Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1 NAME OF THE CANDIDATE AND MS. NIRMALA JOSHY, I YEAR M.Sc. NURSING, B.G.S. COLLEGE OF NURSING ADDRESS (IN BLOCK 2 LETTERS) MYSORE-23 NAME OF THE B.G.S.COLLEGE OF NURSING INSTITUTION 3. KUVEMPUNAGAR SCIENCES, MYSORE. COURSE OF STUDY AND SUBJECT M.Sc. NURSING CHILD HEALTH NURSING. 4. DATE OF ADMISSION 5. TITLE OF THE TOPIC: 15.06.2010 A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE RELATED TO KNOWLEDGE AND ATTITUDE AMONG PRIMI MOTHERS ON MANAGEMENT OF MINOR AILMENTS OF NEWBORN IN SELECTED HOSPITALS AT MYSORE.” INTRODUCTION: “Whose eyes sparkle like the stars? Whose smile outshines the sun? Whose skin is soft as the moon glow? Our precious little one!” Kids brighten up our life and home with their soulful laughter, childish talks and unlimited energy. neonates or newborn are the most delicate group among kids as they are not able to express their feelings of happiness, sad, pain or discomfort and their systems are immature ,just starting to adjust to the extra uterine life. It is very difficult to see a newborn crying when he or she is sick. They are the heart and the soul of their parents, a precious gift to them after a long expectation of nine months. Mothers are angels in disguise, always there for a family, silently supporting each family members and building up the future generations of the society and building up a good family. Being a mother for the first time is a wonderful and exciting feeling for any women in her life. Once she comes to know that she is going to be a mother, she stars preparing for motherhood and waits patiently and expectantly for her baby. Most mothers observe their babies carefully. A mother child bond is being developed soon after the baby is brought to the mother1. As she observes her baby, she might often get worried by minor physical and physiological peculiarities of the baby. This may include milia, Mongolian spot, sneezing, hiccups, napkin rash, acne, cradle cap, colic etc…2 These may be very alarming for a mother especially for a first time mother. When parents have the responsibility for a baby, it is only natural for them to want to protect them as much as possible from sickness and to deal with any signs of sickness quickly. This is perhaps one of the most difficult parts of baby care, as it can be difficult to find the balance between allowing the sickness to take the natural course or rushing to the doctor at every hint of a minor ailment. She must be listened to carefully and given reassurance and advice regarding minor problems and difficulties of the newborn. Adequate explanation and reassurance is necessary to allay her anxiety which may lead to lactation failure. BRIEF RESUME OF INTENDED WORK: 6.1 Need for the study: There are various minor health problems a newborn will suffer at some point of life, especially in the neonatal period. Some of them requires no management, it goes off by itself. some require simple management which can even be done at home, while others requires doctor’s consultation or medical or nursing interventions. Mother’s have to be aware of this. Unless, she is going to be aware of the minor ailments and their management, she is going to get worried about her newborn which is again going to affect her baby adversely. It is worth bearing in mind that for minor ailments, there are some home remedies that will help the baby to get rid of that. A study on knowledge, attitude and practice of neonatal care among post natal mothers in a tertiary care hospital in south India, during April –July 2009, among 100 postnatal mothers concluded that knowledge of mother’s was inadequate in areas of umbilical cord care (35%) thermal care (76%) and vaccine preventable diseases. 19% of them still practice oil instillation into the nostrils of newborn and 61% of them administer gripe water to their babies. The study concluded that awareness and attitude of postnatal mothers towards neonatal care has lots of lacunae especially in those who belong to the lower socio-economic status and that there is a scope for improvement by providing better care and health education for antenatal mothers3. Another study was conducted on Hispanic mothers' beliefs and practices regarding selected children's health problems. The purpose of this study was to identify and describe the Hispanic mothers' initial sources of advice and help with children's illnesses; beliefs about the etiology and seriousness of certain children's illnesses, namely, fever, cough, diarrhea, vomiting, conjunctivitis, skin rash, minor wounds, and burns; practices for the management of these children's health problems, including the use of home remedies, if any. Interviews were conducted with 100 women of Hispanic origin who had at least one child age 5 years or less and who were attending a community clinic in a rural area of central California. Mothers' beliefs about problem etiologies varied widely