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NEWBORN SCRENING AWARENESS 1

Chapter I

Newborn Screening Awareness and Acceptability among Selected Mothers at

Candelaria Municipal Hospital: An Assessment

Introduction

Newborn Screening is a simple method to find out if your baby has congenital

metabolic disorder that may lead to retardation and even death. It is a preventive health

service that should be available to all neonates. Newborn Screening no longer refers to the

screening test itself, but encompasses the entire element essential to all neonates to have

access to a screening system that has optimal quality and performance. (DOH, 2006).

According to World Health Organization (WHO) figures, about two million babies

are born in the Philippines every year, and not all are aware, however, that 33,000 babies

are at risk of life threatening disorders that could cause mental retardation and even death.

Over 99% of parents agree for their baby to have the NBS test and overall about 1 out of

every 1000 babies tested (0.1%) will be diagnosed with a condition as a result of having

NBS (WHO, 2007).

In response to growing concerns over the health of children, newborn screening for

congenital disorders began in the United States in 1961, when Dr. Robert Guthrie designed

an assay for the pre-symptomatic identification of patients with Phenylketonuria (PKU)

using dried blood absorbed into special filter paper. Newborn screening has since been a

routine component of quality newborn care in the United States with newborn coverage of

about 100%. The test involves prickling the babys heel to obtain a small blood sample,

which is then sent to a special laboratory for the testing. The test is best done within 24


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hours, or at least 48 hours after a baby is born. Even though each disease by itself is rare,

all together these diseases affect 1 in 1500 babies. If untreated, they can lead to health

problems, such as poor growth or mental retardation (London, 2007).

This form of testing is known as screening because it involves testing a whole

population - in this case, newborn babies. All babies are tested even if they do not have any

obvious signs of a condition that affects their metabolism, endocrine and blood (Stewart,

2007).

In order to provide optimum level of health for the children and infants, different

researches and programs were inducted to promote development. In July 2000, the

Philippine NBS Project was cited for outstanding health research by the Philippine Council

for Health Research and Development. In October 2000, the NBS Project had already

screened 135,000 babies, 53 of which were confirmed to have one of the disorders included

in the program.

But perhaps the most dramatic achievement, by far, of the Philippine NSB Project

is the approval into law on April 7, 2004;

Republic 9288, entitled, AN ACT PROMULGATING A COMPREHENSIVE

POLICY AND A NATIONAL SYSTEM FOR ENSURING NEWBORNSCREENING.

This Newborn Screening Act of 2004 ensures that every newborn in the Philippines

is given the opportunity to be offered newborn screening. It is the policy of the state to

protect and promote the right to health of the people, including the rights of children to

survival and full and healthy development as normal individuals. In pursuit of such policy,

the State shall institutionalize a national newborn screening system that is comprehensive,

integrative and sustainable, and will facilitate collaboration among government and non-


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government agencies at the national and local levels, the private sector, families and

communities, professional health organization, academic institutions and non-

governmental organization. The National Newborn Screening System shall ensure that

every baby born in the Philippines is offered the opportunity to undergo newborn screening

and thus be spared from heritable conditions that can lead to mental retardation and death if

undetected and untreated. (McKinney, 2007)

The implementation of this law has found renewed impetus through an earlier

Proclamation No. 540, signed by former President Gloria Macapagal Arroyo on January

20, 2004, declaring the 1

st

week of October of each year National Newborn Screening

Week.

However, the greatest challenge remains: making newborn screening available to

all Filipino babies. A critical point of concern is the lack of public awareness about the

benefits of newborn screening. Moreover, and perhaps because of low awareness, there

appears to be some resistance from mothers to the idea of subjecting babies to the

screening procedure.

Even the law acknowledges that NBS may not be acceptable to some parents, as

evidenced by Article 3, Section 7 of the Newborn Screening Act, thus:

Sec. 7.Refusal to be Tested a parent or legal guardian may refuse testing on thegrounds of religious beliefs, but shall acknowledge in writing their understanding

that refusal for testing places their at risk for undiagnosed heritable conditions. A

copy of this refusal documentation shall be made part of the newborn screening

database.

Indeed, the goal of NBS to become program for major disease prevention in the

Philippines has yet to be realized. This is where public support is required so that our

policymakers and health administrators can be compelled to integrate this technology as

part of the Filipino health routine.


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It is this challenge that has prodded the researchers to conduct a study on the

determinants of NBS awareness and acceptability, albeit on a limited scale. The researchers

have chosen to conduct their study at Candelaria Municipal Hospital as they have found out

that out of the average of 101 pregnant mothers who give birth on the hospital, only 45% of

them are subjecting their infants to Newborn Screening.

Statement of The Problem

The study aimed to assess the awareness regarding Newborn Screening and also,

the underlying factors that promote the acceptability of Newborn Screening among Filipino

mothers, specifically among selected mothers in Candelaria Quezon who had just delivered

their babies at the Candelaria Municipal Hospital (CMH).

The following specific problems were sought to be addressed:

1. What are the characteristics of selected respondent-mothers in terms of:

a. Age

b. Civil status

c. Educational status

d. Socio-economic Status

e. Maternal History

2. What is the level of awareness of the respondents about NBS in terms of:

a. Nature of the screening program

b. Availability and accessibility of the program

c. Significance of NBS program

3. What is the level of acceptance of the respondents on Newborn Screening?


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4. What are the variables that affect the acceptance of the respondents on Newborn

Screening?

5. What are the implications of this study to the following :

a. Health Education

b. Program Development

c. Community Health Nursing

THEORETICAL FRAMEWORK

The Casey Model of Nursing (1988) comprises the five concepts of child, family,

health, environment and the nurse. The philosophy behind the model is that the best people

to care for the child is the family with the help from various professional staff. There

should therefore be a partnership between parents and caregivers. In connection to the

study, Philosophy represents the unity and relationship between the nurse and the family to

achieve the best health condition of the child as possible. This includes the responsibility of

the nurses to undergo the child into Newborn Screening to evaluate the possible

abnormalities that may occur to the child as well as to educate the parents, specifically the

mothers beforehand, on the benefits of having the Newborn Screening done on their child.

Moreover, it was also based on the Theory of Human Becoming by Rosemarie

Rizzo Parse (1995). It emphasizes free choice of personal meaning in relating value

priorities, co-creating of rhythmical patterns in exchange with the environment. Parse

believed that each choice opens certain opportunities while closing others since each

individual makes his or her choices, the role of the nurse is that of guidance not

decision maker. In relation to the study, pregnant women are the ones responsible on


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deciding whether to subject or not to subject their child on Newborn Screening. The

nurse will only serve as a guide for women in gathering correct information on newborn

screening and during their decision making concerning the screening of their child.

Conceptual Paradigm


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Profile

Nature of theScreening Program

Availavility and

Enhanced Awareness and

Acceptance of the newborn

screening by mothers.

Analysis of theProgram


Figure 1.NBS Awareness and Acceptability among Mothers


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The purpose of this study is to assess NBS awareness and its acceptability among

selected mothers --- whether they submit or not their child on Newborn Screening.

