Rajivghandiuniversity of Health Science

RAJIVGHANDIUNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Breast-feeding is the ideal form of infant feeding and is crucial for life long health & well being. It provides unique nutritional, immunological, psychological & child spacing benefit.

Baby friendly hospital initiative (BFHI) was launched in 1992 as part of the ‘innocenti declaration’ on promotion, protection & support of breast-feeding by WHO & UNICEF. Baby friendly hospitals are required to adopt a breast-feeding policy to confirm to its ten steps for successful implementation of breast-feeding. The ten steps refers 3 main aspects

1) Written policy to all health care staff.

2) Training of all health care staff

3) Information the mothers regarding exclusive breast-feeding. 1

The BFHI was started in 12 leading countries in 1992. These countries were Bolivia, Brazil, Cote d’Ivorie, Egypt, Gabon, Kenya, Mexico, Nigeria, Pakistan, Philippines, Thailand and Turkey. According to the UNICEF by end of 1994 there were 300 hospitals certified as Baby friendly hospital in these countries. The initiative spread to other countries from 1993 onwards, and now it has spread to 171 countries in the world.. From January to December 1996, the number of baby friendly hospitals has doubled.

The BFHI was initiated in India with focus on the metropolitan cities initially and than spread to whole country. In India, BFHI has picked up towards early 1995. The number of hospitals certified baby friendly hospital has increased from 103 in December 1994 to 604 in December 1995 and 1040 in December 1996. This also included the smaller hospitals (less than 250 deliveries in a year) from kerela and Tamilnadu.2

An infant (0-1yrs) constitutes 2.92% of the total population in India. Of the 140 million children born each year in the world. Although the chances are survival of these new borns has improved by 50% in the last 20years, the first few hours, days and months of there live are still an obstacles race. From the time of birth 20-30% of babies are under weight. That makes them vulnerable to infection and disease. About 50% of total infant mortality occurs in the first months of life. One out of four surviving children received neither the quality nor the quantity of food needed to replace the substances provided by mother’s milk.3

A study shows that, the naval hospital Italy, which contains a level one nursery, made an effort to develop breast feeding support programme, with a goal of educating mothers about breast feeding and encouraging them to continue feeding up to 6 months. In this study the Breast Feeding counselor met each new mother who desired to breast-feeding and during this visit she observed and evaluated each mothers feeding technique. Discharge following up via telephone conducted weekly for 4 weeks, 3 months and 5 months, post – partum revealed that 86.7% of mothers initiated breastfeeding and 51.4% continued breast feeding for 5 to 6 months.4

Lack of knowledge regarding exclusive breast-feeding among the mothers their children suffers. Mostly infection during the infancy due to lack of immunity. This leads to high infant mortality rates in India. The investigator felt & need for the study to make aware the nurses about the BFHI policy implication in their practices. So, the nurses can guide the mothers for exclusive breast feed to their infants.

6.2 NEED FOR THE STUDY

Breast-feeding is the normal method of infant feeding, but many people choose to feed their newborn babies on infant formula. While babies grow & develop with their method of feeding, there is evidence of disadvantages for infants that are not breast-feeding & for their mothers.

A Hmong American friendly association (HAFA) report on 1998 state that, breast feeding apart from being best way of providing nourishment to infants, it is also a natural birth spacing method. As a result for those who do not breast feed, menstruation returns within 2 to 3 month of delivery. 5

The role of the perinatal nurse is successful promotion of breast-feeding also includes knowledge of breast-feeding. Lack of knowledge and inconsistent advice may result in a negative experience for the mothers. Nursing knowledge should encompass the anatomy and physiology of lactation, management of common concerns and problem with breast-feeding. And the benefits of breast-feeding. Finally providing information to the patient regarding breast-feeding resources in the community at the time of hospital discharge is essential for the patient to access as necessary

.

A study was done on breast - feeding pattern in an urban colony of Delhi in 1998 revealed that the breast feeding patterns of mothers of 650 infants was maintained at high level (>90%) through out infancy while exclusive breast-feeding showed a rapid decline. The investigator described that at one month 74%, & at 4 Month 46% of the infants were exclusively breast-feed. She also noted that the time interval between birth and first breast-feed was 24 to 48 hours in most 48.9% of infants & the majority of infants 79.9% received pre- lacted feeds. It is therefore important that exclusive breast-feeding needs to be promoted by educating mothers during pregnancy & lactation.6

In India, according to the countrywide data of the National Family Health Survey 1998-99 (NFHS-2), only 55 % of children at two moths of age are exclusively breastfeed, 23 % receive breast milk plus water and 20 %t receive supplements along with breast milk. Only 24 % put the baby to breast within half an hour after birth and another 20 % only after 24 hours. A large number squeezed the first milk thinking it to be dirty (looking like pus because it is yellowish). The percentage of children exclusively breastfed drops steadily from 72 % for children under one month of age to about 20 % who are six months old, the period during which exclusive breastfeeding is recommended by WHO and UNICEF. However, breastfeeding generally continues even into the second year of a considerable number of children 92% babies are still being breastfed at 12 months and 59 % even at 2 years.7

The investigator as a pediatric nurse observed the limited implication of BFHI policy in the hospitals. It was felt that due to lack of implication of BFHI policy by the nurses, mothers of the babies sometimes due to ignorance other infant formula rather than breast milk give during the second day of delivery, which are harmful for the babies. Hence, the investigator felt the need to assess the knowledge of staff nurses regarding BFHI policy & how far they are implicated to their hospitals to guide the mothers for the breast-feeding. Thus it was expected that a study would help in developing better understanding & provide baseline data on the existing practices of the BHFI policy of the nurses.

