Assessment Of Knowledge, Attitude And Practice By Mothers On The Prevention Of Neonatal Sepsis

INTRODUCTION
1.1 Background to the study
Neonatal sepsis refers to presence of bacterial blood stream infection in the setting of fever (Stoll, 2011). Neonatal septic infection occurs in infants younger than 90 days of age (Edwards et al., 2006). This infection is divided into two categories: early onset sepsis (EOS) and late onset sepsis (LOS). Early onset sepsis presents within seven days of life while late onset sepsis refers to presentation of sepsis from 8 to 89 days of life (Tallur et al., 2000). Neonatal sepsis is characterized by fever, breathing problems, diarrhea, low blood sugar, reduced suckling, slow heart rate, vomiting, swollen belly and jaundice (Verani et al., 2010).
Neonatal sepsis is one of the most common cause of neonatal morbidity and mortality. It is estimated to cause 26% of all neonatal deaths worldwide (Lawn et al, 2005).It’s Incidence varies from country to country but is much higher in developing countries (Kaistha et al, 2009) where it is responsible for about 30-50% of the total of neonatal deaths (Bang et al, 1999).It is one of the most common reasons for admission to neonatal units in developing countries (Shitaye et al)
Neonatal sepsis refers to generalised bacterial infection documented by a positive blood culture in the first 28 days of life. It encompasses various systemic infections of the new born such as septicaemia, meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections. Superficial infections like conjunctivitis and oral thrush are not usually included under neonatal sepsis (Report of the national neonatal perinatal database, National neonatology forum 2002-2003)
Sepsis can be classified into 2 types according to the age of onset; early onset sepsis and late onset sepsis. Early onset sepsis presents within the first 72 hours of life and in severe cases the neonate may be symptomatic at birth. The source of infection for early onset sepsis is usually the maternal genital tract (Singh et al, 1994). Late onset sepsis presents after 72 hours of age. It is usually nosocomial as a complication of neonatal intensive care or community acquired. This classification is important as it helps in determining the most probable organism and mode of transmission. This guides empiric treatment (Forfar and Arneil’s textbook of paediatrics, 6th edition)
The spectrum of organisms that causes neonatal sepsis changes over time and varies from region to region even within the same hospital. This is due to the changing pattern of antibiotic use and changes in lifestyle (Shrestha et al, 2013).The local epidemiology of neonatal sepsis should be constantly updated to detect changes in the pattern of causative organisms and their susceptibility to various antibiotics. Early diagnosis and proper management of neonatal sepsis by rational antimicrobial therapy and supportive care can reduce mortality. Blood culture is the gold standard for diagnosis of sepsis but blood culture reports are usually available after 48 to 72 hours. There is need to Identify the common bacteria causing such infections in every hospital and their susceptibility patterns in order to provide necessary information for timely intervention (Shrestha et al 2013).
The incidence of neonatal sepsis is higher in developing countries (Vergnano et al., 2005) where it is associated with over 50% of deaths that occur in infants (WHO, 2000). In neonatal sepsis death rate is dependent on the pathogen that is associated with the infection, where Gram negative organisms are the leading cause of neonatal deaths. The most common cause of neonatal sepsis in developed countries are group B Streptococci (GBS), Escherichia coli (E. coli) and Listeria monocytogenes (Isaac et al., 1999; Hyde et al., 2002) while Gram negative bacteria and coagulase negative Staphylococci (CONS) are the most common cause of neonatal sepsis in developing countries (Lim et al., 1995; Palazzo et al., 2006 ). The type of pathogen causing disease in newborns may vary from one country to another and also from one medical institution to the next. Hence there is need for studies that will establish the specific bacteria associated with the disease and their response to empirical antimicrobials
(Desinor et al., 2004). This means that, for effective management of neonatal sepsis, studies should be carried out in the various countries, health institutions and even in different units within the hospitals independently without generalization (Alzwaini et al., 2000).
There are many factors that influence newborn health and the resultant mortality. These include immediate causes such as lack of antenatal care, unsupervised or poorly supervised home deliveries, unhygienic and unsafe delivery practices and cord care, prematurity, low birth weight, lack of exclusive breastfeeding and delays in recognition of danger signs in both mother and baby.Health system ineffiencies, infrastructural, logistic and economic constraints also contribute to high rates of neonatal mortality. Wide inequities exist in health service provision such that the lowest coverage rates of known effective maternal and child interventions exist within the poorer income groups.
It is recognized that up to 70% of newborn deaths can be prevented by scaling up evidence based available interventions such as giving tetanus toxoid to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care and early management of infections in newborns.
Exploration of immunological techniques such as assaying for C-Reactive proteins (CRP) may play an important role in the diagnosis of neonatal sepsis although they lack ability to detect specific bacterial pathogens. Blood culture to isolate the pathogen remains the gold standard method for diagnosis of sepsis (Lund et al., 2002). Knowledge of predictors of positive blood culture and antimicrobial susceptibility pattern of common pathogens in a given area is essential in guiding local empirical choice of antibiotics (Goosen, 2000). The objective of the present study was to determine the assessment of knowledge, attitude and practice by mothers on the prevention of neonatal sepsis in Alor.

