A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF POSTNATAL MOTHER REGARDING THE IMPORTANCE OF NUTRITIONAL DIET IN FOLLOW UP CARE IN SELECTED PHC IN GULBARGA, DISTRICT.
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MR. SHANKRARAM KALBI
M. Sc. Nursing 1st Year
AL-KAREEM COLLEGE OF NURSING GULBARGA,
May 2010
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE-11
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MR. SHANKRARAM KALBI M.SC. NURSING (1ST YEAR) Name of the Candidate and 1. AL-KAREEM COLLEGE OF NURSING Address (In Block Letter) BAREY HILLS, ADARSH NAGAR, GULBARGA,
AL-KAREEM COLLEGE OF NURSING 2. Name of the Institution BAREY HILLS, ADARSH NAGAR, GULBARGA,
M. SC. NURSING (1ST YEAR) 3. Course and Study subject COMMUNITY HEALTH NURSING
4. Date of Admission 21-10-2009
Title of the Topic: A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF POSTNATAL 5. MOTHERS REGARDING THE IMPORTANCE OF NUTRITIONAL DIET IN FOLLOW UP CARE IN SELECTED PHC IN GULBARGA, DISTRICT. 6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
Proper postnatal nutrition for mothers is important to serve the essential needs of breastfeeding a newborn baby. Although breast milk is capable of fulfilling the nutritional needs of newborn on its own, there are a number of common concerns about nutrition that face breastfeeding mothers. This article will address proper caloric intake during breastfeeding, achieving safe and normal weight loss, mixing formula supplements and the questions about fluid intake.
One of the biggest questions on the mind of mothers is how many extra calories they should consume to compensate for the natural production and supply of breast milk. In most cases, a woman should be able to attain a reasonable caloric intake by simply following their appetite. It is not unusual for a baby nursing to make mothers feel hungry more frequently than normal. Calories continue may be necessary in your particular situation. If the mother is continue calories, remember that research indicate that a daily intake of eighteen to twenty-two hundred calories will allow mother to a sufficient supply of breast milk. A breast feeding mother will require between three and five hundred more calories after pregnancy than she did while carrying her child.
Each mother’s individual need for calories will very. mother level of exercise, prior nutritional status and body weight will all affect the number of additional calories you need. Some mothers feel the need to begin the process of losing weight during the first weeks following a pregnancy. While weight is a reasonable concern, studies show that mothers who are both breastfeeding and consuming fever calories actually lose more weight when their child is three to six months old. In order to allow mothers body to properly recover from childbirth, you should give yourself at least two months before attempting to lose weight.
Weight loss during the first two months is accomplished normally by simply eating a diet that satisfies hunger. After two months mother can raise her level of activity by walking a half an hour each day. With proper dieting and physical activity it is reasonable to achieve the gradual loss of about a pound a week. Always consult your pediatrician before undertaking any from of weight loss strategy, as it could affect mothers child. 2
Another concern for mothers who breastfeed is whether it is necessary to force fluids in the weeks following childbirth. Just as maintaining a healthy diet requires eating to hunger, fluid intake should be at a level that it comfortably satisfies mothers thirst. By paying attention to mothers body, mother will know when it is appropriate to drink fluid. One recommendation by breast feeding experts is that mothers keep water or some other fluid nearby at all times. This helps prevent mother from ignoring thirst should it arise at an inconvenient time. 3
There are advantages to mixing breast milk with baby formula. Mixing allows mother to increase the supply of breast milk on hand and also supplement the natural immunological benefits of breast milk.
The best way artificially express breast milk safely is with a breast pump. Breast pumps are helpful for a number of reasons. First, they can help ensure that mother keep an adequate supply of milk available for mothers child when mother is separated from him or her. They also give mothers nipples a chance to rest if they have become sore from normal nursing of mothers baby. It is important to choose a quality electric breast pump with a double pump kit to ensure that mother have all the tools need for expressing milk for a baby formula supplement.
In the end, mothers first line of defense in the world of breastfeeding nutrition is simply listening to mothers body and acting when mother realize to hungry or thirsty. Weight loss should be achieved gradually at first and is more effective three to six months baby is born. Supplementing mothers breast milk with baby formula is an acceptable method of keeping mothers baby healthy, it may require the use of a breast feeding pump. By practicing tips for proper postnatal nutrition mother can help ensure that mother and mothers child will successfully enjoy the loving connection that results from breastfeeding. 4 6.2 NEED FOR THE STUDY
A mother’s body has undergone many changes during pregnancy, as well as with birth of her baby. She needs to heal and recover from pregnancy and childbirth. In addition to rest, all mothers need to maintain a healthy diet to promote healing and recovery.
