RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. / Name of the candidate and address / DHANYA L.FIRST YEAR M.SC. NURSING
S. C. S. COLLEGE OF NURSING SCIENCES
K. E. C. T. TOWER
ASHOKNAGAR POST
MANGALORE – 575 006.
2. / Name of the Institution / S. C. S. COLLEGE OF NURSING SCIENCES
ASHOKNAGAR
MANGALORE – 575 006.
3. / Course of study and subject / M. Sc. NURSING,
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / Date of admission to the course / 15.6.2009
5. / Title of the study:
A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME REGARDING BABY FRIENDLY HOSPITAL INITIATIVE AMONG PRIMIPARA MOTHERS ADMITTED IN A SELECTED HOSPITAL AT MANGALORE.
6. / BRIEF RESUME OF THE INTENDED WORK
Introduction
“A newborn baby has only three demands. They are warmth in the arms of its mother, food from the breasts, and security in the knowledge of her presence; breastfeeding satisfies all three”.
Grandly Dick-Read.
Childbirth represents a major developmental rate of passage in a women’s life. The experience of giving birth and becoming a mother affects every aspect of her existence. Her entire identity is transformed. Childbirth is a pivotal experience that deserves a place of honour in a women’s life and in the society.
Breastfeeding is the feeding of an infant or young child with breast milk directly from human breasts. Human breast milk is the healthiest form of milk for human babies1.
Adequate nutrition during infancy is essential for lifelong health and wellbeing. The rate of growth of the infant during the first 6 months of life is greater and faster than any other period of life; keeping this in mind the baby should be nursed adequately2.
Even though we are living in 21st century, our community is not aware of the food which should be recommended during infancy.
The Baby Friendly Hospital Initiative is a worldwide programme of the World Health Organisation and UNICEF, launched in 1991 following the Innocenti Declaration of 1990. The initiative is a global effort for improving the role of maternity services to enable the mother to breastfeed babies for the best start in life.3
6.1 Need for the study
“The solution to adult problems tomorrow depends on large measure upon how our children grow up today”
Margaret Mead
Malnutrition is responsible directly or indirectly for about one third of deaths among children under five. Well above two-third of these deaths are often associated with inappropriate feeding practices during the first year of life.4
More than one million infants worldwide die every year because they are not breastfed or given other foods early. Although the magnitude of death and disease is far greater in the developing world, thousands of infants in the United States suffer the ill effects of the infant formula feeding culture5.
The National Family Health Survey-3 published in late 2006 said only 24.5% of new mothers initiated breastfeeding in the first hour after birth; 46.4 % breastfed exclusively during the first 6 months; and a slightly more encouraging 56.7% nursed beyond 6 months with the introduction of complementary food. But nearly half of underfive children were underweight6.
The solution, according to WHO, is simple as it is natural. Early initiation of breastfeeding, it says within an hour after birth should bring infant mortality rate down by 22%. Breastfeeding alone contributes to 11.6% reduction of infant mortality rate if coverage of population is 99 percent through one to one group counselling6.
A January 2006 series on infant mortality and malnutrition that was published in the medical journal Lancet said nearly 77% (1.06 million) child deaths attributable to suboptimal breastfeeding are due to non-exclusive breastfeeding during the 0-6 months of life6.
A study done by Breastfeeding Promotion Network of India (BPNI), New Delhi suggested that the main stumbling block is the lack of support for mothers from the family, society and medical fraternity. Mothers are also asked to throw away the immune property-rich colostrum or the first milk. Elder women in the family who dictate infant feeding practices cite inadequate breast milk supply and encourage mothers to switch to infant milk substitute.6
A study was conducted for “assessment of the impact of implementation of the baby friendly hospital initiative. The data provides a population based initiative in the urban area of Montes Claros. The increase in exclusive breastfeeding was achieved, from 25% to 40% in each of the first 5 postpartum months7.
