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).

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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)

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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.

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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.

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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.

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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).

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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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