Al Neelain University Graduate College Women's Perception ...

I

Al Neelain University

Graduate College

Women's Perception and Attitude toward Prevention of Puerperal

Sepsis at A turkey hospital Khartoum-Sudan 2020

A thesis Submitted for Partial Fulfillment of Requirements for The Award

The Master Degree in Obstetrics& Gynecological Nursing

Submitted By:

Kawakib Badawi Ibrahim Ismail

University of Khartoum- Bsc 2000

Supervised By:

Dr Ihsan Elyamni Abdullah

Assistant Professor of Obstetrics & Gynecological Nursing

Alneelain University

I

رآنيهـآيه ق

بسم الله الرحمن الرحيم

كمم } ربك هاتكم خلقا من بعد خلق في ظلمات ثلث ذلكمم ه يخلقكم في بطون أم

{له الملك ل إله إل هو فأنى تصرفون

(6سورة الزمر )الايه

II

Dedication

My dedication goes to the spirit of my mother Tahra Hamid and

my father Badawi Ibrahim they have mercy, they were gave me

care, love and send me to school.

To my dear husband Omar Abdelnabi to his great support,

encouragement and patience all over the study period.

To my sisters, brothers, sons and daughters for their patience,

valuable support, encouragement and for according me the opportunity

to go for further studies throughout my study period.

III

Acknowledgement

I would like to say Alhamdulillah for my good health and strength for

completed my research and I would like to thanks faculty of Alneelain

Nursing Sciences, also my sincere gratitude goes to my supervisor Dr.

Ihsan Elyamni, for her continuous support and advice throughout the study,

also I would like to acknowledge the Administration of A turkey hospital

and the help of our participants women for their valuable participation.

IV

Abstract

Background :Puerperal infection contributes to increase morbidity and mortality,

unfortunately any bacterial infection of female genital tract struggling to the process of

childbirth and birth.

Objective: this study was carried out to assess perception and attitude of women

regarding prevention of puerperal sepsis.

Methods: descriptive cross-sectional hospital base study conducted at Al turkey

hospital in postpartum wards, convenience sampling technique was adopted,60

postpartum mothers enrolled in the study data were collected by using structured close

ended questionnaire for perception and attitude ,data processed and analysis by SPSS

version 16 .presented in simple frequency tables and figures.

Results: The results showed that over all perception and attitude, the women had poor

perception related to the definition, causes, symptom, preventive measures, and the

majority of them 51.7% they were poor perception about preventative measures

regarding puerperal sepsis. Furthermore, most of the women had appositive attitude

41.0% to prevent the infection.

Conclusion: Based on the findings of the present study, the study concluded that the

majority of postpartum women were poor perception regarding puerperal sepsis and its

prevention despite that, most of them had positive attitude toward the prevention of the

puerperal infections.

Recommendations: The findings underscored the necessity to raise the women's

perceptions and attitude on puerperal sepsis and it is preventions and provide them with

educational programs in the investigated area.

V

دراسهص اللخستم

زيادة معدل الاصاابات والوفياات سيدات بعد الولاده تساهم في ن الالتهابات التي تصيب الالخلفية:اللاسااا اا التهاااب بيتياارا يصاايب النهاااز التااسااكي لكمااراه يميااا ان يعياا مكياا الساايدات لااد

ولاده والتوليد.معالن ال الساايدات ه الدراساا فاي المست ااتر الترياي وتهاادا الار تاياايم ماد ادرا وسااكو ذانرياات ها:الهدف

التهابات الاتاس .الوالدات لييتي الوقاي من تام نما دراسا وصاتي مستعر ا فاي المست اتر التريار بعااابر الاولاده انريتالبحث:منهجية

تاام توزياا و وماااابكتهن مااوافاتهن ذعياااات ماان سااتين ساايده والااده بعااد ا ااال ذالبيااااات بواسااق تااياا ا اامعالنااا البياااااات وت كيكهاااا باسااات دام ال زمااا تئج وتماااالاساااتبيان قياااد الدراسااا عااام اساااترنا الاتاااا

الانتما ي وتم رض البيااات في يل نداول. لكعكوم الا صائي الم اريات لايس لاديهن ادرا بمعرفا التهاباات الاتااس سيداتان معظم ال و ت الاتائج: النتائج

لااديهن معرفاا لاايس % 5..7 وان اغكبياا هااالاس الساايدات ا را ااها اساابابها وييتي الوقاياا ماهااا ا المرض. ذبييتي الوقاي من ه

معظااام المتبااا لكوقايااا مااان التهاباااات الاتااااس لااااد او ااا ت الدراسااا ان سااايداتفيماااا ي ااا ساااكو الا ذهان لهاا% بااالرغم مان اادم ادراي4..0 لاديهن سااكو ايناابي لكوقاياا مان التهابااات الاتااسالسايدات المرض.يتتاااارن الااار المعرفااا سااايداته الدراسااا اتوصااال الااار ان اغكاااب الذا كااار اتاااائج هاااذارتياااا:لاصدددةالخ

لاااديهن ساااكو ايناااابي وييتيااا الوقايااا ماها.بياماااا بعاااض هاااولاس السااايداتوالادرا بالتهاباااات الاتااااس ا المرض .ذلكوقاي من همسااتو ادرا وسااكوييات الساايدات فيمااا ي اا التهابااات رفاا ج اارورة او اا ت الاتااائالتوصدديا :

