Abstract

Background: Premature babies are babies born before 37weeks of pregnancy (WHO2014) premature babies are immature and therefore need special nursing care. Nurses and midwives therefore should be frontline care providers round the clock. Mother whose babies are born premature are often anxious. Premature babies also have increased risk of complication, that is the earlier the child is born the higher the risk.

Objectives: The main objective was to asses nurses /midwife’s knowledge and practice in the care of premature babies, in the neonatal, pediatric and maternity unit of the Buea Regional Hospital

Method: A descriptive, cross sectional study design was used for this study, A convenient sampling technique was used for the Study. Structured, questionnaire was used for the study, Data was analyzed using SPSS version 27. Data was presented using frequency tables, pie and bar charts.

Results: 42(95%) of the participants knew a cause of prematurity. 42(95%) of them knew the characteristics of a premature baby. More than 80% of the participants practiced the correct method of caring for premature baby. Majority 40(91%) of the participants, don’t have all equipment needed for the care of premature babies.

Conclusion: The nurses and midwives working at the maternity, pediatric and neonatal unit of the Buea regional hospital have good knowledge on premature babies, they also have good knowledge on the Strategies and finally they also faced challenges in the care of premature babies.

CHAPTER ONE

INTRODUCTION

1.1 Background Of The Study

Premature babies are babies born before 37weeks of pregnancy (WHO2014) premature babies are immature and therefore need special nursing care. Nurses and midwives therefore should be frontline care providers round the clock. Mother whose babies are born premature are often anxious. Premature babies also have increased risk of complication, that is the earlier the child is born the higher the risk. Any complication of a premature new born will be addressed in the Neonatal intensive care unit (NICU).

Premature babies are not fully matured to adapt to extra uterine life. Their bodies have underdeveloped parts that include the immune system, digestives system, lungs, and skin among others (American Pregnancy Association 2015). Thankfully, medical technology has made it possible for premature babies to survive for the first few days, weeks and even months of life until they are strong to make it on their own. . As suggested by the National Institute of Child Health and Human Development of the National Institute of Health (NIH) in the USA, we can divide preterm delivery into, Extreme preterm before 28 weeks, Very early preterm between 25-32 week, Early preterm between 32-34 weeks, Late preterm before 34-36 weeks.  Marlowe et al (2005)

Hess (1934) in an extensive and careful study of the development of prematurely-born children ( which he defines as weighing five and half pounds or less at birth irrespective of the duration of gestation compares the weight of prematurely born children at various age periods with that of their full term siblings and comes to the conclusion that the former consistently weight less than the latter until the age of four, after which they conform fairly closely to the weight curves of the full term brothers. He also showed that those babies in the series, which are very small at birth gain weight relatively less rapidly than larger babies in the series of the same sex. He also states that the curve for increase in heightening the premature series lags behind the curve of the full term sibling in the same way as the weight curve. Sullivan , A ( 2020)

In this review we summaries the history of clinical decision making with a focus on the NICU highlight different models of decision making describe the advantages and current limitations of shared decision making and discuss the ongoing and future challenges of decision making in the NICU amidst medical innovations and emerging technologies cummings , C  ( 2020)

The synactive theory of infant development provides a frame work for understanding the behavior of premature infants. The infant’s behavior are grouped according to five subsystems of functioning. The five subsystems are as follows motor, we look at the infant’s motor tone, movement, activity, and posture.

It also describes the infants in constant interaction with the environment from within the womb to the newborn intensive care nursery. The theory gives professionals the framework and tools with which to identify the stepwise and often difficult to achieve component of such infant’s accomplishment that appear simple and self-understood for healthy full term newborns and infants such as steady breathing, efficient swallowing, and smooth digestion.  Maltese (2017)

Each year, 15 million premature babies are born and their survival rate varies dramatically around the world (Blencowe et al…., 2012). About 1.2million premature babies are born each year in low income countries. Middle income and emerging economics have about 3.8 million premature births each while some counties such as Turkey have half deaths for premature babies within a decade (Shiferaw et al 2013). South Asia and sub-Saharan Africa accounts for almost two third (2/3) of the world’s premature babies and over three quarter (3/4) of the world’s new born deaths due to premature birth complications.

Again, about 10% of premature babies can be born between 28 to 32 weeks gestation and in low income countries, more than half of them will die but many could be saved with feasible care, not including intensive care such as ventilation. For babies born before 28 weeks gestation, intensive care will be needed to save, most of them but it is important to realize that these ore the minority about 5% of premature babies. (WHO 2012).

Most premature babies (80%) are born between the 32 and 37 weeks of gestation (moderate or late premature and die needless for lack of sample essential care such as warmth and feeding support (pertruo et all 2006).

In 1990, few babies under 25 weeks gestation were surviving, yet by 2010, 95% of premature babies fewer than 28 weeks survived and more than half of babies born before 25weeks gestation survived, although they later have a higher risk of impairment (pertruo et al…, 2006). Yet the risk of neonatal death due to complication of a premature birth is about twelve times higher for an African baby than a European baby (Liu et al…, 2012).

The weight indicator of a premature baby, which is less than 2500g, which was formally used to describe a premature baby is no longer in use, because children born from diabetic mothers may have a weight of even 2.5kg before 28 weeks of gestation. Whereas, children born from a malnourished mother may weigh less than 2500g even at term (38-40weeks). A premature baby needs intensive care.

1.2 Problem Of Statement

Globally prematurely is the leading cause of death in neonates under the age of 5 years. And in almost all countries with reliable data preterm birth rates are increasing, because premature babies are born before they are ready to leave the womb, they often have health problem. Because of this health concern premature babies are given extra medical assistance immediately after delivery.

In Cameroon, especially in the South West Region there is a paucity of data as concern preterm birth and its related morbidity and outcome. A study conducted in Cameroon reported a prevalence of preterm birth at 13% in 2010. Many deaths still occur due to lack of adequate knowledge, on the level of knowledge and practice of the nurses and midwives in the care of premature babies.

Remarkable progress has been made globally in decreasing under five child mortality with the introduction of  (MDG) but neonatal mortality have declined at a slower pace .

Despite the fact that there is need for current information on the practice of premature care nurses and midwifes still lack adequate information in practicing care of premature babies and also poor communication to the mother’s on the care of their babies.

Several studies have revealed that delay in giving medications ,poor hygienic conditions, poor management of instruments and others may be due to lack of this knowledge which significantly contribute to a large number of neonatal morbidity and mortality in developing countries .

As such this study is conducted to investigate on the knowledge, practices and challenges faced by midwives and nurses in the care of premature babies in the BRH.

1.3 General Research Question

What is the knowledge and practice of Nurses and midwives on the care of premature babies at the Buea Regional Hospital?

1.3.1 Specific Research Questions

1. What do nurses and midwives know about premature babies at the BRH
2. What are the strategies used by nurses and midwives in practicing the care of premature babies at the BRH
3. What are the challenges faced by nurses and midwives in caring for premature babies at the BRH

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