Unraveling the Interplay between Postnatal Mothers' Expertise in Neonatal Care amid the COVID-19 Pandemic and Media Consumption

Abstract

Background The arrival of a newborn is a source of joy and optimism, whereas the loss of an infant is a profoundly tragic event for families worldwide. During the initial days of life, infants demand meticulous care, especially during the critical 1- to 28-day period when they are more vulnerable to infections, necessitating heightened protection and security. In the context of the coronavirus disease 2019 (COVID-19) pandemic, mothers and caregivers have become increasingly cautious regarding the care of newborns. This study aims to assess the knowledge level of postnatal mothers regarding neonatal care and their utilization of mass media during the COVID-19 pandemic.

Materials and Methods Conducted in a tertiary care setting, this study used a descriptive correlation design with 46 primiparous mothers chosen through purposive sampling. The evaluation of mothers' knowledge about newborn care utilized a self-reported questionnaire, whereas a checklist was used to gauge their use of mass media.

Results The study revealed that 60.9% of mothers utilize mass media for more than 6 hours daily. Among the participants, 63% demonstrated adequate knowledge of newborn care, whereas 37% exhibited inadequate knowledge. Additionally, the study indicated a weak negative correlation between mass media usage and postnatal mothers' knowledge of newborn care (r = − 0.034). The type of family (p = 0.023) was significantly associated with postnatal mothers' knowledge (p > 0.05).

Conclusion The findings suggest a correlation between mass media usage and postnatal mothers' knowledge of newborn care. However, no discernible relationship was identified between mass media usage and mothers' awareness of neonatal care during the COVID-19 pandemic. This may indicate that the content disseminated through mass media during the pandemic did not sufficiently emphasize neonatal care, potentially resulting in a limited impact on mothers' awareness in this specific domain.

Keywords

infant - postnatal mothers - newborn - pandemic - COVID-19

Introduction

The critical, initial 28 days of an individual's life, encompassing labor, delivery, and the early postpartum period, demand optimal care to influence the survival of both mother and child. Unfortunately, in low- and middle-income countries, many mothers and newborns lack sufficient care during this crucial period. Specialized care, including eye care and vitamin K administration, is essential for infants during their first month.[1] The mother, as the primary caregiver, plays a pivotal role in ensuring proper care and practices, but nonadherence can increase infection risks, especially for first-time mothers. Health education on newborn care is crucial, with caregivers needing training in hygienic practices due to the vulnerability of newborns.[2]

Infant fatalities, especially in the immediate postpartum period, are common, with causes identified by the World Health Organization including infection, sepsis, pneumonia, tetanus, hypothermia, and diarrhea. Newborns are particularly susceptible to infections, necessitating education on respiratory and hand hygiene practices to prevent perinatal and postnatal transmission of coronavirus disease 2019 (COVID-19).[3] Uncertainty during the pandemic heightened concerns among mothers and families, emphasizing the need for optimal care to prevent infections and highlighting the importance of knowledge about infant care practices.[4]

Factors such as age, education, occupation, family type, and the number of family members influence a mother's understanding of neonatal care. Limited interpersonal interaction during the pandemic led mothers to rely on mass media sources for information on infant care. Postpartum bonding suffered due to restrictions on visiting and touching babies in the neonatal intensive care unit.[5]

Researchers explored postnatal mothers' media consumption and knowledge of neonatal care during the COVID-19 pandemic to understand the correlation between mass media usage and neonatal care understanding. The study investigated how various forms of media influenced mothers' knowledge of newborn care, including infection control, skin care, breastfeeding, bathing, eye care, and umbilical cord care. Specific COVID-19 precautions were outlined.[6] Pregnant women in Singapore were aware of COVID-19 but had unclear knowledge and expectations regarding perinatal and neonatal care.[6]

The risk of neonatal infection is low with recommended precautions, but psychosocial implications and racial/ethnic disparities must be addressed. Pandemic-related prenatal stress can negatively affect infants' regulatory capacity at 3 months, mediated by parenting stress and mother–infant bonding. Neonatal complications were found in neonates born to severe acute respiratory syndrome coronavirus-2-infected mothers, emphasizing the need for isolation and separation from infected caregivers. Parents received electronic communication tools during the pandemic, providing emotional support. Postpartum maternal physical and psychological state plays a fundamental role in the mother–child relationship. Rooming-in and direct breastfeeding are advisable for COVID-19 mothers with mild symptoms, but separate management is necessary when the mother is too sick. Involving fathers in newborn care positively affects the psychological and somatic development of the newborn.[7] [8] [9] [10] [11] [12] [13]

