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(Volume3, Issue8)
Available online at: www.ijarnd.com
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:
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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
K.V.M. College of Nursing
Cherthala
Ms. Jeena Jose
Senior Lecturer
Obstetrics and Gynecologic Nursing
K.V.M. College of 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
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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
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CONTENT
CHAPTERS PAGE NO
1 INTRODUCTION
2 REVIEW OF LITERATURE
3 METHODOLOGY
4 ANALYSIS AND INTERPRETATION
5 SUMMARY AND DISCUSSION
BIBLIOGRAPHY
APPENDICES
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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
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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
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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
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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
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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,
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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.
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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
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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
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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
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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%
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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
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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)
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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
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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
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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
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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.
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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
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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
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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
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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.
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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
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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
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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)
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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)
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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
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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
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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
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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
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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)
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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
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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)
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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
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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)
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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
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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
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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)
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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)
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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,
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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.
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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
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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
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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.
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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.
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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
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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
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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
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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.
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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
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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.
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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
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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
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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
40.6% were primi para mothers.
Figure4.8: Pie diagram showing distribution of samples by
obstetrical score
59.4%
40.6%
Primi gravida
Primi para
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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
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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
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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%
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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
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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
exclusive breastfeeding.
Figure4.12 : Pie diagram representation of knowledge score
46.67%
53.33%Less than median
More than median
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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
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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
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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
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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
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TABLE 4.16: ASSOCIATION OF KNOWLEDGE WITH
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
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TABLE 4.17: ASSOCIATION OF KNOWLEDGE WITH
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
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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
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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
The above table 4.18 shows that the obtained value is more than the table
value, so there is significant association between knowledge score and
monthly income at 0.05 level of significance. Hence hypothesis is accepted
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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
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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
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TABLE 4.21: ASSOCIATION OF KNOWLEDGE WITH
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
The above table 4.21 shows that the obtained value is more than the table
value, so there is significant association between knowledge score and previous
information at 0.05 level of significance. Hence hypothesis is accepted.
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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
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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 .
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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
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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.
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The study was conducted among 180 primi gravida and primi para
mothers without age imitation by using structured interview schedule regarding
exclusive breastfeeding.
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
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
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
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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
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More than half of the samples, 59.4% were primi gravida mothers and
40.6% were primi para mothers.
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.
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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
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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
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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
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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.
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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
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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
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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
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be improved by motivating them and. assist the primi mothers in practicing
exclusive breastfeeding.
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
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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
exclusive breastfeeding.
7. A study can be conducted to assess the attitude of working mothers
towards breastfeeding .
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BIBLIOGRAPHY
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BIBLIOGRAPHY
1. Abrahams , S .W., & Lababok, M. H. (2009). Exploring the impact of the
Baby-Friendly Hospital Initiative on trends in exclusive breastfeeding. International
Breastfeeding Journal, 4 ,11.Retrived from
http://www.internationalbreastfeedingjournal.com/content/4/1/11
2. Al.Sahab,B., Lanes,A., Feldman,M., &Tamim,H. (2010). Prevalence and
predictors of 6-month exclusive breastfeeding among Canadian women: a national
survey. BMC Pediatrics, 10, 20 . Retrieved from.
http://www.biomedcentral.com/1471-2431/10/20
3. Beasley, A., Amir, L.H. (2007). Infant feeding , poverty and human
development. International Breastfeeding Journal , 2.14. Retrieved from
http://www.biomedcentral.com/1746-4358/2/14
4. Biancuzzo, M. (2003). Breastfeeding the Newborn Clinical strategies for
Nurses. (2nd ed). Missouri: Mosby Publishers.
5. Blackburn,S.T.(2003).Maternal, fetal and neonatal physiology - A clinical
perspective . Phildelphia: W.B Saunders
6. Cernadas, J.M.C.,Noceda,G., Barrera, L., Martinez, A.M., & Garsd,A. (2004).
Maternal and perinatal factors influencing duration of exclusive breastfeeding during
first six months of life. Journal of human lactation, 19(2),136-144.
