Place: Bellary
Date: 09.12.2010
From,
Meenakshi. N,
Ist year M. Sc. Nursing Student,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
To,
The Principal,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
THROUGH PROPER CHANNEL
Respected Sir/Madam,
Sub: Submission and forwarding of synopsis for Registration of
Dissertation topic.
****
In accordance with the subject cited above, I the undersigned studying in Ist year M.Sc. Nursing in Obstetrics and Gynaecology have been allotted the dissertation topic “A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF POSTNATAL MOTHERS REGARDING BREAST FEEDING AT VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY” under the guidance of MRS. SARVAMANGALA, Prof., Dept. of OBG, Sharabeshwara College of Nursing Bellary.
I request you to kindly forward the dissertation topic in the prescribed form to the registrar Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka for Approval.
Thanking you,
Signature of Guide: Yours faithfully,
MRS. SARVAMANGALA. S, PhD (MEENAKSHI. N)
Professor and Head,
From,
The Prof. & Head,
Dept. of OBG,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
To,
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka.
THROUGH PROPER CHANNEL
Respected Sir/Madam,
As per the regulations of the University for Registration of Dissertation topic, the following Ist year M.Sc. Nursing student in Obstetric and Gynaecology has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guides of the department of Obstetric and Gynaecology.
Name / Topic / GuideMeenakshi. N,
Ist year M. Sc. Nursing student,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary. / “A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF POSTNATAL MOTHERS REGARDING BREAST FEEDING AT VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY” / Prof. Sarva Mangala. S, PhD
Dept. of Obstetrics & Gynaecology,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.
Thanking you,
Yours faithfully,
MRS. SARVA MANGALA. S, PhD
Professor,
Dept. of Obstetrics & Gynaecology,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA
PROFROMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the candidate and Address / MEENAKSHI. NM.Sc Nursing 1st year student, Sharabeshwara College of Nursing Bellary.
2 / Name of the Institution / Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
3 / Course of study and Subject / I year M. Sc. Nursing
Obstetrics and Gynaecology Nursing – 1.
4 / Date of Admission / 16 -06 -2010
5 / Title of the Topic / “A STUDY TO ASSESS THE KNOWLEDGE & PRACTICE OF POSTNATAL MOTHERS REGARDING BREAST FEEDING AT VIJAYANAGARA INSTITUTE OF HEALTH SCIENCE, BELLARY”.
6 / Brief Resume of the intended work
6.1 Need for the study
Breast feeding is the normal way of providing young infants with the nutrients they need for healthy growth and development1.
Breast milk the preferred method of feeding a newborn because it provides numerous health benefits to both the mother and infant. It remains the ideal nutritional source for infants through the first year of life2.
The United Nations International Children’s Education Find (UNICEF) describes the need to better promote, support and protect breast feeding world wide3.
The breastfed infant is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health development and all other short and long term out comes4.
In our country child deaths account for two third of total morality, half of the pediatric death (one third total mortality in the population) occurred in infancy, in 1992, the infant mortality rate in India was 79 per 1000 live birth, two fifth of infant death fall in the first month of life and nearly half of them occur in the first week of life5.
Immediately after a normal un medicated delivery the mother and child are wide awake for a longtime. In this situation, the baby is very eager to suck although the baby may get very little milk. Sucking on the nipple causes oxytocin to be released from Pituitary gland and helps the uterus to contract and this may help the delivery of placenta & reduces bleeding6.
The Healthy People 2010 goal for Breast feeding is to increase at least 75% of the proportion of mothers who breast fed their babies in the early post partum period and increase to at least 50% of the proportion of mothers who continue breast feeding until their babies are five to six months old7.
6.2 Review of Literature:
Millennium Development Goal 4 (MDG-4) aims at reducing under – five child mortality by two thirds by 2015. According to global data, out of all 10.9 million under five deaths, roughly 4 million babies die during the first month of life. In India, this means out of 11 lakhs new born (up to 28days) deaths 2,50,000 lives can be saved annually by just this ONE act. This means that deaths will have to be brought down appreciably with first month to a make significant dent on the child mortality rates.
