RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA

ANNEXURE-II

PROFOMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. RESHMA.H.,
I YEAR M.Sc. NURSING,
ADARSHA COLLEGE OF NURSING
BANGALORE-43.
KARNATAKA.
2. / NAME OF THE INSTITUTION / ADARSHA COLLEGE OF NURSING
BANGALORE-43.
3. / COURSE OF STUDY
AND SUBJECT / M.Sc. NURSING,
CHILD HEALTH NURSING.
4. / DATE OF ADMISSION / 01.06.2010
5. / TITLE OF THE TOPIC: / “A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICES IN WEANING AMONG MOTHERS OF INFANTS AT RURAL AND URBAN AREA, BANGALORE.”

6.0 BRIEF RESUME OF THE INTENDED WORK:

6.1 INTRODUCTION:-

“Children are like wet cement,

whatever falls on them, makes an impression”.

-Dr. Haim Ginott.

Universally, children’s Day is celebrated on 14th November every year and was adopted by the United Nations General Assembly. Celebrating children’s Day is about giving children “the right to enjoy and grow into healthy, educated citizens of the country”.1

Breast feeding provides an unparalleled manner to supply complete and ideal nourishment for the infant in the beginning of life. Although, some studies show that exclusive breast feeding for more than 6 months may also increase malnutrition. At this age breast-milk alone is not enough to meet the needs of infant. Ideally, an infant should be exclusively breast fed for 6 months followed by additional foods being gradually introduced.2

In 2002, the 55th world health assembly adopted a guideline based on recommendation by WHO and UNICEF, that “the infant milk substitute, feeding bottles and infant food amendment Act, 2003” this National guideline formulation came into action from 1st Jan 2004 on wards.1

Government of India adopted a National policy for children in Aug-1974, describes the “Right of the Child”. The policy declares: “It shall be the policy of the state to provide adequate services to children both before and after birth and through the period of growth, to ensure their full physical, mental and social development. The state shall progressively increase the scope of such services so that, within a reasonable time, all children in the country enjoy optimum conditions for their balanced growth”. The policy recognizes children as “the Nations supreme important asset” (Park.K. 2005).1

A National Nutritional Policy adopted by the Government of India under the aegis of the department of women and child Development in 1993, laid due emphasis on nutrition and health education among mothers of infants to reduce the occurrence of malnutrition. The reason being, “A NATION SMILES THROUGH ITS CHILDREN”.3

Healthy people 2010 policy set an objective in reduction of fetal and infant death. The policy set a target on Infant mortality rate at 4.2 per 1000 live birth in 2010.4 The previous infant mortality statistical rates are;

Ø  2002 - 67/1000 live births

Ø  2008 - 52/1000 live births

Ø  2010 - 50.78/1000 live births5

6.2 NEED FOR STUDY

According to world face book 2010 estimation India is having highest IMR 50.78/1000 live births, among that Karnataka place top in south Indian states 43/1000 live births, compared with 38/1000 live births in Maharashtra and 30/1000 live births in Tamil Nadu.6

WHO (2000-2004) recommends a gradual weaning period from 6 months to 2 years and allows the child to receive the benefits of breast feeding, while also consuming the necessary nutrients from the complementary foods.7

Introduction of complementary foods prior to the recommended length of exclusive breast feeding will increase child’s weight and height is a common misconception among mothers in developing Nations. Preparation of food should contain adequate required nutrients appropriately with suitable texture and temperature. Improper knowledge of appropriate weaning practices and perception of the child’s hunger leads to malnutrition and illness.7

Pearson JA., Hedges R.E.M, Molleson T.I, Ozbek M. (2010) conducted a study on exploring the relationship between weaning and infant mortality to identify the mortality data. The data revealed that infant death were due to weaning foods with low-income content, poor nutritional value and food prepared in Non-sterilized containers. The study suggests that weaning food is to be introduced in the first year of life to achieve a positive effect on their survival.8

Shah.N. Ramankutty.V., Premilal.P.G. Sathy.N., conducted a study at hospital among 400 children under 5 years in South Kerala. Young age, delayed weaning, immunization and sharing bedrooms were the probable significant risk factors for illness. Discontinuation of breast feeding in young infants, delayed weaning causes malnutrition and hypovitaminosis among the children. The study suggested that, primary care takers of the children need sound knowledge in order to overcome malnutrition and deficiency disease.9

Hence, the researcher felt that the need to assess the effectiveness of the structured teaching programme on knowledge and practices on weaning among mothers in rural and urban area at Bangalore. This will be useful for the mothers for future citation.