The weight gained pregnancy helps build stores for mothers recovery and for breastfeeding. After delivery, all mothers need continued nutrition so that they can be healthy and active and able to care for their baby.
Whether they breastfeed or formula feed all mothers need to eat a healthy and balanced diet with vitamins and minerals. Most lactation experts recommend that breastfeeding mothers should eat when they are hungry. But many mothers many be so tried or busy that food gets forgotten. So, it is essential to plan simple and healthy meals that include choices from all of the recommended groups from the food pyramid.
Although most mothers want to loss their pregnancy weight, extreme dieting and rapid weight loss can be hazardous to mothers health and to mothers baby’s breastfeeding. It can take several months for a mother to lose the weight she gained during pregnancy. This can be accomplished by cutting out high-fat snacks and concentrating on a diet with plenty of fresh vegetable and fruits, balanced with proteins and carbohydrate. Exercise also helps burn calories and tone muscle and limbs.
Along with balanced meals, breastfeeding mothers should increase fluid. Many mothers find they become very thirsty while the baby is nursing. Water, milk, and fruits juices are excellent choices. It is helpful to keep a pitcher of water and even some healthy snacks beside mother bed or breastfeeding chair.
Location is a physiological process. Human breast milk is nature’s prefect receipt for your babies growth and development. This special blend of nutrients nourishes mothers baby and provides a unique balance of fats, vitamins, minerals, sugars and proteins. Breast milk empowers mother baby with disease fighting immunoglobulin to help protect baby during those early vulnerable first weeks of life. 2 This study provide a sobering assessment of our current understanding of the critically important interface between maternal nutrition and infant health and feeding practices. We currently have very little useful information about how to feed preterm infants. The reason for that is that we do not have a clear appreciation of the role of maternal nutritional and health status on meeting needs for normal fetal growth and development. 3
To maximize the benefit of mother breast milk a nursing mother must practice good nutrition. Breastfeeding is a learned behaviour that needs a supportive environment. Nutrient needs of the mother during breastfeeding include increased need for energy, vitamins and minerals, and water. Iron supplements may be necessary. Exercise is important.
Eating well during pregnancy and location requires a few adjustments to general good health dietary guidelines. A woman’s need for calories, protein, vitamins, minerals and water all increase. Each woman will require different amounts of foods providing key nutrients to achieve the desired pregnancy weight gain and pregnancy support. Age, weight, activity level, and metabolism all influence how much you will need to eat for optimum weight gain, health, and fetal development or breast milk production.
If mother eat too little while breast feeding, mother may not produce as much milk, when breastfeeding a single baby 300-500 calories per day should be added to the diet. When feeding twins an extra 600-1000 calories per day should be added to mother diet. Total calories intake when lactating is 2300-2500 calories for singleton and 2600-3000 calories for twins.
Obviously calcium for milk production comes from the mother. When calcium level in mom’s blood are not adequate for her needs and those of her child, calcium deposited withdrawn for milk production.
In fact, if something is lacking in mom’s current diet, mom’s body will dip into her reserves of nutrients of keep breast milk nutrient-dense. However, mother is to be healthy for a long time to take care of mothers growing child, so don’t short change yourself. 4 For the above reason, the investigator personally felt that there is a need to assess the knowledge, attitude of postnatal mother regarding the importance of nutritional diet, and to update knowledge and skills regarding nutritional diet in follow up of care. All these prompted the researcher to do this study.
