Peer Review Study Regarding Breastfeeding Within the First Hour of Birth

• Enquiry article
• Open Access
• Published: 06 September 2019

Noesis, attitude, and practice amongst mothers about newborn care in Sindh, Islamic republic of pakistan

• Kourosh Holakouie-Naieni²,
• Reza Majdzadeh²,
• Mir Saeed Yekaninejad²,
• Gholamreza Garmaroudi^three,
• Owais Raza⁴ &
• Shahrzad Nematollahi⁵

BMC Pregnancy and Childbirth book 19, Commodity number:329 (2019) Cite this article

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Abstruse

Groundwork

Each year nearly seven.7 meg children under five years dice around the world; out of which approximately three.one million of the newborns dice during the neonatal catamenia and most all these (99%) deaths occur in the developing countries. According to the Globe Health Organization'south estimation neonatal deaths account for 45% of the nether-v deaths. More than 1-third of these deaths occur in the start 24 h of birth, whereas three-quarter of the neonatal deaths takes identify in the first seven days of nativity. The purpose of this study is to assess the knowledge, attitude, and practices (KAP) among mothers nigh newborns' intendance and its related factors in commune Badin Sindh province of Pakistan.

Methods

A customs-based cross-sectional study was conducted from July 2017 to Baronial 2017 to assess the Knowledge, Mental attitude, and Practices (KAP) in mothers regarding newborn care. A structured questionnaire was administered, later pretest, for data gathering through face up to face interview. All survey participants were identified using multi-stage cluster sampling. A scoring organization was used to calculate the level of KAP among participants. Independent sample t-exam, ANOVA, and GLM were practical to place the statistical departure betwixt the ways of various groups.

Result

A total of 518 survey participants were interviewed. Among the study sample, more than one-half of the newborns were bathed inside six hours of delivery. Around l% started breastfeeding after 1 h of birth. A substantial proportion (45%) of mothers gave pre-lacteal feeding and 44.8% of them did not feed colostrum to their newborns. Among those who administered pre-lacteal to their newborn babies included animal/formula milk (15.4%), honey (24.5%) and fresh butter/ghee (five.ii. %). Mothers with no teaching had less meaning KAP score about newborn intendance as compared to those who had higher teaching (p < 0.05).

Decision

This study revealed that high-risk factors such as immediate bathing, application of traditional substances on the string, delayed initiation of breastfeeding, discarding colostrum and giving pre-lacteal feed to newborns were highly prevalent. This requires urgent attention of Maternal, Newborn and Kid Health (MNCH) programs and health care commitment system to prevent harmful care practices and adopt good for you practices especially in the rural settings.

Peer Review reports

Background

Each year nearly 7.7 million children nether five years die effectually the world; out of which approximately iii.i million of the newborns dice during the neonatal period and most all these (99%) deaths occur in the developing countries [1]. Co-ordinate to the World Wellness Organization interpretation, neonatal deaths account for 45% of the nether-five deaths [two]. More than ane-third of these deaths take place in the kickoff 24 h of nativity, whereas 3-quarter of the neonatal deaths takes place in the first 7 days of birth [iii, 4].

Amid the17 Sustainable Development Goals (SDGs) set past United nations in 2015, the third goal, target (No. 3.two) states that all countries aim to put a stop to millions of avoidable deaths of newborns and nether-five children past 2030. The targets to achieve are: reduction in neonatal mortality and nether-5 mortality to no more than 12 and 25 deaths per 1000 live births respectively [five]. Majority of depression-income countries are far behind achieving this goal mainly because of slow progress in reducing neonatal decease [6].

In Islamic republic of pakistan, despite the reduction in under-five and babe mortality rate, there is virtually no change in neonatal mortality for the concluding two decades (from 56 to 46 per 1000 live births) [seven]. Pakistan ranks third amongst the top ten countries with high incidence of neonatal deaths [viii]. At these mortality levels, 1 in every xiv Pakistani children is unable to survive earlier the beginning birthday, while i in every 11 dies before the age of five [9]. The increasing testify suggests that early newborn care practices impact neonatal bloodshed and morbidity. The brunt of neonatal mortality and morbidity can be reduced by practicing essential newborn care (ENC) practices [10]. Many studies take been done on the newborn intendance topics in Pakistan and in developing countries simply most of them only focus on newborn care practices [eleven,12,13,14].

