https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article Mothers’ Awareness Regarding Home Care Management of a Preterm Baby at the Rapareen Pediatric Teaching Hospital in Erbil City. ABSTRACT World Health Organization (WHO) states that the preterm baby is a baby born alive before 37th week of pregnancy is complet- ed, or an infant’s birth before the 37th week after the first day of the last men- strual period [1]. The preterm babies are divided into three sub-categories based on gestational age: an extremely preterm baby (<28 weeks), very preterm baby Background and objectives: Preterm birth is a global health issue that occurs in every country. Every year, 15 million preterm infants are born worldwide, and one out of ten is a preterm infant. Sixty percent of preterm infants are born in developing countries. This study aimed to assess mothers' awareness regarding home care management of a preterm baby at the Rapareen Pediatric Teaching Hospital in Erbil in the Kurdistan Region of Iraq. Method: A quantitative, descriptive, cross-sectional study was carried out in the Neonatal Intensive Care Unit at the Rapareen Pediatric Teaching Hospital in Erbil from the 7th of Oc- tober 2018 to the 15th of October 2019. A purposive, non-probability sampling technique was used, and 130 mothers were respectively recruited to the study. A questionnaire was developed by the researcher and the research data were collected by direct, face-to-face interviews. Descriptive statistics in the form of frequencies, percentages, and interferential chi-square test were used to analyze the data. Results: More than half (53.8%) of the mothers were 25-33 years old and the majority (77.7%) of them were housewives. The main finding of the study is that most mothers had a neutral level of awareness regarding thermoregulation, breastfeeding, vaccinations, and recognizing danger signs. At the same time, most of the mothers were not aware of the infection prevention, and there was a very high, statistically significant association be- tween mothers' awareness regarding thermoregulation and occupation and a type of fami- ly. Furthermore, there was a statistically significant association between the mothers' awareness regarding breastfeeding and their residency and a type of delivery, and a statis- tically significant association between the mothers' awareness regarding infection preven- tion and their occupation and economic status. Finally, there was a statistically significant association between the mothers' awareness of vaccinations and their age and the type of delivery, and there was a statistically significant association between the mothers' aware- ness about the danger signs and the economic status. Conclusion: The study concluded that mothers who have a preterm baby at the Rapa- reen Pediatric Teaching Hospital in Erbil have poor awareness regarding the care of their babies at home. Keywords: Preterm babies; Mothers; Homecare; Awareness; Rapareen; Erbil Chawarwan Saleem Abdullah; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. (Correspondence: chawarwan.abdulla@gmail.com ) Shukir Saleem Hassan; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. 163 Erbil Journal of Nursing & Midwifery Received: 2/8/2019 Accepted: 13/10/2019 Published: 30/11/2019 INTRODUCTION mailto:chawarwan.abdulla@gmail.com https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article (28 to <32 weeks), and moderate to late preterm baby (32 to <37 weeks) [2]. Every year 15 million babies are born premature- ly and their possibility for life differs dra- matically around the world. For example, in countries with high income, about 1.2 million preterm babies were registered [3]. In 2010, more than 60% of preterm ba- bies were born in Sub-Saharan Africa and South Asia. The countries with the highest numbers of preterm births include Brazil (9.2%), the United States of America (12%), India (13%) and Nigeria (12.2%), demon- strating that the preterm birth is a global problem The rate of preterm births in Iraq, Iran, and Turkey is 6.5%, 11.5,%, and 11.9% respectively [4].The cause of more than half of the preterm births is idiopathic, but some maternal health conditions like pre- eclampsia, gestational diabetes mellitus, polyhydramnios, and maternal chronic con- ditions like hypertension and diabetes are also related to preterm birth [5]. About 30– 35% of preterm births are related to medi- cal or obstetric complications, 40–45% of them are due to spontaneous preterm la- bour, and 25–30% of preterm births are caused by a preterm pre-labour rupture of membranes (PPROM) [6]. More than 85% of newborn deaths are related to the com- plications of prematurity, and neonatal in- fections and complications of prematurity are currently the second leading cause of death [7].Complications