A Study to asSess the effectiveness of stRUCTURED TEACHING PROGRAMME on knowledge & practice regarding Exclusive breast feeding
among post natal mothers in
Govt. dist. Hospital,
tumkur.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Miss G. SUDHA SIROMANI
Obstetrics & Gynaecology Nursing
AKSHAYA COLLEGE OF NURSING
S. I. T. Main Road, Tumkur.
December 2009
RAJIV GANDHI UNIVERSITY OF HEALTH SECIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. Name of the Candidate : G. SUDHA SIROMANI
Address : M.Sc., (N) 1st Year,
AKSHAYA COLLEGE OF NURSING,
S.I.T. MAIN ROAD, TUMKUR
2. Name of the Institution : AKSHAYA COLLEGE OF NURSING,
S.I.T. MAIN ROAD, TUMKUR
3. Course of Study & : M.Sc., (N) 1ST Year,
Subject Obstetrics & Gynaecology Nursing
4. Date of Admission : 5th JUNE 2009
5. Title of the Topic : A Study to assess the effectiveness of
STP on knowledge & practice regarding exclusive breast feeding among post natal mother in Govt. District Hospital at Tumkur.
ETHICAL CLEARANCE CERTIFICATE
(Under Ethical Clearance Committee)
We are hereby granting the permission to Miss.G. SUDHA SIROMANI
1st year M. Sc. (N) Akshaya College of Nursing, Tumkur to conduct the study on Staff Nurses in Government District Hospital, Tumkur.
She has selected the Topic “A Study to assess the effectiveness of structured teaching programme on knowledge & practice regarding exclusive breast feeding among post natal mothers in Govt.Dist. Hospital at Tumkur.
Further she is informed about the following:-
1. She should not disturb the daily routine of the Hospital.
2. She should not harm the study subjects during the course of data collection of intervention.
3. Informed consent should be obtained from the study subjects.
4. She should maintain the confidentiality and anonymity of the subjects and information gathered.
MEMBERS OF THE COMMITTEE
Name Designation Signature.
1. Mrs. Umarani. R.M.Sc.(N) Principal. ……………
Akshaya College of Nursing
2. Mrs. Jalajakshi. B.Sc. L.L.B. Legal Adviser. …………...
Akshaya Education Society
3. Dr. Shobha. S. MBBS.DGO Secretary. ………………
AKshay Education Society
4. Mrs. Seethammal. M.Sc. (N) Asst Professor. ……………..
Akshaya College of Nursing
9. Signature of Candidate
10. Remarks of the Guide
11. NAME AND DESIGNATION OF:
11.1 Guide
11.2 Signature
11.3 Co Guide (if any)
11. 4. Signature
11. 5 Head of the Department:
11. 6 Signature
12. REMARKS OF THE PRINCIPAL
12.1 Signature
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Breast feeding is an important crosscutting component of child survival and maternal health programs. During the first two years of life it can significantly reduce mortality and morbidity. It provides the best health benefits when started immediately after an infant’s birth and continued exclusively for the first six months of life and then continued along with suitable complementary feeding through age two or longer.
During the first six months of life, infants who are exclusively beast fed have one fifth to one sixth the diarrheal mortality and one third to one half the respiratory disease mortality that infants who receive no breast milk will have. Breast milk provides complete nutrition for infants, and its composition changes with time to meet the infants growth needs.1
Breast milk is free from contamination, safe, readily available to the needs of the infants because of its anti infective properties and being free from contaminates the breast fed babies have Low incidence of diarrhoea and acute respiratory infection. There is reduced risk of allergy. 2
According to the WHO infant feeding recommendation exclusive breast feeding should be for the first Six month of life and continued breastfeeding with appropriate complementary feeding six month of age with the introduction of nutritionally adequate safe and appropriate complementary foods in conjunction with continued breast feeding though at least second year of life. Breast feeding should begin immediately after birth or within first hours after birth. Colostrum Produced during the first few days is important as it contains higher consentration of carbohydrates, proteins and antibodies.3
Intervention to prevent child malnutrition should promote age appropriate complementary feeding practices to ensure adequate growth and nutrient intake and reduce the determinental effects of infection and disease.
