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AWARENESS ON THE UNANG YAKAP CAMPAIGN AMONG HEALTH PROFESSIONALS EMPLOYED IN SELECTED RURAL HEALTH
UNITSAND LYING-IN CLINICS IN THE PROVINCE OF CAVITE
Charmaine Joelyn A. Lachica; Jessica Grace C. Lanuzo; Ralph Ronel R. Leoro
An undergraduate research submitted to the faculty of College of Nursing, Cavite State University Indang, Cavite, in partial fulfillment of the requirements for Bachelor of Science in Nursing prepared under the supervision of Mrs. Nenita B. Panaligan, RN, MAN.
INTRODUCTION
The Philippines is one of the 42 countries that account for 90% of under-five
mortality worldwide. Where 82,000 Filipino children under five years old die every year,
37% of them are newborn. Majority of the newborn (3/4) die within the first two days of
life, mostly due to stressful events or conditions during labor, delivery and immediate
postpartum period (Pillitteri, 2007). The current practice of handling newborns, like
clamping and cutting the umbilical cord and washing the baby right after birth, have been
known to actually contribute to the high incidence of neonatal deaths and illnesses in the
(InstantMommy, 2010).
The Department of Health recently launched a nationwide campaign on proper
newborn care practices last December 7, 2009 entitled “Unang Yakap- Yakap ng Ina,
Yakap ng Buhay” which translates to First Embrace- Embrace of Mother, Embrace of
Life. With this campaign, the Department of Health aims to cut down infant mortality in
the Philippines and keep up with the government’s Millennium Development Goal of
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reducing childhood mortality to two-thirds of just six per 1,000 live births by 2015
(Medical Observer, 2010).
Dubbed Unang Yakap, the campaign is embodied in an Administrative Order
(AO) 2009 –entitled “Adopting New Policies and Protocol on Essential Newborn Care
(ENC). The AO is consistent with the AO no. 2008 – 2009 on Implementing Health
Reforms for Rapid Reduction of Maternal and Newborn Mortality and provides key
behaviors and appropriately-timed interventions to make the postnatal period for
newborns safer. It paves the way toward a system that adheres to a globally accepted
evidence-based essential newborn care (Medical Observer, 2010).
According to Former Health Secretary Francisco Duque III (2009), the
government launched the Unang Yakap campaign as an initial reaction to the protocol, in
collaboration with the World Health Organization, to help solve this newborn mortality
problem because if it is not reduced by at least half, the goal of reducing childhood
mortality to two-thirds by 2015 would not be met. He also said that the Philippines is
focusing on the first few hours of life of the newborn with the manual guiding of the
health workers and medical practitioners in providing evidence-based essential newborn
care, thus, the Unang Yakap Campaign (InstantMommy, 2010).
Therefore, this study will be conducted to determine the awareness of health
professionals employed in selected rural health units and lying-in clinics in the province
of Cavite to the Unang Yakap Campaign.
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Statement of the Problem
Specifically, this study sought to answer the following questions:
1. What is the demographic profile of selected health professionals in terms of:
a. Gender
b. Age
c. Civil Status
d. Years of Service
e. Work Stations (rural health unit and lying-in clinic)
f. Specific Profession (i.e., nurse, midwife, doctor)
2. What is the source of information on Unang Yakap Campaign of the selected health
professionals?
3. What is the level of awareness and knowledge of health professionals of the Unang
Yakap Campaign?
4. Is there a significant relationship between the sources of information and level of
awareness and knowledge of the respondents with regard to the Unang Yakap
Campaign?
5. What is the extent of implementation of the Unang Yakap Campaign in the different
rural health units (RHU) and lying-ins in terms of performance of its protocol by
doctors, nurses and midwives?
6. Is there a significant relationship between extent of implementation and level of
awareness and knowledge of health professionals employed in rural health units and
lying-in clinics?
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7. Is there a significant difference on the level of awareness, knowledge, and extent of
implementation among professionals?
8. Is there a significant difference on the extent of implementation of health
professionals between work places and stations?
9. What are the perceived advantages and disadvantages of the Unang Yakap
Campaign?
Hypotheses
1. There is no significant relationship between the sources of information and level of
awareness and knowledge of the respondents with regard to the Unang Yakap
Campaign
2. There is no significant relationship between the extent of implementation of Unang
Yakap Campaign to the level of awareness and knowledge of health professionals.
3. There is no significant difference on the level of awareness, knowledge, and extent of
implementation between Professionals.
4. There is no significant difference on the extent of implementation of health
professionals between work places and stations.
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Objectives of the Study
This study aimed:
1. to assess the demographic profile of selected health professionals in terms of
gender, age, civil status, years of service and specific profession;
2. to determine the source of information of selected health professionals regarding the
Unang Yakap Campaign;
3. to assess the level of awareness and knowledge of selected health professionals in
the implemented Unang Yakap Campaign;
4. to determine the extent of implementation of the Unang Yakap Campaign in the
different rural health units (RHU) and lying-ins in terms of performance of its
protocol by the nurses and midwives;
5. to determine if there is a significant relationship between the sources of information
and level of awareness and knowledge of the respondents with regard to the Unang
Yakap Campaign;
6. to determine if there a significant relationship between extent of implementation
and level of awareness and knowledge of health professionals employed in rural
health units and lying-in clinics;
7. to find out if there a significant difference on the level of awareness, knowledge,
and extent of implementation between professionals;
8. to find out if there a significant difference on the extent of implementation of health
professionals between work places and stations; and
9. to determine the advantages and disadvantages of the Unang Yakap Campaign.
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Significance of the Study
Maternal and newborn health has long been a priority area of concern and activity
of the Department of Health. Evidence shows there is a need for Philippine newborns to
benefit from their mothers’ natural protection in the first hour of life.
This study entitled “Awareness in the Unang Yakap Campaign among Health
Professionals Employed in Rural Health Units and Lying-in Clinics in the Province of
Cavite” will be significant to the following persons or organizations:
a. The health care professionals such as doctors, midwives and nurses
They can use this study as their baseline data for the information about
newborn care and for better understanding of the benefits of “Unang Yakap” that
was implemented by the Department of Health (DOH) last December 2009. This
will also be beneficial to them because they can compare the mortality rate of
infants before and after the implementation of the Unang Yakap Campaign.
b. Policy Makers
They would know if their campaign is being implemented in selected rural
health units and lying-in clinics in the province of Cavite. And also it can help
them if they should disseminate more information regarding the said campaign.
c. Mothers
Through the implementation of the Unang Yakap Campaign by the health
professionals in rural health units and lying-in clinics, the mothers will also be
aware of the benefits they could get from this campaign, such as having direct
contact or bonding with their babies right after the delivery.
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d. Future Researchers
The content of the study will serve as reference to future researchers who
intend to explore the same interest.
Scope and Limitation of the Study
The subject of the study includes 125 health professionals who are randomly
selected at rural health units and lying- in clinics in Cavite.
The study is confined to selected health professionals’ awareness, knowledge and
extent of implementation of the Unang Yakap Campaign under the Essential Newborn
Care protocol.
Theoretical Framework
Parent-Child Interaction Model (Kathryn E. Barnard RN, 2001)
In the 1970s, when Barnard began her studies of infants and their mothers, there
was minimal appreciation of the connections between earliest communication, touch,
brain growth, and the ways humans develop the social, emotional and behavioral
capacities to self-regulate, connect with others, and experience the world as a safe and
predictable place. Even less was known about research-based protocols to help health
care workers assess infant development and intervene to promote parent-infant
interaction. Without empirically derived guidelines, clinicians were hampered in their
abilities to diagnose infants at risk for neglect, abuse, or developmental delays and even
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less certain about how to stimulate parenting that would enhance infants' cognitive,
emotional, and behavioral development.
Patient. In relations to Unang Yakap Campaign by the Department of Health, the
people mainly involved in this study are the mothers and the infants. The Parent -Child
Interaction model is ascertaining that parents should have an early interaction to their
infant as soon as they were born, just like what one of the goals of ENC protocol.
Environment. Birthing homes, hospitals, lying-ins and even a mere home can be
a place where giving birth can happen. Unang Yakap Campaign was designed to be
implemented at areas where immediate care of the newborn can be done and early
bonding was initiated.
Nursing. Not only in the Nursing field but also other health professionals are in
cooperation in making the Unang Yakap Campaign to prevent the increases in infant
mortality and infant well development.
Health. All aspects of health- holistically, including physical, emotional, social,
and behavioral capacities are taken into big consideration in the Unang Yakap Campaign.
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Independent Variable:
Demographic profile of Health
Professionals in the Province of Cavite:
GenderAge
Civil StatusYears of ServiceWork Stations
Specific Profession
Sources of Information of
Health Professionals
Dependent Variable:
Unang Yakap Campaign
Level of Awareness Level of
Knowledge Extent of
Implementation
AO no. 2009-0025: Essential Newborn Care Protocol (ENC) UNANG YAKAP: Yakap ng Ina, Yakap ng Buhay
Conceptual Framework
Figure 1. A representation showing the Essential Newborn Care Protocol. The input which are the independent variable includes the demographic profile of the respondents and their sources of information. The process is the implementation of Unang Yakap Campaign. The dependent variable in the study is the level of awareness, level of knowledge and extent of implementation of the Unang Yakap Campaign.
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Definition of Terms
Awareness- knowledge or having cognizance among RHU nurses, midwives and
physicians in the province of Cavite about Unang Yakap Campaign. Knowledge gained
through one’s own perception or by means of information.
Essential Newborn Care (ENC) protocol- ENC is a comprehensive strategy to
improve the health of the newborn through interventions before conception during
pregnancy, soon after birth, and in the postnatal period. The ENC Protocol provides an
evidence-based, low cost, low technology package of interventions that will save
thousands of lives.
Infant mortality- is the measurement of infants that die in their first year of life,
mostly due to stressful events or conditions during labor, delivery and immediate
postpartum period. This is also the major problem of the Department of Health, they are
aiming to cut the infant mortality sharply that’s why they launched the Unang Yakap
campaign.
Non-time bound intervention- is the second phase in the guidelines of providing
evidence-based essential Newborn care that must be performed by the health
professionals. These interventions are immunizations, eye care, Vitamin K administration
and weighing. Washing must be postponed by at least 6 hours. Provision of appropriate
thermal care through mother and newborn skin-to skin contact maintaining a delivery
room temperature of 25-28 degrees centigrade and wrapping the newborn with clean, dry
cloth. This intervention is done after the first complete breastfeeding of the mother.
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Post-natal procedure- is a procedure required within 24 hours after birth. This
procedure includes eye prophylaxis, delayed bathing until 6 hours of life and the routine
Newborn screening.
Time bound procedures- is the first phase in the guidelines of providing
evidence-based essential newborn care. Time bound procedures are kinds of actions that
should be routinely performed by health professionals which includes clamping the cord
after one to three minutes, not separating the newborn from the mother and last is the
initiation of breastfeeding.
Unang Yakap- Unang Yakap is the campaign launched by the Department of
Health (DOH) last December 7, 2009. Unang Yakap Campaign is an initial reaction to
the protocol, in collaboration with the World Health Organization (WHO), this campaign
will help solve this newborn mortality problems.
Unnecessary procedures- is the third phase in the guidelines of providing
evidence-based essential newborn care. These procedures include the routinely done
suctioning, routine separation of the newborn for observations, administration of
prelacteals like glucose, water formula, foot printing and cutting of the cord (1-3 minutes
or until cord pulsation stops).
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REVIEW OF RELATED LITERATURE
This chapter places the current study into context of previous, related research. As
such, literature review emphasizes the relatedness between the current study and the work
of other authors with the points of agreement and disagreement among previous studies,
as well as with the theoretical and empirical relevance of each of the present research. For
central importance, the literature review provides a thematic narrative which guides the
formulation of the topic and suggests strategies for making operational the independent
and dependent variables considered in the study.
This chapter serves the literature review. This contains gathered information from
articles, pamphlet, book, and internet that is related to the study.
Newborn Care
Newborns undergo profound physiologic changes at the moment of birth, as they
are released from a warm, snug, dark, liquid filled environment that has met all of their
basic needs, into a chilly, unbounded bright lit, gravity based outside world. Within
minutes after being plunged into this strange environment, a newborn’s body must
initiate respirations and accommodate a circulatory system to extra uterine oxygenation.
Within 24 hours, neurologic, endocrine, gastrointestinal, and metabolic must be operating
competently for life to be sustained (Pillitteri, 2007).
How well a newborn makes these major adjustments depends on his or her
genetic competition, the competency of the recent intrauterine environment, the care
received during the labor and birth period, and the care received during the newborn or
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neonatal period. Two thirds of all deaths that occur during the first year of life occur in
the neonatal period. More than half occur in the first 24 hours after birth- an indication of
how hazardous this time is for an infant. Close observation of a newborn for indications
of distress is essential during this period (Pillitteri, 2007).
National Health Goals
A number of National Health Goals deal directly with the newborn period (DHHS, 2000):
1. Increase to at least 75% the proportion of mothers who breast- feed their babies in
the early postpartal period, from a baseline of 64%
2. Increase to at least 50% the proportion of women who continue breast-feeding until
their babies are 5-6 months old, from a baseline of 29%
3. Increase to 70% the percentage of healthy full term infant that are put to sleep on
their backs, from a baseline of 35%
4. Increase to at least 75% of the proportion of parents and caregivers who use
feeding practices that prevent baby- bottle tooth decay.
5. Reduce the neonatal mortality rate to no more than 2.9 per 1,000 live births, from a
baseline of 4.8 per 1,000 live births.