of preterm labour are divided into two categories: short-term and long-term complications. The short- term complications include breathing prob- lems, brain problems, and premature im- mune system problems when babies are born too soon and are more susceptible to infection. The long-term complications of preterm labour include cerebral palsy, im- paired cognitive skills, behavioural and psy- chological problems, and chronic health issues such as asthma and feeding prob- lems [8]. Several medical strategies based on the research evidence are used to pre- vent preterm birth such as progesterone supplementation, cervical cerclage and maternal education regarding avoiding cigarette smoking and alcohol [9].Home care management refers to the care of children with simple or complex health problems and their families in their places of residence for the aims of promoting, maintaining, or restoring health, or for boosting the level of independence while decreasing disability and illness. Some children with multiple health problems after discharge from a hospital need more specific care at home to prevent re- admission [10]. Although all babies need appropriate home care after birth, prem- ature babies are especially susceptible to temperature irregularities, feeding diffi- culties, low blood sugar level, infections and breathing difficulties. Mothers should be aware of and be able to provide care for their preterm babies at home such as thermal care by wrapping and drying ba- by, covering baby's head, providing skin- to-skin care, giving breast milk, which is important for a preterm baby nutritional- ly, immunologically and developmentally. Premature babies have a higher risk of bacterial sepsis, which is why mothers should be aware of and continually do basic hygienic practices such as hand washing, maintaining a clean environ- ment and visiting restrictions, and as- sessing for general danger signs of illness [11]. This study aimed to assess mothers’ awareness regarding home care manage- ment of a preterm baby regarding ther- moregulation, feeding, immunization, in- fection prevention, and danger signs at the Neonatal Intensive Care (NICU) Unit in Erbil, and to find out the association between home care management, mothers’ awareness and selected socio- demographic characteristics. 164 Erbil Journal of Nursing & Midwifery https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article such as the age of the mother, marital sta- tus, occupation, level of education, reli- gion, type of family, economic status, and type of delivery. The second part con- tained an assessment of maternal aware- ness regarding preterm baby home care. A three-point Likert Scale was used (0 for not awareness, 1 for neutral awareness, and 2 for awareness) and consisted of 31 items. The calculation of overall mothers’ awareness was categorized into three groups: poor awareness (0-20), fair awareness (21-41), and good awareness (42-62). The validity of the study instru- ment was determined through the panel of 15 experts of different specialities. The majority of the experts agreed upon the items of the study instrument. A pilot study was conducted on 15 mothers who were randomly selected. The Pearson cor- relation(r) was 0.81. Ethical approval was obtained from the Scientific and Ethical Committees of the College of Nursing of Hawler Medical University on 10th June 2019, the Erbil Directorate of Health, Min- istry of Health, and the director of RPTH. The verbal permission was obtained from the mothers before starting the interview. The data were analyzed using IBM SPSS Software for Statistical Analysis Version 25, and descriptive statistics (frequency and percentage) were calculated. The in- ferential statistical analysis (Chi-square and Fisher's exact test)) was conducted to find out the association between varia- bles. The p-value was considered statisti- cally significant if it was ≤ 0.05, which indi- cated a rejection of the null hypothesis. A total of 130 mothers were interviewed. The majority, 70 (53.8%) of respondents were between 25-33 of age, and most, 101 (77.7%) were housewives, while 3 (2.3%) were private employees.43.1% of mothers were illiterate and only 1.5% A quantitative, cross-sectional, descriptive study was carried out to assess the aware- ness of mothers who attended the NICU at the Rapareen Pediatric Teaching Hospital (RPTH) in Erbil. The mothers were asked to participate in the study about the home care management of a preterm baby in terms of thermoregulation, feeding, im- munization, infection prevention, and danger signs. The data collection lasted from the 7th of October 2018 to the 15th of October 2019. A non-probability pur- posive sample of 130 mothers was recruit- ed to participate in the study using a for- mula which was developed