In Pakistan, mothers are the primary caregiver to newborns hence the care is generally dependent on their level of knowledge, attitude, and practice (KAP) well-nigh newborn care. Therefore, this study aims to investigate the KAP of mothers nigh newborn care and its related factors to achieving optimum newborn care.

Methods

Written report blueprint, area and catamenia

To investigate the research topic, a community based cross-sectional study was performed in Badin, a rural district of province Sindh in Islamic republic of pakistan. The total area of this district is 6527 km². It is divided into 5 sub-districts namely Badin, Matli, TandoBago, Golarchi, and Talhar. The sub-districts are further administratively divided into 46 matrimony councils. The commune has full population 1,917,822. The population density of the district is 285 people per square kilometer and an estimated almanac growth rate of the district is ii.26%. Sex ratio in Badin district is 111 male per 100 females, which is more than the ratio at the national level that is 106. Out of the total population, 53% are males and 47% are females. 84% of the population resides in a rural expanse every bit compared to the xvi% that resides in the urban areas. The main language spoken in Badin district is Sindhi [15]. This report was conducted from June 2017 to July 2017.

Study population

The Study population consisted of married women of reproductive age ranging betwixt fifteen and 49 years, having at least one infant up to 12 months and residing in the locality for at least a year where the report was being conducted. Since it was an observational written report for a limited flow of time without any intervention; therefore an exception to the written consent was given instead verbal consent was taken from participants. All the same, for only two participants written consent was taken from their parents who were below the age of 16.

Sample size determination and sampling technique

A sample size of 528 was calculated with the following assumptions: because 95% confidence interval, standard deviation 30 (taken from the pilot study), 5% precision, ten% non-response charge per unit, and blueprint effect ii.

In order to select a report unit, multi-stage cluster sampling was used. For stage ane, three out of five sub-districts of Badin were selected randomly. At stage ii, via proportionate sampling, allocation of the sample size for each selected sub-district was determined proportionally to the number of households within each sub-district. For the third phase, the total number of the households was divided over the sample size to give sampling interval (chiliad) then participants were selected based on every kth household using a systematic sampling technique. In cases where more than one mother was present in the same household, simply one of them was randomly selected for an interview.

Data collection tools and processes

First questionnaire was adult in the English language language to ensure the data quality balls so it was translated into the local linguistic communication (Sindhi) of the study expanse by professional to make the questions easily understandable to the study population and it was retranslated back into the English language to evaluate its consistency. Data drove was conducted through individual interviews by trained data collectors using a pre-tested structured questionnaire. This questionnaire consisted of four parts; the first office collected socio-demographic details of the participants (such as historic period, education, occupation, residence etc.), whereas the rest three sections inquired the level of KAP (Knowledge, Attitude and Practices) regarding newborn care on thermoregulation, umbilical cord care, and breastfeeding. The knowledge section consisted of eleven questions; attitude section had 5 while do section included of nine questions.

A scoring organization based on the World Health Organization (WHO) essential newborn care guidelines was used to analyze responses on KAP sections [16]. Each correct answer was assigned "1 score" and wrong answer was given "0 score". For the Knowledge scale, the scores ranged from 0 to eleven points, where for Mental attitude, scores ranged from 0 to 5, while for Do scale, the scores ranged between 0 and 9 points.

Validity and reliability procedure

The questionnaire was adopted from WHO tool [16], accordingly from previous studies [xi, 13, 17, xviii] and after consultation with an experts in public health to include their opinions regarding the construct of the questionnaire to ascertain the validity. Required modifications were done based on the outcome variable of the report.

In society to cheque the reliability, a pilot written report was conducted on the xxx participants. The Cronbach'southward blastoff coefficient values for knowledge, attitude and practice items were 0.75, 0.62 and 0.72 respectively.

Statistical analysis

Afterwards data collection was completed, the data was checked for whatsoever errors or incomplete information, so that information technology could exist excluded from the entry. After data cleaning, the data was entered into Microsoft Excel and analyzed using STATA version 14 software. Univariate assay was used for descriptive statistics such equally frequencies, percent distribution, means and standard difference to depict socio-demographic characteristics of the sample mothers.

Socioeconomic status (SES) of the respondents was assessed on the basis of their household'due south assets by using Chief Component Assay (PCA) method. The resulting index was divided into three categories of 'Poor', 'Average' and 'Rich'. This socioeconomic status serves as the proxy indicator of household wealth that has been consequent with household income.

