A Study To Assess The Knowledge, Attitude And Practices Of Employed Mothers Regarding

A STUDY TO ASSESS THE KNOWLEDGE, ATTITUDE AND PRACTICES OF EMPLOYED MOTHERS REGARDING BREAST FEEDING IN SELECTED AREAS OF RAICHUR.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

GAYATRI DEVI.

NAVODAYA COLLEGE OF NURSING, RAICHUR.

NOVEMBER - 2007

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. Name of the candidate : GAYATRI DEVI and address M.Sc. Nursing Ist year, Navodaya college of Nursing P.B. No. 26, Mantralayam Road, Raichur-584103.

2. Name of the Institution : Navodaya College of Nursing.

3. Course of the study and : M.Sc. Nursing Ist Year, subject Obstetric and Gynacology.

4. Date of Admission to : 25/05/07. the course

5. Title of the Topic :

A study to assess the Knowledge, Attitude and practice of Employed mothers regarding breastfeeding in Selected areas of Raichur. 6. Brief Resume Of The Intended Work:

6.1 Need for the study:

‘Milk and Murder’, that deaths resulting from “……misguided propaganda on Infant feeding should be regarded as murder.”1

Children are our future and our most precious resources. For most of the children breast feeding makes the different between life and death and it is the infant “PASSPORT OF LIFE”. Breast milk not only the best our must for the infants. Lack of breast feeding- especially lack of exclusive breast feeding during first few months of life are important risk factor for infant and childhood morbidity and mortality. W.H.O. estimated that 1.5 million infant lives could be saved each year through increased breast feeding. Customs, Superstition, traditions and ignorance sometimes deprive the child from getting this benefit, as the ideal food for the young infant is human milk.2 Mother and children constitute ¼ of the total National population. They are the most vulnerable group to ill health. One of the main cause for neonatal mortality and morbidity is inadequate breast feeding, following faulty breast feeding techniques, ignorance of mother regarding feeding practices, lack of health education given by the nursing personals. Many cultural beliefs and practices are prevalent in post partum period that some mothers may not feed the baby immediately after birth. They neglect, “COLOSTRUM”, instead of it they give sugar water, plain water, honey etc, all these practices lead to suppression of lactation as prolactin gradually ceases and the breast stops secreting milk.3

Major problems exist among the post natal mother would be ignorance of mother regarding breast care and breast feeding lead to suppression of lactation. Due to inadequate breast feeding maternal problems like breast engorgement, mastitis, breast abscess, cracked and sore nipple and sub involution of uterus results with higher risk of post partum hemorrhage. New born once not supplied with breast milk were at risk of getting Gastrointestinal tract infection and respiratory tract infection, iron deficiency anemia, allergy disorders and it gradually increases Neonatal Mortality Rate.4

Breast feeding problems, outcomes and satisfaction of married, well-educated first time mothers who returned to work within six months post partum were compared to those of mothers with the same characteristic who stated at home. Mothers who planned to work after having baby anticipated and experienced shorter duration of breast feeding than did those who planned to remain at home. Breast feeding experiences and satisfaction among working counterparts; however, employment prior to two months post partum exerted some negative effects on breast feeding outcomes.5

A UNICEF (2007) report states that India has close to 2.5 million children born every year, out of these, 1.9 million are under- five, who die in a year. Among the decreased children, 1.4 million children die just within one year and roughly one million children die with in a month. Most of these deaths are associated with infant and young child malnutrition and other preventable disease caused mainly due to poor care and inappropriate infant feeding practices. Only 23.4 % newborn across the country begins breast feeding within a hour of birth. Early initiation of breast feeding practices provides quality health care for children and reduces their specific health problems. W.H.O. also recommends for optimal infant feeding practices to fight against malnutrition and promote child survival.6

Colostrum is pale yellowish milk which is secreted for the first 3 days of delivery. It can be considered as the first vaccine which needs a “warm chain” made by mother-infant contact. It is secreted in very less amounts (30-100 ml/day). So the mothers need to be explained that this small amount of Colostrum is for adequate and must not be denied to the baby. It has abundant anti infective properties.7

As breast feeding has so many advantages for mothers as well as children but in spite of having knowledge employed mothers neglect it because of lack of time and superstitious beliefs. Hence, the researcher felt the need to assess the knowledge, attitudes and practices of breast feeding among employed mothers. 6.2 Review of Literature:. Review of literature is a critical summary of research on a topic of interest generally prepared to put research problems in context on to identify gaps and weakness in prior studies so as to justify a new investigations. In this chapter the investigator reviewed the available research studies and relevant literature from which the strength of study was drawn.

