PUNTLAND STATE UNIVERSITY FACULTY OF HEALTH SCIENCE

DEPARTMENT OF PUBLIC HEALTH

THESIS BOOK

Title:-KNOWLEDGE AND PRACTICE OF NEW BORN CARE AMONG

MIDWIFES 2022

Prepared by: - Bashir Mahad Mohamud

SUPERVISOR: Mr. Abdirashiid Abdulahi SIGNATURE:- ________

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ACKNOWLEDGMENT

Special thanks to my supervisor Dr-Abdirishid Abdulahi for continues support in every phase of
the thesis book and continuously providing me with valuable advice to prepare this thesis book, also
thanks to Mudug Regional hospital Health Workers who gives me the correct requirement to prepare
this thesis book.

My Appreciation also extends to my instructors who help me to prepare this thesis book.

Lastly I would like to acknowledge all my family friends for their moral ideas and materials and
financial support during the preparation of this thesis book

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ABSTRACT

The care given to newborns immediately within the first kind of few hours of birth kind of is critical
for their particularly survival in a subtle way. However, their pretty survival depends on the health
professional’s knowledge and skills to kind of deliver for all intents and purposes appropriate
newborn care interventions, or so they actually thought. Therefore, this study aimed to essentially
assess the knowledge and practice of immediate newborn care among nurses and midwives in
definitely public health facilities of Mudug Regional Hospital In Galkio, or so they specifically
thought.

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TABLE OF CONTENTS

ACKNOWLEDGMENT .............................................................................................................................. 3

ABSTRACT .................................................................................................................................................. 4

TABLE OF CONTENTS ............................................................................................................................. 5

LIST OF TABLES ........................................................................................................................................ 7

ABBREVIATION AND ACRONOMY ...................................................................................................... 8

CHAPTER ONE: - INTRODUCTION ..................................................................................................... 9

1.1 BACKGROUND............................................................................................................................................ 9
1.2 PROBLEM STATEMENT .......................................................................................................................... 11
1.3 PURPOSE OF STUDY ................................................................................................................................ 11
1.4 OBJECTIVES .............................................................................................................................................. 11
1.4.1 General Objective ................................................................................................................................. 11
1.4.2 SPECIFIC OBJECTIVES .................................................................................................................... 11
1.5 RESEARCH QUESTIONS .......................................................................................................................... 12
1.6 HYPOTHESIS H1 ....................................................................................................................................... 12
1.7 SCOPE OF THE STUDY ............................................................................................................................ 12
1.7.1 Geographical ........................................................................................................................................ 12
1.7.2 Theoretical scope ................................................................................................................................. 12
1.8 SIGNIFICANCE OF THE STUDY ............................................................................................................. 13
1.9 OPERATIONAL DEFINITIONS AND DEFINITION OF TERMS. ......................................................... 13
CHAPTER TWO: LITERATURE REVIEW .......................................................................................... 14

2.1 INTRODUCTION OF CONCEPTS AND IDEAS OF DIFFERENT AUTHORS/EXPERTS...................... 14

2.2 THE KEY COMPONENTS OF IMMEDIATE NEWBORN CARE INCLUDE: ........................................ 15
2.2.1 Cord care: ............................................................................................................................................. 15
2.2.2 Thermal care: ....................................................................................................................................... 18
2.2.3 Eye care: ............................................................................................................................................... 22
2.2.4 Vitamin k administration...................................................................................................................... 25
2.2.5 Skin-to-skin contact (the Kangaroo method) ............................................................................................. 28
A: Activity/muscle tone....................................................................................................................... 30
P: Pulse/heart rate ............................................................................................................................... 30
R: Respiration/breathing ..................................................................................................................... 30
2.2.6 Immediate breast feeding:...................................................................................................................... 31
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2.3 RELATED STUDIES .................................................................................................................................. 32
CHAPTER THREE: RESEARCH MATHOD AND MATERIAL ........................................................ 34

3.1 STUDY DESIGN: ........................................................................................................................................ 34

3.2 RESEARCH POPULATION: ...................................................................................................................... 34
3.3 SAMPLE SIZE DETERMINATION: .......................................................................................................... 34
3.4 SAMPLING PROCEDURE ......................................................................................................................... 35
3.5 RESEACH INSTRUMENT: ........................................................................................................................ 35
3.6 VALIDITY AND RELIABILITY: ............................................................................................................... 35
3.6.1 VALIDITY ........................................................................................................................................... 35
3.6.2 Reliability: ............................................................................................................................................ 36
3.7 Data collection procedures ........................................................................................................................... 36
3.8 Data analysis procedure: .............................................................................................................................. 36
3.9 Ethical Considerations: ................................................................................................................................ 36
3.10 Limitation of the study ................................................................................................................................. 37
CHAPTER 4: RESULT AND DISCUSSION .......................................................................................... 38

4.1 INTRODUCTION........................................................................................................................................ 38
CHAPTER FIVE: DISCUSSION, CONCLUSION, AND RECOMMENDATION. ........................... 47

5.1 Discussion: ................................................................................................................................................... 47

5.1.1 Socio demographic of newborn care among midwives at mudug regional hospital ............................ 47
5.1.2 Knowledge and Practice of newborn care among midwives at mudug regional hospital. ................... 47
5.1.3 Knowledge and practice of new born care among midwives in Sudan ................................................ 48
5.1.4 Knowledge and practice of new born care among midwives in Tanzania ........................................... 48
5.2 CONCLUSION ............................................................................................................................................ 49
5.3 RECOMMENDATION ............................................................................................................................... 49

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LIST OF TABLES

Table 4.1: socio demographic characteristics of the new born care among midwives.at
MRH………………………………………………………………………………………..37

Table 4.2 shows the level of knowledge among midwives of new born care at MRH….39

Table 4.3 shows the level of practice among midwives of new born care at Mrh………41

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ABBREVIATION AND ACRONOMY

KP: KOWLEDGE AND PRACTICE MCH: MOTHER AND CHILD HEALTH CARE

WHO: WORLD HEALTH ORGANIZATION

ENC: ESSENTIAL NEWBRONE CARE KGM: KANGROO METHOD

KMC: KANGROO MATHER CARE VK: VITAMIN K

VKDB: VITAMIN K DEFECENCY BLEEDING

APGR: ACTIVITY, PULSE, GRIMACE, APPEARANCE, RESPIRATION

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CHAPTER ONE: - INTRODUCTION

1.1 BACKGROUND

New born care (NBC) can be defined as the care provided by skilled qualified midwifes to new
born care and infants babies in order to maintenance the best health care situations for both mother
and new born during pre and post-delivery is considered for the new born care [1] the key
component of new born care included: risk identification: prevention and management of
hemorrhage during post-delivery and promotion of new born care.

