A study to evaluate the effectiveness of structured teaching programme of knowledge and practice regarding weaning among mothers of infants (6 months – 12 months) in selected
rural area, Kolar district
Proforma for registration of subject for
dissertation
Vasantha Salla
Pavan college of nursing, Kolar
Rajiv Gandhi university of health sciences,
bangalore, karnataka
Proforma for registration of subject for dissertation
1. Name of the candidate and address / ms. vasanthaA.E. & C.S. pavan college of nurisng, kolar
2. Name of the institution / a.e. & .c.s pavan college of nursing, kolar – 563 101.
3. Course of the study / 1st Year M.Sc (N)
Pediatric nursing
4. Date of admission / 31st June 2007
5. Title of the topic
“A study to evaluate the effectiveness of structured teaching programme of knowledge and practice
regarding weaning among mothers of infants
(6 months – 12 months) in selected
rural area, Kolar district”.
6. brief resume of intended work
Introduction
“The childhood shows the man
As Morning shows the day”
- John Milton
Children constitute a major proportion of the global population today. They constitute the most important and vulnerable segment of our population. They are truly the foundation of a Nation. “A healthy child is a sure future” is one of the themes of WHO. The future of our Nation depends on the way in which we nurture our children today.1
Having a baby at home is a wonderful experience. Looking after the baby and caring for its is an even more fulfilling experience. There are several important stages in infant growth. But one of the most important aspects and often misunderstood stage is that of ‘Weaning’.2
The word ‘Weaning’ is derived from Anglo-Saxon word ‘Wenian’ means to be accustomed to something different. As per UNICEF, weaning is defined as “Systematic process of introduction of suitable food at the right time, in addition to mothers’ milk, in order to provide needed nutrients to the baby. Weaning is the second step for self-existence, the first being cutting of umbilical lord.3 According to WHO, introduction of semisolids and solids should preferably be made when the baby is about 5-6 months of age. The concept of ‘Weaning’ has now changed to ‘complementary feeding’ for the simple reason that, with the introduction of other nutritious food, breast feeding needs to continue for a period of 2 years.4
In the world over 10% of 5.8 billion people are children under 5 years of age, and over 10.5 million deaths occur each year among children of under five years of age.1 Two thirds of these deaths occur during the first year of life and are closely associated with poor breast feeding and poor complementary feeding practices.4 Underweight was estimated to cause 3.7 million deaths. This accounted for about 1 in 15 deaths globally. WHO has estimated that approximately 27% (168 million) of children under five years of age are underweight especially in the weaning and post weaning period of 6 – 24 months.5
Over 10.5 million deaths occur each year among children of under five years of age and 22 percent of these deaths occur in India. This proportion is substantially higher than other countries. Malnutrition in children is widely prevalent in India. It is estimated that 5.7 million children are underweight (moderate and severe) and more than 50 percent of deaths in 0 – 4 years are associated with malnutrition. The most vulnerable period for malnutrition is first 3 years (usually 6 months – 2 years of life).6
In the world, the average infant mortality rate is 51.5 per 1000 live births. Among that our country has the highest infant mortality rate estimated to be about 61.4 per 1000 live births. In Karnataka, the IMR is about 58 per 1000 live births, in rural areas it is 70 per 1000 live births and in urban areas it is 25 per 1000 live births.7
These are preventable through simple timely intervention by proper nutrition and immunization.6 Proper nutrition of children leads to adequate growth and good health is the essential foundation of human development.8
A knowledge of weaning foods and practice is an important aspect of preventive and social pediatrics.7 Hence the knowledge and practice of mothers of infants regarding weaning is very essential to overcome malnutrition and other nutritional deficiency disorders and for the healthy growth of the child.
6.1 NEED FOR THE STUDY
“Today’s children are tomorrows citizens and
a healthy nation makes up a wealthy nation.”