6.3 REVIEW OF LITERATURE
In April, Morgan JB, Williams conduct 43 semi-structured interviews (SSIs) and 34 focus group discussions among men, women of reproductive age and health service providers; in September, we added among 21 SSIs among new mothers, new fathers and dais. Two investigators analyzed the findings according to themes within six care types: antenatal, delivery, immediate newborn, routine postpartum, special maternal and special newborn the result was that Finding indicated poor maternal diet and antenatal care-seeking. Home delivery with an untrained dai was the norm. Respondents knew about benefits of clean delivery, but rarely put knowledge into practice. Knowledge and practices for maintaining the newborn’s warmth were good. Delayed initiation of breastfeeding, avoidance of colostrums and prelacteal feeding were almost universal. Unhygienic cord care, including an unclean cut and application of ghee on the cord-stumps, was norm. After delivery, mothers often maintained low fluid intake but otherwise reported healthy nutritional practices. Knowledge of some danger signs in newborns was common, but timely action upon recognition was not the conclusion include that the findings illustrate some beneficial practices, many reported practices are harmful to the newborn. These findings, consistent with the sparse existing data in Pakistan, inform program interventions for household-level behavioral change. 1
Review of literature is a board, comprehensive, in death, systematic and critical review of scholarly publication, unpublished scholarly print material, and audio visual material and personal communication. 2
A study was conduct in UK to assess the knowledge and attitude of 103 postnatal mother regarding the relationship of nutritional diet and exercise the result was only 35% of mother have the knowledge about the relation of nutrition and exercise the conclusion includes that the further study was required to assess the knowledge and attitude of postnatal mother regarding the importance of nutritional diet and exercise in relation to the health of the postnatal mother. 5
Research really conducted research in an intellectual vaccum, their studies are under taken within the context of existing bare of knowledge. A literature helps to ay the foundation and provide context for a new study. By doing a through review, researcher can determine how best to make a contribution to existing bare of evidence. Reviewing the literature also can help to identify relevant conceptual framework or appropriate research and methods. A literature review also plays role at the end of the study as researcher try to make same to their finding’6
A study was conduct in Department of pediatrics, Tarku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku Finland to assess the knowledge and attitude of postnatal mother regarding the physiological changes occur immediately after the delivery in body weight and composition in response to the metabolic load imposed by lactation are highly variable among and within diverse populations. In most reports, rates of weight loss did not differ between lactating and nonlactating women. Despite differences in the hormonal milieu between lactating and nonlactatiing women, only subtle short-term differences were observed in postpartum changes in body composition.. Changes in body composition during location are response to a sequence of complex neuroendocrine and biochemical stimuli that may be significantly modified by environmental factors. Gestational weight gain was the strongest determinant of postpartum weight and fat mass change, which supports the premise that biological mechanism are aimed at restoring prepregnancy body weight and composition. 7
A study was conducted in south America to assess the knowledge of postnatal mother regarding In affluent populations, breast-feeding women often wish to return to their prepregnancy weight as soon as possible postpartum and may restrict energy intake or increase exercise to achieve this goal. The results shows that only few postnatal mother have the knowledge about the importance of nutritional diet and conclusion includes that the postnatal mother dose not have proper knowledge about nutrition diet. 8
A study was conducted in University of Bristol, UK to assess knowledge of postnatal mother regarding the nutritional needs are increased during pregnancy and lactation for support of fetal and infant growth and development along with alterations in maternal tissues and metabolism. Total nutrient needs are not necessarily the sum of those attributable to the maintenance of nonreproducing women. Maternal metabolism is adjusted through the elaboration of hormones that serve as mediators, redirecting nutrients to highly specialized maternal tissue specific to reproduction (i.e., placenta and mammary gland). It is most unlikely that the heightened nutrient needs for successful reproduction can always be met from the maternal diet. 9
6.3 STATEMENT OF THE PROBLEM
A study to assess the knowledge and attitude of postnatal mother regarding the importance of nutritional diet in follow up care in selected PHC in Gulbarga, District.
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge of postnatal mother regarding the importance diet follow up of care. 2. To assess the attitude postnatal mother regarding the importance nutritional diet in fallow up of care 3. To correlate between knowledge and attitude of postnatal mother regarding importance nutritional diet in follow up of care. 4. To associate the knowledge and attitude of postnatal mother regarding the importance nutritional diet in follow up of care.
6.5 OPERATIONAL DEFINITION
1. Knowledge :
Knowledge refers to awareness and understanding of postnatal mother regarding importance nutritional diet in follow up of care.
2. Attitude :
Attitude refers to opinion and way of thinking regarding importance nutritional diet in follow up of care among postnatal mothers.
3. Nutritional diet –
Nutritional diet is defined as the diet which contain all the elements which needed by the body for growth and development and prevention of nutritional diseases.
4. Postnatal mother (20 to 35 years of age group) –
Postnatal mother is defined as the mother who has delivered a baby and is in the postnatal period till six week.
5. Follow up of care – Follow up of care is defined as the revisit of hospital for health checkup after the discharge from the hospital.
6.6 ASSUMPTIONS
1. The postnatal mother may have inadequate knowledge in importance nutritional diet in follow up of care. 2. The postnatal mother may have a negative attitude towards the importance of nutritional diet in follow up of care.
6.7 HYPOTHESIS
H1- There is a significant correlation between knowledge and attitude of postnatal mother regarding the importance of nutritional diet in follow up care.
H2- There is a significant association between knowledge and attitude of postnatal mother regarding the importance of nutritional diet in follow up care.
6.8 DELIMITATION
The study will be delimited to: 1. The postnatal mothers in the age group of 20 to 35 years. 2. Selected PHC of Gulbarga.
7. MATERIAL & METHODS
7.1.1 SOURCE OF DATA
The data will be collected from the postnatal mothers in selected PHC in Gulbarga, Dist…..
7.1.2 Research Design:-
Non experimental, descriptive co relational design and descriptive survey approach.