and revealed several misconceptions, folk beliefs, and lack of knowledge. The findings also revealed that only 32% of the mothers used or would use health professionals as the initial source of advice or help with children's problems. The majority of the subjects (81%) admitted to using home remedies to manage children's problems; 17% sought the help of a folk healer (mainly for the treatment of empacho). The various types of home remedies used by mothers were described and included the ingestion or application of certain foods, fluids, herbal teas, or other materials as well as methods to eliminate the perceived causes of the problems. It is important to note that 11% of the mothers had used azarcon or greta (substances containing lead) for treating empacho and other stomach problems in children. The need for culturally responsive and sensitive health care is discussed4. Another study on Symptoms were assessed in 298 infants under 6 months old seen at home by Thornton AJ, etal was done. In that their mothers were asked if they were concerned about their babies and then questioned about the presence, duration, and severity of 28 predefined symptoms. Forty seven mothers expressed concern about their babies (16%), whereas on direct questioning 241 (81%) reported symptoms present within the last 24 hours. One hundred and twenty three (41%) reported three or more. Many of the symptoms occurred in more than 15 babies (5%). The commonest were cold peripheries (117, 39%), noisy breathing (88, 30%), and rash (68, 23%)5. A study on an overview of Diaper dermatitis, by Prasad H.R.,Verma .K and Srivastava .P. concluded that , it probably results due to an interaction of multiple factors like increased wetness, elevated pH due to urine, fecal enzymes and microorganisms under the nappy. It manifests as an erythematous rash occurring on the convex surfaces of skin under the nappy. Rashes resembling nappy dermatitis can also be caused by some diseases which may have serious systemic manifestations. Therefore it is essential to differentiate and treat them. The principle of treatment of diaper dermatitis is to keep the skin in the nappy area as dry as possible with frequent nappy change. The super absorbent disposable diapers are known to reduce the incidence of diaper dermatitis. Barrier creams to protect the infant's skin and mild topical corticosteroids to reduce the inflammation are mainstays of therapy. The incidence and severity can be reduced by keeping the skin dry under the nappy and protected from irritants and infections6. A study by Atherton on maintaining healthy skin in infancy using prevention of irritant diaper dermatitis concluded that irritant napkin dermatitis is a form of contact dermatitis that occurs in the nappy area as a consequence of the disruption of skin barrier integrity by prolonged contact with feces and urine. It is a condition that still occurs regularly in young children, and is best managed by prevention. In this update, we will consider the reasons that irritant napkin dermatitis develops, and the simple methods that parents can adopt to avert it. These methods are equally appropriate for general skin care in babies, with the aim of preventing atopic dermatitis, another exceedingly common skin problem in this age group7. Another study on Neonatal dermatology at tertiary care teaching hospital by Muhammad Javed found that All children under the age of 28 days, with dermatological problems visiting either Pediatric or Dermatology ward/OPD/ Emergency of Hamdard University Hospital were included in the study, these cases were seen by pediatricians & confirmed by the dermatologist. The history was followed by a general physical and systemic examination and detailed skin examination. Relevant investigations were done including blood cultures. 77 cases below the age of 28 days (neonates) were seen during the study period, there were 26 cases of neonatal skin infections (33.76%), 13 cases of hereditary disorders (16.88%), 12 cases of nappy rash (15.58%), 10 cases of erythema toxicum neonatorum 9.8%), 8 cases of milia (10,38%) and 4 cases of erythema following phototherapy(5.19%)8. An article by Chandramita Bora on neonatal acne says “It has been observed that almost 20% of the newborn babies can get acne, which is also known as neonatal acne and acne infantum within a few weeks after their birth. The incidence of neonatal or baby acne has been found to be more in baby boys than baby girls.” 