EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
Mosalem et al
IMPACT OF REPRODUCTIVE HEALTH AND CHILD CARE TRAINING
PROGRAM ON AWARENESS OF NURSES WORKING IN MCH CENTERS
IN EL-MINIA GOVERNORATE
By
Fadia A. Mosalem*, Nadia H.** and Hoda A.***
Departments of *Public Health and Preventive Medicine, ***Administration, ElMinia Faculty of Medicine and **Administration, Assiut Faculty of Nursing
.
ABSTRACT:
Background: Reproductive health is an essential part of general health and a central
feature of human development. It is a reflection of health during childhood,
adolescence and adulthood. Reproductive health is a universal concern, but is of
special importance for women particularly during the reproductive years. Although
most reproductive health problems arise during the reproductive years, in old age
general health continues to reflect earlier reproductive life events.
Aim of study: *Assess awareness of nurses working in maternal and child health
(MCH) centers in El-Minia governorate, about selected reproductive health and child
care domains. *Evaluate the impact of the reproductive health and child care training
program on nurse’s awareness.
Subjects and methods: The research design used for this study was the interventional
design. A total of 50 (from 78) (response rate is 64.5%) nurses working in MCH
centers in El-Minia governorate were included in the present study. The study was
conducted in all MCH centers in El-Minia governorate (10 MCH centers). A
structured pre-test tool was developed by the investigator to assess awareness of the
nurses. The test was derived from the training program content which covers 6 topics
derived from the needs of MCH centers nurses. The test included 19 multiple choice
questions, it was given prior and immediate post program to the studied nurses. Posttest was applied using the same pretest. The program content stressed on antenatal
care, care for high risk pregnancy, care of the newborn, family planning, counseling
on reproductive health and family planning record. Different teaching methods were
used, it included lecture, discussion, brain storming and various visuals and
instructional media were used in the form of posters, and handouts. The sample was
divided into two groups (25 nurses in each). The training program was conducted over
a period of 6 days, three days for each group, three sessions take about 6 hours every
day to cover all information & practices of the program content. A scoring system
was developed.
Results: Nurse’s awareness level was categorized into low, fair and good according
to pre-determined score. Twenty two percent of the sample had low level and half the
sample had fair level, while 28% had good level of awareness about reproductive and
child health. Nurses working for ten years or more in MCH centers in El-Minia
governorate had a higher percentage of right answers of all topics than those working
less than ten years with a significant difference in some of these topics. In the regard
of counseling, the knowledge of nurses about medical visual aids during counseling
was the most changed post-intervention. Regarding documentation and card keeping,
the knowledge of nurses about how cards are kept was the most changed postintervention. Regarding knowledge related to antenatal, natal and post-natal care, the
knowledge of nurses about meaning of maternal mortality was the most changed post-
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EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
Mosalem et al
intervention. Answers related to neonatal care showed that the most changed item was
what the nurse should do after taking child blood sample for thyroid test.
Conclusion: Half of the primary health care nurses working in MCH centers in ElMinia governorate have moderate level of awareness regarding reproductive health
and child care, while 22% of them have low level. The training program markedly
improves the level of awareness.
Recommendations: There is an urgent need to design programmes to improve the
awareness of nurses about reproductive health and child care.
KEY WORDS:
Reproductive health
Program
MCH centers.
Child care
Awareness
Training
Nurses
best chance of having a healthy infant
(United Nations, 2002).
INTRODUCTION:
Primary health-care centers
provide outpatient health care and
primary preventive activities for
people in general and for mothers and
children in particular. Medical care
aims not only to improve health status,
but also to respond to patients’ needs
and wishes and to ensure their
satisfaction with care (Awadalla et al.,
2009).
Reproductive health is an
essential part of general health and a
central feature of human development.
It is a reflection of health during
childhood, adolescence and adulthood.
Reproductive health is a universal
concern, but is of special importance
for women particularly during the
reproductive years. Although most
reproductive health problems arise
during the reproductive years, in old
age general health continues to reflect
earlier reproductive life events (United
Nations, 2002).
