6.0 BRIEF RESUME OF THE INTENDED WORK.

“The 1st Hour save 1 Million Babies”

6.1 INTRODUCTION

Children are our future and our most precious resources .After birth the health

of the baby depends on the nurturing practices adopted by the families.9 The basic food

for infant feeding is milk .Breastfeeding is the most natural method .Breast milk is the

natural food for babies. It provides all the energy and nutrients that needs for the first

months of life, and it continuous to provide up to half or more of a child‘s needs during

the 2half of the first year.2

W H O [1991] defines Breastfeeding as the child has received breast milk

[direct from the breast or expressed].4 Breastfeeding should be initiated within the first

half an hour after birth. The first milk is the most suitable food for the newborn. It is thick

and yellow colored the SHAASTRAS call it PEEYUSHA AND WESTERN SCIENCE

uses the word Colostrum.9 Breast milk always fresh, pure, readymade, requiring no

preparations. It is also at the right temperature, uncontaminated and aseptic.13

Breast milk promotes sensory and development, immunological and psychological

development. Protects the infant against infectious diseases such as diarrhea, lower

respiratory tract infections, otitimedia, bacteriemia, bacterial meningitis, botulism,

urinary tract infections and necrotizing enterocolitis, chronic diseases childhood leukemia

among neonates.2 According to WHO\UNICEF document at least 1 million deaths per

year from diarrhea; infections are absolutely preventable through breast feeding. The

incidence of respiratory and intestinal infections in breast fed infants is far less than that

of reported in bottle fed babies and breast fed babies have seven times less chance of an

allergy.

Respiratory infections ---5%[in breast fed] ,28%[in bottle fed].

Gastrointestinal infections---6%[ in breast fed],37%[ in bottle fed].13

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Exclusive breast feeding means giving only breast milk. This means no water,

liquids, teas, herbal preparations, or foods through the first six months of life.

International guide lines recommended exclusive breast feeding for the first six months

based on scientific evidence of the benefits for infant survival, growth and cognitive

development and helped to reduce mortality and morbidity rate of neonates’ world wide.

The WHO/UNICEF jointly developed the Global Strategy for infant and young children

feeding which has adopted on 18 may 2002 by the World Health Assembly and endorsed

by UNICEF Executive Board in September 2002.. This strategy aims to set in motion

national actions to improve infant and young child feeding practices world wide, having

their impact on child health, development and survival. August 1 through 7is World

Breast Feeding Week and the Governor has proclaimed August as Breast Feeding

Awareness Month.(WHO / UNICEF)

Number of studies mentioned health benefits of breast fed mothers also .It is

documented that breast feeding increases level of oxytocin, resulting in less post partum

bleeding and more rapid uterine involution and lactating mother have an easier return to

pre pregnant weight, delayed resumption of ovulation with increased child spacing,

improved bone remineralalization and post partum with reduction in hip circumference It

reduces risks of breast cancer of. Pre menopausal endometrial cancer and ovarian cancer.4

As reported there are many barriers which interfere with the success of breast

feeding .Some of these barriers are poor knowledge among health, problems of mothers,

Medical surgical problems of the neonates, in appropriate hospital practices such as

separation of mother and infant soon after birth, delay in getting the infant soon after

birth, anxiety of the mother also has direct effect on lactation.5

6.2 NEED FOR STUDY

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Exclusive Breast Feeding means giving only breast milk .This means no water, liquids,

teas, herbal preparations, or foods through the first six months of life. Human milk is

decidedly superior to other, milks13 and is universally acknowledge as the best and

complete food for infants including sick and preterm as it full fill their specific nutritional

needs. The protective benefits of breast milk for neonates and mothers are well

documented in studies conducted in both developed and developing countries among

various socio economic strata of the society. Breast milk has the best potential help the

babies grow well in later stages of child hood.5

Initiation of breast feeding with in the first half an hour of birth is the first and

most vital step towards reducing infant and under five mortality, by reducing the over

whelming high neonatal mortality rate .save one million babies –beginning with one

action, one hour support and one message. This single intervention can save more than

2.5 lakhs babies in India that is equivalent to 22% of deaths among newborns. In a world

where more than 10 million children die before their fifth birthday due to preventable

causes, malnutrition alone kills more than half of these children. Improving breast

feeding practices saves lives, especially in poor communities.