1.2 Statement of the Problem
Neonatal sepsis has been often associated with morbidity and deaths that occur in newborns despite the various therapeutic and curative measures being under taken especially in the neonatal intensive care units. This may be due to inadequate information on neonatal sepsis in terms of causes, sources, prevalence, drug sensitivity and immune responses. Diagnosis and treatment of neonatal sepsis is further complicated by the varied pathogens responsible for the infection. Failure to make proper diagnosis of neonatal sepsis is further complicated by commonly shared symptoms between sepsis infection and other non-infectious diseases. Neonates are at high risk of developing bacterial infections due to their low production of immune cells, which are also insufficient in their immunologic functions especially the granulocytes. Against this backdrop, this study is an assessment of knowledge, attitude and practice by mothers on the prevention of neonatal sepsis in Alor.

1.3 Objectives of the study.
The main objective of this study is an assessment of knowledge, attitude and practice by mothers on the prevention of neonatal sepsis in Alor. Specifically, the objectives.
1. To assess mother’s knowledge of signs of neonatal sepsis in Alor.
2. To asses the attitudes regarding neonatal sepsis in Alor.
3. To asses the practices regarding neonatal sepsis in Alor.

1.4 Research Question
The study will provide answers to the following research questions
1. What is mother’s level of knowledge of neonatal sepsis in Alor?
2. What is the attitude of mothers on the prevention of neonatal sepsis in Alor ?
3. What is practice of mothers in regard to recognition of neonatal sepsis in Alor?

1.5 Significance of the study
Neonatal sepsis is the single most important cause of neonatal deaths in many communities, accounting for over a half of the deaths that occur (WHO, 2000). In NCRH, 247 neonates were diagnosed with positive clinical signs of neonatal sepsis in the year 2013. In the course of treatment 48 of the neonates lost their lives. This calls for a study to establish the population of neonates with a higher risk of sepsis infection (Kuruvilla et al., 1999) in order to take precaution in their management and treatment. Studies aiming at identifying and describing specific bacterial pathogens causing sepsis in a community and describing their antibiotic susceptibility are necessary (Musoke and Revathi, 2000) in order to identify the appropriate antibiotics for treatment. There is also need to study the unique neonatal immunologic responses such as, determining the cytokines involved in neonatal sepsis since they are immunomodulators. Early diagnosis, proper management and treatment of neonatal sepsis based on enable pediatricians to reduce mortality cases that result from neonatal sepsis infection.

1.6 Scope of the study
The study will be an assessment of knowledge, attitude and practice by mothers on the prevention of neonatal sepsis in Alor. The study is limited to some selected mothers in the area. Hence, the respondents for this study will be obtained from and among mothers in the study area.

1.7 Limitation Of The Study
In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

1.8 Definition Of Terms
Neonate: A baby less than 28 days of age.
Neonatal illness: An unhealthy condition in a baby less than 28 days of age.
Neonatal sepsis: An infection in a baby less than 28 days.
Signs: An objective evidence of disease..

1.9 Organization Of The Study
This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study. Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding. Chapter five gives summary, conclusion, and recommendations made of the study.