Within the framework of WHO
definition of health as a state of
complete physical, mental and social
well-being, and not merely the absence
of disease or infirmity, reproductive
health addresses the reproductive
processes, functions and system at all
stages of life. It implies that people are
able to have a responsible, satisfying
and safe sexy life and that they have
the capability to reproduce and the
freedom to decide if, when and how
often to do so (WHO, 2010). Implicit
in this are the right of men and women
to be informed of and to have access to
safe,
effective,
affordable
and
acceptable methods of fertility
regulation of their choice, and the right
of access to appropriate health care
services that will enable women to go
safely
through
pregnancy
and
childbirth and provide couples with the
According to the Ministry of
Health, maternal mortality in Egypt
was 55 deaths for 100,000 live births
in 2008, indicating a steady decline
from 75 deaths for 100,000 live deaths
in 2002, Central Agency for Public
Mobilization & Statistics (CAPMAS),
(2009). Egypt Service Provision
Assessment Survey (ESPAS) (2004),
found that the vast majority of maternal deaths in Egypt (81%) involve one
or more avoidable factors. One such
factor, contributing to 54% of maternal
deaths, is substandard medical care by
health providers. Maternal deaths are
strongly associated with the absence of
good medical care before, during and
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EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
after delivery. More than half of all
maternal deaths worldwide occur
within 24 hours of delivery, mostly due
to postpartum hemorrhage.
Mosalem et al
comfortable discussing contraception
and be sensitive to the woman's
concerns and feelings. Nurses can
increase the likelihood of a woman
using contraception by providing
contraceptive counseling that is
directed to the woman's specific needs
(Mckinney, 2009).
The most effective way to
prevent maternal deaths is to have
deliveries
attended
by
skilled
personnel who can recognize and treat
or refer any complications that arise.
Skilled personnel include health
professionals such as physicians,
nurses and midwives (Farzaneh, 2003).
According to the WHO,
"Reproductive and sexual ill-health
accounts for 20% of the global burden
of ill-health for women, and 14% for
men (WHO, 2008).
More than 500 000 women die
annually
from
pregnancy-related
complications and millions become ill
from these complications. Altogether,
99% of these deaths occur in the
developing world, especially Africa,
where the average risk of pregnancyrelated death is one in 13, compared
with one in 4085 in developed
countries. Also, 98% of neonatal
deaths occur in developing countries:
42 neonates die per 1000 live births in
Africa compared with at most 10
neonates per 1000 live births in
developed countries (Alan TN Tita, et
al., 2005).
Justification of the study:
Maternal
health
remains
the
Millennium Development Goal target
for which progress has been most
disappointing. An estimated 40% of
deaths in children under five occur in
the first month of life, so improving
newborn care is essential for further
progress (Hogan et al, 2010).
Despite a significant reduction
in the number of maternal deaths –
from an estimated 543 000 in 1990 to
287 000 in 2010 – the rate of decline is
just over half that needed to achieve
the MDG target of a three quarters
reduction in the mortality ratio
between 1990 and 2015.
Health education is an essential
role of today's nurse. Client teaching
begins early, before, and during a
woman's prenatal care, and continues
through her recovery from childbirth.
Nurses motivate women, children, and
families to take charge of and make
responsible decisions about their own
health (Mckinney, 2009). Women will
attend antenatal care if it offers them
information
and
choice
about
childbirth (Fraser & Cooper, 2009).
To reduce the number of
maternal deaths, women need access to
good-quality reproductive health care
and effective interventions. The
proportion of women receiving antenatal care at least once during
pregnancy was about 81% for the
period 2005–2011, but for the
recommended minimum of four visits
or more the corresponding figure drops
to around 55%. The proportion of
births attended by skilled personnel –
crucial for reducing perinatal, neonatal
and maternal deaths – is above 90% in
three of the six WHO regions.
The nurse role in the family
planning is that of counselor and
educator, to fulfill this role, nurses
need current correct information about
contraceptive methods. They must be
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EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
However, increased coverage is needed
in certain regions, such as the WHO
African Region where the figure
remains less than 50% (MDG fact
sheet 290).
Mosalem et al
Setting
The study was conducted in all MCH
centers in El-Minia governorate (10
MCH centers).
Tools:
Tools used for data collection consisted of:
Interviewing sheet, designed by the
investigator to collect socio demographic
data such as sex, age, residence, level of
education, occupation, experience, etc.
A structured test was developed by the
investigator to study Knowledge and
practice of the nurses. The test was
derived from the training program content
which covering 6 topics derived from the
needs of MCH centers nurses. The test
included 19 multiple choice questions, it
was given prior and immediate post
program to the nurses in the sample. Posttest was applied using the same pretest.
