Group Members

S. Name BNMC Roll Reg. no

No

01 Md. Saikat Ahmmed 22109254 126191

Shamim
02 Mst. Tamanna Kanon 22109268 126253
03 Jubaida Khatun 22109217 126203
04 Jesmin Sultana 22109202 126236
05 Sabiha Sultana 22109203 126228
06 Marleen Rimi Shikder 22109260 126208
07 Bristi Halder 22109226 126240
08 Farhana Khatun 22109239 126244
09 Moriam Khatun 22109227 126206
10. Lutfun Nesa 22109262 126195

Page | 1
 CONTENTS
Contents Page No Contents Page No
Chapter-1 03-06  Sample size 09
estimation
 Problem 03  Ethical 09
consideration
 Background 03-04  Data collection 09
procedure
 Objectives 05  Instruments- 10
 Research Question 05  Validity 10
 Significant of the 05  Reliability 10
study
 Hypothesis 05  Back translation of 10
the instruments
 Conceptual/theoreti 06  Data analysis 11
cal framework
 Operational 06
definition/ technical
terms
 Variables 06 Chapter-4 12-14
 Result 12
Chapter-2 07  Discussion 13-14
 Literature review 07
Chapter-5 15-19
Chapter-3 08-11  Limitation 15
 Research design 08  Recommendation 15
 Setting 08  Authors 15
 Target population 08  Acknowledgement 16
 Inclusion criteria 08  Journal 16
 Sample 09  Publication 16
 Sample size 09  References 17-19
 Sampling technique 09

Page | 2
 Chapter-1

Problem:
Neonatal Care Practice among Nurses Working at both Public and Private Hospitals in
Bangladesh.

Background:
The first four weeks or 28 days of a newborn's life are called the neonatal period
(Zimlich , 2021). This period is the most vulnerable for a child's survival (UNICEF
DATA. 2019), and their well-being and proper development depend on the
quality of neonatal care (Encyclopedia, 2023).Globally, the neonatal mortality
rate is still very high. In 2021, approximately 2.3 million children died within their
first month of life (UNICEF DATA., 2019). Notably, neonatal mortality rates are
higher in developing countries compared to developed countries. This rate is
highest in sub-Saharan Africa and South Asia, where a child's risk of death is 10
and 9 times higher, respectively, compared to high-income countries (UNICEF
DATA., 2019).

According to the World Health Organization (WHO)(2021), the primary causes of

neonatal death are preterm birth, complications during childbirth (such as birth
asphyxia), infections, and birth defects (World Health Organization, 2021).
Among these, infections account for 36% of neonatal deaths, followed by
preterm birth at 28% and birth asphyxia at 23% (World Health Organization,
2023). In developing countries, inadequate hygiene practices are a major cause
of infections (Zea-Vera, & Ochoa, 2015).The incidence of neonatal sepsis is
approximately 40 times higher, and mortality rates are two times higher in
middle-income countries compared to high-income countries (Fleischmann-
Struzek et al., 2018).Approximately 52% of neonatal deaths are due to a lack of
appropriate care (Lawn et al., 2014). According to UNICEF (2018), providing
quality care could prevent up to 79% of these deaths (Global annual results
reports, 2021).

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To save the lives of newborns, WHO recommends several essential newborn
care practices, such as clean cord care, thermal protection, early and exclusive
breastfeeding, delayed bathing, care for low birth weight babies, and proper
management (World Health Organization,2021). These services are mainly
provided by trained nurses in NICUs, emergency rooms, and delivery rooms.
However, Bangladesh is facing a critical shortage of nurses, with only 1.07 nurses
available per 10,000 people (Assessment of Healthcare Providers in Bangladesh,
2021). The country has a population-nurse ratio of 5000:1 and a bed-nurse ratio
of 13:1, both of which are far below the international standard of 4:1 for the
bed-nurse ratio (Health workforce in Bangladesh, 2013).Research has shown that
higher nurse staffing is linked to lower newborn mortality rates (Amiri et al.,
2020). In Bangladesh, 88% of all neonatal deaths stem from three preventable
causes: severe infections, birth asphyxia, and complications of preterm birth
(Jahangir, & Sarker, 2016).

Page | 4
Objectives:

 To examine the neonatal care practice among nurses working at public

hospitals in Bangladesh.
 To examine the neonatal care practice among nurses working at private
hospitals in Bangladesh.
 To examine the relationship between the number of nurses ,number of
beds and job experience in public hospitals.
 To examine the relationship between the number of nurses and the
number of beds in private hospitals.

