ASSESSMENT OF KNOWLEDGE REGARDING EXCLUSIVE BREAST … · 2018-08-10 · Nursing student, K V M...

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ASSESSMENT OF KNOWLEDGE REGARDING

EXCLUSIVE BREAST FEEDING AMONG PRIMI GRAVIDA

AND PRIMI PARA MOTHERS

By

CHINCHU MOHAN

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF SCIENCE IN NURSING

UNIVERSITY OF KERALA

2011

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CERTIFICATE

Certified that this is a bonafide work of Miss. Chinchu Mohan, M Sc

Nursing student, K V M College of Nursing, Cherthala, submitted in partial

fulfillment of requirement for the degree of Master of Science in Nursing from

the University of Kerala.

Mrs. S.V.Bhanu

Principal in Charge K V M College of Nursing

Cherthala

Date:

College Seal:




ASSESSMENT OF KNOWLEDGE REGARDING

EXCLUSIVE BREAST FEEDING AMONG PRIMI GRAVIDA

AND PRIMI PARA MOTHERS

ADVISORS

Mrs. S. V. Bhanu, M.Sc( N)

Principal in Charge

K.V.M. College of Nursing

Cherthala

Mrs. Marie Rosy M. Sc (N)

Senior Lecturer

Obstetrics and Gynecologic Nursing


Cherthala

Ms. Jeena Jose

Senior Lecturer

Obstetrics and Gynecologic Nursing


Cherthala

Dr. Mrs. P. G. Sreedevi MBBS, MD

Gynaecologist

K.V.M Hospital

Cherthala

A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF SCIENCE IN

NURSING UNIVERSITY OF KERALA

2011




ACKNOWLEDGEMENT

I will give you thanks O Lord, my God with all my heart will glorify your name for ever more

The investigator praises and gives thanks to the Lord, for His abiding grace, love, compassion

and immense shower of blessings on her, which gave her the strength and courage to overcome

all difficulties and in completing the study successfully.

The investigator is extremely thankful to Dr. V .V. Pyarelal, Director, K V M College of

Nursing for allowing her to conduct this study.

She acknowledges with sincere gratitude Prof. Mrs. Girijamany.K, Principal, K V M College

of Nursing, and Cherthala whose continuous support, reassurance, guidance, and constant

motivation at each step made her to complete the study successfully

She expresses gratitude to Mrs. Marie Rosy, M Sc (N) Senior Lecturer, Department of

Obstetrics and Gynecology Nursing, K V M College of Nursing, Cherthala for her valuable

suggestions, guidance, constant encouragement, concern and interest as a guide which made

this study successful

She is ever greatful to Miss Jeena Jose, co-guide, for her timely support which made this study

a fruitful one.

She expresses her big thanks to Dr. P.G. Sreedevi, MD. DGO , Gynecologist, K V M

Hospital, Cherthala for her guidance to complete this study.

She extends profound gratitude to Mrs. S .V Bhanu , M Sc (N),PGDHA M Sc. Nursing

coordinator , Associate Professor, KVM College of Nursing, Cherthala, for her support,

encouragement and valuable suggestions throughout the study

She acknowledges Prof. Susamma Thomas and Prof. Saramma M. George ,Former HODs,

Obstetrics and Gynecology Nursing, Dr.Sr. Vijaya Puthusseril, Former MSc Nursing

coordinator, K V M College Of Nursing, Cherthala, for their expert guidance

She extends her thanks to Mr. Vipin Xavier, Statistician , K.V.M College of Nursing

Cherthala, for his guidance, immense and unconditional help, for statistical analysis

She owes her sincere thanks to all the experts for validating the tool and self instructional

module. She expresses her thanks to all the faculty of K V M College of Nursing for their

guidance and support.

Her special thanks to Dr. Radhamany, M D, Medical Superintendent of W&C Hospital

Alappuzha, for allowing to conduct research in the hospital. She acknowledges all the mothers

who participated for this study.

Special thanks to staffs of library, KVM trust, Cherthala, Medical College Central library,

College Of Nursing, Trivandrum for extending their help in retrieving the literature

Words are not sufficient to express my love and gratitude to my loving Parents,

family and all my friends. It is because their constant love prayers and support the

investigator, successfully completed this study

My sincere thanks to all those directly or indirectly helped in the success of this dissertation.

Thanks to all




CONTENT

CHAPTERS PAGE NO

1 INTRODUCTION

2 REVIEW OF LITERATURE

3 METHODOLOGY

4 ANALYSIS AND INTERPRETATION

5 SUMMARY AND DISCUSSION

BIBLIOGRAPHY

APPENDICES




LIST OF TABLES

S. No. TABLES PAGE No.

1.1

1.2

4.1

4.2

4.3

4.4

4.5

4.6

4.7

4.8

4.9

4.10

4.11

4.12

4.13

4.14

4.15

4.16

4.17

The vital statistics of India, by UNICEF

Comparison of constituents of human milk and cow’s milk

Distribution of samples by age 1

Distribution of samples by religion 1

Distribution of samples by education

Distribution of samples by employment

Distribution of samples by type of family

Distribution of samples by monthly income

Distribution of samples by place of residence

Distribution of samples by obstetrical score

Distribution of samples by previous information

Distribution of samples by source of knowledge

Assessment of Knowledge level

Overall assessment of knowledge

Area wise analysis of knowledge score

Association of knowledge with age

Association of knowledge with religion

Association of knowledge with education

Association of knowledge with employment

Association of knowledge with type of family




4.18

4.19

4.20

4.21

4.22

4.23

Association of knowledge with monthly income

Association of knowledge with place of residence

Association of knowledge with obstetrical score

Association of knowledge with previous information

Comparison of knowledge of primi gravida and

primi para mothers




LIST OF FIGURES

S. NO. FIGURES PAGE NO.

1.1

3.1

4.1

4.2

4.3

4.4

4.5

4.6

4.7

4.8

4.9

4.10

4.11

4.12

4.13

Conceptual frame work

Schematic representation of research methodology

Column diagram showing distribution of samples by age

Column diagram showing distribution of samples by religion

Doughnut diagram showing distribution of samples by education

Cone diagram showing distribution of samples by employment

Column diagram showing distribution of samples by type of family

Column diagram showing distribution of samples by monthly income

Cone diagram showing distribution of samples by place of residence

Pie diagram showing distribution of samples by obstetrical score

Cone diagram showing distribution of samples by previous information

Column diagram showing distribution of samples by source of

knowledge

Pyramid diagram showing level assessment of Knowledge level

Pie diagram representation of overall assessment of knowledge

Bar representation of area wise analysis of knowledge score

1

1

1

1

1

1

1

1

1

1

1

1

1

1

1




LIST OF APPENDICES

I. Human Ethical Committee Clearance

II. Letter permitting to conduct research study

III. Consent Form – English

IV. Tool – English

V. Self Instructional Module – English

VI. Consent Form – Malayalam

VII. Tool – Malayalam

VIII. Self Instructional Module – Malayalam




ABSTRACT

The first year of life of the baby is crucial in laying the foundation of good health

Breastfeeding is the ideal method suited for the psychological and physiological needs

of the infant. Breast feeding provides numerous health benefits to both the mother and

infant. Breast milk remains as ideal nutritional source for the infant. Breastfeeding is

an unequalled way of providing ideal food for the healthy growth and development of

infants; it is also an integral part of the reproductive process with important

implications for the health of mothers.

Objectives of the study were as follows;

1. To assess the knowledge regarding exclusive breastfeeding among primi gravida

and primi para mothers

2. To find out the relationship between knowledge regarding exclusive breastfeeding

and selected demographic variables.

3. To prepare a self-instructional module on exclusive breastfeeding

4. To compare the knowledge of exclusive breast feeding between primi gravida and

primi para mothers

A descriptive survey research approach was adopted for the study. The research design

used in my study was non-experimental, descriptive survey design. The study was

conducted in antenatal and postnatal wards of W&C Hospital, Alappuzha. Population

of the study was primi gravida and primi para mothers admitted in W&C Hosptal,

Alappuzha. The sample size was 180. Sampling technique was convenience sampling.

A structured interview schedule was used for collecting data which includes socio

demographic variables and knowledge assessment.

The major findings of the study were that 62.78% of the mothers had poor knowledge

regarding exclusive breastfeeding, 28.33% had average knowledge, and 8.9% had good

knowledge. There was significant association of knowledge score with religion,

education, employment, monthly income and previous information. There was no

significant association of knowledge score with age, place of residence, type of family,




and obstetrical score. There was no difference in knowledge among primi gravida and

primi para mothers

The study concluded that level of knowledge of primi mothers regarding exclusive

breastfeeding was poor on the basis of findings. It is recommended that a similar

study is replicated in another setting. It is also recommending that effectiveness of self-

instructional module can be assessed.




CHAPTER I

INTRODUCTION

CONTENT PAGE No.

1.1 Introduction 2

1.2 Background of the problem 3-6

1.3 Need and significance of the study 7-9

1.4 Theoretical framework 9-11

1.5 Statement of the problem 12

1.6 Operational definitions 12

1.7 Objectives 12

1.8 Hypothesis 13

1.9 Research methodology 13

1.11 Limitations of the study 13

1.12 Format of the report 13




1.1 INTRODUCTION

Giving birth and caring her baby is an unexplainable situation for a woman.

The first year of life of the baby is crucial in laying the foundation of good

health. At this time certain specific biological and psychological needs must be

met to ensure the survival and healthy development of the child into a future

adult. Breastfeeding is the ideal method suited for the psychological and

physiological needs of the infant.

Breast milk is the best milk for an infant

It is universally agreed that breast milk is the preferred method of feeding a

newborn. Breast feeding provides numerous health benefits to both the mother

and infant. Breast milk remains as ideal nutritional source for the infant

( Pillitteri,A., 2010).

Breast milk is accepted as the unique, natural and nutritious food, provided

by nature for the newborn. It is universally acknowledged as the best and

complete food for infants ( Kaur ,L.,& Kaur,M., 2008 ).

Breastfeeding is the first fundamental right of the child. The initiation of

breastfeeding and timely introduction of adequate safe and appropriate

complementary foods are of prime importance for the growth, development,

and nutrition of infants and children everywhere .(Kulkarni ,R N.et al 2004)

Breastfeeding is an ancient practice of the most women. Breastfeed is the

best feed for the babies, since it is the unique source of nutrition that plays an




important role in the growth, development and survival of infants ( Shailaja,

K.G. 2008).

The 54th World Health Assembly which met in Geneva in May 2001,

affirmed the importance of exclusive breastfeeding for 6 months (Frazer.D.M.,

& Cooper M. A., 2009)

Breastfeeding practices and the inference of literacy and cultural practices

were studied in mothers attending immunization clinic in an urban community

centre of Navi Mumbai. The study result showed that 36.1% mothers gave

prelacteal feed to their children. Only 7.4% were exclusively breastfed their

children. Only 1.9% of literate mothers had rejected colostrum ( Kulkarni ,R.N.

et al, 2004)

1.2 BACKGROUND OF THE STUDY

Breastfeeding is an unequalled way of providing ideal food for the healthy

growth and development of infants; it is also an integral part of the

reproductive process with important implications for the health of mothers. As

a global public health recommendation, infants should be exclusively breastfed

for the first six months of life to achieve optimal growth, development and

health. Thereafter, to meet their evolving nutritional requirements, infants

should receive nutritionally adequate and safe complementary foods while

breastfeeding continues for up to two years of age or beyond. Exclusive

breastfeeding from birth is possible except for a few medical conditions, and




unrestricted exclusive breastfeeding results in ample milk production. (W H O,

2007)

TABLE 1.1. THE STATISTICS IN INDIA, BY UNICEF

The main cause of infant mortality in India is diarrheal diseases and

infection. The only remedy for this problem is promotion of exclusive

breastfeeding for 6 months.

