“To Evaluate the Effectiveness of Self Instructional Module Regarding Perineal Care among Primipara Postnatal Mothers”

Background: Perineal trauma, particularly caused following vaginal delivery, is associated with short and long-term morbidity for women; therefore, intervention that increases the probability of an intact perineum is necessary. When a child is born, the mother and the postnatal period are both extremely vulnerable. Objectives: 1. To assess the pretest knowledge regarding perineal care in primipara postnatal mothers. 2. To assess the posttest knowledge regarding perineal care in primipara postnatal mothers. 3. To assess the effectiveness of Self Instructional Module on knowledge regarding perineal care in primipara postnatal mothers. 4. To associate the posttest knowledge score regarding perineal care in primipara postnatal mothers with demographic variables. Materials and Methods: A pre-experimental one-group pretest and posttest design was adopted to assess the effectiveness of a self-instruction module on knowledge regarding perineal care among primipara postnatal mothers. This study was carried out using inferential and descriptive data. The techniques for testing knowledge regarding perineal care among primipara postnatal mothers are discussed in this chapter. It comprises a research method description, the design and validation of the tools and questionaries, the data collection procedure and data analysis plan, the identification of targets, and the sample and sampling techniques. Results: Better care with regular maintenance of hygiene of perineal area among the primipara postnatal mothers in selected area in Wardha district allow them from preventing from perineal discomfort and infection and a better quality of life with other intervention and by providing knowledge.

A Study to Assess Perception of Nursing Students about the Effectiveness of Objective Structured Clinical Examination (OSCE) during Perineal Care Procedure in the selected College of Metropolitan City

Aim: 1. To conduct OSCE 2. To assess the perception of nursing students about OSCE 3. To compare the perception of nursing students between traditional evaluation (TE) and Objective Structured Clinical Examination (OSCE). Material and methods: The research approach and design were Qualitative Descriptive. The subjects were 30 students of 4th year Basic BSc Nursing. OSCE conducted under 4 stations namely Hygiene, Execution, Interaction, and Feedback. Data was collected using Demographic data profile; Clinical checklist for hand washing, perineal care SOP; related viva and opinionnaire. Data were analyzed using descriptive and inferential statistics. Results: Hygiene- 16.69% (5) had excellent, 66.6% (19) had Very good, 19.98% (6) had Good score & none of them had an Average or poor score in hand washing. Execution- 73.26% (22) had excellent, 16% (5) had Very good, 9.99% (3) had Good score & none of them had an Average or poor score in vital signs assessment. Interaction- 56.61% (17) had excellent, 43.29% (13) had Very good score &none of them had a Good, Average or poor score in viva. Feedback- 10 Opinionnaire on personal perception about OSCE administered to participants. 100% (30) of them had positively responded. Conclusion: OSCE proved to be an excellent method of clinical evaluation than traditional evaluation.

Javanese Culture in Maternal Postpartum Care at Hargomulyo Village, Kedewan District, Bojonegoro Regency

Maternal and child health problems are inseparable from socio-cultural andenvironmental factors in society. Factors of belief and traditional knowledgepositively or negatively impact Maternal and Child Health (MCH). Culturecould be a predisposing factor for high maternal mortality. This paperdescribes Javanese culture in maternal postpartum care at HargomulyoVillage, Kedewan District, Bojonegoro Regency. This study was descriptiveresearch. It took place at Hargomulyo Village, Kedewan District, BojonegoroRegency, from January to February 2020. The population was mothers whohave experienced postpartum both primipara and multipara. There were 48respondents by total sampling. The instrument used a questionnaire consistingof several questions regarding culture in maternal postpartum care, how tocarry out the culture, and its reasons. Thirty respondents did food taboos(62.5%), six respondents limited their drinking water (12.5%), 40 respondentsdrank herbs (83.3%), 47 respondents wore stagen (97.9%), and fiverespondents used pilis (10.4%). In addition, 48 respondents performedbrokohan and mendem ari ari (100%), 20 respondents were not allowed totake a nap (41.7%), and 18 respondents must be at home for 40 days (37.5%).At the same time, 17 respondents did perineal care after birth with betel leaf(35.4%), 12 respondents walked and sat with feet parallel (25%), and 20respondents did semi-sitting position (41.7%). Postpartum mothers stillpractice many Javanese cultures. This culture has both favorable andunfavorable impacts on health. Furthermore, it is necessary to analyze theinfluence of Javanese culture on the health status of postpartum mothers.