7. Chopra, S.,& Walia, I.(2008).Promotion of breastfeeding with special
reference to the role of counselors. Nightingale Nursing Times. , 32(1),48-52.
8. Chudasama, R.K., & Amin, C.D. (2009). Prevalence of exclusive
breastfeeding and its determinants in first 6 months of life. A prospective study.
Journal of Health and allied Sciences, 8(1),1-7
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 91
9. Creasy, R.K.(2009). Resnick’s Maternal – Fetal Medicine .(6th ed ). China:
Saunder’s Elsevier
10. Cunningham ,F.G.,Lenevo,K .J., Bloom,S.L.,Hauth, J.C .,Gilstrap,L.C., &
Wenstrom ,K. D.(2005).Williams Obstetrics .(22nd ed).New York:Mc.Graw-Hill.
11. Dadhich J.P.,(2009).The World breastfeeding Trends Initiatives : Where does
India stand ?.Nightingale Nursing Times .5(5).4-8.
12. Dadhich, J.P., & Agarwal, R K.,(2009). Mainstreaming Early and Exclusive
Breastfeeding for Improving Child Survival. Indian Pediatrics , 46,11-17.
13. Daftary, S.N.,& Chakravarthy, S.(2011).Manual of obstetrics .(3rd ed). New
Delhi: Elsevier
14. Dashti, M., Scott, J.A., Edwards, C.A., & Al-Sughayer, M. ( 2010).
Determinants of breastfeeding initiation among mothers in Kuwait. International
Breastfeeding Journal,5,7.Retreved from
http://www.internationalbreastfeedingjournal.com/content/5/1/7
15. Duijts,J., Jaddoe,V.W.V., Hofman,A., & Moll, H.A. (2010). Prolonged and
Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy.
Pediatrics, 126( 1), e18-e25.Retrieved from
www.pediatrics.org/cgi/doi/10.1542/peds.2008-3256
16. Dutta, D.C. (2004).Text Book Of Obstetrics (6th ed). Culcutta: New Central
India Limited.
17. Edmonds, D.K. (2007) Dewhurst’s textbook of Obstetrics and Gynecology.
(7th ed).USA: Black well publishing.
18. Fewtrell,M .,Wilson ,D.C.,Booth, I., &Lucas, A., (2011).Six months of
exclusive breast feeding: how good is the evidence? British medical journal,
342,c5955. Retrieved from BMJ 2011; 342:c5955
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 92
19. Fraser, D.A., & Cooper, M.A. (2009). Myles Textbook for Midwives. (15th ed).
Philadelphia: Churchill Livingstone Elsevier Publishers.
20. Ghai, O. P., Paul, V. K.,& Bagga, A. (2009). Essential Pediatrics. (7th ed).
New Delhi: CIS publishers &distributers Pvt. Ltd.
21. Harder, T., Bergmann, R., Kallischnigg. G, & Plagemann.(2005). Duration of
Breastfeeding and Risk of Overweight: A Meta-Analysis. American journal of
Epidemiology, 162 (5), 397-399. Retrieved from aje.oxfordjournals.org
22. Hay, W.W., Levin, M.J., Sondherimer, J.M.,& Deterding, R.R. (2009).
Current diagnosis & treatment Pediatrics. (19th ed).New York: Mc Graw Hill.
23. Henderson C.,& Macdonald, S.(2004) .Maye’s Midfery. A textbook for
Midwifes. (13th ed). Edhinburg: Bailliere Tindall.
24. Hockenberry, M.J., &Wilson, D. (2009).Wong’s Essential Pediatric
Nursing.(8th ed). Missouri : Mosby.
25. Innocenti Declaration .(2005). On Infant and young Child Feeding, complete
report. Accessed 5/29/2010
26. Ip, S., Chung, M. Raman ,G. Chew, P., Magula, N., DeVine, D., Trikalinos.,
T.& Lau, J. ( 2007). Breastfeeding and maternal and infant health outcomes in
developed countries. Evidence report/technological assessment ,Retrieved from
pubmed.gov.
27. Kameswararao, A.A. (2004). Breast feeding behavior of Indian women.
Indian Journal of Community Medicine, 29 (2). 62-64.
