Knowledge, Associated Factors And Practices Of Postpartum Mothers Regarding Puerperal Sepsis Prevention

Knowledge, Associated Factors And Practices Of Postpartum Mothers Regarding Puerperal Sepsis Prevention

Abstract

Puerperal sepsis is infection of the genital tract occurring at any time between the onset of rupture of membranes or labor and the 42 day postpartum. It’s one of the fifth common causes of maternal mortality worldwide. The aim of this study was to assess Knowledge and practices of postnatal mothers regarding prevention of puerperal sepsis. A descriptive cross sectional research design. Purposive samples composed of (87) postnatal mothers from University of Nigeria Teaching Hospital Enugu for obstetric and pediatric at postnatal department. Tools of data collection included a structured interview questionnaire, knowledge assessment tool and practical assessment tool. The study revealed that (87.4%) of the studied women had unsatisfactory knowledge level regarding puerperal sepsis and (74.7%) of the studied sample had poor practice about prevention of puerperal sepsis. There is positive association between total knowledge score and total practices level (p. value < .ooo1) The study concluded that majority of postnatal mothers had poor level of knowledge regarding puerperal sepsis , and around three quarters of them had poor practice about prevention of puerperal sepsis. A positive fair association was found between knowledge and practice scores regarding prevention of puerperal sepsis. Based on the findings, the study recommends that the obstetric nurse could play and implement their role as health educator, counselor, coordinator, and supervisor and help post natal mothers to improve their knowledge and practices regarding puerperal sepsis and its prevention.

Table of Content

• Title Page
• Certification
• Dedication
• Acknowledgement
• Table of Content
• List of Tables
• Abstract

Chapter One:

Introduction

• 1.1 Background of the Study
• 1.2 Statement of the Problem
• 1.3 Objective of the Study
• 1.4 Research Questions
• 1.5 Research Hypothesis
• 1.6 Significance of the Study
• 1.7 Scope of the Study
• 1.8 Limitation of the Study
• 1.9 Definition of Terms
• 1.10 Organisations of the Study

Chapter Two:

Review of Literature

• 2.1 Conceptual Framework
• 2.2 Theoretical Framework
• 2.3 Empirical Review

Chapter Three:

Research Methodology

• 3.1 Introduction
• 3.2 Research Design
• 3.3 Research Settings
• 3.4 Sample
• 3.5 Sample Technique
• 3.6 Inclusion and Exclusion Criteria
• 3.7 Instrument for Data Collection
• 3.8 Validity and Reliability
• 3.9 Pilot Study
• 3.10 Data collection procedure
• 3.11 Ethical Consideration
• 3.12 Statistical Design

Chapter Four:

Data Presentation and Analysis

• 4.1 Socio-Demographic Characteristics and Obstetric History Among Studied Sample
• 4.2 Results
• 4.3 Discussion of Findings

Chapter Five:

Summary, Conclusion and Recommendation

• 5.1 Summary
• 5.2 Conclusion
• 5.3 Recommendation
• References
• APPENDIX
• QUESTIONNAIRE

Chapter One

Introduction

1.1 Background of the Study

According to the World Health Organization definition, puerperal sepsis is a genital tract infection occurring within the rupture of placental membranes or labor until 42nd days of the post – partum period. This disease is characterized by two or more of such symptoms as pelvic pain, fever (i.e., oral temperature of 38.5°C or higher on any occasion), abnormal vaginal discharge and delay in the reduction of the uterus size (WHO, 2015). The vast majority of puerperal sepsis is due to infection of the genital tract pathogens that colonize the cervix and vagina, gain access to amniotic fluid and invade the devitalised uterine tissues. Puerperal sepsis results from infection contacted during childbirth and this is one of the commonest causes of maternal mortality in the developing countries. Common predisposing factors leading to puerperal sepsis are anaemia, prolonged labour, frequent vaginal examinations in labour under unsterilized circumstances, premature rupture of membranes for prolonged periods. (Kiponza et al., 2019).