by Taro Yama- ne in 1967 (, , n=115) [39]. In this formula, n = the sample size, N= the size of the population (RPTH’s reported number of admissions of preterm infants every month was 40 so the estimated popula- tion for four months was 160), e= the al- pha-error of 0.05. The target population consisted of mothers who delivered prem- ature babies. Preterm babies who re- ceived home care management by moth- ers at home were included in the study, while orphan children whose mother died, mothers with psychological problems, ba- bies with congenital anomalies, or who were admitted to the NICU from the la- bour room were are excluded from the study. After the calculation of the sample size using the Yamane formula, the re- searcher considered 115 cases of mothers as a sample size. In order to obtain relia- ble data, the researcher has increased the sample size to 130 cases. The data were gathered through a direct interview (face- to-face) using the questionnaire, which was prepared by the researcher. Each in- terview session took approximately 30-45 minutes. The questionnaire contained two main parts. The first part, the socio- demographic characteristics, included the mother's demographic characteristics 165 Erbil Journal of Nursing & Midwifery METHODS RESULTS https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article had a postgraduate level of education. 43.8% of mothers lived in urban areas. The majority of participants (69.2%) were in a nuclear family. As for the economic status of participants, results showed that more than half (63.1%) had sufficient income for daily needs, and in 12.3% of cases, the in- come exceeded economic needs. Over one third (46.2%) of mothers delivered their 166 Erbil Journal of Nursing & Midwifery babies by a Cesarean Section (C\S) (Table1). According to the Table 2, most (66.2%, 70%, 58.5%, and 66.9%) of moth- ers had neutral awareness regarding ther- moregulation, breastfeeding, vaccinations, and danger signs respectively, while 67.7% of participants were completely not aware regarding infection prevention. Table 1: Socio-demographic Characteristics of Mothers. (n=130) Mothers’ Socio demographic characteristics No. (%) Mother's age 16-24 24 (18.5) 25-33 70 (53.8) 34-42 36 (27.7) Occupation Housewife 101 (77.7) Governmental employee 20 (15.4) Private employee 3 (2.3) Student 6 (4.6) Level of education Illiterate 56 (43.1) Able to read and write 13 (10) Primary school graduate 11 (8.5) Secondary school graduate 21 (16.2) Institute graduate 12 (9.2) College graduate 15 (11.5) Postgraduate 2 (1.5) Residency area Rural 31 (23.8) Urban 57 (43.8) Suburban 42 (32.3) Type of family Nuclear 90 (69.2) Joint 14 (10.8) Extented 26 (20) Economic status Type of delivery Sufficient for daily needs 82 (63.1) Insufficient 32 (24.6) Exceeds needs Normal delivery Cesarean section Episiotomy 16 49 60 21 (12.3) (37.7) (46.2) (16.2) Total 130 (100) https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article and a statistically highly significant associa- tion between awareness of infection pre- vention and their economic status (p-value = 0.004). Our study demonstrated that there was a statistically significant associa- tion (p-value < 0.05) between mothers' vaccinations awareness and their age and a type of delivery. There was no significant association be- tween mothers' awareness of vaccinations and other socio-demographic characteris- tics such as level of education, occupation, residency, type of family, and economic status (Table 6). There was only a statistically significant association between mothers’ awareness regarding danger signs and their economic status (p-value = 0.013) (Table7). 167 Erbil Journal of Nursing & Midwifery Table 3 shows the association between mothers’ awareness regarding thermoreg- ulation and selected socio-demographic characteristics and demonstrates that there was statistically a very highly signifi- cant association between occupation and a family type of mothers and their home care awareness regarding thermoregula- tion (p - value=0.001). There was no statis- tically significant association between mothers’ thermoregulation awareness and other socio-demographic characteristics such as the age of mother, level of educa- tion, residency, economic status, and type of delivery. The current study found that there was a statistically significant association between an area of mother’s residency and a type of delivery and their home care awareness regarding breastfeeding with p-value = 0.037 and 0.050 respectively (Table 4). Table 5 shows the existence of a statistical- ly significant association between mothers’ awareness of infection prevention and their occupation (p-value = 0.037), Table 2: Assessment of mothers’ awareness regarding preterm baby homecare. (n=130) Assessment