RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE.

proFORMA FOR REGISTRATION

of

SUBJECT FOR DISSERTATION

MS. asha susan varghese

1ST YEAR M. Sc. NURSING

obstetricS and gynaecological nursing

2012-2014

SEA COLLEGE OF NURSING

K.R PURAM, BANGALORE – 49

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDTE AND ADDRESS / MS. ASHA SUSAN VARGHESE
1ST YEAR M.SC. NURSING
SEA COLLEGE OF NURSING,
BANGALORE- 49
2 / NAME OF THE INSTITUTION / SEA COLLEGE OF NURSING
3 / COURSE AND SUBJECT / M.Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 29-06-2012
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE ON BREAST FEEDING INITIATION AMONG RURAL WOMEN ADMITTED IN SELECTED HOSPITALS, BANGALORE WITH A VIEW TO DEVELOP SIM”

6.0 BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY

“Every newborn must receive the very first food first!

- World Health Organization

Breast feeding is a mother’s privilege and a baby’s right. From the beginning of human civilization, generations after generation have grown up on mother’s milk, nature’s complete diet for the newborn. Nothing can compare with the breast milk which is a living substance containing enzymes and antibodies specifically designed to protect the infant’s very vulnerable body system. Research conducted worldwide indicates that babies who are not on breast milk are 25 times more susceptible to disease.1

WHO recommends early (i.e. within one hour of giving birth) initiation of breastfeeding. A recent trial has shown that early initiation of breastfeeding could reduce neonatal mortality by 22%, which would contribute to the achievement of the Millennium Development Goals. Globally, over one million newborn infants could be saved each year by initiating breastfeeding within the first hour of life. In developing countries alone, early initiation of breastfeeding could save as many as 1.45 million lives each year by reducing deaths mainly due to diarrheal disorders and lower respiratory tract infections in children.2

In many parts of the world, the rates of early initiation of breastfeeding are extremely low i.e. 17% in Eastern Europe and Central Asian countries and 33% in Asia-Pacific. The highest rates (about 50%) are in Latin America, the Caribbean, East and North Africa.

Global incidence shows that optimal breastfeeding is the most important child survival intervention and the earlier the baby is breastfed, within the first hour of birth, the better. Only 25 percent of mothers in the country initiate breastfeeding within the first hour after birth. In Rajasthan it is 14 percent, while in Bihar and Uttar Pradesh it is 4 and 7 percent. The Government of India and international organizations recommend that infants be fed only breast milk for the first six months of life, with no other foods or fluids added and not even water.3

Breast feeding is a rich traditional practice in Indian society. Many social moral and mythological practices are attached to it. Breast feeding should be initiated within the first hour of birth. The first milk or colostrum is the most suitable food for the new born. Customs, superstitions, traditions and ignorance deprive the baby from getting this benefit.4

A UNICEF 2007 report states that India has close to 25 million children born every year. Out of these 1.4 million children die just within one year and roughly one million babies die within one month, mainly due to poor care and inappropriate infant feeding practices. Only 23.4% of new born across the country begin breast feeding within one hour of birth.5

Less than half (43 per cent) of newborns in the developing world are put to the breast within one hour of birth (2006-2010). Regional averages range from a high of 54 per cent in Eastern and Southern Africa to a low of 39 per cent in South Asia and West and CentralAfrica

Source: UNICEF global databases 2011, from Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other national surveys.6

The benefits of breast milk are incalculable and incomparable. It is a complete mix of nutrients & antibodies. Varying composition of breast milk keeps pace with the infant’s individual growth and changing nutritional needs, prevents many gastro-intestinal disorders in infants and reduces the risk of breast, ovarian, cervical, and endometrial cancers in mothers. It also helps in delaying the return of fertility and spacing of subsequent pregnancies. Breast fed infants typically need fewer sick care visits, prescriptions, and hospitalizations with reduced health care costs.7

A total of 420 new mothers were interviewed in a low-income rural Mississippi community to determine the incidence, predictors, attitudes, and practices of breast-feeding initiation. The result showed that Ninety-six women (24%) initiated breast-feeding (More whites 44% than blacks 20%). Of those 96.59% planned to breast-feed for <6 months and 38% for 6 to 12 months. These findings show that Breast-feeding rates in the Mississippi Delta are low, especially among blacks and suggested the need for effective education programs to increase these rates.8