Health is an essential factor for a happy contended life. If children are healthy, future generation will be healthy resulting in a healthy nation. One of the important factors in determining a child’s health is the pattern of his growth and development, which extends throughout his life cycle.6
Nutritional deficiency constitutes a major public health problem in India and other countries of the developing world. In infants and children every year over 50percent of children are undernourished. The most vulnerable period of malnutrition is first 3 years.6
Poor infant feeding practices (IFP) directly or indirectly contribute to under nutrition, morbidity and mortality in infants. The proportion of underweight, stunting and wasting among under 3years children have been reported to 47percent, 45percent and 16 percent respectively at the National level .So, good feeding and weaning practice is an important factor for under 1year of age because weaning period is the most crucial period in child development.8
Infant feeding practices constitute a major component of child caring practices. Despite global efforts for improving maternal and child health and specific efforts like integrated child development services (ICDS), malnutrition among children remains a significant problem in India.
Recent studies have recognized the link between malnutrition and child feeding practices and weaning.8
Dinesh Kumar, Goel, N.K. et al, 2004, conducted a study on “Influence of infant feeding practices on nutritional status of under five children” in urban anganwadi area, Allahabad. The information was collected from 217 mothers of under five children by interview method and nutritional assessment was done i.e., weight for age, height for age, weight for height. The results showed that among 217 under five children, 36.4 percent had underweight, 51.6 percent had stunted growth and 10.6 percent wasted. Proportions of underweight (45.5 percent) and stunting (81.8 percent) were found maximum among children aged 1 – 24 months, wasting was most prevalent (18.2 percent) among children aged 37 – 48 months. They concluded that delayed initiation of breast feeding, deprivation from colostrum and improper weaning are significant risk factors for under nutrition among under five children.8
Singh M.B., Haldiya K.R., et al 1997 conducted a study on “Infant feeding and weaning practices” in semi-arid rural areas of Rajasthan. The findings have been drawn from 328 rural mothers. They practiced weaning at 27 months which not only affects the health status of mothers and their children but also leads to under nutrition. The findings of the study necessitate to evolve an exhaustive educative programme dealing with various aspects of infant feeding and weaning practices.9
Kishore .S , Garg. BS, 1996 conducted a prospective study on “weaning and supplementation practices” among 200 mothers of infant pairs in a rural area of sewagram, India. The results showed that only 2 mothers (1%) began weaning before 4months of age and between 4 and 6 months 76 (38%) mothers initiated weaning, at 6 months 61%. Illiterate women and mothers with a primary school education, multiparas and those living in joint families were most likely to defer weaning until after 6 months. Health education campaigns focused on the importance of exclusive breast feeding for the first 4 to 6 months, followed by the introduction of semisolid foods are recommended.10
Chirmulay. D, Nisal.R, 1993 conducted a study on “Nutritional status of tribal under five children in relation to weaning or feeding practices in Ahmadnagar, Maharashtra. The results showed that among 605 under five children , the weaning was not started till 1 year of age in majority. Health education messages should stress on importance of timely weaning with introduction of solid foods by 6 to 9 months of age, to address the wide spread problem of malnutrition in under five children.11
Based on the above research studies and personal experience in rural area when went for community postings the investigator found most of the under five children are malnourished. So the investigator felt a need to “assess the knowledge and practice of mothers of infants regarding weaning” and to give structured teaching programme and evaluate the effectiveness of it. In India, mothers are the one who wholly and solely takes care of children. So, the mothers should have adequate knowledge regarding weaning in order to reduce the infant morbidity, mortality, malnutrition under weight and for the happy growth of the child. Because nutrition plays a critical role in infant growth and development and it is a key factor to child’s future.12
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process. It refers to an extensive, exhaustive and systematic examination of publications relevant to the research project. Review of literature helps the investigator to develop deeper insight into problem and gain information on the problem and what has been done before. It provides basis for future investigation, justifies the need for replication, throws the light on the feasibility of the study, constraints of data collection, relates the findings from one study to another with a hope to establish a comprehensive body of scientific knowledge.13
A review of literature pertaining to the present study is aimed at “evaluating the effectiveness of structured teaching programme of knowledge and practice regarding weaning among mothers of infants.
The review of literatures consists of the following parts.