As for the bivariate analysis, contained sample t-examination and ANOVA were applied to identify a statistical deviation betwixt the means of various groups. In social club to compare mean scores of KAP virtually newborn care across the groups with more than two categories, a Scheffe postal service-hoc assay was performed. For multivariate, analysis, the generalized linear model (GLM) was used to identify independent factors associated with the KAP of newborn intendance later making an adjustment for other variables.

Results

The sample consisted of 528 participants and had an overall response rate of 98.one%. The mean age of the mothers was 28.viii ± v.viii years. 55.5% of the participants belonged to the historic period range of 20–29 years. Around 66% of the participants resided in the rural areas and 53% of respondents lived in joint families. 64.ix% had no educational activity at all, whereas only 14.ane% studied up to secondary level. 66% of these women were housewives while 34% had outdoor occupations. 20% of the working mothers were farmers. (Table ane).

Tabular array 1 Percent mean score of knowledge, attitude and practice among mothers regarding newborn care and the issue of adjusted analysis of the result of independent variables. Participants' scores of KAP are calculated out of 100

Full size table

The mean KAP scores for these mothers were v.48 (out of 11) for the scale of Knowledge, 3.14 (out of 5) for the scale of Attitude and four.60 (out of 9) for the scale of Practice.

Respondents' knowledge varied for dissimilar aspects of newborn care equally per WHO guidelines; 57% of the participants had right knowledge regarding peel to pare contact, whereas 55% knew about the correct timing of newborn'southward commencement bathroom, 54.6% had accurate knowledge about initiation of chest milk, 57.six% knew virtually pre-lacteal feed and 55.vi% of the participants could reply correctly near giving colostrum to their newborns. Simply 1.4% of the subjects informed that chlorhexidine should be applied on the umbilical cord and the rest reported that any blazon of oil, dettol, common powder, and antimony could be used. Around 73.4% of study subjects knew that breastfeeding should be given on demand. More than than half of the participants 51.0% were enlightened nearly six months duration of sectional breastfeeding. (Table 2).

Table 2 Distribution of respondents by cognition, attitude and practices among mothers almost newborn intendance

Full size table

Study participants were assessed on their attitude about newborn care, out of total sample unit, 59.v% perceived that skin to skin contact is a preventive method from getting cold to a baby. Most of the respondents 61.0% did not accept delaying bathing of their newborns babies. Bulk of the participants 88.4% preferred to utilise a new bract for string cutting. Around 68.1% believed that prelacteal feeding should not exist administered and 41.i% had a negative mental attitude on regarding colostrum feeding as shown in Tabular array two.

More than half of the respondents stated that they bathed their newborns within six hours of delivery. Around fifty% of subjects breastfed newborns after ane hour of their nascency. 44.8% stated that they did not feed colostrum to their newborns. Approximately 45% of the mothers reported that they gave pre-lacteal feed to their newborns. Among these, 15.iv% of respondents gave animal/formula milk, 24.v% gave love/sugar and 5.2% gave fresh butter/ghee. Majority of mothers 65.one% breastfed their babies on demand. (Tabular array 2).

Knowledge

The significant departure in the mean score was observed between knowledge and age (p = 0.001). Postal service hoc analysis result showed that mothers belonging to the age group of fourteen–19 had significantly lesser knowledge score (p = 0.049) as compared to the ones above 19. The knowledge score was statistically different among education level groups (p = 0.001). The smallest score (43.i) associated with the no education while highest score (70.0) with the higher level grouping. According to postal service-hoc analysis, mothers with no education had significantly lower score compared to those with education (p < 0.001). However, there was no such difference seen in the knowledge score for the mothers with center and higher educational activity (p = 0.117). The mean score of knowledge in occupation groups was seen significantly different (p = 0.001). The respondents who were authorities employees had the maximum score (65.five) whereas housewives had the lowest (47.0). Respondents who were housewives scored lowest compared to other categories (p = < 0.001). But the difference was not significant when the scores of housewives and those working as farmers were compared (p = 0.730). Moreover, the divergence between knowledge mean score and ethnicity was significantly visible (p = 0.001). The highest score (71.0) was in Mohjar and the smallest (47.8) in Sindhi group. The difference between the residence type and cognition score was significant (p = 0.001). The people living in urban had a higher score (62.1) as compared to those who were inhibiting in rural areas (43.4). The knowledge mean score was non significantly detected in the family type (p = 0.088) and sex of the child (p = 0.2). (Tabular array 1).