From inspection and follow up
of nurse's role in reproductive health, it
was found that no recent training was
done for these nurses regarding
reproductive health and child care
which are necessary to improve quality
of nursing care.
Impact of the study:
Training of nurses regarding
reproductive health will provide an
opportunity for improving maternal
and perinatal outcomes by addressing
low and discrepant levels of awareness
and use of effective reproductive
health interventions. It also improves
health outcomes, fosters cost effectiveeness and increases patients' satisfyaction. This will be as a step to reach
Millennium Development Goal 2015.
Steps of program implementation:
The preparatory phase: This phase
was constructed based on the
observation and follow up for the
nursing role in all MCH centers (10
centers) in cities of El-Minia
Governorate. This observation revealed the needs to improve nursing role
and that no recent training was done
for nurses regarding reproductive
health and child care to improve
quality of nursing care. This phase
takes 3 months.
Aim of the study
 Assess awareness of nurses
working in MCH centers in ElMinia governorate about
selected women reproductive
health and child care issues.
 Evaluate the impact of the
education reproductive health
and child care training program
on nurse’s awareness.
Program content: The program
content was developed based on
current literature and modified
according to nurse's needs, which was
assessed through pretest. To allow
comparison, the same questionnaires
were used both in the baseline and the
follow-up survey. They contained
multiple choice questions and referred
to the following issues: maternal care,
care for high risk pregnancy, care of
the newborn, family planning,
counseling on reproductive health and
SUBJECTS AND METHODS :
Design
The research design used for this study
was the interventional design.
Sample
From a total of 78 nurses working in
maternal and child health (MCH)
centers, 50 nurses accepted to participate in the study, were included in the
present study.
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EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
family planning record. The pre- and
post-tests were administered to all
training participants.
Mosalem et al
dealing with qualitative data. To
compare two proportions Z test was
used. A significant P-value was
considered when P was less than 0.05.
The program implementation phase:
Different teaching methods were used,
it included lectures, discussion, brain
storming,
various
visuals
and
instructional media were used in the
form of posters, and handouts. The
sample was divided into two groups
(25 nurses in each). The training
program was conducted over a period
of 6 days, 3 days for each group, 3
sessions take about 6 hours every day
to cover all information & practices of
the program content.
RESULTS:
The study included 50 nurses
working in MCH centers in EL-Minia
governorate, the age ranged from 20 to 60
years with a mean of 39.5 ±11.1 years.
Table 1 showed that 22%, 50% and
28% of the studied nurses had poor, fair
and good levels of awareness respectively.
Percentage of nurses with good level of
awareness were higher (34.5%) among
those working for ten years or more than
those working for less than ten years
(19.1%) and this difference was
statistically significant (P= 0.0.1).
The program evaluation phase:
summative
evaluation
(posttest)
conducted after completion of the
training immediately for each group.
Knowledge regarding reproductive health counseling pre- and
health
training
Ethical and administrative considerations: post-reproductive
Official permissions
were
intervention was assessed by pre- and
obtained from relevant authorities to
post-training questionnaires. In this
proceed with the study. Prior to
regard, the knowledge of nurses about
embarking on the study, ethical
medical visual aids during counseling
approval was obtained from the
was the most changed postScientific Research Ethics Committee
intervention (increased from 42% in
of of El-Minia University, Faculty of
the pre-test to reach 98% in the postMedicine. Official permission was
tests) (p= 0.0007). Seventy eight
obtained from the manager of the
percent of nurses had knowledge that
MCH and the head of each center
the complete reproductive health
before data collection. In addition,
counseling and child health is the
informed consent was secured from
interaction between health care
each participant. All the participants
provider and receiver in the post-test as
were explained about the purpose of
compared to 26% in the pretest (p=
the study and were ensured strict
0.0001). The least changed item was
confidentiality and anonymity before
content of pre-marital counseling (as
proceeding in the interview.
58% in pre-test had the knowledge that
preventing relative marriage is not one
of its contents compared to 68% postSTATISTICAL DESIGN:
The data were coded and verified
test (p= 0.2). Knowledge regarding
prior to data entry. The Statistical
documentation and card keeping prePackage of SPSS version 16 for
and post-reproductive health training
windows was used for data entry and
intervention was assessed by pre- and
analysis. Descriptive Statistics were
post-training questionnaires. In this
2
calculated. Chi test was used in
regard, the knowledge of nurses about
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EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
how cards are kept was the most
changed post-intervention (increased
from 18% in the pre-test to reach 94%
in the post-tests) (p= 0.00001) as
shown in table 2.
