INTRODUCTION:

The neonatal period is the first four weeks of a child's life. It is a time when changes are very rapid. Many critical events occur in this period.⁷Feeding patterns are established and bonding between mother and infant begin. The immediate care of the newborn is imperative for their short-term health. Neonatal care refers to that care given to the newborn from the time of delivery through about the first month of life.¹

Comparatively, the probability of dying after the first month but before reaching age 1 was 12 and after age 1 but before age 5 was 10⁸. Globally, 2.5 million children died in the first month of life in 2017 alone-approximately 7,000 neonatal deaths every day-most of which occurred in the first week, with about 1 million dying on the first day and close to 1 million dying within the next six days.²

India is a country of diversity and wide range of cultural practices in all regions⁹. Various community data obtained support a strong influence of various cultural practices on mortality and morbidity of the mother and the new born. There are various traditional and cultural practices followed which affect the newborn¹⁰. A family which mirrors values, traditions, customs and beliefs, i.e. culture of a society to which it belongs, plays an important role in physical, psychological, social development and health in children.³

STATEMENT OF THE PROBLEM:

A Study to explore the myths related to the care of neonates among mothers of Pallithottam area at Kollam.

OBJECTIVES:

To explore the myths related to care of neonates among mothers of Pallithottam area at Kollam.

REVIEW OF LITERATURE:

1. Studies related to prevalence or incidence of neonatal mortality or morbidity:

A Neonatal Disease Surveillance Study (NDSS) was conducted in Ramtek Revenue Block, Nagpur district, Maharashtra state, where high level of neonatal mortality was observed. All households from five selected primary health centers were screened. Both active and passive surveillance systems were used for systematic collection of mother's health during pregnancy and of baby's health from birth to 4 months after birth. First-year results from November 2006 to October 2007 were presented. The Neonatal Disease Surveillance Study (NDSS) measured the incidence of high-priority neonatal diseases, neonatal health events and associated risk factors to plan appropriate and effective actions. Pregnancy outcomes were available for 1,136 women, with an overall neonatal mortality of 73 per 1,000 live births. The pregnancy outcomes varied by gestational age of the baby; miscarriages and abortions were higher in tribal than in non-tribal women, and tribal women had higher rates of low-birth 9 weight (LBW) neonates than non-tribal women. Tribal communities have inequalities in health care due to the distances that they have to travel. Study findings for morbidity showed that tribal women's babies experience higher sickness based on mothers’ practices-delay in initiation of breastfeeding, unhygienic cord care practices, inadequate number of visits for ANC and non-immunization of the mother against tetanus. Some of these may be attributed to the fact that tribal women have less readyaccess to healthcare facilities than non-tribal women.⁴

2. Studies related to factors affecting neonatal mortality or morbidity:

A Prospective study was conducted to determine the cause and disease pattern of neonatal morbidity and mortality in the secondary care neonatal unit of a districthospital It was conducted in Department of Paediatrics, General Hospital, Chandigarh. All neonates who born in General Hospital, Chandigarh, over 1 year were included inthe study. Outside born neonates and those who were re-admitted in the neonatal nursery after their discharge from hospital were excluded from the study. All consecutive live-born babies in the period of 1-year were included in the study. Babiesreceived in labour room or operation theatre were assigned Apgar score, and vitalparameters were recorded. Sick babies were shifted to neonatal nursery as peradmission policy, and rest of the babies were shifted with mother. All the babies were examined within 24 h of birth and daily thereafter till their discharge from the hospital.There were 6509 live births, of which 50 were twin pairs and 6409 were singleton birth.About 4.33% babies were born prematurely (<37 weeks), 21.7% babies were low birthweight (LBW) (<2500g) including 0.4% very LBW (VLBW) babies (<1500g), and 0.26% as extra LBW (ELBW) (<1000g) babies. Five hundred and ninety-two (9.09%) babies were suffering from various morbidities, and 67(1.03%) died during the hospitalstay. Hyperbilirubinemia (7%) was the leading cause of neonatal morbidity followedby sepsis (3.99%) and respiratory distress (3.9%) among the various causes ofrespiratory distress transient tachypnea of the newborn was the leading cause (33%) followed meconium aspiration syndrome (20.5%) and pneumonia (14.9%). Hyalinemembrane disease was seen in 11.8% of cases. Congenital malformations were seen in 1.75% of cases. Limb defects (31.3%) were the most common malformation followedby cardiac 49.9%, neural tube defect (13.9%), and Down syndrome 7.8%. Birthasphyxia (29.85%) and respiratory distress (22.38%) were the leading cause of death followed by extreme prematurity (22.3%) and sepsis (14.9%). Morbidity and mortality among LBW babies (22.3% and 3.53%) and ELBW (100% and 88%) and VLBW(84.6% and 46.2%) were higher as compared to normal birth weights (5.44% and 0.33%). Morbidity and mortality among preterm babies (58.5% and 11.7%) were highas compared to term babies (6.97% and 0.53%). Morbidity was higher among large for date babies (41%) as compared to small for date (SFD) (17.7%) and appropriate for date (AFD) (6.8%) babies higher mortality was seen in SFD babies (1.9%) as comparedto 0.8% in AFD babies. The study concluded that Hyperbilirubinemia, sepsis,respiratory distress, birth asphyxia, prematurity, and neonatal sepsis were the leadingcauses of neonatal mortality.⁵