United Nations News Centre on August 1st 2011, quoted that Breastfeeding

is directly linked to reducing the death toll of children under five, yet only

36 % of infants below the age of six months in developing countries are

exclusively breastfed, according to the UN Children’s Fund. No other

preventive intervention is more cost effective in reducing the number of

children who die before reaching their fifth birthdays

Infant mortality rate (under 1), 2009 50

Neonatal mortality rate, 2009 34

Percentage of Early initiation of breastfeeding ,

(2005-2009)

41%

Percentage of Children who are exclusively

breastfed (6 months) (2005-2009)

46%




Vafaee,A, et al (2007) stated that prevalence of exclusive breastfeeding

during first six months of life in some regions of the world has decreased. The

study conducted in Northeast Iran revealed that prevalence of exclusive

breastfeeding up to 6 months was 56.4%. Exclusive breastfeeding which are

probably the best recommended infant feeding method during the first six

months of has a protective effect against mortality and morbidity.

Exclusive breastfeeding reduces infant mortality due to common

childhood illness such as diarrhea or pneumonia, and helps for a quicker

recovery during illness. ( Kramer, M. S. , 2007)

Kameswararao,A.A. (2004) conducted a study to assess the extent of

exclusive breast feeding practices in Indian mothers. The study concluded that

exclusive breast feeding practices was inadequate (39.5%). E B F practices

improved with increasing parity and age of marriage. Almost exclusive type

breast feeding was found only in 19% of mothers. EBF practice in mothers is

not as high as expected compared to rural mothers

To reduce the infant mortality and improve health of infants and young

children , the 10th five year plan of Government of India(2003-2007) had set

target ,to increase the EBF rate to 80% and increase the rate of initiation of

breastfeeding within one hour to 50% ( Shailaja K G , 2008)

Recently there has been a surge of interest in the relative value of

breastfeeding versus bottle feeding. Promotion of breastfeeding is of high

priority concern today throughout the world and more so in the developing




countries. Series of steps have been undertaken to increase the incidence and

duration of breastfeeding

1.3 NEED AND SIGNIFICANCE OF THE STUDY

India is home to maximum number of under-five deaths and underweight

children in the world. In 2006, for the first time, the number of children in the

world dying before their fifth birthday fell below 10 million, to 9.7 million

annually. South Asia’s contribution to this figure was 3.1 million out of which

2.1 million deaths occurred in India i.e., 21 percent of the global burden of

under-five deaths. Most of these deaths occur during the neonatal period. A

reduction in the number of deaths among the under-five children reflects the

country’s progress on the fourth Millennium Development Goal (MDG 4)

(Dadhich, J.P., &Agarwal, R. K., 2009)

Appropriate feeding practices are of fundamental importance for survival,

growth, development, health and nutrition of infants and children everywhere.

Developing countries are facing very crucial issue of infant mortality due to

malnutrition and diarrheal diseases. The best way to tackle the problem is

promotion of exclusive breast feeding for 6 months. Breast milk is a hygienic

source of food with the right amount of energy, protein, fat, vitamins, and other

nutrients for infants in the first six months. Exclusive breastfeeding can save

many lives by preventing malnutrition and reducing risk of infection..

(Kameswararao, A.A., 2004)




TABLE 1.2 COMPARISON OF CONSTITUENTS OF HUMAN

MILK AND COW’S MILK (EDMONDS , K. 2007)

Constituents Human milk Cow’s milk

Energy(Kcal/100ml) 75 66

Protein(g/100 ml) 1.1 3.5

Fat (g /100ml ) 4.5 3.7

Lactose(g /100ml) 6.8 4.9

Sodium (mmol/l) 7 2.2

Breast milk contains white blood cells, and a number of anti-infective

factors, which help to protect a baby against many infections. Breastfeeding

protects babies against diarrheal and respiratory illness and also ear infections,

meningitis and urinary tract infections. ( WHO , 2006)

WHO and UNICEF launched BABY FRIENDLY HOSPITAL

INITIATIVE in 1992 as part of global effort to protect, promote and support

breast feeding (Kulkarni R.N. et al 2004). To ensure the practice of breast

feeding, “TEN STEPS TO SUCCESSFUL BREAST FEEDING” was

launched. .

The results of a study conducted by Shailaja K.G. (2008) showed that

19 % of mothers had poor knowledge, and only 15.45% had good knowledge




regarding exclusive breast feeding. 34.54% mothers are confident in

breastfeeding their infants and 21.81% were not at all confident to feed their

babies. And also there is significant association between knowledge and

confidence of mothers.

From the beginning of human race breast feeding is practiced. Many

mothers especially first time mothers are not having enough knowledge

regarding importance and right way of practicing breast feeding. In modern

world women are running back of newer trends. Many breast milk substitutes

are available in market. Mothers think that this is sufficient for their baby.

Many mothers are not willing to breastfeed their baby as it may affect their

figure.

The theme of the year 2011, World Breastfeeding Week, which is an

initiative of the World Alliance for Breastfeeding Action, is “Talk to Me!

Breast feeding – a 3D Experience.” It emphasizes the importance of

communication at various levels and between various sectors to promote

breastfeeding. This highlights the opportunity of new communication

technologies for making qualified support accessible to health care providers,

mothers and families. ( WHO news centre ,2011)

In order to increase the rate of exclusive breastfeeding among infants, at least

up to six months of age, family members need to be helped and encouraged by

health professionals including health councellors . baby friendly hospital have




recognized that constant encouragement is ssential for lactating mothers to

breastfed successfully. (Chopra, S.,& Walia, I.,2008)

No child should be denied the benefits of exclusive breast feeding due to

the lack of information to mother. Mothers’ lack of knowledge and experience

often result in difficulties in feeding especially when feeding first time and it

may resulting in most frustrating experience for the mothers . Mothers should

be motivated for feeding their child exclusively with breast milk for first 6

months

Lack of knowledge often result in inadequate exclusive breastfeeding

especially in first time mothers .Mothers of all background need guidance and

support to successfully breastfeed . All mothers should be motivated and

educated during pregnancy so that they do not face any difficulties

During the investigator’s clinical experience primi mothers expressed their

lack of knowledge regarding exclusive breastfeeding .The investigator feel

that a self instructional module will provide more specific information to primi

mothers regarding exclusive breastfeeding. Hence the investigator felt the need

to do this study to improve the knowledge of primi mothers.

1.4 THEORETICAL FRAME WORK

Conceptual frame work is the overall conceptual underpinnings of the

study. Conceptual models gives a prospective regarding interrelated

phenomena but closely structured. It broadly presents an understanding of the




phenomena of interest and reflects the assumptions and philosophical views of

a researcher. (Polit , D.F., & Beck, C .T., 2011) The conceptual frame work

chosen for this study was derived from Health Promotion Model by Nola. J.

Pender (1996). According to him health promotion model in its current form ,

identifies cognitive perceptual factors in the individual that are modified by

situational, personal and interpersonal characteristics resulting in participation

of health promoting behaviors in the presence of cues of action It defines as a

positive dynamic state , not merely the absence of disease. The HPM identifies

cognitive and perceptual factors as major determinants of health promoting

behavior

The model focuses on the following three major areas of determinants of health

promoting activities

1. The cognitive perceptual factors ( Individual perception)

2. Modifying factors ( demographic and social factors)

3. Participation in health promoting behaviors ( likelihood of action ,

negative and positive behaviors)

4.

The cognitive perceptual factors

The five cognitive factors important to health are perception of health,

perception of self efficiency, perception about benefits of health, perceived

barriers of health promoting behavior.




In the present study cognitive and perceptual factors refers to knowledge of

primi mothers regarding exclusive breastfeeding, this cognitive factor is

influenced by their perception about health of the mother and baby, perception

regarding self efficiency through self awareness to breastfeed the baby

exclusively, perception about benefits of heath by feeding the baby, the barriers

to take health promoting behaviors such as ignorance, misconceptions and

cultural influences

Modifying factors

Health Promotion Model is focused on four modifying factors which are

demographic factors, interpersonal influences, situational factors, behavioral

factors. In the present study, the demographic factors are age, religion,

education, employment, monthly income, type of family, place of residence,

obstetrical score, previous information, and source of information which

influence likelihood of taking action.

Biological characteristics include ignorance of primi mothers about

exclusive breastfeeding. Interpersonal influences refer to lack of information

from family, relatives, health personnel, media, and friends. Situational

characteristics include lack of attention. A behavioral factor refers to mother’s

supernatural beliefs and cultural practices about feeding the baby.

Likelihood of health promoting behavior

Participation in health promoting behavior in the health promotional model

signifies variable affecting the likelihood of action depending on internal and




external cues such as health messages, well being of mother and baby. In the

present study it refers to use of available health resources to improve the health

status of the mother and infant.

1.5 STATEMENT OF THE PROBLEM

Descriptive study to assess the knowledge regarding exclusive breastfeeding

among primi gravida and primi para mothers in a selected hospital of

Alappuzha District.

1.6 OPERATIONAL DEFINITIONS

Exclusive breast feeding: Exclusive breastfeeding means giving a baby only

breast milk, and no other liquids or solids, not even water

Primi gravida mothers: A woman who is pregnant for the first time

Primi para mothers: A woman who has given birth to only one living child

1.7 OBJECITIVES

1. To assess the level of knowledge regarding exclusive breastfeeding

among primi gravida and primi para mothers

2. To find out the association between knowledge regarding exclusive

breastfeeding and selected demographic variables.

3. To prepare a self instructional module on exclusive breastfeeding

4. To compare the knowledge of exclusive breast feeding between primi

gravida and primi para mothers




1.8 HYPOTHESIS

H 1 --There will be significant association between knowledge of primi

gravida and primi para mothers and selected demographic variables

H2 -- There will be significant difference in knowledge regarding exclusive

breastfeeding between primi gravida and primi para mothers

1.9 RESEARCH METHODOLOGY

Research design: Descriptive survey design

Setting: Women and Child Hospital, Alappuzha

Population: Primi gravida and primi para mothers

Sample: Primi gravida and primi para mothers admitted in Women and Child

Hospital, Alappuzha

Sample size: 180

Sampling technique: Convenience sampling

Tool for data collection : Structured interview schedule

1.10 LIMITATIONS

1. This study is limited to primi mothers only

2. The study is limited to those who are admitted in the antenatal and

postnatal wards of Women and Child Hospital, Alappuzha during the

time of data collection




1.11 FORMAT OF THE REPORT

The report is presented in 5 chapters, the details being as follows

Chapter I - This chapter contains background of the problem, need and

significance of the study, theoretical frame work, statement of the problem,

operational definitions, objectives of the study, hypothesis, brief discussion of

methodology , limitations of the study and format of the report

Chapter II - - Presents review of literature

Chapter III -- Deals with the research methodology, which contains research

design, setting, population, sample and sampling technique, duration of the

study, tool and technique used for data collection validity and reliability, pilot

study, data collection process and plan for data analysis.

Chapter IV -- Presents the analysis and interpretation of data.

Chapter V -- Contains the summary, discussion, conclusion, nursing

implications and recommendations for future research.




CHAPTER II

REVIEW OF LITERATURE

CONTENT PAGE No.