In the diagram shown above, the Inputs included are Social Influence, which refers

to the Economic Problems or fear of the mother to be discriminated when results of such

NBS is achieved. Educational Status of the mothers was also considered for their level of

understanding regarding the program would affect their acceptance of it. Culture and

Religion would be referring to Role of traditional healers, values & norms of a person,

family influence & decision making pattern. Socioeconomic Status would be the financial

capability of the mother. Meanwhile, Education refers to the mothers knowledge regarding

NBS which may affect her acceptance of the certain procedure; Services on the Hospital

refers to Method and quality of testing, competence of provider, delivery of the result, and

confidentiality and privacy implemented in the hospital. Together, all these factors may

affect the perception and acceptance of the mothers regarding NBS. If a mother is

knowledgeable or aware about the different advantages given by the NBS on the infant,

and is financially capable of having the procedure done so, and is also satisfied with the

services offered by a certain institution, she may decide to accept the procedure to be done

on her child and this may mean early detection of conditions present on the child which

may suggest prompt treatment accordingly. Moreover, child survival intervention through

immunization, screening, nutrition, education, sanitation and better health care is primarily

the mothers responsibility, and all these depend heavily on her capacity


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Because childs health is affected by factors other than physiology by family

relationship, by living conditions in their home and communities, by political activities---

the NBS program may have to develop strategies to address womens roles from vantage

points outside the clinic. As the NBS program looks toward the future, it will face several

challenges: the need to publicize and market its services and programs to gain a larger

client base; efforts to make operations sustainable instead of reliant on grants from donors;

and decision about how many services to provide and to whom.

Assumptions

For purposes of this study, the researchers have moved along the following

assumptions:

1. Newborn screening is a must for babies after giving birth.

2. Provide knowledge to the parents will let them ensure that they recognize their

responsibilities in promoting their childs right to health and full development.

Scope and Delimitation of the Study

The result of this study have been obtained from direct interviews and analysis of

the checklist questionnaires that were distributed among respondents, who constitute a

sample size of 30 selected mothers who had delivered their babies at the Candelaria

Municipal Hospital within the periodFebruary 2012 to March 2012 which was the time of

collection samples.


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Care was also undertaken to determine ---whether by herself or with the influence

of other members of the family, or friends. The researchers have remained mindful of the

general observation that a key component of the Newborn Screening acceptability is the

provision of not only Newborn Screening services, but also information on the program

itself.

Significanceof the Study

This study aimed to assess the potential of full implementation, particularly since

provision of law mandate the availability of this procedure to all Newborn children.

The researchers expected this study, therefore, to impact on the following

sectors/areas:

To the respondents, for it will make them more knowledgeable or if they are not

aware, give them full knowledge of the importance and benefits of NBS as the researchers

communicate and conduct interviews with them.

To the nurses, for it will provide them awareness about the important role nurses

play in NBS promotion and the provision of health information and will help them gain

confidence towards health education through repeated interaction with the mothers.

For the nursing profession, it will serve as basis for formulating more programs to

implement in order that all children will undergo the Newborn Screening program.


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For the Policymakers, it will inquire them to have immediate feedback about the

provision of the NBS law that may require fine- tuning and/or amendment.

Definition of Terms

The researchers have defined the following terms, either operationally or

contextually, to afford the readers a clearer understanding of the study and its results:

Awareness: It is the state or ability to perceive, to feel, or to be conscious of

events, objects or sensorypatterns. In this level of consciousness, sense data can be

confirmed by an observer without necessarily implying understanding.

Acceptability: The level of acceptability of the given situation that also includes

satisfaction of what is required and what is the standard.

Candelaria Municipal Hospital: This is a secondary hospital located at Candelaria

Quezon where in the researchers would conduct their study on selected mothers

regarding NBS awareness and acceptability.

Mother: It refers to a female parent who nurtures and rears her newborn child.

Newborn: It means a child from complete delivery up to 30 days of life.

Newborn screening (NBS): It is a simple procedure to find out if your baby has a rare

metabolic disorder. Although your baby may look healthy at birth, you cannot be

certain that he will not develop negative outcomes caused by these metabolic
http://en.wikipedia.org/wiki/Conscioushttp://en.wikipedia.org/wiki/Object_(philosophy)http://en.wikipedia.org/wiki/Patternhttp://en.wikipedia.org/wiki/Understandinghttp://en.wikipedia.org/wiki/Conscioushttp://en.wikipedia.org/wiki/Object_(philosophy)http://en.wikipedia.org/wiki/Patternhttp://en.wikipedia.org/wiki/Understanding


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disorders. If the disorders are left untreated, they may lead to physical disabilities,

mental retardation, and even death.

Chapter II

Review of Literature and Related Studies

This chapter contains literature and prior studies related to the researchers study

which may help in lending context and enrich the discussion of the subject matter. This

gave the researchers full understanding of the subject being investigated and studied.

Related Literature

Newborn Screening (NBS) programs identify children who are born with serious

genetic, metabolic, hematologic, infectious or auditory disorders. These children generally

appear normal at birth but have an inherent condition that will lead to disability or death

without intervention. Screening is performed on blood samples that have been collected

shortly after birth and dried on a filter paper. To ensure that the specimen can be re-

evaluated if warranted by the initial screening result, extra samples are collected in the

form of multiple blood spots on a standardized form. Individual states may store these extra

samples for use in the quality control of current test and the development of new tests. In

addition, residual dried blood spots also have many potential uses in public health and

bioemedical research (Olson, 2010)

According to DOH (2011) Newborn screening (NBS) is a public health program

aimed at the early identification of infants who are affected by certain


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genetic/metabolic/infectious conditions. Early identification and timely intervention can

lead to significant reduction of morbidity, mortality, and associated disabilities in affected

infants. NBS in the Philippines started in June 1996 and was integrated into the public

health delivery system with the enactment of the Newborn Screening Act of 2004

(Republic Act 9288). From 1996 to December 2010, the program has saved 45 283

patients. Five conditions are currently screened: Congenital Hypothyroidism, Congenital

Adrenal Hyperplasia, Phenylketonuria, Galactosemia, and Glucose-6-Phosphate

Dehydrogenase Deficiency.

According to National Institutes of Health- UP Manila (2010), Newborn

Screening Promotion, NBS test costs only Php. 500 at a very reasonable price. The DOH

Advisory Committee on Newborn Screening has approved a maximum allowable fee of

P50 for the collection of the sample.

According to Department of Health (DOH) 2011,Newborn screening is available

in participating health institutions (hospitals, lying-ins, Rural Health Units and Health

Centers). If babies are delivered at home, babies may be brought to the nearest institution

offering newborn screening.

According to ACOG (2003) Parent education about newborn screening should

start well before the time of delivery and labor. The babys pediatrician, family physician,

or other health care provider should introduce information about newborn screening to

parents during the third trimester. Education on newborn screening should be included

during the pre-admission process. Community health agencies for pregnant women should


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also include this education. Obstetrician-gynecologists can continue to work to improve the

health of their patients by informing expectant families of the newborn screening process.

According to Nieto (2009), the following are the common diseases found in

newborn screening test:

CH (Congenital hypothyroidism) - is a condition of thyroid hormone

deficiency present at birth. Approximately 1 in 4000 newborn infants has a severe

deficiency of thyroid function, while even more have mild or partial degrees. If

untreated for several months after birth, severe congenital hypothyroidism can lead

to growth failure and permanent mental retardation. Treatment consists of a daily

dose of thyroid hormone (thyroxine) by mouth. Because the treatment is simple,

effective, and inexpensive, nearly all of the developed world practices newborn

screening to detect and treat congenital hypothyroidism in the first weeks of life.

CAH (Congenital adrenal hyperplasia) - refers to any of several autosomal

recessive diseases resulting from mutations of genes for enzymes mediating the

biochemical steps of production of cortisol from cholesterol by the adrenal glands

(steroidogenesis). Most of these conditions involve excessive or deficient

production of sex steroids and can alter development of primary or secondary sex

characteristics in some affected infants, children, or adults. Approximately 95% of

cases of CAH are due to 21-hydroxylase deficiency.

GAL (Galactosemia) - is a rare genetic metabolic disorder which affects an

individual's ability to properly metabolize the sugar galactose. Lactose in food

(such as dairy products) is broken down by the body into glucose and galactose. In

individuals with galactosemia, the enzymes needed for further metabolism of
http://en.wikipedia.org/wiki/Congenital_hypothyroidismhttp://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasiahttp://en.wikipedia.org/wiki/Galactosemiahttp://en.wikipedia.org/wiki/Congenital_hypothyroidismhttp://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasiahttp://en.wikipedia.org/wiki/Galactosemia


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galactose are severely diminished or missing entirely, leading to toxic levels of

galactose to build up in the blood, resulting in hepatomegaly (an enlarged liver),

cirrhosis, renal failure, cataracts, and brain damage. Without treatment, mortality in

infants with galactosemia is about 75%.