7.1.3 Research variable:-
Study variable: knowledge of mother regarding importance of nutritional diet in follow up care.
Attitude of mother regarding importance of nutritional diet in follow up care.
Demographic variable such as, religion, qualification, income, marital status, previous experience.
7.1.4 Settings :
Study will be conducted in selected PHC in Gulbarga. District
7.1.5 Population:
Postnatal mothers who belonging to the age group of 20 to 35 years in selected PHC in Gulbarga.
7.2 METHODS OF DATA COLLECTION: 7.2.1 (a) Sample size : Postnatal in selected PHC and who full fills the criteria and the (b) Sample size is 50.
7.2.2 Criteria for sample selection:
Inclusion criteria:
The postnatal mother who belongs to selected PHC.
The postnatal mothers who are in the period from one to six week.
The postnatal mothers belong to age group of 20 to 35 years.
The postnatal mothers who are willing to participate in the study.
The postnatal mothers who can understand Kanada, Hindi.
The postnatal mothers who are present at the time of study. Exclusion criteria :
The postnatal mothers who did not belongs to selected PHC. The postnatal mother who are not in the period from one to six week. The postnatal mothers not belong to age group 20 to 35 years. The postnatal mothers who are not willing to participate in the study. The postnatal mothers who cannot understand Kanada, Hindi The postnatal mothers who are not present at the time of study.
7.2.3 Sampling technique:- Non-probability convenience sampling technique will be used.
7.2.4 Tools for Data Collection: The tools consist of 3 sections: Section A: To assess the Demographic data. Section B: Structured questionnaire to assess the level of knowledge among the postnatal mothers regarding the importance of nutritional diet in follow up of care. Section C: Structured questionnaire to assess the attitude of postnatal mothers regarding the importance of nutritional diet in follow up of care.
7.2.5 DATA COLLECTION METHODS
Formal permission will be obtained from the higher authorities and head of the PHC before proceeding for data collection. After obtaining informed consent from the sample and assuring about confidentiality of the information, the investigator will be administer the structured questionnaire which contain demographic variable and questionnaire to assess the level of knowledge and attitude among the postnatal mothers regarding importance of nutritional diet in follow up of care.
7.2.6 Plan for data Analysis The data collected will be analyzed by means of descriptive and inferential statistics.
Descriptive statistics: Frequency and percentage distribution, means and standard deviation will be used to analyze the level of knowledge and attitude of postnatal mother regarding the importance of nutritional diet in follow up of care, Correlation co-efficient will be used to correlate between level of knowledge and attitude.
Inferential statistics
Chi square will be used to analyze the association of knowledge and Attitude among postnatal mother with their demographic variable.
7.2.7 Projected outcome After the study the investigator finds the knowledge and attitude of postnatal mother regarding the importance of nutritional diet in follow up to care.
7.2.8 Does the study require any investigation or intervention to be conducted on the Patients or other human or animals?
The investigator is planning for descriptive study and no active manipulation is involved in this study.
7.2.9 Has ethical clearance been obtained from your institution?
Yes, permission will be obtained from concerned authorities of selected PHC in Gulbarga, District The permission is also taken from the college authorities. 8 LIST OF REFRENCE –
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2. BT. Basavanthappa, ‘Community Health Nursing’ Ist edition, New Delhi, Jaypeen Brothers,2007
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Publishers, Jabalpur,2007
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5. Dewey. The Journal of nutrition Vol, 120 No. 2 February 1998, pp. 386s-389s
6. Polit Denise F. Tetano, “Nurisng Research” 8th edition 2006
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381s-385s
8. Kathryn G. Dewey. The Journal of Nutrition Vol. 128 No2 February 1998,PP386s-389s
9. Many Frances Oicciano Role of Dietary Supplement” The Journal of Nutrition
Vol-128 No.-2
10. Lilongwe, Malawi Eur J Clin Nutr. 1999 Apr;53 Suppl 1s78-83 Journal of American nutritional
Association (3) 189,2003
11. Vickers MH, Gluckman PD, Coveny Ah, Hofman PL, Cutfield WS, Gertler A, Breier BH, Harris
Endocrinology. 2008 Apr;149(4):1906-13. Epub 2008 Jan
12. Nutrition promotion Network of India, 2002
13. Nutrition and Diagnosis-Related Care, Fourth EditionSylvia Escott-Stump;
Recommende Dietary Intakes, Recommended Dietary Allowances,
National Academy Press, 1997:
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Dec 6.3 Signature of the Student 9.
Remarks of guide 10.
Name and designation of (in block letter)
11.
11.1 Guide
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
11.5 Head of the department
11.6 Signature
12.1 Remarks of the chairman and Principal 12.
12.2 Signature