. الوقاي ماها وتذويدهن بالبرامج التعكيمي ا هذا المنالالاتاس و

VI

Table of Contents

Title of Contents Page No

Ayah I

Dedication II

Acknowledgement III

Abstract IV

Abstract (Arabic) V

Table of contents VI

List of table VII

List of figures IX

List of abbreviations X

Chapter one

1.1 Introduction 1

1.2 Problem Statement 2

1.3 Justification/rationale 3

1.4 Objectives 4

Chapter two

2. Literature review 5

Chapter three

3. Research Methodology 13

Chapter Four

4. Results 15

Chapter Five

5. Discussion 36

Chapter Six

6.1 Conclusion 38

6.2 Recommandations 39

Références 40

Appendices 43

VII

List of Table

No Tables Page No

Table 4.1 Participants demographic data 15

Table 4.2 participants Perception regarding Puerperal sepsis 18

Table 4.3 participant Perception regarding common postpartum

infections

18

Table 4.4 participant Perception regarding the complications of

puerperal sepsi

19

Table 4.5 participant Perception regarding the risk factors of

puerperal sepsis

19

Table 4.6 Participants perception regarding causes of puerperal sepsis 20

Table 4.7 Participants perception regarding signs and symptoms of

puerperal sepsis

20

Table 4.8 Participants perception regarding causes of urinary tract

infections

21

Table 4.9 Participants perception regarding signs and symptoms of

mastitis

21

Table 4.10 Participants perception regarding factors affect women

knowledge regarding management of puerperal infections

22

Table 4.11 Participants perception regarding management of puerperal

sepsis

22

Table 4.12 Participant's perception regarding the self-care preventive

measures of puerperal sepsis

23

Table 4.13 participants attitude regarding Prevention of puerperal

sepsis

25

Table 4.14 Participants perception in relation to their age to prevent

puerperal sepsis

26

Table 4.15 Participants perception in relation to their level of education

to prevent puerperal sepsis

27

Table 4.16 Participants perception in relation to their occupation to

prevent puerperal sepsis

28

Table4.17 Participants perception in relation to their parity to prevent

puerperal sepsis

29

VIII

Table4.18 Participants perception in relation to their mode of delivery

to prevent puerperal sepsis

30

Table4.19 Participants attitude in relation to their age to prevent

puerperal sepsis

31

Table4.20 Participants attitude in relation to their education to prevent

puerperal sepsis

32

Table4.21 Participants attitude in relation to their occupation to


33

Table 4.22 Participants attitude in relation to their parity to prevent

puerperal sepsis

34

Table 4.23 Participants attitude in relation to their mode of delivery to


35

IX

List of Figures

No Figures Page No

Fig.4.1 Distribution of the study participant according to their mode of

delivery

16

Fig.4.2 Distribution of the study participant according to their number of

children

17

Fig.4.3 Perception of the participant regarding mothers who are exposed to

puerperal sepsis

24

X

List of abbreviations

Abbreviations Full words

ANC Ante Natal Care

CPP Chronic Pelvic Pain

PID Pelvic Inflammatory Diseases

PPROM Preterm Prelabour Rupture of Membrane

WHO World Health Organization

XI

Chapter one

Introduction

1

1. Introduction:

1.1 Background:

Historically, puerperal sepsis has been a common pregnancy-related condition, which

could eventually lead to obstetric shock or even death. During the 18th century, it took

on epidemic proportions, particularly when home delivery practice changed to delivery

lying-in hospital, puerperal sepsis is infection of the genital tract following child birth

still a major cause of maternal death whereas it is undetected and / or untreated .

As with other obstetric morbidities, the definitions of puerperal sepsis vary from one

study to another, which makes their comparability difficult. Moreover, hospital based

studies are not reliable source of data for developing countries, because many women

do not have access to health facilities. (1)

The women should have to raise their awareness about the causes, signs and symptoms,

risk factors and prevention of puerperal sepsis, and they have to maintain their hygiene

at their homes, also the women should have to improve their health-seeking behaviors

to prevent these carious infections. (1)

Further, various studies also reported that there is a lack of knowledge on puerperal

sepsis and its prevention among postnatal mothers. Since puerperal sepsis is a

preventable factor of maternal morbidity and mortality. Thus; the nurse can ease the

transition from pregnancy to motherhood, Therefore, the nurse need to impotency to

educate mothers about puerperal infection and its prevention to improve the knowledge

and practices regarding puerperal sepsis and its prevention.(3)

Perception is defined as the way you think about something and your idea of what it is

like, the way that you notice things with your senses of sight, hearing etc.; the natural

ability to understand or notice things quickly, the perception process consists of three

stages: selection, organization and interpretation, the two dimensions of Perception are:

the physical dimension and psychological dimension. (4)

2

1. 2 Problem Statement:

Postpartum sepsis accounts for most maternal deaths between three and seven days

postpartum, the rate of an incidence is very high and consequently the mother and

newborn virtually higher infection risk (1,3)

In 2013, over 30.000 maternal deaths (11%) were referred to postpartum sepsis, and is

considering as the third most frequent cause of approximately 290.000 maternal deaths

worldwide. (3)

Moreover, other Studies reported that over 5 million/year of maternal sepsis

occur globally with an estimated 75.000 maternal deaths, and mortality rates attributable

to sepsis approach 33% in low-income settings, unfortunately Infection is a painful fact

of life and the chief cause of death in maternal population. Even though the major

infectious diseases are controlled and still infections are the main cause for mortality

and morbidity. (3)

3

1.3 Justification:

Epidemiologically, over 5 million/ year of maternal sepsis occur globally with an

estimated 75,000 maternal deaths, risk of maternal mortality about 2.1% of all maternal

deaths In high-income countries, 11.6% of maternal deaths. e.g.: 2–2.7-fold higher in

Africa, Asia In low-income countries, risk of long-term morbidity is reported to be 0.1–

0.6 per 1000 deliveries, It includes chronic PID, CPP, bilateral tubal occlusion and

infertility, Sepsis is one of the leading causes of preventable maternal mortality in both

high-income and low income countries, especially in low-income countries, prevention

of puerperal infection are the priority.(2,3)

.

Historically, puerperal sepsis has been a common pregnancy-related condition, which

could eventually lead to septic shock or death, during the 18th century it took on

epidemic proportions, particularly when home delivery practice changed to delivery in

hospital, as there still was total ignorance of sepsis. (1)

The incidence of puerperal sepsis (84.9%) was found to be higher among unbooked

patients that a retrospective cohort study was done at Usmanu Danfodiyo University

Teaching Hospital Sokoto, during antenatal care clients are educated continuously on

the benefits of antenatal care, hygiene, nutrition, hospital delivery and presentation to

hospital when problems arises.(1)

Study in university of Nigeria Teaching hospital, reported that premature rupture of

membrane and non adherence to aseptic conditions during delivery was the commonest

predisposing factor to puerperal sepsis 85.7%. (5)

4

1.4. Objectives:

General objective:

To assess women's perception and attitude toward prevention of puerperal sepsis during

postpartum period.

Specific objectives:

To assess perception of postnatal women regarding prevention of puerperal sepsis.

To investigate post partum mother's attitude toward prevention of puerperal sepsis.

5

Chapter Two

Literature review

5

2. Literature review

2.1 Back ground:

The postpartum is a period of risk, according to world health organization, the postnatal

period is the most vulnerable period for the women and new born, childbirth,

Unfortunately, It can be a difficult period, bringing with it new problems like puerperal

sepsis, Puerperal sepsis continues causes deaths continuously in developing countries

mainly .because of inadequate access to skilled care during and after child birth,

Further, various studies also reported that there is a lack of knowledge on puerperal

sepsis and its prevention among postnatal women.(3)

Maternal Sepsis is often undiagnosed or misdiagnosed because infection begins after

hospital discharge without proper follow-up of cases, unfortunately, infection is a

painful fact of life and the chief cause of death in maternal population, Even though the

major infectious diseases are controlled and still infections are the main cause for

mortality and morbidity. (3)

2.2 Definitions of puerperal sepsis:

Puerperal sepsis is defined as infection of the genital tract occurring at any time between

the rupture of membranes or labor and the 42nd day postpartum in which two or more

of the following are present: pelvic pain, fever (oral temperature 38.5oC or higher on

any occasion) abnormal vaginal discharge delay in the rate of reduction in the size of

the uterus (less than 2 cm per day during the first eight days). (6)

