A Quasi Experimental Study to Assess the Effectiveness of Structured Teaching Programme Regarding Integrated Management of Neonatal and Childhood Illness (IMNCI) on Knowledge among Health Workers Working in Selected Health Centres of Odisha, India

INTRODUCTION Every year more than 11 million children in developing countries die before the age of 5. India has one of the highest rates of childhood mortality in the world. Most of these deaths occurring within the first month of a newborns life and nearly half of all neonatal deaths occuring with in the first week of a childs life. India has made a strong commitment to the reduction of neonatal mortality through the implementation of the joint UNICEF and WHO initiative, IMNCI. The main strategy of IMNCI is to train and provide preventive and home based care through Indias primary health care system. Studies show that the integrated approach ensures that all relevant needs of the child are looked at and attended to during the contact of the child with the health workers. IMNCI strategy- The strategy includes both preventive and curative interventions that aim to improve practices in health facilities, the health system and at home. It includes 3 main components. Improvements in the case-management skills of health staff through the provision of locally adapted guidelines on integrated management of Neonatal and childhood illness and activities to promote their use. Improvements in the overall health system required for effective management of childhood illness. Over view of the Indian 3-tier health system. CHC PHC SC Improvements in family and community health care practices. Twelve key practices have been identified by UNICEF and WHO to be of crucial importance in providing good home-care for the child (Hill et. al 2004). Take children as scheduled to complete full course of immunization. Breastfeed infants exclusively for 6 months Starting at six months of age feed children freshly prepared energy and nutrient-rich complementary foods. While continuing to breastfeed up to 2 years or longer. Ensure children receive adequate amount of micronutrients. Dispose of faces safely and wash hands after defecation before preparing meals and before feeding children. Protect children in malaria endemic areas by ensuring they sleep under ITN. Continue to feed and offer more fluids including breast milk when they are sick. Give sick children appropriate home treatment for infections. Recognize when sick children need treatment. Follow health workers advice about treatment, follow up and referral. Promote mental and social development by responding to a childs needs for care and through talking, playing and providing a stimulating environment. Ensure that every pregnant woman has adequate antenatal care. Need for the Study- Reduction in child and neonatal mortality are major public and global health challenges (Arrive et al.2004). The 4th millennium development goal (MDG-4) represents commitment to reduce mortality in children younger than 5 years by 2/3rd between 1990 and 2015 (Sachs et al.2005 MDG MONITOR, 2009). Input of efforts, between 1960 and 2000, resulted in reduction in child mortality (From 2 month to 5 years). Unfortunately the neonatal mortality rate could not be reduced desirably. (Ahmad et. al 2000 lawn et al.2005). WHO& UNICEF lunched IMCI strategy during 1992 followed by IMNCI. Strategy to improve child and neonatal survival through provision of individualized care. For this, Health care staff especially serving in first level rural health care sector has been trained for clinical case management of IMNCI. It is therefore, the investigator felt and need to identify the awareness with assessment of knowledge of health workers ( as they are the direct care giver) regarding IMNCI by a quasi experimental design with control group. Statement of the Problem- A quasi experimental study to assess the effectiveness of structured teaching programme regarding IMNCI on knowledge among health workers working in selected health centres in Odisha. Objectives- 1. To assess the knowledge of health workers regarding IMNCI before and after the implementation of STP in control and experimental group.2. To compare the level of knowledge between before and after the implementation of STP in experimental and control group.3. To find out the association between level of knowledge of IMNCI with selected demographic variables among health workers in experimental and control group. Assumptions- The Present study assumes that - 1. The knowledge of health workers regarding IMNCI will be less before STP.2. The health workers will express their free and frank feelings about IMNCI.3. The health workers are willing to participant in teaching programme to enhance their knowledge on IMNCI.4. STP is an effective method of imparting knowledge to the health workers. Hypotheses- H1- There will be significant difference between pre test and post test knowledge scores of health workers regarding IMNCI. H2- There will be significant relation between the knowledge and the demographic variables. Theoretical Framework- Wood& Haber (1994) stated that