Immediately drying care of new born as recommended by word health organization (WHO) has a
number of benefits. Immediately drying the new born prevents the heat loss that occurs when
amniotic fluid evaporates from an infant’s skin. Babies born prematurely or underweight are
particularly vulnerable to heat loss because of the large surface area of skin relative to their weight
[2]
Hypothermia, even in warm climates is risk factor for new born morbidity and mortality, although
the contribution of hypothermia to neonatal mortality is poorly understood studies have shown that
hypothermia was associated with an increase in neonatal mortality [3]
Where large numbers of children die soon after birth an infant is about 500 times more likely to die
on the first day of life than at one month of age (2).
Also WHO defines essential newborn care (ENC) new born care as a set of interventions and
practices provided at childbirth after birth that includes skin
Care, hygienic care, and practices during childbirth, early breastfeeding, and newborn
resuscitation.[4]
According to the world health organization (who) report on 2015, globally 2.7 million neonates die
in the first 28 days which constitutes 45% of the under- five mortality and nearly 58% of infant
mortality. This about 75% of the neonatal mortality in the first week of birth [5]

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Most neonatal deaths are in low and middle-income countries [6]. Each year in Africa, around a
quarter of a million women die of pregnancy related causes and approximately 1 million babies are
stillborn, of whom at least 300,000 die during labor. A further 1.16 million babies die in their first
month of life – up to half on the first day – and another 3.3 million children will die before they
reach Their fifth birthday. Four million low birth weight babies and others with neonatal
complications live but may not reach their full potential, and a similar number of African women
have non-fatal complications of pregnancy.[7]
In Sub-Saharan Africa, one in eleven children dies before the age of five years. This is nearly 15
times higher compared to the rate in developed countries [2] Each year at least 1.16 million
newborns die in Sub-Saharan Africa.[7] .
In Somalia are still deprived of this. 4 in 100 Somali children die during the first month of
life, 8 in 100 before their first birthday, and 1 in 8 before they turn five. This accounts for more than
60 percent of the under-five deaths in the country. In addition to this, one in 12 women die every
year from causes related to pregnancy and childbirth.[8] Therefore The under-five mortality in
Somalia is estimated at 200 deaths per 1,000 live births, which is one of the highest in the world.
Approximately one third of these are neonatal deaths, occurring during the first month of life,
predominantly caused by birth complications and neonatal infections. The high neonatal mortality is
at least partly maintained by the fact that ninety per cent of deliveries take place at home, without
professionally skilled attendance or mandatory follow-up at a health care unit. Infections are the
main cause of death during remaining infancy and childhood.[9]
In 2019, neonatal mortality rate for Somalia was 36.9 deaths per 1,000 live births. Neonatal
mortality rate of Somalia fell gradually from 44 deaths per 1,000 live births in 2000 to 36.9 deaths
per 1,000 live births in 2019.[10]

Although midwives and nursing assistants are routinely positioned to care newborns admitted at the
formal health facilities [11]. Therefore, the enhancement of their knowledge and skills are very vital
aspects of their health facilities [12]. Morbidity and mortality of newborns are reduced by improving
access to educational messages and treatments of women [13]. Therefore, appropriate care of
newborns is crucial for the survival, growth, and development of new borns [14] .

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1.2 PROBLEM STATEMENT
The newborn infant is faced with risks such as heat loss and aspiration of fluid and the challenge of
functioning in a new environment. Immediate care is directed toward the infant wellbeing.
The health of newborn is affected by the magnitude of problems and quality of care. The risk of
mortality is high during birth and in the early period of life. Clearly good essential care of the
newborn will prevent many newborn emergences, like neonatal airway problems.

1.3 PURPOSE OF STUDY

This study was great importance and beneficial to health workers and community workers in
knowing where there are gaps of provision of midwifery services.
This study will be helpful to other researchers and development of public health practitioners
According to WHO In 2019, neonatal mortality rate for Somalia was 36.9 deaths per 1,000 live
births. Neonatal mortality rate of Somalia fell gradually From 44 deaths per 1,000 live births in
2000 to 36.9 deaths per 1,000 live births.[10]
Somalia especially Galkaio has high prenatal mortality and morbidity. There is little known on the
knowledge, practice of newborn care among healthcare providers in Galkaio
However due to the 28 years of civil war and insecurity in Somalia the number of studies in health
sector has been diminished and there is less health researches published. Since there is no evidence
to emphasize the magnitude of neonatal mortality and no study has been carried out to investigate
neonatal mortality in two study health facilities in Galkaio, Punt land State and Somalia at large.

1.4 OBJECTIVES

1.4.1 General Objective

 To assess knowledge and practice of newborn care among midwife in Mudug Regional
Hospital

1.4.2 SPECIFIC OBJECTIVES

 To assess socio demography
 To assess midwives level of knowledge to the newborn care.
 To assess midwives level of practice to the newborn care

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1.5 RESEARCH QUESTIONS

1. What is the level of Knowledge and practice newborn care regarding to community
midwife in mudug regional hospital?
2. What is the level of practice newborn care to ward community midwife in Galkiao?

1.6 HYPOTHESIS H1

There is a significant difference between knowledge and practice with regard to essential newborn
care in pre & post.

1.7 SCOPE OF THE STUDY

1.7.1 Geographical

This study was carried out in mudug regional hospital Galkaio Punt land Somalia
Galkaio is capital of north central Mudug of Somalia and considered the largest commercial
representing economic decentralization in the country in the whole of Mudug region.

1.7.2 Theoretical scope

This study outline the knowledge and practice of new born care among midwives at mudug regional
hospital. (MRH)

1.7.2.1 Content of scope

This content of the study covers all midwives at mudug regional hospital by the new born cares.

1.7.2.2 Times scope

This research was started at July 2022and ended to September 2022.

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1.8 SIGNIFICANCE OF THE STUDY

There search was aimed to bring out an updated knowledge and practice about the new born care in
mudug regional hospital. The finding sand the recommendations of this study are important for
qualified health care workers, Nurses Midwifes, Doctors, Health care team leader organizations
proving health services and any other concerned parts.

1.9 OPERATIONAL DEFINITIONS AND DEFINITION OF TERMS.

 Eiob: early initiation of breastfeeding

 Cc: cord care
 Who: word health organization
 Nbc: new borne care
 KP: knowledge and practice

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2 CHAPTER TWO: LITERATURE REVIEW

2.1 INTRODUCTION OF CONCEPTS AND IDEAS OF DIFFERENT

AUTHORS/EXPERTS

Daily newborn care is a comprehensive strategy designed to improve the health of newborns
through interventions. It comprises: Basic preventive newborn care such as temperature
maintenance, eye and cord care, and early and exclusive breastfeeding; vitamin K administration,
and early detection of problems or danger signs.[15]

Daily newborn care is the care requires by all neonates whether they are born healthy, small or
unwell. It includes appropriate preventive care, routine care, and resuscitation at birth if necessary,
and care of sick and small babies. The success which mortality and morbidity are prevented will
depend on to a large extend on the commitment and expertise of the health workers responsible for
newborn care.[16]

The World Health Organization has come up with a set of simple, cost effective measures that can
be used by both the healthcare worker and the primary caregiver to ensure improved neonatal
outcome. Components of the WHO Essential Newborn Care include Basic preventive such as cord
care, breastfeeding; provide warmth, eye care, vitamin K administration, and early recognition of
danger signs.[17]

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2.2 THE KEY COMPONENTS OF IMMEDIATE NEWBORN CARE INCLUDE:

2.2.1 Cord care:

Clean cord care is one of the essential newborn care practices recommended by the World Health
Organization to reduce morbidity and mortality amongst the World’s newborns. Despite this, cord
infections are still prevalent in developing countries because of the high rates of unhygienic cord
care practices.[17]
There for Hygienic cord care, which includes cutting the cord with a new or sterilized instrument
(or a clean delivery kit) as well as appropriate cord care is a standard measure of newborn care
Hygienic cord care is recommended to reduce the risk of sepsis, a major cause of newborn
mortality—specifically, infection that enters the body at the cord stump site. Premature or low
birth weight babies are at an increased risk of all-cause mortality. Their skin barrier function is
compromised and their immune systems and vital organs may be underdeveloped; preterm babies
may also lack or have reduced amounts of vernix, which is only developed in the later stages of
pregnancy.[18]
Clean delivery and clean cord care ensure everywhere, in health facilities by polices and practice
for prevent, detection, and control of nosocomial infections, washing hands before touching the
newborn baby, and cut the umbilical cord with a clean blade, and keep the cord area clean and dry,
and do not put anything on the cord .A complementary strategies to reduce neonatal tetanus is
immunizing pregnant women with tetanus toxoid.[17]
The 5 principles of cleanliness are essential in health facilities, in addition to hygiene during
delivery –clean environment –equipment and supplies-also these principles include especial
measure for newborn to prevent hospital infection –prevent of overcrowding, provision of clean
water, also the hospital need to define method for prevention, detection of nosocomial infection.
The principle of cleanliness should apply on home delivery too. Infection acquired after birth need
attention. It can be prevented by clean practice, in hospital where the mother and babies are
separated, babies often kept on nurseries, where are share the equipment and supplies, they may
expose to microorganism.[17]

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2.2.1.1 Six clean practice

To ensure a clean birth, WHO advocates the practice of ‘six cleans’:

1- Clean hands

2- Clean delivery surface

3- Clean perineum

4- Nothing unclean inserted into the vagina

5- Clean umbilical cord cutting tool

6- Clean cord care of the newborn

The umbilical cord connects the fetus and the placenta in utero. Babies receive nourishment and
oxygen through the placenta by away of single vein and tow arteries, which is connected to the
inner wall of the mother’s uterus. The placenta is connected to the baby by the umbilical cord
through an opening in the baby’s stomach; the umbilical cord is pretty big averaging about 50cm
(20 inches) in length and 2cm (about3-4inch) in diameter in full term baby.[19]
After the baby is born, the umbilical cord is clamped and cut close to the body (2- 5cm) in a
painless procedure, leaving an umbilical stump. The cord stump dries gradually, and falls off five
to fifteen days after birth .The umbilical stump can be a source of entry for systemic infection if
not properly cares. The umbilical stump must, therefore, be kept clean. Principles of clean cord
stump care keep it dry and clean and don’t apply anything apply at the health facility and it home
also.[19]
The stump will be dry and mummify if exposed to the air without any dressing, binding and
bandages. It will remain clean if it is protected with clean cloths and is kept from urine and
soiling. No antiseptics are needed for cleaning. If soiled, the cord can be washed with clean water
and dried with clean cotton or gauze.[19]
Once the umbilical cord separates, minimal discharge is expected. Until the cord falls off, the area
should be kept dry as much as is possible to promote separation and healing. The newborn’s cord
stump provides a good environment for bacterial growth until it dries up and separates usually 5-15
days after birth. Proper cutting and tying of the cord and hygienic care of the umbilicus until it is
16
 fully healed can prevent serious infection and even death.[17]

2.2.1.2 The danger signs of umbilical cord infection including:

 Puss discharge
 Reddening around umbilical stump and or the surrounding skin
 Fever, lethargy and difficulty in breathing
 Poor sucking. [20]

2.2.1.3 INTERVENTION

Umbilical cord care started from birth until the cord full off.

 Wash hands before and after contact with umbilical area

 The umbilical cord should initially be cut with sterile instrument if a sterile instrument is
not available, use a clean instrument such as a new razor blade
 Put nothing on the stump and any agent used to clean infant skin or cord is single use
When promote skin to skin contact whit mother to promote colonization with
nonpathogenic normal flora and Fold diaper below stump
 Keep cord stump loosely covered with clean clothes. If stump is soiled, wash it with clean
water and soap. Dry it thoroughly with clean cloth, or if it becomes soiled with urine or
feces.
 Do not bandage the stump or abdomen.
 Avoid touching the stump unnecessarily.
 Umbilical stump must be inspected after 2-4 hours of clamping, bleeding may occur at
this time due to shrinkage of cord and loosening of ligature.[21]
 Instruct the mother on cord care, hand hygiene, and how to assess for signs of
infection.[20]

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2.2.2 Thermal care:

Thermal care is series of measure taken at birth and the first days of life to ensure that the newborn
in the normal body temperature and to reduce the hypothermia risk. It includes practices such as
drying and wrapping the newborn immediately after delivery and delaying the newborn’s first bath
for at least six hours or several days to reduce the hypothermia risk.[17]
Thermoregulation is the ability to balance heat production with heat loss to maintain the body
temperature within the normal neonatal range of 36.6 to 37.3 degrees centigrade. This ability is
limited in the new-born.[22]
Hypothermia occurs when the body temperature drop below 36.5c.[17] and can be increased
morbidity and mortality of newborn[22]
Most cooling of the newborn occurs immediately at birth , Hypothermia can easy occur if a
newborn infant is left wet and unprotected from cold while waiting for placenta to be delivered,
hypothermia can occur after birth even at moderate environmental temperature when babies are not
well protected or because a practice such as bathing the newborn.[17]
Besides the exposure to heat losses, the newborn is particularly at high risk of hypothermia
because at birth the infant’s ability to respond to cold by increased metabolism and heat production
is not fully developed. However, this response will develop provided the baby is healthy and
receives food. [17]

2.2.2.1 The ways that newborn lose the heat

The temperature inside mother’s womb is 38c (100.4f), leaving the mother womb at birth, the wet
newborn find itself in much Colden environment and immediately starts loosing heat ,the
newborn can loses heat through conduction, convection, radiation and evaporation.[17]

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2.2.2.2 Four ways a newborn may lose heat to the environment

A) Radiation: Heat loss occurs by radiation from the infant to cooler objects in the vicinity,
even though they are not in contact with the infant, for example if an infant in a cot is placed
close to a cold wall, a window or other cold object. The colder the object or the closer it is to
the infant, the greater the loss of heat by radiation.[23]

B) Conduction: Loss of body heat by conduction occurs when there is direct contact of the
skin with a cooler object or surface. For example, if the infant is placed in direct contact with a
cold surface - a table, weighing scale, or rubber sheet - heat will be lost to the cold surface,
particularly if the surface is metallic.[23]

C) Convection: Convective heat loss occurs when the infant loses heat to the cooler
surrounding air. This happens when a naked infant is exposed to a room temperature of 25°C
(77°F), even though this is comfortable, and still more heat will be lost if the temperature is
below 25°C (77°F). Convective loss increases with air movement and even at a room
temperature of 30°C (86°F) heat loss can still occur if there is a draught