Mosalem et al
Table (4) shows that 76%,
98%, 98% and 94% of nurses in the
post-test had correct answers related to
neonatal care, the first nursing action
must be done for neonatal resuscitation, the position used to measure
length of the newborn, what the nurse
should do after taking child blood
sample from the heel, and acute side
effects of circumcision that can lead to
death compared to 36%, 82%, 56%
and 68% in the pre-test respectively.
Knowledge regarding antenatal,
natal and post-natal care pre- and postreproductive health training intervention was assessed by pre- and posttraining questionnaires. In this regard,
the knowledge of nurses about meaning of maternal mortality was the
most changed post-intervention (increased from 20% in the pre-test to reach
80% in the post-tests) (p= 0.00001).
The least changed item was the criteria
to use breast-feeding as contraceptive
method (as 54% in pre-test knew these
criteria compared to 62% post-test (p
=0.2) as shown in table 3.
Regarding level of awareness in
general, percentage of those with good
level was improved markedly from 28% in
the pretest to 98 % in the posttest and the
difference was significant (P= 0.0001) as
shown in figure 1.
Table (1): Relation between level of awareness and years of experience among nurses
working in El-Minia MCH centers, 2010.
Years of
experience
<10 years
10 years or more
Total
Chi2 = 9.22
n
9
2
11
Level of awareness
Poor
Fair
% n
% n
42.7 8
38.2
4
6.9 17
58.6 10
22
25
50
14
df= 2
Total
Good
%
19.1
34.5
28
n
21
29
50
%
100
100
100
P= 0.01
Table (2): Percent change in awareness regarding reproductive health counseling and
documentation among nurses working in El-Minia MCH centers pre- and
post- training program, 2010.
Reproductive health counseling and documentation
The uses of medical visual aids by the nurse are:
Complete reproductive health counseling and child health is:
What does pre marital counseling include?
The purpose from prenatal follow up documentation:
Age of registration in child follow up records:
Keeping client card is according to:
195
%
P-value
change
56
0.0007
52
0.0001
10
0.2
20
0.1
32
0.03
76
0.00001
EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
Mosalem et al
Table (3): Percent change in awareness regarding antenatal, natal and post-natal care
among nurses working in El-Minia MCH centers pre- and post- training
program, 2010.
Antenatal, natal and postnatal care
The nurse's role during pregnancy and delivery:
The minimum number of prenatal visits:
Immunity of the first tetanus dose during pregnancy:
Causes of early bleeding during pregnancy:
Maternal mortality means:
The nurse should do uterine massage during first two hours of
labor at a rate of:
Types considered hormonal contraceptive methods:
The action of Pills to prevent pregnancy:
Criteria to use breast feeding as a contraceptive method:
%
change
32
48
32
44
60
44
P-value
0.02
0.00001
0.00001
0.00003
0.00001
0.01
12
52
8
0.2
0.0009
0.2
Table (4): Percent change in items of neonatal care among nurses working in ElMinia MCH centers pre- and post- training program, 2010.
Neonatal and child care
%
P-value
change
40
0.0001
The first nursing action must be done for neonatal resuscitation:
16
0.1
The position the nurse put the newborn in to measure length:
42
0.0005
What the nurse should do after talking blood sample from heel prick:
26
0.08
Acute side effects of circumcision that can lead to death:
100
90
80
70
60
% 50
40
30
20
10
0
98
poor
Fair
Good
50
28
22
0
Pretest
2
Posttest
Test
P= 0.0001
Figure (1): Level of awareness among nurses working in El-Minia MCH centers
pre- and post- training program, 2010.
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EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
DISCUSSION:
Access to reliable evidencebased information is tenuous in
developing countries to decrease maternal and neonatal mortalities (Alan TN
Tita, et al., 2005).
As regard to reproductive health
counseling
and
documentation,
statistically significant differences were
found pre- and post-reproductive health
training intervention of the nurses'
knowledge regarding uses of medical
visual aids, reproductive health
counseling and child health care,
registration in child follow up records
and keeping women record (p=0.0007),
(p=0.0001), (p=0.03), and (p=0.00001)
respectively as shown in table 2.
Ministry of Health and Population
(MOHP) [Egypt] (2003), reported that,
among the visual aids available in 87 %
of health facilities, 79% had teaching
aids about specific types of family
planning, and 84 % had information
pamphlets for clients to take home.