Breast feeding practices fall short of optimal for many reasons. An estimated 60%. Of births in developing countries are not attended by trained birth attendants, in addition to that they lack access to adequate health care. These mothers rarely receive antenatal or extended post partum health care services that support optimal breast feeding. Many women have incorrect virus about breast feeding. Early cessation of breast feeding in favour of commercial breast milk substitutes, needless supplementation, and poorly timed complementary practices are still common. Professional and commercial influences combined to discourage breast feeding as do continued gaps in maternity legislation.4
In 1991 WHO and UNICEF established the baby friendly Hospital initiative to ensure that maternity clinics encourage optimal breast feeding practices. Butthis initiative fails to reach most of mothers since majority are home deliveries especially in rural areas, amongest the lower socioeconomic, illiterate and ignorant mothers, although breast feeding is common, exclusive breast feeding is not a normal practices.5
In Karnataka only 35.6% of the children are breastfed within one hour after birth, 58% are exclusively breast fed and 73% receive semisolid foods. Mother need support to initiate timely breast feeding and maintain exclusive breast feeding and timely initiate of complementary feeding.6
Several studies have demonstrated counselling to take and effective model, the study was under taken to know the effect of breast feeding on post natal mothers in selected Hospital.
6.1Need for the Study
Breast feeding is a unequalled way of providing ideal food for the healthy growth and development of infant. It has unique biological and emotional influence on the health of both mother and child Breast feeding alone estimated to save an additional one to two million lives if breast feeding practices were improved .”breast feeding was the best ,is the best and will remain the best” as for as infant feeding is concerned.
Data for demographic health surveys and reproductive health surveys show that 90% of children are breast fed – yet only a minority of infants are breast fed optimal ways. In most of the countries less than 50% of infants are breast fed with in one hour of birth, less than half are exclusively breast fed.7
The proportion of infants in who as appropriate complementary feeds are introduced at 6 months is similarly low with global average of 60% in 2002.
Malnutrition has been responsible directly (or) indirectly for 60% of 10.9 million deaths annually among children under age five, two things of these deaths are often associated with in appropriate feeding practices occurring during first year of life. Breast feeding is the most critical intervention in saving infant lives.8
Infants between birth to 5 months of age. Who are not beast fed have seven fold and 5 fold increased risk of death from diarrhea and pneumonities compared with infants who are exclusively breast feed.9
Babies who are breast fed have a lower risk of death both in infancy and in early childhood.
Breast Milk Promotes Healthy (growth and development)
The nutrients in breast milk promote child g&d better than any substitute. The composition of breast milk enables babies to easily digest the nutrients they need. Exclusive Breast feeding for until 6 months as well as longer durations of any Breast feeding appear to promote greater weight gain during infancy and greater gains in height as the child grows. 10
Breast feeding also has protective effect against child hood obesity & other cardiac risk factors. Several recent studies have found better cognitive developments among breast fed children.
Breast feeding can help strengthen the emotional bond between mother and their children, though closeness & connectedness.
Breast feeding protect against certain infectious disease
Both direct and indirect immunological benefit of Breast feeding protect against the 2 most common types of child hood diseases – diarrhoea & acute respiratory infection – as well as against middle ear infectious.11
The early introduction of breast milk substitutes, such as cows milk, into infants diet may increase the risk of child hood onset D.M.
Benefits:-
Breast feeding early, ideally as soon as possible after child birth, can help to expel the placenta reduce blood loss, & speed uterine involution.