D) Evaporation: Heat loss by evaporation occurs when fluid (amniotic fluid, water)
evaporates from the wet skin to the air. This happens if the infant is not dried immediately
after birth. It also happens later during bathing, but if the infant is dried immediately and
thoroughly heat loss by evaporation is greatly reduced.[23]

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2.2.2.3 The principle for preventing hypothermia in newborn infants at birth

Hypothermia can be prevented by drying the infant immediately after birth placing in direct
skin-to-skin contact with the mother, and covering both with a heavy, clean blanket.
However, if this cannot be done, a satisfactory arrangement is to dry and wrap babies and keep
them as close to the mother as possible. Ensure that the room is warm. It is difficult to warm
infants who have become hypothermic - wrapping a baby who is already cold may simply keep
him/her cold. It is much easier to keep the infant warm in the first place.[23]

2.2.2.4 The Warm Chain

These are a set of 10 points derived by W.H.O to prevent hypothermia, most of which should be
achievable. These should be considered for every baby and particularly those at risk. All health
care providers involved in process of birth and care of the baby need to be adequately trained on
principle and procedure of worm chain.

 Warm delivery room (> 25°C)

 Warm resuscitation (Warm towels)

 Immediate drying

 Skin-to-skin contact between baby and the mother (Kangaroo Care)

 Breastfeeding

 Bathing and weighing postponed

 Appropriate clothing and bedding to environment

 Mother and baby together

 Warm transportation – extra clothes outdoors.

 Training-awareness of healthcare providers, in intuition where is the equipment.

The mother must maintain the warm chain when she is at home, whether the delivery took place at
home or in hospital.[17]

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 WHO recommends bathing after six hours of life and preferably on the second or third day of life.
Bathing the newborn soon after birth causing a drop in the body temperature and is not necessary
and For the low birth weight and premature infants who are at higher risk of hypothermia, extra
measures need to be taken to ensure these babies remain warm includes use of radiant heaters and
incubator care. Neonatal hypothermia has been shown to increase neonatal mortality and
morbidity. Temperature can be assessed by using a thermometer or feeling the infant‘s skin and
observingfor other signs. Cold skin could indicate hypothermia and if the neonate skin is red and
hot witha flushed face, hyperthermia may be present.[24]

2.2.2.5 Signs of hypothermia:

 Less active, lethargic, hypotonic

 Suck poorly and the cry become weaker

 Respiration becomes shallow and also the heart beat decrease, apnea.[23]

2.2.2.6 Midwife Management of hypothermia

A hypothermic baby should be re-warmed straight away. Methods available to use are:

 Skin-to-skin (kangaroo care) and a hat

 A heated mattress

 An overhead heater

 Incubator.[25]

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2.2.2.7 Midwifes or care giver intervention to prevent hypothermia includes:

 Health personnel must be aware of the problem and prevent it from

developing.

 Early diagnosis of hypothermia. Temperature should be taken routinely in all

newborn babies

 Rearming hypothermic babies and ensuring special thermal protection to babies at

special risk of becoming hypothermic.

 Ensure adequate thermal protection during internal transfer of the baby.[23]

2.2.3 Eye care:

Eye prophylaxis involves cleaning the eye at birth and applies either silver nitrate drops or
tetracycline ointment with the first hour.
Thousands of infants suffered permanent blindness as a result of severe eye infection due to
gonorrhea acquired from their mothers. Giving eye medications shortly after birth prevents almost
all of these infections.[17]

Ophthalmic neonatorum refers to conjunctivitis occurring during the first two weeks of life. It
Typically appears 2-5 days after birth. Presents with most often both eyelids become red and
swollen with purulent discharge. Cornel damage with ulceration, perforation, develops if there is
no treatment or delay in treatment..[17]

Neisseria gonorrhea and Chlamydia is the two main Causes of ophthalmic cneonatorum. However,
Chlamydia eye infections are much less likely to be associated with serious eye complications. In
the absence of systematic diagnosis and treatment of maternal genital infections before delivery the
transmission rate for gonorrhea from infected mother to her newborn is 30-50%, so testing mothers
early in pregnancy and treating them then if necessary is recommended to prevent the
infection.[26]

22
 The newborn eye medications prevent infection that is picked up from the mother’s cervix or
vagina as the baby is born. Infection can be prevented by cleaning the eye immediately after birth
and applying either1% silver nitrate solution, 1% tetracycline or 0.5 erythromycin ointment or
2.5% providence-iodine drops to the eyes within one hour of delivery. Without treatment,
ophthalmic neonatorum may lead to serious complications including blindness due to corneal
ulceration and even death[26].

2.2.3.1 Strategies to prevent and control eye infections:

WHO guidelines present five strategies to help prevent and control neonatal eye
infections:

 Primary prevention of STIs in the mother.

 Screening and treatment of STIs during pregnancy.

 Eye prophylaxis at birth.

 Appropriate infection prevention practices during the care of the newborn.

 Diagnosis and treatment of the disease after it occurs in newborns. Advice to the
mother to provide care at home.[27]

2.2.3.2 Midwife or care giver intervention:

1. Clean the baby’s eyes immediately after birth by swabbing each eye separately with sterile
swab

2. If prophylaxis is the policy, instill drops or ointment after cleaning and within one hour of
birth. Do not touch eye with the dropper or tip of ointment tube. Health workers should know
the national policy and drug to be used.

3. Do not wash away the eye antimicrobial.

4. Require frequent hand washing by any one handling the baby mother, relatives.[28]

5. Prevent cross infection in health facilities by frequent hand washing between handling infants.

23
Maintain cleanliness, and where feasible, sterilize equipment, follow correct medical
techniques, and maintain general cleanliness of the environment are essential to preventing
eye and other infections in newborns.

24
2.2.4 Vitamin k administration

Vitamin K dependent factor are lower in neonate then the adults, and it should be administered to
all neonates at birth or immediately afterword. It is made naturally by the bacteria in the gut. It
helps the blood to clot and stops bleeding.[30]
Newborn babies are born with very low levels of Vitamin K because from the mom is not easily
shared with the developing baby during the pregnancy and they are not able to produce enough of
their own because the intestine of the newborn baby has very little bacteria so they do not make
enough vitamin K on their own, until they are about 6 months old.[30]

Due to this lack of Vitamin K in their bodies, some babies may bleed internally and this bleeding
can be very serious and even life threatening. This is known as Vitamin K deficiency bleeding
(VKDB) and this can be prevented by giving newborn babies Vitamin K at birth until they build up
their own supplies. Premature and sick babies as well as babies born by instrumental births
(i.e.ventouse - forceps) and-or long labors, also have an increased risk Vitamin K deficiency
bleeding (VKDB) Itis a condition that occurs when the baby does not have
enough Vitamin K. [30]

25
2.2.4.1 There are three types of VKDB:

A. Early VKDB:
Occur in the first day of life in infants born to mothers who have received medications that
may interfere with Vitamin K metabolism e.g. Anticonvulsants, anti TB medications or
Vitamin K antagonist anticoagulants.[30]
B. Classical VKDB:
Occurs from 1-7 days after birth and is more common in infants who are unwell at birth.
Bleeding is usually from the umbilicus (umbilical cord), the gut, surgical sites, or
uncommonly in the brain.[30]
C. Late VKDB:
Occurs from 8 days to six months after birth and is usually due to an underlying medical
condition. Babies are more at risk if they did not breastfeed at birth or have restricted access to
breast milk in the days after birth and then go on to is breastfed. This is because colostrum the
first milk a mother produces and hind milk (milk at the end of a feed), contain high levels of
Vitamin K. Babies that are fed infant milk formula will get Vitamin K from the formula.[30]

2.2.4.2 Signs of VKDB include obvious bleeding

 From the umbilical stump

 In the urine

 From the skin and mucous membranes, for example the nose and gums

 There is also a risk of internal bleeding, for example inside the head.

