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Effect of Neonatal Hypothermia Education on Thermal Care Practices among Healthcare Workers in Nigeria

Abstract

Neonatal hypothermia is an important newborn health concern that can increase the risk of complications and death, particularly among preterm and low-birth-weight newborns. Healthcare workers involved in maternity and neonatal care play a critical role in preventing heat loss and maintaining appropriate newborn body temperature immediately after birth and throughout the early neonatal period. Neonatal hypothermia education provides healthcare workers with knowledge and practical skills relating to the causes and risk factors of neonatal hypothermia, mechanisms of newborn heat loss, temperature assessment, immediate newborn thermal protection, skin-to-skin contact, appropriate drying and wrapping, delayed bathing, breastfeeding support, use of warm clothing and coverings, maintenance of appropriate environmental temperature, safe transport of newborns, and recognition and management of neonatal hypothermia. Thermal care practices refer to the actions undertaken by healthcare workers to prevent heat loss and maintain newborn thermal stability, including immediate drying, appropriate wrapping, skin-to-skin care, temperature monitoring, timely breastfeeding, appropriate bathing practices, maintenance of a warm environment, and safe transport and handling of newborns. In Nigeria, inadequate neonatal thermal care education, limited availability of temperature-monitoring equipment, inadequate staffing, high workloads, poor environmental conditions, limited access to appropriate newborn-care supplies, and inconsistent adherence to newborn care guidelines may affect thermal care practices among healthcare workers. Effective neonatal hypothermia education may improve healthcare workers' knowledge, practical skills, confidence, and adherence to recommended thermal care procedures. Against this background, this study investigates the effect of neonatal hypothermia education on thermal care practices among healthcare workers in Nigeria. The study is anchored on Social Cognitive Theory, the Knowledge-Attitude-Practice framework, and Experiential Learning Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare workers' newborn-care practices. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from neonatal hypothermia education may influence thermal care practices. Experiential Learning Theory emphasizes learning through practical experience, demonstration, reflection, and application, making it particularly relevant to skills-based newborn thermal care education. Collectively, these theoretical perspectives provide a suitable framework for explaining how neonatal hypothermia education may influence thermal care practices among healthcare workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers providing maternity and neonatal care in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, neonatal hypothermia knowledge assessment, and an observational thermal care practices checklist. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, maternity units, neonatal units, and eligible healthcare workers. Where feasible, selected healthcare facilities or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured neonatal hypothermia education covering causes and risk factors, mechanisms of newborn heat loss, temperature assessment, immediate drying and wrapping, skin-to-skin contact, breastfeeding support, delayed bathing, appropriate clothing and coverings, maintenance of a warm environment, safe newborn transport, and recognition and management of neonatal hypothermia. Thermal care practices will be assessed using indicators such as immediate drying, appropriate wrapping, skin-to-skin contact, temperature monitoring, timely initiation of breastfeeding, appropriate timing of bathing, maintenance of a warm environment, appropriate use of thermal equipment, and safe newborn transport. Direct observation will be prioritized where feasible to reduce reliance on self-reported practices. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, previous newborn-care training, neonatal hypothermia knowledge, exposure to education, and thermal care practice scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of neonatal hypothermia education on thermal care practices. Where appropriate, pre-intervention and post-intervention practice scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that neonatal hypothermia education has a significant positive effect on thermal care practices among healthcare workers in Nigeria. Healthcare workers exposed to structured neonatal hypothermia education are expected to demonstrate improved knowledge and greater adherence to recommended newborn thermal care procedures. Education may improve immediate drying and wrapping, skin-to-skin care, temperature monitoring, breastfeeding support, delayed bathing, environmental temperature control, appropriate use of thermal equipment, and safe newborn transportation. It may also improve healthcare workers' recognition of newborns at increased risk of hypothermia and strengthen their understanding of the importance of continuous thermal protection. However, education alone may not guarantee sustained thermal care practices because healthcare workers may continue to face barriers such as inadequate staffing, shortages of thermometers and thermal equipment, overcrowded facilities, poor environmental temperature control, limited supplies, high workloads, and inadequate monitoring and supervision. Consequently, neonatal hypothermia education is expected to be most effective when supported by adequate newborn-care resources, functional temperature-monitoring equipment, appropriate staffing, regular supervision, supportive hospital policies, continuing professional development, and adherence to standardized newborn thermal care protocols. The study is expected to contribute to the literature on neonatal hypothermia, newborn thermal care, neonatal health, maternal and child health, healthcare worker education, newborn survival, neonatal nursing, midwifery, clinical practice, and public health in Nigeria by providing empirical evidence on the effect of neonatal hypothermia education on thermal care practices among healthcare workers. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nursing and Midwifery Council of Nigeria, state ministries of health, hospitals, neonatal units, maternity facilities, nursing and midwifery training institutions, professional associations, newborn health programmes, development partners, and policymakers regarding strategies for improving newborn thermal care. The study will also provide evidence-based recommendations for strengthening neonatal hypothermia education, integrating thermal care training into continuing professional development, ensuring availability of appropriate temperature-monitoring and thermal-care equipment, strengthening clinical supervision, improving facility environmental conditions, and promoting consistent thermal care practices among healthcare workers caring for newborns in Nigeria.

Keywords: Neonatal hypothermia education, thermal care practices, healthcare workers, neonatal hypothermia, newborn thermal care, newborn health, neonatal care, maternal and child health, neonatal nursing, midwifery, healthcare worker education, newborn survival, public health, Nigeria.