CHAPTER I: INTRODUCTION

1.1 Background

Postnatal is a period which begins after child birth till 6 weeks ; it is a critical transitional period for a women and
her newborn. The principal objectives of postnatal care services are to provide the quality services to postnatal
women and her newborn to provide the healthy environment to help and support for the adjustment with the
changes. The World Health Organization (WHO) describes the postnatal care as the most critical and most neglected
phase of the life of the mothers and babies as most of the death occur during the postnatal period. According to
WHO : more than 500000 women die each year due to complication of pregnancy. The fact that two thirds of
maternal and newborn deaths occur in the first two days after birth due to the inadequacy of care.

Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. `99% of all
maternal deaths occur in developing countries. (WHO) 2014. The maternal mortality ratio (MMR) for Nepal is 239
deaths per 100,000 live births NDHS 2016.

1.2 Problem statement

Mothers and newborns are vulnerable to illness and deaths during the postnatal period. Postnatal period is known as
the important part of maternal health care as the serious and life threatening complications can occur in postnatal
period. As health of mother is known as the indicator of society development so postnatal care is important for the
health of mother and newborn, family and for their community. Worldwide nearly 600000 mothers between the age
of 15-49 years die every year due to complication arising from pregnancy and childbirth. This means almost every
minutes of every year maternal death occurs, 99% of which occur in developing countries. In developed countries,
the maternal mortality ratio is around 27%/100000 live birth and in developing country the ratio is 20 times higher.
Awareness programs are required to improve knowledge on the different aspects of postnatal care.

1.3 Significance of the study

The assessment of current level of knowledge and practices on postnatal care can provide valuable data to the health
care professionals and policy- making bodies.

It can thus contribute in the designing of effective interventional strategies which can fill the gaps of knowledge
and improve practice

1.4 Research question

What is the level of knowledge and practice of postnatal women regarding postnatal care attending tertiary level
hospital of Gokarneshwor municipality?

1.5 conceptual framework:

1.6 Variables

Independent variables: knowledge and practice

Dependent variables: postnatal care

1.7Operational definitions

Knowledge:

In this study, Knowledge refers to the level of understanding and information about postnatal care. Knowledge
will be assessed with a self-constructed semi-structured questionnaire which has been formulated after a
comprehensive literature review and consultation with subject experts. In the semi- structured questionnaire,
knowledge regarding postnatal care will be divided and assessed as follows:

A. Knowledge related to postnatal care

B. Knowledge regarding component of postnatal care

Scoring interpretation:

0-50%: Inadequate knowledge

51-75% : Moderate knowledge

>76%: Adequate knowledge

Practices on postnatal care .

It refers to utilization and use of postnatal care for early recovery of maternal health and helping the newborn to
adjust to the new environment. And helping to prevent from complication to both mother and newborn. Practice
behaviors adopted by the sample population for prevention and early detection of danger sign on both mother and
newborn . The practices on “postnatal care” will be assessed by using semi-structured questions which will be
divided into two parts:

PART-I: Questions regarding practices on postpartum mother care

PART-II: Questions regarding postnatal newborn care .

CHAPTER II: LITERATURE REVIEW

2.1 Introduction

For the study being conducted, literature review was done through both manual and electronic searching such as
through books (published and unpublished), journals, articles, reference lists, national reports, and different
databases like Google Scholar, HINARI, PubMed, PLOS ONE and Medline. Key words such as knowledge,
practice, postnatal care, were used for electronic searches. This literature review will mainly focus on summary,
synthesis and comparison and critique of related literatures regarding the relationship between knowledge and
practice on postnatal.

2.2 Review of Literature

Keithellakpam Memchoubi, Aakash Kudale, Laishram Lilileima, Liji Koshy and Shubhangi Londhe, 2017 .
level of knowledge on postnatal care is affected by many factors, here the study is conducted to assess the
knowledge of postnatal mothers regarding self-care after childbirth in Bharati hospital and research centre, Pune.
Study contains respondents of 100 postnatal women . The research design used for the study was exploratory survey
design. Findings of the study reveal that most postnatal mothers were having good knowledge but still there are
postnatal mothers whose knowledge level are average and poor. It shows that postpartum care is still limited and it
requires greater attention commitment from health professional. There is no significant association between the
selected demographic variables and the knowledge of the postnatal mothers regarding self-care after childbirth i.e.,
age, education, number of children and income of the family.