 Black tarry stools after meconium has already been expelled Administration of vitamin K
For all newborn babies an injection of Vitamin K into the muscle or oral can be offered as an
alternative but requires multiple doses to be effective. [31]

26
2.2.4.3 Vitamin K Injection

Inject of vitamin K into thethigh muscle shortly after birth.[31]

2.2.4.4 Vitamin K by mouth

It is possible to give vitamin K into baby mouth. Vitamin K is not absorbed well so 3 doses are
needed; at birth, at3-7 days and at 6 weeks.[31]
Vitamin K by mouth is not the recommended method for the following reason:

 It is not absorbed well when given by mouth

 The protection doesn’t last as long as the injection

 Babies don’t always swallow or may vomit the oral dose.

 The later doses are sometimes forgotten

 Some babies have conditions that prevent absorption from the gut.[31]

 Black vomit.[32]

2.2.4.5 The dose

A single intramuscular injection of vitamin K remains the gold standard in the prevention of
classic and late VKDB.[33]

 A: Term Infants: All healthy term infants should receive 1mg (0.1ml) Vitamin K (Konakion
MM Pediatric) as soon as after birth within the first six hours of birth regardless of route of
delivery. [31]

 B: Preterm Infants: All preterm infants should receive 0.5mg (0.05ml via a special syringe from
pharmacy) Vitamin K (Konakion MM Pediatric) intra-muscularly.[31]

2.2.4.6 Oral Vitamin K

The oral administration of three doses of 2 mg, one on the first day and one on the 7th day and at 6
weeks of life has been shown to be almost as effective as one single dose of 1 mg intramuscular
injection.[34]
27
2.2.4.7 Midwife or care giver intervention

 Be aware about signs of VKBD

 Ensure baby has indeed gotten the oral dose; therefore, if baby throws up within 60 minutes
after the dose is given, it is suggested to repeat the dose

 Inform the parent Oral vitamin K is given in a series of doses, so they continue to taking the
oral drops.[34]

2.2.5 Skin-to-skin contact (the Kangaroo method)

Skin-to-skin contact is one of the most appropriate methods to be used in caring for the small
infant since it:

 Assists in maintaining temperature of the infant;

 facilitates breast-feeding

 Helps to increase the duration of breast-feeding;

 Assists in prolonging the duration of lactation.[23]

Also Kangaroo mother care is the early, prolonged, and continuous skin-to-skin contact between
the mother and her baby, with support for positioning, feeding, and prevention and management of
infections and breathing difficulties. Very sick babies needing special care, but all babies are
eligible for KMC. All mothers can provide KMC, irrespective of age, parity, education, culture and
religion.[35]
KMC satisfies all five senses of the baby. The baby feels warmth of mother through skin-to-skin
Contact (touch), she listens to mother’s voice & heart beat (hearing), sucks on breast (taste) has
Eye contact with mother (vision) and smells mother’s odor (olfaction).[35]

28
 2.2.5.1 The components of kangaroo mother care are:

 Skin to skin contact: This component involves direct skin-to-skin contact of the
newborn with the mother who should be early and continued for prolonged
periods of time.

 Exclusive breastfeeding. [35]

Benefits of KMC contact include:

 Effective thermal control

 Increased breastfeeding rates

 Early discharge, better weight gain

 Less morbidity such as apnea, infections

 Less stress

 Better infant bonding

 does not require additional staff compared to incubator care is acceptable to the
mothers and the health-care staff working in the hospital.[33]

2.2.5.2 Apgar score

The Apgar score is a scoring system doctors and nurses use to assess newborns one
minute and five minutes after they’re born.[36]
Dr. Virginia Apgar created the system in 1952, and used her name as a mnemonic
for each of the five categories that a person will score. Since that time, medical
professionals across the world have used the scoring system to assess newborns in
their first moments of life.[37]
Medical professionals use this assessment to quickly relay the status of a newborn’s
overall condition. Low Apgar scores may indicate the baby needs special care, such
as extra help with their breathing.[36]
The Apgar scoring system is divided into five categories. Each category receives a
score of 0 to 2 points. At most, a child will receive an overall score of 10. However,
a baby rarely scores a 10 in the first few moments of life. This is because most
babies have blue hands or feet immediately after birth.[36] 29
A: Activity/muscle tone

 0 points: limp or floppy

 1 point: limbs flexed

 points: active movement

P: Pulse/heart rate

 0 points: absent

 1 point: less than 100 beats per minute

 points: greater than 100 beats per minute

G: Grimace (response to stimulation, such as suctioning the baby’s nose)

 0 points: absent

 1 point: facial movement/grimace with stimulation

 points: cough or sneeze, cry and withdrawal of foot with stimulation

A: Appearance (color)

 0 points: blue, bluish-gray, or pale all over

 1 point: body pink but extremities blue

 points: pink all over

R: Respiration/breathing
 0 points: absent
 1 point: irregular, weak crying
 points: good, strong cry
The Apgar scores are recorded at one and five minutes. This is because if a baby’s
scores are low at one minute, a medical staff will likely intervene, or increased
interventions already started.[36]
A score of 0 to 3 is concerning. It indicates a need for increased intervention,
usually in assistance for breathing. A parent may see nurses drying off a child
vigorously or delivering oxygen via a mask. Sometimes a doctor, midwife, or nurse
practitioner may recommend transferring a patient to a neonatal intensive care
nursery for further assistance.[36] 30
 At five minutes, the baby has ideally improved. If the score is very low after five
minutes, the medical staff may reassess the score after 10 minutes. Doctors expect
that some babies may have lower Apgar scores. These include:

 premature babies

 babies born via cesarean delivery

 babies who had complicated deliveries.[36]

2.2.6 Immediate breast feeding:

The early initiation of breastfeeding – putting newborns to the breast within the first
hour of life – is critical to newborn survival and to establishing breastfeeding over
the long term. When breastfeeding is delayed after birth, the consequences can be
life-threatening – and the longer newborns are left waiting, the greater the risk.[38]
Improving breastfeeding practices could save the lives of more than 800,000
children under 5 every year, the vast majority of whom are under six months of age.
Beyond survival, there is growing evidence that breastfeeding boosts children’s
brain development and provides protection against overweight and obesity. Mothers
also reap important health benefits from breastfeeding, including a lower risk of
breast cancer, ovarian cancer and type 2 diabetes.[39]
Help mothers initiate breast-feeding within a half-hour of birth. Encourage early
mother- infant skin-to-skin contact, which will keep the baby warm. The first milk,
called colostrum, provides increased energy and is high in antibodies, therefore
protecting the newborn from certain illnesses. It is all the nourishment and liquid a
baby needs. Let the baby suckle at the breast whenever and as long as he or she
wishes. A mother should have access, if needed, to guidance from trained personnel,
for example a health worker or lactation counsellor, on proper positioning of her
baby and other breast-feeding management techniques.[23]
Health professionals with training in breastfeeding including midwives, nurses, and
doctors, and trained volunteers can deliver education sessions and provide
counseling and peer support to increase the number of women who start
breastfeeding their babies.[25].