of mothers’ awareness regarding preterm baby homecare Not aware Neutral Awareness F (%) F (%) F (%) Mothers’ awareness regarding thermoregulation 38 (29.2) 86 (66.2) 6 (4.6) Mothers’ awareness regarding breastfeeding 37 (28.5) 91 (70) 2 (1.5) Mothers’ awareness regarding infection prevention 88 (67.7) 41 (31.5) 1 (0.8) Mothers’ awareness regarding vaccination 51 (39.2) 76 (58.5) 3 (2.3) Mothers’ awareness regarding danger signs 40 (30.8) 87 (66.9) 3 (2.3) https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article 168 Erbil Journal of Nursing & Midwifery Table 3: Association between mothers’ awareness regarding thermoregulation and se- lected socio-demographic characteristics. Thermoregulation (scores) Not aware Neutral Awareness P-Value Socio Demographic characteristics No. (%) No. (%) No. (%) Mother's age 16-24 8 (33.3) 13 (54.2) 3 (12.5) 0.213 NS 25-33 19 (27.1) 48 (68.6) 3 (4.3) 34-42 11 (30.6) 25 (69.4) 0 (0) Occupation Housewife 53 (40.8) 36 (27.7) 12 (9.2) 0.001 VHS Governmental employee 11 (8.5) 6 (4.6) 3 (2.3) Private employee 3 (2.3) 0 (0) 0 (0) Student 6 (4.6) 0 (0) 0 (0) Level of education Illiterate 16 (28.6) 37 (66.1) 3 (5.4) 0.603 NS Able to read and write 1 (7.7) 12 (92.3) 0 (0) Primary school graduate 4 (36.4) 7 (63.6) 0 (0) Secondary school gradu- ate 6 (28.6) 13 (61.9) 2 (9.5) Institute graduate 4 (33.3) 8 (66.7) 0 (0) College graduate 7 (46.7) 7 (46.7) 1 (6.7) Post graduate 0 (0) 2 (100) 0 (0) Residency Rural 7 (22.6) 23 (74.2) 1 (3.2) 0.590 NS Urban 15 (26.3) 39 (68.4) 3 (5.3) Suburban 16 (38.1) 24 (57.1) 2 (4.8) Type of family Nuclear 27 (30) 63 (70) 0 (0) 0.001 VHS Joint 5 (35.7) 8 (57.1) 1 (7.1) Extend 6 (23.1) 15 (57.7) 5 (19.2) Economic status Sufficient for daily needs 22 (26.8) 57 (69.5) 3 (3.7) 0.202 NS Insufficient 8 (25) 21 (65.6) 3 (9.4) Exceeds needs 8 (50) 8 (50) 0 (0) Type of delivery Normal vaginal delivery 11 (22.4) 36 (73.5) 2 (4.1) 0.690 NS Caesarean section 21 (35) 36 (60) 3 (5) Episiotomy 6 (28.6) 14 (66.7) 1 (4.8) https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article 169 Erbil Journal of Nursing & Midwifery Table 4:Association between mothers’ awareness regarding breastfeeding and selected socio-demographic characteristics. Breastfeeding (scores) Not aware Neutral Awareness P-Value Socio Demographic characteristics No. (%) No. (%) No. (%) Mother's age 16-24 7 (29.2) 17 (70.8) 0 (0) 0.219 NS 25-33 24 (34.3) 44 (62.9) 2 (2.9) 34-42 6 (16.7) 30 (83.3) 0 (0) Occupation Housewife 29 (28.7) 71 (70.3) 1 (1) 0.331 NS Governmental employee 3 (15) 16 (80) 1 (5) Private employee 2 (66.7) 1 (33.3) 0 (0) Student 3 (50) 3 (50) 0 (0) Level of education Illiterate 15 (26.8) 41 (73.2) 0 (0) 0.529 NS Able to read and write 3 (23.1) 9 (69.2) 1 (7.7) Primary school graduate 3 (27.3) 8 (72.7) 0 (0) Secondary school graduate 9 (42.9) 12 (57.1) 0 (0) Institute graduate 4 (33.3) 8 (66.7) 0 (0) College graduate 3 (20) 11 (73.3) 1 (6.7) Post graduate 0 (0) 2 (100) 0 (0) Residency Rural 11 (8.5) 18 (13.8) 2 (1.5) 0.037 S Urban 34 (26.2) 21 (16.2) 2 (1.5) Suburban 21 (16.2) 17 (13.1) 4 (3.1) Type of family Nuclear 25 (27.8) 63 (70) 2 (2.2) 0.864 NS Joint 5 (35.7) 9 (64.3) 0 (0) Extend 7 (26.9) 19 (73.1) 0 (0) Economic status Sufficient for daily needs 21 (25.6) 60 (73.2) 1 (1.2) 0.340 NS Insufficient 13 (40.6) 18 (56.3) 1 (3.1) Exceeds needs 3 (18.8) 13 (81.3) 0 (0) Type of delivery Normal vaginal delivery 14 (28.6) 34 (69.4) 1 (2) 0.050 S Caesarean section 16 (26.7) 43 (71.7) 1 (1.7) Episiotomy 14 (66.7) 7 (33.3) 0 (0) https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article 170 Erbil Journal of Nursing & Midwifery Table 5: Association between mothers’ awareness regarding infection prevention and selected socio-demographic characteristics. Infection prevention (scores) Not aware Neutral Awareness P-Value Socio Demographic characteristics No. (%) No. (%) No. (%) Mother's age (Years) 16-24 14 (58.3) 10 (41.7) 0 (0) 0.605 NS 25-33 47 (67.1) 22 (31.4) 1 (1.4) 34-42 27 (75) 9 (25) 0 (0) Occupation Housewife 72 (71.3) 29 (28.7) 0 (0) 0.037 S Governmental employ- ee 13 (65) 6 (30) 1 (5) Private employee 2 (66.7) 1 (33.3) 0 (0) Student 1 (16.7) 5 (83.3) 0 (0) Level of education Illiterate 41 (73.2) 15 (26.8) 0 (0) 0.281 NS Able to read and write 8 (61.5) 5 (38.5) 0 (0) Primary school graduate 7 (63.6) 4 (36.4) 0 (0) Secondary school gradu- ate 16 (76.2) 5 (23.8) 0 (0) Institute graduate 5 (41.7) 6 (50) 1 (8.3) College graduate 10 (66.7) 5 (33.3) 0 (0) Post graduate 1 (50) 1 (50) 0 (0) Residency Rural 24 (77.4) 7 (22.6) 0 (0) 0.386 NS Urban 34 (59.6) 22 (38.6) 1 (1.8) Suburban 30 (71.4) 12 (28.6) 0 (0) Type of family Nuclear 60 (66.7) 29 (32.2) 1 (1.1) 0.867 NS Joint 11 (78.6) 3 (21.4) 0 (0) Extend 17 (65.4) 9 (34.6) 0 (0) Economic status Sufficient for daily needs 55 (67.1) 26 (31.7) 1 (1.2) 0.004 