2.1 Introduction

2.2 Section 1: Breast feeding

2.3 Section 2: Exclusive breast feeding

2.4 Section 3: Baby friendly hospital initiatives

2.5 Section 4: Knowledge of mothers regarding exclusive breast

feeding




2.1 INTRODUCTION

Review of literature is an important step in the course of a research

study. The review of literature is the systematic review of literatures relevant to

the field of study It involves the systematic identification, location, scrutiny

and summary of written material that contains information on a research

problem (Polit D.F., & Beck, C .T., 2011)

The review provides a basis for future investigation, justifies the need

for data collection, and relates the findings from one study to another with the

hope to establish a comprehensive body of scientific knowledge in a

professional discipline, from which valid and pertinent theories may be

developed. A review of related research and non-research literature was done

by the investigator to gain in depth knowledge of the selected problem under

study. This chapter helps to provide clearer and broader sense about the

problem

In the present study, the literature is presented as

SECTION 1 --Breastfeeding

SECTION 2--Exclusive Breast Feeding

SECTION 3-- Baby Friendly Hospital Initiative

SECTION 4--Knowledge of mothers regarding Exclusive Breast

Feeding




2.2 SECTION 1: BREAST FEEDING

Infants and children have been breastfed since the dawn of mankind. Method

of feeding is one of the most important choices parents or other caregivers must

make for their newborn. Many factors influence the decision about infants

nutrition, including the attitudes of the primary caregivers and significant

others, health care professionals, the media and personal values and

choices.(Orshan ,S.A.,2007)

Breastfeeding is as old as human being. Breast milk is accepted as the

unique nutritive food provided by the nature to the newborn. It is universally

acknowledged as the best and complete food for infants including sick and

preterm as it fulfills their specific nutritional needs. ( Kaur,L. et al, 2008)

Human breast milk is the ideal infant food choice. It is bacteriologically

safe, fresh, readily available and balanced to meet infants needs (Ward, S .L. &

Hisley S.M., 2010. )

Breast milk is species –specific for human infants and offers many

advantages over formula. The nutrients in breast milk are proportioned

approximately for the newborn and vary to meet the newborn’s changing

needs. Breast milk provides protection against infection and is easily digested.

Maternal immunoglobulins, anti oxidants, enzymes and hormone important for

growth are present in breast milk (Mckinney ,E.S. etal, 2009)




Human milk contains an abundance of factors that are active against

infection. Breast fed infants, compared with formula fed infants, produce

enhanced immune responses to polio, tetanus, diphtheria, and Hemophilus

influenza immunizations,. Human milk contains anti inflammatory factors and

other factors that regulate the response of the immune system against infection.

It is strongest when the baby is exclusively breast fed. Breastfeeding has

several positive hormonal, physiological, and psychosocial effects on mother.

Breast feeding increases the level of oxytocin and helping to expel placenta,

minimize blood loss. Exclusive breastfeeding delays resumption of ovarian

cycle. There are many psychological benefits such as increased self confidence

and facilitating bonding with infants. (Biancuzzo, M ., 2003)

Colostrum is the first milk and the best start in newborn life. It is an

ideal, inimitable, specific food and anchor of nutrition for the newborn life in

early months (Swain,D., 2010)

Colostrum is concentrated with protein that is suitable for early rapid

growth and development of a new born. Colostrum contains approximately

67 kcal/dl. Compared with mature milk colostrum is richer in sodium,

potassium, chloride, protein, fat-soluble vitamins and minerals. It contains less

fat (2%) and lactose than mature milk. Colostrum contains balanced fatty acids

needed for the newborn (Lauwers, J., &Swisher, A., 2005.)

A high proportion of Jordanian women (58.3%) did breastfeeding for

more than one year. ( Khassawneh,M. et al ,2006)




A cohort study on infant feeding practice in city, suburban, and rural

areas in Zhejiang province, China showed that breastfeeding was high in

China. But the rate of exclusive breastfeeding were about 38%,63.4%,61% in

city, sub rural, rural respectively. (Qiu, L., 2008)

A study conducted to assess the determinants of breastfeeding initiation

among mothers in Kuwait revealed that total 92.5% of mothers initiated

breastfeeding early ,but only 10% of infants have exclusively breastfed since

birth, the remained infants received either pre lacteal or supplementary infant

formula feeds. ( Dashti, M., 2010)

Exclusive breastfeeding (EBF) is reported to be a life-saving

intervention in low-income settings. The effect of breastfeeding counseling by

peer counselors was assessed in Africa. Low-intensity individual breastfeeding

peer counseling is achievable and, although it does not affect the diarrhea

prevalence, can be used to effectively increase EBF prevalence in many sub-

Saharan African settings. (Tylleskar, T., 2011)

The percentage of exclusively breastfed children for 6 months in India is

46% in 2003-2008. (UNICEF , 2010)

A study was conducted to analyze the breastfeeding practices in India.

The mean duration of exclusive breastfeeding in India was found 3.31 months

while it was found almost 4.15 months in low infant mortality states in

southern India compared to 1.5 months in high infant mortality states in

northern India. The analysis showed that no maternal education, being an


http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Thorkild+Tyllesk%C3%A4r



unemployed mother and Muslims were associated with early cessation of

exclusive breastfeeding. (Kansal, S., 2011)

Mothers who are breast feeding for the first time may feel an initial

awkwardness in trying to get comfortable while the body settles on to breast

(Lauwers,J .,& Swisher, A .,2005)

A study was conducted to find out the determinants of exclusive

breastfeeding in urban slums of Gwalior, India. The actual rate of exclusive

breast feeding up to the age of 6 months is dismally low in urban slums of

India. Only 3.8% of mother knew that exclusive breastfeeding is to be done

till six months and 7.8 % were actually practicing exclusive breastfeeding.

63.8 % of new born were given pre and post lacteal feed with 26.2% discarded

colostrums. (Tiwari, R., 2009)

Among the most consistently reported benefits of breastfeeding in

developed country settings have been higher results on IQ tests and other

measures of cognitive development among children and adults who had been

breastfed compared with those who were formula-fed. A custom randomized

trial was conducted among a total of 17,046 healthy breastfeeding infants in 31

Belarussian maternity hospitals and their affiliated polyclinics to assess

whether prolonged and exclusive breastfeeding improves children’s cognitive

ability at age 6.5 years. A Breastfeeding promotion intervention modeled on

the Baby-Friendly Hospital Initiative by the World Health Organization and

UNICEF was implemented. The experimental group had higher means on all of




the Wechsler Abbreviated Scales of Intelligence measures, with cluster-

adjusted mean difference of +7.5 for verbal IQ, +2.9 for performance IQ, and

+5.9 for full-scale IQ. Teachers' academic ratings were significantly higher in

the experimental group for both reading and writing. The experimental

intervention led to a large increase in exclusive breastfeeding at age 3 months

and a significantly higher prevalence of any breastfeeding at all ages up to and

including 12 months. ( Kramer,MS , et al. 2008)

Human milk ,in fact, a baby’s first immunization as the babies are born as

immunodeficient. (Abrahams S.W., & Labhok,M.H.,2009)

A study conducted to examine the associations of duration of exclusive

breastfeeding with infections in the upper respiratory (URTI), lower respiratory

(LRTI), and gastrointestinal tracts (GI) in infancy. Compared with never-

breastfed infants, those who were breastfed exclusively until the age of 4

months and partially thereafter had lower risks of infections in the URTI, LRTI,

and GI until the age of 6 months after birth. Infants who were exclusively

breastfed for 6 months have lower risk of lower respiratory tract and

gastrointestinal infections. Similar tendencies were observed for infants who

were exclusively breastfed for 6 months or longer. Partial breastfeeding, even

for 6 months, did not result in significantly lower risks of these infections.

( Duijts,J.etal, 2010)

A study reviewed the evidence on the effects of breastfeeding on short-

and long-term infant and maternal health outcomes in developed countries

reported that a history of breastfeeding is associated with a reduced risk of




many diseases in infants and mothers from developed countries ( Ip,M. et al .,

2005)

A study was conducted in Canada to estimate the duration of exclusive

breastfeeding shows that almost half of the women are exclusively

breastfeeding at 3 months while only 13.8% remain doing so at 6 months.

Results of present study constitute the basis for designing interventions

targeting policy makers and health professionals in order to bridge the gap

between the current practices of breastfeeding and the WHO recommendation.

Single, less educated and nulliparous mothers should constitute a focus of these

intervention programs. Finally, promoting exclusive breastfeeding rates for the

first months of life is highly warranted. (Al-Sahab, B. et al 2010)

Breastfeeding has a significant impact on women’s health .Oxytocin

released during breastfeeding contracts uterus and prevents postpartum

hemorrhage (Lauwers ,J.& Swisher, A. 2005)

A study done on 100,000 women from 14 states of American states, for

a period from 1993 to2005 to determine how many develop breast cancer. The

study found that women with family history of breast cancer were 59% less

likely to develop breast cancer if they breastfeed their children.

(Starbe ,A. 2010)

Breastfeeding currently solve 6 million lives every year preventing

diarrhea and acute respiratory tract infections .A breastfed child is 14 times less

likely to die from diarrhea, 4 times less likely to die from respiratory infections




and 2.5 times less likely to die from other infections compared to non breastfed

infants. Breastfeeding is an efficient contraceptive and responsible for 1/3rd of

the observed fertility suppression (Khassawneh,M. etal,2006)

The benefits of breastfeeding are extensive as they reach beyond the

infants and children in the community and the nation. Direct benefits to the

infant are the provision for their total nutritional requirement protecting them

against malnutrition, protection against bacterial infection and viral pathogens

preventing diarrhea and reduction of risk for morbidity and mortality. For the

mothers it contributes to birth spacing, helps in expulsion of placenta and saves

money as breast milk is provided from available resources of mother and

family. (UNICEF, 2005)

Breast milk contains immunoglobulins which support child’s immunity

and gives protection against allergic manifestations. It contains lactoferrin

which inhibits the growth of enterobacteria and high level of bifidus factor

protects from bacteria E.coli: these two prevent the child from diarrhea. Para –

amino-benzoic acid offers protection against malaria. Secreatory Ig A and

lysozyme gives protection against certain bacterial and viral infections

( Shailaja, U.,& Veena, K.H. 2009)

Breastfeeding contributes to the health and well-being of mothers; it

helps to space children, reduces the risk of ovarian cancer and breast cancer,

increases family and national resources, is a secure way of feeding and is safe

for the environment (WHO, 2007)




2.3 SECTION 2: EXCLUSIVE BREASTFEEDING

Exclusive breastfeeding is defined as no other food or drink, not even

water, except breast milk (including milk expressed or from a wet nurse) for 6

months of life, but allows the infant to receive ORS, drops and syrups

(vitamins, minerals and medicines). (WHO, 2007))American Academy of

Padiatrics (AAP) recommends that infants be breastfed exclusively for first six

months of life and breastfeeding continued for at least 24 months

Exclusive breast feeding as the infant receives only breast milk from

mother or a wet nurse or expressed breast milk and no other liquids or solids,

with the exception of drops or syrups consisting of vitamin and mineral

supplements or medicine. (Kumar, R. 2004)

A cohort study was conducted on Breastfeeding and Hospitalization for

Diarrheal and Respiratory Infection in United Kingdom. The study reveals that

seventy percent of infants were breastfed , 34% received breast milk for at least

4 months, and 1.2% was exclusively breastfed for at least 6 months. By 8

months of age, 12% of infants had been hospitalized (1.1% for diarrhea and

3.2% for lower respiratory tract infection). They suggest an estimated 53% of

diarrhea hospitalizations could have been prevented each month by exclusive

breastfeeding and 31% by partial breastfeeding. Similarly, 27% of lower

respiratory tract infection hospitalizations could have been prevented each

month by exclusive breastfeeding and 25% by partial breastfeeding. The

protective effect of breastfeeding for these outcomes wears off soon after




breastfeeding cessation. Breastfeeding, particularly when exclusive and

prolonged, protects against severe morbidity in contemporary United Kingdom.

A population-level increase in exclusive, prolonged breastfeeding would be of

considerable potential benefit for public health. (Quigley, M A.etal, 2007)

Feeding should be started within half an hour after normal delivery and

within four hours after caesarean section (Shailaja, U., & Veena, K.H. 2009)

Breastfeeding currently saves six million lives each year preventing

diarrhea and acute respiratory tract infections. A breastfed-child is 14 times

less likely to die from diarrhea, four times less likely to die from respiratory

disorder and 25 times less likely to die from other infections compared to non

breastfed infants ( Nayak,B.K., 2009)

Exclusive breastfeeding takes care of two essential element of newborn

care –nutrition and infection control. Exclusive breastfeeding should be

practiced for at least 6 months preferably in poor countries to prevent high risk

of infection through contaminated water and food (Kameswara Rao,A.A.,

2004)

It is estimated that around 35% of infants aged 0-6 months are

exclusively breastfed in the world today. But if all babies and young children

were breastfed exclusively for their first 6 months of life and then given

nutritious complementary food with continued breastfeeding up to two years of

age, the lives of an additional 1.5 million children under five years would be

saved every year. ( Mason ,E.,2010)




To accrue the maximum benefits, the breastfeeding must be exclusively

initiated within half an hour of birth. Recently National Family Welfare survey-

3 documented that only a quarter of infants who were ever breastfed started

breastfeeding within half an hour of birth. Exclusive breastfeeding rate is only

28%at 4-5 months of age. (Ghai,O.P.,2009)

A series of systematic reviews conducted to assess the effects of

breastfeeding on blood pressure, diabetes and related indicators, serum

cholesterol, overweight and obesity, and intellectual performance. Literature

searches were conducted at the World Health Organization in Geneva,

Switzerland, and at the University of Pelotas in Brazil, comprising the

MEDLINE (1966 to March 2006) and Scientific Citation Index databases.