Research Question:

 What are the level of neonatal care practice among nurses working at
public hospitals in Bangladesh?
 What are the level of neonatal care practice among nurses working at
private hospitals in Bangladesh?
 What are the levels of relationship between the number of nurses ,
number of beds and job experience in public hospitals?
 What are the levels of relationship between the number of nurses and
the number of beds in private hospitals?

Significant of the study:

Previous research on newborn care in Bangladesh has predominantly focused on rural,
sub-district, and district areas. However, there is a lack of research specifically on
neonatal care practices within the country, and most of the existing research on this
topic has been conducted in other countries.

To address this gap, the current study aims to explore the neonatal care practices
employed by nurses in Bangladesh. The findings of this research may provide valuable
insights for improving nursing care for both sick and healthy neonates, potentially
contributing to the reduction of neonatal morbidity and mortality rates in the country.

Hypothesis :

 We are unable to find it in this research, and we acknowledge our inability.

Page | 5
Conceptual/theoretical framework :

 We are unable to find it in this research, and we acknowledge our inability.

Operational definition/technical terms:

 Neonatal
 Care Practice
 Nurses
 Public Hospital
 Private Hospital
 Bangladesh

Variables:
There is only one variable

 Neonatal care Practice.

Page | 6
 Chapter-2

Literature reviews :
1. Abdu. H. Gebrselassie, M. Abdu, M. Mars. K. U Tadesse. W & Liben, M. L. (2019)
Knowledge and practice of immediate newborn care among midwives and
nurses in public health facilities of Afar regional stave, Northeast Ethiopia. BMC
Pregnancy Childbirth [Interne] 19(1) Available from: http//[Link].
org/10.118612884-019-2581-3

2. Amiri, A., Vehvilainen - Julkunen, K. Sokunkallio Vahteri, T., & Tuomi, S. (2020).
Impact of noise staffing on reducing infant, neonatal and Perinatal mortality
retes: Evidence from panel data analysis in 25 OECD countries. Int J Nurs Sei
[Internet]. 7(2), 161-9 Available from: [Link]

3. Arba, A & Zana Z. (2019) Knowledge of Essential Newborn Care and Associated
Factors among Nurses and Midwives A Cress Sectional Study at Public Health
Facilities in Wolaita Zone Southern Ethiopia International Journal of Pediatrics
[Internet] 2020, 1-8 Available from: http//[Link]. org/10.1155/2020/3647309

4. Assessment of Healthcare Providers in Bangladesh 2021. [Link]. [cited 2023 Jul

15]. Available from: [Link] Who, int/media/does/default-
sourcce/searro/bangladesh/assessment-of-healthcare-providers-in-bangladesh -
2021. pdf

5. Bangladesh Infant Mortality Rate 1950-2023 [Internet] [Link]. [cited 2023

Jul 15] Available from:
[Link]

6. Berhe, A.K., Tinsae, F., & Gebreegziabhere, G. (2017). Knowledge and practice of
immediate newborn care among health care providers in Eastern zone public
health facilities, Tigray, Ethiopia, 2016. BMC Pediatr [Internet].17 (1) . Available
from: [Link]

Page | 7
 Chapter-3
Methodology

Research Design:
A descriptive Cross sectional study design was used in this Study duration was used in
this study. Study duration was from October 11 to November 19, 2023.

Setting :
The study was conducted at a total of 5 hospitals which included three public hospitals:

[Link] Medical College Hospital.

2. Sir Salimullah Medical college Hospital.

3. Shaheed Suhrawardy Medical college Hospital as well as two private

hospitals.

4. Bangabandhu sheikh Mujib Medical University Hospitals.

5. Institute of child and Mother Hospital, Dhaka, Bangladesh.

Target population :
All nurses from working in selected three public hospitals and two private hospitals.

Inclusion criteria :
The study included nurses criteria who meet specific-

1. Working in neonatal intensive care units (NICU)

2. Possess at least one-year of experience in the selected area

3. Willingness to participate in the study.

4. Be mentally and physically well-oriented

Page | 8
Sample:
This sample is 117 nurses from both three public and two private hospitals in
Dhaka Bangladesh.

Sample size:
The total sample size of this study was 117 nurses.