In the year 2005, a review by Cochrane Collaboration on breast feeding interventions

concluded that malnutrition has been responsible ,directly or in directly, for 60% of the

10.9 million deaths annually among children under five well over two thirds of these

deaths ,which are often associated with in appropriate feeding practices occur during the

first year.

A UNICEF 2007 report states that India has close to 25 million children born every

year .Out of these 1.9 million are under five children, who die in a year. Among the

deceased children, 1.4 million children die just with in 1 year and roughly. One million

children dying with malnutrition and other preventable diseases caused mainly due to

poor care and inappropriate infant feeding practices, delaying and restricting breast feeds

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and giving other products before six months are still common practices which increases

the risk of infection, allergy, long term diseases and death.

Only 23.4% newborns across the country begin breast feeding with in an hour of

birth. This rate has to be improved up to 90% or more in order to achieve Millennium

Development Goals and to fight against the malnutrition and child deaths in India. Early

initiation if breast feeding practice provides quality health care for children and reduces

their specific health problems. Maximum number of child deaths occurs within first

month and first year of life and it is the most crucial period for the children. It can be

safeguard by initiating proper infant feeding practices along with adequate sequence.

WHO also recommends for optimal infant feeding practices to fight Malnutrition and

promote child survival.7 The number of studies has shown protective effect of human

milk feed against sudden infant death syndrome, insulin dependent diabetes mellitus

crohn’s disease, ulcerative colitis, lymphoma, allergic and other chronic digestive

diseases.

But some of the factors affecting the success of breast feeding which are

- Mothers of newly born children don’t know how to feed, what to feed, and end up

adopting harmful practices.

-Lack of knowledge among mothers.

-Medical surgical problems of neonates.

-Inappropriate hospital practices such as separation of mother and infant

soon after birth bonding and suckling reflexes are strong.

-Delay in getting the infant to the breast.

-Increased level of anxiety of the mother.

-Provision of formula feed.

-Following rigid feeding schedule based on clock rather than on neonate’s demand.

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-More over the cultural influence an inadequate or lack of health care support makes it

worse.4

This is supported by a study conducted by Mrs. .V .Selvanayaki,[2003] did study

conducted on knowledge, attitude, practices of breast feeding among employed mother

with below six months of age child.. This study reveled that majority [45%] of the

mothers had average knowledge and 67% had positive attitude towards breast feeding but

practices was partially adoptive for 52% and completely adoptive for 43% of

mothers .However majority of them were not practing exclusive breast feeding.

Recommendation of the study was they need to be educated on exclusive breast feeding

on joy by using self instructional module or structured teaching programme.11

Hence the researcher felt need to be conducted study on knowledge practices of

exclusive breast feeding with a view to develop an information guide sheet.

6.3 REVIEW OF LITERATURE.

Review of literature for the study has been under the following

Field E, Siziva S, Kanakasa C, Moland KM, TylleskarT [2008] conducted a

qualitative approach on assessment of potentials and barriers in the promotion of

exclusive breast feeding in Mazabuka, 130 km south of Lusaka in Zambia among

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Mothers, fathers, health staff, grand mothers, traditional birth attendants in urban and

rural areas. the study reveled that exclusive breast feeding was to be universal, the use of

pre-lacteal feeds appeared to be low, colostrums was rarely discarded, and attitudes to

and knowledge about exclusive breast feeding were good .The barriers reveled were the

perception of insufficient milk, the fear of dying or becoming too sick to be able to breast

feed, convection, the perception of bad milk, lack of knowledge on the subject.

Conclusions of the study were that exclusive breast feeding is beneficial for child health

had reached the health workers and was taught to mothers.1

Suneth B Agammpodi, Thiilini C Agampodi, [2007] conducted cross sectional study

was in the Medical Officer of Health area, Beruwala ,Sri Lanka among 219 mothers

with aged 4to 12 months .The study reveled that the rates of exclusive breast feeding at

4and 6 months were 61.6% [135/219] and 15.5%[24/155] respectively .At the time of the

study,62%[135/2219]of infants were receiving feeds via a bottle and 23%[51/219] were

receiving infant formula. The study concluded that breast feeding and exclusive breast

feeding up to the 4 month is very high in the Medical Officer of Health area,

Beruwala ,Sri Lanka however exclusive breast feeding up to 6 mothers is still low and the

prevalence of inappropriate feeding practices is high.12

Kumar D, Agarwal N, Swami HM[2006] cross sectional study on socio demographic

correlates of breast feeding in urban slums of Chandigarh among 270 mothers .The study

reveled that out of all 270 159[58.9%] initiated breast feeding

Only, 43 [15.9%] discarded colostrums and 108[40.01%] mothers gave prelacteal feed.