Subjects who were breastfed experienced lower mean blood pressure.

Breastfed subjects presented lower mean total cholesterol in adulthood. The

prevalence of overweight/obesity and type-2 diabetes was lower among

breastfed subjects. Performance in intelligence tests was higher among those

subjects who had been breastfed. (WHO, 2007)

A systematic review commissioned by the WHO compared infant and

maternal outcomes for exclusive breastfeeding for 3–4 months versus 6

months. That review concluded that infants exclusively breastfed for 6 mo

experienced less morbidity from gastrointestinal infection and showed no

deficits in growth. ( Fewtrell,M.F.,2011)

A prospective study conducted on prevalence of exclusive breastfeeding

and its determinants in first 6 months of life, showed that prevalence of




exclusive breastfeeding reported at 3 months was 97% which declined to 62%

by 6 months of age. (Chudasama R.K., & Amin, C.D. ,2009)

A meta analysis of observational studies showed that a longer duration

of breastfeeding is associated with a larger decrease in risk of overweight. The

risk of overweight was reduced by 4 percent for each month of breastfeeding.

This effect lasted up to a duration of breastfeeding of 9 months and was

independent of the definition of overweight and age at follow-up

( Harder, T.etal. 2005)

A study assessed the effects on child health, growth, and development,

and on maternal health, of exclusive breastfeeding for six months versus

exclusive breastfeeding for three to four months with mixed breastfeeding.

Infants who are exclusively breastfed for six months experience less morbidity

from gastrointestinal infection than those who are mixed breastfed as of three

or four months, and no deficits have been demonstrated in growth among

infants from either developing or developed countries who are exclusively

breastfed for six months or longer. Moreover, the mothers of such infants have

more prolonged lactational amenorrhea. Although infants should still be

managed individually so that insufficient growth or other adverse outcomes are

not ignored and appropriate interventions are provided, the available evidence

demonstrates no apparent risks in recommending, as a general policy, exclusive

breastfeeding for the first six months of life in both developing and developed-

country settings. (Kramer, M.S., & Kakuma, R. 2007)




The influence of certain factors on the duration of exclusive

breastfeeding during first 6 months of life the rates are at discharge –97% 1

month -83%, 4 months – 56%, 6 months -19%. The median duration of

exclusive breastfeeding was found to be 4 months. A longer duration is

influenced by positive maternal attitudes, adequate family support, good

mother-infant bonding, appropriate sucking technique and no nipple problems.

( Cernadas,J.M.C.et al, 2004)

An estimated 13 per cent of the roughly 10 million under-five deaths,

which occur in the 42 countries that account for 90 per cent of child deaths

worldwide, could be prevented through exclusive breastfeeding in the first six

months (Innocenti Domini Decleration, 2005)

A study conducted to determine the prevalence of exclusive

breastfeeding during the first six months of life and its determinant factors on

the referring children to the health centers in Mashhad, Northeast of Iran. The

exclusive breastfeeding was defined as feeding the children with just breast

milk. All variables were presented as numbers with percentage and statistical

analysis was performed with the Strata 8.0. The 87.4% of mothers have

intended in the study. The prevalence of exclusive breastfeeding was 56.4%.

The 91.7% of the studying infants were fed by their mother milk soon after

being born. In the polygamous logistic regression model, the mother’s age, the

mother’s information of milk adequacy and the relatives’ suggestion to

consume baby formula were the elements which had significant relation with

the breastfeeding during the first six months. Almost, 43% of children had




some substitutions like family foods or baby formula instead of their exclusive

breastfeeding until 6th month (Vafaee, A.etal,2007)

2.4 SECTION 3 : BABY FRIENDLY HOSPITAL INITIATIVE

World Breastfeeding Week (WBW) is celebrated from 1st - 7th August

in more than 120 countries each year. Over the years, the initiatives of WBW

have strived to improve the rate of breastfeeding by stepping up awareness

about the importance of breast milk for the overall well-being of the child and

the mother. More importantly, this is an opportune time every year to dispel

overriding myths which are a deterrent to breastfeeding.

The Baby-friendly Hospital Initiative (BFHI) is a global effort launched

by WHO and UNICEF to implement practices that protect, promote and

support breastfeeding. It was launched in 1992 in response to the Innocenti

Declaration. The global BFHI materials have been revised, updated and

expanded for integrated care. The BFHI has been implemented in about 16,000

hospitals in 171 countries and it has contributed to improving the establishment

of exclusive breastfeeding worldwide. The foundation of the BFHI are TEN

STEPS TO SUCCESSFUL BREAST FEEDING described in protecting,

promoting , and supporting breast feeding ( WHO, 2007)

The hospital with maternity services, have to follow the ten steps to

successful breastfeeding. These hospitals are assessed and certified as baby

friendly (BF) if they adopt the “Ten Steps” and follow these practices. BFHI is


http://scialert.net/asci/author.php?author=A.&last=Vafaee



progressing in the country and about 1300 hospitals have been declared as

Baby Friendly.

A study was conducted regarding the implementation of baby friendly

hospital initiative policy in Newzeland shows that when the Baby Friendly

Hospital Initiative (BFHI) is implemented breastfeeding rates increases.

(Moore,T. etal ,2007)

A baby friendly hospital environment saves the lives of 3000 babies

each day and cost nothing except mother’s time and will (Bhamal,S.S., 2005)

A national survey was conducted to estimate the Breastfeeding Rates in

US Baby-Friendly Hospitals in 2001. US Baby-Friendly hospitals had

breastfeeding rates above state, regional, and national rates, and these rates

were consistently elevated in a variety of settings. Breastfeeding initiation rates

were not associated with the size of the institution, were above average in

regions with low breastfeeding rates, and remained high among populations

who do not traditionally breastfeed. ( Merewood, A. ,2006)

The impact of baby friendly hospital initiative on trends of exclusive

breast feeding was explored the investigators reported that BFHI

implementation was associated with a significant annual increase in rates of

exclusive breastfeeding in the countries under study. ( Abrahams , S .W., &

Lababok, M. H. 2009)




Exclusive breastfeeding rates at 6 months of age is 27.7%.Out of 566

hospitals across country 466 hospitals are accredited as baby friendly hospitals

covering 80% births in 2006.( Olang, B. 2009)

An interview based cross sectional study conducted in two of the

designated Baby Friendly Hospitals of Indore in the year 2008. None of the

hospitals were having a written breastfeeding policy, which is routinely

communicated to all the health workers and no regular training regarding the

program was being imparted. There is a need to develop a BFHI Monitoring

System to ensure that the status is kept in check. Training regarding essential

Criteria of BFHI should be there for all the staff. (Nigam, R. etal , 2010)

The BFHI has been implemented in about 16.000 hospitals in 171

countries and it has contributed to improving the establishment of exclusive

breastfeeding world-wide. While improved maternity services help to increase

the initiation of exclusive breastfeeding, support throughout the health system

is required to help mothers sustain exclusive breastfeeding.

A study was conducted to find out the effect of baby friendly hospital

initiative on long term breast feeding .The results revealed that BFHI increases

the duration of breastfeeding 1.5 times (Camundran,D. A., 2007)




2.5. SECTION 4: KNOWLEDGE OF MOTHERS REGARDING

EXCLUSIVE BREAST FEEDING

Mothers who are breast feeding for the first time may feel an initial

awkwardness in trying to get comfortable while the body settles on to breast

(Lauwers,J., & Swisher,A., 2005)

The study to assess the knowledge and practice regarding colostrums

feeding concluded that the level of knowledge of postnatal mothers showed

more than half (58%) of the sample has good knowledge ( Swain,D., 2010)

In a study conducted to assess the knowledge of mothers regarding

exclusive breast feeding 15.45% of mothers had good knowledge, 19% of

mothers had poor knowledge of exclusive breastfeeding in Karnataka.

(Shailaja, K.G., 2008)

A cross sectional study conducted in five different villages of North

Jordan in order to assess the knowledge, attitude and practice of breastfeeding.

The result of the study revealed that 58.3% was fully breastfed , mixed feeding

in 30.3% , formula feeding in 11.4%. Employed women were not practiced full

breast feeding compared to unemployed women. Regarding women’s

knowledge, they consider three months breastfeeding is long enough for the

baby. ( Khassawneh, M,etal, 2006)

A study to assess knowledge, attitude and practices of mothers

regarding breastfeeding in selected urban and rural communities of Ludhiyana,




Punjab. Findings of relationship between knowledge, attitude and practice

reveal that rural mothers can have a positive attitude regarding breastfeeding if

their knowledge is increased regarding breastfeeding. (Kaur, B., 2011)

A mother’s role in the development of her child is immense, much more

than words can describe. Perhaps the first and most significant step in this

direction is breastfeeding, a guarantee for lifelong health.




CHAPTER III

METHODOLOGY

CONTENT PAGE No.

3.1 Introduction

3.2 Research design

3.3 Setting

3.4 Population

3.5 Sample and sampling technique

3.6 Duration of the study

3.7 Tool and technique

3.8 Pilot study

3.9 Data collection process

3.10 Plan for data analysis




3.1 INTRODUCTION

Research methodology is a way to systematically solve the problem.

Methodology may be understood as a science of studying how research is done

scientifically. In methodology, the various steps that are generally adopted by

the researcher in studying the problem is described along with the logic behind

using them. (C.R Kothari, 2004)

This chapter has many dimensions and research method is only a part of it. The

methodology explains why a research study has been under taken, what data

have been collected and what particular method have been adopted , why

particular technique is used to analyze the data .

This chapter deals with methodology of the study to assess the knowledge of

mothers regarding exclusive breastfeeding

3.2 RESEARCH DESIGN

Research design is the overall plan for addressing a research question,

including specification for enhancing integrity of the study (Polit,D.F., &

Beck ,C.T., 2010)

In this study descriptive survey design was adopted. Descriptive design helped

to gain more information about characteristics within a particular field of study.

Descriptive survey describes the phenomenon objectively. It measures

variables by asking questions to people and examines the relationship among




the variables. It provides a precise measurement or description of phenomenon

within a single group. (Nirmala ,V.J.et al , 2011)

In the present study the investigator conducted a survey with the help of a

structured interview schedule.

The study had two phases

Phase I: The investigator conducted a structure interview. The mothers were

interviewed and knowledge regarding exclusive breastfeeding is assessed.

Phase II: A self instructional module on exclusive breastfeeding was given to

the mothers to enhance their knowledge.

3.3 SETTING OF THE STUDY

The study was planned to be conducted in Women and Child Hospital,

Alappuzha. It is the only maternity hospital under Government of Kerala in

Alappuzha Dist. The hospital renders all necessary maternity services under

Directorate of health services. This hospital is a reputed institution where

nearly 350 deliveries and above 500 admissions per month. The hospital is the

main centre for maternity services in the district of Alappuzha. The total bed

strength of the hospital was 350. The samples were collected from antenatal

and postnatal wards of the Hospital. The average number of admission in the

month of April is nearly 380. This hospital was selected for the study because

of its geographical proximity, feasibility to conduct the study and availability

of sample.