Visual aids related to STIs were
available in the family planning service
area in 17% of the facilities, and
information pamphlets on STIs that
clients can take home were available in
32% of facilities. Nabhana & Ahmed
Tawfik (2007): reported that poor diagnosis and management by providers is
aggravated by lack of consistency in
standards of care, absence of
communication between primary- and
next-level care providers, and failure to
keep records.
In the regard of knowledge
regarding antenatal, natal and postnatal care pre- and post-reproductive
health training intervention, the
knowledge of nurses about meaning of
maternal mortality was the most
changed post-intervention (increased
from 20% in the pre-test to reach 80%
in the post-tests) (p=0.00001) as shown
197
Mosalem et al
in table 3. While in Romanian study,
2004, the largest increase in providers’
knowledge was observed for postnatal
care (45% increase in correct answers).
In addition Zaruhi et al., (2007)
conducted a baseline assessment of
healthcare facilities to collect data on
the performance of health care
providers in delivering antenatal care
(ANC) and postpartum/infant care
(PP/IC); and they found that healthcare
providers were not performing to the
level of internationally-accepted standards (85% of the tasks expected) in
assessed performance areas: The nurses
only performed 29% of the basic ante
natal care (ANC) tasks, midwives
43%, and physicians 58%. Nurses performed 35% of the tasks needed to
provide basic Postpartum/Infant care
(PP/IC). Counseling on ante natal care
and Postpartum is the weakest among
both nurses and physicians: Basic
clinical skills are also low: 33% for
ANC and 24% for PP/IC. Tetanus
toxoid vaccination of pregnant mothers
increased to 78%.
As regard to neonatal and child
care, the current study revealed that
knowledge of nurses about first nursing
action must be done for neonatal
resuscitation, newborn position to
measure length, what should the nurse
do after talking blood sample and acute
side effects of circumcision that can
lead to death were improved post
intervention as shown in table 4. These
results were in accordance with the
results of the study done by McClure et
al., (2007), they evaluate the effectiveness of the World Health Organization (WHO) Essential New-born
Care (ENC) course in improving
knowledge and skills of nurse
midwives in low-risk delivery clinics in
a developing country. They found that
both the knowledge and skills of the
nurse midwives improved significantly
EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
following the course (from 65% correct
pre training to 84% correct posttraining and from 65% to 77% correct
on the performance and written
evaluations, respectively). This result
also corresponds with Carlo, et al.,
(2009), who evaluates the effectiveness
of the American Academy of Pediatrics
Neonatal Resuscitation Program (NRP)
in improving knowledge, skills, and
self-efficacy of nurse midwives in lowrisk delivery clinics in a developing
country, it revealed that after training
nurses knowledge improved markedly.
Regarding level of awareness in
general, all pre-training test results were
relatively low and percentage of those
with good level was improved markedly
from 28% in the pretest to 98 % in the
posttest and the difference was significant
(P= 0.0001) as shown in figure 1. This is
in agreement with the results of
international project of Romania, 2004
that showed that all pre-training test
results were relatively low and providers
answered about half of all questions
correctly.
CONCLUSION:
There is a general shortage of
knowledge regarding various aspects
of reproductive health among nurses.
Half of the primary health care nurses
working in MCH centers in El-Minia
governorate have moderate level of
awareness regarding reproductive
health and child care, while 22% of
them have low level of awareness. The
training program markedly improve
the level of awareness as the
percentage of those with high level
increased from 28% before training to
98% after training.
RECOMMENDATIONS:
Active
interventions
are
required to improve awareness. There
is an urgent need to design on job
198
Mosalem et al
educational training programmes and
foster continuing education to improve
the awareness of nurses about
reproductive health and child care as
well as to improve maternal and
perinatal outcomes.
REFERENCES:
1. Awadalla E. H., Kamel G. E,
Mahfouz M. E. and Refaat M.T.
(2009): Evaluation of maternal and
child health services in El-Minia City,
Egypt. Journal of Public Health,
Volume 17, Number 5, 321-329, DOI:
10.1007/s10389-009-0255-8.
2. WHO, 2010: Reproductive
health.
accessed
online
at
http://www.who.int/Topics/
reproductive-health/strategy.htm.
Retrieved 2010-07-24.