There is some evidence that the implementation of the ten steps to successful breastfeeding of the Baby Friendly Hospital Initiative can increase breastfeeding. Although implementing each step by itself has some effects8. Hence, the investigator felt that there is a strong need to educate primipara mothers regarding implementing the baby friendly hospital initiative policies with minimal cost, within a short period with maximum effectiveness.
6.2 Review of literature
A study was conducted to determine the impact of Baby Friendly Hospital on trends in exclusive breastfeeding. The study used a country level data to examine the relationship between Baby Friendly Hospital Initiative programme and trends in exclusive breastfeeding in 14 developed countries. The findings revealed statistically significant upward trends on exclusive breastfeeding under 2 months and under 6 months. Baby Friendly Hospital Initiative implementation was associated with average annual increase of 1.54 % points in the rate of exclusive breastfeeding of infants under 2 months and 1.11% points in the rate of exclusive breastfeeding of infants under 6 months. However, these rates were not statistically different from Baby Friendly Hospital Initiative trends9.
A cross-sectional survey was conducted in Cambodia from December 2005 to February 2006 to investigate the present status of infant feeding practices and identify factors that affected exclusive breastfeeding practices during the first 6 months. Three hundred and twelve mothers with children aged 6 to 24 months participated in the study. The result showed that 83% of the mothers fed breast milk exclusively in the first month, whereas 51.3% continued exclusive breastfeeding in the first 6 months, 39% of mothers began breastfeeding within 30 minutes after delivery. The findings helped to identify some important factors affecting exclusive breastfeeding practices in the study area.10
A cross-sectional, descriptive study was conducted in 2003 to investigate the relationship between adherence to six of the Baby Friendly Hospital Initiative steps to successful breastfeeding and the duration of breastfeeding in first time mothers. Kaplan Meier Curves and Cox Proportional Hazard Model were used to interpret the data. Three hundred and seventeen women who had given birth to their first baby in a large teaching maternity hospital in Adelaide, south Australia participated in the study. The findings revealed that women whose babies received a bottle feed, used a pacifier or dummy, or who used nipple shield during their post natal stay, were at significantly greater risk of weaning (P<0.05). After adjusting the demographic variables, self-efficacy, intended duration of breastfeeding, and method of delivery, the results unexpectedly showed that the only significant predictor of early weaning was breastfeeding on demand.11
A questionnaire survey was conducted in 2003 in Taiwan to examine the association between number of Baby Friendly Hospital practices experienced by mothers and breastfeeding initiation during hospital stay. A total of 2079 mothers participated in the postal questionnaire survey. The study population consisted of mothers who gave birth to infants without congenital anomalies. The results revealed that only 1% women reported experiencing all 10 steps of the practice, while 5.7% women did not report experiencing any baby friendly practices. Mothers who delivered at certified Baby Friendly hospitals experienced more 10 steps practices. This study found a close response relationship between the number of 10 step practices and their experiences regarding breastfeeding. The findings of this study highlighted the need for greater attention to implement the 10 steps12.