PKU (Phenylketonuria) - is an autosomal recessive genetic disorder characterized

by a deficiency in the enzyme phenylalanine hydroxylase (PAH). This enzyme is

necessary to metabolize the amino acid phenylalanine to the amino acid tyrosine.

When PAH is deficient, phenylalanine accumulates and is converted into

phenylpyruvate (also known as phenylketone), which is detected in the urine. PAH

is found on chromosome number 12.Left untreated, this condition can cause

problems with brain development, leading to progressive mental retardation and

seizures. However, PKU is one of the few genetic diseases that can be controlled by

diet. A diet low in phenylalanine and high in tyrosine can be a very effective

treatment. There is no cure. Damage done is irreversible so early detection is

crucial.

G6PD Deficiency - is an X-linked recessive hereditary disease characterized by

abnormally low levels of the glucose-6-phosphate dehydrogenase enzyme

(abbreviated G6PD or G6PDH). It is a metabolic enzyme involved in the pentose

phosphate pathway, especially important in red blood cell metabolism.

Screening is quick and safe. The heel prick may cause brief discomfort to your

newborn, but holding or feeding them during collection will help. There is a very small risk
http://en.wikipedia.org/wiki/Phenylketonuriahttp://en.wikipedia.org/wiki/G6PD_Deficiencyhttp://en.wikipedia.org/wiki/Phenylketonuriahttp://en.wikipedia.org/wiki/G6PD_Deficiency


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of infection because we are making a small break in the skin, but using gloves and cleaning

the heel beforehand will minimize this risk - Newborn Screening for the health of your

baby (www.health.vic.gov.au).

As a parent, one may refuse newborn screening for her baby only if her religious

beliefs and practices do not allow this testing. If she refuses to have the test done, she may

be asked to sign a paper stating that she refused to have her baby tested for these very

serious disorders(www.aaroncyuntalan.com)

According to Newborn Screening Reference Center (2012), Newborn screening

results are available within seven to fourteen (7 - 14) working days after the newborn

screening samples are received in the NSC. A negative screen means that the result of the

test indicates extremely low risk of having any of the disorders being screened. A positive

screen means that the baby is at increased risk of having one of the disorders being

screened.

Newborn screening (NBS) is important because a baby with one of these illnesses

will appear perfectly healthy and by the time symptoms are visible, irreparable damage can

occur damage such as mental retardation or, in countless instances, death. This program

is essential nowadays because it is a procedure that determines whether the infant has a

congenital defect or anomaly. A mother should always be aware of her infants condition,

because once newborn screening procedure is being done and the result has been revealed

that the infant is positive for any of the congenital disorders/anomalies, it is being followed

up by series of medication, but if the infant did not undergo the procedure and has any of

the congenital defects present at birth, it would be a life-long burden not only for the family

but especially for the child. (London, 2007)
http://www.health.vic.gov.au/http://www.aaroncyuntalan.com/http://www.health.vic.gov.au/http://www.aaroncyuntalan.com/


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Greater education for mothers contributes to new skills, beliefs, and choices about

sound health and nutritional practices that directly influence the proximate determinants of

child health. For instance, knowledge obtained during a mothers education can affect

choices about antenatal care and about childrens nutrition, hygiene, and health care. To the

extent that more-educated mothers make healthier choices for themselves during

pregnancy, education will have a direct effect on the health of the child at birth (Miller and

Rodgers, 2005).

According to Deaton (2003) Richer, better-educated people live longer than poorer,

less-educated people. According to calculations from the National Longitudinal Mortality

Survey which tracks the mortality of people originally interviewed in the CPS and other

surveys, people whose family income in 1980 was greater than $50,000, putting them in

the top 5 percent of incomes, had a life-expectancy at all ages that was about 25 percent

longer than those in the bottom 5 percent, whose family income was less than $5,000.

Related Studies

Local

According to Toletino MJ, (March 2008) based on his findings in his research,

Comparison between Selected Primiparas and Multiparas in the level of Awareness

regarding Newborn Screening at Quezon Medical Center, the respondents, Multiparas are

aware and the Primiparas were unaware of it.

According to Ayrette E. Paderes, (March 2005) her findings based on her research

at Tayabas Community Hospital in Tayabas Quezon, respondents where highly aware of


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the facts, procedure of newborn screening despite the false or negative statement about

newborn screening.

According to Marquez KJ (January 2008), her findings based on her research at

Lucena Medical Mission Group of Hospital and Health Cooperative, Lucena City, the

respondents were highly aware with regard to newborn screening. It is concluded that

postpartum mothers delivered their babies in private hospital were aware on newborn

screening test and concluded also that state needs to improve communication in promoting

newborn screening test in public hospitals.

Foreign

According to the study published on May 2006, Pediatrics Vol. 117 entitled:

Recommendation for Effective Newborn Screening Communication: Results of focus

group with parents and experts that recommended prenatal and primary care providers be

involved in educating about newborn screening. Professional societies and state health

professional should work together to encourage parent and provider education. Uses-

friendly patient provider educational materials, such as those we developed, could from the

basis for this education approach.

According to Dr N J Kerruish, Department of Womens and Childrens Health -

Information and consent for newborn screening: practices and attitudes of service providers

(2008) 93% of LMC in New Zealand report giving parents information concerning NBS,

most frequently after delivery (73%) and in the third trimester (60%). The majority (85%)


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of LMC currently obtain some form of consent (verbal or written) for NBS from parents

and consider this to be the ideal approach (94%). Despite this a significant minority of

LMC (23%) reported considering that NBS should be mandatory. Of those in our survey

who believed that NBS should be mandatory, paradoxically most (89%) still believed that

some form of parental consent should be obtained; of those who believed testing should not

be mandatory, only a small proportion (10%) would accept parental refusal without

question .

(Science Daily, Feb 2010), outweigh the costs of a false positive, according to

new U-M research published in the February issue of the journal Pediatrics."Published

studies of expanded newborn screening in a U.S. setting have resulted in favorable cost-

effective ratios for screening for this illness but did not include primary data for quality of

life effects for a false positive screen," says Lisa Prosser, Ph.D., Research Associate

Professor in the Division of General Pediatrics at the University of Michigan Health

System and the study's lead author. "Our results show that newborn screening remains cost-

effective after accounting for the measured loss in quality of life associated with a false

positive screen" (Benefits Outweigh Risks Associated with Newborn Screening for

Disorder- Chung Yin Kong; Ph.D ; Donna Rusinak, B.A ; and Susan L. Waisbren, Ph.D -

Benefits Outweigh Risks Associated With Newborn Screening for Disorder Feb2010 ).

What is known about communication with parents about newborn bloodspot

screening? (2003), it states that the need for education about the role and limitations of

screening and the meaning of test results. Research specifically about uptake has little

relevance while newborn screening is fully integrated with routine maternity care and

refusal rates are negligible. Research about decision aids and informed consent may


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become more relevant with the offer of more screening programmes and the need to seek

informed consent, whether this is for screening itself, the reporting of results, or the storage

of bloodspots for clinical reasons or research (Stewart; Oliver -What is known about

communication with parents about newborn bloodspot screening? May2003).

Kemper AR et al. (2005) states that fifty programs provide standardized

information about screening, and 32 of these have information available in multiple

languages. Most programs (n=36) believe that parents should be informed about newborn

screening as a part of prenatal care; however, none has rules or regulations requiring this.