3. United Nations, (2002): Program
of action of the International conference on Population and development,
paragraph 7.2, accessed online at
www.iisd.ca/linkages/ Cairo/program/p07002.html,on Dec. 9, 2002. United
Nations
Population
Information
Network (POPIN) UN Population
Division, Department of Economic and
Social Affairs, with support from the
UN Population Fund (UNFPA).
4. Central Agency for Public
Moblisation & Statistics (CAPMAS),
(2009): Annual Report, Egypt:
CAPMAS Publications.
5. Farzaneh, R.F., (2003): Women's
Reproductive Health in the Middle
East and north Africa, Population
Reference Bureau (PRP), Washington,
DC 20009 USA.
6. Alan TN Tita, Beatrice J Selwyn,
D Kim Waller, Asha S Kapadia and
Sylvestre Dongmo, (2005): Evidencebased reproductive health care in
Cameroon: population-based study of
awareness, use and barriers. Bull
World Health Organ vol.83 no.12
Genebra Dec. 2005.
EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011
7. Mckinney, E.,S., Janes. R., S.,
Murray S., & Ashwill W., J., (2009):
Maternal and Child Health, Management of Fertility and Infertility, 3rd.
edition . Saunders Elsevier, Canada,
P.N 25, 185.
8. "Reproductive Health Strategy World Health Organization". http://
www.who.int/reproductive-health/
strategy.htm. Retrieved 2008-07-24.
9. Fraser M.,D., & Cooper A., M.,
(2009): Myles textbook for midwives,
Antenatal care, 5th. Edition, Churchill
Livingstone, London.
10. Ministry Of Health And
Population [Egypt], 2004 Egypt
Service Provision Assessment Survey
111 (Apr. 2005)
11. Hogan MC, Foreman KJ,
Naghavi M, Ahn SY, Wang M, Makela
SM et al. Maternal mortality for 181
countries, 1980—2008: a systematic
analysis
of
progress
towards
Millennium Development Goal 5.
Lancet, 2010, 375:1609-23.
12. Melenium Development Goals,
Fact Sheet N 290, November 2012.
Improving Health Care Providers’
Knowledge, Attitudes, and Practices in
Reproductive Health in Rural Romania. Elaine Claire Himelfarb, MPH.
Project
Concern
International/
Romania, 2004
13. Ministry of Health and Population (MOHP) [Egypt], El-Zanaty
Mosalem et al
Associates, and ORC Macro. (2003).
Egypt Service Provision Assessment
Survey 2002. Calverton, Maryland:
Ministry of Health and Population, ElZanaty Associates, and ORC Macro.
14. Nabhana A., and Ahmed Tawfik
M.S., (2007): Understanding and
attitudes towards patient safety
concepts in obstetrics, 98 INT‘L J. OF
GYNECOLOGY AND OBSTETRICS
212, 215 (2007).
15. Zaruhi Mkrtchyan Z., Sacci I.,
and Vardanyan M., (2007): Reproductive, maternal and child services in
health network, Baseline assessment of
reproductive, maternal and child
services in project NOVA supported
networks.
16. McClure EM, Carlo WA,
Wright LL, Chomba E, Uxa F,
Lincetto O, Bann C. (2007):
Evaluation of the educational impact of
the WHO Essential Newborn Care
course in Zambia. Acta Paediatr. 2007
Aug; 96(8):1135-8.
17. Carlo WA, Wright LL, Chomba
E, McClure EM, Carlo ME, Bann CM,
Collins M, and Harris H (2009):
.Educational impact of the neonatal
resuscitation program in low-risk
delivery centers in a developing
country. J. Pediatr. 2009 Apr;154
(4):504-508.