Recent study defined puerperal sepsis as an infection of the genital tract occurring any

time from the rupture of membranes or the onset of labor to 42nd day of postpartum and

signs include increase of body temperature, pelvic pain, abnormal vaginal discharge and

sub-involution.(7)

Infection of the genital tract occurring at any time between the rupture of membranes or

the onset of labor, and the 42nd day postpartum, in which a fever (oral temperature

38.5°C or higher on any occasion) and 1 or more of the following signs and symptoms

are present: Pelvic pain Abnormal vaginal discharge, e.g. presence of pus, abnormal

smell/foul odor of discharge and Sub involution, i.e. (<2cm/day during the first

8days).(8)

Puerperal infection is a more general term that includes sepsis, but also all extra-genital

infections and incidental infections during the period around childbirth: endometritis,

mastitis, perineal and abdominal wounds and urinary tract infections.(6)

6

Common pathogens causing an infection can be: endogenous: organisms that normally

exist in the woman’s genital tract, bowel or skin. Exogenous: arising from outside the

woman, due to poorly treated existing infections, poor hand washing technique, vaginal

exams or other environmental causes.(7)

Maternal complications from Puerperal infection includes: Prenatal complications:

Chorioamnionitis presents a significant risk for PPROM, preterm birth, and cesarean

section, Chorioamnionitis increases maternal risk for postpartum hemorrhage, wound

infections, pelvic abscesses and postpartum endometritis.

Complications from Puerperal infection during labor is chorioamnionitis (Inflammation

of the amnion and/or chorion from ascending pathogens), which can lead to neonatal

sepsis and pneumonia, preterm infant, Respiratory distress and Neonatal mortality of 1-

4% for term infants and 10% for preterm infants.(8)

The most significant long-term complication of puerperal sepsis is infertility resulting

from tubal occlusion, which annually affects 450,000 females. (2)

2.3 Prevention and treatment of Puerperal sepsis:

Postpartum infection occurs in about 1 to 8% of vaginal deliveries, and it is five to ten

times higher following a caesarean section. Puerperal sepsis morbidity affects 2 to 10%

of patients. Pregnancy-related sepsis was the commonest cause of all maternal deaths, It

is clear that the absence or inappropriate use of management protocols has been a major

factor in a large number of maternal deaths due to pregnancy-related sepsis. And the

level of knowledge and practices regarding prevention of puerperal sepsis among

postpartum women was found statistically significant (9)

WHO estimates that the global prevalence of maternal sepsis is 4·4% among live

births, representing more than 5·7 million cases per year, Despite the relative low

prevalence and the availability of interventions for its prevention and treatment,

maternal sepsis remains a life-threatening condition and one of the leading direct causes

of maternal mortality worldwide, accounting for up to 10% of maternal deaths WHO

launches new guidance on interventions for women to prevent and treat infections

occurring during the peripartum period, the overall approach of these recommendations

is to highlight and encourage effective practices that are underused and discourage

practices that are either ineffective or potentially harmful to women, their babies, and

the general public. The guideline recommends routine antibiotic Prophylaxis for the

obstetric conditions for which the risk of maternal infection is high, observational

7

studies, suggest that antibiotic use could reduce infection risk after an invasive

procedure.(10)

Clear recommendations are also made against the use of prophylactic antibiotics for all

women with the aim of reducing infections during pregnancy or following an

uncomplicated vaginal birth, as well as for some obstetric procedures believed to

increase risk of infection such as assisted vaginal birth (with forceps or vacuum) and

episiotomy. The effects of the interventions recommended in the guideline. For

instance, it highlights the need for health the need for health practitioners and managers

to provide an enabling environment for infection prevention and control, changing their

attitudes and practices and mobilizing resources to ensure that adequate sanitation

facilities are in place, hygiene and infection control measures are implemented and

antimicrobial agents are accessible.

Key research priorities were identified, particularly related to conditions or procedures

that are prevalent globally Such as the use of prophylactic antibiotics for episiotomy,

uncomplicated vaginal birth, or prolonged rupture of membranes at term.

The effects of antibiotics given before caesarean section on infant health also require

further investigation. To achieve the desired goal, WHO recommends that the guideline

implementation and its impact should be monitored at the health services, regional, and

country levels, on the basis of clearly defined indicators that are associated with locally

agreed targets.(10)

Puerperal sepsis is an infectious disease and is indeed preventable. Community health

education will improve the health seeking behavior in this environment, improved

personal and environmental hygiene will minimize microbial load, in addition poverty

alleviation and health insurance will make health care affordable, study conducted in

Zambia identified that low socio-economic status is a risk factor for developing

puerperal sepsis, another study also reported that puerperal sepsis is among the cause of

various forms of morbidity among the woman, campaign about the awareness of sepsis

can reduce the overall risk of mortality and morbidity from maternal sepsis in high

income and low-income countries ,safe delivery practices at primary health centers by

trained birth attendants and twenty four hours full laboratory services every day of the

week will go a long way in prevention of this dreaded maternal disease.(11)

8

2.4 Postpartum Care:

2.4.1 Description of Postpartum Care:

Postpartum care remains a vital process and service of the childbearing Period, it is a

time of reflection, of relieving the birth experiences, a time of adjustment to the new

roles and accommodation of the family to the new member, also involves the involution

of the uterus back to non-pregnant state. It is a very special phase in the life of a woman,

postpartum care is defined as care given to the mother and infant just after delivery until

six to eight weeks in order to assess, identify, give support and counseling on infant

breastfeeding, nutrition, immunization safer sex and family planning.(11)

2.5. Postpartum Service:

Postpartum care is a vital part of the childbearing process that the midwife has to

provide for the mother and the baby immediately following birth to the end of

puerperium, health workers who provide care to families during this transitional and

disruptive period may have unique skills and expertise to offer, this includes general

care and assistance given to the woman after delivery, visit by the health worker within

first week following discharge, and the routine postpartum examination which is done at

the end of puerperium 6-8 weeks after delivery, postpartum assessment is the last

examination, which marks the end of puerperium, probably because of the assumption

that mothers would have recovered from effects of pregnancy and childbirth. It aims at

achieving physical, psychological and emotional wellbeing of the mother, the baby and

the family (11)

.

New parents must be made aware of local community care services. Information lines,

telephone calls from birth facility staff, nurse-managed postpartum outpatient clinics,

and, in some areas, home visits provide information and guidance for postpartum

families. Breastfeeding and parenting classes, “baby and me” walks or exercise

sessions, and postpartum support groups may also be available. (12)

According to WHO partly based on the scarce in the literature, but mainly on personal

experience of members of a technical working group on issues relevant to the

postpartum period, formulated the needs of women as follows : -

Information and Counseling on Care of the baby and breastfeeding, changes happens in

their bodies including signs of possible problems, Self care and hygiene, Sexual life,

contraception and Nutrition , women also support from Health workers, Partner and

family-emotional and psychological, Health care for suspected or manifested

9

complications, Time to care for the baby, Help with domestic tasks, Maternity leave,

Social reintegration into her family and community and Protection from abuse and or

violence.(12)

2.6. Women's perceptions:

Many studies have tried to understand how women give meaning to their childbirth

experience, the impact of different factors on this meaning, and the impact of the

perception of childbirth experience on the mothers’ health and well-being particularly

about the postpartum period. Often these women wished for basic information about

postpartum depression fatigue, and when to expect the resumption, of their health,

women felt poorly prepared for the postpartum period in part because functional

health consequences are not well understood (13)

.