Sampling Technique:
Convenience Sampling technique was used in this study.

Sample size estimation:

To determine the sample [sic] size, G* Power analysis was employed, using an
accepted medium effect size of 0.30, significance level (α) of 0.05, and a
minimum power (1-β) of 0.80. This analysis resulted in a calculated sample size
of 102. To account for potential dropout, an attrition rate of 10% was added,
bringing the final sample size to 117 participants.

Ethical consideration:
The proposal was approved by the Institutional Review Board (IRB) of the
National Institute of Advanced Nursing Education & Research (NJANER),
Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka, Bangladesh.
The use of the hospital as the study site was approved in writing by the directors
"of the Dhaka Medical College Hospital, Sir Salimullah Medical College Hospital,
shaheed Suhrawardy Medical College Hospital, Bangabandhu Sheikh Mujib
Medical University Hospital and Institute of child and Mother Hospital. The goal
of the study was thoroughly explained to the participants, and their written and
verbal agreement was acquired, guaranteeing their anonymity and
confidentiality

Data collection/data collection procedure :

Data were collected by face-to-face interview through structure questionnaire.

Page | 9
Instruments :
The questionnaire comprised two main domains-

1. Socio-demographic related Questionnaire

2. Neonatal Care related Questionnaire

Part-1: The socio-demographic domain included 12 items that covered age, sex,
education level, religion, family Income, Job experience, special training On newborn
care, duration of training, duration of working period and availability of equipment.

Part-2: Neonatal Care related Questionnaire, which was developed based on WHO
guidelines and widely used for assessing neonatal care practices, consisted of 28 (items)
divided into five segments-

 Neonatal management (7 items)

 Thermal protection (3 items)
 Infection control (6 items)
 Care of at-risk and sick neonates (6 items)
 Feeding and management of feeding difficulties (6 items)
The questionnaire used a 3-point Likert scale (0, 1, and 2) to indicate their responses
corresponding to "no or never" (0), "Yes Something"(1), and" yes always" (2).

Validity :
The questionnaires were validated by five experts. Two doctors from the
Neonatal Intensive Care Unit and three PhD- holding nurse educators from the
National Institute of Advanced Nursing Education and Research (NIANER) were
among the specialists.

Reliability :
We are unable to find it in this research and we acknowledge our Inability

Back translation of the Instruments :

The consent form was translated into Bengali language.

Page | 10
Data analysis:
Data were analyzed by using IBM SPSS program version 23 Descriptive and
Inferential Statistics were used

 Descriptive statistics -

Descriptive statistics, such as-

 Frequencies
 Percentages
 Means
 Standard deviation

were used to describe the characteristics and neonatal care practices of the participants
.

 Inferential statistics

Inferential statistics, including-

 T-test
 ANOVA &
 Correlation coefficient

were utilized to explore the relationship between Socio-demographic characteristics and

neonatal care practices among nurses working at both private and public hospitals in
Bangladesh.

Page | 11
 Chapter - 4

Result :
The total mean score of neonatal care practice was 46.27±9.22 in public hospital
and 50.85±5.03 in private hospital The mean age of participants in public was
32.35 (SD=6.85) and in private hospital was 29:91 (SD=3.69) years. There was a
statistically significant positive relationship between number of nurses (r = 834,
P<.001), number of bed (r=.559, P<.001), Job experience (r= .294, P= .023) and
neonatal care practice among nurses in public hospital. There was a statistically
significant negative relationship between number of nurses (r= -.812, P<.001),
number of beds (r= -.812, P<.001) and neonatal care practice among nurses in
private hospitals.

Page | 12
DISCUSSION :
This study attempted to investigate the neonatal care currently provided by
Bangladeshi nurses working in both public and private hospitals. The study's
findings may offer information about nursing care practices for both sick and
healthy newborns, which could help Bangladesh to lower its expected rate of
neonatal morbidity and mortality.

In this study, the total mean score for neonatal care practice among nurses in
public hospitals was 46.27 ± 9.22, indicating a moderate level of neonatal care
being practiced in government hospitals in Bangladesh. On the other hand,
nurses in private hospitals obtained a total mean score of 50.85 ± 5.03,
suggesting a good level of neonatal care practice in the private setting.
Comparing the mean values of the two groups reveals that nurses in private
hospitals exhibit a higher level of neonatal care practice compared to those in
public hospitals.