Nurses can help the nation achieve these goals, by encouraging woman not only
to begin breast-feeding but also to continue it through the first 6 months of life; by
advising parents on the advantage of placing infants on their backs to sleep and on the
danger of tooth decay from letting a baby drink from a bottle of milk or juice while
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falling asleep; and by discussing with parents who use formula the proper methods for the
preparation so the gastrointestinal illness does not occur (Pillitteri, 2007).
Physical Examination
A newborn is given preliminary physical examination immediately after birth, to
establish gestational age and to detect any observable condition such as difficulty
breathing, a congenital heart anomaly, meningocele, cleft lip or palate, hydrocephalus, or
birthmark, imperforate anus, tracheoesophageal atresia, or bowel obstruction. This
assessment may be the responsibility of the delivering physician, nurse practitioner, nurse
midwife, pediatrician, or nurse. This health assessment is done quickly, to prevent
overexposing the newborn, yet not so swiftly that important findings are overlooked
(Pillitteri, 2007).
Height and Weight
Assuming newborns are breathing well, they are weighed nude and without a
blanket immediately after birth in the birthing room. Measurements such as body length
and head, chest, and abdominal circumferences can be obtained in a newborn or
transitional nursery. Performing these measurements while an infant is still damp only
exposes the newborn unnecessary to chilling.
Newborn weight helps to determine maturity and establishes a baseline against
which other weights can be obtained. An infant is weighed nude once a day, at
approximately the same time everyday, during a hospital or birthing center stay.
Abnormal loss of weight may be the first indication that the newborn has an inborn error
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of metabolism, such as adrenogenital syndrome or is becoming dehydrated (Pillitteri,
2007).
Laboratory Studies
After the first hour of undisturbed rest, depending on health agency policy,
newborns may have heel- stick tests for hematocrit hemoglobin, and hypoglycemia
determinations. Heel- sticks require a minimum of blood, and, although not pain free,
they cause a minimal trauma to a baby. In some settings, these tests are not routine but
they reserved only for newborns with symptoms of anemia or hypoglycemia (Pillitteri,
2007).
Hematocrit and hemoglobin determinations are done to detect newborn anemia,
because it is difficult to appreciate that anemia is present by clinical observation alone.
Hypoglycemia may also produce few symptoms, so it is determined by a heel
stick glucose measurement. If a blood glucose reading is less than 40 mg/ 100 ml of
blood, hypoglycemia is present. To correct this condition, the infant is prescribed oral
glucose or infant formula to be given immediately. This elevates the infant’s blood sugar
to a safe level (Pillitteri, 2007).
Care of Newborn at Birth
Delivery and birthing rooms provide an island for newborn care separate from the
supplies needed for the mothers care. Necessary equipments include a radiant heat table
or warmed bassinet; a warm, soft blanket; of equipment for oxygen administration,
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resuscitation, suction, eye care, identification, and weighing of a newborn (Pillitteri,
2007).
The philosophy of caring health care providers has always been that newborns
should be handled as gently at birth as they are at any other time. The image of an
obstetrician holding a newborn up by the heels and spanking to stimulate breathing has
existed only in movies. It has long been accepted that holding the baby by the feet and
letting the back extend fully is probably painful after the months spent in a flexed
position in utero (Pillitteri, 2007).
Keep newborn warm. Gently rub a newborn dry, so that little body heat is loss by
evaporation. Next swaddle the newborn loosely with blanket to prevent compromising
respiratory effort, and place a cap on the infants head (Pillitteri, 2007).
Ask which parent wants to hold the child, and place the infant in the parents arm.
This helps conserves heat and encourages bonding. The period immediately after birth is
an important time for parents to begin interaction with their child. Newborns are alert and
responded well to the parent’s first tentative touches or interaction with them. Although
the temperature of newborns who are dried, wrapped, and then held by their parents
immediately after birth apparently falls slightly lower than that of infants placed in heated
cribs, their core temperatures does not fall below safe limits.
At the end of the first hour of life, reassess the newborns temperature. Axillary
rather than rectal temperatures are recommended for newborns, to prevent accidental
bowel perforation (Pillitteri, 2007).
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During the first day of life, a newborns temperature is usually taken every 4 to 8
hours. Thereafter, unless the temperature is elevated or subnormal, or the infant appears
to be in distress, measurement once a day while in the health care facility is enough
(Pillitteri, 2007).
Promote Adequate Breathing Pattern and Prevent Aspiration. Mucus is suctioned
from a newborns mouth by a bulb syringe as soon as the head is born. As soon as the
body is born, he/she should be held for a few seconds with the head slightly dependent,
for further drainage of secretion. It is important that mucus be removed from the mouth
and pharynx before the first breath this way to prevent aspiration of secretions. If the
infants continue to have an accumulation of mucus in the mouth or nose after this first
steps, you may need to suction further after the baby is placed under a warmer (Pillitteri,
2007).
Inspect and Care for Umbilical Cord. The umbilical cord pulsates for a moment
after an infant is born as al last flow of blood passes from the placenta into the infant.
Two clamps are then applied to the cord about 8 inches from the infant’s abdomen, and
the cord is cut between the clamps. The infant cord is then clamped again by a permanent
cord clamp. The clamp on the maternal end of the cord should not be released after the
cord is cut, to prevent blood still remaining in the placenta from leaking out (Pillitteri,
2007).
Administer Eye Care. Such infections are usually acquired from the mother as the
infant passes through the birth canal. Formerly, eye prophylaxis was applied immediately
after birth. Silver nitrate was exclusively used for prophylaxis from the past; today
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erythromycin ointment has the advantage of eliminating not only the organism of
gonorrhea but that of Chlamydia as well (Pillitteri, 2007).
Parent-Child Relationship
One of the most sacred and divine relationships is the one between a parent and
an offspring. This is one of the most important relationships, perhaps the most important
relationship for many. Parent child relationships often range from the least complicated to
the most complicated. Since this relationship starts with a startling change in a family, the
birth of the child, such a relationship can become complex at times. A relationship that
composes of respect, candidness, conservativeness, friendliness, freedom and binding at
the same time sometimes is sweet and sometimes not so sweet (Mystic Madness, 2010).
The parent-child relationship consists of a combination of behaviors, feelings, and
expectations that are unique to a particular parent and a particular child. The relationship
involves the full extent of a child's development (Kohn, 2005).
Of the many different relationships people form over the course of the life span,
the relationship between parent and child is among the most important. The quality of the
parent-child relationship is affected by the parent's age, experience, and self-confidence;
the stability of the parents' marriage; and the unique characteristics of the child compared
with those of the parent (Kohn, 2005).
If parents can adapt to their babies, meet their needs, and provide nurturance, the
attachment is secure. Psychosocial development can continue based on a strong
foundation of attachment. On the other hand, if a parent's personality and ability to cope
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with the infant's needs for care are minimal, the relationship is at risk and so is the
infant's development (Mystic Madness, 2010).
Cultural norms within a family play a role in determining when a child is
expected to achieve particular developmental milestones. Children who are loved thrive
better than those who are not. Either a parent or a nonparent caregiver may serve as the
primary caregiver or form a primary-parent child love relationship. It is the quality of
time spent with children, not the amount of time, which is important. Loss of love from a
primary caregiver, as might occur with the death of a parent, or interruption of parental
contact through hospitalization, imprisonment, divorce or inadequate parental love, can
interfere with a child’s desire to eat, improve and advance (Pillitteri, 2007).
As babies are cared for by their parents, both parties develop understandings of
the other. Gradually, babies begin to expect that their parent will care for them when they
cry. Gradually, parents respond to and even anticipate their baby's needs. This exchange
and familiarity create the basis for a developing relationship (Post, et al, 2003).
Attachment: The Bond Between Parent and Child
Parents and children share a special bond. Many theories have been proposed to
account for the close ties shared among family members. The most influential to date is
John Bowlby's theory of attachment (Kuther, 2000).
Bowbly reasoned from an ethological perspective, which is basically an extension
of Darwin's theory (remember from high school, survival of the fittest?). From this
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perspective, much of human behavior evolved because of its adaptive value. Bowbly
applied these ideas to the bond that parents and infants share.
Children form an attachment or a bond to parents because it enhances their
chances for survival, from an evolutionary standpoint. We're not aware of this on a
conscious level. Rather, our species is "wired" to form such attachments because our
prehistoric ancestors did and it enhanced their survival (Kuther, 2000).
Bowlby argued that infants and parents are innately attuned to each other. Infants
display what he called "signaling behaviors" such as smiling, laughing, and clinging to
their caregivers. Signaling behaviors attract the caregiver's attention and bring them into
close contact, and thus enhance the infant's chances for survival. In turn, adults innately
respond to an infant's signaling behaviors. Do you find yourself naturally drawn to
babies? According to Bowlby this is a survival mechanism that's innate and enables our
species to proliferate (Kuther, 2000).
Whether or not they adopt this ethological perspective, most psychologists will
agree that there is a bond between parents and infants. Psychologist, Mary Ainsworth
elaborated Bowlby's ideas. She argued that all children develop an attachment to their
parents, even children who are abused. While children of different parenting styles and
environments all develop a bond to their parents, they differ in the security of attachment.
Security refers to children's confidence in their caregiver, the belief that the caregiver will
be available to meet their needs. Ainsworth's research shows that infants tend to develop
secure attachments when their caregivers are compassionate, consistent, and warm
(Kuther, 2000).
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The key to helping your baby form a secure attachment is being sensitive and
responsive to her. This includes responding to her cries, caring for her physical needs
(like food, warmth, safe conditions, etc.), but also meeting her social needs. Babies and
children need more than physical care; they need love, cuddling, and snuggling.
Caregivers who read and react appropriately to their baby's signals for social attention are
more likely to foster strong attachment bonds (Kuther, 2000).
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Essential Newborn Care Protocol (ENC) Program Framework
Figure 2. Program Framework
22
DOH in collaboration with WHO
To solve newborn mortality problem
AO no. 2009-0025Essential Newborn Care Protocol
(ENC) Post- natal Procedure:
●Time Bound Procedure●Non-time Bound intervention
●Unnecessary procedure
Formulation of
UNANG YAKAP: Yakap ng Ina, Yakap ng Buhay
First Embrace: Embrace of Mother, Embrace of Life
Dissemination of Information and Implementation to:
Rural Health Units Lying-in
Clinics
Primary
Secondary
Tertiary
Hospitals
Unang Yakap Campaign
Despite the previous efforts and improvement in general health status indicators,
the rates of decline in maternal and neonatal mortality have decelerated in the past decade
to a point where Philippine commitments to the millennium Development Goals (MDGs)
of lowering maternal mortality ratio (MMR) and infant mortality rate (IMR) may not be
achieved (DOH, 2008).
However, with pregnancy and childbirth continuing to pose risks to Filipino
mothers and their newborn, rapid education in these risks must be realized as quickly as
possible while considering that variations in health outcomes and program performance
across localities and population groups warrant targeted and locally-customized
interventions in order to meet the rapid education goal (DOH, 2008).
The risk of maternal and neonatal deaths for a given population group is
magnified with critical accumulation of the following four risks. First, is the risk of
having mistimed, unplanned, unwanted and unsupported pregnancy. Secondly, having
become pregnant exposes the mother and the fetus to the risk of not securing adequate
care during the course of the pregnancy. Third, is the risk of delivering without being
attended to by skilled birth attendants, namely: skilled midwives, nurses, and physicians
and of not having access to emergency obstetric and neonatal care services. Lastly, there
is the risk of not securing proper postpartum and postnatal care for the mother and
neonate, respectively (DOH, 2008).
Long term control of mortality and morbidity and improvement in the equality of
life require provision and use of continuum of health care services spanning each of the
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life cycle stages. Provision and use of these services would require informed decisions by
mothers and their families (demand side), as well as a health system (supply side) that is
responsive to their needs (DOH, 2008).
Over 40,000 Filipino newborns alarmingly die annually, with majority dying in
the first two days of their lives. Newborn deaths account for 37 percent of the 82,000
Filipino children that die yearly. The Philippines is one of the 42 nations that accounts for
90 percent of global deaths of under 5-year-old children (Fajardo, 2010). Majority of
them (3/4) die within the first two days of life, mostly due to stressful events or
conditions during labor, delivery and immediate postpartum period. This was the report
delivered by Dr. Howard L. Sobel, M.D., MPH, Team Leader for Maternal and Child
Health of Office of the WHO Representative in the Philippines, during the 2009 Annual
Convention and 63rd Anniversary Celebration of the Philippine Obstetrical and
Gynecological Society (Foundation), Inc. According to the Philippine Health Statistics
1998, newborn problems account for over 30% of all deaths in the first year of life
(InstantMommy, 2010).
Deaths during the first week of life are mostly due to conditions originating in
pregnancy or during childbirth. They are a result of inadequate or inappropriate care
during pregnancy, childbirth, or the first critical hours after birth (USAID, 2004).
After the first week, deaths are mostly due to infections acquired after birth, either
at the health facility or at home. Most neonatal deaths, whether during the period
immediately after birth or later, can be avoided with low cost interventions that do not
require sophisticated technology (USAID, 2004).
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Noting an alarming stagnation in the country’s neonatal mortality rate, subsequent
studies have documented a marked lack in the practice of newborn care interventions in
the biggest health facilities in the country (DOH, 2009).
An observational study of consecutive deliveries using a standardized assessment
tool to document minute-by-minute newborn care done in the first hour of life was
undertaken in 51 hospitals in 9 regions of the country in 2008. The study found that
Philippine hospital practices prevented newborns from benefitting from their mothers'
natural protection in the first hour of life. Further, the performance and timing of
evidenced-based interventions in immediate newborn care are below WHO essential
newborn care standards. Specifically (DOH, 2009).:
Only 3% of our study newborns were dried prior to or with cord cutting and only
1 of 26 with difficult breathing was dried first. Hypothermia can lead to infection,
coagulation defects, acidosis, delayed fetal to newborn circulatory adjustment,
hyaline membrane disease and brain hemorrhage.