Mass media usage, defined as spending at least an hour online daily and utilizing print, broadcast, out-of-home media, and the internet for neonatal care information during the pandemic, was a crucial aspect of the study. Mothers heavily relied on media for information, especially first-time mothers facing communication disruptions. This study aimed to compare the knowledge of neonatal care during the COVID-19 epidemic between first-time postnatal mothers and their media usage. The study focused on postpartum women, 2 days after giving birth, who had been exposed to various forms of media during the antepartum period.[6]

Materials and Methods

A quantitative and descriptive correlation methodology was used by the investigator to assess the utilization of media by antenatal mothers for enhancing their comprehension of newborn care during the COVID-19 pandemic. The study took place in the postnatal unit of a tertiary care hospital located in Mangalore, equipped with over 10 specialty divisions and a capacity of 1,000 beds. The research focused on primiparous postnatal mothers within the hospital's population, and the sample size of 46 participants was determined using the simple proportion formula, considering factors such as availability, sample type, and characteristics.

(α indicates the level of significance, d is precision −0.15, and the anticipated proportion is P-37 at 95% confidence level. The required sample size was 46 (with a 15% attrition rate).

Literate mothers who were primipara and engaged in mass media use for at least 1 hour daily were included, while those with stillborn babies or congenital anomalies were excluded from the study.

Description of the Tool

The researcher used a checklist on mass media usage, a questionnaire on newborn care knowledge, and demographic data. Demographic data included the mother's age, education, occupation, family structure, size, and monthly income. The Mass Media Usage Checklist covered various forms of media such as newspapers, periodicals, television, radio, and cell phones. Mothers marked the boxes next to the social media platforms they used for obtaining information on newborn care during the prenatal period, including WhatsApp, Facebook, Instagram, YouTube, Telegram, and Twitter. The study also considered the amount of time mothers spent on each social platform. The Newborn Care Knowledge Questionnaire focused on five areas: breastfeeding, umbilical cord care, bathing, general practices, and practices when mothers had fever, cough, or cold. Mothers expressed their agreement or disagreement with statements in each area and specified the information source.

Method of Data Collection

The investigation adhered to the approval of the hospital administration and eligible participants. Mothers meeting the inclusion criteria were selected after receiving detailed information about the study's objectives. Written consent was obtained from the mothers, ensuring the confidentiality of their participation, and an information sheet outlining their involvement was provided.

Statistics

Frequency, mean, percentage, and standard deviation were utilized to summarize the coded and organized information in a master data sheet. Statistical analysis was performed using SPSS software version 20. The chi-square test was used to examine the relationship between postnatal mothers' knowledge of newborn care and selected demographic variables. An odds ratio with a p-value of 0.05 or lower was used to identify the relationship between media use and knowledge.

Results

Baseline Characteristics

Among the 46 participants, the majority (67.4%) had an educational level below the preuniversity course, 21.7% completed undergraduate studies, 8.7% were postgraduates, and 2.2% held a diploma. The predominant occupation was homemaking, accounting for 76.1% of the participants, followed by 19.6% with a private job and 4.3% with a government job. Regarding family structure, 52.2% belonged to a nuclear family, 45.7% to a joint family, and 2.2% to an extended family. In terms of family size, 54.3% had four to six members, 37.0% had more than six members, and 8.7% had less than or equal to three family members. The distribution based on monthly income revealed that the majority (56.5%) had an income of more than Rs. 20,000, followed by 30.4% with an income of Rs. 15,001 to 20,000, 8.7% with an income of Rs. 10,001 to 15,000, and 4.3% with an income of less than Rs. 10,000.

Knowledge and Media Usage

This study found that the least time dedicated to media consumption was 6.5 hours. The mean and standard deviation of media usage during the COVID-19 outbreak were 6.5 ± 2.38 hours Among the 46 individuals, the average knowledge recorded was 29.65 ± 1.82. Inadequate knowledge was observed in 17 mothers (37%), whereas adequate knowledge was observed in 29 mothers (63%; [Table 1]). In this study, mothers exhibited a keen awareness of health measures. A substantial majority (86.95%) affirmed continued breastfeeding during fever. Most mothers (93.47%) recognized the importance of mask use during symptoms and expressed breast milk in isolation. Impressively, 97.82% were aware of the need to boil instruments for milk feeding. Some mothers considered turmeric on the baby's skin (21), herbs in bathwater (19), nail trimming (29), and powdered milk substitutes (33) as preventive measures or remedies during sickness.

