RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE - II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / CINTHIYA D’SOUZA
FIRST YEAR M. Sc. NURSING
ALVA’S COLLEGE OF NURSING
MOODBIDRI
MANGALORE – 574227
2. / NAME OF THE INSTITUTION / ALVA’S COLLEGE OF NURSING
MOODBIDRI
MANGALORE – 574227
3. / COURSE OF STUDY AND SUBJECT / 1 YEAR M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION TO THE COURSE / 26.09.2012
5.
6. / TITLE OF THE STUDY
PREVALENCE OF PRELACTEAL FEEDING PRACTICE AND EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF DANGERS OF PRELACTEAL FEEDS, BENEFITS OF COLOSTRUM AND EXCLUSIVE BREAST FEEDING AMONG POSTNATAL MOTHERS IN SELECTED HOSPITALS OF MANGALORE.
BRIEF RESUME OF THE INTENTED WORK
6.1 Need For Study
“Bottles fills his stomach, but Breast Feeding fills his soul”
-Diane Wiessinger
Human milk is specific to human species a dynamic and complex biological fluid containing over 200 active constituent including immune protective agent enzymes, hormones, vitamin, growth and other factors as well as essential nutrient in perfect balance for the growth and development of human infants.1
Breast milk is the nature’s most precious gift to the newborn and equivalent of which is yet to be innovated by our scientific community despite tremendous advances in science and technology. WHO estimates that 1.5 million infant’s lives could be saved each year through increased breast feeding. In India exclusive breast feeding rate at 6 months is only 40%.2
Breast feeding is mother’s privilege and baby’s right. From the beginning of human civilization generation after generation have grown up on mother’s milk, nature’s complete diet for the new born.3 Breast milk is best for the baby. It is best started within half an hour of birth as it gives a protective umbrella to baby right at birth. The practice of giving prelacteal feeds like glucose water, sugar water, honey etc is widely prevalent in rural area. It is .an unhealthy practice as it can cause infection in baby and also delays establishment of lactation. Research revealed that any kind of milk other than breast milk, bottle, nipple poopse are harmful for baby.4
Number of studies has shown protective effect of human milk feed against sudden infant death. Research studies provide strong evidence that human milk feeding decreases infection. Breast feeding as also been related to possible enhancement of cognitive development. Literature shows that in India infant mortality can be reduced by achieving 90% target of exclusive breast feeding in first six months of life.5
Colostrum is a thick,yellowish fluid present in the breast during pregnancy, for about 2 to 4 days after delivery. Though small quantity 40 to 50cc during first 24hours provides an ideal nutrient and immunological substance to help, assure the new born successful transition from sterile uterine environment to non sterile extra uterine environment.1
A case-control study on Role of breast-feeding in the prevention and treatment of diarrhoea in Brazil has shown that young infants who are not breast-fed have a 25-time greater risk of dying of diarrhoea than those who are exclusively breast-fed. The study concluded that health professionals need to understand the skills for the management of breast-feeding, so that mothers are given appropriate advice on how to breast-feed and counteract breast feeding problems.6
A study was carried out with a view to finding out factors influencing prelacteal feeding and its relation to establishment of lactation in rural Bangladesh in early post-partum period on 420 mothers. Prelacteal feeding was given to77% of the babies. Reasons of giving prelacteal feeding and the time of first breast feeding influenced the practice significantly (P < 0.05). Type and duration of prelacteal feeding had significant negative influence on "coming in" of milk (P < 0.05). Prelacteal feeding accounted for 44% of variations incoming in of milk.Prelacteal feeding and coming in of milk formed a vicious cycle, the former delayed initiation of lactation and on the other hand delay in coming in of milk encourage prelacteal feeding. These observation emphasized the need for coordinate efforts for promotion of proper infant feeding practices in rural community.7
A community based cross sectional study on breast feeding practice among840 children under 0-5 years was carried in a slum at Bhavnagar, Gujarat. The finding of study suggested that 61.9%received prelacteal feeds,38.1% received breastfeeding with in 24 hour and 36.9% of newborn received colostrum. The study concluded that prenatal education regarding colostrum and breast feeding wasessential.8
From these studies and statistics given above it is clear that educating the mother regarding danger of prelacteal feeds, importance of colostrum and exclusive breastfeeding is very essential to improve the health and reduce infant mortality rate. Breast feeding reduces risk of diarrhoea. Prelacteal feeds delays initiation of breast feeding. Hence the investigator felt the need to educate the mothers regarding breastfeeding and colostrum and avoidance of prelacteal feeds.
7.
8 / 6.2 Review of literature:-