6.3 REVIEW OF LITERATURE:-

Review of literature is a key in research process. According to Nancy burns, the review of literature is a research report and it is a summary of current knowledge about a particular problem and includes, what is known and not known about the problem. The literature is received to summarize knowledge for use in practice or to provide basis for conducting a study.10

A study was conducted at AIMS residential colony to assess the weaning practices among mothers of infants in the age group of 6-12 months and compared these practices among different demographic variables. 50 mothers of infants were assessed by using self administered questionnaires and were grouped in two categories according to their age of commencement of weaning, 42 (84%) infants were received weaning foods in addition to milk, were 8 (16%) were practicing delayed weaning. Even several problems were observed in early weaning which revealed infrequent feeding, usage of expensive commercial cereals in diluted form, improper food preparation practices etc. The study concluded that mothers of this community lacked knowledge in appropriate weaning practices and balanced diet.11

A comparative study was conducted among 250 mothers of Anglo- American and Asian-Indian American, ages one, three, six, nine and 12 months who reside in south east US. The information collected was regarding sources of information about infant feeding practices and dietary intakes by 24 hours recalling method. Anglo- American mothers breast fed for longer duration and introduced formula and solid foods into the infants diet at a later age (p<0.005), where as the Asian –Indian American mothers sought information primarily from the family network during first 6 months and relied more on health professional during second 6 months of infants life. The study reported that the health professionals, including nutritional educators should educate AIA mothers and encourage AA mothers to follow current feeding recommendation and ultimately study suggested that knowledge in weaning must be improved among mothers.12

A descriptive study was conducted on weaning practices among the mothers of infants in selected hospitals in Mangalore, on purposive sampling technique among 104 mothers of infants in the age group of 6-12 months. The study revealed that (56.73%) majority of mothers started weaning with liquid diet, which as fruit juice among 33.65% of mothers, where as 43.27% of mothers started with Ragi porridge. Among the total samples of mothers, 75 mothers reported that they started weaning early to child whereas 6 month reported as late weaning, over 64% of mothers reported that due to inadequate breast milk. The study suggested to educate the mothers on weaning practices.13

A pre-experimental study was conducted on effectiveness of planned teaching programme on knowledge and attitude on complementary feeding among mothers of infants in Udupi. The study was done on 50 mothers with one group pre-test and post-test design , which showed that the mean score of post-test attitude (68) was higher than the mean pre-test attitudes and the mean post-test knowledge score(32) was higher than the pre test knowledge (14), significantly (p<0.005) related with knowledge of mothers on complementary feeding between pretest and post test scores. Finally the study suggested education on feeding among mothers of infants.14

A study was conducted on infant feeding practices among mothers in an urban area at Nepal, among 168 mothers who were interviewed among which, only 43.5% of the mothers initiated breast feeding within one hour of birth and 60.5% were practicing exclusive breast feeding at 5 month. Almost 40% of the mothers started weaning before the recommended age of 6 month and 22.5% delayed introduction of weaning beyond the recommended age. This study concluded that this mothers were lacking in knowledge of weaning and its practices.15

A study was conducted on the development of weaning practices among women of the Mombasa in Kenya. A total of 59 mothers had participated and the result showed 65% of the sample population practicing inadequate weaning, 35% of mothers introducing complementary foods prior to 6 months of age. This study recommended the nurses and other staff members should provide the proposed flyers on breastfeeding and weaning and suggested weaning among mothers in the maternity ward to ensure a better understanding of breast feeding and adequate weaning.16

A qualitative study was conducted on Infant-feeding practices and beliefs on complementary feeding among low-income Brazilian mothers. Outcomes in the area revealed, practices of prolonged breast feeding and delayed complementation on infants with semi-solid foods, emerged as a problem among poor women. Cultural factors and taboos appeared to have an important influence among mothers of infants in feeding patterns and finally the study suggested to improve their knowledge and practices on health education in weaning.17