Five require documented informed consent; only one provides the consent form in a

language other than English. Hospitals and birthing centers are required by many programs

to educate families, including providing information (n=12), obtaining informed consent

(n=5), informing parents of the right to refuse screening (n=13), and documenting refusal

on institutionally developed forms (n=9) (Kemper AR et al. - Informing parents about

newborn screening2005).


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Chapter III

Research Methodology

This chapter tackles on how the researchers approached the topic as well as how

the instrument materialized and how it was be distributed to obtain the necessary

information. It also describes the methodology used in this study by identifying the steps

used in this research process and is consisting of research design, sample, setting,

measurements, data collection, data processing and analysis.

Research Design

This study which is entitled Newborn Screening Awareness and Acceptability

among Selected Mothers of Candelaria Municipal Hospital, seeks to assess the level of

understanding of the mothers regarding Newborn Screening and their level of acceptance

of the procedure. The researchers utilized the descriptive method of research through quota

sampling technique. In quota sampling the selection of the sample is made by the

interviewer, who has been given quotas to fill from specified sub-groups of the population.

Descriptive research is a design which aims to describe the nature of a situation as it exist

at the time of the study and to explore the cause of particular phenomena. (Ardales, 1998)

Descriptive Method was regarded as the most appropriate method to be used.

Research Locale


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Candelaria Municipal Hospital in Candelaria Quezon, was chosen by the

researchers as the locale of their study. The locale is near the town proper. The research

population who served as the sources of data was made up of mothers who were present on

the hospital during the conduction of this study and has a newborn child subjected or not

subjected to newborn screening. An allocated number of respondents were chosen as

subjects to partake in the study, the number chosen by the researchers or allocated by the

researchers will be enough to represent the general population of the respondents taking

into consideration the percentage of marginal error.

The Research Subjects

There were more than 100 documented cases of delivery at Candelaria Municipal

per month. Thirty percent (30%) of the delivery rate per month was selected from this total

population, with 30 questionnaires to be distributed. The questionnaires were distributed to

those mothers who were present during the period of data gathering.

Data Gathering Tool

The survey instrument is a self-made questionnaire, which was used to assess the

awareness and acceptability of NBS among selected mothers who delivered their babies in

Candelaria Municipal Hospital.


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Specifically, a simple survey will be employed. Researchers decided to

paraphrase the original instrument designed for this study into the national language,

Filipino, to assure wider comprehension among respondents.

To establish content validity of the instrument, the questionnaire was submitted to

an experienced research adviser who was asked to evaluate the items for clarity and

appropriateness, and most were accepted with few revisions. The instrument was pre-tested

on eight (8) mothers in a selected facility to determine readability and understanding by

respondents.

Data Gathering Procedure

Personal or face-to-face surveys were conducted among the respondents, thus

assuring that responses are immediately gathered after each interview. The confidentiality

of each participants responses was assured during the interview. The researchers provided

formal letters of communication for the Medical Director, Chief Nurse of the hospital and

to the Head Nurse of the OB-Gyne department to gain permission on conducting the said

study.

Instrumentation

The researchers gathered data that supported the study awareness and

acceptability in Newborn Screening. The data were gathered in different sources such as;

books, articles and even in different websites. After gathering some data, the researchers


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formulated a survey type of questionnaire based on its sub-problems. From English

language, the questions were translated to Filipino language for easy understanding of the

respondents. The researchers also conducted a pilot testing to selected mothers to make

sure that the questions were appropriate to the respondents so that the researchers would

collect the proper data.

The first part of the questionnaire is the checklist about respondents

demographic profile which was composed of age, civil status, educational attainment,

monthly income and maternal history. The second part of the questionnaire is regarding

Level of Awareness regarding Newborn screening. It consists of three (3) parts: Nature of

Screening, Availability and Accessibility of the Program and Significance of Newborn

Screening Program. The third part of the questionnaire contains seven (7) item questions

about the Level of Acceptance on Newborn Screening, so as the fourth part which is

composed of nine (9) questions regarding Factors that Influences Acceptance of Newborn

Screening.

The researcher came up with 3 and 4 points scale for questions with varying

degrees of responses. Responses to items on second part are made on the following scale: 1

- Unaware, 2 Not so Aware, 3 Aware, 4 Fully Aware. The following are the scale of

the third part: 1 - Unacceptable, 2 - Acceptable, 3 - Highly Acceptable. Meanwhile, the

following are the scale of the fourth part: 1 - Doesnt Affect, 2 - Affects, 3 - Highly

Affects.

Data Processing


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1. Frequency Percentage Distribution

To answer the sub-problem `1(demographic profile of the respondents), the

researchers utilized simple statistical method such as frequency ranking technique.

The frequency method is the simplest method that can be obtained by getting the

frequencies of similar responses and ranking them according to the frequency

obtained. The percentage conversion can also be used by converting frequencies

into percentage using the formula;

P = f/n x 100

Where the formula stands for:

P = percentage equivalent

f= the frequencies of similar responses

n = is referable to the number of respondents involved in the study

2. Weighted Arithmetic Mean

To answer sub-problem 2, 3 and 4 (respondents awareness regarding Newborn

Screening; Nature of Screening, Availability and Accessibility of the program &

Significance of Newborn Screening; the Level of Acceptance of Newborn Screening

and Variables that Affect the Acceptance of Mothers on Newborn Screening), the


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researcher used the Likert Scale in the analysis of the central tendencies of the data that

they gathered.

The researchers knew that the Likert Scale is the most appropriate method in the

statistical treatment of their data measuring the degree of agreement of the respondents.

The Likert Scale depended on the response from the questionnaire given to the

respondents.

Measure probability or measure of central tendencies of responses was also

utilized in the course of treatment of the data gathered. The mean weight was highly

commendable for interpreting data that have varying degrees responses. The formula

for the mean weight is;

X = __wf___

n

Whereas:

X = weighted mean

wf = summation of weighted frequency

n = total number of population

MEAN AND DESCRIPTIVE MEANING USED IN THE STUDY

Table I. 4-point Scale Table for Verbal Description of Level of Awareness Regarding

Newborn Screening


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Weighted Mean Range of Weighted Mean Qualitative Description

1 1.00 1.75 Unaware

2 1.76 2.50 Not so Aware

3 2.51 3.25 Aware

4 3.26 - 4.00 Fully Aware

Table II. 3-point Scale for Verbal Description of Level of Acceptance of Newborn

Screening


1 1.00 1.67 Unacceptable

2 1.68 2.35 Acceptable

3 2.36 3.00 Highly Acceptable

Table III. 3-point Scale for Verbal Description of Variables that Affect the

Acceptability of the Respondents on Newborn Screening


1 1.00 1.67 Doesnt Affect

2 1.68 2.35 Affects

3 2.36 3.00 Highly Affects

For a thorough understanding of the collected data from the respondents, data

were presented into graphs and tables. Data processing is important for nursing researcher


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because this is a process of interpreting such gathered data in order to come up with the

result of the study.

Chapter IV

Presentation, Analysis, and Interpretation of Data

This chapter presents findings of the study based on the mothers awareness and

acceptability of Newborn Screening with the following objectives:

1. To identify the mothers awareness regarding newborn screening, its nature,

availability and accessibility, and acceptability.

2. To assess the mothers level of acceptance of newborn screening.

3. To assess mothers perception of different factors affecting the acceptance of NBS

procedure.

The following are tables and chart that corresponds to the questions result. The first

category shows the different charts of respondents profile according to Age, Civil Status,

Educational Attainment, Monthly Income, and Maternal History. The second category

provides the findings about questions under: Level of Awareness regarding Newborn

Screening, Level of Acceptance on Newborn Screening, Factors that Influences

Acceptance of Newborn Screening. The data were presented in numerical as well as text


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terms, and the tables consisted of the demonstrated scores, descriptive statistics and

collective data.