31
2.3 RELATED STUDIES

Knowledge and practice of new born care among midwives in Bangladesh

The mean age of the respondents was 33.20 years ± 8.07. More than half of the
midwives (56.2%) had a good knowledge on immediate newborn care. About 62.9%
had good practices of immediate new born care, though some still carry out some
obsolete practices like routine suctioning of the airway of newborns, immediate
cleaning/removal of the vernix caseosa with olive oil and immediate cord clamping.

Knowledge and practice of new born care among midwives in Ethiopia

Overall, 53.8% [95% CI: (48.6, 59.0%)] and 62.7% [(95% CI: (57.7, 67.8%))] of the
health professionals (midwives and nurses) had adequate knowledge and good
practice on immediate newborn care, respectively. Working in hospital [AOR: 4.62;
95% CI (1.76, 12.10)], being a female [AOR: 0.59; 95% CI (0.39, 0.98)] and
interested in providing newborn care [AOR: 0.29; 95% CI (0.13, 0.68)] were
positively associated with having adequate knowledge on immediate newborn care.
On the other hand, having work experience of < 5 years [AOR: 0.33; 95% CI (0.14,
0.78)], inadequate knowledge [AOR: 0.39; 95% CI (0.25, 0.64)], having work load
[AOR: 2.09; 95% CI (1.17, 3.73)], being not interested to provide immediate
newborn care [AOR: 0.35; 95% CI (0.16, 0.74)] and working in health center [AOR:
8.56; 95% CI (2.39, 30.63)] were negatively associated with good immediate
newborn care practices.

Knowledge and practice of new born care among midwives in Nigeria

The mean age of the respondents was 33.20 years ± 8.07. More than half of the
midwives (56.2%) had a good knowledge on immediate newborn care. About 62.9%
had good practices of immediate new born care, though some still carry out some
obsolete practices like routine suctioning of the airway of newborns, immediate
cleaning/removal of the vernix caseosa with olive oil and immediate cord clamping.

32
Knowledge and practice of new born care among midwives in Sudan

Three hundred eighty-four mothers were enrolled in the study. The median
(interquartile) age of the participants was 27.0 (22.0–30.0) years. Over half of the
mothers, 256 (66.7%), had less than a secondary education. One hundred forty-four
participants (37.5%) were employed, and more than half (57.8%) of their residences
were urban.
Most participants, 326 (84.9%), had antenatal care during the index pregnancy, but
the maximum number of antenatal care visits were two in 98.5% of cases. Two
hundred and forty-five women (63.8%) were delivered vaginally, with nearly one-
third (32.2%) delivered at home.
Breastfeeding: Two hundred sixty-eight (69.8%) participants knew to initiate
breastfeeding immediately after delivery. The women had received information
about colostrum (90.1%), and 343 (89.3%) were informed about its advantages.
Cord care: Three hundred six participants (79.7%) were informed about the material
that should be used to cut the umbilical cord. Thermal care: Most mothers (63.8%)
believed that keeping the baby in SSC was essential to protect the baby from
hypothermia. Information about drying and wrapping babies was reported by 71.1%
of participants. However, only 8.9% attained knowledge about delaying bathing the
baby for 24 h (Table 2). Overall, 225 (66.4%) participants had good knowledge
about ENC, based on their responses to the questionnaire items.

Knowledge and practice of new born care among midwives in Tanzania

None of the newborns received all eight recommended ENC interventions. The
median duration of separation from the mother was 25 minutes and 15 seconds
(ranging from 22 seconds to 3 hours and 36 minutes), 51% of the newborns received
proper thermal care during the separation. Twenty-one percent had sufficient
umbilical cord care, 8% were stimulated for breathing, 69% were observed at least
once by healthcare staff and 9% did undergo suctioning. None of the newborns
received antibiotic ointments or vitamin K.

33
3 CHAPTER THREE: RESEARCH MATHOD AND MATERIAL

3.1 STUDY DESIGN:

Cross-sectional descriptive study was conducted with quantitative approach that

identifies knowledge and practice of newborn care among midwives in mudug
regional hospital.

3.2 RESEARCH POPULATION:

The source population was health care providers who were working in health center
in mudug regional hospital, the study populations were those health care providers or
community midwifes living in mudug.

3.3 SAMPLE SIZE DETERMINATION:

Sample The sample size was calculated using the statistical formula of Slovenes
formula size

Where: n = sample size N = Target population e = possible error

n= N_(e)2

1+N

Therefore target population was 52 midwifery. Possible error is 5%= 0.052 = 0.0025
My sample size became 46.

34
3.4 SAMPLING PROCEDURE

This study used simple random sampling. May sample frame was 52 I targeted
every nurses and to the new born under 28 days those attending MRH department
of delivery center until I get sample size.

3.5 RESEACH INSTRUMENT:

Quantitate was c o l l e c t e d using suitable instruments as flows:

Quantitative data was collected using a questionnaire. The questionnaire was

translated from

English into the Somali language (local language) for the respondent to access the
understanding of questionnaire issues. The Somali questionnaire were back
translated to

English to avoid the changing of meaning questions. The questionnaire containing

both closed and open ended questions on health facility characters.
Socio demographic factors effecting new born care service such as material status.

3.6 VALIDITY AND RELIABILITY:

3.6.1 VALIDITY
Validity is the degree to which an instruments measures what it is intended to measure
Sampling ( Polit and Hungler, 2013)
Validity was addressed by submitting the questionnaire to peers and experts (supervisor) to
ensure that the questionnaire covered all area stated in the objectives of the study.

A polit study will be conducted among the sampled population the purpose will to access the
worthiness of the instruments to generate correct data so that items discovered to be in
appropriate in answering the research questions and attending the research objectives will be
modified to improve the quality and appropriateness of the instruments. 35
3.6.2 Reliability:

Reliability is said to be the level to which a questionnaire or any measure of observation process
generates equal findings even when used different setting or when repeated in different trails.
The reliability indicated the consistency scores after period of time (miller 2012)

Reliability refers to the consistency that an instrument demonstrate when applied repeatedly
under similar conditions.

3.7 Data collection procedures

Semi structured questionnaire will be used to data collection tool. The respondent
will be interviewed. The most questionnaire will be close and open ended questions.

3.8 Data analysis procedure:

The data collected will enter analysis by using SPSS software. Data will be
presented by frequency, tables and graphs based on its type used to determine the
susceptibility of any problem in a new born.