A study was conducted on infant feeding and weaning practices in some rural areas of Rajasthan. Which included 238 rural mothers, the final result revealed that the mean age of weaning was 27.1 months, 81% of mothers were illiterate, 23% initiated breast feeding within 24 hours of delivery, 77% discarded colostrums, 9.1% of them introduced supplementary food before 3 month of age, 15.6% introduced between 3-6 months, 36% began weaning at 6-12 months, and 24% waited until after 12 months of age. The study suggested to introduce teaching strategies among mothers on weaning practices.18

A pre-experimental study was conducted among 40 mothers on maternal knowledge regarding breast feeding and weaning practices in Baroda, using pre-tested questionnaires. Results indicated that only half of the mothers breast fed their babies, if breast feeding stopped at 3-6 months, top feeding and solid supplements were initiated at 4-6 months, 50% of the mother were not in favor of feeding the sick child with small frequent meals. The study revealed lack of knowledge on weaning among mothers.19

A study was conducted on infant and child feeding practices in the urban, slum, and rural areas of the Varanasi, India. A total 784 mothers were interviewed. A result showed 53.8% of urban children were breast fed up to 6 month, as compared to 10.21% of those in urban slums, 66.67% of children were weaned in urban at 6 months, as compared to 40.14% and 33.63% in slum and rural groups, 5-9% of rural children were weaned in a poor manner. The study revealed that rural mothers had poor knowledge in weaning.20

A descriptive study was conducted on mothers knowledge and practice related to weaning in Batajira. A total of 1543 mothers were included in study, of which 40% were started on weaning at the age of 4-6 month, 34% were on exclusively breast feeding beyond the age of 7 months. The study suggested to improve the knowledge among mothers on weaning and practices.21

A cohort study was conducted on breast and complementary feeding practices in relation to morbidity and growth in Malawian infants, UK. Babies’ weight, length, morbidity and feeding patterns were recorded in 4 weekly intervals from birth to 52 weeks. the results revealed the mean age at introduction of water was 2.5 month, complementary foods 3.4 months, solids 4.5 months, over 40% of infants received complementary foods by 2 month and 65% by 3 months, infants with early complementary feeding had lower weight for age at 3-6 months (p<0.005) and at 9 month (p=0.007). Early complementary feeding was significantly associated with increased risk for respiratory infection (p<0.005), risk of eye infection. The study strongly recommended health education on weaning among mothers.22

A study was conducted to assess the prevailing complementary feeding practices in rural area of Agra. Outcomes were 30.9% of the infants were not receiving complementary foods, 21.9% mothers initiated complementary feeding at the right age. There was significant association with literacy status among mothers (p<0.005), 87.1% infants were receiving family pot feeding. Demand feeding was being practiced by 66.7% mothers. The study concluded that the complementary feeding practices were not satisfactory in the rural area of Agra and finally suggested improvement in knowledge on weaning and practices among mothers.23

6.4 STATEMENT OF THE PROBLEM:

“A comparative study to assess the effectiveness of structured teaching programme on knowledge and practices in weaning among mothers of infants at rural and urban area, Bangalore”.

6.5 OBJECTIVE OF THE STUDY:-

  1. To evaluate the knowledge of mothers regarding weaning.
  1. To evaluate the practices of mothers about weaning.
  1. To compare the effectiveness of structure teaching proramme in terms of knowledge gain among mothers on weaning at rural and urban area.
  1. To find out the association between knowledge and practices of mothers regarding weaning with selected specific demographic variables.

6.6 HYPOTHESIS:-

H0- There is no significant difference between the mean pre-test and post-test knowledge and practice among mothers regarding weaning.

H1- There will be a significant difference between area of study, level of knowledge and practice among mothers regarding weaning.

H2- The mean post –test knowledge regarding weaning will be significantly higher than the mean pre-test knowledge.

H3- There will be significant association between the selected demographic variables and the mean knowledge of mothers regarding weaning.

6.7 OPERATIONAL DEFINITIONS:-

1.  Knowledge: Refers to the level of awareness of information on weaning.