With the participation of the admitted mothers in Candelaria Municipal Hospital,

the researchers were able to distribute thirty questionnaires and all of them were able to

answer it.

Part I. Demographic Profile of the Respondents

FIGURE 2. Percentage distribution of the Respondents According to Age

Figure 2 presents the data of the respondents in terms of their age. The sample was

composed of 30 selected mothers who had just delivered their babies in CMH. This figure

3%

17%

37%

27%

10%

3% 3%

Age

Below 18

19 -21

22 -24

25 -27

28 -30

31 -33

34 above


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shows that 37% (11 mothers) of the total respondents were within the age range of 22-24

while 27% (8 mothers) were within the age range of 25-27 years old, 17% (5 mothers)

were within the age range of 19-21years old, 10% (3 mothers) were within the age range of

28-30. And only 3% (1 mother) of the respondents are in ages 18 and below, 31 to 33 and

34 and above.

These data indicates that most mothers are in their stage of Young Adulthood,

wherein they are of more focus on accomplishing maternal tasks and is getting ready for

developing the ability to manage a home and assume responsibilities for her child. (Taylor,

2005)

Figure 3. Percentage distribution of the Respondents According to Civil Status

53%47%

Civil Status

Single

Married


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3% 7%

7%

53%

20%

10%

Educational Attainment

Elementary

Undergraduate

Elementary Graduate

High School

Undergraduate

High School Graduate

College Undergraduate

College Graduate


In figure 3 the data is according to the respondents civil status. This chart shows

that majority of the respondents are single with the average of 53% (16 mothers).

Meanwhile, 47% (14 mothers) were married.

As cited in Single Parent Center.net (2011), single parenting is becoming a rapidly

rising trend in the society. It is of course not only through pre-marital sex or divorce that

spouses are often left alone with a child. The cause of single parenting stretch much wider

than that. Studies in the US alone indicate that there are four single parents to every ten

parents, there two single parents for every ten adults in the country. Single parents are said

to be less knowledgeable than those mothers who are married when it comes to attending

the needs of their children. This is because married mothers are frequently more

experienced in decision making concerning the health of their children. Also, mothers who

are married possess much sense of their own maternal competency in performing care for

their infants and children.


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Figure 4.Percentage distribution of the Respondents According to

Educational Attainment

`

In figure 4 the data of the respondents are presented in terms of educational

attainment. It shows that 53% (16 mothers) of the total respondents were able to finish high

school, 20% (6 mothers) were college undergraduate, 10% (3 mothers) were able to finish

college, 7% (2 mothers), were able to finish elementary, 7% (2 mothers) were high school

undergraduate, and only 3% (1 mother) were elementary undergraduate.

It only indicates that most of the respondents are high school graduates that are

engaged to the study. This data illustrates the maturity of the mothers specifically in

understanding child care. The level of education of the mothers can greatly affect her

understanding of Newborn Screening as her knowledge of it depends on how high her

educational attainment was.

Greater education for mothers contributes to new skills, beliefs, and choices about

sound health and nutritional practices that directly influence the proximate determinants of

child health. For instance, knowledge obtained during a mothers education can affect

choices about antenatal care and about childrens nutrition, hygiene, and health care. To the

extent that more-educated mothers make healthier choices for themselves during

pregnancy, education will have a direct effect on the health of the child at birth (Miller and

Rodgers, 2005).


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37%

43%

17%

0% 3% 0%

Monthly Income

5,000 below

5,001 - 10,000

10,001 - 15,000

15,001 - 20,000

20,001 - 25,000

25,000 above


Figure 5.Percentage distribution respondents According to Monthly Income

In Figure 5, the data of the respondents in terms of monthly income are presented.

It shows that 43% (13 mothers) have a monthly income of 5,001-10,000 per. On the other


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43%

27%

17%6% 7%

Parity

1

2

3

4

5

43%

27%

17%

6% 7%

Gravida

1

2

3

4

5


hand, 37% (11 mothers) have a monthly income of 5,000 and below, 17% (5 mothers) have

a monthly income of 10,000-15,000, 3% ( 1 mother) has a monthly income of 20,000

-25,000, and none of them have monthly income of 25,000 and above,15,000 to 20,000.

It only shows that most of the respondents earn 5,000 to 10,000 per month and

eventually they can afford to subject their child to NBS. Mothers with higher

socioeconomic status are considered to be more knowledgeable and has higher level of

educational attainment.

According to Deaton (2003) Richer, better-educated people live longer than

poorer, less-educated people. According to calculations from the National Longitudinal

Mortality Survey which tracks the mortality of people originally interviewed in the CPS

and other surveys, people whose family income in 1980 was greater than $50,000, putting

them in the top 5 percent of incomes, had a life-expectancy at all ages that was about 25

percent longer than those in the bottom 5 percent, whose family income was less than

$5,000.

A B


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Figure 6. Percentage distribution of the Respondents According to Maternal History

In figure 6 the data of the respondents are presented in terms of their maternal

history. This chart shows that majority of the respondents are primiparas with an average of

43% (13 mothers). Meanwhile, 27% (8 mothers) have 2 children, 17% (5 mothers) have 3

children, 7% (2 mothers) have 5 children, 6% (2 mothers) have 4 children.

According to Toletino MJ, (March 2008) based on his findings in his research,

Comparison between Selected Primiparas and Multiparas in the level of Awareness

regarding Newborn Screening at Quezon Medical Center, the respondents, Multiparas are

aware and the Primiparas were unaware of it. But nowadays, primiparas had gain

knowledge about newborn screening, because the health care provider provides

information about the test before giving birth to their first child.

Table IV. Level of awareness of the respondents about NBS

Table IV.A

STATEMENT UA NA A FA

N WM VD Rank 1 2 3 4

a. Nature of Screening1. Newborn Screening is a simple procedure tofind out if your baby has a rare metabolicdisorder. 2 8 17 3

30 2.57 Aware 7

2. Newborn Screening is a program of the

Department of Health. 1 4 18 7 30 2.98 Aware 3

3. The attending physician or the birth attendant

is responsible in explaining the screening testresults to the parents. 1 7 16 6

30 2.83 Aware 4

4. Newborn Screening test aids in early

detection of five congenital metabolic diseases

of the newborn. 1 2 20 7 30 3.03 Aware 2

5. The baby must undergo NBS after 24 hoursbut not later than three (3) days of his/her birth. 2 4 18 6

30 2.8 Aware 5

6. Newborn screening is safe. 1 4 15 10 30 3.07 Aware 1

7. Newborn Screening Tests are done through 4 4 16 6 3 2.53 Aware 8


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heel prick method to get blood samples. 0

8. The blood samples will be sent in the NewbornScreening Laboratory and the result will bereleased 7 to 14 working days after newbornscreening sample is received in the NBS center. 2 6 19 3

30 2.63 Aware 6

Legend: WM - Weighted MeanVD - Verbal DescriptionR - Rank

Table IV shows that the Level of Awareness of the Respondents about Newborn

Screening, where the scale of 1 means Unaware while the scale of 4 refers to Fully Aware.

This table is divided into three subcategories.

The first subcategory is concerned with the Nature of the Screening. As shown in

the table, majority of the respondents are aware that Newborn screening is safe, obtaining a

mean of 3.07. It is also shown in the table that the second with the highest mean is the

awareness that Newborn Screening test aids in early detection of five congenital metabolic

diseases of the newborn with 3.03 which falls also on Aware. The third item with the

highest mean is Newborn Screening is a program of the Department of Health with 2.98

(Aware). Obtaining the least mean is the item Newborn Screening Tests are done through

heel prick method to get blood samples with Aware and the score of 2.53.