Attitude

A significant divergence was observed in age group (p = 0.002). The age grouping 14–19 had a lower score than others. The Following age group 20–29 had a statistically higher score than 14–19 grouping (p = 0.009). Instruction level, occupation, ethnicity, residence blazon were highly significantly unlike to the attitude score (p < 0.001). Participants belonging to college teaching, Government employee, Mohajir and urban categories had more attitude score on newborn care than the others. All the same, in that location was no significant difference between mental attitude hateful score and family type (p = 0.831) and sex activity of the kid (p = 0.2). (Table 1).

Practice

The do mean score in maternal historic period was significantly unlike (p = 0.001). The oldest age group > 40 had the lowest pct mean do score than the balance. However, the highly significant deviation was observed between the practice score and education (p < 0.001). In the post hoc assay, in that location was a significant difference between no education and the rest (p < 0.001). But the divergence betwixt middle and higher instruction groups was not significant (p = 0.176). The practice score was different among occupation categories (p < 0.001). The housewife had a significantly lower score than a private employee (p = 0.006). There was no pregnant difference between the farmer and housewife groups (p = 0.956). Identify of residence was highly associated (p = 0.01). The significant divergence in exercise mean score was non detected to family type (p = 0.63) and sexual activity of the kid (p = 0.054). (Tabular array i).

Determinants

Mothers aged between 20 to 29 had a significantly college mean score of knowledge as compared to those respondents who were aged 40 and above (B = 9.0; p = 0.014). Women with no formal education had lesser knowledge score compared to the women who had higher instruction (B = -14.3; p = 0.001). Occupation of the respondents did non show any pregnant effect on the knowledge score (p > 0.05). Mothers who were Mohajirs had better hateful knowledge score than those who were Siraiki or belonged to other ethnicities (B = 8.iii; p = 0.012). Those who were living in the urban areas had a college mean score for knowledge than who were residing in rural areas (B = 7.6; p = 0.001).

A meaning relation was found betwixt the levels of education and attitude score of the participants. Mothers with no education had less attitude score towards newborn intendance than participants who had higher or more educational activity (B = -14.vi); p = 0.000).

The practise score was higher amongst mothers who were 20–39 years old every bit compared to those who were forty and above (B = 14.v; p = 0.001). Teaching level proved to be a significant predictor for the practice score. Mothers without no education had less score than mothers who had college education levels. (B = -xiv.4; P < 0.001). Occupations and ethnicity had no event on the practice score. However, Urban residents had better practice score compared to the ones living in rural areas (B = 6.9; p = 0.003). (Table i).

Give-and-take

This study provides a holistic picture depicting knowledge, attitude, and practices in mothers about newborn care, to help design show- based interventions in guild to attain SDG goal iii related to newborn survival in Islamic republic of pakistan.

With respect to thermal protection, WHO has recommended preventive measures such as skin to skin contact, immediate placement of babe on mothers breast and delayed bathing with the gap of minimum vi hours afterwards birth are very important for a newborn as these can forbid the neonatal complication of hypothermia. The early bathing is known to be a leading chance factor for neonatal morbidity such as hypothermia and mortality [19, 20].

Co-ordinate to this study, 57% of the mothers had knowledge about Kangaroo care (skin to skin contact) and 57.1% adept pare to skin contact with their babies. Notwithstanding, these findings are considered depression when compared with a study conducted in North Ethiopia, where 99.3% of the participants had the noesis and 72.ane% practiced skin to skin contact with their babies [21]. This difference could exist related to the difference in study participants. As in to a higher place-mentioned study participants were midwives because of their qualification and positions they may have a improve agreement about the importance of skin to skin contact.

As far as the bathing fourth dimension is concerned, in the present study, more than half (51.8%) of the respondents reported that they bathed their newborns inside vi hours. If compared to the study done in District Matiari, Pakistan, where 32% of respondents stated that they bathed their newborns within half dozen hours, the current written report'southward statistics are quite high [13].

According to a study done in Nepal, cultural beliefs were related to early newborn bathing. Majority of the participants reportedly believed that early bathing of their newborns cleans the dirty coating of Vernix nowadays on the baby. Hence, the written report population has a custom of early bathing to clean and purify the baby instantly [22]. Nearly the same reason tin be held responsible for early bathing practices for newborns found in District Badin. Despite this, the practice percent is much lower in Badin if compared with 78.five% people in Gilgit, 82% people in Karachi, Pakistan and threescore% people in Southern Tanzania [11, xiv, 23]. The difference seen here tin can be due to a difference in socio-cultural characteristics in different regions.

