Proforma for Registration of Subjects for Dissertation s4

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE MS. BINCY SAMUEL AND ADDRESS 1 YEAR MSc NURSING JOSCO COLLEGE OF NURSING, INFANT JESUS BUILDING, NO.3590, CHANNAPPA EXTN, NELAMANGALA, BANGALORE-562123. 2 NAME OF THE INSTITUTION JOSCO COLLEGE OF NURSING, AND ADDRESS INFANT JESUS BUILDING, NO.3590, CHANNAPPA EXTN, NELAMANGALA, BANGALORE-562123

3 COURSE OF STUDY AND MSc NURSING SUBJECT PEDIATRIC NURSING 4 DATE OF ADMISSION TO 30-Nov-08 COURSE 5 TITLE OF STUDY A COMPARATIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING WEANING OF INFANTS AMONG PRIMIPARA AND MULTIPARA MOTHERS IN THE POSTNATAL WARDS OF VARIOUS HOSPITAL OF BANGALORE.

6 BRIEF RESUME OF INTENTED WORK

INTRODUCTION

Weaning of children is a complex process involving the introduction of non-breast- milk food and reduction in suckling activity at the proper age [starting at 4 to 6 months]. This process is gradual, starts by supplementation of small amount of food to provide the complete nutritional need of the child. Many factors affect the knowledge of practice and the application of proper weaning, for example: mother’s age, number of children, family income, and mother’s educational level.

Adequate nutrition is essential for a child to grow and develop normally and to enjoy good health. It is very essential that adequate nutrient requirements are a must for infants below one year of age, because these children are the future citizens.

Ogra and Green stated that “The human neonate and its mammalian counterparts have for millions of year received balanced nutrition during early infancy inclusively through breast feeding till 4 months”. After that the child needed some supplements or replacement of the traditional nursing in the name of “weaning”.

Weaning is very essential for replacing all nutrients which are all absent in the breast milk mainly for immunity. The most important functional index of nutriture in children is growth.

Supplemental feedings are given when the infant is ready to take them. They are given to provide an introduction to different foods, different textures and different modes of ingestion.

In addition, nutrition in infancy has to be scrutinized in relation to effects later in life, as well as immediately. The long-term harmful consequences of malnutrition

are defective brain development, physical shunting, impaired immuno competence etc. so infant feeding plays a much more importance in future life.

A workshop was convened during the International Union of Nutritional Sciences (IUNS) meeting in Brighton, England, in early 1986 to discuss the introduction of semi-solid and solid foods during infancy and the early preschool years.

There is much confusion about the meaning of the word "weaning," although the definition of "wean" given in the Concise Oxford Dictionary, to "accustom to food other than milk," was quoted. In the context of the present need to promote breast-feeding for as long as possible, the term "complementary food" was recently defined by the ACC Sub-committee on Nutrition Consultative Task Force on Maternal and Young Child Nutrition .This emphasizes that foods should be used in addition to breast milk and not as mere replacements for it.

It has not been necessary in most parts of the world to advice mothers to add formula to the infant's diet when their milk appeared inadequate. Most mothers do this on their own, quite often even when it is unnecessary. There was no intention, therefore, to discuss the use of formulae.

In many countries, however, the introduction of semi-solids and solids to infants' diets is unsatisfactory in timing, and the quality and quantity of the foods are insufficient. The effect on infants is growth faltering, which incipiently worsens from around six months of age and results in malnutrition in later months and years.

Summarizing maternal attitudes, many socio-cultural considerations, specific to the different regions, alter the timing of introduction of semi-solids and solids into infants' diets. The privileged populations follow the so-called Western system of feeding. Thus economic background appears to govern the timing and the quality of complementary feeding. The variety of foods offered is limited by the fuel available to cook them and the employment status of mothers. Certainly, the more literate or educated mothers introduce semi-solids and solids earlier than the others.

6.1 NEED FOR STUDY

According to Nelson, “World-wide malnutrition is one of the leading causes of morbidity and mortality in childhood”. One of the main cause of malnutrition is faulty feeding practices in infancy, which includes untimely weaning. As a result of poor knowledge on the part of the mothers regarding the nutritional requirement of the baby many infants do not get adequate food between four months to two years of age, the time they are totally dependent on the mothers. If semisolid and solid foods are not introduced at right time and in insufficient quantity, the child may become under nourished.

In most areas in India mothers are totally unaware of children's nutrition needs. Breast-feeding continues for over a year. Fruits and green leafy vegetables are rarely fed. At about one year some family food is given but is very short of children's requirements. There is a belief that children should not be given solids until they "cut some teeth."Thus in the developing world, the quality and quantity of the weaning diet require, in addition to more energy and protein, more iron, calcium, vitamins A and D, and trace elements. Also, the diet is monotonous.