199
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‫‪EL-MINIA MED. BULL. VOL. 22, NO. 1, JAN., 2011‬‬
‫الملخص العربي‬
‫تأثير برنامج تدريبي عن الصحة اإلنجابية والعناية بالطفل على درجة وعي الممرضات‬
‫العامالت في مراكز رعاية األمومة و الطفولة في محافظة المنيا‬
‫مقدمة‪ :‬الصحة اإلنجابية هي جزء مهم من الصحة العامة وأساس تطور اإلنسان‪ .‬وهي انعكاس‬
‫للصحة في مرحلة الطفولة‪ ,‬المراهقة‪ ,‬والبلوغ‪ .‬للصحة اإلنجابية أهمية عامة وأهمية خاصة بالمرآة‬
‫خالل سنوات اإلنجاب‪ .‬وبالرغم من أن معظم مشكالت الصحة اإلنجابية تحدث خالل سنوات اإلنجاب‪,‬‬
‫اال أن الصحة العامة في العمر المتقدم تعكس أحداث الحياة اإلنجابية األولية‪.‬‬
‫هدف البحث‪:‬‬
‫‪ .1‬تقييم وعي الممرضات العامالت في مراكز رعاية األمومة والطفولة في محافظة المنيا عن بعض‬
‫األشياء المتعلقة بالصحة اإلنجابية والعناية بالطفل‪.‬‬
‫‪ .2‬تقييم تأثير برنامج تدريبي عن الصحة اإلنجابية والعناية بالطفل على درجة وعي الممرضات‪.‬‬
‫طرق البحث‪:‬‬
‫تم إجراء هذه الدراسة بمراكز رعاية األمومة والطفولة ( ‪ 11‬مراكز) بمحافظة المنيا‪.‬‬
‫اشتملت الدراسة على ‪ 01‬ممرضة من الممرضات العامالت بمراكز رعاية األمومة والطفولة من إجمالى‬
‫‪ 87‬ممرضة‪.‬‬
‫تم عمل اختبار بواسطة الباحثين لتقييم وعى الممرضات وقد اشتق من محتوى البرنامج التدريبى الذى‬
‫يغطى ستة موضوعات مشتقة من احتياجات ممرضات مراكز رعاية األمومة والطفولة‪ .‬يحتوى‬
‫االختبار على ‪ 11‬سؤاال متعدد االختيار وقد تم توزيعه قبل وبعد البرنامج مباشرة‪ .‬وقد ركز محتوى‬
‫البرنامج على الرعاية أثناء الحمل‪ ,‬رعاية الحمل الخطر‪ ,‬رعاية حديثى الوالدة‪ ,‬تنظيم األسرة‬
‫والمشورة الخاصة بالصحة اإلنجابية و سجالت تنظيم األسرة‪ .‬تم استخدام طرق تعليمية مختلفة مثل‬
‫المحاضرات‪ ,‬المناقشات‪ ,‬العصف الذهنى وكذلك تم استخدام وسائل مرئية مثل الملصقات‪ .‬وقد تم‬
‫تقسيم إلى مجموعتين (‪ 20‬ممرضة فى كل مجموعة)‪ .‬تم النتهاء من البرنامج التدريبى فى فترة ستة‬
‫أيام‪ ,‬ثالثة ايام لكل مجموعة‪ ,‬ثالثة جلسات تستغرق ما يقرب من ست ساعات يوميا لتغطية كل‬
‫المعلومات و الممارسات الخاصة بمحتوى البرنامج‪.‬‬
‫النتائج‪:‬‬
‫أظهرت الدراسة التأثير اإليجابي للبرنامج التدريبي على وعي الممرضات عن الصحة اإلنجابية‬
‫والعناية بالطفل‪ .‬و قد تبين من دراسة الوعى (المعرفة) بين الممرضات عن الصحة اإلنجابية والعناية‬
‫بالطفل أن ‪ %22‬من الممرضات لديهن مستوى متدنى من المعرفه وأن نصف الممرضات تقريبا‬
‫لديهن مستوى معتدل بينما تبين ان ‪ %27‬منهن لديهن مستوى متقدم من المعررفة‪ .‬كما أظهرتالدراسة‬
‫أيضا تحسنا ملحوظا في مستوى الوعي لدى الممرضات من ‪ %27‬في التقييم القبلي الي ‪ %17‬في‬
‫التقييم البعدي للبرنامج وهذا االختالف ذو داللة إحصائية عالية )‪.(P= 0.0001‬‬
‫الخالصــــة‪:‬‬
‫ونخلص من هذه الدراسة إلى أن نصف الممرضات العامالت في مراكز رعاية األمومة والطفولة‬
‫محافظة المنيا لديهن مستوى متوسط من الوعى عن الصحة اإلنجابية والعناية بالطفل‪ .‬بينما تبين أن‬
‫‪ %22‬منهن لديهن مستوى متدني من الوعي‪ .‬ونستخلص من تنفيذ البرنامج التدريبى أنه أظهر تحسنا‬
‫ملحوظا في مستوى وعي الممرضات‪.‬‬
‫لذلك نوصي بأن‪:‬‬
‫يتم تصميم برامج تدريبية لتحسين وعي الممرضات أثناء الخدمة عن الصحة اإلنجابية والعناية‬
‫بالطفل‪.‬‬
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