(CHAPTER 1,2& 3)



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Chapter 1

INTRODUCTION BACKGROUND OF THE STUDY Teaching is one of the most important nursing activities that promote neonatal wellness. Parents need information about the basic newborn needs, nutrition, infection control, and incorporating the newborn into the family unit. Knowledge and development of the newborn will help them protect their babies from developing disease or illness. Newborn Screening is the process of testing and screening newborn babies for certain potentially dangerous conditions that may lead to mental retardation and even death if left untreated. It is one of the most important public health measure aimed at early identification and management of affected newborns by this it will help lowering infant morbidity and mortality. (Padilla, C.D.,2010) The newborn screening began in the late 1960¶s through the work of Robert Guthrie, he developed a screening test for phenylketunuria,he used blood sample on filter paper obtaining by pricking a newborn baby¶s heel on the second day of life. As of today additional test has been added to many screening programs. ( Newborn from



According to Saadallah ,A. and Rashed S., the current experiences with newborn screening in the Middle East and North Africa region. The population in the region is

about 400 million, with high birth rate and an estimated 10 million newborns per year. The majority of the population is of the Islamic faith and mostly Arab. The population is characterized by a high consanguinity (25±70%) and a high percentage of first-cousin marriages. Haemoglobin disorders, inherited metabolic disorders, neurogenetic disorders and birth defects are relatively common among the population.. Currently, there are only four countries that are executing national newborn screening but they vary from one disease to 23 and coverage is not complete. The region needs to take big steps towards developing national strategies for prevention and should learn from experiences of regional and international screening programmes.

The success of blood spot newborn screening in the USA led to early screening efforts in parts of the Asia Pacific Region in the mid-1960s. While there were early screening leaders in the region, many of the countries with depressed and developing economies are only now beginning organized screening efforts. Four periods of screening growth in the Asia Pacific region were identified. Beginning in the 1960s, blood spot screening began in New Zealand and Australia, followed by Japan and a cord blood screening programme for G6PD deficiency in Singapore. In the 1980s, established programmes added congenital hypothyroidism and new programmes developed in Taiwan, Hong Kong, China (Shanghai), India and Malaysia. Programmes developing in the 1990s built on the experience of others developing more rapidly in Korea, Thailand and the Philippines. In the 2000s, with limited funding support from the International Atomic Energy Agency, there has been screening programme development around detection of congenital hypothyroidism in Indonesia, Mongolia, Sri Lanka, Myanmar and Pakistan. Palau has recently contracted with the Philippine newborn screening

programme.. Since approximately half of the births in the world occur in the Asia Pacific Region, it is important to continue the ongoing implementation and expansion efforts so that these children can attain the same health status as children in more developed parts of the world and their full potential can be realized. ( Padilla,C.D. & Therrell, B.L. (2005) Newborn screening in the Asia Pacific region. Journal of Inherited Metabolic Disease .Volume 30, Number 4. Retrieved Januar 9, 2010 from )

The newborn screening program in the Philippines is mandated by RA. 9288 or the Newborn screening program of 2004. Newborn screening is available in practicing health institutions (hospitals, lying-ins, Rural Health Units and Health Centers) with cooperation with Department of Health diseases have varying degrees of severity. If identified early, many of these conditions can be treated before they cause serious health problems.

Because of the said law the expansion of newborn screening pushed in Cotabato . South Cotabato doctors and medical experts are pushing for the expansion of the newborn screening program of the provincial government to ensure the early diagnosis and treatment of possible serious diseases among infants in the province. South Cotabato Integrated Provincial Health Office (IPHO) health education and medical practitioners in the province have intensified the promotion of the newborn screening program.The program aimed to reduce the cases of serious infant diseases in the province's 10 towns and lone city. South Cotabato Provincial Hospital newborn screening facility has recently

diagnosed at least 200 positive cases of glucose disorder, a health deficiency that leads toanemia, among newborn infants catered by the hospital. ( Expansion of newborn screening pushed in Cotabato. Manila Bulletin. Retrieved January 10, 2011 from )

According to Department of Health (DOH),most babies with metabolic disorders look normal at birth. One will never know that the baby has the disorder until the onset of signs and symptoms and more often ill effects are already irreversible. Hence through the newborn screening program the following disorders can be detected, Congenital Hypothyroidism (CH) , Congenital Adrenal Hyperplasia (CAH), Galactosemia (GAL, Phenylketonuria (PKU), Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def). The said diseases have varying degrees of severity. If identified early, many of these conditions can be treated before they cause serious health problems. Even though the newborn screening program is implemented in different hospital and other health facilities still our clients during our hospital exposures do have problems regarding newborn screening such as lack of knowledge regarding disease being

screened , many patient does know the benifits of newborn screening and they have wrong perception about the newborn screening program. The reasons promtedus to conduct this study are, as a part of the health care providers, we have a responsibility in participating in the nation wide advocacy on Newborn screening and educating the parents about the program , also to correct the misconcepntion of the parents about newborn sccreening by that parents will be aware of

the possible disorders that may develop with their child .Also the research will provide evaluation of the current status of implementation of the newborn screening program in local setting of barangay Dabong- dabong, Valencia City, Bukidnon.