9 Another study conducted by N.Singh and Purtthi P.K, Sachdev A. etal on disposable diapers: safe and effective method, in 2003, concluded that nappy rash is a common problem in infants due to their thinner skin, wetness, heat and friction under cloth nappy, fecal enzymes and alkaline urine. The disposable diapers containing super absorbent material reduce the incidence of nappy rash. 10 In 2009, a University of Texas study observed that colicky babies had a higher incidence of mild intestinal inflammation and a specific intestinal bacterium, Klebsiella. But, a commentary in the same journal, noted that the inflammation and bacteria were most likely just an exaggerated variation of normal.10 In order to bridge the gap in knowledge and the mothers be free of unnecessary anxiety over the minor ailments of newborn they need to be adequately informed and given support and counseling 6.2 Review of Literature: Literature review is an essential step in the whole process of research. The term review of literature refers to the activities involving in identifying and searching for information on a topic and developing an understanding of the state of knowledge on that topic. It is also used to designate a written summary of the state of the art on a research problem. The review of literature has been divided into following headings Review of literature on nappy rash Review of literature on colic in newborn Review of literature on neonatal acne 1. Review of literature on nappy rash A study was conducted in USA on Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity. New Zealand to test that baby diaper wipes with emollient cleansers and a soft cloth would minimize skin compromise relative to cloth and water. 130 NICU infants (gestational age 23-41 weeks, at enrollment 30-51 weeks), measurements of skin condition, i.e., skin erythema, skin rash, transepidermal water loss (TEWL) and surface acidity (pH), within the diaper and at diaper and chest control sites were determined daily for 5-14 days using standardized methods. Experimental design was used and Treatments were randomly assigned based on gestational age and starting skin irritation score A, wipe B, and the current cloth and water NICU. Data were collected by using experimental method and were analyzed using descriptive statistics. Findings of the study showed that Perineal erythema and TEWL were significantly lower for wipes A and B than cloth and water beginning at day 5 for erythema and day 7 for TEWL. Wipe B produced a significantly lower skin pH than wipe A and cloth and water. The study concluded that the Both wipes are appropriate for use on medically stable NICU patients, including both full and preterm infants, and provide more normalized skin condition and barrier function versus the cloth and water standard. Wipe B may facilitate acid mantle development and assist in colonization, infection control and barrier repair11. A study was conducted in USA on Clinical demonstration of skin mildness and suitability for sensitive infant skin of a new baby wipe. To evaluate the skin effects of a novel baby wipe formulation with increased pH buffering. Experimental design was used A series of clinical studies was designed and conducted to evaluate the skin effects of the new baby wipe, a 4-week study in babies with medically confirmed atopic dermatitis (n = 32), a 2-week study comparing skin pH of babies (n = 15) following use of wipes compared with water and wash cloth, a series of clinical skin pH measurements following fecal exposure and subsequent cleaning with different products (n = 50) and a study evaluating comfort of product application on irritated skin (n = 31) and the samples were selected by random sampling technique. The findings showed that The wipes formulation was well-tolerated, even in babies with atopic dermatitis, and was more comfortable versus water and washcloth. Increased buffering capacity of a wet wipes lotion helps to maintain a physiologically balanced skin pH value in the diaper region.12 A Comparative study was conducted in Europe to determine the clinical benefits of a novel disposable diaper designed to deliver a zinc oxide and petrolatum-based formulation continuously to the skin during use. All studies were independent, blinded, randomized clinical trials. Study A was conducted to confirm transfer of the zinc oxide/petrolatum (ZnO/Pet) formulation from the diaper to the child's skin during use. Study C evaluated skin erythema and diaper rash in 268 infants over a 4week usage period. One half of the infants used the ZnO/Pet diaper, while the other half used a control diaper that was identical except for the absence of the ZnO/Pet formulation. The results showed the ointment formulation and ZnO transferred effectively from the diaper to the child's skin during product use. Transfer of ZnO increased from 4.2 microg/cm2 at 3 h to > 8 microg/cm2 at 24 h. Greatest reductions were seen for the ZnO containing formulations. Wearing of the formulation treated diaper was also associated with a significant reduction in skin erythema and diaper rash compared to the control product.. The results demonstrated the clinical benefits associated with continuous topical administration of a zinc oxide/petrolatum-based formulation by this novel diaper13. A study was conducted in Europe, to determine the clinical benefits of a novel disposable diaper designed to