Puerperal sepsis is one of the major causes of preventable maternal morbidity and mortality in the developing countries. World Health Organization estimated that about 800 women die from pregnancy- or childbirth-related complications around the world daily and puerperal sepsis contributes about 15% of these deaths. Majority of maternal mortality (99%) occurs in developing countries, and most can be prevented. Most postpartum infections take place afterhospital discharge, which is usually after 48 hours following delivery. In the absence of postnatal follow-up, as is the case in many developing countries, many cases of puerperal infections go undiagnosed and unreported (Ifunanya et al., 2019). Puerperal sepsis is preventable with provision of adequate antenatal care, referral and timely treatment of complications of pregnancy, promoting institutional delivery and postnatal care. Some developing countries have experienced increased use of health facilities for labor and delivery care, but there is a lack of proper monitoring or checks and balances and there is a possibility that this trend could lead to rising rates of puerperal sepsis. Drug and technological developments need to be combined with effective health system intervention to reduce infection, including puerperal sepsis (Kaur & Ray, 2020). Puerperal sepsis accounts for 15% of maternal deaths worldwide. In Africa, puerperal sepsis is the second leading cause of maternal morbidity and mortality, accounting for more than 10% of maternal deaths. On the other hand, the rate of puerperal sepsis has declined significantly in high-income countries For example, in the United States puerperal sepsis occur in only 5.5% of vaginal deliveries and 7.4% of caesarean section deliveries (Kiponza, 2019).

WHO estimates that the global prevalence of maternal sepsis is 4•4% among live births, that represent more than 5•7 million cases per year. Important variations exist between regions, with higher incidence in low-income and middle-income countries (up to 7%) compared with high-income countries (1–2%). Despite the relative low prevalence and the availability of interventions for its prevention and treatment, maternal sepsis remains a life-threatening condition and one of the leading direct causes of maternal mortality worldwide, accounting for up to 10% of maternal deaths (Bonet et al., 2015). In 2013, over 30.000 maternal deaths (11%) were referred to postpartum sepsis, and is considered as the third most frequent cause of approximately 290.000 maternal deaths worldwide. Moreover, other studies reported that over 5 million/year of maternal sepsis occur globally with an estimated 75.000 maternal death, and mortality rates attributable to sepsis approach 33% in low-income settings (WHO, 2014).

The postpartum period is the most vulnerable period for the mother and newborn. Puerperal sepsis still one of the causes for deaths in developing countries, mainly in Nigeria postnatal infection is the fourth direct leading cause of maternal death (WHO, 2014). The inadequate access to skilled care during and after childbirth, or neglect to provide the mother with adequate knowledge and practice to prevent the puerperal sepsis, that can put the mother at risk for infection (Masoud & Saber, 2016). Since puerperal sepsis is a preventable factor of maternal morbidity and mortality, therefore, the researcher felt the need to educate the postpartum mothers about puerperal sepsis and the steps of precaution to prevent this issue by using the instructional guideline to improve the knowledge and practices regarding puerperal sepsis and its prevention.

1.2 Statement of the Problem

Puerperal sepsis is serious form of septicemia contracted by women during or soon after child birth, miscarriage or unsafe abortion (Chandra et al., 2011). It has been found to be the second most common cause of maternal morbidity and mortality in the developing world (Utoo et al., 2012). Studies from high-income countries report incidence of maternal morbidity due to sepsis having increased from 0.65 per 1000 deliveries in 2002 to 1.13 per 100,000 maternities in 2008 (Bauer et al., 2013). It has been reported that each woman that dies sixteen others Suffer various forms of morbidity, among them puerperal sepsis (Razia et al., 2009).

Over 70% of maternal deaths in the developing world are caused by sepsis among other causes including; hemorrhage, hypertension disorders, unsafe abortion, and obstructed labor. Sepsis was the most frequent underlying cause of maternal morbidity and mortality in the 19th century, responsible for 50% of all cases. It is the leading cause of death in the intensive care unit in the United States (Dillen et al., 2010).

The most effective and least expensive treatment of postpartum infection is prevention. Preventive measures include, good prenatal nutrition to control anemia and intrapartal hemorrhage. Good maternal perineal hygiene with thorough hand washing is emphasized. Nurses in birth centers and hospital settings must be able to identify women at risk for postpartum infection and to provide anticipatory teaching and counseling before discharge. After discharge, telephone follow-up, hot lines, support groups, lactation counselors, home visits by nurses, and teaching materials (videos, written materials) are all interventions that can be implemented to prevent or increase recognition of postpartum infections (Lowdermilk, et al.,2016).