A recent study from rural Ghana, based on 10,947 breastfed singleton infants has shown that if all women began breast feeding within the 1st hour it would save one million of the 4 million newborn deaths. On other hand, there was a marked increase in risk with increasing delay in initiation, overall late initiation (after day one) was associated with a 2-4 fold increase in risk. Giving pre-lactal feeds, that is something other than mother’s milk before beginning to breast feed also increased the risk of neonatal mortality.
The study clearly showed that 22% of all newborn deaths from
0-28days could be reduced. For all countries combined, it was estimated that neonatal mortality could be reduced by 24% if 99% of infants initiated breast feeding on day 1 of life and by 31% if 99% of initiation was within the 1st hour. Numbers of lives saved were estimated to be 8,67,000 and 1,117,000 in these two cases. Initiation of breast feeding within the first hour of birth is thus the first and most vital step towards reducing infant and under-five mortality8.
A Review by Donath et al found that Maternal infant feeding intention was a stronger predictor of breast feeding initiation duration than the standard demographic factors combined. There is evidence to suggest that many women decide how they will feed their babies before they are pregnant or in very early pregnancy and that the earlier the decision to breastfeed is made, the more likely breast feeding will be initiated early. A decision to breast feed made before pregnancy may be even more predictive. In general, breast feeding initiation is closely related to Social class, Income, Education and as stated in the 2003.
Cochrane Meta – analysis interventions used to promote breast feeding, “despite the widely documented health benefits of breast feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups”9.
The World Health Organization (WHO) recommends that all infants be exclusively breastfed from birth to 6 months of age, followed by the gradual introduction of other forms of nutrition and continued breastfeeding into the second year and beyond. In the United States, approximately 70% of women initiate breastfeeding, but by 6months, less than 40% feed their infants any breast milk at all. The US Healthy People 2010 initiative has set objectives that 75% of babies are to be breastfed initially, that 50% receive some breast milk by 6 months of age and that 25% of babies receive some breast milk by 12months of age9.
A case study of Bhavan Singh, it has been observed that breast feed duration varies from one country or geographic region to another. Study in Eldoret Dist. Hospital, Kenya by Esmai et al found only 32% who breast for their children up to 2yr, 33% upto 12 months and 13% stopping at 6 month.
In Bangkok and Bogota the median duration for lactation was less than 7 months. Nairobi exhibited a longer duration of 16 months and in same range, median duration was 20 months. In Latin America and Caribbean only 35% to 60% their children continued being breast fed upto an age of 6 months and with in Latin America in Mexico, frequency of breast feeding has declined notably. A study by Maria et al showed only 34.8% of the study infant breastfed for not more than 1 month10.
Sai Sunil Kishore. M, study was conducted in a rural population of the state to study their breastfeeding practices, knowledge regarding usefulness of breast feeding and factors influencing the breast feeding practices.
Out of the 77 mothers 30% and 10% exclusively breastfed their infants till 4 and 6 months of age respectively. There was “Good attachment” in 42% mother-infant pair and infants were held in “correct position” by 60% mothers. Thirty-nine percent of the mothers had “Satisfactory” Breast feeding knowledge. On multi-variate logistic regression analysis is lack of breast feeding counseling was significantly associated with decreased rates of EBF at 4 months and 6 months and full breast feeding at 6 months of age11.
Madhu K 29th August 2009, Breast feeding practice and newborn care in rural areas. This study was aimed to describe the breast feeding practices prevalent in rural areas. The study was conducted in primary heath centre that is attached to a medical college in Kengeri, rural, Bangalore. Mothers with children who were 9 months old who came to the PHC for measles vaccination were included in the study and data was collected using the pre-tested questionnaire on breast feeding and newborn practices. The study shows 97% of the mothers initiated breast feeding 19% used pre lacteal feeds 90% had hospital deliveries and 10% had home deliveries & 50% used a house knife to cut the umbilical cord among home deliveries. This study emphasizes the need for breastfeeding intervention programmes especially for the mothers during Antenatal and Postnatal check-ups and practices like discarding the Colestrum and early / late weaning are still widely prevalent and need to be addressed12.