The findings of a project carried out by Mr. Shivakumar S. (2006) in Bangalore, reveals, in the low socio economic group, that some cultural beliefs have some controversy in introducing solid foods, at the age of 4 months itself. Illiteracy also plays an important factor.

Another finding of a project carried out by Ms.Vasantha (2007) in Kolar, Karnataka state, reveals that mothers had a better satisfied knowledge about weaning of infants after a structured teaching program.

In a series of experiments in India, it was shown that simple mixtures of malted cereals, pulses, and oilseeds (in proportions of 4:1:1) are acceptable to mothers and children. Malting consists of steeping for 12 hours, germinating for 24 to 72 hours, sun drying, roasting, and milling. The process is time-consuming and

requires space, however. The viscosity of the malted mix is far less than that of roasted mixes (this viscosity is contributed by the malted cereal rather than the pulses).

It is necessary to consider the appropriate timing and quality of complementary foods (semi-solids and solids) because of the prevalence of under-nutrition beginning in late infancy. The strategy for improving the nutrition of young children in underprivileged populations during infancy would be to continue breast-feeding as long as possible, to promote the use of high-quality home-prepared weaning or complementary foods as well as village-prepared weaning foods, and to increase the availability of low-cost, indigenous, centrally processed foods marketed through commercial channels.

Several countries have projects to produce low-cost weaning foods as an intervention for childhood malnutrition. This is especially useful for working mothers. In India several mixtures have been developed, including Indian multipurpose food and corn-soy mixture (CSM). Other mixtures have been developed, for example, in the Sri Avnashilingam Home Science College in Coimbatore.

In his book, Hygienic Care of Children, Dr. Herbert M. Shelton said, "Weaning should be gradual, as we see it in nature, beginning at the age of two and lasting at least until the third birthday." If weaning is abrupt, it is no longer natural as no other creatures that suckle their young would suddenly cut them off. Babies need time to adjust to new foods as well as to emotionally adjust to not having the close physical contact with their mothers any longer. Also, women's breasts would become swollen and sore if they abruptly stopped nursing—they would become filled with the milk that was meant for their babies. Another problem with sudden weaning is that the natural child-spacing effect breast-feeding creates would be halted.

In the book The Womanly Art of Breast-Feeding by the La Leche League, the philosophy of weaning is to let the baby do it—let him nurse until he wants to stop.

A mother should be sensitive to the specific needs of her baby and not follow the rigid guidelines of any book. Just as some babies get their first tooth at only five months old and others not until they're well over a year old, some are ready to wean at younger ages then others.

Based on the review of literature and personal experience of investigator during practice in the field of pediatric nursing. She observed that many of the primipara mothers are not aware about the time of weaning and selection of weaning foods, as compared to multipara mothers. This may happen due to ignorance, illiteracy, financial or cultural factors. In order to assess the knowledge of weaning between primipara and multipara mothers, the investigator has chosen this as her project.

6.2 REVIEW OF LITERATURE

Here deals with review of related literature regarding weaning, which is a systematic selection of potential sources of related study from previous work findings, statistics and other references to the problem. Research literature was undertaken to gain an insight into the present problem for the study of assessing the knowledge of weaning infant from breast feeding.

1. Paul B. Pancharz12, 1985, states that adequate nutrition is essential for a child to grow and develop normally and to enjoy good health. If adequate dietary supplements, formulas and nutritional techniques are followed there is no way to suffer the consequences of under nutrition. 2. Yvonne Jeremiah10, teal. 1989, conducted a study and found a high percentage of iron deficiency in the Asian population and significantly high levels in other sections of community in Asia because of improper weaning. 3. Nursing journal of India10, 1990, survey states that the rate of growth of infant is much faster than older children. So mother’s milk is insufficient to meet the demand, start giving other home made foods which are necessary in addition to breast milk.

4. Devgan A.K. etal7, 1991, states that introducing semi solid and solid foods are necessary for good growth and development. Sudden weaning can be traumatic and should be avoided. Considering the general growth and physiological development of baby, by about a month the baby is ready to eat solid foods to meet its growing need. 5. Dorothy R. Marlow etal2, 1992, states that weaning is when the infant ceases to nurse from either the bottle or the breast and begins to drink from, a cup. Mothers who breast feed the infant may be ambivalent about starting weaning their infant. 6. Gajanan, etal9, 1993 conducted a survey in Bombay slums regarding the nutritional knowledge and practice of mothers regarding breast feeding and supplementary feeding shows that in relating to education, economic status and parity of mothers illiterate and economically under privileged women’s breast fed their babies for longer duration. 7. TNAI15, 1993, report shows that weaning food should be selected and prepared clearly and cooked property and served according to the age of the baby to avoid reaction following it. 8. Khangaankar M.B.11, 1993, reveals that in India 36% of all infants in the rural areas and 40% among urban poor is still being exclusively breast fed at the age of one year. So delaying weaning comes million of infants to be push down the slope of malnutrition. 9. Sukhamuider Kaur13, 1993, states that after 3 moths of age semi solid and solid foods should be given to the child in addition to the breast milk like fruit juices, strained cereals or mashed potatoes and yolk of egg. 10. Velhal, etal16, 1993, states that mothers who have less education and belong to poor economic status fed their babies for longer duration and delayed supplementary feeding. 11. Glenys Sykes, etal10, 1996, has conducted a project for 3 years and found that some mothers were confused about what they should feed their babies. They were using ready made foods, thinking that it will contain the right nutrients.