Illiterate/just literate mothers who delivered at home were found at high risk of delay in

initiation of breast feeding .The study was concluded that promotion of institutional

delivers, health education to mothers for protecting and promotion of breast feeding

practices.3

Monika Kaushal, Rajiv Aggarwal, Ashwani Singal[2005] conducted study on to

evaluate the knowledge of mothers and grand mothers regarding breast feeding and

health –seeking behaviour for neonatal sickness in a rural community New Delhi. A

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cross-sectional survey structured questionnaire method was used most of grand mothers

and mothers believed in early feeding within 2hours of delivery, they often administered

prelacteal feeds such as ghutti and honey. The results of the study indicated that

knowledge regarding desirable breast feeding practices was inadequate and quite a few in

appropriate beliefs were widely prevalent.6

Sachdev HP, Mehrotra S.[2004] conducted a cross multivariate comparison on

predictors of exclusive breast feeding in early infancy among 501 mothers of children

between the age group of 0-6 months at urban teaching hospital opd ,New Delhi. The

study reveled that exclusive breast feeding until 6 months of age was practiced by 307

mothers [61.3%],158 infants [31.5%] were partially fed and 36(72%) were receiving no

breast milk , in sufficient milk supplies, inferred from the infant’s crying, was the reason

given for breast milk supplementation by 52.3% of mothers who initiated this practice,

among mothers who had totally weaned their infant, 28% cited breast rejection by the

baby as the cause. These finding suggest a need for educational campaigns aimed at

supporting breast feeding mothers especially those who perceive their milk supply to be

inadequate.10

Radhakrishnan R, Mini Jacob S, Parameshwari S (2003) conducted study on

exclusive breast feeding practices among women visiting institute of obstetrics and

gynecology at Chennai(Urban) Tamil Nadu, India and government head quarters hospital

at Namakkal (rural). In this study 1000 mothers were taken. The results of the study 89%

of mothers in Chennai and 84% of mothers were aware the benefits of breast feeding,

41% of mothers at Chennai and 62% mothers at Namakkal fed their infant with sugar

water, honey and jaggery water soon after the delivery 39 % of mothers in Chennai and

24% mothers in Namakkal practiced exclusive breast feeding with the average duration

of 2.8 and 2.6 months. 90% feed their infant with colostrums at Chennai and 85% at

Namakkal. The study concluded that exclusive breast feeding is uncommon especially

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among in rural women the prelacteal traditional feeding practices have to be discouraged

by educating prospective mothers, counseling on exclusive breast feeding for at least 6

months need to emphasized at antenatal clinics to all pregnant women.8

STATEMENT OF PROBLEM:

A STUDY TO ASSES THE KNOWLEDGE AND PRACTICES

REGARDING EXCLUSIVE BREAST FEEDING AMONG PRIMI PARA

MOTHERS IN POSTNATAL OUT PATIENT DEPARTMENT AT DISTRICT

HOSPITAL , BELLARY. WITH A VIEW TO DEVELOP AN INFORMATION

GUIDE SHEET.

6.4 Objectives of the Study

To asses the level of knowledge on exclusive breast feeding among primi

Para mother s.

To asses the knowledge on practices of exclusive breast feeding among primi Para

mothers.

To determine the association between the knowledge and practices of

exclusive breast feeding among primi Para mothers.

To determine the association between the knowledge of exclusive

breast feeding and demographic variables.

To determine the association between the knowledge on practices

and demographic variables.

To develop an information guide sheet on exclusive breast feeding.

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6.5 NULL HYPOTHESIS:

* There is no significant association between knowledge and

Selected demographic variables on exclusive breast feeding.

* There is no significant association between demographic variables and

Practices of exclusive breast feeding.

RESEARCH VARIABLES;

[a]. Dependent variable: Knowledge of exclusive breast feeding among primi para

mothers attending to postnatal OPD

[b] Attribute variables: Age, type of family, education, income, and

Occupation.

6.6 OPERATIONAL DEFINITIONS:

Assessment: To estimate the knowledge of prim Para mothers

regarding exclusive breast feeding.