A descriptive study was conducted in the United States in 1999 to explain the relationship among breastfeeding knowledge, breastfeeding confidence and infant feeding plans and their effect on feeding practices in first time breastfeeding mothers. Eighty-three first time mothers revealed that breastfeeding knowledge was strongly correlated with breastfeeding confidence (r= 0.262, P=0.025) compared with women planning to exclusively breastfeed their infants, those planning for combination feed planned shorter breastfeeding duration (P=0.022). The study concluded that expectation and the actual breastfeeding experience differed among women planning to combination feed and those planning to exclusively breastfeed.13
National Institute of Public Cooperation and Child Development, New Delhi (2003) conducted a survey. This reported the strengths and weaknesses of policies and programmes to promote, protect and to support optimal feeding practices. The study found that 55% of children in India were exclusively breastfed for the earlier recommended period of 4 months. Children in Kerala and several states in the North Eastern region were most likely to receive timely complementary feeding. Bottle feeding infant was common in Goa (63%), Delhi (41%) and Tamilnadu (34%). There is no separate policy for infants and young children, therefore efforts were made to incorporate policy of breastfeeding in existing policy or programmes of the government protection and promotion of appropriate breastfeeding.14
A study was conducted to evaluate breastfeeding and weaning practices in relation to nutritional status of infants of tea garden workers of Assam. Information about current status of breastfeeding and weaning practices were obtained from mothers of 110 infants, using pre-tested questionnaire. The results showed that 16.36% of mothers were literate and 100% breastfeeding rate was maintained throughout 0 to 12 months. Exclusive breastfeeding rate was 69.35% up to 6 months of age. Infants’ length and weight were measured using standard procedures and methods. Prevalence of underweight, standing and wasting was lower (22.6%, 32.3%, 8.1% respectively) in 0-6 months age compared to those of 6- 12 months (64.6%, 41.7%, 39.6 %). Exclusive breastfeed has to be promoted due to beneficial effect on growth and development of infants.15
6.3 Statement of the problem
A study to assess the effectiveness of planned teaching programme regarding Baby Friendly Hospital Initiative among primipara mothers admitted in a selected hospital at Mangalore.
6.4 Objectives of the study
1. To assess the pre-interventional knowledge on Baby Friendly Hospital Initiative among primipara mothers.
2. To conduct a planned teaching programme on Baby Friendly Hospital Initiative among primipara mothers.
3. To find the effectiveness of planned teaching programme on Baby Friendly Hospital Initiative among primipara mothers in terms of gain in post-test knowledge scores.
4. To find the association between pre-test knowledge scores with selected demographic variables.
6.5 Operational definitions
1. Effectiveness: In this study, effectiveness refers to determining the extent to which the planned teaching programme has achieved the desired effect and is measured in terms of gain in post-test scores of primipara mothers.
2. Planned teaching programme: In this study, planned teaching programme refers to the systematic teaching programme on Baby Friendly Hospital Initiative for primipara mothers which includes the concept of breastfeeding and the steps of Baby Friendly Hospital Initiative.
3. Baby Friendly Hospital Initiative: In this study, Baby Friendly Hospital Initiative means ; to:
a. inform women about the benefits of breastfeeding.
b. teach women about breastfeeding.
c. help women to initiate breastfeeding within 1 hour of birth.
d. exclusive breastfeed.
e. practice rooming- in.
f. encourage breastfeeding on demand.
g. give no artificial teats or pacifiers.
4. Primipara mothers: In this study, primipara mothers refers to the women who have undergone vaginal delivery for the first time with a healthy viable newborn.
6.6 Assumptions
The study assumes that:
1. Primipara mothers will have lack of knowledge regarding Baby Friendly Hospital Initiative.
2. Planned teaching programme will enhance the knowledge of primipara mothers regarding Baby Friendly Hospital Initiative.
6.7 Delimitations
The study is delimited to
1. primipara mothers admitted to the selected hospital at Mangalore
2. Primipara mothers who are able to understand Kannada or English.
6.8 Hypotheses
All hypotheses will be tested at 0.05 level of significance.
H1: The mean post-test knowledge score of the primipara mothers will be significantly higher than their mean pre-test knowledge score.
H2: There will be significant association between the pre-test knowledge scores and selected demographic variables.
7. / Material and methods
7.1 Sources of data
Primipara mothers who are available in a selected hospital of Mangalore.
7.1.1 Research design
One group pre-test post-test design:
Pre-test / Administration of PTP / Post test
O1 / X / O2
O1 - Administration of structured interview schedule on Baby Friendly Hospital Initiative.
X - Conducting planned teaching programme on Baby Friendly Hospital Initiative.
O2 - Administration of structured interview schedule on Baby Friendly Hospital Initiative on
7th day of planned teaching programme.