12. Forest Health care NHS Trust10, 1996, had conducted a local study, showing a prevalence rate of iron deficiency anemia of 16-26% in children aged between 10 and 36 months of age because of lack of dietary intake of iron and exclusive breast feeding for more than one year. 13. Stordy and Morgans10, 1996, conducted a study and found that home prepared foods have shortage of calories, so it did not necessarily meet the nutrient levels required. Good awareness regarding the selection of foods should be important to mothers. 14. According to Canadian pediatric society14, 1996, studies shows that weaning was started only after 9 months of age. So the Canadian pediatric society, nutritional committee recommends that the introduction of solid food should be given within 4-6 months of age. 15. Elizabeth, etal8,1997, found that nearly 80 million (63%) of under 5 children are estimated to suffer from varying grades of protein energy malnutrition. One of the causes for this problem is not giving early weaning at 3-4 months of age.

PROBLEM STATEMENT

A comparative study to assess the knowledge regarding weaning of infants among primipara and multipara mothers in the postnatal ward of various Hospital of Bangalore.

6.3 OBJECTIVES OF THE STUDY

a) To assess the level of knowledge of primipara mothers regarding weaning infants from breast

b) To assess the level of knowledge of multipara mothers regarding weaning infants

c) To compare the knowledge among primipara and multipara mothers.

d) Find out association between selected demographic variables and knowledge of mothers

6.4 OPERATIONAL DEFINITIONS

a) Knowledge :Mother’s awareness regarding weaning and ability to answer the questions

b) Weaning: Taking away the baby from the breast and substituting with other foods after 4-5 months of age

c) Infant :A time extending from the first month after birth to 12 months of age.

d) Primipara mothers: A women who has given birth to one viable child indicated by para-1 on the patient chart.

e) Multipara mothers : A women who has delivered more than one viable child

f) Postnatal ward : It is a ward in which mothers stay from the first postnatal day to the seventh postnatal day.

6.5 HYPOTHESIS

H 1:- There is significant increase in the knowledge score for multipara mothers than primipara mothers.

H 2:- There is association between the selected demographic variables and knowledge.

6.6 VARIABLES:

6.6.1 Dependent Variables: Knowledge of primi & multipara mothers on weaning.

6.6.2 Independent Variables: Comparative study of mothers knowledge.

6.6.3 Attributed Variables: Age, Number of children, Education, Occupation, . Income, Religion, Source of information

DELIMITATIONS The data will be collected from mothers who are admitted in postnatal ward of various Hospitals of Bangalore.

7. METERIALS AND METHODS

7.1 Source of Data: The study is conducted to assess the knowledge regarding weaning among primipara and multipara mothers in the postnatal ward of various Hospitals in Bangalore.

7.2 METHOD OF DATA COLLECTION:

7.2.1 Research approach: The approach which was used for this study is comparative survey, which can be used to compare the knowledge of mothers, which is an overall plan for collecting and analyzing the data for comparison. For the comparison, the researches had taken mothers who are in postnatal ward having one or more babies.

7.2.2 Research Setting: The study is conducted in the postnatal ward of various Hospitals of Bangalore, depends on availability of subject and feasibility of conducting study.

7.2.3 Population: The population in the study constitutes all primipara mothers (with one baby) and multipara mothers (with more than one baby) , in the postnatal wards.

7.2.4 Sample: Mothers admitted in the postnatal wards of various Hospital of Bangalore.

7.2.5 Sample Size: A sample of 40 mothers, out of which 20 primipara mothers and 20 multipara mothers, whoever was willing to participate in this study, were chosen.

7.2.6 Sampling technique:

The method of sampling that the investigator has employed is non-probability sampling and the technique used is convenient sampling, which fulfill the criteria.

7.2.7 Sampling Criteria

A. Criteria for inclusion a) Primipara and multipara mother who are willing to participate in the study b) The normal vaginal as well as cesarean section delivery mothers. c) Primipara and multipara mothers who are literate as well as illiterate. d) Mothers who had previous abortions and give birth to first viable child considered as primapara

B. Criteria for exclusion a) Primipara and multipara mothers who are not willing to participate in the study. b) Mothers with postpartum psychosis.