deliver a petrolatum-based formulation continuously to the skin during use. Two independent, blinded, randomized clinical trials were conducted, involving an aggregate total of 391 children, 8-24 months of age. All comparisons were done versus a control diaper, identical to the test product except for the absence of the petrolatum formulation. The studies determined the effects of the novel diaper on skin erythema and diaper rash using a convenience sample. The results were use of the formulation-treated diaper was associated with significant reductions in severity of erythema and diaper rash compared to the control product. The study concluded that clinical benefits associated with continuous topical administration of a petrolatum-based formulation by this novel diaper.14 Another study on frequency and contributory factors in hospital attending children was done in UK to better understand the frequency of diaper dermatitis, treatment practices and the current importance of previously identified etiologic factors was done. Research design was descriptive. A questionnaire survey method of parents who had children wearing diapers (n==532) attending a UK general hospital was undertaken. Results were that at the time of survey, only 16% of the study population had diaper dermatitis. 48% of the study population had never had an episode of diaper dermatitis. In a multivariate analysis current diaper dermatitis was independently associated with 4 factors: presence of oral thrush, number of previous episodes, frequency of diaper changes and diarrhea. Recurrent episodes of diaper dermatitis were associated with increasing age, lack of barrier cream use, current diaper rash and frequency of diaper changes. The study concluded that diaper dermatitis usually presents and is treated successfully outside the hospital setting and is not a common clinical problem in secondary care.15 2. Review of literature on colic in newborn A study was conducted in USA on new strategies for the treatment of colic: modifying the parent/infant interaction to validate the effectiveness of behavior modification in treating colicky infants. A quasi-experimental design with an untreated control group and a pretest and posttest was used for the study. Twenty-three infants were randomly assigned to intervention, nonintervention, and control groups. Crying diaries kept by the parents were used to obtain quantitative measurements of crying before and after intervention. The Nursing Child Assessment Feeding Scale (NCAFS) was used to measure parent/infant interaction. The results were crying was significantly reduced from 3.79 hours per day to 1.12 hours per day among infants whose parents received interventions of individualized counseling and education. Caregivers of colicky infants in the intervention group scored lower on the NCAFS. The study concluded that crying can be reduced by modifying parental responses to the infant.16 Another study was conducted in USA on excessively crying infant in the family: mother-infant, father-infant and mother-father interaction to find out the relationship between family interaction and colic in infants. Mother-infant, father-infant and mother-father interaction in 32 families with an excessively crying infant and in 30 control families were studied. The group with excessive criers was divided further into subgroups of severe colic (n=13) and moderate colic (n=19). The three dyads of the family were video-recorded when the infants were an average of 5 weeks old. The assessment was carried out during the infant's feeding, nappy change and discussion between the parents. During the assessment, only four infants were crying. The Parent Child Early Relational Assessment Scale and the Beavers Scale were used. The results were that both parents of colicky infants had less optimal parent-child interaction compared with the control parents. The father-infant interaction was less optimal in 13 items of 65 (20%) in the severe colic group, in one item of 65 (2%) in the moderate colic group and in none of the items in the control group. The mother-infant interaction was less optimal in six items out of 65 (9%) in the severe colic group, in three items out of 65 (5%) in the moderate colic, and in none of the items in the control group. Severely colicky infants were also less competent in interacting with their parents. In addition, interaction between the parents was more often dysfunctional in the severe colic group. The study concluded that the problems in early family interaction may threaten the wellbeing of families with excessively crying infants and they therefore deserve special attention from the health care professionals.17 A study conducted was in America, on excessive infant crying: the impact of varying definitions to assess the impact of varying definitions of excessive crying and infantile colic on prevalence estimates and to assess to what extent these definitions