2.7. Women's perceptions &Knowledge regarding prevention of

puerperal sepsis:

Transition to parenthood implies important cognitive, emotional and interpersonal

changes. During this period, the childbirth experience is incorporated; negative

perceptions of childbirth experience may lead to emotional problems and negative

Perceptions about the newborn’s behavior,making the development of maternal identity

and parental care more difficult.

The type of delivery seems to be an important factor that should be taken into account

in intervention programs to promote an adaptive and more positive psychological

integration of the childbirth experience, with an impact not only on the mothers’

memories of their childbirth experience, but also on the changes in these perceptions

over time.(13)

Two hospital-based studies conducted in Bangladesh revealed that maternal mortality

due to puerperal sepsis, the study show that two-third of the study participants don’t

know that ensuring balanced diet can prevents puerperal sepsis, the study reported that

health and nutrition education intervention enable the women take away some of the

11

unhealthy traditional postpartum practices, also more than seven-tenths know that the

environment should be free of dust by frequent mopping and restricting visitors prevent

puerperal sepsis and more than eight-tenth know that during periods, use soft sanitary

napkins, change it frequently and maintain hygiene prevents puerperal sepsis.

The above studies contribute to knowledge about women’s perceptions of their

childbirth experience and may help health professionals, such as general practitioners,

obstetricians and pediatricians, to better support patients throughout the motherhood

experience. (13)

One of the predisposing conditions usually leading to puerperal sepsis is the home

delivery in unhygienic conditions. In their study the participants was agreed to maintain

proper hygiene especially around perineum, the study reported that puerperal women

should practice strict hygiene in her postpartum period, most of the study participants

that gave answer correctly about knowledge on prevention of puerperal sepsis, this

reason proved the findings in the study which revealed that 96 percent women were

uneducated and only the rest had below primary level of education who developed

puerperal sepsis. (13)

The findings reported that most of the study participants had poor level of knowledge

regarding prevention of puerperal sepsis, however, the study participants had

satisfactory practice level about prevention of puerperal sepsis. (13)

Vigilant attention to hygiene during delivery, sterilizing labor equipment, materials and

delivery room, and using aseptic techniques before and during delivery, regular

reinforcement of and attention to necessary supplies (e.g. soap, disinfectants) can

prevent much of postpartum sepsis, the community as a whole can be targeted for health

education on the major causes of sepsis prevention and the responsibility of families to

prevent sepsis, This can only happen if the women have a good knowledge on sepsis.( 13)

11

2.8. The preventive measures that the mothers should had to know to

prevent them from infection:

Breast care: Maintenance of adequate breast hygiene especially in the last two

months of pregnancy to prevent breast disorders (cracked nibble, retracted

nibble) that can be during antenatal period till post natal period, regular

continues breast feeding and express residual milk after each feeding to prevent

breast engorgement, use of antibiotic and analgesic as required to prevent

complications (mastitis, breast abscess).(14)

Episiotomy and perineum care: regular changing and use of sanitary pads,

observe episiotomy and perineal area for signs and symptoms of infections

(blood secretion, bad odour and delay of wound healing), clean perineal area

daily with antiseptic solution before changing dressing and keep the area dry,

use of asitz pack after each bowel movement to clean rectal area and relieve

pain and proper hand washing before and after perineal care.(14)

Wound site care: dressing as ordered, clean and dry the area around the wound

daily, maintain good nutrition to promote healing, take the medication as

prescribed, take adequate fluid and avoid practicing wrong habits such as using

of herbals in wound healing. (14)

Nutrition: mothers should eaten nutrient and wide variety of food to meet their

needs for their health and their new born infant, avoid high fat, sugar and salt

diet, and take plenty of water and fluid.(14)

Hygiene: stress proper hand washing before and after perineal care and breast

feeding, frequent changing of perineal pads applying from front to back to

prevent contamination from the rectal area to genital area, showering once or

twice daily using mild soap and avoid soap on nibble and reinforce proper

perineal care and how to rinse the perineum with the peribotile filled with water

after voids or defecates to prevent infection.(14)

Taking preventive medications: use of prophylactic antibiotics for caesarean

births as ordered and take the routine antibiotic prophylaxis following invasive

procedure in which the risk of maternal infection is high.(14)

12

Exercises: routine exercise should be resumed gradually beginning with kegel

exercises on the first postpartum day and by the second week progressing to

abdominal, buttock, and thigh-toning exercises, walking is an excellent form of

exercise that women should have to do during postpartum period.(14)

13

Chapter Three

Research Methodology

13

3. Research Methodology

3.1 Study Design:

Descriptive cross-sectional hospital base study in a turkey hospital.

3.2 Study Setting:

This research was carried out at Al turkey teaching hospital which was inaugurated in

1996 at AL kalakla area and located western to Jabal Awlliea street as a specialized

hospital for the purpose of raising maternal and newborn care, the hospital included

pediatrics, obstetric and gynecological out patients ,labor room with three beds,

postnatal wards divided into two normal and cesarean births with twenty two beds,

antenatal word with ten beds, pediatrics wards where it had twenty beds and sixteen

nurseries also there were a blood bank and laboratory tests ,on 2003 the operations

complex was opened with a room for operations, the study was conducted on the

postnatal wards.

Services: obstetric and gynecological consultations, hospitalizations, deferent types of

laboratory tests and operations including caesarian birth and various obstetrical and

gynecological operations and procedures.

3.3 Study Population:

The target populations for this study were postnatal women in postnatal ward in a

turkey hospital.

3.4 Inclusion criteria:

1/ Primiparous and multiparous postnatal mothers.

2/ whose delivered normally or by cesarean section.

3/ Post natal mothers who are free from any infectious diseases.

3.5 Exclusion criteria:

1/ women did not fulfill the above criteria.

2/ Very sick mothers.

14

3.6 Data Collection tool& technique:

Self-administered questionnaire, structured interview was constructed to assess the

mother's perception and attitude regarding puerperal sepsis and its prevention, the

questionnaire was given to the sixty (60) women.

Part two: twelve closed ended questions, contains statements related to mother's

perception regarding puerperal sepsis and its prevention, the responses were based on a

five points likert scale of perception, whether they were poor, fair, good, very good or

excellent.(15)

Part three: Based on women's attitudes regarding preventive measures of puerperal

sepsis, the responses were based on five points of likert scale, whether they were

strongly disagree, Disagree, Neither agree or disagree (Neutral), Agree or strongly

agree.(15)

3.7 Study variables:

Part 1:#socio-demographic data:

Age, Education, Job qualification, Parity and type of delivery.