3. Studies related to myths regarding the care of neonates.

A descriptive study was conducted to identify and analyze the traditional practices of newborn care used in Kerala, to chalk out the deviations from the WHO guidelines, to identify the areas of potential resistance for behavior change and to recommend the desired interventions necessary for improving newborn care. A preliminary data regarding neonatal practices was collected via literature review and random feedbacks from the various faculties in the campus of Ahalia Ayurveda Medical College. Based on utility and futility, National Neonatology Forum has classified traditional health care practices of neonatal care into four main groups. The practices followed in Kerala ones were assorted under the respective categories. I. Useful traditional practices 1. Drinking milk and avoiding tea or coffee during pregnancy. 2. Sexual abstinence during pregnancy. 3. Confinement and delivery at mother’s place. 4. Oil massage of the duo. 5. Universal and prolonged breast feeding. 6. Use of ‘gokarna’ / ‘paalada’ for feeding. 7. Nursing babies in sitting position8. Putting ‘Parnayavani’ (Coleus aromaticus) leaf in the anterior fontanel of the infant. 9. Isolation of mother and child for the first 40days following delivery.10. The mother is encouraged to nurse the baby and sleep alongside her the whole day during the initial days of postpartum. 11. Restriction of heavy foods during the initial days following delivery. II. Harmful traditional practices 1. Restriction of food intake of pregnant woman. 2. Use of rags during delivery 3. Application of kajal to eyes. 4. Use of pacifier/dummy nipple. 5. Early/Delayed weaning. 6. Typical massaging procedures. 7. Bathing mother in steaming water during the first month after delivery. 8. Giving pre-lacteal feeds like honey, tea etc. 9. Avoiding intake of certain foods during lactation. 10. Giving water to breastfed babies III. Inconsequential traditional practices 1. Circumcision. 2. Giving pre-lacteal feeds like glucose water, jiggery water etc. 3. Nose and ear piercing. 4. Removing bad eye. 5. Massaging of anterior fontanel of the newborn. 6. Making or buying clothes for baby only after delivery. 7. Blowing into the crown and ear of the baby after bath. 8. Keeping articles made of iron under the pillow of the mother. IV. Traditional practices of Doubtful utility 1. ‘URAMARUNNU’- a mixture of traditional medicines given to neonates on the 28th day following birth. 2. Administration of Grape water. 3. Use of a variety of traditional galactagogues. 4. Wearing of threads with Panchaloha around the hip of the infant. Among the thirty-three neonatal practices considered for the study, 11 were identified as useful, 10 of them as harmful, 8 were found inconsequential and 4 of them as of doubtful utility. Traditional practices have been found to dominate newborn care in developing countries. Despite organizations like the National Neonatology Forum incessantly working to educate the public, itis a matter of serious concern that there are some harmful traditional practices followed blindly through generations.⁶

MATERIALS AND METHODS:

Methods:

Quantitative approach was used in this study to explore the myths related to care of neonates among mothers.

Non Experimental Exploratory Research design was adopted for the study. Research variable is the variable considered in the study which was myth related to the care of neonates. The present study was conducted in selected community area at Kollam.In this study the accessible population comprise of mothers who is taking care or has taken care of a neonate.In this study sampling technique adopted was convenient sampling.

Tools/Instruments:

Tools consisted of two sections: Section A-demographic variables and Section B-self structured questionnaire which were validated by the experts.

Data collection:

Data were collected after obtaining prior administrative permission and informed consent from mothers. The tools for data collection were demographic proforma including age, education, occupation, type of family and income and a self-structured questionnaire to explore the myths related to care of neonates among mothers.