A descriptive study was conducted to assess the knowledge, attitude and practice of breastfeeding among 50 mothers of under five in Dobhigat,Gavipura urban slum in Bangalore. The finding of study showed that 76.7% of mothers had adequate knowledge in the area of importance breastfeeding, 84% had adequate practice about importance breastfeeding,56% of the mothers gave colostrum. The study suggested that the importance of health education regarding initiation of breastfeeding,position,burping and exclusive breastfeeding .3
A study was conducted for determining the prevalence of prelacteal feeding presenting among 180 mothers in Wandha. The result revealed that43.5% gave prelactealfeeding of which 63% female babies. The study suggested that education especially during antenatal period can reduce the prevalence of prelacteal feeds.4
A comparative study was conducted on determinant of prelacteal feeding on infants of less than one year among 375 mothers was conducted in R.S Pura of Jammu and Kashmir. The study finding revealed that 88% mothers fed their infant with prelacteal feeds. Out of this 89% rural and 84% urban mothers. Income seemed to have significant effect on preference of prelacteal feeds. Low income groups showing lower preference and high income groups higher preference for giving prelacteal feeds. It was seen that preferred prelacteal feed for all social group is honey. The study concluded that a poor knowledge regarding infant feeding practice was prevalent among mothers. Study suggested that communication and transmission of information, motivation, supervision and education contributes in the field of breast feeding.9
A cross sectional study conducted on 270 mothers The study aimed at socio demographic correlates of breast feeding in urban slum of Chandigarh. Out of all 270 respondents, 159 initiated breast feeding with in 6 hours of birth, only 15.9% discarded colostrum and 40% mother gave prelacteal feeds. The study suggested the importance of health education to mothers for protecting and promoting optimal breast feeding practice.1
An analytic survey used to study the infant feeding and weaning practice in some rural areas of Rajasthan among 328 mothers. The study result revealed that 23% mothers initiated breast feeding in 24hours, 77% discarded colostrum and 65.2% mothers gave prelacteal feeds. The finding of study necessitate exhaustive education programme dealing with various aspect of infant feeding.11
A descriptive study to assess the knowledge of 120 mothers from upper socioeconomic status regarding infant feeding practices. The result showed that 57.7% gave prelacteal feeds and initiation of breast feeding delayed by more than 24 hours by 68.3% of mothers. Colostrum was discarded by 53% of mothers .These observation highlights health education in school, college, nonformal gathering and the antenatal period are suggested as means to remove the ignorance.12
6.3 Problem statement:-
Prevalence of prelacteal feeding practice and effectiveness of structured teaching programme on knowledge of dangers of prelacteal feeds, benefits of colostrum and exclusive breast feeding among postnatal mothers in selected hospitals of Mangalore.
6.4 Objectives:-
The objectives of study are to:
·  find the prevalence of prelacteal feeding practices among postnatal mothers
·  assess the pre-test knowledge level on dangers of prelacteal feeding, benefits of colostrum and exclusive breastfeeding among postnatal mothers
·  evaluate the effectiveness of structured teaching programme on dangers of prelacteal feeding, benefits of colostrum and exclusive
breast feeding among postnatal mothers
·  find an association between prevalence of prelacteal feeding practices and selected demographic variables
·  find an association between pre-test knowledge score and selected demographic variables.
6.5 Operational definitions:-
Prevalence: In this study prevalence refers to occurrence of practice of pre lacteal feeding.
Prelacteal feeds: In this study, it refers anything other than breast milk is given to infants from birth to six months is called prelacteal feeds. Example for this is honey, sugar water, glucose water, lactogen, water etc.
Effectiveness: In this study, effectiveness refers to the extent to which structured teaching programme(health education) has achieved the intended results in terms of gain in knowledge score measured by using structured knowledge questionnaire
Structured teaching programme: In this study a structured teaching programme refers to systematically developed teaching programme designed for postnatal mothers to provide information on dangers of prelacteal feeds, benefits of colostrum and exclusive breast feeding.
Knowledge: In this study, knowledge refers to correct responses given by postnatal mothers regarding dangers of prelacteal feeds, benefits of colostrum and exclusive breast feeding.
Benefits: In this study , benefits refers to the advantages of colostrum and breast milk to infants.
Colostrum : In this study, colostrum refers to thick yellowish fluid present in breast during pregnancy and up to 2-4 days after birth
Exclusive breast feeding: In this study, it refers to only feeding breast milk from birth till six months of life.
Postnatal mothers: In this study postnatal mothers refers to women who delivered by vaginal or abdominal route and hospitalised for more than five days.
6.6 Assumptions:-
The study assumes that:
·  postnatal mothers have inadequate knowledge regarding dangers of prelacteal feeds, benefits of colostrum and exclusive breast feeding.
·  structured teaching programme will enhance the knowledge regarding prelacteal feeding, benefits of colostrum and exclusive breast feeding