Unnecessary delays and restrictions on immediate and sustained skin-to-skin
contact, early latching on, rooming in ad full breastfeeding compromised the
newborns' chance for maintenance of warmth and sustained breastfeeding. These
earliest interventions contribute to hospital infection control as they directly
reduce risk of neonatal sepsis.
Almost no newborn benefited from the natural transfusion through non-immediate
cord clamping. A Cochrane systematic review of 7 Randomized Controlled Trials
(RCTs) showed that among infants less than 37 weeks of gestation, non-
immediate cord clamping is associated with fewer transfusions due to anemia or
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low blood pressure and fewer intraventricular hemorrhages. Full-term neonates
also benefit by having lower incidence of anemia.
Only 61.3of newborns were initiated to breastfeeding within the first hour.
However, newborns were given a median of only about two minutes to get
colostrum, their first immunization. Furthermore, they were being forced to
breastfeed at median of 10 minutes, long before the typical newborn would be
ready.
More than 80% was exposed to hypothermia during washing. The WHO
recommends that initial bathing should be six hours after birth or longer. The
vernix was washed off at a median of 8 minutes thereby removing a protective
barrier to bacteria such E. coli and Group B Strep. Furthermore, washing removes
the crawling reflex.
Virtually all healthy newborns were suctioned unnecessarily, 80% more than once
- a practice WHO discourages (DOH, 2009).
In her presentation, DOH National Disease Prevention Director Dr. Yolanda
Oliveros said that 82,000 Filipino children die annually, with half of newborn deaths
occurring in the first two days of life. “But the thing is, many of these deaths could have
actually been prevented,” she said, citing the Lancet 2003 study (The Philippine Star,
2010).
In Dr. Oliveros’ discussion of the minute-by-minute assessment of newborn care
within the first hour of life, Dr. Oliveros said that the usual practice of cord clamping in
most Philippine hospitals is 12 seconds with 99 percent under one minute, whereas WHO
standards require one to three minutes or until pulsations stop. Ninety-seven percent of
26
them also do drying after one minute, when WHO standards say it should be done
immediately (The Philippine Star, 2010).
Immediate skin-to-skin contact is not also being observed, adds Dr. Oliveros, with
only 9.6% doing it after five minutes when it should be done over 90 percent of the time.
Other “bad habits” include putting babies on a cold surface (12 percent), not drying the
baby (2.5 percent), not drying the head (6.2 percent), and washing or giving the baby a
bath (84 percent of hospitals do it within eight minutes), when it could actually be
delayed until after six hours. Under the newly-approved guidelines, transferring babies to
a nursery is no longer necessary — instead, newborns should be roomed in with their
mothers immediately (The Philippine Star, 2010).
Separating the baby from the mother, weighing, and examining the newborn
should also be done at least after more than an hour, not in just after 10 minutes, which is
the usual practice. Other newborn interventions cited include rooming in babies with their
mother and immediate breastfeeding (within one hour after birth or as soon as baby
shows signs).
Dr. Oliveros ended her presentation by saying a new set of newborn care protocol
is needed because there is now a wide variety of practices among health practitioners.
There were also reports of inappropriate care being given the newborns, as well as
continuously skyrocketing costs of health care (The Philippine Star, 2010).
Because the challenges of newborn mortality are enormous, and health experts
concur that there is an urgent need to increase the scale of work in the area. In September
2000, the Philippines committed to the UN Millennium Declaration, targeting reduction
27
of poverty, hunger and ill health in the country, including reduction of maternal, newborn
and child mortality. The Philippines is currently "on track" to reach its Millennium
Development Goal #4 target of reducing under-five mortality. However, some 40,000
Filipino newborns still die every year. Half of these newborns die in the first two days of
life (WHO, 2009).
To meet the Millennium Development Goal of reducing deaths of children before
their fifth birthday by two-thirds between 1990 and 2015, strengthening the
implementation of specific newborn health interventions must be put in place at the local,
national and global levels. However, the gains have slowed in recent years because
newborn deaths remain high.
Over the last decade, the under-five mortality rate (U5MR) has declined. The
1998 NDHS reported a fall from 54 deaths per 1000 births in 1988-92 to 48 in the period
1993-97. According to The State of the World’s Children (2003), the rate declined by
42%, from 66 childhood deaths per 1000 live births in 1990 to 38 in 2001. Nevertheless,
the Philippines still ranks 88 among countries in under-five mortality (USAID, 2004).
Overall, the neonatal mortality rate (NMR), within the first 28 days, declined
from 5 per 1,000 live births in 1991 to 4 per 1,000 live births in 1995. In 2000, the infant
mortality (for children up to age 1 year) was 12.3 deaths per 1000 live births. In Region
4, the NMR was 4 per 1,000 live births and the infant mortality rate was 12.4 deaths per
1,000 live births (USAID, 2004).
And although childhood death rates in the country showed downward trend from
1993 to 2003, the decline slowed down in the last 10 years. The under-five mortality rate
28
decrease to only 32 per 100 live births in 2003 from 52 per 1000 live births in 1988. And
neonatal and post neonatal deaths decline in the slowest over the past 20 years with the
reduction of only 9 percent and 7 percent, respectively, from 1988 to 2003 (Healthbeat,
2009).
Newborns account for under half of all deaths of children prior to five years of
age. This translates to about 40,000 newborns dying in the Philippines every year. Half of
these newborns die in the first two days of life, and they die of mostly preventable causes
(Healthbeat, 2009).
According to the World Health Organization (WHO), the major direct cause of
newborn deaths globally is neonatal infection or sepsis, which is responsible for about
33% of newborn deaths. Sepsis includes conditions such as septicemia, meningitis,
pneumonia, tetanus, and congenital syphilis. Birth asphyxia and trauma account for
another 28% of neonatal deaths, and congenital malformations for another 10%.
While according to Former Secretary Duque, 50 percent of all neonatal and post
neonatal deaths occur during the first two days of life, mainly caused by birth asphyxia
(31 percent), complications of prematurity (30 percent) and severe infection (19 percent)
(Medical Observer, 2010).
Inadequate health care is another factor. About 72% of deliveries occur outside of
health facilities, frequently without the assistance of a skilled birth attendant, and many
deliveries do not meet the minimal conditions for early essential newborn care (WHO,
2009).
29
These current practice of handling newborns, like clamping and cutting the
umbilical cord and washing the baby right after birth, have been known to actually
contribute to the high incidence of neonatal deaths and illnesses in the country. These
hospital practices in the country prevented newborns from benefitting from their mothers
natural protection in the first hour of life. Further, the performance and timing of
evidence-based interventions in immediate newborn care are below WHO essential
newborn care standards. Thus, there has been a need for a paradigm shift from the
prevailing standard procedures into the new protocol. If newborn mortality is not reduced
by at least half, the MDG # 4 target of reducing childhood mortality by two-thirds by
2015 would not be met (Healthbeat, 2009).
The current state of newborn care needs urgent action that can eliminate the
unnecessary tragedy of Filipino babies. To this end, the Department of Health issued an
administrative order to implement the ENC protocol with the goal of rapidly reducing the
number of newborn deaths in the Philippines. Administrative Order 2009-0025, entitled
“Adopting new Policies and Protocols on Essential Newborn Care (ENC) outlines
specific policies and principles for health care providers with regard the prescribed
systematic implementation of interventions that address health risks known to lead to
preventable neonatal deaths. This AO is consistent with AO no. 2008-0029 on
Implementing Health Reforms for Rapid Reduction of Maternal and Newborn Mortality
and supports all DOH initiatives and programs for newborn and child health. Its objective
is to guide health workers and medical practitioners in providing evidence-based essential
newborn care. With AO 2009 - 0025, the whole hierarchy of the DOH and its attached
agencies, public and private providers of health care and development partners
30
implementing the Maternal, Newborn and Child Health and Nutrition Strategy and all
health practitioners of maternal and newborn care are enjoined to adopt the policies and
protocol on Essential Newborn Care. Implementation of the ENC protocol has the
potential to avert approximately 70 percent of newborn deaths that are due to preventable
causes (DOH, 2009).
Standard essential newborn care practices guidelines are organized by time,
beginning at the time of perineal bulging until one week of life (DOH, 2009). It is strictly
defined as a “comprehensive strategy to improve the health of the newborn through
interventions before conception during pregnancy, at and soon after birth, and in the
postnatal period.” It is a new program to address neonatal deaths in the country. However
for this Administrative Order and for the DOH protocol, it is focusing on the first few
hours of life of the newborn with the manual guiding the health workers and medical
practitioners in providing evidence-based essential newborn care, thus, the Unang Yakap
Campaign emphasis is given to care interventions that should be provided to the newborn
from birth until the first 6 hours of life (Healthbeat, 2009).
Since AO provides key behaviors and appropriately timed interventions to make
the postnatal period for newborns safer, it paves the way toward a system that adheres to
a globally accepted evidence-based essential newborn care health. With the new ENC
protocol, the government is hoping to reduce neonatal deaths by six per 1,000 live births
(Medical Observer, 2010). Newborn care is defined as the management of the neonate
during the transition to extrauterrine life and subsequent period of stabilization (Pillitteri,
2007).
31
Department of Health, in Collaboration with the World Health Organization, then
introduces the Essential Newborn Care Protocol. This is a series of time bound,
chronologically-ordered, and standard procedures that a baby receives after birth
(Healthbeat, 2009). Clinical and epidemiological studies have shown that newborn
mortality can be significantly reduced through simple, low-technology, cost-effective,
and time-bound steps. These steps are outlined in the Essential Newborn Care (ENC)
Protocol, according to Dr. Sobel (The Philippine Star, 2010).
On December 7, 2009, the Department of Health launched the Unang Yakap
Campaign. With this campaign, the DOH aims to cut down infant mortality in the
Philippines by at least half. The Medium Development Goal target is 6 per 1000 live
births by 2015. The government launched the Unang Yakap Campaign as an initial
reaction to the Protocol (PIA, 2009). The Unang Yakap campaign is a call to action by
the Department of Health on the national and local sectors, public and private health and
related sectors, individuals and organizations, mass media, and academe to strengthen
alliances to implement the Essential Newborn Care protocol. The ENC protocol can
prevent at least half of newborn deaths without additional cost to both families and
hospitals. It is time to rapidly reduce neonatal mortality (DOH, 2010). The launching
coincided with the signing of former Health Secretary Francisco Duque III of the
Essential Newborn Care (ENC) Protocol on the same day (PIA, 2009).
The ENC Protocol provides an evidence-based, low cost, low technology package
of interventions that will save thousands of lives. It is a step by step guide for health
workers and medical practitioners issued by DOH for implementation under the A.O.
2009-025 (DOH, 2009). It is an evidenced based strategic intervention which details
32
specific policies and principles to follow all health care providers involved in Newborn
care and aims at improving newborn care and helping cut neonatal mortality.
Interventions comprised of a core sequence of actions or steps (DOH, 2010).
The Essential Newborn Care categorizes post-natal procedures into time-bound,
non-time bound and unnecessary actions undertaken to lessen newborn death
(Rwchick, 2010). At the heart of the protocol are time bound interventions. The AO
stresses the provision of correct time bound interventions which includes; immediate
drying (within 30 seconds), postponing washing, initiation of skin-to-skin contact, and
delayed cord clamping. Likewise, early initiation of breastfeeding (within 90 minutes
after birth) is also included in the new protocol (Fajardo, 2010).
ENC Time-Bound Interventions
33
Figure 3. Essential Newborn Care Time-Bound Interventions
Time bound actions are actions that need to be taken immediately to lessen the
statistics on newborn deaths and should be routinely performed first. This is the aspect of
newborn care in the Philippines that have not met international standards, and should
therefore, be taught and re-learned by all health care providers. It is also interesting to
know that only 4 steps are time bound that are needed to be undertaken immediately to
lessen statistics on newborn death (DOH, 2009). These are:
1. Immediate and thorough drying of the Newborn
Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head,
front and back, arms and legs (WHO, 2009). Immediate and thorough drying for 30
seconds to one minute warms and prevents hypothermia to the newborn, which is
extremely important to survival the newborn and stimulates breathing (DOH, 2009).
34
The image of an obstetrician holding a newborn up by the heels and spanking to
stimulate breathing has existed only in movies. It has long been accepted that holding a
baby by the feet and letting the back extend fully is probably painful after the months
spent in a flexed position in utero; in addition, a measure such as spanking is not as
effective in helping a newborn breathe as is gentle stimulation such as rubbing the back
(Pillitteri, 2007).
However, bathing or washing should be made at least after 6 hours of the
newborns life. Bathing the newborn soon after birth causes a drop in the body’s
temperature leading to increase risk of developing infections, coagulation defects and
brain hemorrhage. Washing also removes the vernix which covers the newborn and is a
protective barrier against bacteria, such as E. coli and Group B Streptococcus, that cause
neonatal sepsis and removes the crawling reflex (Healthbeat, 2009).
2. Uninterrupted skin-to-skin contact
Keeping the mother and the baby in uninterrupted skin-to-skin contact prevents
hypothermia. Aside from the warmth and immediate bonding between mother and child,
it has been found that early skin-to-skin contact contributes to a host of medical benefits
such as the overall success of breastfeeding/colostrums feeding and stimulation of the
mucosa—associated lymphoid tissue system. It also allows the newborn to be colonized
by good bacteria from the mother’s skin, so-called family flora to protect the infant from
sepsis and other life-threatening infections and hypoglycemia (Healthbeat, 2009).
3. Proper cord clamping and cutting
35
Another simple change in practice that can save lives is not clamping the
umbilical cord immediately. Dr. Sobel cited research evidence showing that delayed cord
clamping until umbilical pulsations stop, typically between one to three minutes
improved newborn outcomes by increasing blood circulation and also newborns’ iron
reserves. He further noted delayed cord clamping did not result in mothers’ postpartum
bleeding. This time bound intervention is also found to decrease anemia in one out of
every three premature babies and prevents brain hemorrhage in one out of two
(Healthbeat, 2009).