3.4 POPULATION

Population is the entire aggregate of cases in which researcher is interested

Population is the total number of cases who met the criteria that the researcher

has established for the study, from whom subjects will be selected and to

whom the findings will be generalized ( Polit D.F., & BeckC.T., 2010)

In this study, population was all primi gravida and primi para mothers who

were admitted in Women and Child Hospital, Alappuzha

3.5 SAMPLE AND SAMPLING TECHNIQUE

A sample is a finite part of a statistical population whose properties are

studied to gain information about whole population. (Nirmala V.J.etal, 2011).

A sample is a subject of population selected to participate in a research study

( Polit,D.F., &Beck C.T., 2010)

In the present study, 180 primi gravida and primi para mothers who

meet the inclusion criteria and admitted in maternity wards of Women and

Child Hospital, Alappuzha were selected as sample

Sampling is a process of selecting a portion to represent the entire

population (Polit,D.F., & Beck,C.T.,2010). Sampling technique of the study

was convenience sampling. Convenience sampling entails using the most

conveniently available people as participants.




Inclusion criteria

1. Pregnant women in third trimester

2. Women in first 3 days of postpartum period

Exclusion criteria

1. Multiparous woman

2. Mothers who were not willing to participate

3. Mothers who were seriously ill.

3.6 DURATION OF THE STUDY

The plan of data collection begins after a research problem has

been defined and research design or plan chalked out (Kothari, C.R., 2009).

Research proposal and data collection tool was presented before the

Institutional ethical committee. After making corrections suggested by the

ethical committee, the investigator got the ethical clearance from the

Institutional ethical committee for data collection. With written permission

from the concerned authority of college and the medical Superintendent of

W & C Hospital, Alappuzha prior to the data collection, the data was

collected for a period extending from May 15th 2011 to June 30th 2011 at

antenatal and postnatal wards of W & C Hospital Alappuzha .

3.7 TOOL AND TECHNIQUE

Tools are the instruments used by the investigator to collect required data. The

tool was prepared to meet the objectives of the study. The investigator selected




a structured interview schedule on assessing the knowledge regarding exclusive

breastfeeding for collecting information from the mother.

Structured interview schedule was developed for this study has 2 sections.

Section A : Socio -demographic data consists of 10 items which reveals the

basis information. Age, religion, education, employment, type of family,

monthly income, place of residence, obstetrical score, previous information,

source of information etc are included for finding out association of these with

knowledge of mothers

Section B: includes 24 items that assess knowledge regarding Exclusive

breastfeeding, Colostrum, Advantages of breastfeeding, Positions of

breastfeeding, Burping, Contraindications, and Baby Friendly Hospital

Initiatives.

Total score for the questionnaire is 35. The investigator scores the answer

given by the mothers.

The directions for interpretation of the score is given below

Below 50% Poor

51-75 % Average

76-100% Good




A self instructional module exclusive breastfeeding had

prepared which was administered to all the mothers who participated in the

study

3.7.1 VALIDITY AND RELIABILITY

Validity is the ability of an instrument to produce information that the

researcher intended to measure and ensure that the information collected is

relevant to the research question. A tool should measure what it suppose to

measure what it suppose to measure ( Polit & Beck,2010)

The prepared instrument along with the objectives, criteria rating scale was

submitted to 3 experts in the field of Obstetrics and Gynecology nursing and

medical practice. The opinion is marked as relevant, not relevant, needs

modification. They gave their valuable suggestions .The tool was modified as

per their suggestions.

Self instructional module was validated on the basis of criteria checklist by

assessing the appropriateness of content selection, organization of content,

language, visual images and usefulness to primi mothers

Reliability is defined as the extent to which the instrument yields the

same results on repeated measures. It is concerned with consistency, accuracy,

stability and homogenecity (Polit, D.F., & Beck C.T., 2011)

A split-half method was used to measure the internal consistency of the

structured interview schedule. The reliability of the tool was found out by using




Spearman Brown Prophecy Formula and it was found to be 0.93, which

indicated that the tool was highly reliable.

3.8 PILOT STUDY

Pilot study is a miniature of the main study ( Polit,D.F., & Beck,C.T.,2010).

The main aim of the conducting pilot study was to assess the feasibility, and

practicability of the tool.

The investigator conducted the pilot study in Women and Child

Hospital, Alappuzha from 1st May to 3rd May, 2011. The sample size for pilot

study was 18. A written permission was obtained from medical superintendent

of Women &Child Hospital, Alappuzha

The purpose of the study was explained to the subjects prior to the study

to obtain their co-operation, after which the tool was administered

The result of pilot shows that most of the mothers that is 66.7%, had

poor knowledge 33.3% of the samples had average knowledge, no one had

good knowledge.

More than half, 55.6% of the samples were Hindus, a similar

percentage that is 22.2 % were Christians and Muslims.

44.4% were educated up to higher secondary, 33.3% were graduates,

16.7 % were studied lower secondary and 5.5% were post graduates.

Most of the samples, 72.2% were housewives, a similar percentages that

is 5.5% were labourers, and private employee and 16.7% were others.




More than half of the samples, 55.6% were belongs to nuclear family

and 44.4% were belongs to joint family.

Majority that is 83.3% had the income less than Rs. 2500 and 16.7%

were in the income group of Rs. 2501-5500.

More than half, 55. 6% of the samples were belongs to municipality and

44.4% were from panchayath .

More than half 55. 6% of the samples were primi gravida mothers and

44.4% were primi para mothers.

Most of the samples,83.3% had previous information regarding

exclusive breastfeeding and 16.7% had no previous information regarding

exclusive breastfeeding.

53.3% of the samples had family as source of information, 20 % had

gained information from medias, 13.3 % gained information from all the

four sources and also from health workers.

Some difficulties were encountered during pilot study. There was a

tendency to skip the questions. Some questions in the interview schedule had

confusions. Corrections were done.

3.8 DATA COLLECTION PROCESS

Data collection is done from 15.5.2011 to 30.6.2011 in Women and

Child Hospital, Alappuzha. On a daily basis, the investigator visited antenatal

and postnatal wards from 8 am to 6 pm .The investigator introduced her to the

subjects and obtained their co-operation. A written informed consent was




obtained from the mothers after assuring the confidentiality. The structured

interview schedule was administered after giving the necessary instruction to

the individual subjects at the bedside. The data was collected from 10 am to 4

pm in all week days. The average number of samples interviewed a day is 7-8.

The investigator took nearly 20-30 minutes for an interview. The investigator

was satisfied and impressed by the co-operation, interest and appreciation from

the mothers.

3.10 PLAN FOR DATA ANALYSIS

1. Demographic data would be analyzed in terms of frequency and

percentage distribution and presented as tables and figures

2. Knowledge level was assessed by calculating the percentage of

correct responses.

3. The association between knowledge and selected variables were

analyzed by the chi-square test.

4. Knowledge level of primi gravida and primi para mothers were

compared using unpaired t test.




CHAPTER IV

ANALYSIS AND INTERPRETATION OF DATA

CONTENT PAGE No.

4.1 Introduction

4.2 Organization of findings

4.3 Frequency distribution of demographic variables

4.4 Level of knowledge

4.5 Overall assessment of knowledge score

4.6 Area wise analysis of knowledge

4.7 Association of knowledge with selected demographic

variables

4.8 Comparison of knowledge between primi gravida and

primipara mothers

4.9 Summary




4.1 INTRODUCTION

This chapter deals with analysis and interpretation of the data collected

to assess the knowledge regarding exclusive breastfeeding which is collected

using a structured interview schedule. Analysis of the data can be defined as

the systematic organization and synthesis of research and the testing of

research hypothesis using those data.

The analysis and interpretation of this study was based on the data

collected through structured interview schedule, of 180 primi mothers

admitted in Women and children hospital, Alappuzha.

The data can be analyzed and interpreted on the basis of objectives of

the study using descriptive and inferential statistics (chi square test, t test).

The following are the objectives of the present study

1. To assess the knowledge regarding exclusive breastfeeding among

primi gravida and primi para mothers









Hypothesis

H1— There is significant association between knowledge of primi gravida

and primi para mothers and selected demographic variables

H2—There is significant difference in knowledge among primi gravida

and primi para mothers.

4.2. ORGANISATION OF FINDINGS

The data collected is organized and presented under the following headings

Section 1--Frequency distribution of demographic variables

Section 2-- Level of knowledge of primi gravida and primi para mothers

regarding exclusive breastfeeding.

Section 3 -- Overall analysis of knowledge score

Section 4-- Area wise analysis regarding exclusive breast feeding

Section 5-- Association of selected demographic variables with knowledge

level of mothers regarding exclusive breastfeeding

Section 6--Comparison of knowledge of exclusive breastfeeding between

primi gravid and primi para mothers




4.3. SECTION 1 — FREQUENCY DISTRIBUTION OF

DEMOGRAPHIC VARIABLES

The 180 samples collected through purposive sampling based on inclusion

criteria. The data obtained are analyzed using descriptive statistics. In this

section the data on socio demographic characteristics of primi mothers are

presented. The socio demographic variables includes age, religion, education,

employment, monthly income, type of family , place of residence, obstetrical

score previous information, and source of information




TABLE 4. 1: DISTRIBUTION OF SAMPLES BY AGE IN YEARS

N=180

Age Frequency Percentage (%)

< 20 25 13.9

21-25 115 63.9

26-30 31 17.2

> 31 9 5.0

Total 180 100

Table4. 1 shows most of the samples that is 63.9% were between the age group

of 21-25yrs, 17.2% were between 26-30yrs, 13.9% were less than 20 yrs and

5% were more than 31 yrs

Figure 4.1 : Column diagram showing distribution of samples by age

13.9 %

63.9%

17.2%

5%

0

10

20

30

40

50

60

70

< 20 21-25 26-30 > 31

Per

cen

tage

Age




TABLE 4.2 : DISTRIBUTION OF SAMPLES BY RELIGION

N=180

Religion Frequency Percentage (%)

Christian 40 22.2

Hindu 92 51.1

Muslim 48 26.7

Total 180 100

Table4. 2 shows that 51.1% of samples were Hindus, 26.7% of them were

Muslims and 22.2% were Christian.

Figure4. 2 : Column diagram showing distribution of samples by

Religion

0

10

20

30

40

50

60

Christian Hindu Muslim

22.2%

51.1%

26.7%

Per

cen

tage

Religion




TABLE4. 3 : DISTRIBUTION OF SAMPLES BY EDUCATION

N=180

Education Frequency Percentage (%)

Lower secondary 57 31.7

Higher Secondary 70 38.9

Graduate 51 28.3

Post graduate 2 1.1

Total 180 100

Table 4. 3 shows 38.9% of the samples were educated up to higher secondary,

31.7% of samples were studied lower secondary, 28.3% were graduates, and

only 1.1% were postgraduates.

Figure4. 3 : Doughnut diagram showing distribution of samples by

education

31.7%

38.9%

28.3%

1%

Lower secondary

Higher Secondary

Graduate

Post graduate




TABLE4. 4: DISTRIBUTION OF SAMPLES BY EMPLOYMENT

N=180

Employment Frequency Percentage (%)

House wife 149 82.8

Labourer 2 1.1

Govt. employee 5 2.8

Private employee 17 9.4

Others 7 3.9

Table 4.4shows that most of the samples that is 82.8% were house

wives,9.4% of them were private employees, 3.9% of samples were other

employees,2.8% of them were Govt. employees, and 1.1% were labourer

Figure 4. 4: Cone diagram showing distribution of samples by

employment

0

10

20

30

40

50

60

70

80

90

House wife Labourer Govt.employee

Privateemployee

Others

82.8%

1.1% 2.8%9.4%

3.9%

Per

cen

tage

Employment




TABLE4. 5 :DISTRIBUTION OF SAMPLES BY TYPE OF

FAMILY

N=180

Type of Family Frequency Percentage ( %)

Joint family 100 55.6

Nuclear family 79 43.9

Others 1 0.6

Total 180 100.0

Table 4. 5 shows 55.6% belongs to joint family,43.9% belongs to nuclear

family, and 6% belongs to others.