Part2: Women's perception regarding puerperal sepsis and its prevention

Part3: Women's attitudes regarding preventive measures of puerperal sepsis

3.8 Sample size:

The total number of postnatal women for this study was sixty (60), convenience

sampling techniques adopted to select the sampling.

3.9 Data Analysis:

The questionnaire was collected and analyzed using Statistical Package for Social

Science (SPSS) SPSS version 16.

3.10 Ethical Consideration:

- Ethical clearance from AlNeelain University.

- A permission from a turkey Hospital Administration.

- An informed consent the participant (women).

15

Chapter Four

Results

16

4. Results

Table 1: participants demographic data n=60

Variable Frequency Percentage

Age

18-24 15 25.0

25-31 33 55.0

32-38 11 18.3

40 and above 1 1.7

Total 60 100.0

Level of

education

illiterate 3 5.0

Basic 18 30.0

secondary 24 40.0

Graduate 15 25.0

Total 60 100.0

Occupation

Employee 4 6.7

House wife 56 93.3

Total 60 100.0

15

16

Figure (4.1): Distribution of the study participant according to their mode of delivery n=60

17

Figure (4.2): Distribution of the study participant according to their number of children n=60

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Multipara Primypara

76.7%

23.3%

Series1

18

Table (4.2): participants Perception regarding Puerperal sepsis n=60

Level of knowledge Frequency Percentage

Poor 32 53.3

Fair 1 1.7

Good 1 1.7

Very good 1 1.7

Excellent 25 41.7

Total 60 100.0

Table (4.3): participant Perception regarding common postpartum infections n=60


Poor 30 50.0

Fair 1 1.7

Good 1 1.7

Very good 1 1.7

Excellent 27 45.0

Total 60 100.0

19

Table (4.4): participant Perception regarding the complications of puerperal sepsis n=60


Poor 37 61.7

Fair 1 1.7

Good 2 3.3

Very good 1 1.7

Excellent 19 31.7

Total 60 100.0

Table (4.5): participant Perception regarding the risk factors of puerperal sepsis n=60


Poor 22 36.7

Fair 1 1.7

Good 1 1.7

Very good 1 1.7

Excellent 35 58.3

Total 60 100.0

21

Table (4.6): Participants perception regarding causes of puerperal sepsis n=60


Poor 45 75.0

Fair 1 1.7

Good 1 1.7

Very good 1 1.7

Excellent 12 20.0

Total 60 100.0

Table (4.7): Participants perception regarding signs and symptoms of puerperal sepsis n=60


Poor 25 41.7

Fair 1 1.7

Good 1 1.7

Very good 2 3.3

Excellent 31 51.7

Total 60 100.0

21

Table (4.8): Participants perception regarding causes of urinary tract infections n=60


Poor 29 48.3

Fair 1 1.7

Good 1 1.7

Very good 1 1.7

Excellent 28 46.7

Total 60 100.0

Table (4.9): Participants perception regarding signs and symptoms of mastitis n=60


Poor 28 46.7

Fair 1 1.7

Good 1 1.7

Very good 1 1.7

Excellent 29 48.3

Total 60 100.0

22

Table (4.10): Participants perception regarding factors affect women

knowledge regarding management of puerperal infections n=60


Poor 23 38.3

Fair 1 1.7

Good 1 1.7

Very good 1 1.7

Excellent 34 56.7

Total 60 100.0

Table (4.11): Participants perception regarding management of puerperal

sepsis n=60


Poor 26 43.3

Fair 2 3.3

Good 1 1.7

Very good 1 1.7

Excellent 30 50.0

Total 60 100.0

23

Table (4.12): Participants perception regarding the self-care preventive

measures of puerperal sepsis n=60


Poor 31 51.7

Fair 2 3.3

Good 1 1.7

Very good 1 1.7

Excellent 25 41.7

Total 60 100.0

24

Figure (4.3): Participants Perception regarding mothers who are exposed

to puerperal sepsis n=60

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Excellent very good good Fair Poor

31.6%

1.7% 1.7% 1.7%

63.3%

Series1

25

Table (4.13): Participants attitude regarding Prevention of

puerperal sepsis n=60

Items

Strongly

disagree

disagree Neutral Agree Strongly

agree

Count %

Count %

Count %

Count %

Count %

Keep body resistance high - by eating

well and treating all ailments 23.3 11.7 11.7 711.7 4981.7

Preservation of the breast feeding baby

immediately after birth

11.7

11.7

11.7

711.7

5083.2

The under wear be sterilized properly 11.7 11.7 11.7 813.3 4981.7

Observe the perineum in case of

episiotomy for S&S of infection (blood

secretion-bad odor-delay wound

healing) should go to the doctor

immediately

11.7 11.7

46.6

2745.0

2745.0

Follow up involution process in15 days 11.7 11.7 610.0 4473.3 813.3

Follow up odour,colour and amount of

lochia

11.7

11.7

610.0

4168.3

1118.3

Attention to good nutrition 11.7 11.7 58.3 4371.7 1016.6

Take enough rest 11.7 11.7 11.7 4371.7 1423.3

Drink plenty fluids intake constantly 11.7 11.7 11.7 4575.0 1219.9

Avoiding using vaginal dosh 11.7 11.7 11.7 4575.0 1219.9

Far from source of infection 11.7 11.7 2541.6 3050.0 35.0

Avoiding practicing sexual activities

during first 40 days 11.7 11.7

2948.3

26 43.3

35.0

Interest in sports such as daily activities 11.7 11.7 3050.0 2541.6 35.0

Careful to reduce visitors and make sure

that they are free from respiratory or any

infectious diseases

00.0 11.7

3456.7

22 36.6

35.0

Total 141.7

141.7

14517.3

41349.1

25430.2

26

Table (4.14): participants perceptions in relation to their age to prevent


Age

Total 18-24 25-31 32-38 40 and above

Preventative

measures about

puerperal sepsis

Poor Count 10 20 1 0 31

% of Total 16.7% 33.3% 1.7% .0% 51.7%

Fair Count 1 0 1 0 2

% of Total 1.7% .0% 1.7% .0% 3.3%

good Count 0 1 0 0 1

% of Total .0% 1.7% .0% .0% 1.7%

very

good

Count 0 0 1 0 1

% of Total .0% .0% 1.7% .0% 1.7%

Excell

ent

Count 4 12 8 1 25

% of Total 6.7% 20.0% 13.3% 1.7% 41.7%

Total Count 15 33 11 1 60

% of Total 25.0% 55.0% 18.3% 1.7% 100.0%

P value=0.00

27

Table (4.15): participants perceptions in relation to their education to prevent puerperal