6.3 STATEMENT OF THE PROBLEM

A study to describe the knowledge of staff nurses regarding the implication of baby friendly hospital initiative (BFHI) policy in pediatric and obstetric ward in selected hospitals at Bangalore.

6.4 OBJECTIVES

1. To describe the demographic variables.

2.To assess the staff nurses knowledge regarding the BFHI policy.

3. To associate the knowledge with the selected demographic variables.

6.5 OPERATIONAL DEFINITION

1. Knowledge:It refers, to verbal response given by staff nurses regarding 10 steps of BFHI policy (written policy to health staff, training of staffs, information to pregnant mothers regarding exclusive breast feeding, infant and mother together 24 hours etc.)

2. Staff Nurse:All the staff nurse who registered and provide care to the needs of nursing mothers & their new born in the obstetric unit & pediatric unit of selected hospitals Bangalore.

3. Implication: It refers to the extent to which BFHI policy is put into practices by the staff nurses evidenced by scores obtained by them on knowledge of the ten steps of BFHI policy.

4. BFHIpolicy: Baby friendly hospital initiative (BFHI) was launched in 1992 as part of the ‘innocenti declaration’ on promotion, protection & support of breast-feeding by WHO & UNICEF. It includes (written policy, training, information, exclusive breast feeding, technique of breast feeding, feed on demand, mother and child room in etc)

6.6 ASSUMPTION

1) BFHI policy must be implemented to all maternity and paediatric

units to promote protect & support on breast-feeding.

2) Staff nurses have adequate knowledge on BFHI policy, even then

which extent they practices these policy?

3) Establishment of these policies in their practicing area will promote

on breast-feeding.

6.7 NULL HYPOTHESIS

HO1-The staff nurses have inadequate knowledge regarding the

implication of BFHI policy.

HO2-There is no significant association of the knowledge level of staff

nurses regarding BFHI policy with selected demographic

variables.

6.8 REVIEW OF LITERATUE:

An important aspect of research literature review is to make sure what is already done in relation to the problem of interest. Several studies which have been conducted in relation to breast feeding and BFHI policy may enlighten several aspects breast feeding which needs more focus for the development of future studies.

A study was conducted among 450 pregnant women to investigate whether antenatal breast-feeding education or postnatal lactation support improves the rates of exclusive breast-feeding compared with routine hospital care. The outcome of the study was breast feeding education and postnatal lactation support, as single interventions significantly improved the rates of exclusive breast feeding up to six months after delivery. In this Postnatal support was marginally more effective than antenatal education.8

A study was conducted on 741 healthy postpartum women in maternity hospitals in Moscow regarding the ten steps of BFHI Policy. It was shown that practices could increase breast-feeding rates as well as maternal satisfaction. It is also recommended that BFHIs pay attention to maintaining adherence to the criteria of the 10 steps of the baby friendly hospital initiative.9

A randomized control trial Study was conducted to determine whether infants of women randomized to a prenatal and postpartum lactation support intervention cure fewer otitis media disease than control the disease.338 sample has taken (163 for intervention group and 175 for control group) in two urban community health center. The result shown there was a significant interaction between treatment and Medicaid, among those not recived Medicaid, the number of otitis media was higher among controls groupintervention group infant recived more breast milk than controls group. So, for those ottitis media is reduced than who have less breast feed.10

A cohort study conducted in the area in 1988 regarding to evaluate the impact of training based on the baby friendly hospital initiative breast feeding practices in maternity wards and during the first 6 months of life. The study was done on nursing auxiliaries and midwives were trained at two institutions (A&B ) in palmers state. The results show the training promoted partial change to some practices related to breast feeding, having positive effect on total and exclusive breast feeding at the maternity wards.11

An observational study done to examine the effect of the baby friendly hospital initiative on breast-feeding rates in Scotland. 33 maternity units with over 50 births per annum and; 464,246 infants born in Scotland between 1995 and 2002 are participants. The result shows being born in a hospital that held the award increase the chance of being breast fed.12

A cohort study was done the aim was to investigate the effect of breast feeding on asthma and sensitization to airborne allergens among children up to 4 years of age. 4089 children’s are participants. the result shown that exclusive breast feeding for 4 months or more reduced the risk of asthma at the age of 4 years 95%.13

A comparative study done to compare the growth and illness pattern of infants who were exclusive breast fed for 6 months with those of infants commenced on complementary feeding before the age of 6 months and ascertains reasons for the early introduction of complementary feeding. The result concluded that exclusive breast-feeding supported adequate growth during the first 6 months of life for most of the infants studied. Early introduction of complementary foods did not provide any advantages in terms of weight gain in our environment; it was frequently associated with illness episodes and growth faltering. Many mothers however require support, encouragement and access to health care providers to breast feed exclusively for the first six months of life.1