A cross sectional study was conducted among 291 children in the age group of six months to two years in Salem district, Tamil Nadu. The result showed that 60.5% initiated breast feeding within half an hour after delivery. Various demographic factors like the education of the mother, type of delivery, type of family, occupation, number of children, monthly income, family size, age at marriage and religion had a direct influence on exclusive breast feeding, which in turn influenced the weight of the baby and immune status of the child.9

A community-based study was conducted on 1050 mothers with infants younger than 24 months to examine breast feeding and infant feeding practices in rural areas of Central Karnataka in India. The result showed that only 3 infants (0.3%) were offered breastfeeding within 1 hour after delivery. By 72 hours post-delivery, 90.9% of infants had begun breast feeding. All infants had received prelacteal feeds and 28.6% of mothers discarded the colostrum. The exclusive breast feeding rate was 94% at 1 month, 83.5% at 2 months, 72.5% at 3 months, and 61.2% at 4 months. 97% of infants were ever breast fed. These findings show that rural mothers in Central Karnataka delay initiation of breast feeding and reject the colostrum.10

A study was conducted to assess the current breastfeeding knowledge, attitude, and practices of 310 mothers in five rural communities in the Savannah region of Nigeria. One hundred and sixty-two (52.3 per cent) mothers were illiterate while 148 (47.7 per cent) had either primary or secondary school education. Apart from giving babies colostrum, which was seen more amongst mothers with higher levels of education (p < 0.001), other practices such as exclusive breastfeeding, demand feeding, 'rooming-in', and time of first breastfeed were not influenced by the mother's level of education. Fifty-four percent of mothers did not give their babies colostrum. Only 28.6 percent of babies were breastfed within 24 hours of birth. The mean time after birth for the first breastfeed was 47.7 hours. Although breastfeeding is widely practiced, none of the babies were exclusively breastfed, and prelacteal feeds ranging from water, formula, or herbal tea were given by all the mothers. The practice of discarding colostrum and replacing it with a wide range of prelacteal feeds and late initiation of breastfeeding has implications for health education programmes and neonatal feeding strategies.11

During the clinical experience, the researcher observed that the rural postnatal mothers were reluctant to breastfeed their newborns within one hour due to deep rooted beliefs.

The researcher is hence interested to explore the knowledge and attitude of rural women regarding breast feeding initiation.

6.2 REVIEW OF LITERATURE

1) Studies related to breast feeding initiation

A prospective study was conducted to examine the prevalence of colostrum feeding and time of initiation of breast-feeding in 143 rural Bangladeshi women. The result showed that Fifty-nine per cent of mothers initiated breast-feeding within 4 hours, and 88% within 12 hours of parturition. The percentage of mothers who fed their child Colostrum was higher, and times to initial breast-feeding were shorter, than almost all previous reports from South Asia. These findings suggested that recent changes towards earlier initiation of breast-feeding have taken place in rural Bangladesh.12

A prospective cross-sectional study was conducted to assess the breast feeding initiation and prevalence from birth to 6 months among 401 Irish-national and forty-nine non-Irish-national mothers in Infants University Hospital, Dublin. The result showed that breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47 % and 79.6 %, respectively. Factors associated with breast-feeding initiation were age of 35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breastfeeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation. The studies concluded that the breast-feeding initiation and prevalence rates of the Irish-national population remained low and lagged considerably behind national and international targets and the study suggested that inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland and public health campaigns that focus on increasing the social acceptability of breastfeeding which may prove effective in addressing this cultural barrier.13

A cohort study was conducted to identify the prevalence and determinants of the breast feeding initiation in Xinjiang, PR China among 1219 mothers from five hospitals or institutes located in urban and rural areas. The result showed that, 92.2% of the mothers were breastfeeding including 66.2% who were exclusively breastfed and a total of 88 mothers (7.8%) were not breastfeeding on discharge from hospital.14