4. Non-separation of the newborn from the mother for early breastfeeding
initiation and rooming-in
The Rooming-In and Breastfeeding Act (1992) for hospitals and health facilities
and the Code of Marketing of Breastmilk Substitutes (1996) were enacted to improve
breastfeeding practices. The Philippines is one of seven countries that have established
formal monitoring of the WHO Code of Ethics (USAID, 2004).
Breast- feeding has major physiologic advantages for a baby. Breast milk contains
secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins,
including viruses and bacteria, keeping them from being absorbed from the
gastrointestinal tract into the infant. Lactoferrin is an iron binding protein in breast milk
that interferes with the growth of pathogenic bacteria. The enzymes lysozyme in breast
milk apparently actively destroys bacteria by lysing their cell membranes, possibly
increasing the effectiveness of antibodies. Leukocytes in breast milk provide protection
36
against common respiratory infections invades, macrophages, responsible for producing
interferon, interferes with virus growth (Pillitteri, 2007).
The baby should be placed on mother’s chest or between her breast for skin-to-
skin contact and breastfeeding within the first hour of life should be initiated and
supported. Colostrum, the mother's first milk, is high in antibodies that fight infections.
The earlier the baby breastfeeds, the lesser the risk of death (Healthbeat, 2009).
There are three reasons for breast-feeding: the milk is always at the right
temperature; it comes in attractive containers; and the cat can't get it. ~Irena Chalmers.
Delaying initiation of breastfeeding is harmful; a one-day delay will increase
almost threefold the risk of the newborn getting sick or dying (Healthbeat, 2009).
Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin
contact) but will also prevent doing unnecessary procedures like putting the newborn on a
cold surface for examination (thereby exposing the baby to hypothermia), administering
glucose water or formula and foot printing (which increases risk of contamination from
ink pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix
protects the newborn from infection) (WHO, 2010). It is also helpful for the mother since
during breastfeeding, oxytocin is released from the posterior pituitary gland which aids in
uterine involution (Pillitteri, 2007).
Breastfeeding also provides excellent opportunity to enhance a true symbolic
bond between mother and child (Pillitteri, 2007).
37
A meta analysis of 30 randomized trials reveals that skin-to-skin contact
contributes to the success of breastfeeding by stimulating early breastfeeding initiation,
and eventually leading to prolonged exclusive breastfeeding. In turn, a 2008 study in
Nepal showed that early initiation of breastfeeding reduced the risk of a newborn dying
from infections (Fajardo, 2010).
Non-time bound intervention should only be done after the first full breastfeed,
usually given within 6 hours after birth, namely: Vitamin K injection; BCG and Hepatitis
B vaccinations; newborn examinations for checking birth injuries, malformation or
defects; cord care; newborn resuscitation; and additional care for a small baby or twin.
These interventions should never be made to compete with time-bound interventions
(Healthbeat, 2009):
Give Vitamin K prophylaxis
a) A single dose of 0.5 to 1.0 mg of vitamin K is administered intramuscularly to
prevent bleeding disorders (Pillitteri, 2007).
b) Offer oral vitamin K as a second line (DOH, 2009).
Inject Hepatitis B and BCG vaccinations
a) Inject hepatitis B vaccine IM and BCG intradermally (DOH, 2009).
Administer Eye Care
Every state in the US requires that newborns receive prophylactic eye treatment
against gonorrheal conjunctivitis. As long as it is completed as soon as possible after
birth, either in the birthing room or on arrival in the nursery, the exact time the ointment
38
is administered is unimportant. Silver nitrate was exclusively used for prophylaxis in the
past; today, erythromycin ointment is the drug of choice. Erythromycin ointment has the
advantage of eliminating not only the organism of gonorrhea but that of Chlamydia as
well (Pillitteri, 2007).
Examine the newborn. Check for birth injuries, malformations or defects
a) Weigh the newborn and record.
b) Look for possible birth injury and/or malformations.
c) Refer for special treatment and/or evaluation if available.
d) If the newborn has feeding difficulties because of the injury/malformation, help the
mother to breastfeed. If not successful, teach her alternative feeding methods (DOH,
2009).
Cord Care
a) Wash hands.
b) Fold diaper below stump. Keep cord stump loosely covered with clean clothes.
c) If stump is soiled, wash it with clean water and soap. Dry it thoroughly with clean
cloth.
d) Explain to the mother that she should seek care if the umbilicus is red or draining pus.
e) Teach the mother to treat local umbilical infection three times a day (DOH, 2009).
Newborn Resuscitation
39
a) Start resuscitation if the newborn is not breathing or is gasping after 30 seconds of
drying or before 30 seconds of drying if the newborn is completely floppy and not
breathing.
b) Clamp and cut the cord immediately.
c) Call for help.
d) Transfer the newborn to dry, clean and warm surface. Keep the newborn wrapped or
under a heat source if available.
e) Inform the mother that the newborn needs help to breathe (DOH, 2009).
Provide additional care for a small baby or twin
For a visibly small newborn or a newborn born >1 month early:
a) Encourage the mother to keep the small newborn in skin-to-skin contact with her as
much as possible
b) Provide extra blankets to keep the baby warm
c) If mother cannot keep the baby skin-to-skin because of complications, wrap the baby
in a clean, dry, warm cloth and place in a cot. Cover with a blanket. Use a radiant
warmer if room not warm or baby small.
d) Do not bathe the small baby. Ensure hygiene by wiping with a damp cloth but only
after 6 hours.
e) Prepare a very small baby (<1.5 kg) or a baby born >2 months early for referral.
Meanwhile, unnecessary procedures that were observed to have been routinely
given in Philippine hospitals but, in fact, are not recommended for all newborns include:
40
a) Routine suctioning - Suctioning has no benefit if the amniotic fluid is clear and
especially with newborn who cry or breathe immediately after birth. Moreover, a
dirty bulb can become a source of infection. Routine suctioning has also been
associated with cardiac arrhythmia. Suctioning is indicated only if the mouth/nose is
blocked with secretions or other materials (DOH, 2009).
b) Early bathing/washing - The WHO recommends bathing at least after 6 hours of the
newborn's life. Bathing the newborn soon after birth causes a drop in the body's
temperature leading to increased risk of developing infections, coagulation defects
and brain hemorrhage. It also removes the vernix which is protective against bacteria
and cause neonatal sepsis and removes crawling reflex (DOH, 2009).
c) Giving sugar water formula or other prelacteals and the use of bottles or pacifiers -
delaying initiation to breastfeeding has been linked to a 2.6 fold increase in the
chances of newborn deaths due to infection. If the sugar water, formula or prelacteals
are introduced using a bottle, the newborn may develop a learned preference for the
bottle leading to nipple confusion and inefficient suckling which can further lead to
failure in breastfeeding. A pacifier likewise contributes to nipple confusion especially
if these are used before the newborn is offered mother's breast. This undermines the
chances of successful breastfeeding by contributing to a vicious cycle of poor
attachment, sore nipples and lactational insufficiency (DOH, 2009).
d) Footprinting - Footprinting has proven to be an inadequate technique for newborn
identification purposes. Better identification techniques, such as DNA genotyping and
human leukocyte tests can serve more this purpose according to the American
41
Academy of Pediatrics (AAP) and the American College of Obstetricians and
Gynecologists (ACOG) (DOH, 2009).
e) Application of alcohol, medicine and other substances on the cord stump and
bandaging the cord stump or abdomen - The umbilical stump is an entry point for
systemic infections in the newborn. The devitalized tissue of the cord stump can be an
excellent medium for bacterial growth, especially if the stump is kept moist and
unclean substances are applied to it. Cleaning with alcohol and bandaging delays
healing and falling off of the stump. The alcohol keeps the stump moist while
bandaging prevents aeration which facilitates drying process (DOH, 2009).
The new Protocol is considered a paradigm shift in newborn practice. The DOH
believes that this protocol will pave the way for the solution on the problems the country
is facing on neonatal deaths (Healthbeat, 2009).
Currently, only DOH hospitals, Quirino Memorial Medical Center in Quezon City
and Fabella Memorial Hospital in Manila, implement the protocol. The DOH is targeting
the nationwide implementation by 2010 (Healthbeat, 2009).
To accelerate the implementation strategies of the AO, the new protocol will be
part of the Normal Spontaneous Deliveries and Maternal Care Packages of PhilHealth.
An assessment of the Philippine Health Insurance Corporation Benchbook is in progress
to facilitate the integration of the ENC protocol interventions. DOH will also promote the
knowledge of the said protocol among medical, pharmaceutical and proper learning
environment (Fajardo, 2010).
42
METHODOLOGY
This chapter comprises the research method that was used in the study, which
includes the respondents of this study including the total population sampling type and
technique, research instrument, validation of the research instrument, data gathering
procedure, data processing method and statistical treatment of data that will be used.
Research Design
This study made use of descriptive research method to gather information about
the existing condition of the Unang Yakap Campaign. The purpose of utilizing this
method was to describe the nature of the change, as it existed at the time of the study and
to explore the cause of change. In this method, the level of awareness among health care
professionals in the province of Cavite about the Unang Yakap Campaign was assessed
by giving survey questionnaires.
Sample Size
The researchers gathered data from 125 respondents who are currently working as
doctors, midwives, and nurses from selected rural health units (RHUs) and lying-in
clinics in the province of Cavite.
43
Sampling Design and Technique
For the selection of respondents, cluster sampling, simple random sampling and
quota sampling were used. Data were gathered from doctors, midwives, and public health
nurses (PHN) or registered nurses (RN).
Data Gathering Method
The researchers used cluster sampling which grouped the municipalities in the
province of Cavite in seven (7) districts and then simple random sampling through lottery
method for the selection of RHUs and lying-in clinics in Cavite was used. Sampling was
done by choosing five (5) districts from the seven (7) districts of Cavite through lottery
method. From those chosen districts, one (1) municipality was drawn from the first two
(2) districts since they only have one (1) municipality per district while three (3) were
drawn from the last three (3) districts. And then, one (1) RHU and one (1) lying-in clinic
were chosen per municipality. A total of eleven (11) RHUs and ten (10) lying-in clinics
were chosen from eleven (11) municipalities. And through nonproportional quota
sampling, the desired number of respondents were one (1) doctor, five (5) midwives,
three (3) public health nurses in every rural health units (RHUs) while one (1) midwife
and one (1) registered nurse were desired in every lying-in. The expected number of
respondents were 119 but due to certain circumstances such as some of the health
professionals were on leave or busy and sometimes there were more than the desired
number of health professionals present in the RHU or lying-in clinics during the time of
the survey, a total of 125 respondents were obtained during the actual data gathering
procedure, which consisted of seven doctors, 50 nurses, and 68 midwives.
44
Table 1. The desired number of respondents by municipalities and occupation
DISTRICTS MUNICIPALITIES RHU’S AND LYING-IN CLINICS
DOCTOR MIDWIFE PHN/RN
District 3 Imus 1 RHU1 Lying-In
0 31
41
District 4 Dasmariñas 1 RHU1 Lying-In
0 73
70
District 5 GMA 1 RHU1 Lying-In
0 31
31
Carmona 1 RHU 1 4 3Rosario 1 RHU
1 Lying-In1 3
334
District 6 General Trias 1 RHU1 Lying-In
1 52
50
Trece 1 RHU1 Lying-In
1 13
50
Tanza 1 RHU1 Lying-In
0 62
00
District 7 Tagaytay 1 RHU1 Lying-In
1 51
41
Mendez 1 RHU1 Lying-In
1 52
30
Naic 1 RHU1 Lying-In
1 62
60
TOTAL: 125 7 68 50
Research Instrument
Primary data was obtained using a research instrument with five parts formulated
by the researchers. The first part is the demographic profile of the respondents; second
part is the level of awareness regarding the Unang Yakap Campaign and what are their
sources of information; third part is the perceived advantages and disadvantages of the
respondents to the said campaign; fourth part is divided into two sections- section A is
the level of knowledge of every health professionals and section B is the steps in ENC
45
protocol; the last part is the extent of implementation of every procedures in the recently
implemented campaign.
The questionnaire for demographic characteristics basically determined the
respondents’ personal data including name, age, civil status, gender, their profession,
work stations and the length of their years of service.
The questionnaire used to evaluate the level of awareness is composed of five
statements regarding the general information about the Unang Yakap campaign. A 2-
point scale was used to measure the level of awareness of the respondents with the scale
of 2- fully aware, 1- slightly aware and 0- not aware. The following range was used to
determine the results of the gathered data:
NUMERICAL RATING ADJECTIVAL RATING
0.00 – 0.66 Low
0.67 – 1.32 Average
1.33 – 2.00 High
The part for level of knowledge is in multiple choice form comprised of 24 items
ranging from A to D and A to E. The remaining 6 items is composed of putting up the
given procedures in chronological order. Scores on this 30-item test was scaled into
following grade equivalent:
46
GRADE EQUIVALENT NUMERICAL RANGE PERCENTAGE
Excellent 28-30 91-100%
Very Good 25-27 81-90%
Average 21-24 70-80%
Fair 15-20 50-69%
Poor 15-below 50% below
The last part is a Likert type with a 5-point scale to evaluate the extent of
implementation of the procedures in the Essential Newborn Care protocol. Protocols are
divided into time bound interventions, non-time bound interventions and the unnecessary
procedures, and overall, this part is composed of fifteen (15) questions.