1. Literature related to knowledge of mothers regarding weaning.
2. Literature related to practice of mothers regarding weaning.
3. Literature related to different types of weaning foods.
4. Literature related to association of knowledge and practice of mothers with selected demographic variables regarding weaning.
6.2.1 Literature related to knowledge of mothers regarding weaning.
Binns C, Lee A, Wang Y, 2007. conducted a longitudinal study on “Introduction of complementary foods to infants within the first six months postpartum in Xinjiang, China. Information was collected from 1219 mothers. The results showed that after discharge, the overall introduction rates of water, cow’s milk and solid food were 23%, 2% and 6% before discharge, and 76%, 39% and 78% at six months. The rates were different between ethnic groups. Mothers from Uygur and other minorities introduced cow’s milk earlier than Han mothers. Uygur mothers also introduce solid foods earlier (10% pre discharge and 91% by six months) when compared to Han (3% pre discharge and 85% by six months) and other minorities (4% pre discharge and 48% by six months). The pattern of introduction of complementary foods in this region does not follow internationally recognized practices, suggesting the need for further education of parents.14
Walker R.B, Conn JA, Davies MJ, Moore VM, 2006. conducted a longitudinal study on “Mothers views on feeding practices around the time of weaning in Adelaide, South Australia, among 505 pregnant women . The results showed that 14% of women considered cow’s milk as the main drink for weaned infants, majority of women (84%) viewed fruit juice as suitable weaned food, 77% women believed that additives in food could cause health problems in adulthood. Further health promotion effects are needed to achieve greater consistency with recommendations and to address others concerns women have.15
Hasan J, Khan Z, Sinha SN, 1991. conducted a longitudinal study on “Socio – cultural factors influencing nutritional states of infants” in rural area near Aligarh, India. The results showed that among 200 mothers of infants, 50.5% did not give semi solid foods until after 9 months, 20.5% did not give any semi solid food at one year. They thought that semi solid foods causes diarrhea. 62.5% of infants received family food and 5% received biscuits. 98% had poor knowledge about nutritional requirements of infants. Educational status of mothers and fathers was significantly associated with nutritional status. These findings show that inadequate knowledge about proper weaning, not lack of food, is the limiting factor in infant nutrition. Education about the importance of proper weaning imparted by gross root level workers is needed. 16
6.2.2 Literature related to practice of mothers regarding weaning.
Kalanda BF, Verhoeff FH, Brabin BJ, 2006. conducted a comparative study on “complementary feeding practices in relation to morbidity and growth in Malawian infants in U.K. among infants receiving complementary feeding early before 3 months age, with those receiving after 3 months. From birth to 12 months age, weight, length, morbidity and feeding patterns were recorded. The results showed that mean age at introduction of water was 2.5 months, complementary foods 3.4 months and solids 4.5 months. Over 40% of infants had received complementary foods by 2 months and 65% by 3 months. Infants with early complementary feeding had lower weight for age at 3 and 6 months and at 9 months. Early complementary feeding was significantly associated with risk for respiratory infection, while later complementary feeding was associated with reduced infant morbidity and improved growth. Greater emphasis is required to improve complementary feeding practices. 17
Kruger R, Gericke GJ, 2003. conducted a exploratory qualitative study on “feeding and weaning practices, knowledge and attitudes on nutrition” in South Africa. The data collected from mothers of children upto 3 years by interview method, the results showed that solid food was introduced early (2-3 months) and a mixed family diet at 7-9 months. They concluded that inadequate nutrition knowledge and adherence to cultural practices leads to poor quality feeding practices. Nutrition knowledge needs to be changed towards implementing improved feeding practices.18
Savage SA, Reilly JJ, Edwards CA, 1998. conducted a longitudinal study on “weaning practice in the Glasgow, U.K. The results showed that among 127 infants, the median age at introduction of solid food was at 11 weeks, only 7% of infants has not been weaned before 4 months age, 73% of 98 mothers reported that they weaned their babies because they felt that they required more food. They concluded that compliance with recommendations on timing of weaning (not before 4 months) weaning foods, and cow’s milk in Glasgow is poor. Public health message in relation to weaning may not be reaching their target audience.19