7.2.8 Tool for data collection

 Development of tools: The tool consists of interview schedule as well as written questionnaire, questionnaire is used to assess the knowledge of mothers.

 Format of the tool: The tool consist of 2 sections. Section -1: Deals with demographic details. Section-11:To assess the knowledge of mothers.

Section-1: Demographic Data  Age of the mother  Number of children  Educational status  Occupation  Income  Religion  Source of information

Section II-Knowledge of weaning Structured interview schedule as well as written questionnaire to assess the knowledge of mothers regarding weaning

7.2.9 Method of Data Collection:

A written questionnaire will be used to collect the data from the mothers. The purpose of study will be explained and consent from the participant will be obtained to involve in the study.

7.2.10 Data analysis and interpretations

Data will be analyzed on the basis of objectives and hypothesis by using descriptive and inferential statistics. In descriptive statistics the frequency, percentage, mean and standard deviation will be used for the data analysis. In inferential statistics: paired t test will be used to know the comparison of knowledge among mothers and the chi-square test will be used to find the association between selected demographic variables and knowledge level.

7.3 DOES THE STUDY REQUIRES, INTERVENTION TO BE CONDUCTED ON PATIENT OR ANY OTHER HUMAN OR ANIMALS?

No, only educational intervention is carried out by comparison of primi and multipara mothers knowledge regarding weaning

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? IN CASE OF ABOVE

Confidentiality and anonymity of the subjects will be maintained.

1. The ethical clearance will be sought from the research committee of Josco College of Nursing, Bangalore. 2. Consent will be obtained from the mothers before conducting the study. 3. Clearance from the institutional authority is obtained.

8. REFERENCES:

1) Dorothy R. Marlow. Etal.”Text Book of Pediatric Nursing”.6th edition. W.B. Sounders Company.1992.London. P.No.584-585

2) D C Dutta, “Text Book of Obstetrics Including Perinatology and Contraception”, 6th edition, New Central Book Agency Publishers Ltd, 2004, Calcutta, P.No. 456

3) Mahajan. B.K. Gupta MC. “Text Book of Preventive and social medicine”. Jaypee brother’s medical publishers.1991.New Delhi.P.No.71

4) Shanthi Ghose.”The feeding and care of infant and young children”. Volunteer’s health association of India. Revised edition.1997.New Delhi.P.No.35-36

5) Suraj Gupta.”The Short Text Book of Pediatrics”.Jaypee brother’s publishers 7th edition,1996.New Delhi.46-47 JOURNALS 6) Elizabeth.K.E.etal. “Indian Pediatrics”. Volume-34.Number-8.August- 1997.P.No-18-19

7)Cordova L, Amador M. Prevencion y eradicacion de la male nutrición en Cuba. Rev Cubana Pediat 1978;50: 171

8) Devagan.A.K.”Module on weaning and Supplementary feeding”.Nursing Journals of India. Delhi. March.1991.P.No.21-22

9) Gopaldas T. Malted versus roasted weaning mixes: development, storage, acceptability and growth trials. In: Achaya KT, ed. Interfaces between

agriculture, nutrition and food science. Tokyo: United Nations University, 1984.P.No.25-36 10) Mata LJ, Behar M. Malnutrition and infection in a typical rural Guatemalan village: lessons for the planning of preventive measures. Epol Food Nutr 1975:4:P.No.41-47.

11) Gajanan etal.”Nutritional Knowledge and Practice”.Swasth Hind. XXXVII.Number-8.August 1993.P.No.8-10

12) Jane Seymour.”Weaning Dietary Advice for Parents” Nursing Times. Volume 92, July 19-1996.P.No.14-16

13) Hofvander Y. Maternal and young child nutrition. Unesco education series no. 3. Paris: Unesco, 1983.P.No.51-55

14) Soysa P, Senanayake M. The introduction of a low-cost weaning food, its acceptability and effectiveness in a well-baby clinic. Ceylon J Child Hlth 1985.14(1):21-26.

15) Dr. Khamgaankar.MB.”Nutritional for Child Survival and Beyond”. Swasth Hind. Volume XXXVII Number-9. Sep-Oct-1993.P.No.34-35

16) Consultative group on maternal and young child nutrition. Food Nutr Bull 1979;1(3):20-22.

9 SIGNATURE OF THE CANDIDATE 10 REMARKS OF THE GUIDE Can Be Approved For Main Study

11 NAME AND DESIGNATION OF

1. GUIDE Ms KALAICHELVI

2. SIGNATURE

3 CO-GUIDE

4. SIGNATURE

5. HEAD OF THE Ms KALAICHELVI DEPARTMENT

6.SIGNATURE

12 REMARKS OF THE The study is appropriate in the present CHAIRMAN OR PRINCIPAL scenario. May be approved