sepsis n=60

Level of education

Total illiterate Basic secondary graduate

Preventative measures

about puerperal sepsis

Poor Count 3 13 13 2 31

% of Total 5.0% 21.7% 21.7% 3.3% 51.7%

fair Count 0 1 0 1 2

% of Total .0% 1.7% .0% 1.7% 3.3%

good Count 0 0 1 0 1

% of Total .0% .0% 1.7% .0% 1.7%

very good Count 0 0 0 1 1

% of Total .0% .0% .0% 1.7% 1.7%

Excellent Count 0 4 10 11 25

% of Total .0% 6.7% 16.7% 18.3% 41.7%


% of Total 5.0% 30.0% 40.0% 25.0% 100.0%

P value=0.05

28

Table (4.16): participants perceptions in relation to their occupation to

prevent puerperal sepsis n=60

Occupation

Total Employee Housewife



Poor Count 3 28 31

% of Total 5.0% 46.7% 51.7%

fair Count 0 2 2

% of Total .0% 3.3% 3.3%

good Count 0 1 1

% of Total .0% 1.7% 1.7%

very good Count 0 1 1

% of Total .0% 1.7% 1.7%

Excellent Count 1 24 25

% of Total 1.7% 40.0% 41.7%

Total Count 4 56 60

% of Total 6.7% 93.3% 100.0%

P value=0.90

29

Table (4.17): participants perceptions in relation to their parity to prevent


Parity

Total Primypara Multipara

Preventative

measures about

puerperal sepsis

Poor Count

% of Total

10 21 31

16.7% 35.0% 51.7%

Fair Count 1 1 2

% of Total 1.7% 1.7% 3.3%

Good Count 0 1 1

% of Total .0% 36.7% 1.7%


% of Total .0% 1.7% 1.7%


% of Total 5.0% 1.7% 41.7%

Total Count 14 46 60

% of Total 23.3% 76.7% 100.0%

P value 0.33

31

Table (4.18):participants perceptions in relation to their mode of delivery to


Mode of delivery

Total Vaginal Cesarean



Poor Count 20 11 31

% of Total 33.3% 18.3% 51.7%

fair Count 1 1 2

% of Total 1.7% 1.7% 3.3%

good Count 1 0 1

% of Total 1.7% .0% 1.7%


% of Total .0% 1.7% 1.7%


% of Total 13.3% 28.3% 41.7%


% of Total 50.0% 50.0% 100.0%

P value 0.09

31

Table (4. 19): participants attitude in relation to their age to prevent


Age

Total 18-24 25-31 32-38 40 and above

Attitude Strongly

disagree

Count 2 0 0 0 2

% of Total 3.3% .0% .0% .0% 3.3%

disagree Count 2 0 0 0 2

% of Total 3.3% .0% .0% .0% 3.3%

Neutral Count 10 0 0 0 10

% of Total 16.7% .0% .0% .0% 16.7%

Agree Count 1 28 0 0 29

% of Total 1.7% 46.7% .0% .0% 48.3%

strongly agree Count 0 5 11 1 17

% of Total .0% 8.3% 18.3% 1.7% 28.3%


% of Total 25.0% 55.0% 18.3% 1.7% 100.0%

P value=0.00

32

Table (4.20): participants attitude in relation to their level of education to prevent


Level of education

Total illiterate basic secondary graduate

Attitude Strongly

disagree

Count 2 0 0 0 2

% of Total 3.3% .0% .0% .0% 3.3%

disagree Count 1 1 0 0 2

% of Total 1.7% 1.7% .0% .0% 3.3%

Neutral Count 0 10 0 0 10

% of Total .0% 16.7% .0% .0% 16.7%

Agree Count 0 7 22 0 29

% of Total .0% 11.7% 36.7% .0% 48.3%

strongly agree Count 0 0 2 15 17

% of Total .0% .0% 3.3% 25.0% 28.3%


% of Total 5.0% 30.0% 40.0% 25.0% 100.0%

P value=0.00

33

Table (4.21): participants attitude in relation to their occupation to prevent


Occupation

Total Employee Housewife

Attitude Strongly

disagree

Count 2 0 2

% of Total 3.3% .0% 3.3%

disagree Count 2 0 2

% of Total 3.3% .0% 3.3%

Neutral Count 0 10 10

% of Total .0% 16.7% 16.7%

Agree Count 0 29 29

% of Total .0% 48.3% 48.3%

strongly

agree

Count 0 17 17

% of Total .0% 28.3% 28.3%

Total Count 4 56 60

% of Total 6.7% 93.3% 100.0%

P value=0.00

34

Table (4.22): participants attitude in relation to their parity to prevent


Parity

Total Primypara Multipara

Attitude Strongly

disagree

Count 2 0 2

% of Total 3.3% .0% 3.3%


% of Total 3.3% .0% 3.3%


% of Total 16.7% .0% 16.7%

Agree Count 0 29 29

% of Total .0% 48.3% 48.3%

strongly

agree

Count 0 17 17

% of Total .0% 28.3% 28.3%


% of Total 23.3% 76.7% 100.0%

P value =0.00

35

Table (4.23): participants attitude in relation to their mode of delivery to


Mode of delivery

Total Vaginal Cesarean

Attitude Strongly

disagree

Count 2 0 2

% of Total 3.3% .0% 3.3%


% of Total 3.3% .0% 3.3%


% of Total 16.7% .0% 16.7%

Agree Count 16 13 29

% of Total 26.7% 21.7% 48.3%

strongly agree Count 0 17 17

% of Total .0% 28.3% 28.3%


% of Total 50.0% 50.0% 100.0%

P value=0.00

36

Chapter Five

Discussion

36

5. Discussion

Puerperal sepsis is serious form of septicemia contracted by women during or soon after

child birth, miscarriage or unsafe abortion, it has been found to be the second most

common cause of maternal morbidity and mortality in the developing world. It was

observed that internationally puerperal infection has indexes ranging from 3 to 20%,

with values of 9%.

The present study documented that the majority of age of the women were ranged

between 25-31 years 55.0%. they were housewives 93.3%, and their educational

qualification were secondary level of education 40.0%, and also the majority of them

they were multiparous 76.7%, while they were at the same number of mode of delivery

50.0%/50.0%.