Figure 4. 5 : Column diagram showing distribution of samples by

Type of Family

55.6%

43.9%

0.6%0

10

20

30

40

50

60

Joint family Nuclear family Others

Per

cen

tage

Type of family




TABLE 4.6 : DISTRIBUTION OF SAMPLES BY MONTHLY

INCOME

N=180

Monthly Income( Rs) Frequency Percentage (%)

<2500 133 73.9

2501-5500 25 13.9

5501-12000 20 11.1

>12001 2 1.1

Total 180 100

Table 4.6. represents that most of the samples that is 73.9% were belongs to

the income group of Rs. < 2500, 13.9% had monthly income between Rs.

2501-5500, 11.1% had monthly income between Rs. 5501-12000 and only

1.1% had income more than 12001

Figure 4.6 : Column diagram showing distribution of samples by

Monthly Income

73.9%

13.9% 11.1%

1.1%0

10

20

30

40

50

60

70

80

<2500 2501-5500 5501-12000 >12001

Per

cen

tage

Monthly Income




TABLE 4.7 : DISTRIBUTION OF SAMPLES BY PLACE OF

RESIDENCE

N=180

Place of residence Frequency Percentage (%)

Panchayath 124 68.9

Municipality 55 30.6

Corporation 1 .6

Total 180 100.0

Table 4.7 revels that more than half of the samples that is 68.9% were from

Panchayath , 30.6% from municipality and only 0.6% of them were from

corporation.

Figure 4.7 : Cone diagram showing Frequency distribution of

samples by Place of Residence

0

10

20

30

40

50

60

70

Panchayath Municipality Corporation

68.9%

30.6%

0.6%

Pe

rce

nta

ge

Plac of residence




TABLE 4.8. DISTRIBUTION OF SAMPLES BY OBSTETRICAL

SCORE

N=180

Obstetrical score Frequency Percentage (%)

Primi gravida 107 59.4

Primi para 73 40.6

Total 180 100

Table 4.8 shows that 59.4% of the samples were primi gravida mothers and


Figure4.8: Pie diagram showing distribution of samples by

obstetrical score

59.4%

40.6%

Primi gravida

Primi para




TABLE4.9: DISTRIBUTION OF SAMPLES BY PREVIOUS

KNOWLEDGE

N=180

Previous knowledge Frequency Percent

Yes 88 48.9

No 92 51.1

Total 180 100.0

Table4.9 shows that 51.1% of the samples had no previous information

regarding exclusive breastfeeding and 48.9% got previous information.

Figure 4.9: Cone diagram showing distribution of samples by

Previous Knowledge

47.5

48

48.5

49

49.5

50

50.5

51

51.5

Yes No

48.9%

51.1%

Per

cen

tage

Previous information




TABLE4. 10: DISTRIBUTION OF SAMPLES BY SOURCE OF

INFORMATION

Source Frequency Percentage (%)

Family 46 53.4

Media 11 12.5

Health professionals 17 9.4

Friends 2 1.1

Family & Media 4 2.2

Family & Health professionals 2 1.1

Media & Health professionals 2 1.1

Health professionals & friends 1 0.5

Family, Health professionals &

Media

2 1.1

Family , Media, Health

professionals & Friends

1 0.5




Table 4.10 shows that more than half of the samples that is 53.4% got

information from family, 12.5 % had informed by media, 9.4 % got

information from health professionals, 2.2% from both family and media,

1.1% had the source of information from family & health professionals,

friends , media & health professionals , and family, media, health

professionals. 0.5% got information from health professionals & friends, and

from all the 4 sources.

Figure4. 10 : Column diagram showing source of information of

samples

0

10

20

30

40

50

60 53.4%

12.5%9.4%

1.1% 2.2% 1.1% 1.1% 0.5% 1.1% 0.5%




4.4 SECTION 2 :LEVEL OF KNOWLEDGE AMONG PRIMI

GRAVIDA AND PRIMI PARA MOTHERS

TABLE 4. 11: LEVEL OF KNOWLEDGE

Knowledge level Frequency Percentage (%)

Poor 113 62.78

Average 51 28.33

Good 16 8.89

Total 180 100

Table 4.11 shows that most of the mothers, 62. 78% had poor knowledge

regarding exclusive breast feeding, 28.33% had average knowledge and 8.89%

had good knowledge.

Figure 4. 11: Pyramid diagram showing level of knowledge of

mothers

0

10

20

30

40

50

60

70

Poor Average Good

62.78%

28.33%

8.89%Pe

rce

nta

ge

Knowledge




4.5 . SECTION 3 OVERALL ANALYSIS OF KNOWLEDGE

SCORE ON EXCLUSIVE BREASTFEEDING

TABLE4.12: OVERALL ANALYSIS OF KNOWLEDGE SCORE

ON EXCLUSIVE BREASTFEEDING

Knowledge Percentage

%

Range Mean Median SD Mean

%

Less than median 46.67

6-28

16.78

16

5.14

47.94 More than median 53.33

Table 4.12 represent the overall mean score of primi mothers was 16.78,

median was 16, and standard deviation 5.14 and the overall mean percentage

47.94%. This indicates that primi mothers have less knowledge regarding


Figure4.12 : Pie diagram representation of knowledge score

46.67%

53.33%Less than median

More than median




4.6 SECTION -4 AREA WISE ANALYSIS OF KNOWLEDGE OF

MOTHERS

TABLE4.13:AREA WISE ANALYSIS OF KNOWLEDGE OF

MOTHERS

Area No. of

item

Max.

marks

Min-max Mean Median SD Mean

% to

max.

score

Exclusive

breastfeeding

6 6 0-6 3.6 4 1.09 60

Colostrum 5 7 0-7 3.19 3 1.53 45.57

Advantages

of EBF

3 9 0-9 3.89 4 2.2 43.2

Position

&technique

5 6 0-6 3.09 3 1.27 51.5

Burping 2 2 0-2 1.46 2 .69 73

Contra

indications

1 1 0-1 .04 0 0.2 4

BFHI 2 4 0-4 1.53 1 0.9 38.25

Total 24 35 0-35 16.8 16 7.88 48




Table 4.13 indicates that the primi mothers had more knowledge 73%

in the area of burping ,60% knowledge in the exclusive breastfeding area

51.5% knowledge in , position and technique, 45.57% in the area of colostrum,

43.2% in advantages of breastfeeding 38.25% in the area of baby friendly

hospital initiative and less knowledge, 4% in the area of contra indication of

breastfeeding.

Figure 4.13:Bar representation of area wise analysis of knowledge

score

60%

45.57%

43.2%

51.5%

73%

4%

38.25%

0 20 40 60 80

Exclusive breastfeeding

Colostrum

Advantages

Position &technique

Burping

Contra indications

Baby Friendly hospital Initiative

Percentage

Are

as




4.7. SECTION 5 :ASSOCIATION OF KNOWLEDGE WITH

SELECTED DEMOGRAPHIC VARIABLES.

TABLE4. 14: ASSOCIATION OF KNOWLEDGE WITH AGE

Age

Knowledge

Total

Chi-

Square

(χ2 )

df Level of

significance Poor Average Good

<20 19 5 1 25

5.377

6

.496

NS

21-25 72 31 12 115

26-30 18 11 2 31

>31 4 3 2 9

Total

113 50 17 180

NS-Not Significant

χ2(6,0.05) =12.592

The table 4.14 shows that the obtained value is less than the table value , so

there is no significant association between the knowledge score with age at

0.05 level of significance. Hence hypothesis is rejected




TABLE 4.15: ASSOCIATION OF KNOWLEDGE WITH

RELIGION

Religion

Knowledge

Total

Chi-

Square

(χ2 )

df Level of

significance

Poor Average Good

Christian

21 11 8 40

11.348

4

.023*

S

Hindhu

56 27 9 92

Muslim

36 12 0 48

Total

113 50 17 180

S- Significant

χ2 (4,0.05)=9.488

The above table 4.15 shows that the obtained value is more than the table

value,so there is significant association between knowledge score with religion

at 0.05 level of significance . Hypothesis is accepted





EDUCATION

Education

Knowledge

Total

Chi-

Square

(χ2 )

df Level of

significance

Poor Average

Good

Lower Secondary 47 9 1 57

63.038

6

.000*

S

Higher Secondary 55 13 2 70

Graduate 10 27 14 51

Post graduate 1 1 0 2

Total 113 50 17 180

S- Significant

χ2 (6, 0.05)= 12.59

The above table 4.15 shows that the obtained value is much more than the table

value, so there is significant association between knowledge score with

education at 0.05 level of significance . Hence hypothesis is accepted





EMPLOYMENT

Employment

Knowledge

Total

Chi-

Square

(χ2 )

df

Level of

Significance Poor Average

Good

House wife 101 37 11 149

25.146

8

.001*

S

Labourer 1 1 0 2

Govt. employee 2 1 2 5

Private employee 4 11 2 17

Others 5 0 2 7

Total 113 50 17 180

S- Significant

χ2 (8, 0.05)= 15.507

The above table 4.17shows that the obtained value is more than the table

value, so there is significant association between knowledge score with

employment at 0.05 level of significance . Hence hypothesis is accepted




TABLE.4.18: ASSOCIATION OF KNOWLEDGE WITH TYPE OF

FAMILY

Type of family

Knowledge

Total

Chi-

Square

(χ2 )

df

Level of

significance

Poor Average Good

Joint family 60 28 12 100

4.503

4

.342

NS

Nuclear family 53 21 5 79

Others 0 1 0 1

Total

113 50 17 180

N S- Not Significant

χ2 (4, 0.05)= 9.488

The above table 4.18 shows that the obtained value is less than the table value,

so there is no significant association between knowledge score with type of

family at 0.05 level of significance. Hence hypothesis is rejected




TABLE 4. 16: ASSOCIATION OF KNOWLEDGE WITH

MONTHLY INCOME

Monthly

Income

Knowledge

Total

Chi-

Square

(χ2 )

df Level of

significance

Poor Average Good

<2500 92 34 7 133

28.171

6

.000*

S

2501-5500 16 7 2 25

5501-12000 5 8 7 20

>12001 0 1 1 2

Total 113 50 17 180

S- Significant

χ2 (6, 0.05) = 12.59


value, so there is significant association between knowledge score and

monthly income at 0.05 level of significance. Hence hypothesis is accepted




TABLE4. 19: ASSOCIATION OF KNOWLEDGE WITH PLACE

OF RESIDENCE

Place of

residence

Knowledge

Total

Chi-

Square

(χ2 )

df Level of

significance

Poor Average Good

Panchayath 73 35 16 124

6.445

4

.168

NS

Muncipality 39 15 1 55

Corporation 1 0 0 1

Total 113 50 17 180

NS- Not Significant

χ2 (4, 0.05) = 9.488

The above table 4.19 shows that the obtained value is less than the table value,

so there is no significant association between knowledge score with place of

residence at 0.05 level of significance . Hence hypothesis is rejected




TABLE 4. 20: ASSOCIATION OF KNOWLEDGE WITH

OBSTETRICAL SCORE

Obstetrical

Score

Knowledge

Total

Chi-

Square

(χ2 )

df Level of

significance

Poor Average

Good

Primigravida 68 27 12 107

1.516

2

.469

NS

Primipara 45 23 5 73

Total 113 50 17 180

NS- Not Significant

χ2 (2, 0.05) = 5.991

The above table 4.20 shows that the obtained value is less than the table

value, so there is no significant association between knowledge score and

obstetrical score at 0.05 level of significance. Hence hypothesis is rejected





PREVIOUS INFORMATION

Previous

information

Knowledge

Total

Chi-

Square

(χ2)

df Level of

significance

Poor Average Good

Yes 46 28 14 88

11.657

2

.003*

S

No 67 22 3 92

Total 113 50 17 180

S- Significant

χ2 (2, 0.05) = 5.991


value, so there is significant association between knowledge score and previous

information at 0.05 level of significance. Hence hypothesis is accepted.




4.8. SECTION 6

TABLE 4.22 :COMPARISON OF THE KNOWLEDGE BETWEEN

PRIMI GRAVIDA AND PRIMI PARA MOTHERS ON

EXCLUSIVE BREASTFEEDING

Obstetrical

Score N Mean

Std.