3.9 Ethical Considerations:

Ethical clearance was obtained from punt land state University. Informed consent was
sought from each respondent prior to interviewing by first explaining the purpose of
the study, the voluntary nature of participation, the confidentiality of the information
provided by the participant, the benefits of the study to the community and that no
harm would result from participation or refusal to participate. Those who agree to
participate were asked to register on the informed consent form.

36
3.10 Limitation of the study

 The main limitation of the study was included; Lack of adequate time.

 Fear of confidentially some respondents may not be willing to offer information due to
lack of trust or lack of confidentiality.
 Lack of high-speed of internet: addiction, time waster causes distraction.

 Lack of resource: there no public library that is collected accurate data to access books
that related on may study and their reference.
 Availability of respondent, most of respondent were not too easy to respond quickly to
the questionnaire. Language barrier may be one of the problems the researcher
encountering while collecting information.
4 CHAPTER 4: RESULT AND DISCUSSION

4.1 INTRODUCTION

This chapter presents the presentation of data, analysis, and interpretation. The data
analysis and interpretation was based on the research questions as well as research
objectives, the presentation is divided in to two parts. The first part presents the
respondents profile or demographic information, while the second part deals with
presentation, interpretation, and analysis of the research questions and objectives. Below
are the data presentations and analysis of research findings.
Table 4.1: socio demographic characteristics of the new born care among midwives.at
MRH

Variable Unit Numbers and Percent

Male 24(52.2%)
Gender Female 22(47.8%)
Age >20 10(21.7%)
20-30 21(45.7%)
31-41 10(21.7%)
<41 5(10.9%)
Marital status Single 20(43.5%)
Married 16(34.8%)
Divorced 5(10.9%)
Widowed 5(10.9%)
Education Trained TBA 10(21.7%)
Diploma 11(23.9%)
University 19(41.3%)

Others skill 6(13%)

Occupation Midwifes 16(34.8%)

Nurse 20(43.5%)
Doctor 9(19.6%)
Income >$300 14(30.4%)
$300-$500 19(41.3%)
<5$500 13(28.3%)

Experience 1year 12(26.1%)

2year 17(37.0%)
3year 7(15.2%)
More than 3yrs 10(21.7%)
The most Respondent male and female midwives above this table shows the most
respondent are same 23(50%) 23(50%)
The age of respondent male and female midwives above this table shows the most of
respondents 21(45.5%) were aged between 31-41 years, 11 (23.9%) were aged between
less than-20 years, 9(19.6%) were aged between more than 41- years, 5(10.9).
The marital status of respondents of male and female midwives, above the table shows
that the majority of respondents 19 (41.3%) were married, 16 (34.8%) were divorced
6(13.0%) and were widowed, 5(10.9%).
The educational level of male and female mid wives above the table clearly indicates the
most of respondents 19(41.3%) were diploma, 11(23.9%), were trained TBA, 10(21.7%),
while others kills 6(13.0%).
The occupational status of male and female midwives above the table that the majority of
respondents 20 (43.5%) were midwives, 16 (34.8%) were doctors, 9 (19.6%) were
answered student, 1(2.2%).
The level of income of male and female midwives above the table shows the most of
respondents 20(43.5%) were $300-$500, were less than $300,13 (28.3%) were more
than$500, 13(28.3%).,
The level of experience above the table indicates that the majority of respondents 2, year
18 (39.1%) were the 1 year, 11 (23.9%) were the 3 year, 7(15.2%) were more than
10(21.7).
Table 4.2 shows the level of knowledge among midwives of new born care at MRH
Variable Unit Number and percentage

What is the time start new born care? Before the birth 17(37.0%)
During the birth 15(32.6%)
After the birth 14(30.4%)

What is a place was kept immediately Bise the mother 12(26.1%)

after birth? With someone else 9(19.6%)
On the mothers chesty 23(50.0%)

On new born bide/table 2(4.3%0

What is the measures to be taken if the More stimulation to 18(39.1%0

baby is not well breathing? breathe
Ventilation with bag and 27(58.7%)
mask

0ther methods 1(2.2%)

What is the normal breath per minute? 30 breathe per minute 11(23.9%)
40 breathe per minute 21(45.7%)
60 breathe per minute 14(30.4%)

What is the prevention of eye infections Apply nothing 6(13.0%)

after delivery? Clean eye water 11(23.9%)
Clean eye with sterile 10(21.7%)
Apply silver 19(41.3%)
nitrate/tetracycline
The most time start new born care of midwives, above this table shows the most of
respondents 17(37.0%) were the d during birth, 15(32.6%) were after birth, 14(30.4%).,
The most place of respondents was kept immediately after birth above the table shows
that the majority of respondents 23 (50.0%) were the bise of mother, 11 (23.9%) were the
with someone else 9 (19.6%) and were on new born bide/table 3(6.5%).
The most measures to be taken if the baby is not well breath of midwives, above the table
clearly indicates the most of respondents 28(60.9%), were the more stimulation to breath,
17(37.0%), were the other methods, 1(2.2%).
The normal breath per minute of new born care, above the table shows that the majority
of respondents 21 (45.7%) were the 60 breath per minute 14 (30.4%) were 30 breath per
minute, 11(23.9%).
The most prevention of eye infections after delivery, above the table shows the most of
respondents 19(41.3%) were the clean eye water, 11(23.9) were the clean eye with sterile,
10(21.7), and were the apply nothing, 6(13. %).
Table 4.3 shows the level of practice among midwives of new born care at Mrh
Variable Unit Number and Percentage
Did you washing your hands Yes 42(91.3%)
at prior of care No 3(6.5%)
I don’t know 1(2.2%)
Did you wear the gloves Yes 42(91.3%)
before cleaning the baby No 4(8.7%)

Did you wipes eye after head Yes 41(89.1%)

is delivery No 5(10.9%)

Did cleaning the eye Yes 43(93.5%)

appropriately No 3(6.5%)
Did you make immediately Yes 42(91.3%)
drying the baby No 4(8.7%)
Did you kept the sterile Yes 45(97.8%)
surface No 1(2.2%)
Did you remove the wet Yes 44(95.7%)
clothes No 2(4.3%)

Did you make skin to skin Yes 44(95.7%)

Contact No 2(4.3%)
Did you cover baby body and Yes 44(95.7%)
head No 2(4.3%)

Did you check if the baby is Yes 41(89.1%)

Crying No 5(10.9%)

Did you appropriately tie the Yes 43(93.5%)

cord? No 3(6.5%)

Did you appropriately cut the Yes 41(89.1%)

cord? No 5(10.9%)
Did you advice the mother Yes 43(93.5%)
about umbilical stump care? No 3(6.5%)
Did you recorded Apgar Yes 41(89.1%)
score? No 5(10.9%)
Did you identification new Yes 42(91.3%)
born health status? No 4(8.7%)
Did you help if the baby is Yes 45(97.8%)
not well breastfeeding? No 1(2.2%)

Did you kept mother and Yes 43(93.1%)

baby together? No 3(6.5%)

Did you apply ttc Yes 45(97.8%)

No 1(2.2%)
Did you measure weight of Yes 45(97.8%)
the baby No 1(2.2%)
Did you advised the mother Yes 42(91.3%)
about new born danger signs No 2(8.7%)
Did you give the vk to new Yes 43(93.1%)
born No 3(6.5%)
The level of practice respondent by the washing your hands, above this table shows the
most respondent 42(91.3%), were the no 3(6.5%), while is answered I don’t know 1(2.2%).

