AWARENESS ON THE UNANG YAKAP CAMPAIGN AMONG HEALTH PROFESSIONALS EMPLOYED IN SELECTED RURAL HEALTH UNITSAND LYING-IN CLINICS

IN THE PROVINCE OF CAVITE Charmaine Joelyn A. Lachica; Jessica Grace C. Lanuzo; Ralph Ronel R. Leoro

An undergraduate research submitted to the faculty of College of Nursing, Cavite State University Indang, Cavite, in partial fulfillment of the requirements for Bachelor of Science in Nursing prepared under the supervision of Mrs. Nenita B. Panaligan, RN, MAN.

INTRODUCTION

The Philippines is one of the 42 countries that account for 90% of under-five mortality worldwide. Where 82,000 Filipino children under five years old die every year, 37% of them are newborn. Majority of the newborn (3/4) die within the first two days of life, mostly due to stressful events or conditions during labor, delivery and immediate postpartum period (Pillitteri, 2007). The current practice of handling newborns, like clamping and cutting the umbilical cord and washing the baby right after birth, have been known to actually contribute to the high incidence of neonatal deaths and illnesses in the (InstantMommy, 2010). The Department of Health recently launched a nationwide campaign on proper newborn care practices last December 7, 2009 entitled Unang Yakap- Yakap ng Ina, Yakap ng Buhay which translates to First Embrace- Embrace of Mother, Embrace of Life. With this campaign, the Department of Health aims to cut down infant mortality in the Philippines and keep up with the governments Millennium Development Goal of

reducing childhood mortality to two-thirds of just six per 1,000 live births by 2015 (Medical Observer, 2010). Dubbed Unang Yakap, the campaign is embodied in an Administrative Order (AO) 2009 entitled Adopting New Policies and Protocol on Essential Newborn Care (ENC). The AO is consistent with the AO no. 2008 2009 on Implementing Health Reforms for Rapid Reduction of Maternal and Newborn Mortality and provides key behaviors and appropriately-timed interventions to make the postnatal period for newborns safer. It paves the way toward a system that adheres to a globally accepted evidence-based essential newborn care (Medical Observer, 2010). According to Former Health Secretary Francisco Duque III (2009), the government launched the Unang Yakap campaign as an initial reaction to the protocol, in collaboration with the World Health Organization, to help solve this newborn mortality problem because if it is not reduced by at least half, the goal of reducing childhood mortality to two-thirds by 2015 would not be met. He also said that the Philippines is focusing on the first few hours of life of the newborn with the manual guiding of the health workers and medical practitioners in providing evidence-based essential newborn care, thus, the Unang Yakap Campaign (InstantMommy, 2010). Therefore, this study will be conducted to determine the awareness of health professionals employed in selected rural health units and lying-in clinics in the province of Cavite to the Unang Yakap Campaign. Statement of the Problem Specifically, this study sought to answer the following questions:
1. What is the demographic profile of selected health professionals in terms of:

a. Gender
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b. Age c. Civil Status d. Years of Service

e. Work Stations (rural health unit and lying-in clinic)

f. Specific Profession (i.e., nurse, midwife, doctor)

2. What is the source of information on Unang Yakap Campaign of the selected health

professionals?
3. What is the level of awareness and knowledge of health professionals of the Unang

Yakap Campaign?
4. Is there a significant relationship between the sources of information and level of

awareness and knowledge of the respondents with regard to the Unang Yakap Campaign?
5. What is the extent of implementation of the Unang Yakap Campaign in the different

rural health units (RHU) and lying-ins in terms of performance of its protocol by doctors, nurses and midwives?
6. Is there a significant relationship between extent of implementation and level of

awareness and knowledge of health professionals employed in rural health units and lying-in clinics?
7. Is there a significant difference on the level of awareness, knowledge, and extent of

implementation among professionals?

8. Is there a significant difference on the extent of implementation of health

professionals between work places and stations? 9. What are the perceived advantages and disadvantages of the Unang Yakap Campaign?

Hypotheses 1. There is no significant relationship between the sources of information and level of awareness and knowledge of the respondents with regard to the Unang Yakap Campaign 2. There is no significant relationship between the extent of implementation of Unang Yakap Campaign to the level of awareness and knowledge of health professionals. 3. There is no significant difference on the level of awareness, knowledge, and extent of implementation between Professionals. 4. There is no significant difference on the extent of implementation of health professionals between work places and stations.

Objectives of the Study This study aimed:

1. to assess the demographic profile of selected health professionals in terms of

gender, age, civil status, years of service and specific profession;

2. to determine the source of information of selected health professionals regarding the

Unang Yakap Campaign;

3. to assess the level of awareness and knowledge of selected health professionals in

the implemented Unang Yakap Campaign;

4. to determine the extent of implementation of the Unang Yakap Campaign in the

different rural health units (RHU) and lying-ins in terms of performance of its protocol by the nurses and midwives;
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5. to determine if there is a significant relationship between the sources of information

and level of awareness and knowledge of the respondents with regard to the Unang Yakap Campaign;
6. to determine if there a significant relationship between extent of implementation

and level of awareness and knowledge of health professionals employed in rural health units and lying-in clinics;
7. to find out if there a significant difference on the level of awareness, knowledge,

and extent of implementation between professionals;

8. to find out if there a significant difference on the extent of implementation of health

professionals between work places and stations; and

9. to determine the advantages and disadvantages of the Unang Yakap Campaign.

Significance of the Study Maternal and newborn health has long been a priority area of concern and activity of the Department of Health. Evidence shows there is a need for Philippine newborns to benefit from their mothers natural protection in the first hour of life. This study entitled Awareness in the Unang Yakap Campaign among Health Professionals Employed in Rural Health Units and Lying-in Clinics in the Province of Cavite will be significant to the following persons or organizations:
a. The health care professionals such as doctors, midwives and nurses

They can use this study as their baseline data for the information about newborn care and for better understanding of the benefits of Unang Yakap that was implemented by the Department of Health (DOH) last December 2009. This

will also be beneficial to them because they can compare the mortality rate of infants before and after the implementation of the Unang Yakap Campaign. b. Policy Makers They would know if their campaign is being implemented in selected rural health units and lying-in clinics in the province of Cavite. And also it can help them if they should disseminate more information regarding the said campaign. c. Mothers Through the implementation of the Unang Yakap Campaign by the health professionals in rural health units and lying-in clinics, the mothers will also be aware of the benefits they could get from this campaign, such as having direct contact or bonding with their babies right after the delivery.

d. Future Researchers The content of the study will serve as reference to future researchers who intend to explore the same interest.

Scope and Limitation of the Study The subject of the study includes 125 health professionals who are randomly selected at rural health units and lying- in clinics in Cavite. The study is confined to selected health professionals awareness, knowledge and extent of implementation of the Unang Yakap Campaign under the Essential Newborn Care protocol.

Theoretical Framework
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Parent-Child Interaction Model (Kathryn E. Barnard RN, 2001) In the 1970s, when Barnard began her studies of infants and their mothers, there was minimal appreciation of the connections between earliest communication, touch, brain growth, and the ways humans develop the social, emotional and behavioral capacities to self-regulate, connect with others, and experience the world as a safe and predictable place. Even less was known about research-based protocols to help health care workers assess infant development and intervene to promote parent-infant interaction. Without empirically derived guidelines, clinicians were hampered in their abilities to diagnose infants at risk for neglect, abuse, or developmental delays and even less certain about how to stimulate parenting that would enhance infants' cognitive, emotional, and behavioral development. Patient. In relations to Unang Yakap Campaign by the Department of Health, the people mainly involved in this study are the mothers and the infants. The Parent -Child Interaction model is ascertaining that parents should have an early interaction to their infant as soon as they were born, just like what one of the goals of ENC protocol. Environment. Birthing homes, hospitals, lying-ins and even a mere home can be a place where giving birth can happen. Unang Yakap Campaign was designed to be implemented at areas where immediate care of the newborn can be done and early bonding was initiated. Nursing. Not only in the Nursing field but also other health professionals are in cooperation in making the Unang Yakap Campaign to prevent the increases in infant mortality and infant well development. Health. All aspects of health- holistically, including physical, emotional, social, and behavioral capacities are taken into big consideration in the Unang Yakap Campaign.
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Conceptual Framework Dependent Variable: Essential Newborn Care Protocol (ENC) AO no. 2009-0025: Independent Variable: UNANG Unang YakapYAKAP: Yakap ng Ina, Yakap ng Buhay Demographic profile Campaign of Health Level of Awareness Professionals in the Level of Knowledge Province of of Extent Cavite: Gender Implementation Age Civil Status Years of Service Work Stations Specific Profession Sources of Information of Health Professionals

Figure 1. A representation showing the Essential Newborn Care Protocol. The input which are the independent variable includes the demographic profile of the respondents and their sources of information. The process is the implementation of Unang Yakap Campaign. The dependent variable in the study is the level of awareness, level of knowledge and extent of implementation of the Unang Yakap Campaign.

Definition of Terms Awareness- knowledge or having cognizance among RHU nurses, midwives and physicians in the province of Cavite about Unang Yakap Campaign. Knowledge gained through ones own perception or by means of information. Essential Newborn Care (ENC) protocol- ENC is a comprehensive strategy to improve the health of the newborn through interventions before conception during pregnancy, soon after birth, and in the postnatal period. The ENC Protocol provides an

evidence-based, low cost, low technology package of interventions that will save thousands of lives. Infant mortality- is the measurement of infants that die in their first year of life, mostly due to stressful events or conditions during labor, delivery and immediate postpartum period. This is also the major problem of the Department of Health, they are aiming to cut the infant mortality sharply thats why they launched the Unang Yakap campaign. Non-time bound intervention- is the second phase in the guidelines of providing evidence-based essential Newborn care that must be performed by the health professionals. These interventions are immunizations, eye care, Vitamin K administration and weighing. Washing must be postponed by at least 6 hours. Provision of appropriate thermal care through mother and newborn skin-to skin contact maintaining a delivery room temperature of 25-28 degrees centigrade and wrapping the newborn with clean, dry cloth. This intervention is done after the first complete breastfeeding of the mother. Post-natal procedure- is a procedure required within 24 hours after birth. This procedure includes eye prophylaxis, delayed bathing until 6 hours of life and the routine Newborn screening. Time bound procedures- is the first phase in the guidelines of providing evidence-based essential newborn care. Time bound procedures are kinds of actions that should be routinely performed by health professionals which includes clamping the cord after one to three minutes, not separating the newborn from the mother and last is the initiation of breastfeeding. Unang Yakap- Unang Yakap is the campaign launched by the Department of Health (DOH) last December 7, 2009. Unang Yakap Campaign is an initial reaction to

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the protocol, in collaboration with the World Health Organization (WHO), this campaign will help solve this newborn mortality problems. Unnecessary procedures- is the third phase in the guidelines of providing evidence-based essential newborn care. These procedures include the routinely done suctioning, routine separation of the newborn for observations, administration of prelacteals like glucose, water formula, foot printing and cutting of the cord (1-3 minutes or until cord pulsation stops).

REVIEW OF RELATED LITERATURE This chapter places the current study into context of previous, related research. As such, literature review emphasizes the relatedness between the current study and the work of other authors with the points of agreement and disagreement among previous studies, as well as with the theoretical and empirical relevance of each of the present research. For central importance, the literature review provides a thematic narrative which guides the formulation of the topic and suggests strategies for making operational the independent and dependent variables considered in the study. This chapter serves the literature review. This contains gathered information from articles, pamphlet, book, and internet that is related to the study. Newborn Care Newborns undergo profound physiologic changes at the moment of birth, as they are released from a warm, snug, dark, liquid filled environment that has met all of their basic needs, into a chilly, unbounded bright lit, gravity based outside world. Within
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minutes after being plunged into this strange environment, a newborns body must initiate respirations and accommodate a circulatory system to extra uterine oxygenation. Within 24 hours, neurologic, endocrine, gastrointestinal, and metabolic must be operating competently for life to be sustained (Pillitteri, 2007). How well a newborn makes these major adjustments depends on his or her genetic competition, the competency of the recent intrauterine environment, the care received during the labor and birth period, and the care received during the newborn or neonatal period. Two thirds of all deaths that occur during the first year of life occur in the neonatal period. More than half occur in the first 24 hours after birth- an indication of how hazardous this time is for an infant. Close observation of a newborn for indications of distress is essential during this period (Pillitteri, 2007). National Health Goals A number of National Health Goals deal directly with the newborn period (DHHS, 2000): 1. Increase to at least 75% the proportion of mothers who breast- feed their babies in the early postpartal period, from a baseline of 64% 2. Increase to at least 50% the proportion of women who continue breast-feeding until their babies are 5-6 months old, from a baseline of 29% 3. Increase to 70% the percentage of healthy full term infant that are put to sleep on their backs, from a baseline of 35% 4. Increase to at least 75% of the proportion of parents and caregivers who use feeding practices that prevent baby- bottle tooth decay.
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5. Reduce the neonatal mortality rate to no more than 2.9 per 1,000 live births, from a baseline of 4.8 per 1,000 live births. Nurses can help the nation achieve these goals, by encouraging woman not only to begin breast-feeding but also to continue it through the first 6 months of life; by advising parents on the advantage of placing infants on their backs to sleep and on the danger of tooth decay from letting a baby drink from a bottle of milk or juice while falling asleep; and by discussing with parents who use formula the proper methods for the preparation so the gastrointestinal illness does not occur (Pillitteri, 2007). Physical Examination A newborn is given preliminary physical examination immediately after birth, to establish gestational age and to detect any observable condition such as difficulty breathing, a congenital heart anomaly, meningocele, cleft lip or palate, hydrocephalus, or birthmark, imperforate anus, tracheoesophageal atresia, or bowel obstruction. This assessment may be the responsibility of the delivering physician, nurse practitioner, nurse midwife, pediatrician, or nurse. This health assessment is done quickly, to prevent overexposing the newborn, yet not so swiftly that important findings are overlooked (Pillitteri, 2007). Height and Weight Assuming newborns are breathing well, they are weighed nude and without a blanket immediately after birth in the birthing room. Measurements such as body length and head, chest, and abdominal circumferences can be obtained in a newborn or