As cited in www.health.vic.gov.au. Screening is quick and safe. The heel prick

may cause brief discomfort to your newborn, but holding or feeding them during collection

will help. There is a very small risk of infection because we are making a small break in the

skin, but using gloves and cleaning the heel beforehand will minimize this risk. Mothers

are aware of the procedure but it has the least mean as shown on the table above, and as

cited in, Newborn screening is a simple procedure. Using the heel prick method, a few
http://www.health.vic.gov.au/http://www.health.vic.gov.au/


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drops are taken from the baby's heel and blotted on 1 a special absorbent filter card. The

blood is dry 3 to for 4 hours and sent to the Newborn Screening Laboratory.

Table IV. B

STATEMENT

UA NA A FA

N WM VD Rank1 2 3 4

b. Availability and Accessibility of the Program1. Newborn Screening is available in participatingNewborn Screening facilities (hospital, lying-ins,rural health units and health centers). 3 3 18 6 30 2.7 Aware 2

2. The facilities providing NBS are withinaccessible locations. 4 8 11 7 30 2.43

Not so

Aware 3

3. The NBS program is within financial capabilityof the family. 1 3 14 12 30 3.17 Aware 1


The second subcategory of Table IV is about the Availability and Accessibility of

the Program. The scale of 1 means Unaware while the scale of 4 means Fully Aware.

Majority of the respondents are aware of NBS program is within financial capability of the

family which obtained the mean of 3.17 While, Newborn Screening is available in

participating Newborn Screening facilities (hospital, lying-ins, rural health units and health

centers) which obtains 2.7 and the mothers are not so aware of The facilities providing

NBS are within accessible locations with the average of 2.43.


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According to Department of Health (DOH) 2011,Newborn screening is available

in participating health institutions (hospitals, lying-ins, Rural Health Units and Health

Centers). If babies are delivered at home, babies may be brought to the nearest institution

offering newborn screening. According to National Institutes of Health- UP Manila (2010),

Newborn Screening Promotion, NBS test costs only Php. 500 at a very reasonable price.

The DOH Advisory Committee on Newborn Screening has approved a maximum

allowable fee of P50 for the collection of the sample Newborn Screening Promotion.

Table IVC.

STATEMENT

UA NA A FA

N WM VD Rank 1 2 3 4

c. Significance of Newborn Screening

1. Newborn Screening test is important to

ensure the infants good health condition. 1 1 19 9 30 3.13 Aware 1

2. It helps in detecting the metabolic

disorders of an infant so that it would not

lead to further deterioration of the childs

health status. 2 5 18 5 30 2.73 Aware 3

3. When diagnosed early of disorders, there is

a chance of excellent prognosis and the babymay be spared from lifelong impairment andcan enjoy normal life. 2 3 17 8 30 2.9 Aware 2

4. If my baby is not screened, it could lead tosevere mental retardation and even death. 1 9 17 3 30 2.67 Aware 4


The third subcategory of Table IV is about the Significance of Newborn

Screening. Majority of the respondents are aware that Newborn Screening test is important

to ensure the infants good health condition obtaining a mean of 3.13. With a mean of 2.9,

the respondents are aware that if the child was diagnosed early of having one of the


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disorders, there is a chance of excellent prognosis and the baby may be spared from

lifelong impairment and can enjoy normal life. The respondents are aware with the least

mean of 2.67 that If their baby is not screened, it could lead to severe mental retardation

and even death.

Newborn screening (NBS) is important because a baby with one of these illnesses

will appear perfectly healthy and by the time symptoms are visible, irreparable damage can

occur damage such as mental retardation or, in countless instances, death. This program

is essential nowadays because it is a procedure that determines whether the infant has a

congenital defect or anomaly. A mother should always be aware of her infants condition,

because once newborn screening procedure is being done and the result has been revealed

that the infant is positive for any of the congenital disorders/anomalies, it is being followed

up by series of medication, but if the infant did not undergo the procedure and has any of

the congenital defects present at birth, it would be a life-long burden not only for the family

but especially for the child. (London, 2007)


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Table V. Level of acceptance on Newborn Screening

Statement

UA A HA

N WM VD RANK 1 2 3

1. I understood everything that thenurse/ hospital worker/ doctor toldme about NBS test. 1 23 6 30 2.1 Acceptable 5

2. I am financially capable to havemy child undergo NBS. 2 22 6 30 2 Acceptable 7

3. I would like to subject my childfor NBS, since my first child had

undergone to this test too. 1 16 13 30 2.33 Acceptable 3

4. NBS is not against my cultural

and religious beliefs 0 11 19 30 2.63

Highly

Acceptable 15. The hospital emphasizes

promotion of NBS based on thepolicies and standards of the

institution. 1 15 14 30 2.37

Highly

Acceptable 2

6. I am prepared to whatever resultsthe NBS test may give. 2 14 14 30 2.27 Acceptable 4

7. I would like to subject my child fornewborn screening 3 15 6 30 2.1 Acceptable 6

Legend: WM - Weighted MeanVD - Verbal Description

R - Rank

Table V shows the Level of Acceptance on newborn screening, where the

scale of 1 Unacceptable, while the scale of 5 refers to Highly Acceptable. As shown

in the table, majority of the respondents highly accepts that NBS is not against their

cultural and religious beliefs, obtaining the mean of 2.63. It shows that in the

hospital setting, The hospital emphasizes promotion of NBS based on the policies

and standards of the institution with a mean of 2.37. On the other hand, with a mean


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of 2.33, respondents accept and would like to subject their child for NBS, since

their first child had undergone to this test too. Moreover, obtaining the least mean

in the item I am financially capable to have my child undergo NBS with a score of

2. Most mothers accept the fact that they are financially capable of subjecting their

child to the test.

As cited in www.slh.wisc.edu, as a parent, you may refuse newborn

screening for your baby only if your religious beliefs and practices do not allow this

testing. If you refuse to have the test done, you may be asked to sign a paper

stating that you refused to have your baby tested for these very serious disorders.

According to National Institutes of Health- UP Manila (2010), Newborn

Screening Promotion, NBS test costs only Php. 500 at a very reasonable price. The

DOH Advisory Committee on Newborn Screening has approved a maximum

allowable fee of P50 for the collection of the sample Newborn Screening

Promotion.
http://www.slh.wisc.edu/http://www.slh.wisc.edu/


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Table VIII. Variables that Influence the Acceptability of Newborn Screening

among Respondents

Statement

DA A HA

N WM VD Rank 1 2 3

1. Personal experience of health and

illness as well as parenting.0 11 19 2.63 2.63 Highly

Affects1

2. Interest and knowledge in healthmatters.

6 9 15 1.9 1.9Affects

5

3. Influence of friends and other people.6 6 18 2 2

Affects4

4. Religious and Cultural belief of myfamily.

7 8 15 1.8 1.8Affects

7

5. The provider of informationregarding Newborn Screening.

5 6 19 2.13 2.13 Affects 3

6. Financial Capability to undergoNewborn Screening.

7 9 14 1.77 1.77Affects

8.5

7. Quality of Services rendered under theNBS program.

5 15 10 1.83 1.83Affects

6

8. Policies/ Standard Procedures Set by

the Hospital.2 9 19 2.43 2.43 Highly

Affects2

9. The possibility for a positive result ofthe test.

8 5 17 1.77 1.77Affects

8.5


As shown in the table majority of the mothers responds that Highly Affects

their Newborn Screening Acceptance Personal experience of health and illness as

well as parenting with a mean of 2.63 and Policies/ Standard Procedures Set by the

Hospital obtaining a mean of 2.43. However, the least item are the Financial

Capability to undergo Newborn Screening and The possibility for a positive result of

the test with both a mean of 1.77.