1.3 Objectives of the Study

The major of this study is to critically examine the knowledge, associated factors and practices of postpartum mothers regarding puerperal sepsis prevention. By extension, this study will specifically;

1. Assess the knowledge of postpartum mothers about puerperal sepsis.
2. Ascertain the associated factors with the practices of postpartum mothers regarding puerperal sepsis prevention.
3. Determine the the practices of postpartum mothers about puerperal sepsis.
4. Find out if there is an association between knowledge and practices of postpartum mothers regarding puerperal sepsis.

1.4 Research Questions

The study will be guided by the following questions;

1. What are the knowledge of postnatal mothers about puerperal sepsis?
2. What are the practices of postnatal mothers about puerperal sepsis?
3. Is their are association between knowledge and practices of postnatal mothers regarding puerperal sepsis?

1.5 Research Hypothesis

• Ho: There is no association between knowledge and practices of postpartum mothers regarding puerperal sepsis.
• Ha: There is an association between knowledge and practices of postpartum mothers regarding puerperal sepsis.

1.5 Significance of the Study

The study will help to educate the postpartum mothers about puerperal sepsis and the steps of precaution to prevent this issue by using the instructional guideline to improve the knowledge and practices regarding puerperal sepsis and its prevention.

Results from the study will highlight gaps in infection control strategies informing subsequent interventions to reduce the levels of infections and associated maternal morbidity. This will also boost the attainment of MDG goal five on reducing maternal mortality ratio.

1.6 Scope of the Study

This study is to critically examine the knowledge, associated factors and practices of postpartum mothers regarding puerperal sepsis prevention. Geographically, this study will be delimited to in Lagos State.

1.8. Limitation of the Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.

1.9 Definition of Terms

Assess:

The ability or quality of or to evaluate or estimate the nature.

Knowledge:

Knowledge refers to information among postnatal mothers regarding prevention of puerperal infection includes perineal care, mastitis, breast engorgement and urinary tract infection.

Practices:

It refers to the verbal response of postnatal mothers that what they are doing for the prevention of puerperal infection.

Puerperal Infection:

It is an infection of the genital tract during the postnatal period upto 42 days following childbirth.

Prevention:

Refers to the measures which are given to control or reduce from a puerperal sepsis during postnatal period.

1.10 Organization of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the knowledge, associated factors and practices of postpartum mothers regarding puerperal sepsis prevention. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was to examine the knowledge, associated factors and practices of postpartum mothers regarding puerperal sepsis prevention. The study was specifically focused to assess the knowledge of postpartum mothers about puerperal sepsis, ascertain the associated factors with the practices of postpartum mothers regarding puerperal sepsis prevention, determine the the practices of postpartum mothers about puerperal sepsis, and find out if there is an association between knowledge and practices of postpartum mothers regarding puerperal sepsis.
The study adopted the descriptive cross-sectional research design and purposefully enrolled participants in the study. A total of 87 responses were validated from the enrolled participants where all respondent arepostnatal mothers in the study area.

5.3 Conclusions

Based on the results of the present study, it can be concluded that the study concluded that majority of postnatal mothers had poor level of knowledge regarding puerperal sepsis, and around three quarters of them had poor practice about prevention of puerperal sepsis.

5.4 Recommendation

Based on the findings the researcher recommends that;

1. Continuing education of the nurses who work in obstetrics and gynecological areas must be updated with the necessary knowledge about puerperal sepsis and its prevention.
2. Puerperal sepsis guidelines can be introduced to the women antenatal and then it can be used postnatal.
3. The obstetric nurse could play and implement their role as health educator, counselor, coordinator, and supervisor and help post natal mothers to improve their knowledge regarding puerperal sepsis and its prevention.
4. Further researches are needed regarding factors and barriers associated with the utilization of self-care practices through reproductive years for women as well as for prevention and management of various obstetrics and gynecological problems.

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