HS Insufficient 23 (71.9) 9 (28.1) 0 (0) Exceeds needs 10 (62.5) 6 (37.5) 0 (0) Type of delivery Normal vaginal delivery 37 (75.5) 12 (24.5) 0 (0) 0.447 NS Caesarean section 39 (65) 20 (33.3) 1 (1.7) Episiotomy 12 (57.1) 9 (42.9) 0 (0) https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article 171 Erbil Journal of Nursing & Midwifery Table 6: Association between mothers’ awareness regarding vaccination and selected socio-demographic characteristics. Vaccination (scores) Not aware Neutral Awareness P-Value Socio Demographic characteristics No. (%) No. (%) No. (%) Mother's age (Years) 16-24 18 (13.8) 5 (3.8) 1 (0.8) 0.047 S 25-33 49 (37.7) 20 (15) 1 (0.8) 34-42 30 (23.1) 6 (5) 0 (0) Occupation Housewife 37 (36.6) 61 (60.4) 3 (3) 0.320 NS Governmental employee 7 (35) 13 (65) 0 (0) Private employee 2 (66.7) 1 (33.3) 0 (0) Student 5 (83.3) 1 (16.7) 0 (0) Level of education Illiterate 20 (35.7) 34 (60.7) 2 (3.6) 0.855 NS Able to read and write 6 (46.2) 7 (53.8) 0 (0) Primary school graduate 2 (18.2) 8 (72.7) 1 (9.1) Secondary school graduate 9 (42.9) 12 (57.1) 0 (0) Institute graduate 6 (50) 6 (50) 0 (0) College graduate 7 (46.7) 8 (53.3) 0 (0) Post graduate 1 (50) 1 (50) 0 (0) Residency Rural 14 (45.2) 16 (51.6) 1 (3.2) 0.716 NS Urban 24 (42.1) 32 (56.1) 1 (1.8) Suburban 13 (31) 28 (66.7) 1 (2.4) Type of family Nuclear 33 (36.7) 56 (62.2) 1 (1.1) 0.392 NS Joint 5 (35.7) 8 (57.1) 1 (7.1) Extend 13 (50) 12 (46.2) 1 (3.8) Economic status Sufficient for daily needs 33 (40.2) 47 (57.3) 2 (2.4) 0.662 NS Insufficient 14 (43.8) 17 (53.1) 1 (3.1) Exceeds needs 4 (25) 12 (75) 0 (0) Type of delivery Normal vaginal delivery 21 (42.9) 25 (51) 3 (6.1) 0.02 S Caesarean section 20 (33.3) 40 (66.7) 0 (0) Episiotomy 10 (47.6) 11 (52.4) 0 (0) https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article 172 Erbil Journal of Nursing & Midwifery Table 7: Association between mothers’ awareness regarding danger signs and selected socio-demographic characteristics. Danger signs (scores) Not aware Neutral Awareness P-Value Socio Demographic characteristics No. (%) No. (%) No. (%) Mother's age (Years) 16-24 6 (25) 17 (70.8) 1 (4.2) 0.680 NS 25-33 24 (34.3) 44 (62.9) 2 (2.9) 34-42 10 (27.8) 26 (72.2) 0 (0) Occupation Housewife 34 (33.7) 65 (64.3) 2 (2) 0.340 NS Governmental employee 4 (20) 15 (75) 1 (5) Private employee 2 (66.7) 1 (33.3) 0 (0) Student 0 (0) 6 (100) 0 (0) Level of education Illiterate 20 (35.7) 36 (64.3) 0 (0) 0.061 NS Able to read and write 2 (15.4) 11 (84.6) 0 (0) Primary school graduate 2 (18.2) 9 (81.8) 0 (0) Secondary school gradu- ate 10 (47.6) 10 (47.6) 1 (4.8) Institute graduate 1 (8.3) 11 (91.7) 0 (0) College graduate 4 (26.7) 9 (60) 2 (13.3) Post graduate 1 (50) 1 (50) 0 (0) Residency Rural 14 (45.2) 16 (51.6) 1 (3.2) 0.227 NS Urban 15 (26.3) 40 (70.2) 2 (3.5) Suburban 11 (26.2) 31 (73.8) 0 (0) Type of family Nuclear 25 (27.8) 62 (68.9) 3 (3.3) 0.665 NS Joint 5 (35.7) 9 (64.3) 0 (0) Extend 10 (38.5) 16 (61.5) 0 (0) Economical status Sufficient for daily needs 29 (35.4) 52 (63.4) 1 (1.2) 0.013 S Insufficient 10 (31.3) 22 (68.8) 0 (0) Exceeds needs 1 (6.3) 13 (81.3) 2 (12.5) Type of delivery Normal vaginal delivery 17 (34.7) 31 (63.3) 1 (2) 0.785 NS Caesarean section 18 (30) 40 (66.7) 2 (3.3) Episiotomy 5 (23.8) 16 (76.2) 0 (0) https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article Assessment of socio-demographic charac- teristics of mothers. More than half (53.8%) of the mothers in the present study were between 25-33 years of age. These results are similar to a study carried out by Raffray et al (2014) in Colombia, which revealed that 46.6% of participants were 25-30 years old [12], but are different from a study done by Gul et al in the neonatology unit of Khyber Teaching Hospital in Peshawar in 2018, which stated that most of the mothers (62.7%) were in the age group of 21-31 years [13]. The cur- rent study showed that the highest per- centages of the participants were house- wives. This result agrees with the studies by Abbasi-Shavazi (2019) from Iran and Ah- med (2007) from Egypt, in which the ma- jority of mothers were also housewives [14, 15]. The results of the present study revealed that less than half of the research sample was illiterate. This result agrees with a study by Roba et al in eastern Ethio- pia who mentioned that most mothers did not have any education [16]. However, the results are different from a study done by Çelen and Arsalan in Turkey in 2017, which indicated that 38.25% of mothers had a primary school education [17]. In the cur- rent study, most participants lived in urban areas. This finding is in agreement with a study carried by Abdel-Latif et al in Austral- ia, which showed that the highest percent- age of mothers lived in urban areas [18], and also similar to a study done by Roba