Deviation

Std.

Error

Mean

Knowledge

Primigravida 107 16.8692 5.00393 .48375

Primipara 73 16.3288 5.29951 .62026

Independent Samples Test

unpaired t-test for Equality of Means

t df Significance

Mean

Difference

Std. Error

Difference

.695 178 .488 .54039 .77808

Since the significance is very much greater than 0.05, we can conclude

that the null hypothesis that there is no significant difference in the mean scores

is accepted. So there is no difference in the knowledge between primi gravida

and primi para mothers on exclusive breast feeding. Hence hypothesis is

rejected




4.9. SUMMARY

There is significant association between knowledge and religion,

education, employment, monthly income and previous knowledge. Most of the

mothers have poor knowledge regarding exclusive breastfeeding. The mothers

have good knowledge regarding advantages of exclusive breastfeeding , and

poor knowledge regarding contra indications of breastfeeding .While

comparing the knowledge of primi gravida and primi para mothers, there is no

much difference in knowledge score .




CHAPTER V

SUMMARY AND DISCUSSION

CONTENTS PAGE NO

5.1 Introduction

5.2 Summary

5.3 Discussion

5.4 Conclusion

5.5 Nursing implications

5.6 Recommendations




5.1 INTRODUCTION

This chapter discusses the major findings of the study and reviews them

in terms of the results.

The first year of life is crucial in laying the foundation of good health.

At this time certain specific biological and psychological needs must be met to

ensure the survival and healthy development of the child into a future adult.

Breastfeeding is the ideal method suited for the psychological and

physiological needs of the infant. After birth, breastfeeding creates an unique

bond between the mother and her baby. When the mother breastfeeds, she gives

adequate warmth, affection and security as well as food and protection to her

baby. Breast feeding is the most important child rearing skill to be learnt by a

mother. Mothers are to be self motivated and knowledgeable in order to care

her baby best. WHO &UNICEF takes initiative for promotion of exclusive

breastfeeding all over the world.

The aim of the study was to assess the level of knowledge of primi

gravida and primi para mothers and prepare a self instructional module on

exclusive breast feeding.

A structured interview schedule was used to collect the data. A non

experimental, descriptive study design was used to assess the knowledge of

mothers regarding exclusive breast feeding. The researcher has utilized the non

probability convenience sampling to select the samples.




The study was conducted among 180 primi gravida and primi para

mothers without age imitation by using structured interview schedule regarding


The Objectives of the present study were as follows.

1. To assess the level of knowledge regarding exclusive breastfeeding

among primi gravida and primi para mothers






Review of literature helped the investigator to find out the present day

situation and by assessing the level of knowledge of the primi gravida and

primi para mothers

5.2. SUMMARY

The findings of the study were categorized under the following headings

1. Demographic variables

2. Assessment of level of knowledge of primi mothers regarding

exclusive breastfeeding

3. Overall knowledge of mothers




4. Area wise analysis

5. Association between knowledge score and demographic variables

6. Comparison of knowledge among primi gravida and primi para mothers

On the basis of data collected the major findings of the study were

Section 1. Demographic variables

Majority of the subjects were within the age group of 21-25 yrs.

(63.9%).17.2 % were in between 21-25%

More than half of the samples 51.1% of the study samples were

Hindus, 2.2% of samples were Christian, 26.7% were Muslims

Only 38.9 % of the samples were educated up to higher secondary,

31.7% of samples were studied lower secondary, 28.3% were graduates, and

only 1.1% were postgraduates.

Most of the samples, 82.8% were housewives, 9.4%were private

employees, 3.9% were there employees , 2.8%were govt. employees and 1.1%

were labourer.

More than half of the samples, 55.6% belongs to joint family. 43.9% are

from nuclear family. And 0.6% are others

Most of the samples73.9% belongs to income < Rs. 2500, 13.9%

belongs to the income group 2501-5500, 11.1% belongs to 5501-12000group

and 1.1% only have income more than 12001.

Most of the samples, 68.9% were belongs to Panchayath, 30.6% were

from municipality, and only 0.6% were from corporation




More than half of the samples, 59.4% were primi gravida mothers and


More than half of the samples 51.1% had no previous information and

48.9% had previous information regarding exclusive breastfeeding

More than half of the samples that is 53.4% got information about

exclusive breastfeeding from family, 12.5 % had informed by media, 9.4 %

got information from health professionals, 2.2% from both family and media,

1.1% had the source of information from family & health professionals,

friends , media & health professionals , and family, media, health

professionals. 0.5% got information from health professionals & friends, and

from family, media, health professionals and friends

Section 2. Assessment of level of knowledge

Most of the samples ie. 62.78% of mothers had poor knowledge

regarding exclusive breastfeeding 28.33% had average knowledge. And 8.89%

had good knowledge regarding exclusive breastfeeding.

Section 3. Over all knowledge of mothers.

Overall mean knowledge obtained by the primi mothers was 16.78 and

median scoring 16 with standard deviation of 5.14 and mean percentage of

47.94 % had less than average score, 53.33 % had more than average score.




Section 4. Area wise analysis

The area wise analysis indicates that the maximum mean

knowledge score was 73% in the area if burping and minimum mean

knowledge was 4% in the area of contraindication.

Section 5. Association between knowledge level and demographic

variables

There is association between knowledge and religion at 0.05

(p value = 0.023),

There is an association between knowledge and education at 0.05

(p value = .000),

There is association between knowledge and employment at 0.05

(p value =0.001),

There is association between knowledge and monthly income at 0.05

(p value =0.000)

There is association between knowledge and previous information at 0.05

(p value =0.003)

There is no association between knowledge and age, type of family, place

of residence and obstetrical score

Section 6. Comparison of Knowledge among primi gravida & primi

para mothers.

There is no difference in knowledge between primi gravida and primi




para mothers.

5.3. DISCUSSION

There is best evidence to show that promotion of exclusive

breastfeeding is still an important aspect in India. The mothers are lacking good

knowledge regarding exclusive breastfeeding. This study reflects the need to

provide health education or an educational program regarding exclusive

breastfeeding for the mothers especially the first time mothers need more

motivation to improve their knowledge. A knowledgeable mother only can

practice effective breastfeeding. It provides complete well being of the mother

and her infant. The advantages of the exclusive breastfeeding are to be

propagated in order to build a good generation for future. As India is a

developing country more and more threats are arising day by day in the areas of

maternal mortality and infant mortality.

Demographic characteristics

Age in years

Majority of the subjects, 63.9% were within the age group of 21-25 yrs, 17.2%

were in between 26-30yrs 13.9% were less than 20yrs and 5% were more than

31yrs. A similar finding of the study was consistent by Garg,R., Deepti,S.S.,

Padda,A ,and Singh T. ( 2010) the demographic profile of the 1,000

respondents showed that most of them, i.e., 423 (42.3%) were in the age group

of 26–35 years; 200 (20.0%), 242 (24.2%), 90 (9.0%), and 45 (4.5%) were in




the age group of 18–25 years, 36–45 years, 46–55 years, and 55 years and

above, respectively.

Religion

More than half that is 51.1% of the study samples were Hindus, 2.2% of

samples are Christian, 26.7% are Muslims the similar findings of the study was

supported by study by Singh B (2008) which shows about 79.0% were

Christians by religion and 19% were Muslims

Education

38.9% of the samples were educated up to higher secondary, 31.7% of samples

were studied lower secondary, 28.3% were graduates, and only 1.1% were

postgraduates. A similar finding is reported in a study conducted by Garg,R.,

Deepti,S.S., Padda,A,and Singh T. ( 2010). 223 (22.3%), 113 (11.3%), 230

(23.0%), and 24 (24.0%) of the respondents were educated up to primary,

middle, higher secondary, and graduates and above, respectively, while 410

(41.0%) were illiterate..

Employment

Most of the samples, 82.8% were housewives, 9.4% were private

employees,3.9% were other employees , 2.8% were govt. employees and 1.1%

were laborer. A similar study findings are shown in a study by Singh B

showed 42.0% were traders10.1% were Housewife , 6.0% were Teachers,

14.0% were Unemployed and10.0% were others




Type of family

More than half of the samples that is 55.6% were belongs to joint family,

43.9% were from nuclear family and 0.6% were others

Monthly income

Most of the samples that is 73.9% had monthly income < Rs. 2500 , 13.9%

belongs to the income group of Rs. 2501-5500, 11.1% belongs to 5501-12000

group and 1.1% had income more than 12001. A similar study findings are

shown in a study by Singh B(2008) Most mothers fell in the average income

group which was about 39.0% of the total followed by high income group

33.0% and low income group 28.0%.

Place of residence

More than half of the samples that is 68.9% belongs to Panchayath, 30.6%

were from municipality, and only 0.6% were from corporation. Similarly in a

study conducted by 50% of the samples were belongs to nuclear family, and

other 50% belongs to joint family.

Obstetrical score

More than half of the samples 59.4% were primi gravida mothers and 40.6%

were primi para mothers.

Previous information

Half of the samples ie 51.1% had no previous knowledge and 48.9% had

previous information regarding exclusive breast feeding.




Source of information

More than half of the samples got information from family ie 53.4%.

Assessment of level of knowledge regarding exclusive breastfeeding

The study results showed that most of the 62.78% of the mothers had poor

knowledge, 28.33% had average knowledge and 8. 89% had good knowledge

regarding exclusive breastfeeding the results are supported by A study

conducted by Shailaja, K. G (2008) which showed that 19.09% had poor

knowledge, 65.45% had average knowledge, only 15.45% had good knowledge

regarding exclusive breastfeeding.

Section 5. Association between knowledge level and demographic

variables

There is association between knowledge and religion at 0.05 (p value = 0.023)

There is an association between knowledge and education at 0.05 (p value =

.000), employment at 0.05 (p value =0.001), monthly income at 0.05 (p value

=0.000) , previous information at 0.05 (p value =0.003)

A study conducted by Shailaja K G ( 2008) showed that there is statistically

significant association between knowledge of EBF and family income.

There is no association between knowledge and age, type of family, place of

residence and obstetrical score




5.4. CONCLUSION

In the present study, the levels of knowledge of 180 samples of primi gravida

and primi para mothers were assessed. It is found that most of the samples had

poor knowledge regarding exclusive breastfeeding .The association of the

knowledge with demographic variables were assessed. This reveals that

knowledge had association with religion, education, employment, monthly

income, and previous information. A self instructional module was prepared

and distributed among the primi mothers to improve their knowledge regarding

exclusive breastfeeding. The knowledge of primi gravida and primi para

mothers was compared and there is no difference in their knowledge.

5.5 NURSING IMPLICATIONS

The findings of the study had implications in the area of nursing practice,

nursing education, nursing administration and nursing research.

5.5.1. Implication in nursing practice

The study findings reveal that most of the primi mothers lack knowledge

regarding exclusive breastfeeding. So there is a need for developing health

education packages with regarding to exclusive breastfeeding. Health care

workers are the first teachers of a mother. They get enough opportunity to

interact with the mothers when they come for regular check up and also in the

community area where they meet them at their home situation. By improving




the rate of exclusive breast feeding we may protect the health of mother, child

and also the community.

Pamphlets or booklets can be distributed to all primi mothers attending the

hospitals.

Nurses working in maternal, child care and community must ensure that all

women have gained accurate and appropriate knowledge regarding exclusive

breastfeeding during antenatal and postnatal period. Government and hospital

administrators should give emphasis on the policies of Baby Friendly hospital

initiative and promote exclusive breastfeeding among mothers admitted in the

Hospitals.

The nurse working in the community and clinical setting should practice health

education as an important part of nursing profession. This will help the first

time mothers to improve the health status of their babies.

5.5.2. Implication in nursing education

Nursing education should prepare the nurses to impart health teaching

regarding exclusive breastfeeding. Exclusive breastfeeding and its advantages

should be taught in the nursing curriculum and they should be trained for

dissemination of the health information using various educational technology.