Table 1 Frequency, percentage distribution, mean, and standard deviation of postnatal mothers' usage of mass media during the COVID-19 pandemic (n = 46)

Variables		Frequency (f)	%	Mean ± standard deviation
Usage of mass media	Less than average hours of usage	18	39.1	6.5 ± 2.38
	More than average hours of usage	28	60.9
Postnatal mother's knowledge of neonatal care	Inadequate knowledge	17	37.0	29.65 ± 1.82
	Adequate knowledge	29	63.0

[Table 2] displays that the mean score for knowledge on caring for a newborn is 29.65, whereas the average time spent consuming mass media is 6.59 hours. The computed r-value is −0.034, indicating a weak negative correlation, suggesting a negligible relationship between the variables, with a p-value of 0.82. Although there is a tendency for both variables to increase in response to each other, the correlation is not significantly robust. Therefore, there is no significant correlation between the utilization of mass media and the knowledge of postnatal mothers regarding neonatal care. Consequently, the null hypothesis (H1) is accepted.

Table 2 Correlation between mass media usage and postnatal mother's knowledge of neonatal care during the COVID-19 pandemic using Pearson correlation

Correlation between variables	Mean ± standard deviation	r	p
Knowledge of neonatal care	29.65 ± 1.816	− 0.034	0.82
Hours of mass media usage	6.59 ± 2.381

The mothers' knowledge of neonatal care is not significantly impacted by the use of mass media, as evidenced by an odds ratio (−0.051) falling below the lower limit of the 95% confidence interval (0.736) and a p-value (0.696) exceeding 0.05 ([Table 3]). Hence, there is no significant relationship between mass media usage and postnatal mothers' knowledge of neonatal care during the COVID-19 pandemic, leading to the rejection of H2.

Table 3 Relationship between mass media usage and postnatal mother's knowledge of neonatal care during the COVID-19 pandemic using odds ratio

Usage of mass media		Knowledge of neonatal care		Odds ratio (95% CI)	p
		Adequate knowledge	Inadequate knowledge
Hours of mass media usage	Average usage	12	6	−0.051 (0.736–1.227)	0.696
	More than average usage	11	17

The Fisher's exact test was used for the association between postnatal mothers' knowledge and selected demographic variables. The calculated p-values for educational status (p = 1), occupation (p = 0.425), number of family members (p = 0.425), and monthly income in rupees (p = 0.418) were all greater than 0.05 (p > 0.05). Thus, the results indicate no significant relationship between postnatal mothers' knowledge and demographic variables such as educational status, occupation, number of family members, or monthly income in rupees, except for the type of family. Therefore, the research hypothesis H3 is rejected. However, the type of family showed a significant association, with a calculated p-value of less than 0.05 (0.023).

Discussion

The results of the educational background study are consistent with a comparable study that aimed to assess primigravida mothers' attitudes, behaviors, and knowledge about caring for their newborns. According to the survey that was cited, 32% of moms had completed their basic degree, and 15% had gone on to earn a postgraduate degree.[14]

Education significantly influences knowledge, impacting attitudes and practices in newborn care. Disparities based on education levels should be approached judiciously, considering cultural norms and socioeconomic factors. Occupation patterns align with a prior study, indicating 40% stay-at-home moms, 27% private sector workers, and 24% government employees.[14]

Maternal Knowledge Disparities

Similar findings are found in another study, which finds a positive association (p = 0.046) between greater levels of schooling with achieving enough knowledge.[15]

Family Structure Insights

The current study's findings are consistent with a previous study's, showing that 54% of participants were members of joint families, 27% of nuclear families, and 19% of extended families.[14]

Research on media's role during the 2019 coronavirus outbreak aligns with this study, revealing a surge in mass media usage during lockdown. It underscores media's potency as a tool for disseminating information and fostering a positive environment amid the COVID-19 pandemic.[16]

Media Consumption Trends during the Lockdown: Insights from the Study

The investigation unveils a scenario where individuals had limited alternatives for spending their time during the lockdown, leading to a heightened reliance on the internet. Notably, all activities were exclusively conducted and promoted through online platforms.