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transitional nursery. Performing these measurements while an infant is still damp only exposes the newborn unnecessary to chilling. Newborn weight helps to determine maturity and establishes a baseline against which other weights can be obtained. An infant is weighed nude once a day, at approximately the same time everyday, during a hospital or birthing center stay. Abnormal loss of weight may be the first indication that the newborn has an inborn error of metabolism, such as adrenogenital syndrome or is becoming dehydrated (Pillitteri, 2007). Laboratory Studies After the first hour of undisturbed rest, depending on health agency policy, newborns may have heel- stick tests for hematocrit hemoglobin, and hypoglycemia determinations. Heel- sticks require a minimum of blood, and, although not pain free, they cause a minimal trauma to a baby. In some settings, these tests are not routine but they reserved only for newborns with symptoms of anemia or hypoglycemia (Pillitteri, 2007). Hematocrit and hemoglobin determinations are done to detect newborn anemia, because it is difficult to appreciate that anemia is present by clinical observation alone. Hypoglycemia may also produce few symptoms, so it is determined by a heel stick glucose measurement. If a blood glucose reading is less than 40 mg/ 100 ml of blood, hypoglycemia is present. To correct this condition, the infant is prescribed oral glucose or infant formula to be given immediately. This elevates the infants blood sugar to a safe level (Pillitteri, 2007).
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Care of Newborn at Birth Delivery and birthing rooms provide an island for newborn care separate from the supplies needed for the mothers care. Necessary equipments include a radiant heat table or warmed bassinet; a warm, soft blanket; of equipment for oxygen administration, resuscitation, suction, eye care, identification, and weighing of a newborn (Pillitteri, 2007). The philosophy of caring health care providers has always been that newborns should be handled as gently at birth as they are at any other time. The image of an obstetrician holding a newborn up by the heels and spanking to stimulate breathing has existed only in movies. It has long been accepted that holding the baby by the feet and letting the back extend fully is probably painful after the months spent in a flexed position in utero (Pillitteri, 2007). Keep newborn warm. Gently rub a newborn dry, so that little body heat is loss by evaporation. Next swaddle the newborn loosely with blanket to prevent compromising respiratory effort, and place a cap on the infants head (Pillitteri, 2007). Ask which parent wants to hold the child, and place the infant in the parents arm. This helps conserves heat and encourages bonding. The period immediately after birth is an important time for parents to begin interaction with their child. Newborns are alert and responded well to the parents first tentative touches or interaction with them. Although the temperature of newborns who are dried, wrapped, and then held by their parents immediately after birth apparently falls slightly lower than that of infants placed in heated cribs, their core temperatures does not fall below safe limits.

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At the end of the first hour of life, reassess the newborns temperature. Axillary rather than rectal temperatures are recommended for newborns, to prevent accidental bowel perforation (Pillitteri, 2007). During the first day of life, a newborns temperature is usually taken every 4 to 8 hours. Thereafter, unless the temperature is elevated or subnormal, or the infant appears to be in distress, measurement once a day while in the health care facility is enough (Pillitteri, 2007). Promote Adequate Breathing Pattern and Prevent Aspiration. Mucus is suctioned from a newborns mouth by a bulb syringe as soon as the head is born. As soon as the body is born, he/she should be held for a few seconds with the head slightly dependent, for further drainage of secretion. It is important that mucus be removed from the mouth and pharynx before the first breath this way to prevent aspiration of secretions. If the infants continue to have an accumulation of mucus in the mouth or nose after this first steps, you may need to suction further after the baby is placed under a warmer (Pillitteri, 2007). Inspect and Care for Umbilical Cord. The umbilical cord pulsates for a moment after an infant is born as al last flow of blood passes from the placenta into the infant. Two clamps are then applied to the cord about 8 inches from the infants abdomen, and the cord is cut between the clamps. The infant cord is then clamped again by a permanent cord clamp. The clamp on the maternal end of the cord should not be released after the cord is cut, to prevent blood still remaining in the placenta from leaking out (Pillitteri, 2007).

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Administer Eye Care. Such infections are usually acquired from the mother as the infant passes through the birth canal. Formerly, eye prophylaxis was applied immediately after birth. Silver nitrate was exclusively used for prophylaxis from the past; today erythromycin ointment has the advantage of eliminating not only the organism of gonorrhea but that of Chlamydia as well (Pillitteri, 2007). Parent-Child Relationship One of the most sacred and divine relationships is the one between a parent and an offspring. This is one of the most important relationships, perhaps the most important relationship for many. Parent child relationships often range from the least complicated to the most complicated. Since this relationship starts with a startling change in a family, the birth of the child, such a relationship can become complex at times. A relationship that composes of respect, candidness, conservativeness, friendliness, freedom and binding at the same time sometimes is sweet and sometimes not so sweet (Mystic Madness, 2010). The parent-child relationship consists of a combination of behaviors, feelings, and expectations that are unique to a particular parent and a particular child. The relationship involves the full extent of a child's development (Kohn, 2005). Of the many different relationships people form over the course of the life span, the relationship between parent and child is among the most important. The quality of the parent-child relationship is affected by the parent's age, experience, and self-confidence; the stability of the parents' marriage; and the unique characteristics of the child compared with those of the parent (Kohn, 2005).

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If parents can adapt to their babies, meet their needs, and provide nurturance, the attachment is secure. Psychosocial development can continue based on a strong foundation of attachment. On the other hand, if a parent's personality and ability to cope with the infant's needs for care are minimal, the relationship is at risk and so is the infant's development (Mystic Madness, 2010). Cultural norms within a family play a role in determining when a child is expected to achieve particular developmental milestones. Children who are loved thrive better than those who are not. Either a parent or a nonparent caregiver may serve as the primary caregiver or form a primary-parent child love relationship. It is the quality of time spent with children, not the amount of time, which is important. Loss of love from a primary caregiver, as might occur with the death of a parent, or interruption of parental contact through hospitalization, imprisonment, divorce or inadequate parental love, can interfere with a childs desire to eat, improve and advance (Pillitteri, 2007). As babies are cared for by their parents, both parties develop understandings of the other. Gradually, babies begin to expect that their parent will care for them when they cry. Gradually, parents respond to and even anticipate their baby's needs. This exchange and familiarity create the basis for a developing relationship (Post, et al, 2003).

Attachment: The Bond Between Parent and Child Parents and children share a special bond. Many theories have been proposed to account for the close ties shared among family members. The most influential to date is John Bowlby's theory of attachment (Kuther, 2000).
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Bowbly reasoned from an ethological perspective, which is basically an extension of Darwin's theory (remember from high school, survival of the fittest?). From this perspective, much of human behavior evolved because of its adaptive value. Bowbly applied these ideas to the bond that parents and infants share. Children form an attachment or a bond to parents because it enhances their chances for survival, from an evolutionary standpoint. We're not aware of this on a conscious level. Rather, our species is "wired" to form such attachments because our prehistoric ancestors did and it enhanced their survival (Kuther, 2000). Bowlby argued that infants and parents are innately attuned to each other. Infants display what he called "signaling behaviors" such as smiling, laughing, and clinging to their caregivers. Signaling behaviors attract the caregiver's attention and bring them into close contact, and thus enhance the infant's chances for survival. In turn, adults innately respond to an infant's signaling behaviors. Do you find yourself naturally drawn to babies? According to Bowlby this is a survival mechanism that's innate and enables our species to proliferate (Kuther, 2000). Whether or not they adopt this ethological perspective, most psychologists will agree that there is a bond between parents and infants. Psychologist, Mary Ainsworth elaborated Bowlby's ideas. She argued that all children develop an attachment to their parents, even children who are abused. While children of different parenting styles and environments all develop a bond to their parents, they differ in the security of attachment. Security refers to children's confidence in their caregiver, the belief that the caregiver will be available to meet their needs. Ainsworth's research shows that infants tend to develop

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secure attachments when their caregivers are compassionate, consistent, and warm (Kuther, 2000). The key to helping your baby form a secure attachment is being sensitive and responsive to her. This includes responding to her cries, caring for her physical needs (like food, warmth, safe conditions, etc.), but also meeting her social needs. Babies and children need more than physical care; they need love, cuddling, and snuggling. Caregivers who read and react appropriately to their baby's signals for social attention are more likely to foster strong attachment bonds (Kuther, 2000).

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Essential Newborn Care Protocol (ENC) Program Framework

DOH in collaboration with WHO To solve newborn mortality problem

AO no. 2009-0025 Essential Newborn Care Protocol (ENC) Post- natal Procedure: Time Bound Procedure Non-time Bound intervention Unnecessary procedure

Formulation of UNANG YAKAP: Yakap ng Ina, Yakap ng Buhay First Embrace: Embrace of Mother, Embrace of Life

Dissemination of Information and Implementation to:

Primary Secondary Tertiary Hospitals

Rural Health Units

Lying-in Clinics

Figure 2. Program Framework Unang Yakap Campaign

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Despite the previous efforts and improvement in general health status indicators, the rates of decline in maternal and neonatal mortality have decelerated in the past decade to a point where Philippine commitments to the millennium Development Goals (MDGs) of lowering maternal mortality ratio (MMR) and infant mortality rate (IMR) may not be achieved (DOH, 2008). However, with pregnancy and childbirth continuing to pose risks to Filipino mothers and their newborn, rapid education in these risks must be realized as quickly as possible while considering that variations in health outcomes and program performance across localities and population groups warrant targeted and locally-customized interventions in order to meet the rapid education goal (DOH, 2008). The risk of maternal and neonatal deaths for a given population group is magnified with critical accumulation of the following four risks. First, is the risk of having mistimed, unplanned, unwanted and unsupported pregnancy. Secondly, having become pregnant exposes the mother and the fetus to the risk of not securing adequate care during the course of the pregnancy. Third, is the risk of delivering without being attended to by skilled birth attendants, namely: skilled midwives, nurses, and physicians and of not having access to emergency obstetric and neonatal care services. Lastly, there is the risk of not securing proper postpartum and postnatal care for the mother and neonate, respectively (DOH, 2008). Long term control of mortality and morbidity and improvement in the equality of life require provision and use of continuum of health care services spanning each of the life cycle stages. Provision and use of these services would require informed decisions by

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mothers and their families (demand side), as well as a health system (supply side) that is responsive to their needs (DOH, 2008). Over 40,000 Filipino newborns alarmingly die annually, with majority dying in the first two days of their lives. Newborn deaths account for 37 percent of the 82,000 Filipino children that die yearly. The Philippines is one of the 42 nations that accounts for 90 percent of global deaths of under 5-year-old children (Fajardo, 2010). Majority of them (3/4) die within the first two days of life, mostly due to stressful events or conditions during labor, delivery and immediate postpartum period. This was the report delivered by Dr. Howard L. Sobel, M.D., MPH, Team Leader for Maternal and Child Health of Office of the WHO Representative in the Philippines, during the 2009 Annual Convention and 63rd Anniversary Celebration of the Philippine Obstetrical and Gynecological Society (Foundation), Inc. According to the Philippine Health Statistics 1998, newborn problems account for over 30% of all deaths in the first year of life (InstantMommy, 2010). Deaths during the first week of life are mostly due to conditions originating in pregnancy or during childbirth. They are a result of inadequate or inappropriate care during pregnancy, childbirth, or the first critical hours after birth (USAID, 2004). After the first week, deaths are mostly due to infections acquired after birth, either at the health facility or at home. Most neonatal deaths, whether during the period immediately after birth or later, can be avoided with low cost interventions that do not require sophisticated technology (USAID, 2004).