An umbilical cord is some other sensitive issue concerning newborn care. WHO stresses the importance of hygiene while handling the cord and applying chlorhexidine, specially in regions where there are higher neonatal mortality rates [24]. Unhygienic deliveries and unsafe cord cutting and caring practices cause tetanus and sepsis which are two leading reasons for maternal and neonatal illnesses and deaths [19, 25].

The importance of applying Chlorhexidine was stated by Imdad A. et al. in Pakistan; he demonstrated a pregnant reduction in a number of cases of umbilical string infections among newborns delivered at habitation [26]. In the current study, 65.4% of the respondents stated that the umbilical cord was cutting past a new blade. Near 26.ix% of respondents reported using traditional substances on the string, whereas, only 1.5% used chlorhexidine. Yet, these findings were not consequent with a study conducted in urban areas of Rohtak Haryana located in the neighboring country India, where a new blade was used in 88.six% of the deliveries and 40% of the mothers used traditional substances on the cord [12]. The differences observed might exist due to study settings and the difference in a socio-cultural groundwork of the participants.

According to WHO, chest milk is the best way of feeding babies and supplying them with nutrients essential for their healthy growth and evolution [27].

Regarding the knowledge of breastfeeding, our study found out that 54.6% of the mothers knew that breastfeeding should exist initiated within an hour of the baby'south birth. 57.5% knew that pre-lacteal feed should non be given to neonates and 55.half dozen% of them stated that colostrum should exist given to their newborns. These figures did not match with the ones establish in a study done in Ethiopia; the respondents there had college knowledge about breastfeeding. Effectually 80.9% stated in that written report that breastfeeding should be initiated within the first hour of birth, 95.ix% stated that pre-lacteal feed should not be given to the newborns and 96.4% stated that colostrum should be given to the newborns [28]. The possible caption for such a stark difference in responses might be because the study in Ethiopia was conducted in urban areas every bit compared to this one done in rural areas that make a difference in the information about newborn care.

In this present study around half (50%) of the participants initiated breastfeeding within 1 60 minutes of birth, 54.eight% of them did not give whatsoever pre-lacteal feed and 55.ii% administered colostrum to their newborns. This finding is higher than the findings in a study done in commune Matairi, Pakistan which shows that chest milk was initiated within one hour by 41%, pre-lacteal feed was non given by 52.1% respondents and colostrum was given past 44% mothers [13]. This departure might be due to awareness interventions in the study customs by various organizations working on child health.

According to the outcome of the multivariate analysis, amongst socio-demographic and other related factors such as maternal age, instruction, and place of residence had meaning associations with the Knowledge and Practice score of mothers. Mothers within the age group of 20–39 had on boilerplate higher knowledge and practice score on newborn intendance every bit compared to women who were xl or in a higher place. This figure appeared to exist consistent with some other study washed in Ethiopia [24]. The suggested possible caption for the to a higher place result could exist that mothers with immature age may accept better awareness regarding the benefits of newborn care practices. While older mothers may take more traditional influence or come from the traditional cohort, therefore, were less likely to have cognition and practise in comparison to young mothers. Mothers' education level was found to exist significantly associated with the KAP of newborn care. Respondents with no formal educational activity had lesser score than those mothers who had higher education. This finding is consistent with studies washed at Tamil Nadu, in southeastern India and Kanchipuram district, Bharat [18, 29]. A likely explanation for this finding might be that a highly educated mother could have a better understanding or awareness about the importance of newborn care. Thus, giving these mothers confidence to take the correct decisions to have intendance of their newborns, resulting in better knowledge and accurate practices. In this study, there was no significant association of mothers' occupation with KAP of mothers about newborn care. This finding is similar to the report done at Mandura District, Northwest Ethiopia, In which no association between mothers occupation and mothers exercise of newborn care was found [xxx]. This inconsistency could be considering of the difference in socio-demographic weather condition of the respondents in the written report area. Urban resident mothers were associated with the practice of newborn care than who were living in rural areas. This is in line with the two studies done in Ethiopia [30, 31]. A probable reason for this departure might exist easy access to healthcare services and better education in urban areas as compared to rural areas. In our study, the socioeconomic status of the respondents had no clan with the practice of newborn care. This finding is also like to the study done in Ethiopia [31]. The reason behind this could be that health care provider disseminates information about the importance of newborn care house to firm irrespective of socioeconomic condition.