NUMERICAL RATING ADJECTIVAL RATING
1.00 – 1.79 Never
1.80 – 2.59 Seldom
2.60 – 3.39 Sometimes
3.40 – 4.19 Often
4.20 – 5.00 Always
Validation of Research Instrument
The survey questionnaire was based from non-standardized form of questionnaire
which was expertly validated by three (3) professionals: a midwife, a doctor and a
prominent research coordinator.
47
Samples were pre-tested among 15 selected nurses and midwives employed in the
rural health unit (RHU) and lying-in clinic in Indang, Cavite. They were not included to
actual respondents of the study. Cron- Bach’s alpha test was used to estimate the extent to
which different subparts of an instrument, which is the survey questionnaire, were
reliably measured.
Revisions were done after pointing out some confusing parts. Conflicts were also
identified thereafter. Statements were then reconstructed, paraphrased, and simplified.
Data Gathering Procedures
Letter of Request was given to the Municipal/City Health Officer and midwife of
each institution to ask for permission and approval to conduct the study. The letter of
request contained the purpose, scope, and nature as well as the time allotted in conducting
the study. After the approval of the letter, the researchers located the health care
professionals who participated in the study. They were asked for their permission and full
cooperation in answering the survey questionnaire.
Statistical Treatment of Data
The following statistical tools were used to modify the method of analysis which
corresponded to the objective of the study.
The first step was the setting of the frequency distribution; the arrangement of the
data had shown the frequency occurrence of different values of the variable (demographic
profile of the respondents).
48
1. Frequency Distribution and Relative Frequency
Used for analyzing demographic profile of respondents.
P= (f/n) x 100
Where:
P= Percentage (%) out of 100%
f= number of person who responded to an item
n= total number of respondents
2. Mean
This was used to determine the level of awareness of the respondents regarding the
Unang Yakap Campaign of Department of Health. The mean is equal to the sum of all
scores divided by the total number of scores.
Formula of Mean is:
Where:
X= mean
Σ= the sum of
Xi= each individual raw score
N= number of respondent
49
3. T-test (one-tailed test)
A two-tailed t-test divides α in half, placing half in the each tail. The null hypothesis
in this case is a particular value, and there are two alternative hypotheses, one positive
and one negative.
Where:
t - Experimental effect
X- Sample mean
µ- mean
S- Standard deviation
N- Random sample
4. Spearman’s Rank- Order Correlation (Spearman’s rho)
It is a correlation coefficient indicating the magnitude of a relationship between variables
measured on the ordinal scale (Polit, 2008).
The Spearman’s Rank Correlation Coefficient is a nonparametric measure of
correlation of 2 variables, X and Y, which assesses how well an arbitrary monotonic
function could describe the relationship between two variables, without making
assumptions about the frequency distribution of the variable. The formula is:
ρ=1− 6 Σ D 2
N (N2−1)Where:
N = no. of observation
ΣD2 = square of the difference of x and y
50
The Spearman’s Rank Correlation Coefficient was used in the study to describe
the relationship between the level of awareness and knowledge of the healthcare
professionals and the extent to which they implement the protocols of the recently
implemented Unang Yakap Campaign.
5. Kruskal Wallis Statistics
Kruskal Wallis Statistics according to Polit(2008) is a nonparametric test Analysis of
Variance used in assigning ranks to various groups.
K= (N-1)∑i=1
g
ni¿¿
Where:
ni= number of observations in group i
rij= rank of observation j from group i
N= total number of observation across all groups
51
6. Mann-Whitney Test
Mann-Whitney Test is a nonparametric test (distribution-free) used to compare two
independent groups of sampled data.
Where:
n1 is the sample size for sample 1
R1 is the sum of the ranks in sample 1
7. Point Biserial Correlation Coefficient
The study also used point Biserial correlation coefficient, a correlation coefficient
used when one variable is dichotomous.
The following is the formula used in computing for Point Biserial Correlation:
r pb=
M 1−M 0
Sn√n1 n2
n2
Where:
M1= is the mean value of the continuous variable
X= for all data points in group 1
M0= is the mean value of the continuous variable
n1= is the number of data points in group 1
n0= is the number of data points in group 2
n= total sample size
52
RESULTS AND DISCUSSION
This chapter presents the results and discussion gathered by the researchers
regarding the level of awareness on the Unang Yakap Campaign among health
professionals employed in selected rural health units and lying-in clinics in the province
of Cavite
The study from the data gathered through the questionnaire that were distributed
to the respondents was carefully checked and the results were classified, tabulated,
discussed, and analyzed.
Demographic Characteristics of the Respondents
Figure 4. Frequency and percentage distribution of the respondents by gender
Gender. Figure 4 shows that out of the total 125 respondents, 95 (76%) are
females while the remaining 30 (24%) are males. The result showed that the majority of
the respondents are females.
53
30 (24%)
95 (76%)
MaleFemale
People that are involved when it comes to providing health care are mostly
female. Almost all midwives are female. Even for nurses assigned in the public health
setting, women are in the frontline in terms of initiating activities and programs proposed
by both Department of Health and local government. According to the article by Daisy
Jane RN, entitled “Is Nursing for Women Only?” nursing isn’t limited for women only,
nor should it believe to be so. Although female nurses do have more gentle touches, this
saying that men are stronger and could have less than gentle touch but not concluding so,
male nurses have more stamina and more strength, specially observable in times when
patients need to be lifted and in working more waking hours.
Figure 5. Frequency and percentage distribution of the respondents by age
Age. Figure 5 shows the age of respondents ranging from 29 years old and below
up to 50 years old and above. Out of 125 respondents, 55 (44%) are 29 years old and
below, 26 (21%) are between 30-39 years old, 24 (19%) are between 40-49 years old and
20 (16%) are 50 years old and above. The result reveals that majority of the respondents
are 29 years old and below.
54
55 (44%)
26 (21%)
24 (19%)
20 (16%)
29 and below30 to 3940 to 4950 and above
When choosing the right path to career planning, the division of age group
presented above is suitable. Almost half of the respondents are 29 years old and below
showing that younger people tends to be responsible to find the job specifically in the
health field and to serve to the public. The other remaining age group had their fair share
of respondents. Despite their age, respondents ages 50 and up are still working and
serving the public.
Figure 6. Frequency and percentage distribution of the respondents by civil status
Civil status. Figure 6 shows the civil status of the respondents wherein 65 (52%)
are married, 58 (46%) are single and two (2%) are widow. The result shows that most of
the respondents are married.
Coleman (2007) mentioned that OECD (Organization for Economic Cooperation
and Development) glossary of statistical terms defines marital status as the civil status of
each individual in relation to the marriage law or customs of the country. There are
various marital status options such as: married, single separated, divorced, living with
55
58 (46%)
65 (52%)
2 (2%)
SingleMarriedWidow
partner and widowed.
According to Philippine National Census and Statistics Office (2006),
Filipino men generally married at an older age than women as reflected by the
median age for grooms, which was 27 while for the brides, at age 22. For Filipino grooms
and Filipina brides, the modal age at marriage was 25-29 and 20-24 years, respectively.
Figure 7.
Frequency and percentage distribution of the respondents by work stations
Work stations. Figure 7 shows the distribution of the respondents by the work
stations wherein 98 (78%) are working at the rural health unit while 27 (22%) are
working at lying-in clinics. The result revealed that most of the respondents are working
at rural health units.
The Philippine health care delivery system is composed of two sectors: (1) the
public sector (e.g. rural health units) which is largely financed through a tax-based
budgeting system at both national and local levels, and (2) private sector (e.g. lying-in
clinics) which is largely market-oriented and where health care is paid through user fees
56
98 (78%)
27 (22%)
RHULying-in
at the point of service (Public Health Nursing in the Philippines, 2007). All cities and
municipalities shall establish and maintain at least one (1) Local Health Unit (LHU) or
rural health unit (RHU) which shall be under the supervision of the city or municipal
health officer. For cities or municipalities with populations of more than twenty thousand
(20,000), there shall be one LHU for each succeeding 20,000 population (Angara, 2010).
This shows that the rural health unit can have more than one midwife and nurse
depending on the population of the municipality while the private sectors can employ the
number of employees they desire as long as they will be able to compensate them. Based
on the researchers’ data gathering, most of the lying-in clinics have one midwife and one
nurse.
The city health office supervises the health centers, the lying-in clinics, and
diagnostic facilities. The municipal health office manages the rural health units and the
barangay health stations (Gregorio, 2003). The DOLE shall ensure that the health
personnel requirements for private establishment under the Labor Code are complied
with (Angara, 2010).
57
Figure 8. Frequency and percentage distribution of the respondents by profession
Profession. Figure 8 shows the distribution of the different health professionals
that served as respondents for this study. Out of 125 respondents, 68 (54%) are midwives,
50 (40%) are nurses and the remaining seven (6%) are doctors. The result revealed that
more than half of the respondents work as midwives.
The rural health unit team generally consists of the physician, dentist, public
health nurse, midwife, sanitarian, and other health workers (Public Health Nursing in the
Philippines, 2007).
The Local Health Unit (LHU) or rural health unit (RHI) shall have at least the
following health personnel: (a) a duly licensed physician as head of unit; (b) a registered
nurse for every 5,000 population but no less than two (2) in each LHU, one of whom
shall be a roving nurse; (c) a midwife and (d) a medical technologist. The city or
municipality shall add health personnel to the LHU's plantilla to avoid understaffing or
overloading based on the patient-health worker ratios determined by the DOH, and as
58
50 (40%)
68(54%)
7 (6%)
NurseMidwifeDoctor
said city or municipality may deem necessary to ensure the delivery of complete health
services (Angara, 2010).
From 1990 to 1995, the World Health Organization (WHO) estimated that there
were 82,494 doctors, 259,629 nurses, and 102,878 midwives. Majority of these, however,
worked in the private sector and engaged in private practice. In 1997, the LGUs
employed 3,123 doctors, 1,782 dentists, 4,882 nurses, and 15,647 midwives (Gregorio,
2003). These show that even in the past, the midwives have the highest distribution
among health professionals in the public sector of the Philippines’ health care delivery
system.
The DOLE shall ensure that the health personnel requirements for private
establishment under the Labor Code are complied with (Angara, 2010).
59
Figure 9. Frequency and percentage distribution of the respondents by years of service
Years of service. Figure 9 shows the length of time the respondents are serving as
health professionals in their designated areas of work. 59 (47%) of the respondents have
been working for five years and below, 27 (22%) have been working for 11-20 years, 22
(18%) have been working for 6 to 10 years and 17 (13%) have been working for more
than 21 years.
The continuing and massive exodus of Philippine nurses and doctors to other
countries all over the world is now taking a heavy toll on the country’s already
inadequate health-care system. The lure of better pay abroad and better lives for their
families back home has become so strong that even licensed medical doctors are studying
to become nurses (Conde, 2004).
Castro said his group has studied the phenomenon and found out that the most
vulnerable areas in this crisis are the rural areas, where most of the country’s poor live
and where health care is, in many instances, nonexistent. Statistics show that every year,
60
59 (47%)
22 (18%)
27 (22%)
17 (13%)5 and below
6 to 10
11 to 20
21 and above
between 5,000 and 8,000 nurses leave for abroad, around 2,000 of them former doctors
(Conde, 2004).
But Padilla said there is actually no shortage of nurses and doctors in the
Philippines. “What we have is a shortage of skilled nurses and doctors, and those who are
committed enough to go to the rural areas,” she said (Conde, 2004).
Sources of Information
Seminars SHI Pamphlets Internet NHAI TV0
10
20
30
40
50
60
7061
51
33
14
73
36
30
20
8
42
FrequencyPercent
Figure 10. Frequency and percentage distribution on the sources of information of the respondents regarding the Unang Yakap Campaign
Figure 10 shows the sources of information where the respondents heard and got
their awareness and knowledge regarding the recently implemented Unang Yakap
Campaign by the department of Health (DOH). Of 125 respondents, 61 or 36% heard
about the campaign from seminars, 51 respondents (30%) is through second hand
61
information; 33 (20%) is from pamphlets; 14 respondents (8%) is from the internet; seven
or four percent(4%) have not heard about the campaign; while only three (3) or two
percent (2%) obtain awareness and cognizance from the television (TV).
It is alarming to know that there are still 7 out of 125 respondents who don’t have
any idea about the Unang Yakap Campaign. This is evidence which proves that
Department of Health together with local government units is not seriously paying
attention in disseminating information on the said campaign.
The results show that most of the health professionals obtain information from
seminars conducted by the Department of Health.
According to DOH, together with the National Center for Disease Prevention and
Control (NCDPC), the Health Human Resource Development Bureau (HHRDB) must
develop and finalize training programs relative to the propagation of Maternal and
Newborn Care policies (included EmONC). In collaboration with the HHRDB, NCDPC
should provide support for capacity development to ensure that Maternal and Newborn
Care (including EmONC) trainers and implementers are updated on Maternal Newborn
Care. They must also coordinate the training program/modules with the HHRB and the
management of the different service components of heath care facilities. While Center for
Health Development should also develop the capacity of the provincial/municipal health
workers to implement the protocol, it could be through trainings, orientations, reading
materials, promotional videos, etc and provide technical assistance to the LGUs(DOH,
2009).
62
It is also the responsibility of the local government units (LGUs) to conduct
orientation/seminars/trainings for private and public health workers on the
implementation of the Maternal and Newborn Care policies including this protocol and to
coordinate and collaborate with the DOH and LGUs in the conduct of Maternal and
Newborn care activities. It is also the responsibility of the LGUs, facilities, and DOH
retained hospitals to conduct orientation on the protocol for its personnel and lower level
facilities (DOH, 2009).
Level of Awareness of the Respondents on the Unang Yakap Campaign
Table 2 shows the level of awareness of the respondents on the Unang Yakap
Campaign program of Department of Health. Items 1-5 refer to the general information of
this program.