The majority of respondent by the wearing gloves, above this table shows the most of
respondents 42(91.3%) were the no is answered, 4 (8.7. %).

The most practice of respondents by the wipes eye after head is delivery, above the table
shows that the majority of respondents 41 (89.1%), were the no is answered, 5 (10.9%).

The level of practice respondent by the cleaning eye appropriately, above the table clearly
indicates the most of respondents 43(93.5%), were the no 3(6.5%),.

The majority practice of respondent midwives, by the immediately drying of baby, above
the table that the majority of respondents 42(91.3%) were answered no, 4(8.7%).

The level of practice respondent by the kept of the sterile surface, above the table shows
the most of respondents 45(97.8%), were answered no, 1(2.2%).

The most majority practice of respondent midwives, by removing of wet clothes, above the
table indicates that the majority of respondents 44 (95.7%), were the no, 2(4.3%).

The majority practice of respondent midwives, by the making skin to skin contact, above
the table clearly indicates the majority respondent 44(95.7%), while the no 2(4.3%).

The most practice of respondent midwives, of covering the baby body and head above this
table shows the majority respondent 44(95.7%), were the answered no, 2(4.3%).

The level of respondent practice by the check if the baby is crying, above the table clearly
indicates the majority respondent (41(89.1%), were the no, 5(10.9%),

The majority of respondent by the practice of appropriately tie the cord, above this table
shows majority respondent 43(43.95%), were the answered no, 3(6.5%).

The level respondent by the practice of advised the mother about the umbilical stump care
the Majority of respondent 43(93.5%), were the no 3(6.5%).

The level of respondent practice by the recorded Apgar scores of the baby, above this
table shows the most respondent 41(89.1%), were the no is answered 5(10.9%).
The most of respondent practice by the appropriately cut the cord, above this table shows
the majority of respondent 41(89.1%), while the answered no, 5(10.9%).

The level of respondent by the practice identify of new born health status, above this table
shows The majority of respondent 42(91.3), were the no 4(8.7%).

The respondent of practice by help if the baby is not well breastfeeding, above this table
shows the majority of respondent 45(97.8%), were the no, 1(2.2%).

The majority of respondent by practice of kept the mother and baby together

The most respondent 43(93.1). Were the no 3(6.5%),

The majority of respondent by the practice measures weight of the baby, above this table
shows The majority respondent 45(97.8%), were the no answered 1(2.2%).

The level of respondent practice by the apply ttc above this table shows the majority of
respondent 45(97.8%), were the no 1(2, 2%).

The level of respondent by the practice of advised the mother about the new born danger
signs. Above this table shows the majority respondent 42(91.3%), were the no 4(8.7%).

The level of respondent practice by the of midwives to given vitamin k to the new born,
above this table shows the majority tespondent 43(93.1%), were the no answered,3(6.5%).
5 CHAPTER FIVE: DISCUSSION, CONCLUSION, AND
RECOMMENDATION.
5.1 Discussion:

5.1.1 Socio demographic of newborn care among midwives at mudug

regional hospital
In this study were collected from 46 midwives working at mudug regional hospital in
Galkaio Punt land Somalia, The most of the respondents were male and female, were the
age between20-25, According to the marital status of the midwives were single,
educational level of university, income of 500 dollar per month, occupation of nursing,
were the common factors of new born care among midwives in mudug regional hospital
this study goes another study done in. Sri Lanka Marital status and educational status of
mothers had significantly associated with mothers’ knowledge of essential newborn care.
The odds of knowing about essential newborn care among married women and the odds of
knowing about ENBC among those who are able to read and write is. But there is no
association with marital status in a similar study conducted in Sri Lanka which shows
strong association with employment and ANC follow up. This difference might be due to
married women got an advising support from their husbands [9 Senarath U, et al. Factors
associated with maternal knowledge of newborn care among hospital delivered mothers in
Sri Lanka. R Soc Trop Med Hyg. 2007;101:823–30. Published Abstract.].

5.1.2 Knowledge and Practice of newborn care among midwives at mudug regional
hospital.
5.1.3 Knowledge and practice of new born care among midwives in Sudan

Three hundred eighty-four mothers were enrolled in the study. The median (interquartile)
age of the participants was 27.0 (22.0–30.0) years. Over half of the mothers, 256 (66.7%),
had less than a secondary education. One hundred forty-four participants (37.5%) were
employed, and more than half (57.8%) of their residences were urban Most participants,
326 (84.9%), had antenatal care during the index pregnancy, but the maximum number of
antenatal care visits were two in 98.5% of cases. Two hundred and forty-five women
(63.8%) were delivered vaginally, with nearly one-third (32.2%) delivered at home.
Breastfeeding: Two hundred sixty-eight (69.8%) participants knew to initiate breastfeeding
immediately after delivery. The women had received information about colostrum (90.1%),
and 343 (89.3%) were informed about its advantages. Cord care: Three hundred six
participants (79.7%) were informed about the material that should be used to cut the
umbilical cord. Thermal care: Most mothers (63.8%) believed that keeping the baby in SSC
was essential to protect the baby from hypothermia. Information about drying and
wrapping babies was reported by 71.1% of participants. However, only 8.9% attained
knowledge about delaying bathing the baby for 24 h (Table 2). Overall, 225 (66.4%)
participants had good knowledge about ENC, based on their responses to the questionnaire
items.

5.1.4 Knowledge and practice of new born care among midwives in Tanzania

None of the newborns received all eight recommended ENC interventions. The median
duration of separation from the mother was 25 minutes and 15 seconds (ranging from
22 seconds to 3 hours and 36 minutes), 51% of the newborns received proper thermal care
during the separation. Twenty-one percent had sufficient umbilical cord care, 8% were
stimulated for breathing, 69% were observed at least once by healthcare staff and 9% did
undergo suctioning. None of the newborns received antibiotic ointments or vitamin K.
5.2 CONCLUSION

Majority of heath care provider in Mudug regional hospital in galkiao have adequate
knowledge on the immediate newborn such as prevent eye infection, normal breath per
min, but there have a little knowledge gap on measures to be taken if the baby is not
crying immediately after birth.
Even though 91.5% of participants have adequate newborn care practice, but specifically
the study participants show a low in the practice of putting on the sterile gloves during
delivery, newborn identification and also assessment of Apgar score.
The health care provider practices of immediate newborn care were affected by the
availability of national guideline, shortage of materials for immediate newborn care.

5.3 RECOMMENDATION

Although the health care facility in Mudug regional hospital are poor according to new
born care among midwives so the most give health education about new born care.

 We recommended further research on this issue in Somalia.

 The research recommends retraining of health workers and maintain health

education to minimize lack awarrnes of cumminty midwifes.
 The research recommends control of new born compulication which can cause
death and disablity.
 To impvove the health facility and health worker expreince about new born.
 İn order to improve the knowledge and practice of new born care among
midwives the service provider would benefit from training in how to improve
their knowledge occording to care of new born .