Over all perception of postnatal women concerning the perception of postnatal women

on prevention of puerperal sepsis the study presented that the majority of the women

had poor perception about definition 53.3% causes 75.3%,signs and symptoms 61.0%,

risk factors 58.3% and preventive measures 51.7% ,in contradiction with the finding

regarding to age of the women, the majority of them 33.3% they were at the group of

age 25-31years they were poor perception about preventative measures regarding

puerperal sepsis, there Our results in agreement with study at the BeniSuef general

hospital in Egypt, their result have shown that the great majority of the women had

poor score of knowledge related to the definition, causes, symptom, preventive

measures of puerperal sepsis.(3)

In relation to women's level of education , the study presented that most of these

women had attained only basic and secondary school education they were poor

perception regarding puerperal sepsis and it is prevention 21.7% ,in relation to job these

women they were house wives and they were poor perception regarding puerperal sepsis

and it is prevention 64.7%, that similarly to, another study carried out in two hospitals

in Nandi County on Kenya, according to them lack of educational qualification and

inadequate resources to afford the cost of health facility, poverty constraints construct a

social barrier the access of many women to health service and lack of preventative

measures regarding puerperal sepsis.(2)

37

The present study assigned that, 76.7% of the women were multiparous while 23.3%

were primiparous, and the women who they were multiparous they had good perception

36.7% and positive attitude 48.3% compared with those who they were primiparous

they had poor perception 3.3%, Perhaps, this may have resulted from the fact that the

young inexperienced mothers had lack of perception on the benefits of health care

services, and health-seeking behavior to prevent this carious infection.

In relation to mode of delivery, the finding revealed that the women whose delivered

vaginal birth they had poor perception of preventative measures regarding puerperal

sepsis (33.3)%, a researcher on the similar subject conducting his study in Bishop

Shanahan hospital Nsukka, in Nigeria, he revealed that the women who had vaginal

delivery(5.5%) they were poor of knowledge to prevent puerperal sepsis.(5)

Over all attitude of the women to prevent puerperal sepsis in relation to their

demographic data, the present study, presented that the women who their age between

25-31years they had positive attitude related to the self-care preventative measures of

puerperal sepsis 46.7%.

The study revealed that the women who their educational qualification secondary 36.7%

and graduated 25.0% had positive attitude compared with those who were basic 11.7%

and illiterate 3.3% regarding prevention of puerperal sepsis.

The study revealed that the women who they were housewives 93.3% they had a

significant positive attitude 48.3% of the self-care preventative measures of puerperal

sepsis, compared to those who were employee 3.3% to prevent the infection.

The present study documented that, the women who their type of birth were vaginal

birth they had appositive attitude on prevention of the puerperal sepsis 28.3%,

compared to the women who delivered caesarian birth 26.7% that in line with the study

conducted in Bishop Shanahan hospital Nsukka, Nigeria in their study they reported that

the rate of puerperal sepsis is higher in women who have delivered caesarean section

(7.4%) than in women who had vaginal delivery (5.5%), due to their lack of knowledge

and self-care preventive measure regarding puerperal sepsis.(14)

38

Chapter Six

Conclusions

Recommendations

References

Appendices

38

6.1 Conclusions

Based on the findings of the present study, it can be concluded that the majority of

postpartum women had poor in the essential knowledge and perception regarding

puerperal sepsis and its prevention also results of this study supported the investigated

hypothesis of the study, this study are limited to only the hospital environment. The

nature and extend of the impact of this disease could be different in various settings.

Therefore, further community-based studies are needed to be conducted on the same

issue, the study concluded that the postnatal mothers had poor\perception related to

puerperal sepsis and its prevention while they had a positive attitude on prevention of

this infection.

39

6.2 Recommendations on the light of the study findings, the researcher

recommended that to the ministry of health:

Implementation of Puerperal sepsis guidelines and can be introduced to the

women antenatal and then it can be used postnatal.

The findings underscored the necessity to raise the women's perceptions and

attitude on puerperal sepsis and provide them with educational programs in the

investigated area.

There is a need to enlighten the community on the need for ANC attendance,

skilled attendant at delivery and hospital delivery under aseptic conditions and

also maintaining high hygiene after delivery.

Further extensive and intensive researches are needed in this area with a large

sample size.

Further researches are needed regarding factors and barriers associated with the

utilization of self-care practices through reproductive years for women as well as

for prevention and management of various obstetrics and gynecological

problems.

41

References

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Hospital, Sokoto: Aten year review. European Journal Of Pharmaceutical and

Medical Research {Internet}.2018 {cited 27 September 2020}; 5(4):PP569-573

Available from: http//ww.researchgate net/publication/324227834.

2. Chepchirchir MV, Nyamari J and Keraka M. Associated factors with Puerperal

Sepsis among Reproductive Age Women in Nandi County, Kenya. Journal of

Midwifery and Reproductive Health. 2017{cited 27 September 2020}; 5(4):

PP1032-1040. DOI: 10.22038/JMRH.2017.9348.

3. Ayat M.A.S.O.U.D, Omar M.A.S.O.U.D and N.A.H.E.D Moussa Saber

Effectiveness of Puerperal Sepsis Self-Care Guideline on Women's Health

during Pueriperium .IOSR Journal of Nursing and Health Science (IOSR-

JNHS).2016 {cited 27 September 2020};5(6): PP1940-2320.

4. Qing. O.U.A brief Introduction to Perception. Studies in Literature and

Language,2017;{cited 27 September2020}.15(4),18-220.Availablefrom:

http://www.cscanada.net/index.php/sll/article/view/10055doi:http://dx.doi.org/1

0.3968/10055.

5. Momoh.M.A, Ezugwe, O.J, Causes and Management of Puerperal Sepsis

.Department of Pharmaceutics ,University of Nigeria Teaching hospital Enugus,

Nigeria. School of Midwifery , Bishop Shanahan hospital Nsukka,

Nigeria.c2010; {cited 27 September 2020}.4(3), pp.153-158.

6. Jeak, B.A.M.F.O.Managimg the risks of sepsis in pregnancy. Maternal Sepsis

.Best Pract Res ClinObstetGynaecol. October 2013; {cited 27sept 2020}.PP 95-

583. {Online} .Available from:http://dx.doi.org/10.1016/j. bpobgyn .2013.

04.003.

http://dx.doi.org/10.1016/j.bpobgyn.2013.04.003

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7. Karsnitz .DB. Puerperal Infections of the Genital Tract: A Clinical Review.

Journal of Midwifery & Women’s Health. Royal College of Obstetricians and

Gynecologists. November 2013; {Cited 27 September 2020}.58(6): 42- 632.

8. Arulkumaran N, Singer M. Puerperal sepsis. Best Pract Res

ClinObstetGynaecol. December 2013; {cited 27 September 2020}.27(6):893-

902. http://dx.doi.org/10.1016/j.bpobgyn.2013.07.004.

9. Shirin.S.U.L.T.A.N.A,Fatema.Z.O.H.R.A.M.E.T.H.E,Faisal.

M.U.H.AM.M.A.D. and AbmA.L.A.U.D.D.I.N.C.H.O.W.D.H.U.R.Y.

Knowledge and practice regarding prevention of puerperal sepsis among

postpartum women attending a private hospital in Bangladesh. International

Journal of Research in Medical Sciences Sultana Set al Int J Res Med Sci. 29

October 2018; {cited 27 September 2020}.6(10), pp.3265-3269.Available from:

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184029

10. Stein C, D.O.L.E.A.C.New WHO guidance on prevention and treatment of

maternal peripartum infections November 2015{cited 27 September

2020}.{online},PP.667-668. Available from:www.thelancet.com/lancetgh.