28. Kansal, S. (2011) .P1-452 Breastfeeding practices in India: a survival analysis.
Journal of Epidemiology and Community Health, 1(65),A192. Retrieved from
http://jech.bmj.com/content/65/Suppl_1/A192.3.
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 93
29. Kaur, B., Emmanuel ,A.,& Mahal, R. ( 2011). Assessing Knowledge, attitude,
and practices of mothers regarding Breast feeding . Health action, 24 (1), 31 -33.
30. Kaur, L., Kalia,R .,Walia, I.,&Chopra ,S. (2008).Promotion Of Breast feeding
Practices. An observational study in hospital setting. Nightingale Nursing Times,
32(4), 57-59
31. Khassawneh ,M., Khader, Y. ,Amarin ,Z. & Alkafajei, A. (2006).
Knowledge, attitude and practice of breastfeeding in the north Jordan: a cross-
sectional study. International Breastfeeding Journal, 1,17
32. Kothari, C.R.( 2004). Research Methodology Methods and Techniques. (2nd
ed). New Delhi: New age International Publishers.
33. Kramer M.S. (2006). Promotion of breastfeeding intervention trial: A
randomized trial in the Republic of Belarus. Journal of the American Medical
Association, 285(4), 413-420 Retrieved from
34. Kramer, M.S., & Kakuma, R. ( 2006). Optimal duration of exclusive
breastfeeding. Cochrane Database of Systematic Reviews, 1, Retrieved from
http://www.who.int/child-adolescent-health.
35. Kramer,M.S ., Aboud,F., Mironova ,E., Vanilovich,I., Platt, R. W.,& Matush,
L. et al .( 2008). Breastfeeding and Child Cognitive Development New Evidence
from a Large Randomized Trial. Archives of General psychiatry,. 65 (5),578-584.
Retrieve from http://archpsyc.ama .org
36. Kulkarni,R.N., Anjenya,S., & Gujar,R. (2004). Breast feeding Practices in an
Urban Community of Kalamboli, Navi Mumbai. Indian Journal of Community
Medicine, 2(4), 179-180
37. Kumar, R.( 2004). Exclusive breastfeeding Every child’s first right . Health
action,17(1),35-37
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 94
38. Lauwers,J .,&Swisher, A. (2005). Councelling the Nursing Mother- A
lactation consultant’s guide .( 4th ed). Massachusetts: Jones and Bartlett publishers.
39. Littleton L.Y., Engebretson,J.C. (2007).Maternity Nursing care.
( 1st ed). India: Thomson Delmar learning.
40. Lowdermilk, D.L.,& Perry,S.E.(2004). Maternity and Women’s Health. (8th
ed). Missouri. Mosby Publications.
41. Mahajan B.K(1997).Methods in Biostatistics.(6th ed).New Delhi: Jaypee
brothers medical Publications (P) limited .
42. Marcdante, K., Kliegman, R.M., Jenson H.B., &Behrman R.E. (2011). Nelson
Essential Pediatrics (6th ed). Philadelphia: Saunders.
43. Marild,S., Hansson, S., Jodal,U., Oden A. , & Svedberg,K.(2004) Protective
effect of breastfeeding against urinary tract infection. Acta Paediatrica Scandinavia,
93(2) ,164-168. Retrieved from http://www.cirp.org/library/disease/UTI/marild4/
44. McKinney, E.S., James S.R., Murray, S.S.,& Ashwill W.J. (2009) Maternal –
Child Nursing. (3rd ed). Missouri: Saunders Elsevier.
45. Merewood,A., Mehta,S.D. , Chamberlain, L.B .,Philipp ,B.,&
Bauchner,H.(2005).Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a
National Survey. Pediatrics, 116,628-634
46. Moore,T. , Gauld, R., & Williams, S.( 2007). Implementing Baby Friendly
Hospital Initiative policy: the case of New Zealand public hospitals. International
Breastfeeding Journal, 2,8
47. Nancy ,B., & Susan K.G.,(2009).Understanding Nursing research (3rd ed)
Philadelphia : W.B. Saunders company .