In measuring the level of awareness of the respondents about the general
information about the Unang Yakap campaign, the results revealed that the respondents
are fully aware of the following information about the Unang Yakap Campaign: the
Department of Health (DOH) issued an administrative order AO 2009-0025 to implement
the Essential Newborn Care (ENC) Protocol (m=1.75); DOH is in collaboration with
WHO in implementing ENC protocol “Unang Yakap” Campaign (m=1.70); Millennium
Development Goal (MDG) 4 aims for a reduction in under –five mortality by two-thirds
by 2015 (m=1.68); the Philippines is one of the 42 nations that account for 90 percent of
global under-five mortality (m=1.59); and Unang Yakap was implemented on December
7, 2009 (m=1.50). Therefore, the health professionals employed in selected rural health
63
units and lying-in clinics in Cavite have high level of awareness regarding the Unang
Yakap Campaign and Essential Newborn Care (ENC) even if the campaign was recently
implemented by the DOH.
Table 2. Level of awareness of the respondents on the Unang Yakap Campaign
ITEM NUMBER
MEAN* SD VI
1 The Department of Health (DOH) issued an administrative order AO 2009-0025 to implement the Essential Newborn Care (ENC) Protocol
1.75 0.534 High
2 DOH is in collaboration with WHO in implementing ENC protocol “Unang Yakap” Campaign
1.70 0.568 High
3 Unang Yakap was implemented on December 7, 2009
1.50 0.667 High
4 Millennium Development Goal (MDG) 4 aims for a reduction in under –five mortality by two-thirds by 2015
1.68 0.617 High
5 The Philippines is one of 42 nations that account for 90 percent of global under-five mortality
1.59 0.661 High
OVER ALL SCORE 1.65 0.536 High
Scale Rating Interpretation*Legend 0.00 – 0.66 Not Aware (NA) Low 0.67 – 1.32 Slightly Aware (SA) Average 1.33 – 2.00 Fully Aware (FA) High
Level of the Respondents’ Knowledge to Unang Yakap Campaign
64
Mean = 15.38 ± 4.206Verbal Interpretation = Fair
Figure 11. Frequency and percentage distribution on the level of knowledge of respondents to Unang Yakap Campaign
Figure 11 reveals the level of knowledge of the respondents to the recently
implemented Unang Yakap Campaign by the DOH. Of 125 respondents, 59 of the
respondents or 47% have fair level of knowledge (score is between 15-20), 53
respondents (42%) have poor level of knowledge to the Unang Yakap Campaign (score is
below 15), ten percent (10%) or 12 of the respondents are average (score is between 21-
24), one percent (1%) or only one is excellent and no respondent has very good level of
knowledge to the campaign since no one scored between 25-27.
The mean of the respondents’ scores is 15.38±4.206 Therefore, the results show
that almost half or 47% of health professionals only has fair level of knowledge in the
Essential Newborn Care Protocol Unang Yakap Campaign of the Department of Health.
65
0
10
20
30
40
50
60 5359
12
0 1
4247
10
0 1
FrequencyPercent
Poor Fair Average Very good Excellent
Below 15 15 – 20 21 – 24 25 – 27 28 – 30
Fair is defined as no more than acceptable or average,it is acceptable and
understandable but not ideal enough. In the results shown, it seems like out of 30 item
questions, most of their scores ranged from only 15- 20 correct answers. In the sources of
information which are discussed before this item, the sources of information such as
seminars, pamphlet, internet and television didn’t help much enough to add to their
knowledge to answer all of the questions correctly. On the other hand, it is disturbing to
know that 42 percent with a verbal interpretation of poor had a score of below 15 in the
objective type of questions regarding the protocol.
Relationship Between the Source of Information and Level of Awareness of the Unang Yakap Campaign
Table 3 shows the relationship between the sources of information of respondents
to their level of awareness to Unang Yakap Campaign. T-test was used to determine the
difference between various sources of information for Department of Health’s Essential
Newborn Care Protocol. These sources were seminar, pamphlet, internet, television and
second hand information. Respondents were also assessed if they don’t have any idea
regarding the campaign by including an option “not heard about it” in the questionnaire
and asked where else they got their information which is not included in the options.
Table 3 revealed that for those who obtained their information from seminars
(m=1.81+0.296), have higher level of awareness than those who did not attend seminars
(m=1.49+0.655). It had a point biserial of 0.304 and a t-computed value of 3.535 which
exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore, there is a
significant relationship between attending seminars as a source of information and the
level of awareness on the Unang Yakap Campaign among health professionals.
66
Those who got their information from pamphlets (m=1.94+0.221) have higher
level of awareness than those who did not read pamphlets (m=1.54+0.576). It had a point
biserial of 0.327 and a t-computed value of 3.843 which exceeded the critical value of
1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between
reading pamphlets as a source of information and the level of awareness on the Unang
Yakap Campaign among health professionals.
Those who got their information from the internet (m=1.64+0.361) have lower
level of awareness than those who did not (m=1.65+0.555). It had a point biserial of -
0.002 and a t-computed value of -0.026 which did not exceed the critical value of 1.96,
accepting the null hypothesis. Therefore, there is no significant relationship between
reading from the internet as a source of information and the level of awareness on the
Unang Yakap Campaign among health professionals since their mean is not statistically
significant.
Those who got their information from watching the television (m=2.00+0.000)
have higher level of awareness than those who did not (m=1.64+0.540). It had a point
biserial of 0.103 and a t-computed value of 1.154which exceeded the critical value of
1.96 but their mean is not statistically significant, making the null hypothesis be accepted.
Therefore, there is no significant relationship in watching television as a source of
information to the level of awareness on the Unang Yakap Campaign among health
professionals.
Those who heard about the campaign from others (m=1.52+0.519) have lower
level of awareness than those who did not hear it from others (m=1.73+0.534) and had a
67
different source of information. It had a point biserial of -0.193 and a t-computed value of
-2.186 which exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore,
there is a significant relationship between hearing the information about the Unang
Yakap Campaign from other sources and the level of awareness on the Unang Yakap
Campaign among health professionals. The result revealed that hearing from other
sources about the campaign is not a good source of information.
And lastly, the respondents who claimed that they neither hear anything about the
Unang Yakap Campaign nor Essential Newborn Care Protocol (m=0.60+0.959) have
lower level of awareness than those who heard about it (m=1.71+0.433). It had a point
biserial of -0.476 and a t-computed value of -5.996, which exceeded the critical value of
1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between
not hearing anything about the Unang Yakap Campaign and level of awareness on the
said campaign among health professionals. This means that those who heard about the
Unang Yakap Campaign have higher level of awareness than those who did not.
In summary, the results revealed that attending seminars and reading pamphlets as
sources of information increase the level of awareness of the health professionals on the
Unang Yakap Campaign. While those health professionals who did not hear anything
about the campaign and those who heard it from other sources have lower level of
awareness on the Unang Yakap Campaign. Meanwhile, those who got their information
about the Unang Yakap Campaign from the internet and television have no relation to the
level of awareness of the health professionals since their mean is not statistically
significant.
68
It is the responsibility of the local government units (LGUs) to conduct
orientation/ seminars/trainings for private and public health workers on the
implementation of the Maternal and Newborn Care policies including this protocol and to
coordinate and collaborate with the DOH and LGUs in the conduct of Maternal and
Newborn care activities. It is also the responsibility of the LGUs, facilities, groups, DOH
retained hospitals to conduct orientation on the protocol for its personnel and lower level
facilities (DOH, 2009).
Table 3. Relationship between the source of information and their level of awareness of the Unang Yakap Campaign
SOURCE OF INFORMATION
RESPONSE MEAN STANDARD DEVIATION
POINT BISERIAL CORRELATION COEFFICIENT
T-COMPUTED
REMARKS
Seminars Yes 1.81 0.296 0.304 3.535 Reject HoNo 1.49 0.655
Pamphlets Yes 1.94 0.221 0.327 3.843 Reject Ho
No 1.54 0.576
Internet Yes 1.64 0.361 -0.002 -0.026 Accept Ho
No 1.65 0.555
TV Yes 2.00 0.000 0.103 1.154 Accept Ho
No 1.64 0.540
SHI Yes 1.52 0.519 -0.193 -2.186 Reject Ho
No 1.73 0.534
NHAI Yes 0.60 0.959 -0.476 -5.996 Reject Ho
No 1.71 0.433
Critical value of t-test = 1.96
69
Relationship between the Source of Information and Level of Knowledge of the Unang Yakap Campaign
Table 4 is about the respondents’ level of knowledge about the Unang Yakap
Campaign. This part of the questionnaire is in multiple choice forms which tested the
respondents’ way of analyzing whether the situations will be appropriate to the
procedures and information given. T-test was also used to determine the differences in
the level of knowledge of respondents from the various sources of information.
The result showed that those who attended seminar to gain knowledge about
Unang Yakap Campaign (m=16.05+3.801) have higher level of knowledge than those
who did not attend seminars (m=14.73+4.494). Though the mean of those who attended
the seminars is higher than those who did not, it is not statistically high enough to prove
any relationship between variables. It had a point biserial of 0.156 and a t-computed
value of 1.755, which did not exceed the critical value of 1.96, accepting the null
hypothesis. Therefore, there is no significant relationship between attending seminars as a
source of information and the level of knowledge on the Unang Yakap Campaign among
health professionals.
Those who got their information from pamphlets (m=17.18+3.423) have higher
level of knowledge than those who did not read the pamphlets (m=14.73+4.287). It had a
point biserial of 0.257 and a t-computed value of 2.951 which exceeded the critical value
of 1.96, rejecting the null hypothesis. Therefore, there is a significant relationship of
reading pamphlets as a source of information to the level of knowledge of the Unang
Yakap Campaign among health professionals.
70
Those who got their information from the internet (m=15.21+5.605) have lower
level of knowledge than those who did not (m=15.40+4.208). It had a point biserial of -
0.014 and a t-computed value of -0.151 which did not exceed the critical value of 1.96,
accepting the null hypothesis. Therefore, there is no significant relationship between
reading from the internet as a source of information and the level of knowledge on the
Unang Yakap Campaign among health professionals since their mean is not statistically
significant.
Those who got their information from watching the television (m=14.00+2.646)
have lower level of knowledge than those who did not (m=15.41+4.238). It had a point
biserial of -0.051 and a t-computed value of -0.570 which was lower than the critical
value of 1.96, accepting the null hypothesis. Therefore, there is no significant relationship
in watching television as a source of information to the level of knowledge of the Unang
Yakap Campaign among health professionals.
Those who heard about the campaign from other sources (m=15.21+4.003) have
lower level of awareness than those who did not hear it from others (m=15.55+4.238) and
had a different source of information. It had a point biserial of -0.051 and a t-computed
value of -0.566 which did not exceed the critical value of 1.96, accepting the null
hypothesis. Therefore, there is no significant relationship between hearing the
information about the Unang Yakap Campaign to others and the level of knowledge of
the Unang Yakap Campaign among health professionals.
And lastly, the respondents who claimed that they neither hear anything about the
Unang Yakap Campaign nor Essential Newborn Care Protocol (m=9.71+3.592) have
71
lower level of awareness than those who heard about it (m=15.71+4.007). It had a point
biserial of -0.328 and a t-computed value of -3.849, which exceeded the critical value of
1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between
not hearing anything about the Unang Yakap Campaign and level of knowledge on the
said campaign among health professionals. This means that those who heard about the
Unang Yakap Campaign have higher level of knowledge than those who did not.
In summary, the results revealed that reading pamphlets as sources of information
increases the level of knowledge of the health professionals on the Unang Yakap
Campaign. While those health professionals who did not hear anything about the
campaign have lower level of knowledge on the Unang Yakap Campaign. Attending
seminars, surfing the internet, watching television and hearing the campaign from others
have no relation to the level of knowledge of the health professionals regarding the
Unang Yakap Campaign.
According to DOH, together with the NCDPC, Health Human Resource
Development Bureau must develop and finalize training programs relative to the
propagation of Maternal and Newborn Care policies (included EmONC). In collaboration
with the HHRDB, National Center for Disease Prevention and Control should provide
support for capacity development to ensure that Maternal and Newborn Care (including
EmONC) trainers and implementers are updated on Maternal Newborn Care. They must
also coordinate the training program/modules with the HHRB n the management of the
different service components of heath care facilities. While Center for Health
Development should also develop the capacity of the provincial/municipal health workers
72
to implement the protocol, could be through trainings, orientations, reading materials,
promotional videos, etc and provide technical assistance to the LGUs (DOH, 2009).
Table 4. Relationship between the source of information and their level of knowledge of the Unang Yakap Campaign
SOURCE OF INFORMATION
RESPONSE MEAN STANDARD DEVIATION
POINT BISERIAL CORRELATION COEFFICIENT
T-COMPUTED REMARKS
Seminars Yes 16.05 3.801 0.156 1.755 Accept HoNo 14.73 4.494
Pamphlets Yes 17.18 3.423 0.257 2.951 Reject Ho
No 14.73 4.287
Internet Yes 15.21 5.605 -0.014 -0.151 Accept Ho
No 15.40 4.028
TV Yes 14.00 2.646 -0.051 -0.570 Accept Ho
No 15.41 4.238
SHI Yes 15.12 4.003 -0.051 -0.566 Accept Ho
No 15.55 4.358
NHAI Yes 9.71 3.592 -0.328 -3.849 Reject Ho
No 15.71 4.007
Critical value of t-test = 1.96
Extent of Implementation of the Unang Yakap Campaign
Table 5 shows the extent of implementation of the respondents of the procedures
included in the Unang Yakap Campaign. Item numbers one to five refer to the time
bound interventions, item numbers six and seven refer to non-time bound interventions,
while item number eight pertains to unnecessary procedures included in Essential
Newborn Care.