An exploratory study was conducted to assess the breast feeding initiation among low income multiethnic population in northern California. 64 mothers with 0-24 months of age child were interviewed regarding their infant feeding education, breast feeding attitudes, behavior and social support. The study showed that Fifty-nine percent of the entire study population initiated breastfeeding. Initiation rates were highest for the Asian American group (86 percent), and lowest for Latinas (48 percent). The study revealed that further research is needed regarding modifiable influences on breastfeeding initiation, including physician encouragement to breastfeed for various ethnic groups.15

A study was conducted to identify the determinants of breast feeding initiation and duration among 830 mothers and their children aged 1 to 5 years in Lebanon. The result showed that only 18.3% of the mothers initiated breastfeeding within half an hour after birth. Mother's occupational status and whether she was breastfed were significantly associated with breastfeeding duration.16

A community based study was carried out among 608 mother infant pairs to assess the prevalence of timely initiation of breast feeding in GobaWoreda, South East Ethiopia. The result showed that the prevalence of timely initiation of breastfeeding was 52.4%. The study concluded that the practice of timely initiation of breast feeding was low as nearly half the mothers did not start breastfeeding within one hour after delivery and suggested that breast feeding behavior change communication especially during the post natal period is critical in promoting optimal practice in the initiation of breast feeding and rural mothers need special attention as they are distant from various information sources.17

A study was conducted to identify the incidence of breast feeding and the factors associated with the initiation of breast feeding among 373 women from four hospitals in Kuwait. The result showed that, 92.5% of mothers initiated breast feeding, among them 55% were partially breast feeding, with only 30% of mothers fully breast feeding. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breast feed until 24 hours or more after delivery. The study concluded that hospital policies and staff training are needed to promote the early initiation of breast feeding.18

A study was conducted to identify current infant feeding practices in 12 rural communities in the Gambia. The results indicated that delayed initiation of breastfeeding, prelacteal feeding and failure to practice exclusive breastfeeding were widespread. Qualitative data further indicated that current beliefs and practices were strongly influenced by traditional beliefs and practices. The study suggested that a strategy for promoting early initiation of breastfeeding, feeding of colostrum and exclusive breastfeeding for 6 months in rural communities should therefore incorporate traditional beliefs and practices into modern messages on optimal breastfeeding.19

An interviewer – administered survey was conducted to investigate Breast-feeding initiation and exclusive breast-feeding within first week after deliveryin rural Vietnam. Four hundred and sixty-three women participated in the study, of whom181 delivered at the district hospital (39.1%), 229 at a community health centre (49.5%) and 53 at home attended by a traditional birth attendant (11.4%). The results identified that the initiation and exclusive breast-feeding rates were relatively high at 98.3% and 83.6% respectively. These findings suggested that to promote breast-feeding practices of rural mothers, health education on breast-feeding should take into account local socio-cultural features in addition to improving the counseling skills of health workers.20

A cross-sectional study was conducted to evaluate the prevalence of breastfeeding initiation within the first hour of life in Brazil. A group of 1,309 mother-child pairs were included in the study. Information about mother's and baby's characteristics, pregnancy, birth, and time of breastfeeding initiation was collected in the first 72 hours after delivery, through interview with mothers and hospital records. The result showed that 47.1% of the mothers initiated breastfeeding within the first hour after birth. The study concluded that in order to improve the rates of breastfeeding within the first hour of life, health care professionals must promote the factors favoring this practice such as prenatal guidance regarding the advantages of breastfeeding, vaginal delivery and full term birth, and stimulate this practice in vulnerable situations such as mothers with caesarean section and preterm birth.21

A community-based study was conducted to examine the association between breast feeding initiation time and neonatal mortality among 10,464 newborns in rural villages of Tamil Nadu, India. The result showed that, 82.1% were first breast-fed before 12 hours, 13.8% were breast-fed between 12 and 24 hours, and 4.1% were breast-fed after 24 hours. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 hours) were at 78% higher risk of death. There was no difference in mortality risk of babies fed in the first 12 hours compared with the second 1 hour after birth. The study concluded that the late (>24 hours) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu and suggested that emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.22