One large study found a reduced risk of breast cancers averaging 14% among women who never breast fed compared with women who never breast fed.12
As a national resource, values of mother milk amount to RS. 6500 crores value for diarrhea protection by Breast feeding comes to RS 176 crores & value for fertility control amount to 495/- crores for the nation.13
Factors:-
The maternal factors such as elderly mothers, lower educational status, return to work, lack of support form family & friends insufficient prenatal breast feeding Education, hospital discharge pacts, lack of societal support, television & general magazine advertising have led to the discontinuation of Breast feeding.14
Exclusive Breast Feeding:-
It means Infant receives only breast milk (from mother, a wet nurse (or) expended breast milk) & no other liquids (or) foods. During this period water is also no permitted (the only exception is undiluted syrups, drops of medicine ie. Vitamin drops, antibacterial etc.)15
Baby friendly Hospital Initiative:-
The BFHI is a global UNICEF| WHO sponsored effort to promote breast feeding by assuring that all women are provided with sound intimation regarding their. Infant feeding choices.16
Exclusive Breast feeding should continue for 6 months with complementary feeding beginning at 6 month of age & not before age ever.
Cultural norms, painful breast feeding experiences, separation of mother & baby & lack of appropriate support & information often leads to premature introduction of inappropriate foods before the age of 6 month.
Too early introduction of these liquids & foods & reduced Breast feeding Exposes the infant to harmful pathogen, jeopardizes the infants growth, decreases the mothers breast milk supply & disrupts the birth spacing effect of Breast feeding.17
On the other side of the spectrum, if foods are introduced too late infants may be at risk from limited energy & nutrient intake that can affect their growth, development, & health.
Breast milk is the perfect food for a normal neonate. It is the best gift a mother can give her baby. It contains all the nutrients for the normal growth and development for the baby from the time of birth to the first six months of life.
A number of strategies have been used to promote optimal breast feeding behavior, but most of the effect concentrate only at the time of delivery & at the time of discharge from the hospital.
The investigator felt that it is importance of exclusive breast feeding Among post natal mothers, to gain the knowledge in hospital through STP
6.2 REVIEW OF LITERATURE
A study was conducted in urban Brazil to assess the efficacy of counselor trained in Breast feeding counseling on the rates of exclusive Breast feeding. The results showed that exclusive Breast feeding are was 38% in the intervention group & 35% in the control group.18
A Study conducted at Islamic Republic to assess the effect of Brest feeding. Education on feeding pattern & health of infant revealed that Exclusive Breast feeding Rate was 54% in the intention group with 6.5% in the control group.19
A study was conducted to evaluate the effectiveness of a peer counseling program at king Breast feeding by participant in the mississippi W/C clinics. the results were that the incidence of breast feeding rose from 12.3% to 19.9% in those clinics with peer counseling programs, but only from 9.2% to 10.7% in clinics count the program.20
A study was conducted in Iowa to test the effectiveness of peer counseling on breastfeeding duration. The result revealed that initiation of Breast feeding was 82% in the intervention group compared 31% in the control group. At forth week of postnatal period, 50% of mothers in the intervention group & 10% in the control group were still Breast feeding.21
A randomized controlled trial conducted at Dhaka, Bangladesh revealed that, peer counseling significantly improved breast feeding Practices. The primary outcome that is the prevalence of Exclusive breast feeding at 5 month was 70% for the intervention group & 6% for the control group & for the secondary outcomes, mothers in the intervention group initiated Breast feeding earlier than control mothers & were Less likely to give prolacteal & post lacteal feeds.22
A randomized control trial was conducted on promotion of Breast feeding to assess the effect of Breast feeding promotion on Breast feeding duration & Exclosity & gastrointestinal, Respiratory infection & atopic Eczema. The results showed that exclusive at third & 6th month was 43.3% V/S 6.4% in the intervention & control group respectively.23
In a study conduct at Haryana on the effect of community based promotion of exclusive breast feeding on diarrheal illness & growth, revealed that at 3 month, exclusive breast feeding rates were 79% in the intervention & 48% in the control group, initiation of breast feeding with in 3 hours was 50% in the intervention group & 24% in the control group & administration of pre lacteal feeds was 31% in the intervention group & 75% in the control groups. The 7 day diarrhea prevalence was lower in the intervention than in the control at 3 month & 6 months.24
A study conducted in Scotland to assess the effectiveness of a peer coaching intervention showed that there was significant increase in breast feeding from 34.3% to 41% in the study population at 2 week. After birth compared with a decline in breast feeding the rest of Scotland from 44% to 43.6% breast feeding rates increased compared with base line rates at all points until 8 months.