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Noting an alarming stagnation in the countrys neonatal mortality rate, subsequent studies have documented a marked lack in the practice of newborn care interventions in the biggest health facilities in the country (DOH, 2009). An observational study of consecutive deliveries using a standardized assessment tool to document minute-by-minute newborn care done in the first hour of life was undertaken in 51 hospitals in 9 regions of the country in 2008. The study found that Philippine hospital practices prevented newborns from benefitting from their mothers' natural protection in the first hour of life. Further, the performance and timing of evidenced-based interventions in immediate newborn care are below WHO essential newborn care standards. Specifically (DOH, 2009).: Only 3% of our study newborns were dried prior to or with cord cutting and only 1 of 26 with difficult breathing was dried first. Hypothermia can lead to infection, coagulation defects, acidosis, delayed fetal to newborn circulatory adjustment, hyaline membrane disease and brain hemorrhage. Unnecessary delays and restrictions on immediate and sustained skin-to-skin contact, early latching on, rooming in ad full breastfeeding compromised the newborns' chance for maintenance of warmth and sustained breastfeeding. These earliest interventions contribute to hospital infection control as they directly reduce risk of neonatal sepsis.
Almost no newborn benefited from the natural transfusion through non-immediate

cord clamping. A Cochrane systematic review of 7 Randomized Controlled Trials (RCTs) showed that among infants less than 37 weeks of gestation, nonimmediate cord clamping is associated with fewer transfusions due to anemia or

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low blood pressure and fewer intraventricular hemorrhages. Full-term neonates also benefit by having lower incidence of anemia. Only 61.3of newborns were initiated to breastfeeding within the first hour. However, newborns were given a median of only about two minutes to get colostrum, their first immunization. Furthermore, they were being forced to breastfeed at median of 10 minutes, long before the typical newborn would be ready. More than 80% was exposed to hypothermia during washing. The WHO recommends that initial bathing should be six hours after birth or longer. The vernix was washed off at a median of 8 minutes thereby removing a protective barrier to bacteria such E. coli and Group B Strep. Furthermore, washing removes the crawling reflex.
Virtually all healthy newborns were suctioned unnecessarily, 80% more than once

- a practice WHO discourages (DOH, 2009). In her presentation, DOH National Disease Prevention Director Dr. Yolanda Oliveros said that 82,000 Filipino children die annually, with half of newborn deaths occurring in the first two days of life. But the thing is, many of these deaths could have actually been prevented, she said, citing the Lancet 2003 study (The Philippine Star, 2010). In Dr. Oliveros discussion of the minute-by-minute assessment of newborn care within the first hour of life, Dr. Oliveros said that the usual practice of cord clamping in most Philippine hospitals is 12 seconds with 99 percent under one minute, whereas WHO standards require one to three minutes or until pulsations stop. Ninety-seven percent of

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them also do drying after one minute, when WHO standards say it should be done immediately (The Philippine Star, 2010). Immediate skin-to-skin contact is not also being observed, adds Dr. Oliveros, with only 9.6% doing it after five minutes when it should be done over 90 percent of the time. Other bad habits include putting babies on a cold surface (12 percent), not drying the baby (2.5 percent), not drying the head (6.2 percent), and washing or giving the baby a bath (84 percent of hospitals do it within eight minutes), when it could actually be delayed until after six hours. Under the newly-approved guidelines, transferring babies to a nursery is no longer necessary instead, newborns should be roomed in with their mothers immediately (The Philippine Star, 2010). Separating the baby from the mother, weighing, and examining the newborn should also be done at least after more than an hour, not in just after 10 minutes, which is the usual practice. Other newborn interventions cited include rooming in babies with their mother and immediate breastfeeding (within one hour after birth or as soon as baby shows signs). Dr. Oliveros ended her presentation by saying a new set of newborn care protocol is needed because there is now a wide variety of practices among health practitioners. There were also reports of inappropriate care being given the newborns, as well as continuously skyrocketing costs of health care (The Philippine Star, 2010). Because the challenges of newborn mortality are enormous, and health experts concur that there is an urgent need to increase the scale of work in the area. In September 2000, the Philippines committed to the UN Millennium Declaration, targeting reduction of poverty, hunger and ill health in the country, including reduction of maternal, newborn
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and child mortality. The Philippines is currently "on track" to reach its Millennium Development Goal #4 target of reducing under-five mortality. However, some 40,000 Filipino newborns still die every year. Half of these newborns die in the first two days of life (WHO, 2009). To meet the Millennium Development Goal of reducing deaths of children before their fifth birthday by two-thirds between 1990 and 2015, strengthening the implementation of specific newborn health interventions must be put in place at the local, national and global levels. However, the gains have slowed in recent years because newborn deaths remain high. Over the last decade, the under-five mortality rate (U5MR) has declined. The 1998 NDHS reported a fall from 54 deaths per 1000 births in 1988-92 to 48 in the period 1993-97. According to The State of the Worlds Children (2003), the rate declined by 42%, from 66 childhood deaths per 1000 live births in 1990 to 38 in 2001. Nevertheless, the Philippines still ranks 88 among countries in under-five mortality (USAID, 2004). Overall, the neonatal mortality rate (NMR), within the first 28 days, declined from 5 per 1,000 live births in 1991 to 4 per 1,000 live births in 1995. In 2000, the infant mortality (for children up to age 1 year) was 12.3 deaths per 1000 live births. In Region 4, the NMR was 4 per 1,000 live births and the infant mortality rate was 12.4 deaths per 1,000 live births (USAID, 2004). And although childhood death rates in the country showed downward trend from 1993 to 2003, the decline slowed down in the last 10 years. The under-five mortality rate decrease to only 32 per 100 live births in 2003 from 52 per 1000 live births in 1988. And neonatal and post neonatal deaths decline in the slowest over the past 20 years with the
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reduction of only 9 percent and 7 percent, respectively, from 1988 to 2003 (Healthbeat, 2009). Newborns account for under half of all deaths of children prior to five years of age. This translates to about 40,000 newborns dying in the Philippines every year. Half of these newborns die in the first two days of life, and they die of mostly preventable causes (Healthbeat, 2009). According to the World Health Organization (WHO), the major direct cause of newborn deaths globally is neonatal infection or sepsis, which is responsible for about 33% of newborn deaths. Sepsis includes conditions such as septicemia, meningitis, pneumonia, tetanus, and congenital syphilis. Birth asphyxia and trauma account for another 28% of neonatal deaths, and congenital malformations for another 10%. While according to Former Secretary Duque, 50 percent of all neonatal and post neonatal deaths occur during the first two days of life, mainly caused by birth asphyxia (31 percent), complications of prematurity (30 percent) and severe infection (19 percent) (Medical Observer, 2010). Inadequate health care is another factor. About 72% of deliveries occur outside of health facilities, frequently without the assistance of a skilled birth attendant, and many deliveries do not meet the minimal conditions for early essential newborn care (WHO, 2009). These current practice of handling newborns, like clamping and cutting the umbilical cord and washing the baby right after birth, have been known to actually contribute to the high incidence of neonatal deaths and illnesses in the country. These
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hospital practices in the country prevented newborns from benefitting from their mothers natural protection in the first hour of life. Further, the performance and timing of evidence-based interventions in immediate newborn care are below WHO essential newborn care standards. Thus, there has been a need for a paradigm shift from the prevailing standard procedures into the new protocol. If newborn mortality is not reduced by at least half, the MDG # 4 target of reducing childhood mortality by two-thirds by 2015 would not be met (Healthbeat, 2009). The current state of newborn care needs urgent action that can eliminate the unnecessary tragedy of Filipino babies. To this end, the Department of Health issued an administrative order to implement the ENC protocol with the goal of rapidly reducing the number of newborn deaths in the Philippines. Administrative Order 2009-0025, entitled Adopting new Policies and Protocols on Essential Newborn Care (ENC) outlines specific policies and principles for health care providers with regard the prescribed systematic implementation of interventions that address health risks known to lead to preventable neonatal deaths. This AO is consistent with AO no. 2008-0029 on Implementing Health Reforms for Rapid Reduction of Maternal and Newborn Mortality and supports all DOH initiatives and programs for newborn and child health. Its objective is to guide health workers and medical practitioners in providing evidence-based essential newborn care. With AO 2009 - 0025, the whole hierarchy of the DOH and its attached agencies, public and private providers of health care and development partners implementing the Maternal, Newborn and Child Health and Nutrition Strategy and all health practitioners of maternal and newborn care are enjoined to adopt the policies and protocol on Essential Newborn Care. Implementation of the ENC protocol has the

29

potential to avert approximately 70 percent of newborn deaths that are due to preventable causes (DOH, 2009). Standard essential newborn care practices guidelines are organized by time, beginning at the time of perineal bulging until one week of life (DOH, 2009). It is strictly defined as a comprehensive strategy to improve the health of the newborn through interventions before conception during pregnancy, at and soon after birth, and in the postnatal period. It is a new program to address neonatal deaths in the country. However for this Administrative Order and for the DOH protocol, it is focusing on the first few hours of life of the newborn with the manual guiding the health workers and medical practitioners in providing evidence-based essential newborn care, thus, the Unang Yakap Campaign emphasis is given to care interventions that should be provided to the newborn from birth until the first 6 hours of life (Healthbeat, 2009). Since AO provides key behaviors and appropriately timed interventions to make the postnatal period for newborns safer, it paves the way toward a system that adheres to a globally accepted evidence-based essential newborn care health. With the new ENC protocol, the government is hoping to reduce neonatal deaths by six per 1,000 live births (Medical Observer, 2010). Newborn care is defined as the management of the neonate during the transition to extrauterrine life and subsequent period of stabilization (Pillitteri, 2007). Department of Health, in Collaboration with the World Health Organization, then introduces the Essential Newborn Care Protocol. This is a series of time bound, chronologically-ordered, and standard procedures that a baby receives after birth (Healthbeat, 2009). Clinical and epidemiological studies have shown that newborn
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mortality can be significantly reduced through simple, low-technology, cost-effective, and time-bound steps. These steps are outlined in the Essential Newborn Care (ENC) Protocol, according to Dr. Sobel (The Philippine Star, 2010). On December 7, 2009, the Department of Health launched the Unang Yakap Campaign. With this campaign, the DOH aims to cut down infant mortality in the Philippines by at least half. The Medium Development Goal target is 6 per 1000 live births by 2015. The government launched the Unang Yakap Campaign as an initial reaction to the Protocol (PIA, 2009). The Unang Yakap campaign is a call to action by the Department of Health on the national and local sectors, public and private health and related sectors, individuals and organizations, mass media, and academe to strengthen alliances to implement the Essential Newborn Care protocol. The ENC protocol can prevent at least half of newborn deaths without additional cost to both families and hospitals. It is time to rapidly reduce neonatal mortality (DOH, 2010). The launching coincided with the signing of former Health Secretary Francisco Duque III of the Essential Newborn Care (ENC) Protocol on the same day (PIA, 2009). The ENC Protocol provides an evidence-based, low cost, low technology package of interventions that will save thousands of lives. It is a step by step guide for health workers and medical practitioners issued by DOH for implementation under the A.O. 2009-025 (DOH, 2009). It is an evidenced based strategic intervention which details specific policies and principles to follow all health care providers involved in Newborn care and aims at improving newborn care and helping cut neonatal mortality. Interventions comprised of a core sequence of actions or steps (DOH, 2010).

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The Essential Newborn Care categorizes post-natal procedures into time-bound, non-time bound and unnecessary actions undertaken to lessen newborn death (Rwchick, 2010). At the heart of the protocol are time bound interventions. The AO stresses the provision of correct time bound interventions which includes; immediate drying (within 30 seconds), postponing washing, initiation of skin-to-skin contact, and delayed cord clamping. Likewise, early initiation of breastfeeding (within 90 minutes after birth) is also included in the new protocol (Fajardo, 2010).

ENC Time-Bound Interventions

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Figure 3. Essential Newborn Care Time-Bound Interventions Time bound actions are actions that need to be taken immediately to lessen the statistics on newborn deaths and should be routinely performed first. This is the aspect of newborn care in the Philippines that have not met international standards, and should therefore, be taught and re-learned by all health care providers. It is also interesting to know that only 4 steps are time bound that are needed to be undertaken immediately to lessen statistics on newborn death (DOH, 2009). These are:

1. Immediate and thorough drying of the Newborn

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Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms and legs (WHO, 2009). Immediate and thorough drying for 30 seconds to one minute warms and prevents hypothermia to the newborn, which is extremely important to survival the newborn and stimulates breathing (DOH, 2009). The image of an obstetrician holding a newborn up by the heels and spanking to stimulate breathing has existed only in movies. It has long been accepted that holding a baby by the feet and letting the back extend fully is probably painful after the months spent in a flexed position in utero; in addition, a measure such as spanking is not as effective in helping a newborn breathe as is gentle stimulation such as rubbing the back (Pillitteri, 2007). However, bathing or washing should be made at least after 6 hours of the newborns life. Bathing the newborn soon after birth causes a drop in the bodys temperature leading to increase risk of developing infections, coagulation defects and brain hemorrhage. Washing also removes the vernix which covers the newborn and is a protective barrier against bacteria, such as E. coli and Group B Streptococcus, that cause neonatal sepsis and removes the crawling reflex (Healthbeat, 2009). 2. Uninterrupted skin-to-skin contact Keeping the mother and the baby in uninterrupted skin-to-skin contact prevents hypothermia. Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrums feeding and stimulation of the mucosaassociated lymphoid tissue system. It also allows the newborn to be colonized