The main data collection for the study was conducted from 10/12/2018 to 15/12/2018. The settings for the study was Pallithottam area at Kollam. The investigator obtained a formal written permission from the concerned authorities. The mothers in the community area who fulfilled the sampling criteria were identified. The investigator introduced herself to the subjects and explained the purpose of the study to them. Confidentiality was assured and written consent was obtained. The mothers were given checklist consisting of 30 questions and requested them to go through the checklist and put tick mark in the relevant columns. The investigators collected the completed checklist for data analysis.

Data analysis:

The data were analyzed using descriptive statistics. Simple characteristics were analyzed using frequency and percentage distribution.

RESULT:

Based on utility and futility, National Neonatology Forum has classified traditional health care practices of neonatal care into four main groups namely ‘useful, harmful, inconsequential and of doubtful utility’. Among the thirty neonatal practices considered in the study, 13 were identified as harmful, 8 of them as useful, 5 were found 42 inconsequential and 4 of them as of doubtful utility. 100 mothers were selected for the study and each of them were given a checklist consisting of 30 myths related to the care of neonates and they were asked to give their opinion by putting tick mark in the ‘yes’ or ‘no’ option against each practice. Out of the 100 mothers selected for the study, in harmful practices 26% of mothers follow low harmful practices, 34% of mothers follow average harmful practices and 40% follow high harmful practices. In useful practices 56% follow low useful practices, 35% follow average useful practices and 9% follow high useful practices. Among practices of doubtful utility 30% follow practices of high doubtful utility, 38% follow practices of average doubtful utility and 32% follow practices of low doubtful utility. Among inconsequential practices 4% follow high inconsequential practice, 12% follow average inconsequential practices and 84% follow low inconsequential practices.

Table 1: Frequency and percentage distribution of prevalence of myths related to care of neonates

Sl. No.	Exploration of myths related to care of neonates	Frequency	%
1	Harmful Practices
	· Low harmful practice	26	26%
	· Average harmful practice	34	34%
	· High harmful practice	40	40%
2	Useful Practices
	· Low useful practice	56	56%
	· Average useful practice	35	35%
	· High useful practice	9	9%
3	Doubtful Utility
	· High doubtful utility	30	30%
	· Average doubtful utility	38	38%
	· Low doubtful utility	32	32%
4	Inconsequential Practice
	· High inconsequential practice	4	4%
	· Average inconsequential practice	12	12%
	· Low inconsequential practice	84	84%

DISCUSSION:

The present study finding is consistent with another study, which was conducted in Ahalia Ayurveda Medical College.The study was conducted to identify and analyze the traditional practices of newborn care used in Kerala, to chalk out the deviations from the WHO guidelines, to identify the areas of potential resistance for behavior change and to recommend the desired interventions necessary for improving newborn care.Among the thirty-three neonatal practices considered for the study, 11 were identified as useful, 10 of them as harmful, 8 were found inconsequential and 4 of them as of doubtful utility.

In the present study48.31% of the mothers have positive attitude towards the harmful practices, 70% have positive attitude towards useful practices, 96.4% have positive attitude towards inconsequential practices and 70.75% have belief towards practices of doubtful utility.

CONCLUSION:

The present study was aimed to explore the myths related to care of neonates among mothers of Pallithottam area at Kollam. The study result showed that there are certain myths related to care of neonates still prevalent among mothers of Pallithottam area at Kollam.

The most prevalent myths are given below: 1) Applying artificial kajal in the eyes of newborn. 2) Tying black thread and beads around the neck and wrist of the newborn. 3) Giving pre-lacteal feeds such as honey and sugar soon after birth. 4) Giving water to the breastfed babies. 5) Isolating the mother and the baby from crowd areas for the first 40 days following delivery. 6) Giving oil massage to the baby. 7) Practicing sunbathing for the baby early in the morning. 8) Bathing the baby daily. 9) Massaging the anterior fontanelle of the baby with oil. 10) Massaging the baby’s nose for reshaping it.

RECOMMENDATIONS:

Based on the findings of the study, it is recommended that,

· A similar kind of study can be conducted for a larger group of mothers.

· An experimental study can be conducted to assess the effectiveness of structured teaching programme on knowledge regarding harmful traditional practices related to neonatal care among mothers.

REFERENCE:

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3. P Sasikala, C Jyothi, V Chandrasekhar, C Kumar, S Bhaskar. A Study on Traditional Beliefs and Practices in Newborn Care Among Women. NJRCM. 2017 Apr-Jun; 6(2). 120-124.

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10. The Cambridge dictionary [Internet]. Cambridge university press; 2019. Available from: https://dictionary.cambridge.org/dictionary/ english/explore

Received on 05.03.2021 Modified on 12.04.2021

Asian J. Nursing Education and Research. 2021; 11(3):391-394.

DOI: 10.52711/2349-2996.2021.00094