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Parent education about newborn screening should start well before the

time of delivery and labor. The babys pediatrician, family physician, or other

health care provider should introduce information about newborn screening to

parents during the third trimester. Education on newborn screening should be

included during the pre-admission process. Community health agencies for

pregnant women should also include this education. The American College of

Obstetrics and Gynecology (ACOG) Committee on Genetics Opinion Number 27,

October 2003 states: "Obstetrician-gynecologists can continue to work to improve

the health of their patients by informing expectant families of the newborn

screening process."

According to the study published on line on May 2006, Pediatrics Vol. 117

entitled: Recommendation for Effective Newborn Screening Communication:

Results of focus group with parents and experts that recommended prenatal and

primary care providers be involved in educating about newborn screening.

Professional societies and state health professional should work together to

encourage parent and provider education. Uses- friendly patient provider

educational materials, such as those we developed, could from the basis for this

education.


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Chapter V

Summary, Conclusion, And Recommendation

This chapter presents the summary of the study, formulated conclusion and

recommendation offered. The method used to conduct the study has been taken into

account. A discussion of the significance of the findings that included the

implication to in and on for nursing profession will follow with respect to education

for mothers about Newborn Screening Program. Limitations of the study are

discussed along with recommendation for further research.

Summary

This study was conducted within Candelaria Municipal Hospital in

Candelaria Quezon, which aims to seek out, the Newborn Screening Awareness

and Acceptability among Selected Mothers at Candelaria Municipal Hospital: An

Assessment. The descriptive method of research was utilized and self-made

questionnaire served as the principal data gathering instrument. The study was

conducted in the month of February 2011. There are 30 respondents who filled up

every questionnaire. Participant completed the questionnaire in the said hospital

and returned the questionnaires immediately after answering. The results of the

questionnaire were tabulated and interpreted from which the findings and

conclusion were drawn. The purpose of this study was to:


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1. Assess the mothers level of awareness of the Newborn Screening

Program.

2. Identify mothers acceptance of the Program.

3. Assess the mothers awareness of the factors that affects Newborn

Screening.

The following are the summary of findings of the study based from all the

data presented, analyzed and interpreted in Chapter IV:

1. Demographic Profile of the Respondents

1.1A total of thirty (30) respondents were chosen for this study.

1.2 Majority of the respondent- mothers are of age 22-24.

1.3When grouped according to Civil Status, 16 (53%) out of 30 are

single. Married respondents numbered 14 with 47% of the

sample.

1.4 Most of the respondents finished High School (53%), 7% are

able to finish Elementary , 10% are able to finish college.

School (7%), Elementary (3%)

1.5Majority of the sample has a monthly income of 5,001- 10,000

which constitutes 43% of the sample population.


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1.6 Majority of the respondents are primigravidas with 43%, and

multigravidas are composed of, one child, two children (27%),

three chid (17%), four child (7%), five child (7%).

2. Level of Awareness regarding Newborn Screening

2.1Majority of the respondents are aware that Newborn screening

is safe, obtaining a mean of 3.07 while the least obtained the

mean of 2.53 which is the item Newborn Screening Tests are

done through heel prick method to get blood samples.

2.2Majority of the respondents are aware that The NBS program is

within financial capability of the family which obtained the

mean of 3.17. It shows that mothers are aware of The facilities

providing NBS are within accessible locations, with an average

weighted mean of 2. 43

2.3Majority of the mothers are aware of Newborn Screening test is

important to ensure the infants good health condition with an

average weighted mean of 3.13. It shows that mothers aware of

the statement If my baby is not screened, it could lead to severe

mental retardation and even death with an average weighted

mean of 2.67.


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3. Level of Acceptance on Newborn Screening

3.1Majority of the respondents Highly Accepts the item NBS is

tweighted mean of 2.67. While the respondents only Accepts the

item I am financially capable to have my child undergo NBS

with a least mean of 2.

4. Variables that Influences Acceptance of Newborn Screening

4.1Majority of the mothers responds that it Highly Affects their

Newborn Screening Acceptance in Personal experience of health

and illness as well as parenting with a mean of 2.63 and

Policies/ Standard Procedures Set by the Hospital obtaining a

mean of 2.43. However, the least item are the Financial

Capability to undergo Newborn Screening and The possibility

for a positive result of the test with both a mean of 1.77.


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Conclusion

Based from the results of the researchers data gathering, they arrived at the

following conclusions:

1. Majority of the respondents are ages 22-24, ,most of the mothers are

Single and High School graduate. The respondents earns 5,000 to

10,000 monthly and most of them are primapara.

2. Respondents are aware that the Newborn Screening is safe. The

respondents are also aware that Newborn Screening test aids in early

detection of five congenital metabolic diseases of the newborn and that

Newborn Screening is a program of Department of Health. They have

little knowledge that Newborn Screening Tests are done through heel

prick method to get blood samples.

3. The respondents are less aware that the facilities providing NBS are

within accessible locations while the respondents are much aware that

The NBS program is within financial capability of the family and

Newborn Screening is available in participating Newborn Screening

Facilities.


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4. The respondents are aware that Newborn Screening test is important to

ensure the infants good health condition. The mother respondents are

also aware that When diagnosed early disorders, there is a chance of

excellent prognosis and the baby may be spared from lifelong

impairment and can enjoy normal life and it also helps in detecting the

metabolic disorders of an infant so that it would not lead to further

deterioration of the childs health status. The respondents are least

aware that If their baby is not screened, it could lead to severe mental

retardation and even death.`

5. Mothers highly accept that the hospital emphasizes promotion of NBS

based on the policies and standards of the institution and that NBS is

not against their cultural and religious beliefs. the respondents would

like to subject their child for NBS, since their first child had undergone

to this test too. I am financially capable to have my child undergo to

this test is the least acceptable for the respondents.

6. Mothers responded that all factors affect their acceptance of Newborn

Screening for their child which includes Personal Experience of health

and illness as well as parenting, Interest and knowledge in health

matters, Influence of friends and other people, Religious and Cultural

belief of my family, The provider of information regarding Newborn


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Screening, Financial Capability to undergo Newborn Screening,

Quality of Services rendered under the NBS program, Policies/

Standard Procedures Set by the Hospital and The possibility for a

positive result of the test.

7. Mothers responded that Personal Experience of health and illness as

well as parenting and Policies/Standard Procedures set by hospital

highly affects them in accepting Newborn Screening. The respondents

also responded that The provider of information regarding NBS and the

rest of the tatements affects them in accepting the test. The Financial

capability to undergo NBS least affect to the respondents.

Recommendations:

Based on conclusions mentioned above, the researchers of this study hereby

recommend the following:

1. Implement an effective health education plan for the mothers who are

about to give birth in order to raise their awareness towards NBS.

a. The level of current support and training for health professionals in

health education needs to be considered. This includes those

professionals directly involved with implementation of the NBS


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programme, those providing information and education as well as

NBS programme staff.

b. Student nurses should also take part on educating the pregnant

mothers in the OB ward in order to make sure that they are given

enough information on what NBS is for.

2. Certain programs must be formulated to provide reinforcement NBS

among mothers.

a. For the hospital, the institution must plan to implement a program

that will conduct a seminar to pregnant woman before their delivery

to strengthen the health education of Newborn Screening.

b. Also, further policy development regarding best practice in the

timing and distribution of information about NBS should be

required.

3. The area of Community Health Nursing must also be given priority.

a. For the midwives of the community, they should have formal

education plan for the mothers regarding the different congenital

disorders which will be taught to them during prenatal visit in order

for them to gain knowledge and understanding of how NBS could

help towards early detection of these disorders.


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b. Provide some leaflets for pregnant mothers containing information

regarding NBS procedure and its importance so that mothers may

read it and learn at home if they dont have enough time to go to the

Barangay Health Center.

4. Future studies should be done on the effectiveness of the health

education plan and programs implemented on the communities and the

particular hospital studied. It would provide them basis if they still have

to implement more programs or improve their strategies on health

education.