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by good bacteria from the mothers skin, so-called family flora to protect the infant from sepsis and other life-threatening infections and hypoglycemia (Healthbeat, 2009). 3. Proper cord clamping and cutting Another simple change in practice that can save lives is not clamping the umbilical cord immediately. Dr. Sobel cited research evidence showing that delayed cord clamping until umbilical pulsations stop, typically between one to three minutes improved newborn outcomes by increasing blood circulation and also newborns iron reserves. He further noted delayed cord clamping did not result in mothers postpartum bleeding. This time bound intervention is also found to decrease anemia in one out of every three premature babies and prevents brain hemorrhage in one out of two (Healthbeat, 2009). 4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in The Rooming-In and Breastfeeding Act (1992) for hospitals and health facilities and the Code of Marketing of Breastmilk Substitutes (1996) were enacted to improve breastfeeding practices. The Philippines is one of seven countries that have established formal monitoring of the WHO Code of Ethics (USAID, 2004). Breast- feeding has major physiologic advantages for a baby. Breast milk contains secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins, including viruses and bacteria, keeping them from being absorbed from the gastrointestinal tract into the infant. Lactoferrin is an iron binding protein in breast milk that interferes with the growth of pathogenic bacteria. The enzymes lysozyme in breast
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milk apparently actively destroys bacteria by lysing their cell membranes, possibly increasing the effectiveness of antibodies. Leukocytes in breast milk provide protection against common respiratory infections invades, macrophages, responsible for producing interferon, interferes with virus growth (Pillitteri, 2007). The baby should be placed on mothers chest or between her breast for skin-toskin contact and breastfeeding within the first hour of life should be initiated and supported. Colostrum, the mother's first milk, is high in antibodies that fight infections. The earlier the baby breastfeeds, the lesser the risk of death (Healthbeat, 2009). There are three reasons for breast-feeding: the milk is always at the right temperature; it comes in attractive containers; and the cat can't get it. ~Irena Chalmers. Delaying initiation of breastfeeding is harmful; a one-day delay will increase almost threefold the risk of the newborn getting sick or dying (Healthbeat, 2009). Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures like putting the newborn on a cold surface for examination (thereby exposing the baby to hypothermia), administering glucose water or formula and foot printing (which increases risk of contamination from ink pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix protects the newborn from infection) (WHO, 2010). It is also helpful for the mother since during breastfeeding, oxytocin is released from the posterior pituitary gland which aids in uterine involution (Pillitteri, 2007). Breastfeeding also provides excellent opportunity to enhance a true symbolic bond between mother and child (Pillitteri, 2007).

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A meta analysis of 30 randomized trials reveals that skin-to-skin contact contributes to the success of breastfeeding by stimulating early breastfeeding initiation, and eventually leading to prolonged exclusive breastfeeding. In turn, a 2008 study in Nepal showed that early initiation of breastfeeding reduced the risk of a newborn dying from infections (Fajardo, 2010). Non-time bound intervention should only be done after the first full breastfeed, usually given within 6 hours after birth, namely: Vitamin K injection; BCG and Hepatitis B vaccinations; newborn examinations for checking birth injuries, malformation or defects; cord care; newborn resuscitation; and additional care for a small baby or twin. These interventions should never be made to compete with time-bound interventions (Healthbeat, 2009): Give Vitamin K prophylaxis
a) A single dose of 0.5 to 1.0 mg of vitamin K is administered intramuscularly to

prevent bleeding disorders (Pillitteri, 2007).

b) Offer oral vitamin K as a second line (DOH, 2009).

Inject Hepatitis B and BCG vaccinations

a) Inject hepatitis B vaccine IM and BCG intradermally (DOH, 2009).

Administer Eye Care Every state in the US requires that newborns receive prophylactic eye treatment against gonorrheal conjunctivitis. As long as it is completed as soon as possible after birth, either in the birthing room or on arrival in the nursery, the exact time the ointment is administered is unimportant. Silver nitrate was exclusively used for prophylaxis in the
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past; today, erythromycin ointment is the drug of choice. Erythromycin ointment has the advantage of eliminating not only the organism of gonorrhea but that of Chlamydia as well (Pillitteri, 2007). Examine the newborn. Check for birth injuries, malformations or defects a) Weigh the newborn and record. b) Look for possible birth injury and/or malformations. c) Refer for special treatment and/or evaluation if available.
d) If the newborn has feeding difficulties because of the injury/malformation, help the

mother to breastfeed. If not successful, teach her alternative feeding methods (DOH, 2009). Cord Care a) Wash hands. b) Fold diaper below stump. Keep cord stump loosely covered with clean clothes. c) If stump is soiled, wash it with clean water and soap. Dry it thoroughly with clean cloth. d) Explain to the mother that she should seek care if the umbilicus is red or draining pus.
e) Teach the mother to treat local umbilical infection three times a day (DOH, 2009).

Newborn Resuscitation a) Start resuscitation if the newborn is not breathing or is gasping after 30 seconds of drying or before 30 seconds of drying if the newborn is completely floppy and not breathing. b) Clamp and cut the cord immediately.
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c) Call for help. d) Transfer the newborn to dry, clean and warm surface. Keep the newborn wrapped or under a heat source if available.
e) Inform the mother that the newborn needs help to breathe (DOH, 2009).

Provide additional care for a small baby or twin For a visibly small newborn or a newborn born >1 month early: a) Encourage the mother to keep the small newborn in skin-to-skin contact with her as much as possible b) Provide extra blankets to keep the baby warm c) If mother cannot keep the baby skin-to-skin because of complications, wrap the baby in a clean, dry, warm cloth and place in a cot. Cover with a blanket. Use a radiant warmer if room not warm or baby small. d) Do not bathe the small baby. Ensure hygiene by wiping with a damp cloth but only after 6 hours. e) Prepare a very small baby (<1.5 kg) or a baby born >2 months early for referral. Meanwhile, unnecessary procedures that were observed to have been routinely given in Philippine hospitals but, in fact, are not recommended for all newborns include:
a) Routine suctioning - Suctioning has no benefit if the amniotic fluid is clear and

especially with newborn who cry or breathe immediately after birth. Moreover, a dirty bulb can become a source of infection. Routine suctioning has also been associated with cardiac arrhythmia. Suctioning is indicated only if the mouth/nose is blocked with secretions or other materials (DOH, 2009).

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b) Early bathing/washing - The WHO recommends bathing at least after 6 hours of the

newborn's life. Bathing the newborn soon after birth causes a drop in the body's temperature leading to increased risk of developing infections, coagulation defects and brain hemorrhage. It also removes the vernix which is protective against bacteria and cause neonatal sepsis and removes crawling reflex (DOH, 2009).
c) Giving sugar water formula or other prelacteals and the use of bottles or pacifiers -

delaying initiation to breastfeeding has been linked to a 2.6 fold increase in the chances of newborn deaths due to infection. If the sugar water, formula or prelacteals are introduced using a bottle, the newborn may develop a learned preference for the bottle leading to nipple confusion and inefficient suckling which can further lead to failure in breastfeeding. A pacifier likewise contributes to nipple confusion especially if these are used before the newborn is offered mother's breast. This undermines the chances of successful breastfeeding by contributing to a vicious cycle of poor attachment, sore nipples and lactational insufficiency (DOH, 2009).
d) Footprinting - Footprinting has proven to be an inadequate technique for newborn

identification purposes. Better identification techniques, such as DNA genotyping and human leukocyte tests can serve more this purpose according to the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) (DOH, 2009).
e) Application of alcohol, medicine and other substances on the cord stump and

bandaging the cord stump or abdomen - The umbilical stump is an entry point for systemic infections in the newborn. The devitalized tissue of the cord stump can be an excellent medium for bacterial growth, especially if the stump is kept moist and unclean substances are applied to it. Cleaning with alcohol and bandaging delays

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healing and falling off of the stump. The alcohol keeps the stump moist while bandaging prevents aeration which facilitates drying process (DOH, 2009). The new Protocol is considered a paradigm shift in newborn practice. The DOH believes that this protocol will pave the way for the solution on the problems the country is facing on neonatal deaths (Healthbeat, 2009). Currently, only DOH hospitals, Quirino Memorial Medical Center in Quezon City and Fabella Memorial Hospital in Manila, implement the protocol. The DOH is targeting the nationwide implementation by 2010 (Healthbeat, 2009). To accelerate the implementation strategies of the AO, the new protocol will be part of the Normal Spontaneous Deliveries and Maternal Care Packages of PhilHealth. An assessment of the Philippine Health Insurance Corporation Benchbook is in progress to facilitate the integration of the ENC protocol interventions. DOH will also promote the knowledge of the said protocol among medical, pharmaceutical and proper learning environment (Fajardo, 2010). METHODOLOGY

This chapter comprises the research method that was used in the study, which includes the respondents of this study including the total population sampling type and technique, research instrument, validation of the research instrument, data gathering procedure, data processing method and statistical treatment of data that will be used.

Research Design
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This study made use of descriptive research method to gather information about the existing condition of the Unang Yakap Campaign. The purpose of utilizing this method was to describe the nature of the change, as it existed at the time of the study and to explore the cause of change. In this method, the level of awareness among health care professionals in the province of Cavite about the Unang Yakap Campaign was assessed by giving survey questionnaires.

Sample Size The researchers gathered data from 125 respondents who are currently working as doctors, midwives, and nurses from selected rural health units (RHUs) and lying-in clinics in the province of Cavite.

Sampling Design and Technique For the selection of respondents, cluster sampling, simple random sampling and quota sampling were used. Data were gathered from doctors, midwives, and public health nurses (PHN) or registered nurses (RN).

Data Gathering Method The researchers used cluster sampling which grouped the municipalities in the province of Cavite in seven (7) districts and then simple random sampling through lottery method for the selection of RHUs and lying-in clinics in Cavite was used. Sampling was done by choosing five (5) districts from the seven (7) districts of Cavite through lottery method. From those chosen districts, one (1) municipality was drawn from the first two (2) districts since they only have one (1) municipality per district while three (3) were

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drawn from the last three (3) districts. And then, one (1) RHU and one (1) lying-in clinic were chosen per municipality. A total of eleven (11) RHUs and ten (10) lying-in clinics were chosen from eleven (11) municipalities. And through nonproportional quota sampling, the desired number of respondents were one (1) doctor, five (5) midwives, three (3) public health nurses in every rural health units (RHUs) while one (1) midwife and one (1) registered nurse were desired in every lying-in. The expected number of respondents were 119 but due to certain circumstances such as some of the health professionals were on leave or busy and sometimes there were more than the desired number of health professionals present in the RHU or lying-in clinics during the time of the survey, a total of 125 respondents were obtained during the actual data gathering procedure, which consisted of seven doctors, 50 nurses, and 68 midwives. Table 1. The desired number of respondents by municipalities and occupation
DISTRICTS MUNICIPALITIES RHUS AND LYING-IN CLINICS DOCTOR MIDWIFE PHN/RN

District 3

Imus

1 RHU 1 Lying-In

3 1

4 1 7 0 3 1 3 3 4 5

District 4

Dasmarias

1 RHU 1 Lying-In

7 3

District 5

GMA

1 RHU 1 Lying-In

3 1

Carmona Rosario

1 RHU 1 RHU 1 Lying-In

1 1

4 3 3

District 6

General Trias

1 RHU

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1 Lying-In Trece 1 RHU 1 Lying-In Tanza 1 RHU 1 Lying-In District 7 Tagaytay 1 RHU 1 Lying-In Mendez 1 RHU 1 Lying-In Naic 1 RHU 1 Lying-In TOTAL: 125 7 1 1 1 0 1

2 1 3 6 2 5 1 5 2 6 2 68

0 5 0 0 0 4 1 3 0 6 0 50

Research Instrument Primary data was obtained using a research instrument with five parts formulated by the researchers. The first part is the demographic profile of the respondents; second part is the level of awareness regarding the Unang Yakap Campaign and what are their sources of information; third part is the perceived advantages and disadvantages of the respondents to the said campaign; fourth part is divided into two sections- section A is the level of knowledge of every health professionals and section B is the steps in ENC protocol; the last part is the extent of implementation of every procedures in the recently implemented campaign.

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The questionnaire for demographic characteristics basically determined the respondents personal data including name, age, civil status, gender, their profession, work stations and the length of their years of service. The questionnaire used to evaluate the level of awareness is composed of five statements regarding the general information about the Unang Yakap campaign. A 2point scale was used to measure the level of awareness of the respondents with the scale of 2- fully aware, 1- slightly aware and 0- not aware. The following range was used to determine the results of the gathered data: NUMERICAL RATING 0.00 0.66 0.67 1.32 1.33 2.00 ADJECTIVAL RATING Low Average High

The part for level of knowledge is in multiple choice form comprised of 24 items ranging from A to D and A to E. The remaining 6 items is composed of putting up the given procedures in chronological order. Scores on this 30-item test was scaled into following grade equivalent:

GRADE EQUIVALENT Excellent Very Good

NUMERICAL RANGE 28-30 25-27

PERCENTAGE 91-100% 81-90%

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Average Fair Poor

21-24 15-20 15-below

70-80% 50-69% 50% below

The last part is a Likert type with a 5-point scale to evaluate the extent of implementation of the procedures in the Essential Newborn Care protocol. Protocols are divided into time bound interventions, non-time bound interventions and the unnecessary procedures, and overall, this part is composed of fifteen (15) questions. NUMERICAL RATING 1.00 1.79 1.80 2.59 2.60 3.39 3.40 4.19 4.20 5.00 ADJECTIVAL RATING Never Seldom Sometimes Often Always

Validation of Research Instrument The survey questionnaire was based from non-standardized form of questionnaire which was expertly validated by three (3) professionals: a midwife, a doctor and a prominent research coordinator. Samples were pre-tested among 15 selected nurses and midwives employed in the rural health unit (RHU) and lying-in clinic in Indang, Cavite. They were not included to actual respondents of the study. Cron- Bachs alpha test was used to estimate the extent to which different subparts of an instrument, which is the survey questionnaire, were reliably measured.
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Revisions were done after pointing out some confusing parts. Conflicts were also identified thereafter. Statements were then reconstructed, paraphrased, and simplified.