comprise the same children. Parents of 3345 infants aged 1, 3, and 6 months were interviewed on the crying behavior of their infant in a Dutch cross-sectional national population-based study. The results were Overall prevalence rates of excessive crying varied strongly between definitions, from 1.5% to 11.9%. They were always highest in 1-month-old infants. The study concluded that: Different definitions of excessive crying lead to the inclusion of very dissimilar groups of infants. We recommend presenting study results using clearly described definitions, preferably concerning both duration of crying and parental distress. This may improve the comparability of studies on the cause and treatment of excessive infant crying. The impact of the method of data collection on this comparability needs additional study colic, preventive child health care, prevention, infancy.18 Another study was conducted in Netherlands, on prevalence of parental behavior to diminish the crying of infants that may lead to abuse to estimate the prevalence of parental actions to stop infant crying that may threaten infant health, and to determine specific risk groups regarding these actions. Before their visit to a well-baby clinic in the Netherlands, parents of 3345 infants aged 1-6 months (96.5% response) filled out an anonymous questionnaire on actions that they undertook to stop their child crying. The results of the study was at 6 months, 5.6% of all the parents reported having smothered, slapped, or shaken their infant at least once because of its crying. The highest risks for detrimental parental actions were run by infants of parents from nonindustrialized countries, of parents with no or only a part-time job, and of parents who had judged their infant's crying as excessive. The study concluded that Clinicians should be aware of the observed risk factors for abuse of young children known to cry a lot, in order to help parents to cope with this crying.19 A study was conducted in Britain on systematic review of effectiveness of treatments for infantile colic to evaluate the effectiveness of diets, drug treatment, and behavioral interventions on infantile colic in trials with crying or the presence of colic as the primary outcome measure. Research design was experimental. Controlled clinical trials identified by a highly sensitive search strategy in Medline (1966-96), Embase (1986-95), and the Cochrane Controlled Trials Register, in combination with reference checking for further relevant publications. Two independent assessors selected controlled trials with interventions lasting at least 3 days that included infants younger than 6 months who cried excessively. The results were27 controlled trials were identified. Elimination of cows' milk protein was effective when substituted by hypoallergenic formula milks. The effectiveness of substitution by soy formula milks was unclear when only trials of good methodological quality were considered. The benefit of eliminating cows' milk protein was not restricted to highly selected populations. Dicyclomine was effective but serious side effects have been reported. The advice to reduce stimulation was beneficial, whereas the advice to increase carrying and holding seemed not to reduce crying. No benefit was shown for simethicone. Uncertainty remained about the effectiveness of low lactose formula milks. The study concluded that infantile colic should preferably be treated by advising carers to reduce stimulation and with a one week trial of a hypoallergenic formula milk20 3. Review of literature related to newborn acne A retrospective study was conducted on 16 cases on infantile acne in France on infantile acne was done to improve knowledge about the epidemiology and clinical course of infantile acne and evaluate approaches to treatment. The research design was survey method and covered the period between 1985-2007. The data were drawn from clinical and photographic records, followed by administration of a telephone questionnaire to parents. It was proposed that each case be reviewed on the basis of the child's appearance and score on an acne scar clinical grading scale. Sixteen children were included. The results were that nine had a family history of severe adolescent acne. The average duration of disease was 22 months. Two patients had been effectively treated with oral isotretinoin. More than half of the patients exhibited scars. The study concluded that On the basis of the frequency of scarring, and the severity and average duration of lesions, the use of oral retinoid in severe infantile acne warrants evaluation.21 A study was conducted in eastern Saudi Arabia on acne neonatorum to elucidate the clinical profile of acne neonatorum in eastern Saudi Arabia. Research design was survey method sampling technique was purposive sampling. The results were acne neonatorum was diagnosed in 26 patients (male/female ratio 1:1). The lesions included mainly