BC. Chembe and S. Siziya , 2017. Level of knowledge on postnatal care is associated to many factors, here the
study is conducted to access level of knowledge on postnatal care and its associated factors in Ndola, Zambia. Study
contains respondents of 268 mothers as sample size. Among the respondents 18.7 % had knowledge on postnatal
care. The results also show that the majority of women did not know what postnatal care is with regard to, postnatal
care timing, activities conducted in postnatal clinic and benefits of utilizing postnatal care services. Knowledge on
postnatal care was only significantly associated with respondents education level .

Muna Maharjan, Babita Singh, 2017. Knowledge on postnatal care is affected by various factors , here the study
is conducted to access knowledge Regarding Postnatal Care Among Postnatal Mother: A Hospital Based Study
.Non probability purposive sampling is use to select the postnatal mothers. Study contains respondents of 57
mothers as sample size. Among 57 postnatal mother half of the postnatal mothers, 30 (52.63%) had average level of
knowledge regarding postnatal care. Highest knowledge was in the area of breastfeeding and lowest in the areas of
family planning.

Pradhan (Thaiba) A, Rani U, 2017. Postnatal care is affected by many factors ,this study tries to identify the
relationship between knowledge and practice ON SELECTED ASPECTS OF POSTNATAL CARE AMONG
POSTNATAL MOTHERS. This is a quantitative research. The purposive sampling technique was used to select the
60 samples of postnatal mothers. The collected data were analyzed by using descriptive and inferential statistics.
Thirty Three (55%) respondents were having moderately adequate knowledge regarding selected aspects of
postnatal care, 24(40%) were having inadequate knowledge and only 03(05%) of respondents had adequate
knowledge . The level of practice was out of 60 respondents, 29(48.33%) respondents were having inadequate
practices, 26(43.33%) were having moderately adequate practices and only 05(08.34%) of them had adequate
practices on selected aspects of postnatal care. The findings of the study conclude that the postnatal mothers had
moderately adequate knowledge and practices on selected aspects of postnatal care.

P. Kavitha, R. Aroun Prasath, P. Krishnaraj, 2012. Postnatal care is affected by many factors ,This research
aims to assess the knowledge regarding postnatal care among the postnatal mothers . A study was done among 20
samples . The research design for this study was non-experimental descriptive design. Samples were selected by
convenient sampling method. Structured interview questionnaire was used as evaluation tool. The present study
concluded that knowledge assessment regarding postal care among the postal mothers shows that 85% of mothers
had moderately adequate and 15% had adequate knowledge.

2.3 Summary

The majority of the studies show that there is a correlation between knowledge and practice on postnatal care.
Maximum maternal women have moderately adequate knowledge regarding thee postnatal care, even though
women have knowledge but they are not using their knowledge for the proper practice of postnatal care. women
have higher knowledge in danger sign but lacking information on family planning.

CHAPTER III-RESEARCH OBJECTIVES

General objective:

To assess the level of knowledge and practice of postnatal women regarding postnatal care attending tertiary level
hospital of Gokarneshwor municipality.

Specific objectives:

• To identify the level of knowledge of postnatal women regarding postnatal care

• To determine the practice of postnatal care among postnatal women.

• To assess the factors influencing postnatal care

• To assess the relationship between knowledge and postnatal care

CHAPTER IV- RESEARCH METHODOLOGY

4.1 Study Design: A descriptive cross sectional study

4.2 Study Sitting: NMCTH gyne OPD and PNC ward.

4.3 Target Population: postnatal women

4.4 Study Population: postnatal women attending at NMCTH

4.5 Sample size calculation

The study results shows that most of the respondents 123 (62.76%) had average knowledge whereas 72(36.73%) had
good knowledge and 1(0.51%) had poor knowledge on postnatal care. The maximum knowledge score was 78 and
minimum knowledge score was 27. The overall mean knowledge score was 56.62. Most of the respondents
123(62.76%) had average level of knowledge on postnatal care. Highest knowledge was in the area of danger sign of
mothers and newborn and the lowest in the areas of family planning. The overall mean percentage was 64.34.