Data Gathering Procedures Letter of Request was given to the Municipal/City Health Officer and midwife of each institution to ask for permission and approval to conduct the study. The letter of request contained the purpose, scope, and nature as well as the time allotted in conducting the study. After the approval of the letter, the researchers located the health care professionals who participated in the study. They were asked for their permission and full cooperation in answering the survey questionnaire.

Statistical Treatment of Data The following statistical tools were used to modify the method of analysis which corresponded to the objective of the study. The first step was the setting of the frequency distribution; the arrangement of the data had shown the frequency occurrence of different values of the variable (demographic profile of the respondents).

1. Frequency Distribution and Relative Frequency Used for analyzing demographic profile of respondents. P= (f/n) x 100 Where: P= Percentage (%) out of 100% f= number of person who responded to an item
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n= total number of respondents 2. Mean This was used to determine the level of awareness of the respondents regarding the Unang Yakap Campaign of Department of Health. The mean is equal to the sum of all scores divided by the total number of scores. Formula of Mean is:

Where: X= mean = the sum of Xi= each individual raw score N= number of respondent

3. T-test (one-tailed test) A two-tailed t-test divides in half, placing half in the each tail. The null hypothesis in this case is a particular value, and there are two alternative hypotheses, one positive and one negative.

Where:
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t - Experimental effect X- Sample mean - mean S- Standard deviation N- Random sample 4. Spearmans Rank- Order Correlation (Spearmans rho) It is a correlation coefficient indicating the magnitude of a relationship between variables measured on the ordinal scale (Polit, 2008). The Spearmans Rank Correlation Coefficient is a nonparametric measure of correlation of 2 variables, X and Y, which assesses how well an arbitrary monotonic function could describe the relationship between two variables, without making assumptions about the frequency distribution of the variable. The formula is:
=1- 6D2N(N2- 1)

Where: N = no. of observation D2 = square of the difference of x and y The Spearmans Rank Correlation Coefficient was used in the study to describe the relationship between the level of awareness and knowledge of the healthcare professionals and the extent to which they implement the protocols of the recently implemented Unang Yakap Campaign.

5. Kruskal Wallis Statistics Kruskal Wallis Statistics according to Polit(2008) is a nonparametric test Analysis of Variance used in assigning ranks to various groups.

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K= (N-1)i=1gniri-ri=1gj=1n1rij-r
Where: ni= number of observations in group i rij= rank of observation j from group i N= total number of observation across all groups

6. Mann-Whitney Test Mann-Whitney Test is a nonparametric test (distribution-free) used to compare two independent groups of sampled data.

Where: n1 is the sample size for sample 1 R1 is the sum of the ranks in sample 1

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7. Point Biserial Correlation Coefficient The study also used point Biserial correlation coefficient, a correlation coefficient used when one variable is dichotomous. The following is the formula used in computing for Point Biserial Correlation: rpb= M1- M0Sn n1n2n2 Where: M1= is the mean value of the continuous variable X= for all data points in group 1 M0= is the mean value of the continuous variable n1= is the number of data points in group 1 n0= is the number of data points in group 2 n= total sample size RESULTS AND DISCUSSION This chapter presents the results and discussion gathered by the researchers regarding the level of awareness on the Unang Yakap Campaign among health professionals employed in selected rural health units and lying-in clinics in the province of Cavite The study from the data gathered through the questionnaire that were distributed to the respondents was carefully checked and the results were classified, tabulated, discussed, and analyzed. Demographic Characteristics of the Respondents

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Figure 4. Frequency and percentage distribution of the respondents by gender Gender. Figure 4 shows that out of the total 125 respondents, 95 (76%) are females while the remaining 30 (24%) are males. The result showed that the majority of the respondents are females. People that are involved when it comes to providing health care are mostly female. Almost all midwives are female. Even for nurses assigned in the public health setting, women are in the frontline in terms of initiating activities and programs proposed by both Department of Health and local government. According to the article by Daisy Jane RN, entitled Is Nursing for Women Only? nursing isnt limited for women only, nor should it believe to be so. Although female nurses do have more gentle touches, this saying that men are stronger and could have less than gentle touch but not concluding so, male nurses have more stamina and more strength, specially observable in times when patients need to be lifted and in working more waking hours.

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Figure 5. Frequency and percentage distribution of the respondents by age Age. Figure 5 shows the age of respondents ranging from 29 years old and below up to 50 years old and above. Out of 125 respondents, 55 (44%) are 29 years old and below, 26 (21%) are between 30-39 years old, 24 (19%) are between 40-49 years old and 20 (16%) are 50 years old and above. The result reveals that majority of the respondents are 29 years old and below. When choosing the right path to career planning, the division of age group presented above is suitable. Almost half of the respondents are 29 years old and below showing that younger people tends to be responsible to find the job specifically in the health field and to serve to the public. The other remaining age group had their fair share of respondents. Despite their age, respondents ages 50 and up are still working and serving the public.

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Figure 6. Frequency and percentage distribution of the respondents by civil status Civil status. Figure 6 shows the civil status of the respondents wherein 65 (52%) are married, 58 (46%) are single and two (2%) are widow. The result shows that most of the respondents are married. Coleman (2007) mentioned that OECD (Organization for Economic Cooperation and Development) glossary of statistical terms defines marital status as the civil status of each individual in relation to the marriage law or customs of the country. There are various marital status options such as: married, single separated, divorced, living with partner and widowed. According to Philippine National Census and Statistics Office (2006), Filipino men generally married at an older age than women as reflected by the median age for grooms, which was 27 while for the brides, at age 22. For Filipino grooms and Filipina brides, the modal age at marriage was 25-29 and 20-24 years, respectively.

Figure 7. Frequency and percentage distribution of the respondents by work stations

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Work stations. Figure 7 shows the distribution of the respondents by the work stations wherein 98 (78%) are working at the rural health unit while 27 (22%) are working at lying-in clinics. The result revealed that most of the respondents are working at rural health units. The Philippine health care delivery system is composed of two sectors: (1) the public sector (e.g. rural health units) which is largely financed through a tax-based budgeting system at both national and local levels, and (2) private sector (e.g. lying-in clinics) which is largely market-oriented and where health care is paid through user fees at the point of service (Public Health Nursing in the Philippines, 2007). All cities and municipalities shall establish and maintain at least one (1) Local Health Unit (LHU) or rural health unit (RHU) which shall be under the supervision of the city or municipal health officer. For cities or municipalities with populations of more than twenty thousand (20,000), there shall be one LHU for each succeeding 20,000 population (Angara, 2010). This shows that the rural health unit can have more than one midwife and nurse depending on the population of the municipality while the private sectors can employ the number of employees they desire as long as they will be able to compensate them. Based on the researchers data gathering, most of the lying-in clinics have one midwife and one nurse. The city health office supervises the health centers, the lying-in clinics, and diagnostic facilities. The municipal health office manages the rural health units and the barangay health stations (Gregorio, 2003). The DOLE shall ensure that the health personnel requirements for private establishment under the Labor Code are complied with (Angara, 2010).

55

56

Figure 8. Frequency and percentage distribution of the respondents by profession Profession. Figure 8 shows the distribution of the different health professionals that served as respondents for this study. Out of 125 respondents, 68 (54%) are midwives, 50 (40%) are nurses and the remaining seven (6%) are doctors. The result revealed that more than half of the respondents work as midwives. The rural health unit team generally consists of the physician, dentist, public health nurse, midwife, sanitarian, and other health workers (Public Health Nursing in the Philippines, 2007). The Local Health Unit (LHU) or rural health unit (RHI) shall have at least the following health personnel: (a) a duly licensed physician as head of unit; (b) a registered nurse for every 5,000 population but no less than two (2) in each LHU, one of whom shall be a roving nurse; (c) a midwife and (d) a medical technologist. The city or municipality shall add health personnel to the LHU's plantilla to avoid understaffing or overloading based on the patient-health worker ratios determined by the DOH, and as
57

said city or municipality may deem necessary to ensure the delivery of complete health services (Angara, 2010). From 1990 to 1995, the World Health Organization (WHO) estimated that there were 82,494 doctors, 259,629 nurses, and 102,878 midwives. Majority of these, however, worked in the private sector and engaged in private practice. In 1997, the LGUs employed 3,123 doctors, 1,782 dentists, 4,882 nurses, and 15,647 midwives (Gregorio, 2003). These show that even in the past, the midwives have the highest distribution among health professionals in the public sector of the Philippines health care delivery system. The DOLE shall ensure that the health personnel requirements for private establishment under the Labor Code are complied with (Angara, 2010).

58

Figure 9. Frequency and percentage distribution of the respondents by years of service Years of service. Figure 9 shows the length of time the respondents are serving as health professionals in their designated areas of work. 59 (47%) of the respondents have been working for five years and below, 27 (22%) have been working for 11-20 years, 22 (18%) have been working for 6 to 10 years and 17 (13%) have been working for more than 21 years. The continuing and massive exodus of Philippine nurses and doctors to other countries all over the world is now taking a heavy toll on the countrys already inadequate health-care system. The lure of better pay abroad and better lives for their families back home has become so strong that even licensed medical doctors are studying to become nurses (Conde, 2004). Castro said his group has studied the phenomenon and found out that the most vulnerable areas in this crisis are the rural areas, where most of the countrys poor live and where health care is, in many instances, nonexistent. Statistics show that every year, between 5,000 and 8,000 nurses leave for abroad, around 2,000 of them former doctors (Conde, 2004).

59

But Padilla said there is actually no shortage of nurses and doctors in the Philippines. What we have is a shortage of skilled nurses and doctors, and those who are committed enough to go to the rural areas, she said (Conde, 2004).

Sources of Information

Figure 10. Frequency and percentage distribution on the sources of information of the respondents regarding the Unang Yakap Campaign

Figure 10 shows the sources of information where the respondents heard and got their awareness and knowledge regarding the recently implemented Unang Yakap Campaign by the department of Health (DOH). Of 125 respondents, 61 or 36% heard about the campaign from seminars, 51 respondents (30%) is through second hand information; 33 (20%) is from pamphlets; 14 respondents (8%) is from the internet; seven or four percent(4%) have not heard about the campaign; while only three (3) or two percent (2%) obtain awareness and cognizance from the television (TV). It is alarming to know that there are still 7 out of 125 respondents who dont have any idea about the Unang Yakap Campaign. This is evidence which proves that Department of Health together with local government units is not seriously paying attention in disseminating information on the said campaign. The results show that most of the health professionals obtain information from seminars conducted by the Department of Health.

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According to DOH, together with the National Center for Disease Prevention and Control (NCDPC), the Health Human Resource Development Bureau (HHRDB) must develop and finalize training programs relative to the propagation of Maternal and Newborn Care policies (included EmONC). In collaboration with the HHRDB, NCDPC should provide support for capacity development to ensure that Maternal and Newborn Care (including EmONC) trainers and implementers are updated on Maternal Newborn Care. They must also coordinate the training program/modules with the HHRB and the management of the different service components of heath care facilities. While Center for Health Development should also develop the capacity of the provincial/municipal health workers to implement the protocol, it could be through trainings, orientations, reading materials, promotional videos, etc and provide technical assistance to the LGUs(DOH, 2009). It is also the responsibility of the local government units (LGUs) to conduct orientation/seminars/trainings for private and public health workers on the

implementation of the Maternal and Newborn Care policies including this protocol and to coordinate and collaborate with the DOH and LGUs in the conduct of Maternal and Newborn care activities. It is also the responsibility of the LGUs, facilities, and DOH retained hospitals to conduct orientation on the protocol for its personnel and lower level facilities (DOH, 2009).

Level of Awareness of the Respondents on the Unang Yakap Campaign

61

Table 2 shows the level of awareness of the respondents on the Unang Yakap Campaign program of Department of Health. Items 1-5 refer to the general information of this program. In measuring the level of awareness of the respondents about the general information about the Unang Yakap campaign, the results revealed that the respondents are fully aware of the following information about the Unang Yakap Campaign: the Department of Health (DOH) issued an administrative order AO 2009-0025 to implement the Essential Newborn Care (ENC) Protocol (m=1.75); DOH is in collaboration with WHO in implementing ENC protocol Unang Yakap Campaign (m=1.70); Millennium Development Goal (MDG) 4 aims for a reduction in under five mortality by two-thirds by 2015 (m=1.68); the Philippines is one of the 42 nations that account for 90 percent of global under-five mortality (m=1.59); and Unang Yakap was implemented on December 7, 2009 (m=1.50). Therefore, the health professionals employed in selected rural health units and lying-in clinics in Cavite have high level of awareness regarding the Unang Yakap Campaign and Essential Newborn Care (ENC) even if the campaign was recently implemented by the DOH.