Limitations of the study

Since the study is cantankerous-sectional it may not be potent enough to demonstrate a causal relationship between dependent and independent variables due to the nature of the study. Similar studies done on KAP of newborn care are express in our country to brand comparative discussion. The information on KAP of newborn care was collected from the mothers who had given live birth during the past twelve months prior to the start of this survey. Hence, there might be some recall bias that afflicted the quality of data.

Conclusion

The findings of this study showed gaps in knowledge and practice for newborn care. High-take chances factors were identified in this study such as immediate bathing, application of traditional substances on the umbilical cord, delayed initiation of breastfeeding, discarding colostrum and giving pre-lacteal feed to newborns; these all need immediate attention of MNCH programs in Sindh province. Moreover, this written report has also revealed many socio-demographic factors which take significant effects on the mothers' KAP regarding newborn care. These factors included educational activity level of mother and place of residence. Therefore, data gained from this written report tin be used as a baseline to provide input for developing feasible and sustainable behavioral change and educational interventions. Community-based programs are expected to address the poor practices to amend neonatal outcomes. Furthermore, it is recommended to conduct qualitative research to explore the reasons and beliefs associated with unsafe newborn care practices.

Availability of data and materials

The datasets used and/or analyzed during the current report are available from the respective writer on reasonable request.

Abbreviations

ANOVA:

Assay of variance

GLM:

Generalized Linear Model

KAP:

Noesis, Mental attitude and Practise

MNCH:

Maternal, Newborn and Kid Health

SDG:

Sustainable Development Goals

SES:

Socio-Economic Status

WHO:

World Health Organization

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Acknowledgments

The inquiry team would like to sincerely admit all written report respondents who gave their valuable information and time voluntarily. The researchers wish to thank Tehran University of Medical Sciences for financial support of this study. The authors declare no conflict of interests most the publication of this paper.

Funding

Tehran University of Medical Sciences has provided provincial support equally office of Chief's Written report program. Funding approving had no role in designing, implementation and production of this manuscript.

Writer information

Affiliations

1. School of Public Wellness, International Campus, Tehran University of Medical Sciences, Tehran, Iran

   Javed Memon

2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran Academy of Medical Sciences, Tehran, Iran

   Kourosh Holakouie-Naieni, Reza Majdzadeh & Mir Saeed Yekaninejad

3. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

   Gholamreza Garmaroudi

4. Department of Health Education & Promotion School of Public Health, Tehran Academy of Medical Sciences, Tehran, Iran

   Owais Raza

5. Men`south Wellness & Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

   Shahrzad Nematollahi

Contributions

JM, KH, RM, GG, MSY, OR, SN were responsible for the conception and design of the study.JM wrote the first draft of the manuscript and all other authors contributed in finalization of information technology.KH, RM, and MSY supervised the overall implementation of the project.GG, OR and SN assisted in validating the instrument tool. JM, MSY, OR and SN conducted data analysis and guided in the interpretation of the data. OR assisted in the publication process of the written report. All authors read and approved the final version of the manuscript for publication.

Corresponding author

Correspondence to Javed Memon.

Ethics declarations

Ethics blessing and consent to participate

This survey was part of a student thesis. Ethical approval and clearance of the enquiry proposal were obtained from "Medical Ideals Committee, Tehran University of Medical Sciences" with project registration number (IR.TUMS.SPH.REC.1396.3179). In add-on to this, verbal consent was also obtained from the local government and community stakeholders at the district level. Respondents were explained about the objectives of the study, the confidentiality of data and their rights before starting the data collection. Equally this survey was a brusque observational study and did not involve whatever intervention, and near all the participants were adults, therefore, simply verbal consent from the participants was taken instead of a written consent.

Note: In this study, in that location were just two minor participants under the age of 16 hence, for them a written consent was obtained from their parents.

Consent for publication

Not applicable.

Competing interests

The authors declare that they accept no competing interests.

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Memon, J., Holakouie-Naieni, K., Majdzadeh, R. et al. Noesis, attitude, and practice among mothers about newborn care in Sindh, Pakistan. BMC Pregnancy Childbirth xix, 329 (2019). https://doi.org/10.1186/s12884-019-2479-0

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• Received: 02 June 2018

• Accustomed: 26 August 2019

• Published: 06 September 2019

• DOI : https://doi.org/x.1186/s12884-019-2479-0

Keywords

• Knowledge
• Attitude
• Practice
• Newborn care

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Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2479-0

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