birth weigh babies.
Limitation
The study will be limited to mother:1. Who will give birth to a baby with less than 2000 grams,
2. Who will be physically and mentally fit to take care for their babies,
7. Materials and Methods
7.1

Source of Data

7.2

Method of Data Collection

Research Designs

Postnatal mothers with low birth weight

babies admitted in the postnatal ward
and Neonatal intensive care unit.
Experimental design with control group
will be used to assess the effectiveness
of self instrumental module on home
management of low birth weight babies.

Setting

This study will be conducted at

selected hospital in Bangalore.

Population

Postnatal mothers
11

Sample

Postnatal mothers with low birth weight

babies will be the samples of the study

Sample Size

30 postnatal mother for experimental

group and 30 postnatal mother control
group postnatal mothers with low birth
weight babies

Sampling Techniques

Purposive sampling techniques will be

used to select the postnatal mother will
low birth weight babies.

Inclusion criteria

Postnatal Mothers willing to participate

Postnatal Mothers available at the time
of data collection.
Postnatal mothers who knows to read,
write and speak Kannada.

Tools

Structured

questionnaires

and

self

instructional module will be used to

collect the data from postnatal mothers
with low birth weight babies.
Data Collection

Prior to the data collection written

permission will obtained from the
concerned hospital authorities. The
investigator herself will collect the data
from the mothers through structured
Questionnaires

before

and

after

intervention.
Data Analysis, Presentation And

The collected data will be organized,

Interpretation

tabulated

and

analyzed

by

using

descriptive and inferential statistics.

Descriptive statistics includes, mean,
median, mode, percentage and standard
deviation. Inferential statistics include
Chi

square

effectiveness

test
of

to
self

assess

the

instructional
12

module. The results will be presented in

the form of tables diagrams and graphs.

7.3 Does the study require any investigation of interventions to be conducted on

the patients or other humans or animals? If so, describe briefly.
Yes, study will conducted on mothers with low birth weight babies who
admitted in postnatal ward neonatal intensive care unit.

7.4. Has ethical clearance been obtained from your institution in case of 7.3?
Yes, informed consent will be obtained from concerned subjects and authority
of institution.
Privacy, Confidentiality and anonymity will be guarded.

Ethical Committee
TITLE OF THE TOPIC

Effectiveness of self instruction module

on home management of low birth
weight babies among postnatal mothers
at selected hospitals, Bangalore.

NAME OF THE CANDITAE

LATHA.U.S

COURSE AND SUBJECT

M. Sc. Nursing
PAEDIATRIC NURSING Specialty

NAME OF THE GUIDE

Prof. Elizabeth Dora

Head of the Department
Department of child health nursing
Diana college of Nursing, Bangalore.

Ethical Committee

APPROVED

Members of ethical committee

1. Prof. Veda vivek
Principal and HOD
Department of Community Health Nursing
13

Diana College of Nursing, Bangalore 64

2. Prof. Elizabeth Dora
Head of Department
Department of the Child Health Nursing
Diana College of Nursing, Bangalore - 64
3. Prof. Kalaivani
Head of the Department
Department of Obstetrics and gynecological Nursing
Diana College of Nursing, Bangalore 64
4. Prof. Vasantha Chitra
Head of the Department
Department of Medical Surgical Nursing
Diana College of Nursing, Bangalore 64
5. Prof. Surendra
Biostatistician, GKVK, Jakkur, Bangalore.

List of References
Books

1. O P Gahi , Piyush Gupta , V K Paul , Essential pediatrics

5th edition, mehta publishers .,2003.
2. Meharban Singh Essential pediatrics for nurses.,
1st edition. sagar publications., new delhi-2004.
3. Dawn C.S., Textbook of Obstetrics and Neonatology., 12th
edition. Calcutta. New Central Book Agency Private Limited., 1997.
4. Nelson. Wallow etal., Nelson Textbook of pediatrics., 15th edition.,
Philadelphia. W.B.Saunders company. 1996.
5. Robertson. N.R.C., Textbook of Neonatology., 2nd edition., Tokyo.,
Churchill Livingstone., 1992.
6. Viswanathan.j.etal. Achars Textbook of Pediatrics. 3rd edition.,
Hyderabad. Orient Longman Publication.,1995.
7. Piyush Gupta Essential pediatric Nursing, 5th edition, A.P.jain&co ,

2004.
8. IGNOU school of health sciences, Pediatric Nursing,2006.
Journals

1 .Prozialeck , Linda L and Persole , Lorne Evalution in a family case

management programe; determining outcomes for low birth weight
14

deliveries. 17 (3) ; 195-201 , May/June 2006

2 Camel T Collins , Philip Ryan , Caroline AndrewEffects of Bottacles , Eups
& Clummies Jmcphee , Susan Paterson on Breast feed in preterm infants.
18th June 2004 P-193-198.
3.Nurosan Dede Cinar and Tuncay muge Filiz , Neonatal Termo
regulation.April 2006
4.Em Mc Call, FA Alderdice, HL Halliday JG Jenkins, S.Vohra Interventions
to prevent hypothermia at birth in preterm and /or low birth weight
infants2008.
5. Nea , Joffe and Jan hall , Jouranal of neonatal nursing ,June 2006.
6. Leanne monterosso and Linda krist janson Neuro motor development and
physiologic effects of positioning in very low birth weight infant, 9th march
2006 , p 138-146.
7. Nirmala . p , Swarna rekha and Maryam Washington , kangaroo mother
care; effect and perception of mothers and health personnel act 2006 ,
P 177-184.
8. Frank ,m.Ringsted and helle samelsen Early home based recognition of
anemia via general danger signs in young children in a malaria endemic
community in north east Tanzania ,Nov 2006.
9. Blake A, stewart A and Turcan D., Parents of very low birth weight
babies
,Ciba Found Symp., 1995.,P 271-288.
10.Garman, parents behavior affects development of low birth weight
babies,Journal of developmental and behavioral pediatrics,, December
1999, p 112-114.
11. Hopkins john , Exclusive breast feeding in small babies, Journal of
clinical nutrition, March 2001,p 156-158.
12. Hopkins john , Zinc in prevention of infection in low birth weight
babies,Paediatrics, ,January 2001, p 1280-1285.
13.Kumar Rajesh and Aggarval Arun , Accuracy of maternal perception of
neonatal temperature Indian Paediatrics, September 1991,p 553-554.
9. Signature of Candidate
15

10. Remarks of the Guide

The research topic selected by the

candidate is relevant as it is on the
aspect on new born care. Hence, there is
a need to assess the knowledge of
postnatal mothers on home management
of Low Birth weight babies at their
home setting.

11. Name and Designation of

Guide

Prof. Elizabeth Dora

Head of the Department
Department of child health nursing
Diana college of Nosing, Bangalore-

Signature
Head of the Department

Prof. Elizabeth Dora

Head of the Department
Department of child health nursing
Diana college of Nosing, Bangalore-

Signature
12. Remarks of the Chairman
and Principal

The research topic selected is relevant

and forwarded for your needful action.

12.1 Signature

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