et al in eastern Ethiopia, which indicated that more than half (55.87%) of mothers lived in urban areas [16]. Nearly three-quarters of mothers in the current study lived in a nu- clear family. This finding is similar to a con- ducted by Nepal and Thapa in 2017, which showed that more than half of mothers were living in a nuclear family [19]. Our finding differs from a study of Castalino et al from India who found that the majority 173 Erbil Journal of Nursing & Midwifery of mothers lived in a joint family [20].Regarding the economic status, most participants of the current study indicated that their income was sufficient for daily needs. This result is consistent with the finding of a Bangladeshi study by Khatun and Rahman from 2008, which mentioned that most of the mothers' economic sta- tus satisfied their daily needs [21].One- third of the participants of the current study delivered preterm babies by C\S. These finding is supported by a study of Çelen and Arsalan in Turkey, which found that the majority of mothers had C\S de- livery [17], and also by a randomized clini- cal trial study by Akbarian et al (2017) in Iran, which showed that 74% of mothers in the intervention group and 66% moth- ers in the control group delivered by a ce- sarean section [22]. Assessment of mothers’ awareness re- garding preterm baby home care. The high percentage (66.2%) of mothers in the current study had neutral aware- ness regarding thermoregulation of pre- term babies at home. A similar study was conducted by Malathi et al (2014) in India, which revealed that the majority of moth- ers had a neutral level of awareness about thermoregulation [23]. The majority (70%) of mothers in the current study had neu- tral awareness regarding breastfeeding. The results are the same as in a cross- sectional survey conducted in Bangalore on postnatal mothers, which reported that most of the mothers had neutral breastfeeding awareness [26]. Most of the mothers in the current study had poor awareness regarding infection prevention. This finding disagrees with a study by Kha- lesi et al (2015) in Iran, which found that most parents were aware of regular hy- giene to prevent infection [30]. The ma- jority of mothers had neutral awareness regarding vaccinations. A similar study, which was done by Meseka et al (2017) DISCUSSION https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article in South Sudan found that most partici- pants had gaps in awareness about vac- cinations [24]. The high percentage (66.9%) of mothers in this study had neutral aware- ness regarding recognizing danger signs. This finding is not supported by Anmut et al (2017) who conducted a study in Ethio- pia, which revealed that mothers had poor awareness about recognizing danger signs [34]. Home care Our study shows statistically a very highly significant association between mothers’ awareness of thermoregulation and their type of occupation with the p-value=0.001. This finding is consistent with a study done by Meseka et al in Soudan, which men- tioned a highly significant statistical associ- ation between mothers’ awareness and their type of occupation [24]. The findings further show that there is statistically a very highly significant association between a type of family and their awareness re- garding thermoregulation. This finding is supported by a study of Panda et al in In- dia, which found a statistically significant association between the type of family of mothers and their awareness regarding thermoregulation, with the p-value <0.001 [25]. The result of the current study shows that there was no statistically significant association between the age of participants and their awareness regarding thermoreg- ulation. This finding is in agreement with a study of Malathi (2015), which found that there was no statistically significant associ- ation between the age of the participants and their awareness regarding thermoreg- ulation [23]. Current results show that there is no statistically significant associa- tion between the level of education of mothers and their awareness regarding thermoregulation, which is supported by a study of Malathi (2015) who found no sta- tistically significant association between the level of education of mothers and their 174 Erbil Journal of Nursing & Midwifery awareness regarding thermoregulation [23]. The result of the current study also shows no statistically significant associa- tion between the area of living of mothers and their awareness regarding thermoreg- ulation. This finding is not supported by a study, which was conducted by Panda et al in India who found a statistically signifi- cant association between the area of liv- ing of mothers and their awareness re- garding thermoregulation with the p- value <0.001 [25]. There is also no statisti- cally