Table 2. Level of awareness of the respondents on the Unang Yakap Campaign

ITEM NUMBER 1 The Department of Health (DOH) issued an administrative order AO 2009-0025 to implement the Essential Newborn Care (ENC) Protocol DOH is in collaboration with WHO in implementing MEAN* SD VI

1.75

0.534

High

1.70

0.568

High

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ENC protocol Unang Yakap Campaign 3 4 Unang Yakap was implemented on December 7, 2009 Millennium Development Goal (MDG) 4 aims for a reduction in under five mortality by two-thirds by 2015 The Philippines is one of 42 nations that account for 90 percent of global under-five mortality OVER ALL SCORE
Scale 0.00 0.66 0.67 1.32 1.33 2.00 Rating Not Aware (NA) Slightly Aware (SA) Fully Aware (FA)

1.50 1.68

0.667 0.617

High High

1.59 1.65

0.661 0.536

High High

*Legend

Interpretation Low Average High

Level of the Respondents Knowledge to Unang Yakap Campaign

Mean Verbal Interpretation

= 15.38 4.206 = Fair

Figure 11. Frequency and percentage distribution on the level of knowledge of respondents to Unang Yakap Campaign Figure 11 reveals the level of knowledge of the respondents to the recently implemented Unang Yakap Campaign by the DOH. Of 125 respondents, 59 of the respondents or 47% have fair level of knowledge (score is between 15-20), 53 respondents (42%) have poor level of knowledge to the Unang Yakap Campaign (score is below 15), ten percent (10%) or 12 of the respondents are average (score is between 2124), one percent (1%) or only one is excellent and no respondent has very good level of knowledge to the campaign since no one scored between 25-27.

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The mean of the respondents scores is 15.38 4.206 Therefore, the results show that almost half or 47% of health professionals only has fair level of knowledge in the Essential Newborn Care Protocol Unang Yakap Campaign of the Department of Health. Fair is defined as no more than acceptable or average,it is acceptable and understandable but not ideal enough. In the results shown, it seems like out of 30 item questions, most of their scores ranged from only 15- 20 correct answers. In the sources of information which are discussed before this item, the sources of information such as seminars, pamphlet, internet and television didnt help much enough to add to their knowledge to answer all of the questions correctly. On the other hand, it is disturbing to know that 42 percent with a verbal interpretation of poor had a score of below 15 in the objective type of questions regarding the protocol.

Relationship Between the Source of Information and Level of Awareness of the Unang Yakap Campaign Table 3 shows the relationship between the sources of information of respondents to their level of awareness to Unang Yakap Campaign. T-test was used to determine the difference between various sources of information for Department of Healths Essential Newborn Care Protocol. These sources were seminar, pamphlet, internet, television and second hand information. Respondents were also assessed if they dont have any idea regarding the campaign by including an option not heard about it in the questionnaire and asked where else they got their information which is not included in the options. Table 3 revealed that for those who obtained their information from seminars (m=1.81+0.296), have higher level of awareness than those who did not attend seminars (m=1.49+0.655). It had a point biserial of 0.304 and a t-computed value of 3.535 which
64

exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between attending seminars as a source of information and the level of awareness on the Unang Yakap Campaign among health professionals. Those who got their information from pamphlets (m=1.94+0.221) have higher level of awareness than those who did not read pamphlets (m=1.54+0.576). It had a point biserial of 0.327 and a t-computed value of 3.843 which exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between reading pamphlets as a source of information and the level of awareness on the Unang Yakap Campaign among health professionals. Those who got their information from the internet (m=1.64+0.361) have lower level of awareness than those who did not (m=1.65+0.555). It had a point biserial of -0.002 and a t-computed value of -0.026 which did not exceed the critical value of 1.96, accepting the null hypothesis. Therefore, there is no significant relationship between reading from the internet as a source of information and the level of awareness on the Unang Yakap Campaign among health professionals since their mean is not statistically significant. Those who got their information from watching the television (m=2.00+0.000) have higher level of awareness than those who did not (m=1.64+0.540). It had a point biserial of 0.103 and a t-computed value of 1.154which exceeded the critical value of 1.96 but their mean is not statistically significant, making the null hypothesis be accepted. Therefore, there is no significant relationship in watching television as a source of information to the level of awareness on the Unang Yakap Campaign among health professionals.
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Those who heard about the campaign from others (m=1.52+0.519) have lower level of awareness than those who did not hear it from others (m=1.73+0.534) and had a different source of information. It had a point biserial of -0.193 and a t-computed value of -2.186 which exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between hearing the information about the Unang Yakap Campaign from other sources and the level of awareness on the Unang Yakap Campaign among health professionals. The result revealed that hearing from other sources about the campaign is not a good source of information. And lastly, the respondents who claimed that they neither hear anything about the Unang Yakap Campaign nor Essential Newborn Care Protocol (m=0.60+0.959) have lower level of awareness than those who heard about it (m=1.71+0.433). It had a point biserial of -0.476 and a t-computed value of -5.996, which exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between not hearing anything about the Unang Yakap Campaign and level of awareness on the said campaign among health professionals. This means that those who heard about the Unang Yakap Campaign have higher level of awareness than those who did not. In summary, the results revealed that attending seminars and reading pamphlets as sources of information increase the level of awareness of the health professionals on the Unang Yakap Campaign. While those health professionals who did not hear anything about the campaign and those who heard it from other sources have lower level of awareness on the Unang Yakap Campaign. Meanwhile, those who got their information about the Unang Yakap Campaign from the internet and television have no relation to the level of awareness of the health professionals since their mean is not statistically significant.
66

It is the responsibility of the local government units (LGUs) to conduct orientation/ seminars/trainings for private and public health workers on the implementation of the Maternal and Newborn Care policies including this protocol and to coordinate and collaborate with the DOH and LGUs in the conduct of Maternal and Newborn care activities. It is also the responsibility of the LGUs, facilities, groups, DOH retained hospitals to conduct orientation on the protocol for its personnel and lower level facilities (DOH, 2009).

Table 3. Relationship between the source of information and their level of awareness of the Unang Yakap Campaign
SOURCE OF RESPONSE MEAN STANDARD POINT BISERIAL TREMARKS INFORMATION DEVIATION CORRELATION COMPUTED COEFFICIENT Seminars Yes No 1.81 1.49 0.296 0.655 0.304 3.535 Reject Ho

Pamphlets

Yes No

1.94 1.54

0.221 0.576

0.327

3.843

Reject Ho

Internet

Yes No

1.64 1.65

0.361 0.555

-0.002

-0.026

Accept Ho

TV

Yes No

2.00 1.64

0.000 0.540

0.103

1.154

Accept Ho

SHI

Yes No

1.52 1.73

0.519 0.534

-0.193

-2.186

Reject Ho

NHAI

Yes

0.60

0.959

-0.476

-5.996

Reject Ho

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No Critical value of t-test = 1.96

1.71

0.433

Relationship between the Source of Information and Level of Knowledge of the Unang Yakap Campaign Table 4 is about the respondents level of knowledge about the Unang Yakap Campaign. This part of the questionnaire is in multiple choice forms which tested the respondents way of analyzing whether the situations will be appropriate to the procedures and information given. T-test was also used to determine the differences in the level of knowledge of respondents from the various sources of information. The result showed that those who attended seminar to gain knowledge about Unang Yakap Campaign (m=16.05+3.801) have higher level of knowledge than those who did not attend seminars (m=14.73+4.494). Though the mean of those who attended the seminars is higher than those who did not, it is not statistically high enough to prove any relationship between variables. It had a point biserial of 0.156 and a t-computed value of 1.755, which did not exceed the critical value of 1.96, accepting the null hypothesis. Therefore, there is no significant relationship between attending seminars as a source of information and the level of knowledge on the Unang Yakap Campaign among health professionals. Those who got their information from pamphlets (m=17.18+3.423) have higher level of knowledge than those who did not read the pamphlets (m=14.73+4.287). It had a point biserial of 0.257 and a t-computed value of 2.951 which exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore, there is a significant relationship of
68

reading pamphlets as a source of information to the level of knowledge of the Unang Yakap Campaign among health professionals. Those who got their information from the internet (m=15.21+5.605) have lower level of knowledge than those who did not (m=15.40+4.208). It had a point biserial of -0.014 and a t-computed value of -0.151 which did not exceed the critical value of 1.96, accepting the null hypothesis. Therefore, there is no significant relationship between reading from the internet as a source of information and the level of knowledge on the Unang Yakap Campaign among health professionals since their mean is not statistically significant. Those who got their information from watching the television (m=14.00+2.646) have lower level of knowledge than those who did not (m=15.41+4.238). It had a point biserial of -0.051 and a t-computed value of -0.570 which was lower than the critical value of 1.96, accepting the null hypothesis. Therefore, there is no significant relationship in watching television as a source of information to the level of knowledge of the Unang Yakap Campaign among health professionals. Those who heard about the campaign from other sources (m=15.21+4.003) have lower level of awareness than those who did not hear it from others (m=15.55+4.238) and had a different source of information. It had a point biserial of -0.051 and a t-computed value of -0.566 which did not exceed the critical value of 1.96, accepting the null hypothesis. Therefore, there is no significant relationship between hearing the information about the Unang Yakap Campaign to others and the level of knowledge of the Unang Yakap Campaign among health professionals.

69

And lastly, the respondents who claimed that they neither hear anything about the Unang Yakap Campaign nor Essential Newborn Care Protocol (m=9.71+3.592) have lower level of awareness than those who heard about it (m=15.71+4.007). It had a point biserial of -0.328 and a t-computed value of -3.849, which exceeded the critical value of 1.96, rejecting the null hypothesis. Therefore, there is a significant relationship between not hearing anything about the Unang Yakap Campaign and level of knowledge on the said campaign among health professionals. This means that those who heard about the Unang Yakap Campaign have higher level of knowledge than those who did not. In summary, the results revealed that reading pamphlets as sources of information increases the level of knowledge of the health professionals on the Unang Yakap Campaign. While those health professionals who did not hear anything about the campaign have lower level of knowledge on the Unang Yakap Campaign. Attending seminars, surfing the internet, watching television and hearing the campaign from others have no relation to the level of knowledge of the health professionals regarding the Unang Yakap Campaign. According to DOH, together with the NCDPC, Health Human Resource Development Bureau must develop and finalize training programs relative to the propagation of Maternal and Newborn Care policies (included EmONC). In collaboration with the HHRDB, National Center for Disease Prevention and Control should provide support for capacity development to ensure that Maternal and Newborn Care (including EmONC) trainers and implementers are updated on Maternal Newborn Care. They must also coordinate the training program/modules with the HHRB n the management of the different service components of heath care facilities. While Center for Health Development should also develop the capacity of the provincial/municipal health workers
70

to implement the protocol, could be through trainings, orientations, reading materials, promotional videos, etc and provide technical assistance to the LGUs (DOH, 2009).

Table 4. Relationship between the source of information and their level of knowledge of the Unang Yakap Campaign
SOURCE OF RESPONSE MEAN INFORMATION Seminars Yes No 16.05 14.73 STANDARD POINT BISERIAL T-COMPUTED REMARKS DEVIATION CORRELATION COEFFICIENT 3.801 4.494 0.156 1.755 Accept Ho

Pamphlets

Yes No

17.18 14.73

3.423 4.287

0.257

2.951

Reject Ho

Internet

Yes No

15.21 15.40

5.605 4.028

-0.014

-0.151

Accept Ho

TV

Yes No

14.00 15.41

2.646 4.238

-0.051

-0.570

Accept Ho

SHI

Yes No

15.12 15.55

4.003 4.358

-0.051

-0.566

Accept Ho

NHAI

Yes No

9.71 15.71

3.592 4.007

-0.328

-3.849

Reject Ho

Critical value of t-test = 1.96

Extent of Implementation of the Unang Yakap Campaign

71

Table 5 shows the extent of implementation of the respondents of the procedures included in the Unang Yakap Campaign. Item numbers one to five refer to the time bound interventions, item numbers six and seven refer to non-time bound interventions, while item number eight pertains to unnecessary procedures included in Essential Newborn Care. The result showed that health professionals from selected rural health units and lying-in clinics in the province of Cavite have very high extent of implementation in most of the Unang Yakap Campaign specifically in the following procedures: Immediate and thorough drying of the newborn for 30 seconds to one minute (m= 4.74+.720); There should be early skin-to-skin contact between the mother and newborn (m= 4.89+.542); washing the newborn must be delayed for at least 6 hours (m= 4.81+.549); waiting for the cord pulsations to stop (clamping of the cord after 1-3 min.) (m=4.82+.540); early breastfeeding which provides colostrums (babies first immunization)(m=4.86+.573); completing non-time bound interventions within 6 hours(m= 4.72+736); doing non-time bound interventions after the first full breastfeed; provision of vaccinations and physical examination (m=4.74+.795); eye care (m=4.84+.574 ) ;Vitamin K administration (m=4.81+.618); weighing (m= 4.77+.686); and newborn Screening Test (m=4.39+1.099). However, for the unnecessary procedures which include routine suctioning (m=3.51+1.620), it revealed that it is the only procedure often or highly implemented. Both routine separation of newborns for observations (m= 2.94+1.515) and newborn foot printing (m=2.61+1.809) are the procedures that are sometimes implemented. Lastly, the giving of prelacteals like glucose, water formula (m=2.30+1.681) is seldom implemented as compared to other procedures.