facial comedones (30.8%); papules and pustules (15.3% each); and combination of papules, pustules, and cysts (53.4%). The study concluded that all patients recovered spontaneously. In 50% of the cases, one of the parents reported having had acne vulgaris during adolescence. Hereditary factors seem to play a significant role in our series.22 Another study was conducted in USA on Colonization of neonate skin by Malassezia species: relationship with neonatal cephalic pustulosis. To determine the skin colonization by Malassezia in healthy newborns, and to investigate its association with neonatal cephalic pustulosis. Research design was descriptive design and method of sampling was randomized sampling. Samples for Malassezia colonization were taken from cheeks and scalps of 104 neonates between 24 and 72 hours after birth, and again 2 or 4 weeks later. Pustules were sampled with concomitant nonlesional skin cultures if neonatal cephalic pustulosis was diagnosed. The results were Malassezia colonization increased significantly with age of the neonate (5% at the first week, 30% at 2-4 weeks). In all, 26 patients were given the diagnosis of neonatal cephalic pustulosis during followup. No correlation was found between the severity of the disease and Malassezia isolation. Skin colonization of patients with neonatal cephalic pustulosis (20.8%) was not higher than colonization of healthy newborns (37%). The study concluded that Malassezia colonization increases after the first week of life. No correlation was found between neonatal cephalic pustulosis and Malassezia.23 6.3 Problem Statement: A study to evaluate the effectiveness of self instructional module related to knowledge and attitude among primi mothers on the management of selected minor ailments of newborn in selected hospitals at Mysore. 6.4 Objectives of the Study: 1. To develop a self instructional module on management of selected minor ailments of newborn for primi mothers. 2. To assess the knowledge and attitude of primi mothers on management of selected minor ailments of newborn. 3. To assess the effectiveness of self instructional module on management of minor ailments of newborn 4. To correlate the knowledge and attitude regarding management of minor ailments of newborn. 5. To find out the association between knowledge and attitude of management of minor ailments of newborn with selected background factors. 6.5 Operational Definitions: 1. Effectiveness: In this study effectiveness refers to gain in knowledge and altered attitude toward the management among primi mothers. 2. Knowledge: In this study, refers to the amount of information or understanding about management of minor ailments of newborn; as measured by structured questionnaire. 3. Attitude: In this study it refers to way of thinking towards management of minor ailments of newborn. 4. Minor ailments : In this study it refers to nappy rash, newborn acne and colic in newborn. 5. Newborn: In this study, it refers to babies between one to twenty eight days. 6.6 Assumptions: The researcher assumes that primi mothers will Have some knowledge on minor ailments of newborn. Be willing to participate in the study. Give free and frank responses during pre-test and post-test. Delimitations: The study is delimited to primi mothers Ready to participate in the study Available at the time of the study. 6.8 Projected Outcome (Hypothesis): At 0.05 level of significance. H1: The mean post-test knowledge scores of the primi mothers getting the self instructional module will be significantly higher than the mean pre-test knowledge scores on management of minor ailments of newborn. H2 : The mean post-test attitude scores of the primi mothers getting the self instructional module will be significantly higher than the mean pre-test attitude scores on minor ailments of newborn. MATERIALS AND METHODS: 7.1 SOURCE OF DATA: The data will be collected from primi mothers who had delivered the baby or underwent caesarian section and admitted in selected hospitals at Mysore. 7.1.1 Research Design: The study design selected for this study is one group pre-test and post-test (preexperimental) design. Pre-test Treatment 01 Post-test X 02 7.1.2. Variables: Independent variable: self instructional module Dependent variable: knowledge and attitude on management of minor ailments of newborn. Extraneous variables: age, education, socioeconomic status. 7.1.2 Settings: The study will be conducted in selected hospitals at Mysore. 7.1.3 Population: Primi mothers who had delivered the baby or underwent caesarian section admitted in selected hospitals at Mysore. 7.2. METHOD OF DATA COLLECTION The data will be collected from primi mothers who had delivered the baby or underwent caesarian section regarding the knowledge and attitude on management of selected minor ailments of newborn using structured questionnaire method and rating scale. 