Knowledge: It refers to the correct response of prim Para mothers

giving breast feeding to the child

Practice: The detailed description of breast feeding and maintenance of

health status of child and mother.

Exclusive Breast Feeding: It means giving only breast milk with out

giving water, liquids. Teas, foods, through the first six months of life.

Primi Para mothers: It refers to the mothers who gave birth to child at

first time.

Information guide sheet: It refers to self explanatory information sheet

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prepared by the investigator regarding exclusive breast feeding

importance and purposes and practices.

6.7 ASSUMPTIONS:

The study is based on following assumptions

Most of the primi para mothers may not have adequate knowledge

regarding exclusive breast feeding.

It assumed that primi para mothers may not have adequate knowledge on

practices of exclusive breast feeding.

6.8 LIMITATIONS:

The study is limited to:

* Primi Para mothers giving breast feeding to the child.

* Primi Para mothers who are attending to postnatal OPD

* Primi Para mothers who are available on the day of data

Collection.

* Who are attending to postnatal OPD at district hospital who can

. understand Kannada and English.

*primi Para mothers who are willing to participate in the study.

7. MATERIALS AND METHODS

7.1. Source of Data : Data will be collected from Primi para mothers

who are attending to postnatal O.P.D.

7.2. Method of Collection of Data

7.2.1 Definition of the Study Subject : Primi Para mothers

7.2.2. Inclusion and Exclusion Criteria

a) Inclusion Criteria :

1) Primi Para mothers who are attending to postnatal O.P.D.

at district hospital.

2) Primi Para mothers who are willing to participate in the study

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3) Primi Para mothers who are available on the day of data

collection

4) Primi Para mothers who are attending to post natal O.P.D.

Who can understand Kannada and English

b) Exclusion Criteria :

1) Primi Para mothers who are attending to postnatal O.P.D.

at district hospital.

2) Primi para mothers who are not attending to postnatal OPD

3) Primi para mothers who are not willing participate in the

study

4) Primi Para mothers who are sick/ill.

7.2.3. Research design : Descriptive in nature

7.2.4. Setting : Primi Para mothers who are attending to

postnatal O.P.D. at district hospital.

7.2.5. Sampling Technique : Convenient sample

7.2.6 [a] Sample Size : 100

[b] Duration of the study :

7.2.7 Tools of Research

→ The investigator will asses the socio demographic variables

Such as age, family type, education, income, occupation

cultural believes, place of delivery, delivery conducted by.

→ The investigator will develop structured questionnaire and

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attitude scale to asses the knowledge and practices of primi

para mothers.

→ The investigator will develop and provide an information

guide sheet based on the assessed knowledge and

practices regarding exclusive breast feeding.

7.2.8 Collection Of Data :

The investigator will collect the data by using structured

Questionnaire.

7.2.9 Method of data analysis and Presentation :

a)The investigator will be used descriptive and, inferential

Statistical techniques for data analysis.

b) Descriptive statistics such as frequency, percentage and

standard deviation will be used for analyzing the

demographic variables and knowledge and practices of

exclusive breast feeding.

c) Inferential statistics : chi-square test will be used to

associate the relationship between demographic variables

with the knowledge and practices of exclusive breast

feeding.

7.3. Does the study require any investigation to be conducted on patient or other

human or animals? If so please describe briefly?

Yes, study will be conducted on primi para mothers regarding exclusive breast

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feeding knowledge and practices

7.4 Has ethical clearance has been obtained from your institution in case of 7.3?

→ Yes, informed .Consent will be obtained from concerned subjects and

authority of institution.

→ Privacy, confidentiality and anonymity will be guarded.

→ Scientific objectivity of the study will be maintained with honesty and

impartiality.

8. LIST OF REFERENCES.

1.Field E, Siziva S, etal, Study on Potentials and Barriers in the Promotion of Exclusive Breast Feding ,2008, Nov 5;3 [1];26.

2. Kramer Met al, Study on Promotion of Breast Feeding, Intervention Trial, Journal of the American association, 2001.

3.Kumar D, Agarwal N, Swami H.M, study on Socio Demographic Correlates of Breast feeding, 2006 Nov 60[1]; 461-6

4.Ms.Lakhwinder Kaur, Mahinder Kaur, Study on Importance of Breast Feeding Role of Health Professionals, Indian Journal of Holistic Nursing ,Vol -2,Nnnov-4, 2007,pag-25- 26.5. Lakhwinder kaur, Raman Kalia, etal,Study on Promotion of Breast Feeding Practices, Nightingale Nursing Times, Vol-3,issue-10, 2008, pag-57-58.