48. Nayak , B M .(2009). Breastfeeding problems and management. Health
action, 22(8),37-38
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 95
49. Nigam, R., Nigam, M., Wavre, R.R., Deshpande, A., &Chandorkar, R.K., (
2010) Breastfeeding practices in baby friendly hospitals of Indore. Indian Journal of
Pediatrics , 77(6), 689-690f
50. Nirmala, V., Edison, J. S., & Sumi M.S. (2011). Research methodology in
nursing Kochi: Jaypee Brothers Medical Publishers.
51. Oddy, W.H. (2000) Breastfeeding and asthma in children: findings from a
West Australian study .Breastfeed Review, 8(1),5-11. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/10842574
52. Olang,B. , Farivar, K. , Heidarzadeh A., Strandvik, B.,& Yngve, A. (
2009). Breastfeeding in Iran: prevalence, duration and current recommendations.
International Breastfeeding Journal , 4,8 . Retrieved from
http://www.internationalbreastfeedingjournal.com.
53. Orshan,S.A.(2007).Maternity , Newborn& Women’s Health nursing.
Comprehensive care across life span. Philadelphia: Lippincott Williams and
Wilkins.
54. Park.K(2010) Textbook of preventive and Social Medicine. (21st ed ) New
Delhi: Bhanarsidas Bhanot publishers .
55. Phatak ,A. (2010).The Ten Steps And Baby Friendly Hospital Initiative .
Nightingale Nursing Times.6 (5). 3,33-34.
56. Pillitteri, A. (2010). Maternal and Child Health Nursing .(6th ed).
Philadelphia: Lippincott Williams and Wilkins Publishers.
57. Plenge-Bönig,A., Soto-Ramírez,N., Karmaus,W. Petersen, G., Davis,S.,&
Forster,J.(2010). Breastfeeding protects against acute gastroenteritis due to rotavirus
in infants . European Journal of Pediatrics , 169( 12), 1471-1476. Retrieved from
http://www.springerlink.com/content/w472g47w58k12x20/
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 96
58. Polit, D. F., & Hungler., B.P. (2000) Nursing Research Principles and
methods. (6th ed). Philadelphia: Lippincott publishers.
59. Polit, D.F., & Beck, C.T. (2010). Nursing Research Generating and
Assessing Evidence for Nursing Practice. (8th ed). New Delhi: Lippincott
Williams and Wilkins.
60. Prabhudeva ,S.S(2010).World Breastfeeding Week :1-7August , 2010.
Nightingale Nursing Times .6(5),1.
61. Qiu , L., Zhao, Y., Binns, C.W., Lee, A. H., & Xie, X. ( 2009). Initiation of
breastfeeding and prevalence of exclusive breastfeeding at hospital discharge in
urban, suburban and rural areas of Zhejiang China . International Breastfeeding
Journal, 4,1. Retrieved from http://www.internationalbreastfeedingjournal.com
62. Quiley, M.A., Kelly,Y.J.,& Sacker, A.(2007). Breastfeeding and
Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom
millennium Cohort study. Pediatrics , 119,e837.Retrieved from
http://pediatrics.aappublications.org/content/119/4/e837.full.html
63. Rao, K.( 2011). Text book of Midwifery – Obstetrics for Nurses (1st ed).
Kolkata: Elsevier.
64. Ricci,S.S.(2007). Essentials of Maternity Newborn and Women’s Health
Nursing. (1sted). Philadelphia: Lippincott Williams & Wilkins.
65. Rudan,I., Boschi-Pinto,C., Biloglav,Z., Mulholland,K., & Campbell,H.
(2008). Epidemiology and etiology of childhood pneumonia. Bulletin of the World
Health Organization ,86,408–416. Retrieved from scileosp.org .
66. Sarah Yang,(2004) New analysis links breastfeeding to reduced risk of
childhood leukemia .26 October 2004. Retrieved from
http://berkeley.edu/news/media/releases/2004/10/26_breastfeeding.shtml
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 97
67. Shailaja ,K.G.(2008). A study to assess the knowledge and confidence of
primipara mothers regarding exclusive breastfeeding in postnatal units of selected
hospitals of Belgaum, Karnataka. Nightingale Nursing Times, 32(1), 29-32
68. Shailaja, U., & Veena, K.H .(2009). Golden tips for breastfeeding. Health
action, 22(8),36
69. Sharma, S. K. (2009). Nursing Research Statistics. (2nd ed). Philadelphia :
Elsevier Publishers.