significant association between eco- nomic status and mothers’awareness of thermoregulation in the present study. This finding is in contrast with a study of Malathi (2015) who found a statistically significant association between the eco- nomic status and thermoregulation awareness with the p-value=<0.05 [23]. Our findings revealed no statistically sig- nificant association between the type of delivery and the mothers’ awareness of thermoregulation. It is the same result as in a study of Çelen and Arsalan in Turkey (2017), which found there was no signifi- cant association between the type of de- livery and their awareness regarding ther- moregulation [17]. Association between mothers’ awareness regarding breastfeeding and selected so- cio-demographic characteristics. Our findings show that there is a statisti- cally significant association between a res- idency of the mothers and their aware- ness of breastfeeding with p-value=0.037. Vijayalakshmi et al (2015) conducted a cross-sectional survey in Bangalore on postnatal mothers, which found a statisti- cally significant association between the participants’ area of living and their awareness regarding breastfeeding with the p-value=0.012 [26]. A type of delivery was statistically significantly associated with mothers’ awareness regarding breastfeeding with the p-value = 0.050. https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article Jamil et al (2018) in Lahore found a signifi- cant association between the modes of de- livery of participants and mothers’ aware- ness regarding breastfeeding with the p- value=0.037 [27]. The present study indi- cates that there is no significant association between mother's awareness regarding breastfeeding and their age, occupation and educational level. Abdel Aziz et al (2018) in Burkina Faso conducted a de- scriptive study among mothers, which found no significant association between mothers’ awareness of breastfeeding and their age, occupation and educational level [28]. There was no significant association between mothers’ awareness regarding breastfeeding and their types of family and economic status. This finding agrees with a cross-sectional study by Vijayalakshmi et al (2015) in Bangalore who conducted a study on mothers of preterm babies, which found no significant association between mother's awareness regarding breastfeed- ing and their types of family and economic status [26]. Association between mothers’ awareness regarding infection prevention and select- ed socio-demographic characteristics. The researcher found that there is a highly sig- nificant statistical association between mothers' awareness of infection preven- tion and their economic status. This result is not matched with a study, which was done in India and mentioned that econom- ic status does not influence mothers' awareness of infection prevention [21]. Our study reveals that there is a statistical- ly significant association between mother's awareness regarding infection prevention and their occupation with the p-value = 0.037. This finding is supported by a cross- sectional study of Amolo et al (2017) in Kenya, which showed that there was a sta- tistically significant association between poor mothers' awareness and their occupa- tion regarding infection prevention [29]. 175 Erbil Journal of Nursing & Midwifery Table 4 shows that there is no statistically significant association between mothers' awareness regarding infection prevention and their age in the present study. This result disagrees with the research of Kha- lesi et al (2015) in Iran who conducted a descriptive, cross-sectional study and found that there was a statistically signifi- cant association between mothers' aware- ness and the age of participants [30]. Re- garding the level of education, the present study shows that there is no statistically significant association between mothers' awareness regarding infection prevention and their level of education. This result is in line with a study done in Kenya, which found that there was a statistically signifi- cant association between mothers' poor awareness of infection prevention and their level of education [29]. The current study found that a residency area, types of family and a mode of delivery of partici- pants hadn't influenced mothers' aware- ness regarding infection prevention. It correlates with a previous study, which was done in India and found no statistical- ly significant association between residen- cy areas, types of family and a mode of delivery with mothers' awareness of infec- tion prevention [21]. Association between mothers’ awareness regarding vaccinations and selected socio- demographic characteristics. Our findings show that there is a statisti- cally significant association between mothers' awareness regarding