Theoretical Framework


This study is anchored on the Interacting systems theory of Imogene King .Nursing for King is an act wherein the nurse interacts and communicates with the client. The nurse helps the client identify the existing health condition, exploring and agreeing on activities to promote health .(Octaviano, E. &Balita C., 2008 )

The central focus of King¶s framework is man as a dynamic human being whose perceptions of objects, persons, and events influence his behavior, social interaction, and health (King, 1971). King¶s model is composed of three inter-acting systems these are personal, interpersonal, and social communication. The personal system that King speaks of refers to the individual The concepts within the personal system and fundamental in understanding human beings are perception, self, body image, growth and development, time, and space. Interpersonal systems involve individuals interacting with one another. King refers to two individuals interacting as dyads, three individuals as triads, and four or more individuals as small or large groups (King, 1981). The concepts associated with interpersonal systems are interaction, transaction, communication, role and stress. The third and final interacting system in King¶s model is the social system. Social systems are groups of people within a community or society that share common goals, interests, and values. Social systems provide a framework for social interaction and relationships, and establish rules of behavior and courses of action (King, 1971).

Thus in relation to what King pointed out on her Conceptual Framework and Theory of Goal Attainment, this theory can be implemented in a rural area setting. Thus this study applies last two concepts from King¶s framework that are useful when working with rural clients are communication and interaction. If the nurse is to have any influence on the health behaviors of rural residents, then s/he must be able to communicate with them effectively. Once the nurse has established an effective means of communicating with rural clients, s/he may be able to implement health-promoting behaviors. Good communication will result in a trusting relationship between nurse and client; an essential element for favorable interactions. Interactions between the nurse and the client lead to transactions that result in goal attainment. Human beings are dynamic individuals and they are continuously interacting with their respective environments.



Independent Variables y y y y Age Educational Attainment Health Care Insurrance Civil Status

Dependent Variables Knowledge and attitude towards newborn screening program according to: y y

Purpose Disease Compliance

Conceptual Framework showing factors influencing the Knowledge and attitudes of Parents to Newborn screening program.

Statement of the problem This study aims to determine the knowledge and attitude of parents towards Newborn screening Program in Dabong-dabong Valencia City. Specifically , this study will answer the following questions: 1. What is the current status of the respondents in terms of: 1.1 1.2 1.3 1.4 2. Age Educational Attainment Healthcare insurance Civil Status

What is the level of knowledge and attitude of the respondents in terms of : 1.1 1.2 1.3 Purpose id\f the program Disease Screened Compliance


Is there significant difference between participation in NBS and their level of

knowledge and attitude? 4. Is there a significant relationship between patient¶s demographic profile and the

level of knowledge and attitude towards newborn screening?

Hypothesis Ho: There is no significant relationship between parent¶s demographic profile and there level of knowledge and attitude towards newborn screening. H1: There is a significant relationship between parent¶s demographic profile and there level of knowledge and attitude towards newborn screening. Ho: There is no significant difference between participation in Newborn Screening and there level of knowledge and attitude. H1: There is a significant difference between participation in Newborn Screening and there level of knowledge and attitude.

Significance of the study

This study compels its significant contribution to the health worker¶s, parents, students, and researchers. Parents. This study is significant to the parents because they will be able to evaluate their knowledge about Newborn screening. NBS is important procedure to determine if the parents are of new born screening because they hold the decision to have their babies undergo the procedure If they are well informed about it and its benefit to their infants.

Health care providers. The concepts of the study will help the health care provider promote the awareness of parents to NBS. To aid them in their practice on health promotion . It will widen their knowledge about common concepts of NBS. This study will help as guide for the promotion of health and prevention of disease among new born children. Students. This helps us in harnessing knowledge and attitude since this study is about newborn screening , it will give us more facts that will help us in advocating the program to our clients. Researchers: This study will also serve as a guide for the future researchers related to subject under investigation . To provide date and aid researchers to prove their study. Scope and Limitation of the Study The study is focused on the determination if the knowledge and attitude of the parents towards NBS. The study will be implemented in Sitio Dabongdabong, Brgy. Mailag, Valencia City, Bukidnon and will be covering all parents having newborn infants up to 2 years of age.

Furthermore, this study will not include those parents who don¶t have a newborn infants up to indicated age of life. This study is also limited to the land area specified to where the study is to be conducted.

Definition of terms Age. A state od development at which the body has change as measured by physical and laboratory standards to what is normal for a female or male of the same chronologic span of life. Attitude. A state of readiness to respond in a characteristic way in a stimulus. Congenital. Referring to disease or condition that could be dated from birth or acquired during development in the uterus and not through heredity Diagnostic process. A procedure that is utilizing methods that would yield into a diagnosis. Disease. Is a condition of abnormal vital function in any body part or system of an organism. Heel prick. A methods that is done during sample taking where in a lancet is used to puncture the heel portion of a baby¶s foot. Knowledge. The fact or condition of knowing something with familiarity gained through awareness of something. Newborn screening. A procedure done to early diagnose an infant for certain condition called congenital metabolic disorder. Puncture site. The area where in a sharp object is cautiously inserted through the skin enough to facilitate the bleeding.

Sterile. A state where in an object is free from any living organism and especially microorganism .

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