73
The result showed that health professionals from selected rural health units and
lying-in clinics in the province of Cavite have very high extent of implementation in most
of the Unang Yakap Campaign specifically in the following procedures: Immediate and
thorough drying of the newborn for 30 seconds to one minute (m= 4.74+.720); There
should be early skin-to-skin contact between the mother and newborn (m= 4.89+.542);
washing the newborn must be delayed for at least 6 hours (m= 4.81+.549); waiting for the
cord pulsations to stop (clamping of the cord after 1-3 min.) (m=4.82+.540); early
breastfeeding which provides colostrums (babies first immunization)(m=4.86+.573);
completing non-time bound interventions within 6 hours(m= 4.72+736); doing non-time
bound interventions after the first full breastfeed; provision of vaccinations and physical
examination (m=4.74+.795); eye care (m=4.84+.574 ) ;Vitamin K administration
(m=4.81+.618); weighing (m= 4.77+.686); and newborn Screening Test (m=4.39+1.099).
However, for the unnecessary procedures which include routine suctioning
(m=3.51+1.620), it revealed that it is the only procedure often or highly implemented.
Both routine separation of newborns for observations (m= 2.94+1.515) and newborn foot
printing (m=2.61+1.809) are the procedures that are sometimes implemented. Lastly, the
giving of prelacteals like glucose, water formula (m=2.30+1.681) is seldom implemented
as compared to other procedures.
In measuring the extent of implementation of the respondents regarding the
Unang Yakap Campaign, item numbers 1 to 7 that have a mean score ranging from 7.39
to 7.89 (having item number 2 with the highest mean score of 7.89) suggest that most of
the respondents always follow the procedures included in the time bound and non-time
bound interventions. Therefore, the extent of their implementation to item numbers 1 to 7
74
is very high. Item number 8a, has a mean score of 3.51 which shows that most of the
respondents often perform suctioning of the newborn and this procedure is highly
implemented. Item numbers 8b and 8c, have a mean score of 2.94 and 2.61, respectively
reveals that most of the respondents sometimes perform routine separation of newborns
for observations and newborn printing and that these procedures are only sometimes
implemented. Item number 8c has a mean score of 2.30, which means that most of the
respondents seldom give prelacteals like glucose and water formula to newborns and that
the extent of their implementation to this procedure is low.
The overall mean of 4.25 shows that the extent of implementation regarding the
procedures included in the Unang Yakap Campaign by the majority of health
professionals employed from the selected rural health units (RHUs) and lying in clinics in
the province of Cavite is very high.
This result shows that health professionals have a very high extent of
implementation regarding time bound and non-time bound interventions while
procedures in unnecessary procedures were ranging from low to high extent of
implementation. This may be because the first two interventions should be finished
within the first six hours of life of the newborn while unnecessary interventions are not
actually recommended for all newborns which means that they can be skipped unless
needed.
The Essential Newborn Care categorizes post-natal procedures into time-bound,
non-time bound and unnecessary actions which were undertaken to lessen newborn death.
At the heart of the protocol are time bound interventions, which are actions containing
75
four steps that need to be taken immediately to lessen the statistics on newborn deaths
and should be routinely performed first. First is immediate and thorough drying of the
newborn for 30 seconds to one minute warms, preventing hypothermia to the newborn
and stimulating breathing (DOH, 2009). Washing the newborn must be delayed for at
least six hours. Second is early skin-to-skin contact between the mother and the newborn
prevents hypothermia. It also promotes bonding between the mother and child and
promotes success of breastfeeding. Third is proper cord clamping and cutting. By waiting
for the cord pulsations to stop before clamping (1-3 minutes), newborn’s blood
circulation and iron reserves are increased. This time bound intervention is also found to
decrease anemia in one out of every three premature babies and prevents brain
hemorrhage in one out of two (Healthbeat, 2009). Lastly, early breastfeeding, which is
initiated within the first hour of life, protects the baby from infections because of the
colostrums present in the mother’s breastmilk. Keeping the baby latched on to the mother
will not only benefit the baby (see skin-to-skin contact) but will also prevent doing
unnecessary procedures (Healthbeat, 2009).
Non-time bound intervention should only be done after the first full breastfeed,
usually given within six hours after birth, which are: Vitamin K injection; BCG and
Hepatitis B vaccinations; eye care; newborn examinations for checking birth injuries,
malformation or defects; cord care; newborn resuscitation; and additional care for a small
baby or twin. A single dose of 0.5 to 1.0 mg of vitamin K is administered intramuscularly
to prevent bleeding disorders or an oral vitamin K is offered if the parents refuse the
injection (Pillitteri, 2007). Inject hepatitis B vaccine IM and BCG intradermally (DOH,
2009). Silver nitrate was exclusively used for eye prophylaxis in the past; today,
76
erythromycin ointment is the drug of choice. Erythromycin ointment has the advantage of
eliminating not only the organism of gonorrhea but that of Chlamydia as well (Pillitteri,
2007). Weighing of the newborn is done while examining the newborn and checking for
birth injuries, malformations or defects (DOH, 2009).
Unnecessary procedures were interventions that have been routinely given in
Philippine hospitals but, are not recommended for all newborns. These include: routine
suctioning which has no benefit if the amniotic fluid is clear and especially with newborn
who cry or breathe immediately after birth and it has been associated with cardiac
arrhythmia; routine separation of newborns for observations/ early bathing causes a drop
in the body's temperature leading to increased risk of developing infections, coagulation
defects and brain hemorrhage; giving sugar water formula or other prelacteals and the use
of bottles or pacifiers may develop newborn’s preference for the bottle leading to nipple
confusion and inefficient suckling which can further lead to failure in breastfeeding;
footprinting has proven to be an inadequate technique for newborn identification
purposes (DOH, 2009).
77
Table 5. Extent of implementation of the respondents Unang Yakap Campaign
ITEM NUMBER
ENC PROCEDURES MEAN SD VI
1 Immediate and thorough drying of the newborn for 30 seconds to one minute.
4.74 0.720 VH
2 There should be early skin-to-skin contact between the mother and newborn
4.89 0.542 VH
3 Washing the newborn must be delayed for at least 6 hours
4.81 0.549 VH
4 Wait for the cord pulsations to stop (clamping of the cord after 1-3 min.).
4.82 0.540 VH
5 Early breastfeeding which provides colostrums (babies first immunization).
4.86 0.573 VH
6 Non-time bound interventions should be completed within 6 hours
4.72 0.736 VH
7a Non-time bound interventions should be done after the first full breastfeed:Provision of vaccinations and physical examination;
4.74 0.795 VH
7b Eye care 4.84 0.574 VH7c Vitamin K administration; 4.81 0.618 VH7d Weighing 4.77 0.686 VH7e Newborn Screening Test 4.39 1.099 VH
8a Unnecessary procedures include: Routine suctioning 3.51 1.620 H8b Routine separation of newborns for observations 2.94 1.515 A8c Giving of prelacteals like glucose, water formula 2.30 1.681 L8d Newborn footprinting 2.61 1.809 A
OVER ALL SCORE 4.25 0.511 Very High
Legend Range Verbal Interpretation 1.00 – 1.79 Never Very Low (VL)
1.80 – 2.59 Seldom Low (L) 2.60 – 3.39 Sometimes Average (A) 3.40 – 4.19 Often High (H)
4.20 – 5.00 Always Very High (VH)
78
Relationship of Respondent’s Level of Awareness and Level of Knowledge to their Extent of Implementation of the Unang Yakap Campaign
Spearman rank correlation coefficient was used to determine the relationship of
the respondents’ level of awareness and knowledge of the Unang Yakap Campaign to the
extent they are implementing its protocols.
As evident in table 6, the correlation coefficient based on the respondents’ level of
awareness is 0.112 with a P-value of 0.214 which exceeded the significant level of 0.05.
There is a need to accept the null hypothesis. Therefore, the level of awareness of the
respondents of the Unang Yakap Campaign does not affect the extent to which health
professionals implement its protocols.
Table 6. Relationship of respondent’s level of awareness and level of knowledge to their extent of implementation of the Unang Yakap Campaign
AWARENESS SPEARMAN RANK CORRELATION COEFFICIENT
P-VALUE
REMARKS
Level of Awareness 0.112 0.214 Accept Ho
Level of Knowledge
-0.027 0.765 Accept Ho
Significant Level ≤ 0.05
79
The level of awareness, level of knowledge, and extent of implementation among professionals
Awareness. Table 7 shows the respondents' level of awareness on the Unang Yakap
Campaign by specific professions, namely: nurses, midwives and doctors employed in
selected rural health units and lying-in clinics in Cavite. The data on nurses (m=1.43),
midwives (m=1.79) and doctors (m=1.80) obtained a Kruskal Wallis Statistics of 10.988
with a total p-computed value of 0.004 which did not exceed the significant value of 0.05,
hence, the null hypothesis was rejected. This means that there is a significant relationship
between the professionals and their level of awareness on the said campaign.
Knowledge. Table 7 shows the relationship between the respondents' different
professions to their level of knowledge of the Unang Yakap Campaign. The data on
nurses (m=13.86), midwives (m=16.15) and doctors (m=18.71) obtained a Kruskal
Wallis Statistics of 12.919 with a total p-computed value of 0.002 which did not exceed
the significant value of 0.05, hence, the null hypothesis was rejected. Thus, there is a
significant difference on the level of knowledge among the three types of professionals.
Extent of Implementation. Table 7 shows the relationship between the professionals to
the extent to which they implement the protocols included in the Unang Yakap
Campaign. The data on nurses (m=4.21), midwives (m=4.30) and doctors (m=4.05)
obtained a Kruskal Wallis Statistics of 2.102 and a total p-computed value of 0.350 which
exceeded the significant value of 0.05, hence, the null hypothesis was accepted. Thus
there is no significant difference on the extent of implementation of the Unang Yakap
Campaign among the professionals.
80
Therefore, table 7 reveals that by order in level of awareness and knowledge,
doctors are more aware and knowledgeable than midwives who ranked as second and
nurses who are in last place. However in terms of extent of implementation, midwives
ranked as first followed by nurses and lastly, by doctors. Since the doctors are able to
attend seminars and can easily access on the source of information, they are more aware
and knowledgeable than the nurses and midwives. Midwives, on the other hand, are more
firsthand and are in the frontline when it comes to attending to childbirth and newborn
care.
Table 7. The level of awareness, level of knowledge, and extent of implementation among professionals
VARIABLES PROFESSIONS MEAN MEAN RANK
KRUSKALL-WALLIS
STATISTICS
P-VALUE
REMARKS
Awareness Nurse 1.43 51.09 b 10.988 0.004 SignificantMidwife 1.79 70.72 aDoctor 1.80 73.07 a
Knowledge Nurse 13.86 49.23 b 12.919 0.002 SignificantMidwife 16.15 70.99 aDoctor 18.71 83.71 a
Extent of Implementation
Nurse 4.21 61.38 2.102 0.350 Not SignificantMidwife 4.30 65.93
Doctor 4.05 46.07*Mean rank followed by a common letters are not significant at 5% level.
81
The Extent of Unang Yakap Campaign Implementation among Work Stations
Table 8 shows the ranking of work stations according to their extent of
implementation of the Unang Yakap Campaign. Kruskal Wallis test was used to rank the
following work stations. With the significant level of 0.05 or 5%, there is a significant
difference among work stations as proven by a p- value of 0.003. From the mean rank,
Carmona got the highest mean with 81.25 followed by Imus at second spot with 78.67,
Mendez ranked third (74.68), Tanza ranked fourth (74.19), Rosario ranked fifth (73.46),
Dasmarinas ranked sixth place (73.00), Trece Martirez City ranked seventh (64.55),
GMA ranked eighth place (63.94), Naic at ninth place (56.70), General Trias ranked
tenth place (37.81) and lastly, which is less likely to implement the Unang Yakap
Campaign is Tagaytay (27.79).
Table 8. The Extent of Unang Yakap Campaign Implementation among Work Stations
VARIABLES WORK STATIONS
MEAN MEAN
RANK
KRUSKAL-WALLIS
STATISTICS
P-VALUE
REMARKS
Extent of Implementatio
n
1- Tagaytay 3.94 27.79 b 26.533 0.003 Significant2- Mendez 4.48 74.68 ab3- Dasmarinas 4.26 73.00 ab4- Imus 4.33 78.67 a5- General Trias 4.03 37.81 ab6- Tanza 4.35 74.19 ab7-Carmona 4.36 81.25 a8-GMA 4.16 63.94 ab9-Trece 4.23 64.55 ab10-Naic 4.23 56.70 ab11-Rosario 4.44 73.46 ab
*Mean rank followed by a common letters are not significant at 5% level.
82
The Extent of Implementation Between the Two Work Places
Table 9 shows the extent of implementation of the Unang Yakap Campaign in
two different work places, RHU and lying-in. The RHUs has a mean score of 4.28 and a
mean rank of 64.90, while the lying-in clinics have a mean score of 4.15 and a mean rank
of 56.09. Mann-Whitney test was used to compare two independent groups, the result is -
1.126 which is not significant.
The extent of implementation regarding the procedures included in the Unang
Yakap Campaign by the majority of health professionals employed from the selected
RHUs is quite higher than the ones employed in lying-In clinics in Cavite. The result is
not significant which indicates there is no significant difference on the level of extent of
implementation between the two work places.