11. Mavis kebalepile ,T.A.P.I.W.A .An Evaluation of the Quality of Midwives

Provide During the Postpartum Period in Nor Botswana. June 2001. (cited 27

September 2020) PP: 10-20.

12. Mennah.M.R.F.A.D.I.N.D.I.N.G. Assessment of Knowledge, Attitude and

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http://www.thelancet.com/lancetgh

42

13. Ana A.l.B.E.R.T, Barbara F.I.G.UE.I.R.E.D, Raquel C.O.S.T.A, Alexandra

P.A.C.H.O and Alvaro P.A.I.S. Perception of the childbirth experience:

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14. James. DC, Postpartum Physiologic Adaptations. In: Kr, S.I.M.P.S.O.N

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http://dx.doi.org/10%20.1080/02646830801918414

43

Appendices

43

Annex: showed the map of Turkey hospital where the study take place.

44

Questionnaire

Women's Perception and attitude in Prevention of Puerperal Sepsis

during Post-Partum Period in A turkey teaching hospital 2019-2020

Date............

Serial No..........

Part one:

back ground data:

1) Age:

a) 18 -24 ( )

b) 25 – 31 ( )

c) 32 – 39 ( )

d) 40 and Above ( )

2) Level of education:

a ) Illiterate ( )

b) Primary Education ( )

c) Secondary Education ( )

d) University Education ( )

3) Occupation:

Working ( )

Not working ( )

4) Mode of delivery:

Vaginal ( )

Cesarean ( )

Parity: 5

Primypara ( )

Multipara ( )

45

Part two:

Women's perceptions and knowledge regarding puerperal sepsis

1-Puerperal sepsis is:

(a) A genital tract infection occurring at any time within the rupture of extra placental

membranes.( )

(b) Disease is characterized by two or more of such symptoms as pelvic pain, fever.( )

(c) The disease associated with vaginal discharge.( )

(d) Delay in the reduction of the uterus size.( )

(e) Frequent vaginal examination can lead to puerperal infection ( )

2- Common postpartum infections include:

a) Metritis ( )

b) Post partum wound infections, such as caesarean section and episiotomy( )

c) Urinary tract infections ( )

d) Mastitis ( )

3-Puerperal sepses a serious type of post partum infections associated with:

(a) Septicemia ( )

(b) Vaginal discharge ( )

(c) Peritonitis or abscess formation leading to surgery ( )

(d) Endotoxic shock ( )

(e) Increase Mortality among mothers.( )

4-the risk factors of puerperal sepsis are:

( a) Irregular antenatal visit ( )

(b) Mode of delivery vaginal delivery or caesarean section ( )

(c)Long duration of labour ( )

(d)Long duration of rupture of membranes ( )

(e)Anemia with pregnancy ( )

5- Metritis is an infectious condition that involves the endometrium, deciduas and

adjacent myometrium of the uterus which happened due to:

a) Early rupture of the amniotic sac.( )

b) As a consequence of labor, birth, and associated manipulations( )

c) Anaerobic and aerobic bacteria can contaminate the uterus from bowel( )

d) Caesarean incision,( )

46

e) Full bladder ( )

6- Wound Infections break in the skin or mucous membranes, sites of wound

infection include cesarean surgical incisions, the episiotomy site in the

perineum:

a) Some infections may not manifest until after discharge.( )

b) Signs symptoms to look for should be included in all discharge teaching.( )

c) Which associated by a low-grade fever (<100.4°F). ( )

d) Poor appetite and a low energy level persist for a few days. ( )

e) Severe pain in the wound site. ( )

7- Urinary tract infections are most common cause of puerperal infections

which happened due to:

a) Urinary catheterization. ( )

b) Frequent vaginal examinations .( )

c) Genital trauma increase the likelihood of a urinary tract infection. ( )

d) Decrease fluids intake and dehydration.( )

e) Poor premium hygiene ( (

8- Mastitis inflammation of breast tissues one of common causes of puerperal

infections.

a)Flulike symptoms, including malaise, fever, and chills( )

b) Tender, hot, red, painful area on one breast ( )

c) Breast tenderness ( )

d) Cracking of skin or around nipple or areola ( )

e) Breast distention with milk ( )

9- Factors affect women knowledge regarding management of puerperal

infections:

(a) Lacked adequate information on puerperal sepsis ( )

(b) Delayed in seeking for health care service.( )

(c) High levels of poverty and ignorance. ( )

(d) The lack of funds prompts these women to try cheap forms of treatment including

herbs( )

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(e) Failure to maintain personal hygiene at their homes. ( )

10-Management of puerperal infections which focus on client teaching is essential

about:

a) Review and emphasizing the danger signs and symptoms Most importantly.( )

b) Stress proper hand washing, especially after perineal care and before and after

breastfeeding.( )

c) Promote breastfeeding, including proper breast care.( )

d) Antibiotic therapy if ordered.( )

e) Wound dressing and rehydration.( )

11-The self care preventative measures from puerperal sepsis:

a) Hands washing before and after perineal care ( )

b) Changing pads regularly ( )

c) Clean genital and perineal area several times daily with antiseptic solution before

changing dressing ( )

d) Drying the perineum well with clean and dry towel ( )

(e) Avoiding of practicing the wrong habits after birth e.g.: use of herbals in wound

healing, sitting in hot water and used of un sterilized pads ( )

12- The most mother who are exposed to puerperal sepsis:

(a) Mothers with inadequate nutrition. ( )

b) Mothers likely not to have attended the antenatal care visits.( )

(c) Mothers with poor hygienic methods. ( )

(d) Limited access to adequate and timely therapy. ( )

(e) Mothers with poor health-seeking behaviors. ( )

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Part three:

Women's attitudes regarding prevention of puerperal sepsis

Based on women's attitudes regarding puerperal sepsis, please tick mark whether they

are Strongly disagree (SD), Disagree (D) , Neutral (N) , Agree (A) or strongly agree

(SD

Strongly

agree

Agree Neutral Disagree

Strongly

disagree

Item

No

Keep body resistance high - by eating

well and treating all ailments

1

Preservation of the breast feeding baby

immediately after birth

2

The under wear be sterilized properly 3

Observe the perineum in case of

episiotomy for S&S of infection

(blood secretion-bad odour-delay

wound healing)should go to the doctor

immediately

4

Follow up involution process in15

days

5

Follow up odour,colour and amount of

lochia

6

Attention to good nutrition 7

Take enough rest 8

Drink plenty fluids intake constantly 9

Avoiding using vaginal dosh 11

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Far from source of infection 11

Avoiding practicing sexual activities

during first 40 days

12

Interest in sports such as daily

activities

13

Careful to reduce visitors and make

sure that they are free from respiratory

or any infectious diseases

14

Al Neelain University Graduate College Women's Perception ...

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