·  knowledge creates awareness and that in turn promotes practice
6.7 Delimitations:-
The study is limited to:
·  Postnatal mothers who are admitted in the selected hospitals.
6.8 Projected outcome (Hypotheses):-
The study is based on the following hypotheses which will be tested at 0.05 level of significance.
H1: There will be a significant difference between the mean pre-test and post test knowledge scores of postnatal mothers in selected hospitals
H2: There will be a significant association between the pre-test
knowledge scores of postnatal mothers in and selected demographic variables (age educational status, occupation and source of information).
H3: There will be a significant association between prevalence of prelacteal feeding practices and selected demographic variables
MATERIAL AND METHODS:-
7.1 Sources of data:-
Data will be collected from postnatal mothers in selected hospitals
of Mangalore.
7.1.1 Research design:-
The research design used in this study will be pre-experimental (one group
pre test and post test) design.
Subject / Pre-test / Intervention / Post-test
Postnatal mothers / O1 / X / O2
7.1.2 Setting:-
The study will be undertaken on postnatal mothers in selected hospitals
of Mangalore Taluk.
7.1.3 Population:-
The population for this study includes all the postnatal mothers in
selected hospitals of Mangalore.
7.2 Method of data collection:-
7.2.1 Sampling procedure:-
Non probability purposive sampling technique will be used to select the sample for study.
7.2.2 Sample size:-
In this study sample size will be 60 postnatal mothers from
selected hospitals of Mangalore.
7.2.3 Inclusion criteria:-
Postnatal mothers who are:-
·  hospitalised for not less than 5days
·  can read and write english or kannada
·  willing to participate in the study.
7.2.4 Exclusion criteria:-
Postnatal mothers who are:-
·  discharged within 5days.
7.2.5 Instruments used:-
Tool 1: Demographic proforma
Tool 2: Structured interview schedule
7.2.6  Data collection methods:-
·  The investigator will obtain written permission from the concerned authorities or medical officer incharge of selected hospitals.
·  The investigator will introduce herself to the participants.
·  The purpose of the study and method of data collection will be explained to subjects.
·  Informed consent will be obtained from subjects.
·  Data will be collected for six weeks.
·  On the first day pre-test knowledge will be measured by administering structured interview schedule followed by providing teaching programme.
·  Post test will be conducted after six days of teaching programme using the same structured interview schedule.
7.2.7 Data analysis plan
·  Demographic data will be analyzed using frequency and percentage.
·  Knowledge score will be analyzed by computing mean, median, mean percentage and standard deviation.
·  The mean pre-test and post-test knowledge score differences will be analysed by applying paired‘t’ test.
·  Chi- square test for finding association between
·  the pre-test knowledge score and selected demographic variables.
7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals?
Yes, the investigator needs to assess the knowledge of postnatal mothers on dangers of prelacteal feeds, benefits of colostrum and exclusive breast feeding and also to administer structured teaching programme after getting the informed consent from them.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance is obtained from the research ethical committee of concerned institution
List of reference:-
1)  World Health Organisation Wellstart International Lactation Management Level1 2009. Available at http://www.wellstart.org. Accessed Jul26.
2)  Manjula AK. Role of father in breastfeeding. Nightingale Nursing Times 2011 Aug.7(5):57-60
3)  Savitha SV. Practice of breastfeeding among mothers in an urban slum. Nightingale Nursing Times 2011 Aug.7(5):63-64
4)  Jagzape T, Lokare A, Vagha J, Bhavana B, Lakhkar. Prevalence of prelacteal feeding practice in Waradha and effect of antenatal education on it. Doctors Corner 2011Mar.
5)  Kaur L, Kaur M. Importance of breast feeding: role of health professionals. Indian Journal of holistic nursing 2007 Mar.2(4):25-28
6)  Huffman SL, Combest C. Role of breast-feeding in the prevention and treatment of diarrhoea. Journal of diarrhoeal disease research 1990 Sep.8(3):68-81

7)  Ahmed FU, Rahman ME, Alam MS. Prelacteal feeding: influencing factors and

relation to establishment of lactation. Bangladesh Med Res Council Bulletin 1996 Aug.22 (2):60-6

8)  Raval D, JankarDV,Singh MP.A study of breast feeding practices among infants.HealthlineISSn2229-337X 2011 Jul-Dec.2(2)

9)  Raina KS, Mange V, Singh G.Determents of prelacteal feeding among infant RS pura black of Jammu and Kashmir. Journal of family medicine and primary care2012 Dec6(1):27-29
10) Kumar D, Aagrawal N, Swami HM. Socio demographic correlates of breast feeding slum of Chandigarh. Indian journal of medical science2006 Nov60(11):461-6
11) Singh MB, Haldiya KR, Lakshminarayan J. The infant feeding and weaning practice in some arid rural areas of Rajasthan. Journal Indian Medical Association 1997Nov95(11):576-90
12) Singhania RU, Kabra SK, Bensal A. Infant feeding practice in educated mother from upper socio economic status. Indian Paediatric 1990Jun77(6):591-9


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