Jayanth Deshpande. D Feb.-2009, Socio-cultural practices in relation to breast feeding, weaning among Indian mothers. The study was conducted at Pravara rural hospital Maharasthra. A structured Questionnaire was used to interview 300 mothers of children between age groups 0-5yrs attending Immunization Clinic & Pediatric OPD. Information was collected on socio-demographic characteristics, breast feeding & weaning practices.
There were 61.3% male children & 37.3% female children. Observed that only 43% children could be labeled as normal while 57% fell in various grades of malnutrition.
The critical window of the first five years of life high light the importance of appropriate feeding and weaning practices in infants and toddlers. For most problems related to malnutrition may be tackled by engendering awareness in rural mothers and there by promoting healthy eating13.
Juliff, Dianne Therese 2005 comparison of breast feeding knowledge and of selected adolescent males and females from rural & metropolitan secondary schools. Research has indicated that adolescents hold both negative and positives and have common misconceptions about breast feeding that appear to result from their limited knowledge and reduced exposure to breast feeding. This quantitative descriptive study using a cross-sectional design, involved consenting secondary school students completion a self-report questionnaire. The study employed purposive sampling and included 1845 males and females in both year-9 and year-12 at designated metropolitan and rural secondary schools in 2001.
The study results indicated that overall western Australian adolescent secondary school students have less than ideal knowledge of breast feeding which is consistent with finding from other studies. For both year groups females student had higher breast feeding knowledge scores than male students. With regards to attitude towards breast feeding, students had a tendency for neutral responses to questions14.
6.3. Statement of Problem; Assess knowledge, practice of postnatal mothers regarding breastfeeding VIMS Hospital, Bellary.
6.4 Objectives of the Study:
1. To Assess Knowledge, and Practice of Postnatal mothers
regarding breast feeding.
2. To Find association between Knowledge, and Practice of
Postnatal Mothers regarding breast feeding in selected demographic variables.
6.5 Variables
Independent Variables : - Postnatal mothers age, parity, educational quality.
Dependent Variables :- Knowledge & practice about breastfeeding.
6.6 .Operational Definitions
Assessment: It refers to measurement of knowledge and practice of postnatal mothers regarding breastfeeding.
Knowledge: It is the correct response of the mother to the knowledge items regarding initiation, duration, benefits of breast feeding and techniques of breast feeding.
Expressed opinion of mothers regarding breast feeding as stated in the interview schedule.
Practice: Verbal responses of the mothers to practice items related to initiation, duration of breast feeding and techniques of breast feeding.
Postnatal mother: Mother, period not less than 10 and not more than 28 days after the end of labour.
.
6.7. Assumptions:
1. The mothers will have some knowledge regarding breast
feeding
2. Mothers might be practicing breast feeding.
6.8. Delimitations;
1. Mothers who are feeding in post natal ward
2. Mothers who are willing to participate in the study
3. Mothers who are present during the period of data collection.
6.9 Materials & Methods:
7. / SOURCE OF DATA : Data will be collected from mothers in
Post natal ward at VIMS hospital.
7.1 Method of Collection of data : Through Structured interview schedule
7.2. 1. Research Design : Descriptive design
7.2. 2.Research Approach :
In view of the nature of the problem under study and to accomplish the objectives of the study, Descriptive survey approach was found to be appropriate to describe knowledge and practice of post natal mothers regarding breastfeeding.
7.2.3.Research Setting : VIMS Hospital,
It is a RCH unit consists of 1000 beds, 6 km from Guggarahatti, 300-400 patients month are admitted in Obstetrical ward, 200-300 patients are delivering in this hospital.
7.2. 4.Population : Mothers in post natal ward
7.2. 5. Sample size : 100 mothers who are in the postnatal ward at
VIMS Hospital.
7.2. 6.Sampling Technique ;
Purposive sampling technique, a type of non - probability sampling approach was found to be appropriate for the present study.