An observational study of consecutive deliveries using a standardized assessment
tool to document minute-by-minute newborn care done in the first hour of life was
undertaken in 51 hospitals in nine regions of the country in 2008. The study found that
Philippine hospital practices prevented newborns from benefitting from their mothers'
natural protection in the first hour of life. Further, the performance and timing of
evidenced-based interventions in immediate newborn care are below WHO essential
newborn care standards. Almost no newborn benefited from the natural transfusion
through non-immediate cord clamping. A Cochrane systematic review of seven
Randomized Controlled Trials (RCTs) showed that among infants less than 37 weeks of
gestation, non-immediate cord clamping is associated with fewer transfusions due to
anemia or low blood pressure and fewer intraventricular hemorrhages. Full-term neonates
83
also benefit by having lower incidence of anemia (DOH, 2009). Policy paper: A Minute-
by-Minute Assessment of Newborn Care within the First Hour of Life in Fifty-One
Large hospitals in the Philippines
Table 9. The extent of implementation between the two Work Places
VARIABLE WORK PLACE
MEAN MEAN RANK
MANN-WHITNEY STATISTICS
P-VALUE REMARKS
Extent of
Implementatio
n
RHU 4.28 64.90 -1.126 0.260 Not
SignificantLying-in 4.15 56.09
84
Difference on the level of extent of implementation between Work Stations
Table 10 shows the result that among the selected work stations in the province of
Cavite, Mendez (m=4.48) has the highest level of extent of implementation on Unang
Yakap Campaign; followed by Rosario (m=4.44); third is Carmona (m=4.36); fourth is
Tanza (m=4.35); fifth is Imus (m=4.33); sixth is Dasmarińas (m=4.26); seventh is Trece
(m=4.23); eighth is Naic (m=4.23); ninth is GMA (m=4.16); tenth is General Trias
(m=4.03); and at eleventh place is Tagaytay (m=3.94). With the considerable level of
0.05 or 5%, there is a significant difference between work stations proven with a p- value
of 0.003. It means that implementation of the said program of the Department of Health
is done though not to the extent of always doing it or completely following the given
protocol.
Therefore, Mendez has the highest level of extent of implementation among the
other work stations in the province of Cavite. On the other hand, Tagaytay has the lowest
level of extent of implementation. Long term control of mortality and morbidity and
improvement in the equality of life require provision and use of continuum of health care
services spanning each of the life cycle stages. Provision and use of these services would
require informed decisions by mothers and their families (demand side), as well as a
health system (supply side) that is responsive to their needs (DOH, 2008).
85
Table 10. Difference on the level of extent of implementation among Work Stations
VARIABLESWORK
STATIONSMEAN
MEAN RANK
KRUSKAL-WALLIS
STATISTICS
P-VALUE
REMARKS
Extent of Implementatio
n
1. Mendez 4.48 74.68 ab
26.533 0.003 Significant
2. Rosario 4.44 73.46 ab3. Carmona 4.36 81.25 a4. Tanza 4.35 74.19 ab5. Imus 4.33 78.67 a6. Dasmarinas 4.26 73.00 ab7. Trece 4.23 64.55 ab8. Naic 4.23 56.70 ab9. GMA 4.16 63.94 ab10.General Trias 4.03 37.81 ab11. Tagaytay 3.94 27.79 b
*Mean rank followed by a common letters are not significant at 5% level.
Advantages of the Unang Yakap Campaign as perceived by Health Professionals
Table 11 shows the advantages of the Unang Yakap Campaign. The advantages
were ranked highest to lowest with its corresponding percentage. The leading advantage
that acquired the most frequency of answers which is 46 (36.8%) as perceived by the
respondents is that the campaign promotes uninterrupted skin-to-skin contact between the
mother and newborn. Second is that it reduces mortality and morbidity rate of Newborn
got 29 (23.2%). Third is that it improves health of newborn that obtained 26 (20.8%).
Bonding between newborn and mother is at fourth place with 23 (18.4%). Reduces the
incidence of anemia is at fifth place with 19 (15.2%). Stimulates breastfeeding with 16
(12.8%) is at sixth place. Early treatment and assessment with 8 (6.4%) is at seventh
place. Increases blood circulation with five (4%) falls at eighth place. Stimulates
breathing with two (1.6%) falls at ninth place. Decreases maternal death falls at tenth
86
place with one (0.8%). And last at eleventh place is that the campaign helps in better
contraction of the mother with one (0.8%).
Therefore, the perception of the respondents is that the campaign causes
uninterrupted skin-to-skin contact between the mother and newborn and the least
common answer from the respondents is that it helps in better contraction of the mother.
The highest in the ranking of the advantages is keeping the mother and the baby
in uninterrupted skin-to-skin contact which prevents hypothermia (Healthbeat, 2009).
Aside from the warmth and immediate bonding between mother and child, it has been
found that early skin-to-skin contact contributes to a host of medical benefits such as the
overall success of breastfeeding/colostrum feeding and stimulation of the mucosa—
associated lymphoid tissue system. It also allows the newborn to be colonized by good
bacteria from the mother’s skin, so-called family flora to protect the infant from sepsis
and other life-threatening infections and hypoglycemia (Healthbeat, 2009).
87
Table 11. Advantages of the Unang Yakap Campaign as perceived by the respondents
PERCEIVED ADVANTAGES FREQUENY PERCENTAGE (%)1. Uninterrupted skin-to-skin contact 46 36.82. Reduces Mortality and morbidity rate
of Newborn29 23.2
3. Improves Health of Newborn 26 20.8
4. Bonding between Newborn and Mother 23 18.4
5. Reduces the incidence of Anemia 19 15.2
6. Stimulates breastfeeding (passive immunity)
16 12.8
7. Early treatment and assessment 8 6.4
8. Increases blood circulation 5 4
9. Stimulates breathing 2 1.6
10. Decreases maternal death 1 0.8
11. Helps in better contraction of the mother
1 0.8
Disadvantages of the Unang Yakap Campaign as perceived by the respondents
Table 12 shows the disadvantages of the Unang Yakap Campaign as perceived by
the respondents. The disadvantages were ranked highest to lowest with its corresponding
frequency and percentage. The first disadvantage that acquired the most frequency of
answers, which is 11 (8.8%), from the respondents is that the campaign is time
consuming; delayed bathing, dressing and clamping of the cord is at second place with
three (2.4%); uncomfortable to the mother is at third place with two (1.6%); confusing to
the health professionals got the lowest rank at fourth place with two (1.6%).
Therefore, the most common disadvantage of the Unang Yakap Campaign as
perceived by the respondents is that the campaign is time consuming on the other hand
the disadvantage that obtained the least frequency of answers is that the campaign is
somewhat confusing for the health professionals since the campaign was just
88
implemented last 2010. According to the campaign bathing or washing should be made at
least after 6 hours of the newborns life which makes the said campaign time consuming
for the health care professionals.
Table 12. Disadvantages of the Unang Yakap Campaign as perceived by the respondents
PERCEIVED DISADVANTAGES FREQUENCY PERCENTAGE (%)
1. Time consuming 11 8.8
2. Delayed bathing, dressing and clamping
3 2.4
3. Uncomfortable to the mother 2 1.6
4. Confusing 2 1.6
89
SUMMARY, CONCLUSION AND RECOMMENDATION
Summary
The study was conducted to determine the level of awareness on the Unang
Yakap Campaign among health professional employed in selected rural health units and
lying-in clinics in the province of Cavite.
Specifically, it aimed to (1) describe the demographic profile of selected health
professionals in terms of gender, age, civil status, years of service, work stations, specific
profession; (2) determine the source of information on Unang Yakap Campaign of the
selected health professionals; (3) assess the level of awareness and knowledge of
selected health professionals of the implemented Unang Yakap Campaign; (4) determine
the extent of implementation of the Unang Yakap Campaign in the different RHUs and
lying-ins in terms of performance of its protocol by the nurses and midwives; (5)
determine if there is a significant relationship between the sources of information and
level of awareness and knowledge of the respondents with regard to the Unang Yakap
Campaign; (6) determine if there is significant relationship between extent of
implementation and level of awareness and knowledge of health professionals employed
in rural health units and lying-in clinics; (7) find out if there is significant difference on
the level of awareness, knowledge, and extent of implementation between Professionals;
(8) find out if there is significant difference on the extent of implementation of health
professionals between work places and stations; (9) determine the perceived advantages
and disadvantages on the Unang Yakap Campaign.
90
The study was conducted among 125 respondents, specifically nurses, midwives
and doctors employed in selected rural health units and lying-in clinics in the province of
Cavite. The information and data needed were gathered through the use of questionnaires
which were answered within 30 minutes to 1 hour. The inquiry was conducted from
September 10 to October 2011. To find out the necessary data, a five-part questionnaire
was utilized. The first part is the demographic profile of the respondents; second part is
the level of awareness regarding the Unang Yakap Campaign and what are their sources
of information; third part is the perceived advantages and disadvantages of the
respondents to the said campaign; fourth part is divided into two sections- section A is
the level of knowledge of every health professionals and section B is the steps in ENC
protocol; the last part is the extent of implementation of every procedures in the recently
implemented campaign.
The statistical measures employed to study the significant relationship between
the level of awareness and knowledge and the extent of the implementation of the
respondents of the Unang Yakap campaign were the following: mean, frequency count,
percentage, standard deviation, Spearman’s correlation coefficient, point biserial
correlation coefficient, Kruskal-Wallis statistics and Mann-Whitney Statistics..
This study made use of descriptive research method to gather information about
the present existing condition. For the selection of respondents, cluster sampling, simple
random sampling and quota sampling was used. A T test was used to compare the
difference between two means. Spearman's rank Correlation was also used in this study
to indicate the magnitude of a relationship between variables measured on the ordinal
scale (Polit, 2008). This study also used Point Biserial Correlation Coefficient since the
91
variable is dichotomous. Kruskal Wallis Statistics was also used to test the difference in
ranks of scores of 3+ independent groups. This test is used when the number of groups is
greater than two and a one-way test for independent samples is desired.
The results revealed that the source of information affects the level of awareness
and knowledge of the health professionals of the Unang Yakap Campaign by the DOH.
The hypothesis that there is no significant relationship between the respondents’
specific profession to their level of awareness and knowledge regarding the Unang Yakap
Campaign was rejected. The results revealed that there is a significant difference on the
level of awareness and knowledge between professionals, however there is no significant
difference on their extent of implementation.
The hypothesis that there is no significant relationship between level of awareness
and knowledge of informed health professional to those who are not informed was
rejected. The results revealed that the health professionals who were informed through
seminars, pamphlets and second hand information have greater level of awareness than
those who were not informed. And the health professionals who were informed through
pamphlets have greater level of knowledge than those who were not informed. The other
sources of information do not affect the level of awareness and knowledge of the health
professionals regarding the Unang Yakap Campaign.
The null hypothesis that there is no significant relationship between the extent of
implementation of Unang Yakap Campaign to the level of awareness and knowledge of
health professionals was accepted.
92
The null hypothesis that there is no significant difference on the extent of
implementation of health professionals between work stations was rejected. The results
revealed that the extent of implementation of health professionals differ on the work
stations they are employed. On the other hand, the null hypothesis that there is no
significant difference on the extent of implementation of health professionals between
work places was accepted.
Conclusion
The results revealed that most of the respondents are 44 years old. There are more
females and majority of the respondents are married, most of them work in the rural
health unit and most of the respondents are midwives. Most of the respondents work in
their respective facility for five years and below.
The doctors, nurses and midwives are highly knowledgeable about the Unang
Yakap Campaign. They are aware about the collaboration between the Department of
Health (DOH) and World Health Organization (WHO). The number one source of
information on the Unang Yakap Campaign is seminars. The health professionals
employed in the selected rural health units (RHUs) and lying-in clinics in Cavite have fair
level of knowledge to the said campaign.
There is a relationship between the respondent’s level of awareness and
knowledge on the Unang Yakap Campaign and the extent to which they follow the
protocol included in the ENC.
93
The most common advantage of the Unang Yakap Campaign as perceived by the
respondents is that the campaign causes uninterrupted skin-to-skin contact between the
mother and newborn and the least advantage is that it helps in better contraction of the
mother. The most common disadvantage of the Unang Yakap Campaign as perceived by
the respondents is that the campaign is time consuming and the least disadvantage is that
the campaign is somewhat confusing for the health professionals since the campaign was
just implemented last 2010.
The health care professionals who were informed about the said campaign has a
greater awareness than those who did not hear about it, which proves that level of
implementation is significantly related to the level of awareness of health care
professionals. There is no significant relationship between the extent of implementation
of Unang Yakap Campaign to the level of awareness and knowledge of health
professionals and there is also no significant difference on the extent of implementation
of health professionals between work places and stations.
Recommendation
Stated below are the recommendations made based on the outcomes gathered in this
study:
1. Though implemented nationwide, the Unang Yakap Campaign seems to be
unknown to other health professionals. The researchers would like to recommend
to give more seminars and trainings especially to midwives as well as to nurses to
enhance their knowledge and to apply it in their profession.
94
2. The Department of Health (DOH) must focus on producing pamphlets that
contains the important component of Essential Newborn Care Protocol- Unang
Yakap Campaign. This pamphlets must be disseminated to local government
units specifically RHUs for better understanding of health professionals that are
serving the public. In this way, lesser time for attending seminars and is more
convenient to those health care provider.
3. As for the primary beneficiary of this study, the nurses, midwifes and doctors
should keep themselves up to what is the latest programs and revised protocols
that are made by the Department of Health. They can do it by using technology
such as the internet and browsing the homepage of DOH which is
www.doh.gov.ph. Aside from these electronic sources, there are also monthly
publications released by DOH that is available to every RHU that can be read by
these health professionals to enhance their knowledge.
4. The DOH can collaborate with television stations that can be one of the ways to
spread the concept of UYC and to implement it. They can use promotional videos
that can catch the attention of health professionals and ordinary people to help
them to be aware that the old system of newborn care is already revised
5. Future researchers may use the data obtained from this study as their reference
and to enhance their knowledge regarding the same topic.
6. To test whether there is increase in implementation of the ENC UYC, one can
conduct further research to correlate with the result of this study, not just in the
implementation but also in the level of awareness and knowledge of nurses,
midwives and doctors to UYC.
95
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