70. Stuebe, A.M., Willet, W.C., Xiu, F., &Michels, K.B. (2009). Lactation and
Incidence of Premenopausal Breast Cancer .A Longitudinal Study. Archives Internal
Medicine, 169(15),1364-1371.Retrieved from www.archinternmed.com.
71. Swain, D. ( 2010) Knowledge and practice of colostrums feeding among
postnatal mothers. Nightingale Nursing Times, 5 (11),52-55
72. Syamalan, K. (2006).Statistics in Medicine.(1st ed). Trivandrum; Global
Education Bureau.
73. Thompson, E.D.(1997). Introduction to Maternity and Pediatric Nursing.
(2nd ed). Philadelphia : WB Saunders Company.
74. Tiwari, R. (2009). The determinants of exclusive breastfeeding in urban
slums: a community based study. Journal of Tropical Paediatrics, 55(1), 49-
54.Retrived from Medline
75. Tomey, A.M., & Alligood, M .R.(2006).Nursing Theorists and their work. (6th
ed). Missouri: Mosby Elsevier.
76. Tylleskär ,T ., Jackson, D., Meda, N. ,Engebresten I.M.S.,Chopra, M.et al.
(2011). Exclusive breastfeeding promotion by peer counselors in sub-Saharan Africa
(PROMISE-EBF): a cluster-randomised trial. The Lancet, 378, 420-427.Retrieved
from http://www.thelancet.com
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 98
77. UN’s message to mothers: breastfeeding can save your baby’s life,
( 2011 August 1). WHO NEWS CENTRE
78. UNICF. (2006). Celebrating the Innocenti declaration on the Protection,
promotion and support of breastfeeding Past achievements, present challenges and
priority actions for infant and young child feeding. (2nd ed). Italy: UNICEF
Innocenti Research Centre.
79. Vafaee, A., Khabazkhoob, M., Moradi,A., & Najafpoor,A.A. (2007).
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. Journal of Applied Science,10, 343-348. Retrieved from
http://scialert.net/abstract/?doi=jas.2010.343. 348
80. W .H .O .(2006). Infant and Young Child Feeding Counselling: An Integrated
Course ,Participants manual. Switzerland: Department of Nutrition for Health and
Development.
81. Ward, S. L., & Hisley, S.M. (2010). Maternal Child Nursing Care
Optimizing Outcomes for Mothers, children and families. ( 1st ed ). New
Delhi : Jaypee Brothers medical publishers
82. Yadav ,R.J., Singh, P. ( 2004). Knowledge, attitude and practices of mothers
about breastfeeding in Bihar. Indian Journal of Community Medicine, 29(5),130-131
Web sites
83. http://www.who.int/nutrition/topics/exclusivebreastfeding.
84. pagingdrgupta.blogs.cnn.com/.../new-study-supports-exclusive-breastfeeding-
for-first-six-months/
85. www.cochrane.org/reviews/en/ab003517.html -
International Journal of Advance Research and Development
© 2018, www.IJARND.com All Rights Reserved Page | 99
86. www.medline.com
87. www.ncbi.nlm.nih.gov/pubmed/
88. www.scialert.net/fulltext/?doi=jas.2010.343.348&org=1
89. www.unicef.com
90. www.who.com
91. www.pubmed.com
92. www.wileyonline library.com
93. www.bfhi.org
94. www.mdconsult.com
95. www.nursingconsult.com
96. www.worldbreastfeedingweek.org
97. www.medscape.com/
98. www. international breastfeeding journal.org
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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
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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
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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
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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
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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
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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?
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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
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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
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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
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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
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SELF INSTRUCTIONAL MODULE
PREPARED BY
Chinchu Mohan
M Sc Nursing Student
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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 ?
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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.
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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
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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
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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
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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.
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All mothers should breast feed their babies. This will ensure healthy future of
your baby.