In a study of mother to mother peer support on optimal breast feeding practices in Peri urban Guatemala city found that the percentage of breast feeding with in one hour was 26% in home visits & 21% in support group , 32% home visits & support group . The Percentage of exclusive breast feeding
was 32% in home visits, 42% in support group 45% in home visit & support group.25
A study conducted on effect of peer counseling on breast feeding Practieces in the community in Belgaum dist Karnataka Showed that initiation of breast feeding with in 30 mts was higher in intervention group compared to control group (41.82% V/S 10.90% P< 0.001) more number of babies in the intervention group received colostrums compound to control group, 65% of the mother in the control group administer per lacteal feeds compared to 20% in the intervention group (P< 0.001) & 72.42% mothers in the intention group practiced exclusive breast feeding at 6 months compared to 25.45% in the control group (P< 0.0000).26
According to the recent evidence published exclusive breast feeding for first 6 months & continued breast feeding for 6 – 11 months could save about 13 to 15% of deaths in children under age 5 year in India which means 3,00,000 deaths could be saved. Appropriate & adequate complementary feeding contributes to 6% reduction in deaths. This is higher than any other intervention. More recent data from rural Ghana shows that breast feeding initiation with in 1 hours helps to reduce 20% of neonatal deaths.27
In a study done on a population of low income, in USA it was found that participants in the peer counselor group exhibited higher rates of exclusive breast feeding than those without the counselor.28
6.3 Statement of Problem :-
“A study to assess the effectiveness of structured teaching programme on Knowledge & Practice regarding exclusive Breast feeding among post natal mothers in Govt. Dist. hospital at Tumkur.”
6.4 Objectives of study
1. To assess the knowledge regarding exclusive breast feeding in post natal mothers in Govt Dt Hospital at Tumkur.
2. To develop & administer STP on exclusive breast feeding
3. To compare the level of knowledge of Post.Natal. Mothers regarding care of exclusive Breast feeding before & after STP.
4. To identity the relationship between knowledge regarding exclusive Breast feeding on postnatal mother of with selected demographic variables.
6.5 Operational Definitions :-
ASSESS:- It is the organized systemic and continues process of collecting data from Post Natal mothers regarding exclusive Breast feeding.
Effectiveness – It is the extent to which an action produces an intended (or) desired outcome. In this study effectiveness refers to the extent to which the STP on exclusive breast feedingas achieved the desired effect inimproving the knowledge of post natal mother as evident from gain in knowledge score.
Structured teaching programme:- It refers to systematically organize teaching strategies for a group of post natal mothers that enhances the knowledge regardingbreast feeding. It consists of meaning, definitions, factors, Benefits of breast feeding associated with pictures.
Knowledge:- It refers to the information (or) understanding gained by a person about a person, fact (or) a thing by experience (or) by any other means.
Breast– It refers theMilk secreting organ in woman. The upper anterior aspect of the chest. The mammary gland secretes milk used for nourishment of the infant.
Exclusive Breast Feeding – “It is defined as an infant consumption of human milk with no supplementation of any type”
Evaluation – It refers to the Post Natal .mother responses to before & after STP regarding breast feeding
6.6 Assumptions:-
-It is assumed that post natal mother may have some knowledge about breastfeeding.
-STP may enhancethe knowledge of post natal mother regarding breastfeeding .
6.7 Hypothesis:-
- The mean post test knowledge scores of post natal mother on knowledge & practices will be significantly higher than their pre – test knowledge scores.
- There will be significant relation ship between selected demographic variables & pre-test knowledge of post natal mother regarding breast feeding ..