A cluster randomized trails study was done to assess the effects of breast-feeding promotion on breast-feeding duration and exclusively and gastrointestinal and respiratory infection and atopic eczema among infants. A total 46 mother-infant pairs consisting of full-term singleton infants weighing at least 2500gms and their healthy mothers who intended to breastfeed, 16491 (96.78) of which completed the entire 12 months of follow-up. The result of infants from the intervention sites were significantly more likely; than control infants to be breastfed to any degree at 12 months (19.7%vs 11.4%) were more likely to exclusive breast fed at 3 months (43.3%vs 6.4%) at 6 months (7.9 %vs0.6%) and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs13.2%) and of the actopic eczema (3.3%vs6.3%) but no significant reduction in respiratory tract infection.15

A study was conducted in 1998 in faziabad, where assessed the practices of breast-feeding where very popular. The mothers of 340 under five children were selected for this study, which revealed that the frequency of breast-feeding was found 10.26+_ 2.45 times in a day. The mean time breast-feeding by the urban mothers was significantly higher than their rural parts. But illiterate & rural mothers due to economic reasons breast-feed practiced for longer duration.16

A recently published coherence systematic review examined the effectiveness of report for breast-feeding mothers reported in 34 trails & involving 29,385 mothers across 14 countries. The author concluded that additional professional support was effective in prolonging way of breast feeding but effect of exclusive breast feeding were less.17

A coherence systematic review examined the effect of child health and on maternal health, of exclusive breast-feeding for 6 months versus introduction of complementary food with breast-feeding for 6 months. The author found that, infants who are exclusive breast feed for 6 months experience less morbidity from gastrointestinal infection than those who are mixed breast feed as of 6 months.18

7. MATERIALS AND METHOD

7.1 SOURCES OF DATA

Staff nurses working in K C G hospital and Indira Gandhi hospital Bangalore.

7.2 METHODS OF DATA COLLECTION

i) Research design

Non-experimental.

A descriptive approach is used to assess the knowledge of staff nurses

ii) Research Variables

Study variables: knowledge of the staff nurse regarding the BFHI policy implication.

Demographic Variables: Designation, qualification, ward, years of experience in month, training of BFHI, duration of training.

iii) Setting

The study will be conducted in pediatric and obstetric units in KCG hospital and, pediatric unit in Indira Gandhi hospital Bangalore.

iv) Population

All staff nurse working in pediatric and obstetric ward in K C G hospital and all staff nurses working in pediatric unit in indira Ghandi hospital Bangalore.

v) Sample

All staff nurse who fulfill the inclusion criteria are considered as sample and the sample size is – 60

vi) Criteria for sample selection

Inclusion criteria: -

1. Staff nurses working in obstetric and pediatric unit in K C G hospital,

and staff nurses working in pediatric unit in indira Gandhi hospital

Bangalore.

2. Having minimum 1-year’s experiences in pediatric and obstetric

ward.

Exclusion criteria:-

The study excludes the staff nurses who are

1. Unwilling to participate.

2. Not available at the time of data collection due to leave and night shift

vii)Sampling technique

Sampling technique adopted for selection of sample is non-probability, convenient sampling.

viii) Tool for data collection

The structured interview scheduled consist of following section

Section A – To assess demographic data.

Section B – Questionnaire of staff nurses on to assess the level of staff nurse knowledge on BFHI policy.

ix) Method of data collection:

After obtaining the permission form hospital authorities the investigator will obtained informed concerned from the staff nurses personally in the pediatric and obstetric ward in selected hospitals. The investigator personally assess the knowledge of staff nurses regarding BFHI policy by using structured interview scheduled per day approximately 5- 6 staff nurse will be interviewed.

Duration of study: 4- 6 weeks

x) Plan for data analysis:

The data collected will be analyzed by means of descriptive statistics, & inferential statistics.

Descriptive study frequency, percentage distribution of demographic variables and mean, standard deviation will be used for level of knowledge.

Inferential statistics chi- square test is will be used to associate the level of knowledge and selected demographic variables.

xi) Projected outcomes

After the study the researcher will know the level of knowledge of staff nurses regarding implication of BFHI policy in the pediatric and obstetric wards, which will help the investigator to develop a leaflet on importance of BFHI policy which will cover following aspects

1. A written breast-feeding policy circulated to all health care staff.
2. Training all health care staff in skilled necessary to implant the policy.
3. Inform all pregnant women about the benefit of breast-feeding.
4. Encourage the mother’s initiative breast-feeding within a half hour of normal delivery and 4 hours after caesarian delivery.
5. Showing the technique of breast-feeding.
6. Encourage exclusive breast-feeding.
7. Keep mothers and infant 24 hours together a day.
8. Breast-feed on demand of the child.
9. No artificial teats/ Pacifier should be give.
10. On discharge refers the mothers to foster group.

7.3 Does the study require any investigation or intervention to the patient or other human beings or animal?