Android-Based Education toward the Role of Postpartum Primipara Mothers in Fulfilling the Independent Perinium Care

Background: Educating mothers during their postpartum period could potentially help them to overcome some important phases after giving birth. The process of education is evaluated based on the mothers’ knowledge about their independent self-care. Independency is an activity that is started individually and is done based on self-capability. The independency in the postpartum care is not only important to decrease the mother’s mortality and morbidity rate, but it is also crucial to strengthen and improve the post-partum mother’s healthy behavior during the perineal care. Providing education using Android-based application called BUBI Care could be potential to facilitate a more dynamic transfer of knowledge to the postpartum mothers.Aims: To analyze the knowledge, skills, and independence of primipara postpartum mothers in independent perineal care before and after accessing BUBI Care app. Research Method: employing quasi experimental research with pre-test and post-test design with control group design. The sample for this research were 19 pregnant mothers TM III (pregnancy age of ? 38 weeks) on each group. The treatment group was educated using BUBI Care Android app that was conducted at one of Public Health Center. The control group was educated without BUBI Care that was conducted at a Midwife Practice Clinic. The research was conducted on September to October 2020. Study Result: According to the Wilcoxon test, there was a difference in the pre-test knowledge of the treatment and control groups with the similar median of 53 and p-value of 0.666, the treatment group showed their scores improved to 80 on the post-test while the control group stayed at 53 with the p-value of 0.000. It means that BUBI Care app education influences the post-test. On the other hand, the perineal care skill saw a difference between the intervention and control groups. The intervention group had a mean of 70.05 and 56.68 for the control group with the p-value of 0.002 which means that there was an influence from the BUBI Care app education. Additionally, Mann Whitney test showed that the intervention group had a mean score of 78.95, but the control group only had 49.26, the total difference between the two are 29.69 with the p-value of 0.000. It can be concluded that there is a significance in difference in the independency rate from the provision of BUBI Care Android app education.Conclusion: there is a significance effect on the intervention group in terms of Android based usage.

PENERAPAN EDUKASI FAMILY CENTERED MATERNITY CARE TERHADAP PERILAKU IBU POSTPARTUM MELALUI ASUHAN HOME CARE

Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) in Indonesia are higher than the other Southeast Asia countries. To solve these problems, the utilization of an appropriate educational model for postnatal women is required with involving the family as social support. This study aimed to analyze the effect of the implementation of the FCMC model on postpartum mothers' attitude in the puerperium care in the Public Health Center of Gambirsari Surakarta. The length of this study was approximately one year from January to Desember 2020. Wilcoxon test was used as the data was not normally distributed (p-value 0,000). There is an effect in the implementation of FCMC model on postpartum mother's attitude in postpartum perineal care. There is an effect in the implementation of FCMC model on postpartum mother's attitude in postpartum homecare.

Mothers’ Knowledge about Diaper Rash and Preventive Measures in Bangladesh

Background: Use of disposable diapers by parents for their children has grown in last few decades. Although, most of the time diaper rash is not life threatening, it is a concern for the parents, and uncomfortable and painful for children Objectives: To measure the knowledge and practice of mothers when diapering and administering perineal care to infants wearing disposable diapers and factors that can influence the frequency of the occurrence of diaper rash in children between 0-12 months in Bangladesh. Methods: This cross-sectional study was conducted during the outpatient visits of mothers and their infants at the Combined Military Hospital located in Cumilla, Bangladesh between 01 February 2015 and 31 July 2015 with their infants. A structured, self-completed, closed-ended questionnaire was provided to 110 mothers who came to visit the Pediatric outdoors. Results: Thirty-seven (33.64%) infants aged one or under were reported to have experienced diaper rash during or prior to enrolment in the study. Study analysis showed that the risk of diaper rash was significantly higher in babies who used only 1-2 diapers/day than for babies who used more than 4 diapers/day (40.0% vs 21.43%). Infants whose mothers had knowledge of the causes and preventions of diaper rash and/or who received information about the importance of the proper cleaning of the diaper area during diaper changes suffered fewer incidents of diaper rash than those whose mothers did not (24% vs 36.48%). The causes of diaper rash were described by 48.65% mothers as heat followed by 27.03% mothers by frequent stool/urine. Conclusion: Frequently changing disposable diapers and cleaning the diaper area thoroughly can reduce cases of diaper rash dramatically in children less than one year old. The knowledge of mothers regarding diaper rash is an important factor in reducing diaper rash in their children. DS (Child) H J 2020; 36(1) : 39-45