7.2.1 Sampling Procedure: This research study will adopt convenient sampling for selecting samples. Out of the total population defined those who will meet the inclusion criteria will be selected for the study. 7.2.2 Sampling Size: Fifty primi mothers will be selected for the sample by convenient sampling. 7.2.3 Inclusion Criteria for Sampling: The study will include Primi mothers who had undergone normal delivery. Primi mothers who had undergone caesarian section. Those who are present at the time of the study. 7.2.4 Exclusion Criteria for Sampling: The study will exclude Those who do not give consent to participate in the study. Those who are absent during the data collection. Those who are multiparous. 7.2.5 Instrument Used The following tool will be developed by the researcher using review of literature and consultation with subject experts: A structured questionnaire to assess the knowledge and a rating scale to measure the attitude. 7.2.6 Data Collection Method: The data collection technique adopted in the study is structured questionnaire on knowledge and rating scale for attitude. 7.2.7 Data Analysis Plan: The data obtained would be analyzed using both descriptive and inferential statistics. The analysis will be done on the basis of objectives and hypothesis stated. The significance of pre-test and post-test scores would be tested using ‘t’ test. 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION ON INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY: Yes, the study requires providing a self instructional module among primi mothers who had undergone normal delivery or caesarian section. 7.4HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3: Yes, Ethical clearance has been obtained from our institution LIST OF REFERENCES 1. Singh Meharban “.Care of the newborn”.6th ed, New Delhi, Sagar publications: 2004: p: 135 2. Parthasarathy A, Nair MKC, Menon PSN.” IAP Textbook of pediatrics”. 3rd ed. New Delhi, Jaypee publication; 2004: p: 56 3. Mohamed Asif Padiyath, etal. “Knowledge attitude and practice of neonatal care among postnatal mothers “. Current Pediatr Research 2010; 14 (2): p: 147-152 4. Mikhail BI. “Hispanic mothers' beliefs and practices regarding selected children's health problems”. West J Nurs Res; 1994 Dec; 16(6): p: 623-38 5. Thornton AJ, etal. “Symptoms in 298 infant under 6 months old, seen at home. Arch Dis Child”; 1990 Mar; 65(3): p: 280-5. 6. Prasad HR, Srivastava P, Verma KK. “Diaper dermatitis – an overview” Indian J Pediatr. 2003 Aug; 70(8): p: 635-7. 7. Atherton DJ. “The aetiology and management of irritant diaper dermatitis”.J Eur Acad Dermatol Venereol; 2001 Sep; 15 Suppl 1(): p:1-4. 8. Muhammad Javed. “Neonatal dermatology at tertiary care teaching hospital” Eastern journal of medicine 2010; 15: p: 90- 92 9. 10. Chandrmita Bora. “Neonatal acne.” Indian J Pediatr. 2003 Sep; 70(9):721-2. Singh N .etal. “Disposable diapers: safe and effective”. Indian J Pediatr. 2003 Sep; 70(9): p: 721-2. 11. Leung AK, Lemay JF. “Infantile colic: a review.” J R Soc Promot Health. 2004 Jul; 124(4): p: 162-6. 12. Adam R, etal. “Clinical demonstration of skin mildness and suitability for sensitive infant skin of a new baby wipe”.Pediatr Dermatol; 2009 Sep-Oct; 26(5): p: 506-13 13. Visscher M, etal. “Skin care in the NICU patient: effects of wipes versus cloth and water on stratum corneum integrity”. Neonatology; 2009; 96(4): p: 226-34. 14. Baldwin S .etal. “Skin benefits from continuous topical administration of a zinc oxide/petrolatum formulation by a novel disposable diaper”. J Eur Acad Dermatol Venereol; 2001 Sep; 15 Suppl 1(): p: 5-11. 15. Odio MR, etal. “Continuous topical administration of a petrolatum formulation by a novel disposable diaper. 2. Effect on skin condition”. Dermatology; 2000; 200(3):p:238-43 16. Dihigo SK. “New strategies for the treatment of colic: modifying the parent/infant interaction”. Pediatrics. 1996 Apr; 97(4): p: 601-2. 17. Räihä H,etal. “Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction.” Child Care Health Dev; 2002 Sep; 28(5): p: 419-29. 18. Reijneveld SA, .etal. “Excessive infant crying: the impact of varying definitions.” Pediatrics; 2001 Oct; 108(4): p: 893-7. 19. Reijneveld SA, etal. “Prevalence of parental behavior to diminish the crying of infants that may lead to abuse.” Ned Tijdschr Geneeskd; 2004 Nov; 148(45): p: 2227-30 20. Parkin PC, etal. “Randomized controlled trial of three interventions in the management of persistent crying of infancy.” Pediatrics. 1996 Apr; 97(4): p: 601-2. 21. Alakloby OM, etal. “Acne neonatorum in the eastern Saudi Arabia.” Indian J Dermatol Venereol Leprol; 2008 May-Jun; 74(3): p: 298. 22. Niamba P, etal. “Is common neonatal cephalic pustulosis (neonatal acne) triggered by Malassezia sympodialis?” Arch Dermatol; 1998 Aug 134(8): p:995-8. 23. Hello M, etal. “Infantile acne: a retrospective study of 16 cases.” Pediatr Dermatol; 2008 Jul-Aug; 25(4): p: 434-8. Website address. www.google.com www.askmedline.com www.pubmed.com