6. Monika Kaushal, Rajiv Aggarwal,etal, Study on Breast Feeding Practices and Health Seeking Behavior for Neonatal Sickness in a rural communities, 2005, 51[6];366-376.

7. S.S Prabhudeva, Study on Breast Feeding, Nightingale Nursing Times, Vol-3, issue-5,2007, pag-3.

8. RadhaKrishnan R,Mini Jacob S, etal, Study on Exclusive Breast Feeding Practices 2003,8[1];1066.

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9. Rinda John, , Study on Knowledge, Attitude and Practices of Employed mothers onBreast Feeding, Nurses of India, vol-6, issue-1, 2005, pag-5-6.

10.Sacdev HP, Mehrotra S, Study on Predictors of Study on Exclusive Breast Feeding Practices in early Infancy, 2004, Dec;32[12];1287-96.

11.Mrs v. Selvanayaki, Study on Knowledge, Attitude and Practices of Employed mothers on Breast Feeding , Nurses of India, Vol-9,issue-5,2008,pag-11-12.

12. Suneth b, Agampodi, Thilin C, Agampodi, Study on Breast Feeding PracticesIn a Public Health Field Practice area, 2007.

13. Suraj Gupta,2004, The Short text book of Pediatrics, 10th edi New Delhi,Jaypee Brothers Medical Publishers, pag-113-116.

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9. Signature of Candidate : 10. Remarks of the Guide : The topic selected for the research Study is relevant as because of

knowledge and practices among the mothers about exclusive breast feeding it leading to malnourishment, mortality and morbidities among children.

11. NAME&DESIGNATION OF11.1 GUIDE : Smt. BUELA

H.O.D Department of Community Health Nursing,Indian College of Nursing, Bellary.

11.2 SIGNATURE :

11.3 CO-GUIDE : SUNITHA LECTURERDepartment of Community Health Nursing,Indian College of Nursing, Bellary.

11.4 SIGNATURE :

11.5 HEAD OF THE : Smt. BUELA DEPARTMENT H.O.D Department of

Community Health Nursing,Indian College of Nursing, Bellary.

11.6 SIGNATURE :

12. 12.1 Remarks of the : I discussed with the Principal Research Committee I felt research problem

is good and feasible.

12.2 Signature :

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ETHICAL COMMITTEE CLERANCE

1.TITLE OF THE DISSERTATION : Study to asses the knowledge and practices regarding exclusive breast feeding among primi Para mothers in postnatal opd at district hospital, Bellary .with a view to develop an information guide sheet.

2. NAME OF THE CANDIDATE : Miss UMADEVI .A 1st Year M.Sc.Nursing

Indian College of Nursing Tilak Nagar, Bypass road, Bellary [dist], KARNATAKA.

3. SUBJECT : COMMUNITY HEALTH NURSING.

4. NAME OF THE GUIDE :

5. APPROVED/NOT APPROVED: [If not approved, suggested]

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RAJIV GANDHI UNIVERSITY OF HEALTH SCEINCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION1. NAME OF THE CANDIDATE : Miss. UMA DEVI. A

AND ADDRESS IST YEAR M.Sc. NURSING

INDIAN COLLEGE OF NURSING,

TILAK NAGAR, BYPASS ROAD,

BELLARY – 04

2. NAME OF THE INSTITUTION : INDIAN COLLEGE OF NURSING,

TILAK NAGAR, BYPASS ROAD,

BELLARY – 04

3. COURSE OF STUDY & SUBJECT : IST YEAR M.Sc. NURSING

COMMUNITY HEALTH NURSING

4. DATE OF ADMISSSION : 16/06/2008

5. TITLE OF THE TOPIC : A STUDY TO ASSESS THE

KNOWLEDGE AND PRACTICES

REGARDING EXCLUSIVE BREAST

FEEDING AMONG PRIMI PARA

MOTHERS IN POSTNATAL OPD AT

DISTRICT HOSPITAL, BELLARY.WITH

A VIEW TO DEVELOP AN

INFORMATION GUIDE SHEET.

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