The findings of the study showed that health workers have to play a role in

promotion of exclusive breast feeding. The knowledge of the mothers should




be improved by motivating them and. assist the primi mothers in practicing


5.5.3. Implications for nursing research

There is a need for extended and intensive nursing research in the area of

maternal, child health and community health specialty. A research can be

conducted based on innovative methods of teaching, better practice of nursing

care and help the mothers and health worker. A study can be conducted to

assess the attitude and extend of practice of exclusive breastfeeding.

Collaborate with governmental agencies to conduct research in community

setting. Communicate the findings of various studies conducted in order to

make the results useful to the population.

5.5.4. Implication in nursing administration.

Nursing administration should take initiative in organizing in-service education

programs on exclusive breastfeeding and motivate nurses to participate in

such activities. Conduct campaigns for the antenatal and postnatal mothers

regarding exclusive breastfeeding. Nurse administrators should arrange

facilities for providing health education regarding exclusive breastfeeding in

the Hospital. The Ten Steps of BFHI should be practiced in every hospital

setting.

A health education team can be prepared and mother craft classes can be

arranged in the outpatient department .Resource materials can be distributed to

all expecting mothers attending the hospital. There should be necessary health




education material and administrative support provided to conduct health

programs. Adequate funds should be allocated for preparation and distribution

of health teaching materials in the hospital as well as in the community.

In service education for staff nurses to update their knowledge in the maternal

and child care areas should be arranged periodically.

5.6. RECOMMENDATIONS

1. A similar study can be conducted in community to find the knowledge

and practice of exclusive breastfeeding

2. A study to assess the effectiveness of the Self Instructional Module can

be conducted.

3. A planned teaching program can be developed regarding exclusive

breastfeeding.

4. An experimental study can be conducted to find the effectiveness of a

planned teaching program.

5. A similar study can be replicated in another setting.

6. A study can be conducted to determine the factor influencing practice of


7. A study can be conducted to assess the attitude of working mothers

towards breastfeeding .




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RUCTURED INTERVIEW SCHEDULE TO ASSESS THE

KNOWLEDGE REGARDING EXCLUSIVE BREAST FEEDING

SECTION A

SOCIO DEMOGHAPHIC DATA

Sample No

1. Age :

2. Religion

1)Christian

2) Hindu

3) Muslim

4) Others

3. Education

1) Lower secondary

2) Higher secondary

3) Graduate

4) Postgraduate

4. Employment

1) House wife

2) Laborer

3)Govt. employee

4) Private employee

5) Business

6) Others




5. Type of family

1) Joint

2) Nuclear

6. Family income

1)<2500

2) 2501-5500

3) 5501-12000

4)>12001

7. Place of residence

1) Panchayath

2) Municipality

3) Corporation

8. Obstetrical Score : G P L A

9. Have you got any information regarding exclusive breastfeeding?

1) Yes 2) No

10. Which is the source of information?

1) Family

2) Media

3) Hospital

4) Friends




SECTION B

I. EXCLUSIVE BREASTFEEDING

11. What is the ideal food for a new born baby?

1) Cow’s milk

2) Milk powder

3) Breast milk

4) Orange juice

12. How long the breast milk can be given to baby ?

1) Up to 6 month

2) Up to 1 year

3) Up to 2 year

4) As long as possible

13. What is exclusive breastfeeding?

1) Giving breast milk along with formula

2) Giving breast milk alone for 6 months

3) Giving breast milk and water

4) Feeding breast milk along with vitamin syrups

14. When should the mother start breast feeding after normal delivery?

1) Within ½ an hour of delivery

2) After a day




3) After 1 hour

4) Within 4hours

15. When should the mother start breast feeding after Caesarian section ?

1) Within ½ an hour of delivery

2) After a day

3) After 1 hour

4) Within 4hours

16. How often should the baby be fed?

1) Whenever baby is hungry

2) Every 5-6 hours

3) 4 times a day

4) At mother’s convenience

II. COLOSTRUM

17. What is colostrum?

1)Milk produced after 1 month

2)Milk produced after a week

3)Milk produced after 2 days

4)The first milk produced from the breast

18. When does colostrum form?

1) During pregnancy

2) Immediately after delivery




3) After 1 day of delivery

4) After 3 days of delivery

19. Which are the components of colostrum?

1) Antibodies

2) Fatty acids

3) Proteins

4) Vitamins

20. What is the major component of breast milk?

1) Vitamins

2) Proteins

3) Calcium

4) Water

21. What can be given to the new born besides colostrum?

1) Honey

2) Sugar water

3) Plain water

4) Do not give anything

III. ADVANTAGES OF EXCLUSIVE BREASTFEEDING

22. How is Exclusive Breast Feeding beneficial to the newborn baby ?

1) Prevention of infection

2) Prevention of poliomyelitis




3) Prevention of malnutrition

4) Easily digestible

5) Prevention of cardiac diseases

6) Promoting bonding between mother and newborn

23. Which of the following are the benefits of Exclusive Breastfeeding to

mother?

1) Prevention of postpartum hemorrhage

2) Prevention of breast cancer

3) Prevention of postnatal depression

4) As contraceptive method

5) Prevention of genital tract infections

6) Prevention of breast complications

24. Which are the disadvantages of giving breast milk substitutes?

1) Chances for getting diarrheal diseases

2) Prevention of mental retardation

3) Malnutrition

4) All the above

IV. POSITION AND TECHNIQUE

25. Which is the best position that the mother should assume during breast

feeding?




1) Side lying

2) Sitting

3) Semi sitting

4)Supine

26. What should be done to ensure adequate milk production?

1) Frequent feeding

2) Take adequate rest

3) Express breast milk frequently

4) Clean the breast with warm water

27. How do you know the baby is adequately fed?

1) Baby sucks continuously

2) Baby well settled between feeds

3) Baby weight increases

4) Baby is restless

28. Does the infant need water or other liquids in addition to breast milk in

the first six months?

1) Yes 2) No

29. Does the mother need preparation for breastfeeding during antenatal

period?

1) Yes 2) No

V. BURPING




30. What is burping ?

1) Expelling excess milk

2) Expelling aspirated milk

3) Expelling the swallowed air

4) None of the above

31. How is burping done?

1) By massaging abdomen

2) By patting on back of the baby

3) By rubbing the back

4) By patting on head

VI. CONTRA INDICATIONS OF BREAST FEEDING

32. Which are the contraindications for breastfeeding?

1) Slight maternal fever

2) Very low birth weight

3) Diarrhea of the baby

4)Cleft palate

VII. BABY FRIENDLY HOSPITAL INITIATIVE (BFHI)

33. Which is World Breastfeeding Week?

1) March 1-7




2) April 1-7

3) June 1-7

4) August1-7

34. How is the Govt. promoting and supporting Exclusive Breast Feeding?

1) Providing Maternity Leave

2) Promoting Baby Friendly Hospital Initiative

3) Banning the breast milk substitute advertisements

4) All the above

ANSWER KEY

11 3

12 4

13 2

14 1

15 4

16 1

17 1

18 1

19 4

20 4




21 4

22 1,3,4,6

23 1,2,4,6

24 1

25 2

26 1

27 2,3

28 2

29 1

30 3

31 2

32 4

33 4

34 4




SELF INSTRUCTIONAL MODULE

PREPARED BY

Chinchu Mohan

M Sc Nursing Student




Breast milk is the gift of nature for the new born baby. A mother is born

along with a baby. She takes care her baby more than any one. Nutrition is the

fundamental element in baby’s care.

From ancient times mothers feed their babies with breast milk. Motherhood is

said to be completed only when the mother breastfeeds.

Don’t you wish to best and pure feed to your baby? Breast milk is

uncontaminated food. It contains all the nutrients needed for the growth of your

baby for the first 6 months of life. These are easy to digest and absorb into the

blood of your baby.

Do you know what are the benefits of breastfeeding to our baby ?




Breast fed babies have faster physical and psychological growth and

development .the antibodies in the breast milk, provides immunity, thus these

babies had less chance for getting the diseases All mothers wish that their

babies to be happy always breast fed babies are less prone for allergies like

eczema, asthma, diarrhea and pneumonia.

Breast milk contains components that help for improving the intelligence and

growth of thee baby. Breastfed children have more IQ and cognitive capacity.

Breast feeding enhances emotional bonding between mother and baby.

Not only the infants, mothers also benefited from breastfeeding their baby.

The uterus of a breastfeeding mother will be well contracted, thus reduces

blood loss following delivery and improved health of mother. Breast feeding is

said to be a natural contraceptive which delays the next pregnancy. Studies

showed that breastfeeding protects the mother from breast cancer and cervical

cancer.

Exclusive Breastfeeding.




WHO’s latest proclamation is to promote exclusive breastfeeding in

developing countries like India. According WHO , exclusive breast feeding

should be practiced strictly for the first six months of an infant. No prelacteal

feeds are given to the baby. Breast feed the baby as soon as possible after the

delivery. Babies should be put to breast within half an hour of a normal

delivery and within 4 hrs of a caesarean section

Colostrum

During the last months of pregnancy the breast produces colostrums which is a

thin yellowish fluid. This is to be given to the babies strictly as it is rich in

antibodies that provide passive immunity to the baby. Colostrums contains

minerals, proteins , carbohydrates and water. I enhances smooth digestion and

excretion of stool.

Breast feeding should not be restricted with a time table. Baby should be

fed on demand. Feed the baby till the baby satisfies his hunger. Feed the baby




from both the breasts alternatively . The baby will be sleeping calm and quite

between feeds if the baby is given enough milk frequently. The baby’s weight

increases as days passing. Baby passes urine at least 6 times a day and

eliminates soft stools.

The mother should wash her hands before the baby. The technique of

the breast feeding is also equally important. It is important that you and the

baby should be in a comfortable position. The nipple and areola should be

inside the mouth. Hold the baby in such a way that baby’s neck should be

supported by hands of mother. Baby’s chest and abdomen should come in

contact with mothers chest and abdomen respectively. The baby should be

hold towards mother instead of mother lean towards the baby. Mother should

look at the face of baby with love and pat the baby with fingers.this will

enhance the emotional bonding to the baby. If the mother feeds the baby

properly, the infant get sufficient milk




The baby may swallow air while feeding. The swallowed air can be

expelled by burping after feeding the baby. .Hold the baby’s neck with hands

put the baby on the shoulder and pat on the back with the other hand.

Some conditions are contra indicated for breastfeeding. For example ,

Mother who has chronic illnesses , active TB ,who are on chemotherapy and

anti psychotics , , Drug abusers ,are contra indicated for breast feeding. Babies

with acute illness, severe degree of cleft palate, galactosemia,are also not to be

breast fed.

If the mother is a working woman, or if the mother has to go out without her

baby expressed breast milk can be stored upto 6-8 hours in normal room

temperature .the expressed milk can be given using palada or spoon.

Baby Friendly Hospital Initiative

The Baby-friendly Hospital Initiative (BFHI) is a global effort launched by

WHO and UNICEF to implement practices that protect, promote and support

breastfeeding




The hospital with maternity services, have to follow the ten steps to successful

breastfeeding. These hospitals are assessed and certified as baby friendly (BF)

if they adopt the “Ten Steps” and follow these practices.

The Ten Steps for health facilities to take towards ensuring successful

breastfeeding are as follows:

1. Have a written breastfeeding policy that is routinely communicated to

all health care staff.

2. Train all health care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of

breastfeeding.

4. Help mothers initiate breastfeeding within half an hour of birth.

5. Show mothers how to breastfeed, and how to maintain lactation even if

they should be separated from their infants.

6. Give newborn infants no food or drink other than breast milk unless

medically indicated.

7. Practice "rooming in" – allow mothers and infants to remain together –

24 hours a day.

8. Encourage breastfeeding on demand – whenever the baby is hungry.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to

breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer

mothers to them on discharge from the hospital or clinic.




All mothers should breast feed their babies. This will ensure healthy future of

your baby.


ASSESSMENT OF KNOWLEDGE REGARDING EXCLUSIVE BREAST … · 2018-08-10 · Nursing student, K V M...

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