Parents and Caregivers Satisfaction After Palliative Treatment of Spastic Hip Dislocation in Cerebral Palsy

Objectives: Pain appearance is one the most common complication of spastic hip disease in children with cerebral palsy (CP). It determines child and caregiver quality of life and life priorities. Reconstruction hip surgery should be considered as a treatment of choice. Some clinical conditions give the inability to perform such a procedure. In our paper, we would like to present four palliative methods of spastic hip dislocation treatment in children with CP.Material: We analyzed four groups of patients treated because of hip pain. Inclusion criteria were pain appearance (visual analog scale-11 or numeric rating scale-11) and hip joint dislocation (migration percentage >80%). All patients were admitted to our department between 2008 and 2018. In the first group, patients were treated only by steroid injections to hip joints; in the second group, patients were recruits after hip interposition arthroplasty with shoulder spacer; in the third group, they were patients after valgus subtrochanteric osteotomy (Schanz); and in the fourth group, these were patients after proximal femoral resection (Castle procedure). The minimal follow-up time was 2 years. The first group consisted of 15 patients (15 hips) with a mean age of 15.5 (8–17) years; the second group, 20 patients (24 hips) with a mean age of 14.2 (9–22.6) years; the third group, 22 patients (24 hips) with a mean age of 13.5 (7–20.5) years; and the fourth group, 10 patients (15 hips) with a mean age of 12.9 (7–17.6) years.Methods: Radiological evaluation was based on a standardized anteroposterior X-ray of the hip joints. Pain severity before surgery and at the last follow-up time was measured by visual analog scale-11. Parents or caregivers were asked about their child's pain during sitting, perineal care, and rest. During the visit, all caregivers were asked about treatment satisfaction (no 0 to max 10) and if they would decide again for the same surgery.Results: In all groups of patients, we observed a decrease in pain complaints. The observed reduction of pain in the first group was from 7.88 (4–10) to 3.08 (0–8) (p = 0.05), but results of injection were observed only for 4 months (2–8), and it has to be repeated (average: two times). In the second group, level of pain was reduced from 4.93 (1–10) to 0.93 (0–5) (p < 0.001); in the third group, from 6.22 (3–10) to 0.59 (0–6) (p < 0.001); and in the fourth group, pain reduces from 5.43 (2–10) to 2.13 (0–5) (p < 0.001). Observed changes concerned mostly sitting position and perineal care. The complication rate was in the second group, 6 of 24 cases of extraarticular ossification; in the third group, 2 of 24 cases with extraarticular ossification, two cases of revision surgery. In the fourth group, two cases needed another femoral resection. In the first group, five patients died during follow-up time, so they were excluded from the study. In the steroid injection group, parents' treatment evaluation was 6.83 (0–10), and only in three cases that they would resign from the treatment. In the hip interposition arthroplasty group, caregivers' evaluation was 7.41 (0–10), and in five cases, parents did not accept the surgery. In the Schanz osteotomy group, parents' evaluation was 5.9 (0–10), and in eight cases, caregivers would not repeat surgery. In the proximal femoral resection group, satisfaction was the highest, 8.3 (3–10), and only two parents would not decide for surgery again.Conclusion: All procedures can be considered as palliative treatment options for pain complain in a spastic hip joint dislocation in children with CP. Steroid injections to the hip joint need to be repeated, and with the follow-up time, it becomes less effective. Steroid injection seems to be the treatment of choice for patients with general anesthesia contraindications. Interposition arthroplasty of the hip joint seems to give better final results, but the highest parents' satisfaction surprisingly was observed in the proximal femoral resection group, but differences were not statistically significant.

Postpartum Labial Adhesion Presenting with Apareunia: A Case Report

Labial adhesion is commonly seen in the paediatric and post-menopausal age groups and treatment of this condition with oestrogen cream is effective. On the other hand, postpartum labial adhesion is an unusual complication of vaginal birth except when it associated with trauma to the perineum. In that situation, treatment with oestrogen cream is usually in-effective. A 19-year-old primipara presented 15 months after vaginal birth with difficulty in having sexual intercourse. She had sustained a perineal tear during her last childbirth at home. Pelvic examination revealed fusion of the medial aspect of the labia minora with a membrane inferior to the external urethral opening completely closing the vaginal orifice. A surgical division under anaesthesia was carried out and she resumed sexual intercourse within five days. Postpartum labial adhesion is an uncommon complication of vaginal births and surgical division of labial adhesions is the first line of management. Good postpartum perineal care for perineal laceration following vaginal births should be encouraged to prevent apareunia.