vaccina- tions and their age. As in research done by Adefolalu et al (2019) who conducted a cross-sectional descriptive study in Ikor- odu Local Government Area (LGA) of La- gos, which found that there was a statisti- cal association between mothers' aware- ness regarding vaccinations and their age [31]. Our study shows a statistically signifi- cant association between mothers' aware- ness regarding vaccination and their type https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article of delivery, which is different from a study of Castalino et al (2014), which found no such association [21]. Regarding mothers' occupation and residency, the current study demonstrates that there is no statis- tical association between mothers' aware- ness regarding vaccination and their occu- pation and residency area. Bofarraj (2008) in Libya conducted a cross-sectional survey of a non-randomized sample of 200 moth- ers and found that there was no statistical association between mothers' knowledge regarding vaccinations and their occupa- tion and residency area (p-value=>0.05) [32]. According to the results of the pre- sent study, there is no statistical associa- tion between mothers' awareness of vac- cinations and their level of education. A study by Adefolalu et al (2019) in Local Government Area (LGA) of Lagos also re- ported that there was no statistical associa- tion between mothers' awareness regard- ing vaccinations and their level of educa- tion [31]. Regarding economic status and a type of family, the current study shows there was no statistical association be- tween mothers' awareness regarding vac- cinations and their economic status and a type of family. These findings are support- ed by a study of Jose et al (2013) conduct- ed a study in Mangalore, which concluded that there was no statistical association between mothers' awareness of vaccina- tions and their economic status and a type of family [33]. Association between mothers’ awareness regarding danger signs and selected socio- demographic characteristics. Our study shows that there is a statistically significant association between mothers’ awareness regarding danger signs and eco- nomic status. This result is in line with a study of Adem et al (2015), who conducted a cross-sectional study in Ethiopia and found a statistically significant association between mothers' awareness regarding 176 Erbil Journal of Nursing & Midwifery danger signs and their economic status [35]. Regarding the mothers' age, this study found no statistically significant as- sociation between mothers' awareness of danger signs and their age and level of education. These results agree with a study done by Ekwochi et al (2015) in Ni- geria who stated that there was no statis- tically significant association between mothers' awareness regarding danger signs and their age and level of education [36]. Furthermore, according to the cur- rent study, there is no statistically signifi- cant association between mothers' aware- ness of danger signs and their occupation and residency area. These results are different from the conclusions of a study by Jemberia et al (2018) conducted in Ethiopia, which described a statistically significant association between mothers' awareness of danger signs and their occu- pation and residency area [37]. Addition- ally, this research found no statistically significant associations between mothers' awareness regarding danger signs and the type of family and the mode of delivery. These findings agree with findings of Prab- hakaran (2015) who conducted quantita- tive pre-experimental research in India and mentioned that there were no statis- tically significant associations between mothers' awareness regarding danger signs the type of family and the mode of delivery [38]. This study found that the majority of stud- ied mothers were of childbearing age, the majority were illiterate, housewives and lived in an urban area. The results further indicate that most of the mothers had poor awareness regarding preterm baby home care, and occupation, type of fami- ly, residency, type of delivery, age of mothers, and economic status influenced the mothers’ awareness regarding CONCLUSION https://doi.org/10.15218/ejnm.2019.20 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article preterm baby home care. There is no actual or potential conflict of interest. [1] World Health Organization. Preterm birth. WHO Headquarters in Geneva.2018. Availa- ble from: http://www.who.int/news-room/ fact-sheets/detail/preterm-birth [2] Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, NarwalR, et al. National, regional, and worldwide estimates of pre- term birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The lancet. 2012. 379(9832), pp.2162-2172. 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