7.1.2 Setting
The study will be conducted in the selected hospital of Mangalore.
7.1.3 Population
Primipara mothers who are admitted to the selected hospital of Mangalore.
7.2 Method of data collection
7.2.1 Sampling procedure
Samples will be selected by purposive sampling technique.
7.2.2 Sample size
In this study, sample size will be 30 primipara mothers admitted to the selected hospital of Mangalore.
7.2.3 Inclusion criteria
Primipara mothers,
1. who have undergone vaginal delivery.
2. who are willing to participate in the study.
3. who are able to understand Kannada or English.
7.2.4 Exclusion criteria
1. Primipara mothers who have undergone caesarean section.
7.2.5 Instruments intended to be used
Structured interview schedule developed by the researcher.
7.2.6 Data collection method
Prior to data collection permission will be obtained from the concerned hospital authority for conducting the study. Subjects will be selected according to the selection criteria of the study. First, pre-test knowledge will be measured by a structured interview schedule. Planned teaching programme will be administered to the primipara mothers. After 7 days of the planned teaching programme, post-test knowledge will be measured by the same structured interview schedule.
7.2.7 Data analysis plan
Collected data will be analyzed by descriptive and inferential statistics.
7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals?
Yes, a planned teaching programme on Baby friendly Hospital initiative will be administered to the primipara mothers.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance will be obtained from the ethical committee of the institution.
List of references
1. Breastfeeding-suckling and nursing are synonyms. [Online]. Available from: url:http//en.wikipedia.org/wiki/breast_feeding.
2. Dutta DC. Textbook of obstetrics. 5th ed. Calcutta: New Central Book Agency (P) Ltd.; 2001.
3. Park K. Textbook of preventive and social medicine. 17th ed. Jabalpur: M/s. Bhanarsidas Bhanot Publishers; 2002.
4. WHO: Promoting proper feeding for infants and young children. [online]. Available from: URL:http://www.who.int/nutrition/topics/infant_feeding/en/index.html.
5. Baby-Friendly USA: The Baby-Friendly Hospital Initiative. [online]. Available from: URL:http://www.babyfriendlyusa.org/eng/docs.2009.
6. Ramalingam K. Mother and child. India Together. [online] Available from: URL:http://www.indiatogether.org.
7. Caldeira PA, Gonsalves E. Assessment of impact of implementation of the BFHI. Journal of Paediatrics. 2007;83(2):127-32.
8. WHO: Evidence for the 10 steps to successful breast feeding. [online] Available from: URL:http://whqlibdoc.who.int/publications/2004/9241591544_eng.pdf.2004
9. Abrahams WS, Labhok HM. Exploring the impact of the BFHI on trends in exclusive breast feeding. International Breast Feeding Journal 2009 Oct;4(11):1186.
10. Sasaki Y, Ali M, Kakimoto K, Saroeun O, Kanal K, Kuroiwa C. Predictors of exclusive breastfeeding in early infancy: A survey report. Journal of Paediatrics Nursing 2009 Jul;4(10):1010-16.
11. Pincombe JB, Baghurst PB, Peat B. Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first time mothers. Journal of Midwifery 2008 Mar;24(1):55-61.
12. Chien YL, Tai JC, Chu HK, Ko LY. The number of Baby Friendly hospital practices experienced by mothers is positively associated with breast feeding: A questionnaire survey. IJONS 2007;44(7):1138-46.
13. Chezem CJ, Friesen C, Boettcher J. Breastfeeding knowledge, breastfeeding confidence and infant feeding plans: Effects on actual feeding practices. JOGNN 2003;32(1):40-7.
14. Institute of Public co-operation and child development. Documentation Centre on Women and Children Research Bulletin 2004 Oct-Dec;4:26-8.
15. Medhi KG, Mahanta J, Breastfeeding, Weaning Practices and Nutritional Status of infants of tea garden workers of Assam. Indian Paediatrics 2004 Dec; 41:1277-79.