In public hospitals, the participants' level of education and duration of working

period were found to be positively linked to neonatal care practice. The findings
suggested that nurses holding diplomas were more involved in neonatal practice
compared to those with higher education levels. This difference could be
attributed to the limited human resources in hospital settings, where highly
educated nurses may be engaged in managerial activities, leaving more hands-on
care to diploma holders.

These results align with previous studies conducted by other authors (Arba, &
Zana, 2019) (Negussie et al., 2017). Additionally, this study also revealed a
statistically significant positive relationship between job experience and
neonatal care practice, which mirrors the findings of a previous study (Arba, &
Zana, 2019).

Similar to previous studies by some authors (Neogi et al., 2016) (Abdu et

al.,2019), a statistically significant positive relationship was observed between
neonatal care practice and the number of nurses and beds available in public
settings. This suggests that having more nurses leads to better care practices.
Evidence indicates that nurse understaffing is linked to higher infection rates,
while proper and adequate staffing is associated with lower morbidity and
mortality rates (Neogi et al., 2016). However, in the Private Hospital, a
statistically significant negative relationship was found between neonatal care
practice and the age of nurses, as well as the number of nurses and beds. This

Page | 13
finding contradicts other past studies (Arba, & Zana, 2019) (Neogi et al., 2016).
The difference in results may be attributed to variations in sample size, study
settings, study periods, and hospital policies across regions. In contrast to some
previous authors (Negussie et al.,2017) (Arba, & Zana, 2019) (Abdu et al., 2019),
this study noticed a statistically significant positive correlation between family
income and neonatal care practice among nurses in private establishments.

Page | 14
 Chapter 5:
Limitation:
This study has some limitations-

1. Cross-sectional study

2. Limited sample size

3. Only five selected tertiary-level hospitals.

Recommendation:
To overcome the limitations of this study.

• Conduct large-scale, Population-based studies, to ensure that findings can be

generalized across all levels of healthcare institutions.

• Increase training opportunities for nurses, particularly on neonatal care

practices to enhance quality of care.

• Improve nurse-to-bed and nurse-to-patient ratio, especially in public hospitals

where understaffing is more common.

• Ensure the availability of essential equipment, in government healthcare

facilities to support effective neonatal care.

• Implement WHO-recommended newborn care practices more effectively, with

a special focus on improving standards in public hospitals.

Authors:
1. Atiar Jahan Ankhi,
2. Shanzida Khatun,
3. Happy Bandana Biswas
4. Fahima Khatun

Page | 15
Acknowledgement:
The researcher would like to express their Sincere gratitude to all the
participants from the selected hospitals for their invaluable contributions.
Special thanks are extended to the authorities of the National Institute of
Advanced Nursing Education and Research (NIANER) and Bangabandhu Sheikh
Mujib Medical University (BSMMU) Hospital for their generous support and
cooperation in facilitating this study amidst their busy schedules.

Journal :
Saudi Journal of Nursing and Health Care

Publication :
Publication date: 20 December 2023

Page | 16
Reference :
1. Abdu. H. Gebrselassie, M. Abdu, M. Mars. K. U Tadesse. W & Liben, M. L. (2019)
knowledge and practice of immediate newborn care among midwives and nurses
in public health facilities of Afar regional stave, Northeast Ethiopia. BMC
Pregnancy Childbirth [Interne] 19(1) Available from: http//[Link].
org/10.118612884-019-2581-3

2. Amiri, A., Vehvilainen - Julkunen, K. Sokunkallio Vahteri, T., & Tuomi, S. (2020).
Impact of noise staffing on reducing infant, neonatal and Perinatal mortality
retes: Evidence from panel data analysis in 25 OECD countries. Int J Nurs Sei
[Internet]. 7(2), 161-9 Available from: [Link]

3. Arba, A & Zana Z. (2019) Knowledge of Essential Newborn Care and Associated
Factors among Nurses and Midwives A Cress Sectional Study at Public Health
Facilities in Wolaita Zone Southern Ethiopia International Journal of Pediatrics
[Internet] 2020, 1-8 Available from: http//[Link]. org/10.1155/2020/3647309

4. Assessment of Healthcare Providers in Bangladesh 2021. [Link]. [cited 2023

Jul 15]. Available from: [Link] Who, int/media/does/default-
sourcce/searro/bangladesh/assessment-of-healthcare-providers-in-bangladesh -
2021. pdf