Corroborating evidence from prior research indicates that individuals typically dedicated around 3 hours daily to digital social platforms before the onset of the COVID-19 epidemic. However, the study indicates a postpandemic shift, with respondents now surpassing 4 hours of daily social media use. Among the 12 digital social networks evaluated, WhatsApp, Telegram, and Instagram emerged as the predominant platforms for accessing information related to COVID-19.[17]

Internet Usage Patterns among Mothers: An Intriguing Observation

This study suggests the internet is likely used for specific tasks or hobbies rather than being a primary media source. Notably, Facebook and WhatsApp are prevalent, underscoring their pivotal role in communication within the studied mother cohort. Interpretation requires acknowledging the unique context and demographics influencing media usage behaviors, highlighting the importance of cultural, geographical, and socioeconomic factors for a comprehensive understanding of research outcomes.

Postnatal Mothers' Awareness of Neonatal Care amid the COVID-19 Pandemic

A prior study underscores the significance of imparting comprehensive information to primiparous mothers, emphasizing that such knowledge is pivotal for the adept handling of routine newborn concerns.[18] Notably, survey findings allude to the fact that only 37% of postpartum women, with a mere 47.4% manifesting positive attitudes, were adequately informed about neonatal care.[19] The findings reveal a prevalent trend, with a significant portion of mothers displaying satisfactory awareness of neonatal care. A minority showed a lack of knowledge. Possessing adequate knowledge indicates these mothers were well-informed and equipped with insights to navigate infant care challenges during the turbulent conditions of the COVID-19 pandemic.

Another pertinent descriptive cross-sectional study aligns with the present research. This study disclosed that 75.3% of participants displayed an adequate level of knowledge, contrasting with the 24.7% who exhibited inadequacy in this realm.[20] In a study, 52% of mothers had adequate knowledge, 27% moderately adequate, and 21% inadequate. Overall, 79% showed foundational knowledge in newborn care, emphasizing a positive collective outcome.[14] Mothers demonstrated an impressive 88.64% proficiency in comprehending COVID-19 and fever-related protocols. In a related study, 94.5% of participants displayed a strong understanding, 3.7% had an average understanding, and only 1.8% showed poor knowledge, with a mean score of 18.0 ± 3.18.[21]

Correlation between Mass Media Usage and Postnatal Mothers' Knowledge about Neonatal Care during the COVID-19 Pandemic

Results align with a study on mass media's impact on rural women's antenatal care. Mothers exposed to media during pregnancy showed higher engagement in antenatal visits, proper rest, sleep practices, and tetanus toxoid immunization. The study concludes that mass media positively contributes to maternal healthcare by enhancing antenatal care service participation.[22]

In a randomized controlled trial, the integration of social media-based education, leveraging widespread smartphone use, proved promising in disseminating maternal care information, particularly on postnatal care. The study indicates a valuable approach to enhance maternal and neonatal health in resource-constrained settings through targeted smartphone-based educational interventions.[23]

The wired mothers' intervention, utilizing mobile phones, significantly boosts pregnant women attending the recommended four antenatal care appointments. This approach not only fosters adherence to schedules but also encourages heightened engagement in preventative healthcare measures. Additionally, it influences the timing of antenatal care initiation, contributing to timely diagnoses and referrals for antepartum issues.[24] A related study identified a need for better information dissemination on preventing COVID-19 transmission among mothers during hospital stays and postdischarge. This underscores the potential information overload, particularly through mass media, during the pandemic, highlighting the importance of targeted communication strategies in healthcare settings.[25]

Limitations of the Study

Amid the second COVID-19 surge, reluctance limited participation, yielding a sample of 46 mothers and restricting generalization. Limited literature constrained a comprehensive review of mass media use by postpartum mothers during the outbreak in India. The study's scope was confined to a hospital setting and primiparous mothers.

Conflict of Interest

None declared.

Acknowledgments

The authors of this article would like to express their gratitude to the Nitte (Deemed to be University) for their assistance and support. Also, our special thanks to Ms. Jise C.K., Ms. Aiswarya Thomas, Ms. Arathi Krishna, Ms. Lisel Rhea Pereira, Ms. Anaswara T.R., and Mr. Dani K. Aby for their support during the study.

Ethical Approval

The study proposal received approval from the institutional and scientific review boards. The hospital officially sanctioned the execution of the study. The 46 mothers were informed of the study's purpose, and their consent to participate in the data-gathering process was assured.

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Publication History

Article published online:
14 June 2024