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In measuring the extent of implementation of the respondents regarding the Unang Yakap Campaign, item numbers 1 to 7 that have a mean score ranging from 7.39 to 7.89 (having item number 2 with the highest mean score of 7.89) suggest that most of the respondents always follow the procedures included in the time bound and non-time bound interventions. Therefore, the extent of their implementation to item numbers 1 to 7 is very high. Item number 8a, has a mean score of 3.51 which shows that most of the respondents often perform suctioning of the newborn and this procedure is highly implemented. Item numbers 8b and 8c, have a mean score of 2.94 and 2.61, respectively reveals that most of the respondents sometimes perform routine separation of newborns for observations and newborn printing and that these procedures are only sometimes implemented. Item number 8c has a mean score of 2.30, which means that most of the respondents seldom give prelacteals like glucose and water formula to newborns and that the extent of their implementation to this procedure is low. The overall mean of 4.25 shows that the extent of implementation regarding the procedures included in the Unang Yakap Campaign by the majority of health professionals employed from the selected rural health units (RHUs) and lying in clinics in the province of Cavite is very high. This result shows that health professionals have a very high extent of implementation regarding time bound and non-time bound interventions while procedures in unnecessary procedures were ranging from low to high extent of implementation. This may be because the first two interventions should be finished within the first six hours of life of the newborn while unnecessary interventions are not actually recommended for all newborns which means that they can be skipped unless needed.
73

The Essential Newborn Care categorizes post-natal procedures into time-bound, non-time bound and unnecessary actions which were undertaken to lessen newborn death. At the heart of the protocol are time bound interventions, which are actions containing four steps that need to be taken immediately to lessen the statistics on newborn deaths and should be routinely performed first. First is immediate and thorough drying of the newborn for 30 seconds to one minute warms, preventing hypothermia to the newborn and stimulating breathing (DOH, 2009). Washing the newborn must be delayed for at least six hours. Second is early skin-to-skin contact between the mother and the newborn prevents hypothermia. It also promotes bonding between the mother and child and promotes success of breastfeeding. Third is proper cord clamping and cutting. By waiting for the cord pulsations to stop before clamping (1-3 minutes), newborns blood circulation and iron reserves are increased. This time bound intervention is also found to decrease anemia in one out of every three premature babies and prevents brain hemorrhage in one out of two (Healthbeat, 2009). Lastly, early breastfeeding, which is initiated within the first hour of life, protects the baby from infections because of the colostrums present in the mothers breastmilk. Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures (Healthbeat, 2009). Non-time bound intervention should only be done after the first full breastfeed, usually given within six hours after birth, which are: Vitamin K injection; BCG and Hepatitis B vaccinations; eye care; newborn examinations for checking birth injuries, malformation or defects; cord care; newborn resuscitation; and additional care for a small baby or twin. A single dose of 0.5 to 1.0 mg of vitamin K is administered intramuscularly to prevent bleeding disorders or an oral vitamin K is offered if the parents refuse the
74

injection (Pillitteri, 2007). Inject hepatitis B vaccine IM and BCG intradermally (DOH, 2009). Silver nitrate was exclusively used for eye prophylaxis in the past; today, erythromycin ointment is the drug of choice. Erythromycin ointment has the advantage of eliminating not only the organism of gonorrhea but that of Chlamydia as well (Pillitteri, 2007). Weighing of the newborn is done while examining the newborn and checking for birth injuries, malformations or defects (DOH, 2009). Unnecessary procedures were interventions that have been routinely given in Philippine hospitals but, are not recommended for all newborns. These include: routine suctioning which has no benefit if the amniotic fluid is clear and especially with newborn who cry or breathe immediately after birth and it has been associated with cardiac arrhythmia; routine separation of newborns for observations/ early bathing causes a drop in the body's temperature leading to increased risk of developing infections, coagulation defects and brain hemorrhage; giving sugar water formula or other prelacteals and the use of bottles or pacifiers may develop newborns preference for the bottle leading to nipple confusion and inefficient suckling which can further lead to failure in breastfeeding; footprinting has proven to be an inadequate technique for newborn identification purposes (DOH, 2009).

Table 5. Extent of implementation of the respondents Unang Yakap Campaign ITEM NUMBER 1 2 ENC PROCEDURES Immediate and thorough drying of the newborn for 30 seconds to one minute. There should be early skin-to-skin contact between the mother and newborn MEAN 4.74 4.89 SD 0.720 0.542 VI VH VH

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3 4 5 6 7a

Washing the newborn must be delayed for at least 6 hours Wait for the cord pulsations to stop (clamping of the cord after 1-3 min.). Early breastfeeding which provides colostrums (babies first immunization). Non-time bound interventions should be completed within 6 hours Non-time bound interventions should be done after the first full breastfeed: Provision of vaccinations and physical examination; Eye care Vitamin K administration; Weighing Newborn Screening Test Unnecessary procedures include: Routine suctioning Routine separation of newborns for observations Giving of prelacteals like glucose, water formula Newborn footprinting

4.81 4.82 4.86 4.72 4.74

0.549 0.540 0.573 0.736 0.795

VH VH VH VH VH

7b 7c 7d 7e 8a 8b 8c 8d

4.84 4.81 4.77 4.39 3.51 2.94 2.30 2.61 4.25

Verbal Interpretation Very Low (VL) Low (L) Average (A) High (H) Very High (VH)

0.574 0.618 0.686 1.099 1.620 1.515 1.681 1.809

VH VH VH VH H A L A

OVER ALL SCORE

Legend Range 1.00 1.79 1.80 2.59 2.60 3.39 3.40 4.19 4.20 5.00

0.511 Very High

Never Seldom Sometimes Often Always

Relationship of Respondents Level of Awareness and Level of Knowledge to their Extent of Implementation of the Unang Yakap Campaign Spearman rank correlation coefficient was used to determine the relationship of the respondents level of awareness and knowledge of the Unang Yakap Campaign to the extent they are implementing its protocols.

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As evident in table 6, the correlation coefficient based on the respondents level of awareness is 0.112 with a P-value of 0.214 which exceeded the significant level of 0.05. There is a need to accept the null hypothesis. Therefore, the level of awareness of the respondents of the Unang Yakap Campaign does not affect the extent to which health professionals implement its protocols.

Table 6. Relationship of respondents level of awareness and level of knowledge to their extent of implementation of the Unang Yakap Campaign
AWARENESS Level of Awareness SPEARMAN RANK CORRELATION COEFFICIENT 0.112 PREMARKS VALUE 0.214 Accept Ho

Level of

-0.027

0.765

Accept Ho

Knowledge

Significant Level 0.05

The level of awareness, level of knowledge, and extent of implementation among professionals Awareness. Table 7 shows the respondents' level of awareness on the Unang Yakap Campaign by specific professions, namely: nurses, midwives and doctors employed in selected rural health units and lying-in clinics in Cavite. The data on nurses (m=1.43), midwives (m=1.79) and doctors (m=1.80) obtained a Kruskal Wallis Statistics of 10.988 with a total p-computed value of 0.004 which did not exceed the significant value of 0.05, hence, the null hypothesis was rejected. This means that there is a significant relationship between the professionals and their level of awareness on the said campaign.

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Knowledge. Table 7 shows the relationship between the respondents' different professions to their level of knowledge of the Unang Yakap Campaign. The data on nurses (m=13.86), midwives (m=16.15) and doctors (m=18.71) obtained a Kruskal Wallis Statistics of 12.919 with a total p-computed value of 0.002 which did not exceed the significant value of 0.05, hence, the null hypothesis was rejected. Thus, there is a significant difference on the level of knowledge among the three types of professionals. Extent of Implementation. Table 7 shows the relationship between the professionals to the extent to which they implement the protocols included in the Unang Yakap Campaign. The data on nurses (m=4.21), midwives (m=4.30) and doctors (m=4.05) obtained a Kruskal Wallis Statistics of 2.102 and a total p-computed value of 0.350 which exceeded the significant value of 0.05, hence, the null hypothesis was accepted. Thus there is no significant difference on the extent of implementation of the Unang Yakap Campaign among the professionals. Therefore, table 7 reveals that by order in level of awareness and knowledge, doctors are more aware and knowledgeable than midwives who ranked as second and nurses who are in last place. However in terms of extent of implementation, midwives ranked as first followed by nurses and lastly, by doctors. Since the doctors are able to attend seminars and can easily access on the source of information, they are more aware and knowledgeable than the nurses and midwives. Midwives, on the other hand, are more firsthand and are in the frontline when it comes to attending to childbirth and newborn care.

Table 7. The level of awareness, level of knowledge, and extent of implementation among professionals
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VARIABLES

PROFESSIONS MEAN MEAN KRUSKALLPREMARKS RANK WALLIS VALUE STATISTICS Nurse Midwife Doctor 1.43 1.79 1.80 51.09 b 70.72 a 73.07 a 10.988 0.004 Significant

Awareness

Knowledge

Nurse Midwife Doctor

13.86 16.15 18.71

49.23 b 70.99 a 83.71 a

12.919

0.002

Significant

Extent of Nurse Implementation Midwife Doctor

4.21 4.30 4.05

61.38 65.93 46.07

2.102

0.350

Not Significant

*Mean rank followed by a common letters are not significant at 5% level.

The Extent of Unang Yakap Campaign Implementation among Work Stations Table 8 shows the ranking of work stations according to their extent of implementation of the Unang Yakap Campaign. Kruskal Wallis test was used to rank the following work stations. With the significant level of 0.05 or 5%, there is a significant difference among work stations as proven by a p- value of 0.003. From the mean rank, Carmona got the highest mean with 81.25 followed by Imus at second spot with 78.67, Mendez ranked third (74.68), Tanza ranked fourth (74.19), Rosario ranked fifth (73.46),
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Dasmarinas ranked sixth place (73.00), Trece Martirez City ranked seventh (64.55), GMA ranked eighth place (63.94), Naic at ninth place (56.70), General Trias ranked tenth place (37.81) and lastly, which is less likely to implement the Unang Yakap Campaign is Tagaytay (27.79).

Table 8. The Extent of Unang Yakap Campaign Implementation among Work Stations VARIABLES WORK STATIONS MEAN MEAN RANK KRUSKALPREMARKS WALLIS VALUE STATISTICS 26.533 0.003 Significant

Extent of 1- Tagaytay Implementation 2- Mendez 3- Dasmarinas 4- Imus 5- General Trias 6- Tanza 7-Carmona 8-GMA 9-Trece 10-Naic 11-Rosario

3.94 4.48 4.26 4.33 4.03 4.35 4.36 4.16 4.23 4.23 4.44

27.79 b 74.68 ab 73.00 ab 78.67 a 37.81 ab 74.19 ab 81.25 a 63.94 ab 64.55 ab 56.70 ab 73.46 ab

*Mean rank followed by a common letters are not significant at 5% level.

The Extent of Implementation Between the Two Work Places Table 9 shows the extent of implementation of the Unang Yakap Campaign in two different work places, RHU and lying-in. The RHUs has a mean score of 4.28 and a
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mean rank of 64.90, while the lying-in clinics have a mean score of 4.15 and a mean rank of 56.09. Mann-Whitney test was used to compare two independent groups, the result is -1.126 which is not significant. The extent of implementation regarding the procedures included in the Unang Yakap Campaign by the majority of health professionals employed from the selected RHUs is quite higher than the ones employed in lying-In clinics in Cavite. The result is not significant which indicates there is no significant difference on the level of extent of implementation between the two work places. An observational study of consecutive deliveries using a standardized assessment tool to document minute-by-minute newborn care done in the first hour of life was undertaken in 51 hospitals in nine regions of the country in 2008. The study found that Philippine hospital practices prevented newborns from benefitting from their mothers' natural protection in the first hour of life. Further, the performance and timing of evidenced-based interventions in immediate newborn care are below WHO essential newborn care standards. Almost no newborn benefited from the natural transfusion through non-immediate cord clamping. A Cochrane systematic review of seven Randomized Controlled Trials (RCTs) showed that among infants less than 37 weeks of gestation, non-immediate cord clamping is associated with fewer transfusions due to anemia or low blood pressure and fewer intraventricular hemorrhages. Full-term neonates also benefit by having lower incidence of anemia (DOH, 2009). Policy paper: A Minuteby-Minute Assessment of Newborn Care within the First Hour of Life in Fifty-One Large hospitals in the Philippines

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Table 9. The extent of implementation between the two Work Places VARIABLE WORK PLACE RHU MEAN MEAN MANNP-VALUE REMARKS RANK WHITNEY STATISTICS 64.90 56.09 -1.126 0.260 Not Significant

Extent of

4.28 4.15

Implementation Lying-in

Difference on the level of extent of implementation between Work Stations Table 10 shows the result that among the selected work stations in the province of Cavite, Mendez (m=4.48) has the highest level of extent of implementation on Unang Yakap Campaign; followed by Rosario (m=4.44); third is Carmona (m=4.36); fourth is Tanza (m=4.35); fifth is Imus (m=4.33); sixth is Dasmarias (m=4.26); seventh is Trece (m=4.23); eighth is Naic (m=4.23); ninth is GMA (m=4.16); tenth is General Trias (m=4.03); and at eleventh place is Tagaytay (m=3.94). With the considerable level of 0.05 or 5%, there is a significant difference between work stations proven with a p- value of 0.003. It means that implementation of the said program of the Department of Health is done though not to the extent of always doing it or completely following the given protocol. Therefore, Mendez has the highest level of extent of implementation among the other work stations in the province of Cavite. On the other hand, Tagaytay has the lowest level of extent of implementation. Long term control of mortality and morbidity and improvement in the equality of life require provision and use of continuum of health care
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services spanning each of the life cycle stages. Provision and use of these services would require informed decisions by mothers and their families (demand side), as well as a health system (supply side) that is responsive to their needs (DOH, 2008). Table 10. Difference on the level of extent of implementation among Work Stations VARIABLES WORK STATIONS 1. Mendez 2. Rosario 3. Carmona 4. Tanza 5. Imus Extent of Implementatio 6. Dasmarinas n 7. Trece 8. Naic 9. GMA MEAN 4.48 4.44 4.36 4.35 4.33 4.26 4.23 4.23 4.16 MEAN RANK 74.68 ab 73.46 ab 81.25 a 74.19 ab 78.67 a 73.00 ab 64.55 ab 56.70 ab 63.94 ab 37.81 ab 27.79 b 26.533 0.003 Significant KRUSKALPWALLIS REMARKS VALUE STATISTICS

10.General Trias 4.03 11. Tagaytay 3.94

*Mean rank followed by a common letters are not significant at 5% level.