5. Bangladesh Infant Mortality Rate 1950-2023 [Internet] [Link].[cited 2023

Jul 15] Available from:
[Link]

6. Berhe, A.K., Tinsae, F., & Gebreegziabhere, G. (2017). Knowledge and practice of
immediate newborn care among health care providers in Eastern zone public
health facilities, Tigray, Ethiopia, 2016. BMC Pediatr [Internet].17 (1) . Available
from: [Link]

7. Child mortality and causes of death [Internet] [Link]. [cited 2023 Jul 15]. Available
from:[Link] /themes /topics /topic
details/GHO/child-mortality-and-causes-of- death

Page | 17
8. Fleischman-Struzek, C. Goldfarb, D. M., Schlattman, P., Schlapbach , L.J., Reinhart,K.,
& Kissoon, N. (2018) The global burden of paediatric and neonatal sepsis: a
systematic review. Lancet Respire Med [Internet] 62, 223-30. Available from:
[Link] (18) 30003-8

9. Global annual results reports 2021 [Internet]. [Link] [cited 2023 Jul 15].
Available from: [Link] -2021

10. Health worforce in Bangladesh [Internet] bdnews [Link], 2013 [cited 2023
Jul 15 Available from: https:// [Link]/opinion/comment /health-
workforce-in-bangladesh

11. Islam, N., Islam, M. J., Yoshimura, Y., Nisha, M.K., Yasmin, N (2015) Newborn
care practice in rural Bangladesh. Res Rep Neonatal [Internet] C5. Available from:
[Link]

12. Jahangir, M., & Sarker, A. National Newborn : Health Bulletin GOV. bd. 2016
[cited 2023 Jul 15 Available from: [Link]
1% 20 Newborn % 20 Health % 20 Bulletin_ % 20 IMCT % 20 Dec % 2020 16% 20
(1) pdf

13. Lawn, J. E., Blencowe, H., oza, s, You, D., Lee, A. c. Waiswa, P., & Cousens, S.N.
(2014). Every Newborn progress, priorities, and potential" beyond survival. The
lancet, 389 (9938), 189-208. Available from: [Link]
6736(19) 00196-7

14. Negussie, BB. Hailu FB & Megenta, A D (2017) Knowledge and practice of essential
newborn care and associated factors among nurses and midwife working at
health centers in Jimma zone. Ethiopia, 2016 .J Nurs Care [Internet ] .07(01)
Available From : https;//www. [Link]/open-access/knowledge and
practice-of-essential newborn-care and associated factors among nurses-and-
midwives working at health-centers in jim 2167-11681000446 pdf

Page | 18
15. Neogi, S. B. Khanna, R. Chauhan, M. Sharma, I Gupta G. Srivastava, R. & Paul V. K.
(2016) Inpatient care of small and sick newborns m healthcare facilities Journal
of Perinatology 1631 518-523 Available from: [Link] 2016.
186

16. Neonatal Care Internet Encyclopedia com [cited 2023 Jul 15]. Available from:
[Link] com/medicine/encyclopedias almanacs-transcripts-
and-maps/neonatal-came.

17. Neonatal mortality [Internet] UNICEF DATA 2019 [cited 2023 Jul 15 ] Available from:
[Link]

18. Newborn mortality [Internet]. Who int. [cited 2023 Jul 15] Available from:
[Link] int/news-Room/factsheets/detail/levels-and-trends -in-child-
mortality - report -2021

19. Polit D F & Beck. C. 1. Essentials of nursing research. Appraising evidence for nursing
practice Philadelphia Wolters Kluwer, 2014

20. Tasew, H. Teshale. T. Bahrey, D., Mariye. T & Teklay, G (2019) Immediate newborn
care of knowledge, practice and associated factors among health care providers
in Northwestern Zonal health facilities Tigray, Ethiopia 2018 BMC Res Notes
[Internet] 12:427 . Available from: [Link]

21. Zea - Vera, A. & Ochoa, T. J. (2015). Challenges in the diagnosis and management of
neonatal sepsis. J Trop Pediatr [Internet]. 61(1), 1-13, Available from:
[Link] Amu 079

22. Zimlich R. What is the neonatal period ? (Internet) Very well Health 2021 [cited 2023
Jul 15]. Available from: [Link] well [Link] /neonatal-period-
5176591

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