The sample size was calculated using above , assuming 95% confidence level, that is 1.96, and a sample error of
10%, sample size was calculated using the following formula:

n = (Zα1/2)2 pq /d2

n= ((1.96)2 𝑥 0.6276 𝑥 0.3734)/(0.09)2

n = 112

In above formula ,

n = required sample size

z = confidence interval at 95 % (standard value 1.96)

P= (62.76%) = .6276

q = 1-p = 0.3734

d = allowable error; 9% of p= 0.09

Considering 10% response error,

10 % of 112= 11.2

Thus, the final sample size is 112 + 11.2 = 123.2

4.6 Sampling Technique : Non probability- purposive sampling

method

4.7 Tools for Data Collection: Self-constructed questionnaire with three main parts will be used which has been
formulated after a comprehensive literature review and consultation with subject experts.

PART-I: Socio-demographic data

PART-II: Knowledge regarding postnatal care

PART-III: Practices regarding postnatal care.

Techniques of Data Collection: Interview method.

Pre-test: Pretesting will be conducted in 10% of the total sample population that is n=237 among the postnatal
mother visiting NMCT Validity and Reliability of the tool:

The content validity of the instrument will be maintained by consulting with research advisor, subject experts and
different literature review. Cronbach’s alpha correlation test will be used to test internal consistency of tool.
4.8 Inclusion Criteria:

Postnatal women visiting NMCTH.

Women giving consent for participation.

4.9 Exclusion Criteria:

Female visitors in wards or OPD and women who have not given

4.10 Data Processing and Analysis:

Data processing will be done using SPSS (Statistical Package for Social Science) software version 16. Mean,
percentage and frequency will be used for data analysis, Chi-square will be used for association of different socio-
demographic variables with the knowledge regarding Postnatal care .

4.11 Ethical Considerations :

1. Ethical approval will be obtained from NMC-IRC.

2. Permission will be taken from NMCTH for conducting research.

3. Verbal and written consent will be taken from all the participants

before data collection and confidentiality of the study participants

will be maintained.

4. The participants could withdraw from the study at any time without giving reason and without fear.

5. Anonymity will be maintained by using numerical codes for each

participants.

4.12 Delimitation :

Only one hospital will be included, thus study cannot be generalized.

Non-probability sampling technique will be used.

4. 13 Plan for Dissemination:

Oral form:

Oral or poster presentation at conferences, seminars, workshop when possible

Written form:

Research report will be submitted to department, review committee, hospital and library.

Research will be published in peer-reviewed journals if accepted.

4.13 Work plan:

4.14 Rationale of study:

According to sustainable goal (2014-2030) of Nepal it includes 17 goals among them third goal is directly link
with health and it consist of 9 targets among which target 1 and 2 focuses on maternal and newborn respectively.

It is targeted that: By 2030, SDG 3 targets for Nepal for 2030 are to reduce maternal mortality ratio (MMR) to
less than 70 per 100,000 live births, to reduce prevent-able deaths to less than 1 percent of newborns (neonatal
mortality to at least as low as 12 per 1000 live births)

Owing to the global target, there is demand for more research in the field and hence strategies to increase the
knowledge and practice among postnatal women. However, not many studies have been conducted in Nepal on the
topic. Besides, being personal interest in maternity health has also prompted for the study.

4.15 Budget Plan

4. 16 References:
1. Organization, W. H. (2019). Maternal mortality. World Health Organization.

2. pariyar, s. (2016). knowledge and practice regarding postnatal care among mothers residing in selected slum area
of dharan, Nepal . international journal of health and medicine vol (1), 15.

3. Keithellakpam Memchoubi, A. K. (2017). A study to assess the knowledge of postnatal mothers regarding self-
care after childbirth in Bharati hospital and research centre, Pune. International Journal of Applied Research.

4. BC Chembe1, S. S. (2017). Level of knowledge on postnatal care and its associated factors in Ndola, Zambia.
Ndola, Zambia: semanticscholar.

5. Muna Maharjan, B. S. (2017). Knowledge Regarding Postnatal Care Among Postnatal Mother: A Hospital Based
Study. International Journal of New Technology and Research(IJNTR).

6. P. Kavitha, R. A. (2012). A STUDY TO ASSESS THE KNOWLEDGE REGARDING POSTNATAL CARE

AMONG THE POSTNATAL MOTHERS . International Journal of Current Pharmaceutical & Clinical
Research .

7. Pradhan (Thaiba) A, R. U. (2017). KNOWLEDGE AND PRACTICE ON SELECTED ASPECTS OF POSTNATAL

CARE AMONG POSTNATAL MOTHERS. Bangalore: researchgate.

4.17 Appendices:

 Inform consent

 Questionnaire