Advantages of the Unang Yakap Campaign as perceived by Health Professionals Table 11 shows the advantages of the Unang Yakap Campaign. The advantages were ranked highest to lowest with its corresponding percentage. The leading advantage that acquired the most frequency of answers which is 46 (36.8%) as perceived by the respondents is that the campaign promotes uninterrupted skin-to-skin contact between the mother and newborn. Second is that it reduces mortality and morbidity rate of Newborn
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got 29 (23.2%). Third is that it improves health of newborn that obtained 26 (20.8%). Bonding between newborn and mother is at fourth place with 23 (18.4%). Reduces the incidence of anemia is at fifth place with 19 (15.2%). Stimulates breastfeeding with 16 (12.8%) is at sixth place. Early treatment and assessment with 8 (6.4%) is at seventh place. Increases blood circulation with five (4%) falls at eighth place. Stimulates breathing with two (1.6%) falls at ninth place. Decreases maternal death falls at tenth place with one (0.8%). And last at eleventh place is that the campaign helps in better contraction of the mother with one (0.8%). Therefore, the perception of the respondents is that the campaign causes uninterrupted skin-to-skin contact between the mother and newborn and the least common answer from the respondents is that it helps in better contraction of the mother. The highest in the ranking of the advantages is keeping the mother and the baby in uninterrupted skin-to-skin contact which prevents hypothermia (Healthbeat, 2009). Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrum feeding and stimulation of the mucosa associated lymphoid tissue system. It also allows the newborn to be colonized by good bacteria from the mothers skin, so-called family flora to protect the infant from sepsis and other life-threatening infections and hypoglycemia (Healthbeat, 2009).

Table 11. Advantages of the Unang Yakap Campaign as perceived by the respondents

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Disadvantages of the Unang Yakap Campaign as perceived by the respondents Table 12 shows the disadvantages of the Unang Yakap Campaign as perceived by PERCEIVED ADVANTAGES 1. Uninterrupted skin-to-skin contact 2. Reduces Mortality and morbidity rate of Newborn 3. Improves Health of Newborn 4. Bonding between Newborn and Mother 5. Reduces the incidence of Anemia 6. Stimulates breastfeeding (passive immunity) 7. Early treatment and assessment 8. Increases blood circulation 9. Stimulates breathing 10. Decreases maternal death 11. Helps in better contraction of the mother FREQUENY 46 29 26 23 19 16 8 5 2 1 1 PERCENTAGE (%) 36.8 23.2 20.8 18.4 15.2 12.8 6.4 4 1.6 0.8 0.8

the respondents. The disadvantages were ranked highest to lowest with its corresponding frequency and percentage. The first disadvantage that acquired the most frequency of answers, which is 11 (8.8%), from the respondents is that the campaign is time consuming; delayed bathing, dressing and clamping of the cord is at second place with three (2.4%); uncomfortable to the mother is at third place with two (1.6%); confusing to the health professionals got the lowest rank at fourth place with two (1.6%). Therefore, the most common disadvantage of the Unang Yakap Campaign as perceived by the respondents is that the campaign is time consuming on the other hand
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the disadvantage that obtained the least frequency of answers is that the campaign is somewhat confusing for the health professionals since the campaign was just implemented last 2010. According to the campaign bathing or washing should be made at least after 6 hours of the newborns life which makes the said campaign time consuming for the health care professionals.

Table 12. Disadvantages of the Unang Yakap Campaign as perceived by the respondents PERCEIVED DISADVANTAGES 1. Time consuming 2. Delayed bathing, dressing and clamping 3. Uncomfortable to the mother 4. Confusing FREQUENCY 11 3 2 2 PERCENTAGE (%) 8.8 2.4 1.6 1.6

SUMMARY, CONCLUSION AND RECOMMENDATION Summary The study was conducted to determine the level of awareness on the Unang Yakap Campaign among health professional employed in selected rural health units and lying-in clinics in the province of Cavite. Specifically, it aimed to (1) describe the demographic profile of selected health professionals in terms of gender, age, civil status, years of service, work stations, specific profession; (2) determine the source of information on Unang Yakap Campaign of the

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selected health professionals; (3) assess the level of awareness and knowledge

of

selected health professionals of the implemented Unang Yakap Campaign; (4) determine the extent of implementation of the Unang Yakap Campaign in the different RHUs and lying-ins in terms of performance of its protocol by the nurses and midwives; (5) determine if there is a significant relationship between the sources of information and level of awareness and knowledge of the respondents with regard to the Unang Yakap Campaign; (6) determine if there is significant relationship between extent of implementation and level of awareness and knowledge of health professionals employed in rural health units and lying-in clinics; (7) find out if there is significant difference on the level of awareness, knowledge, and extent of implementation between Professionals; (8) find out if there is significant difference on the extent of implementation of health professionals between work places and stations; (9) determine the perceived advantages and disadvantages on the Unang Yakap Campaign.

The study was conducted among 125 respondents, specifically nurses, midwives and doctors employed in selected rural health units and lying-in clinics in the province of Cavite. The information and data needed were gathered through the use of questionnaires which were answered within 30 minutes to 1 hour. The inquiry was conducted from September 10 to October 2011. To find out the necessary data, a five-part questionnaire was utilized. The first part is the demographic profile of the respondents; second part is the level of awareness regarding the Unang Yakap Campaign and what are their sources of information; third part is the perceived advantages and disadvantages of the respondents to the said campaign; fourth part is divided into two sections- section A is the level of knowledge of every health professionals and section B is the steps in ENC
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protocol; the last part is the extent of implementation of every procedures in the recently implemented campaign. The statistical measures employed to study the significant relationship between the level of awareness and knowledge and the extent of the implementation of the respondents of the Unang Yakap campaign were the following: mean, frequency count, percentage, standard deviation, Spearmans correlation coefficient, point biserial correlation coefficient, Kruskal-Wallis statistics and Mann-Whitney Statistics.. This study made use of descriptive research method to gather information about the present existing condition. For the selection of respondents, cluster sampling, simple random sampling and quota sampling was used. A T test was used to compare the difference between two means. Spearman's rank Correlation was also used in this study to indicate the magnitude of a relationship between variables measured on the ordinal scale (Polit, 2008). This study also used Point Biserial Correlation Coefficient since the variable is dichotomous. Kruskal Wallis Statistics was also used to test the difference in ranks of scores of 3+ independent groups. This test is used when the number of groups is greater than two and a one-way test for independent samples is desired. The results revealed that the source of information affects the level of awareness and knowledge of the health professionals of the Unang Yakap Campaign by the DOH. The hypothesis that there is no significant relationship between the respondents specific profession to their level of awareness and knowledge regarding the Unang Yakap Campaign was rejected. The results revealed that there is a significant difference on the level of awareness and knowledge between professionals, however there is no significant difference on their extent of implementation.
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The hypothesis that there is no significant relationship between level of awareness and knowledge of informed health professional to those who are not informed was rejected. The results revealed that the health professionals who were informed through seminars, pamphlets and second hand information have greater level of awareness than those who were not informed. And the health professionals who were informed through pamphlets have greater level of knowledge than those who were not informed. The other sources of information do not affect the level of awareness and knowledge of the health professionals regarding the Unang Yakap Campaign. The null hypothesis that there is no significant relationship between the extent of implementation of Unang Yakap Campaign to the level of awareness and knowledge of health professionals was accepted. The null hypothesis that there is no significant difference on the extent of implementation of health professionals between work stations was rejected. The results revealed that the extent of implementation of health professionals differ on the work stations they are employed. On the other hand, the null hypothesis that there is no significant difference on the extent of implementation of health professionals between work places was accepted.

Conclusion The results revealed that most of the respondents are 44 years old. There are more females and majority of the respondents are married, most of them work in the rural

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health unit and most of the respondents are midwives. Most of the respondents work in their respective facility for five years and below. The doctors, nurses and midwives are highly knowledgeable about the Unang Yakap Campaign. They are aware about the collaboration between the Department of Health (DOH) and World Health Organization (WHO). The number one source of information on the Unang Yakap Campaign is seminars. The health professionals employed in the selected rural health units (RHUs) and lying-in clinics in Cavite have fair level of knowledge to the said campaign. There is a relationship between the respondents level of awareness and knowledge on the Unang Yakap Campaign and the extent to which they follow the protocol included in the ENC. The most common advantage of the Unang Yakap Campaign as perceived by the respondents is that the campaign causes uninterrupted skin-to-skin contact between the mother and newborn and the least advantage is that it helps in better contraction of the mother. The most common disadvantage of the Unang Yakap Campaign as perceived by the respondents is that the campaign is time consuming and the least disadvantage is that the campaign is somewhat confusing for the health professionals since the campaign was just implemented last 2010. The health care professionals who were informed about the said campaign has a greater awareness than those who did not hear about it, which proves that level of implementation is significantly related to the level of awareness of health care professionals. There is no significant relationship between the extent of implementation of Unang Yakap Campaign to the level of awareness and knowledge of health
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professionals and there is also no significant difference on the extent of implementation of health professionals between work places and stations.

Recommendation Stated below are the recommendations made based on the outcomes gathered in this study:
1. Though implemented nationwide, the Unang Yakap Campaign seems to be

unknown to other health professionals. The researchers would like to recommend to give more seminars and trainings especially to midwives as well as to nurses to enhance their knowledge and to apply it in their profession.
2. The Department of Health (DOH) must focus on producing pamphlets that

contains the important component of Essential Newborn Care Protocol- Unang Yakap Campaign. This pamphlets must be disseminated to local government units specifically RHUs for better understanding of health professionals that are serving the public. In this way, lesser time for attending seminars and is more convenient to those health care provider.
3. As for the primary beneficiary of this study, the nurses, midwifes and doctors

should keep themselves up to what is the latest programs and revised protocols that are made by the Department of Health. They can do it by using technology such as the internet and browsing the homepage of DOH which is www.doh.gov.ph. Aside from these electronic sources, there are also monthly publications released by DOH that is available to every RHU that can be read by these health professionals to enhance their knowledge.
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4. The DOH can collaborate with television stations that can be one of the ways to spread the concept of UYC and to implement it. They can use promotional videos that can catch the attention of health professionals and ordinary people to help them to be aware that the old system of newborn care is already revised 5. Future researchers may use the data obtained from this study as their reference and to enhance their knowledge regarding the same topic.
6. To test whether there is increase in implementation of the ENC UYC, one can

conduct further research to correlate with the result of this study, not just in the implementation but also in the level of awareness and knowledge of nurses, midwives and doctors to UYC.

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World Health Organization. AO Advances Essential Newborn Care. WHO Online (2010). 21 January 2011<http://www.wpro.who.int/phl/files/unangyakap/press% 20releases/pr_ao.pdf>. Online Posting InstantMommmy. The DOH Unang Yakap Campaign. Online Posting. 01 April 2010. InstantMommy Blogspot. 21 January 2011<http://instantmami.blogspot.com/ 2010/04/doh-unang-yakap-campaign.html>. Pea, Anna Katharina. Essential Newborn Care, Unang Yakap Campaign. Online Posting. BlogAnnaKatharinaMD.com. 07 March 2010. 21 January 2011<http:// www.annakatharinamd.com/2010/03/07/essential-newborn-care-unang-yakapcampaign>. Rwchick. Unang Yakap. Online Posting. 01 September 2010 . Mom Exchange. 21 January 2011 <http://mom.exchange.ph/node/15480>. Pamphlet Essential Newborn Care: Protocol for New Life. Manila, Philippines: Department of Health, 2010. Research USAID. Newborn Health in the Philippines: A Situation Analysis. Arlington, Virginia: BASICS II, June 2004.

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