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REFERENCES

Books

Olson, Steve. (2010) Challenges and Opportunities in Using Residual

Newborn Screening Samples for Translational Research. Washington, D.C.,

The National Academic Press.

London, Marticia (2007). Maternal and Child Nursing Care (3rd Edition).

Washington D.C.

Stewart, Heather. (2007)Maternal & Child Nursing Care (2nd Edition)

Journals


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Ayrette E. Paderes, (March 2005).Level of Awareness on Newborn

Screening of Selected Mothers in Tayabas Quezon.

Deatus, Angus (2003)Health, Income and Inequality.

Fant KE, Clark SJ, Kemper AR. (2005) Completeness and complexity of

information available to parents from newborn screening

programs.Pediatrics, 44.

Jane Miller and Yana Rodgers (2005) Mothers Education and Childrens

Nutritional Status: New Evidence from Cambodia. Vol. 26; pp. 132-134

Kemper AR, Fant KE, Clark SJ. (2005)Informing parents about newborn

screening. Public Health Nurs.

Moyer VA, (2008) Expanding newborn screening: process, policy, and

priorities. Hastings Cent Rep.;pp. 3231

Stewart; Oliver (May 2003). What is known about communication with

parents about newborn bloodspot screening?

The American College of Obstetrics and Gynecology (ACOG) Committee

on Genetics Opinion Number 27, October 2003


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Toletino MJ, (March 2008). Comparison between Selected Primiparas and

Multiparas in the level of Awareness regarding Newborn Screening at

Quezon Medical Center.

Pediatrics Vol. 117 entitled:Recommendation for Effective Newborn

Screening Communications

Electronic Sources

Department of Health, Republic of the Philippines (2011 October) Where is

Newborn Screening available Retrieved February 2012, from

http://www.doh.gov.ph/node/766

Depertment of Health, Republic of the Philippines (2011 October) Newborn

Screening Retrieved Feb 2012, from

http://www.doh.gov.ph/content/newborn-screening

The LawPhil Project Arellano Foundation (2004, April 07). Republic of the

Philippines, Congress of the Philippines Retrieved January 2012, from

http://www.lawphil.net/statutes/repacts/ra2004/ra_9288_2004.html
http://www.doh.gov.ph/node/766http://www.doh.gov.ph/content/newborn-screeninghttp://www.doh.gov.ph/node/766http://www.doh.gov.ph/content/newborn-screening


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N Dickson (2008, January 24) Information and consent for newborn

screening: practices and attitudes of service providers. Retrived January

2012, from http://jme.bmj.com/content/34/9/648.abstract

National Institutes of Health - UP Manila (2010) Newborn Screening

Promotion from

https://sites.google.com/site/vylhphilippines/vylhadvocacies/newborn-

screening-promotion/basic-information-on-newborn-screening

Newborn Screening for the Health of your baby 2011

http://www.health.vic.gov.au/nbs/downloads/nbs_dl.pdf
http://jme.bmj.com/content/34/9/648.abstracthttps://sites.google.com/site/vylhphilippines/vylhadvocacies/newborn-screening-promotion/basic-information-on-newborn-screeninghttps://sites.google.com/site/vylhphilippines/vylhadvocacies/newborn-screening-promotion/basic-information-on-newborn-screeninghttp://www.health.vic.gov.au/nbs/downloads/nbs_dl.pdfhttp://jme.bmj.com/content/34/9/648.abstracthttps://sites.google.com/site/vylhphilippines/vylhadvocacies/newborn-screening-promotion/basic-information-on-newborn-screeninghttps://sites.google.com/site/vylhphilippines/vylhadvocacies/newborn-screening-promotion/basic-information-on-newborn-screeninghttp://www.health.vic.gov.au/nbs/downloads/nbs_dl.pdf


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APPENDICES

APPENDIX A

Calayan Educational foundation IncorporatedCollege of Nursing

Lucena City

Date:
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Dr. Grace S. Mirando MD., MHA, PHSAEChief of Hospital

Candelaria Municipal HospitalCandelaria, Quezon

THRU:Mrs. Myrnalita Trinidad RN.OB Head NurseCandelaria Municipal HospitalCandelaria, Quezon

Dear Sir/Madamme:

Good day! We are senior nursing students of Calayan Educational Foundation

Incorporated and we will be conducting a study entitled Newborn ScreeningAwareness and Acceptability of Selected Mothers In CandelariaMunicipal Hospital, An Assessment as a requirement for the courseBachelor f Science in Nursing.

In connection with this, may we request from your good office for permission toconduct the aforementioned study. Rest assured that all findings will be treatedwith utmost confidentiality.

Hoping for your favorable consideration.

Thank you very much.

Respectfully yours,Jieneth AngoyEmiliano SuayanBSN IV

Approved By:Mr. Nelson J. Hugo, MATResearch Professor

Noted By:Dr.Maria Theresa S. ImperialDean, College of Nursing

APPENDIX B

CALAYAN EDUCATIONAL FOUNDATION INC.

Red V, Lucena City
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Petsa:__________

Sa mga kinauukulan,

Kami po ay nagsasagawa ng aming pananaliksik na pinamagatang NEWBORNSCREENING AWARENESS AND ACCEPTABILITY OF SELECTED

MOTHERS IN CANDELARIA MUNICIPAL HOSPITAL: AN

ASSESSMENT. Ang layunin po ng pag-aaral na ito ay upang malaman ang mgasalik na nakaiimpluwensya upang ipa-newborn screening o hindi ipa-newbornscreening ng mga nanay ang kanilang mga sanggol pagkatapos ipanganak.Hinihingi po naming ang inyong partisipasyon para sa pag-aaral na ito.

Maaasahan po ninyong ang mga impormasyong makukuha mula sa inyo aymapapanatiling pribado.

Maraming salamat po..

Lubos na gumagalang,

Jieneth Angoy

Emiliano Suayan

Mga Mananaliksik

Endorsed By:

Mrs. Sonia A. Delantar, MANTagapayo

Ni-notahan ni:

Mr. Nelson J. Hugo, MAT

Research Professor

APPENDIX C

QUESTIONNAIRE
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Part I: Demographic ProfileDirection: Check ( / ) or fill up the spaces provided according to your responses.

A. Age: _____

B. Civil Status:

_____ Single_____ Married

C. Educational Attainment

Graduate Undergraduate

Elementary

High Schoool

College

Not Applicable

D. Monthly Income____5,000 and below____ 5,001 10,000____ 10,001 15,000

____ 15,001 20,000____ 20,001 25,000____ 25,001 and above

E. Maternal History

____ No. of Pregnancies____ No. of Deliveries

Part II. Level of Awareness regarding Newborn Screening
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Direction: Read each item carefully. Indicate your answer by putting a check ( / )

on the box which corresponds to your answer guided by the following:

Scale:4 - Fully Aware

3 - Aware

2 - Not so Aware

1 - Unaware

Part III. LEVEL OF ACCEPTANCE ON NEWBORN SCREENING

Direction: Read each item carefully. Indicate your answer by putting a check ( / )

which corresponds to your answer guided by the following:

Scale:

3 - Highly Acceptable

2 - Acceptable

1 - Unacceptable

6. Newborn screening is safe

7. Newborn Screening Tests are done through heel prick

method to get blood samples.

8. The blood samples will be sent in the Newborn

Screening Laboratory and the result will be released 7

to 14 working days after newborn screening sample is

received in the NBS center.

B. Availability and Accessibility of the Program

1. Newborn Screening is available in participating

Newborn Screening facilities (hospital, lying-ins, rural

health units and health centers).

2. The facilities providing NBS are within accessible

locations.

3. The NBS program is within financial capability of the

family.

C. Significance of Newborn Screening Program

1. Newborn Screening test is important to ensure the

infants good health condition.

2. It helps in detecting the metabolic diso

Documents

2(Final n Tlga)