An observational study was conducted to assess the breastfeeding practices of post natal mothers in selected hospitals of Hydrabad. A sample of 60 mothers was selected by random sampling. Data were collected by observational checklist and structured interview schedule. The results of the study showed that 50% mothers had adequate knowledge but majority were ignorant about hygienic practices. The study recommended that health education specially about importance of Colostrum, breast feeding techniques and hygienic practices are needed.8

A descriptive survey was conducted on “knowledge, attitude and practices of employed mothers about breast feeding in selected areas of Mangalore city.” Purposive sampling technique was used to select 60 mothers, working in selected colleges having a child with two years of age. A structured interview schedule was prepared to determine the knowledge and attitude and semi-structured interview schedule was prepared to determine the practice of breast feeding. The results of the study showed that 73% of mothers have knowledge regarding the benefits of breast feeding but only 24% of them had knowledge regarding ‘expression and storage of breast milk.’ The finding also reveals that all 100% mothers had positive attitude towards breast feeding.2

A descriptive survey was conducted to find out the “Existing breast feeding practices among the urban mothers in selected areas of Manipur.” Fifty mothers with the age group of 16 to 35 years were chosen for the study. Semi structured questionnaire was used to collect the data. The finding revealed that most of the mothers started breastfeeding within 24 to 48 hours of delivery. The study reveals that there is significant (p>0.001) relationship between mothers educational level, duration of breast feeding, social-economic status of family, mothers with higher education. Socio-economic status tend to stop breast feeding earlier than the mothers from lower educational and socio-economic status.9

A descriptive study was conducted on “Breastfeeding and weaning practices among postnatal mothers in selected government hospitals of Delhi.” The sample of 350 post natal mothers was taken for the study. Data collection was done with structured questionnaire. The study finding reveled that 58.8% of mothers answered that they follow breast feeding, since the other women do, 12% of mother undertook it on the advice of elder women, 12% undertook on medical advice and remaining considered breast milk to be pure food for babies. 10 A retrospective study was conducted on “Duration of breast milk expression among working mothers enrolled in an employer sponsored lactation program in the selected areas of Burbanr” Canada. A sample of 462 mothers employed by 5 corporations is taken. Data was collected by interview schedule. The results showed the breast feeding was initiated by 97.5 per cent of the participants, with 57.8 per cent continuing for at least 6 months, of the 435(94.2 per cent) attempted pumping milk at work, and 336(98 percent) were successful. They expressed milk in the workplace for a mean of 6.3 months (S.D. = 3.9, range 2 weeks to 21 months). Most of the women who pumped their milk at work were working full time (84.2 per cent).11

6.3 Statement Of The Problem. A study to assess the knowledge, attitude and practices of employed mothers regarding breast feeding in selected areas of Raichur

6.4 Objectives Of The Study . 1. To determine knowledge, attitude and practice of employed mothers regarding breastfeeding. 2. To find association of knowledge, attitude and practice of employed mothers regarding breastfeeding with demographic variables.

6.5 Hypothesis:  There will be a significant relationship between the knowledge of employed mothers regarding breast feeding with the selected socio demographic variation.  There will be a significant relationship between the attitudes of employed mothers regarding breast feeding with the selected socio demographic variables.  There will be significant relationship between the practices of employed mothers regarding breastfeeding with the selected socio demographic variables.

6.6 Operational Definitions 1. Knowledge: Refers to the level of understanding of employed mothers with regard to breastfeeding as measured by the correct responses of the women to the knowledge items of questionnaire. 2. Attitude: Refers to the opinion, ideas, beliefs and feeling of employed mother with regard to breastfeeding as responded to the attitude scale. 3. Practices: It refers to the activities followed or undertaken by the mothers with regard to breastfeeding among employed mothers. 4. Employed mothers: Refers to women who do services in return for payment. 5. Breastfeeding : Refers to the right act of giving breast milk by the mother to the new born baby till one year and so on which includes the position, time and hygiene in the postnatal period. 7. Materials and Methods.

7.1 Source of Data. Design: A descriptive survey design will be adapted for conducting the present study.

Setting of the Study: Raichur is one of the backward district situated in Northern Karnataka. It has an area of 60 Sq. and consists of 5 towns and 300 villages. The total urban population of Raichur is 2, 07,421 with a total number of 38,080 homes. Raichur town consists of 35 election wards and 15 revenue wards. Among above mentioned areas Vidya Nagar has been selected for the study.

Population: The population of the study comprised of all the employed mothers in urban areas of Raichur.

Sample: A sample consists of subjects of units that comprise the population for present study. The sample size is 60 employed mothers.

Sample Technique: Cluster sampling will be used to select the area and purposive sampling technique will be used for selecting the sample. Inclusion criteria: The study includes the mothers, who are:  employed and having children.  residing in Vidya Nagar.  able to read and write Kannada or English.  available at the time of data collection.  willing to participate in the study.

Exclusion criteria: The study excludes the mothers, who are not:  employed.  residing in Vidya Nagar.  able to read and write Kannada or English.  available at the time of data collection.  willing to participate in the study.

SELECTED VARIABLES: Variables included in the present study are:

Dependent variables: Knowledge, attitude and practices of breast feeding among employed mothers. Extraneous variables 1. Age: Age of the subjects in present study is categorized as: (a). 19-24 years (b). 25-30 years (c) 31-36 years (d). Above 37 years 2. Religion: Refers to the system of faith or worship the females follows: (a) Hindu (b) Muslim (c) Christian (d) Others 3. Education of mothers: It refers to previous education of subjects. It is categorized as: (a) Primary school (b) Secondary school (c) High school (d) PUC (e) Graduation (f) Post-Graduation and above 4. Type of family: It refer to the family type. For the present study it is categorized as: (a) Nuclear (b) Joint 5. Number of children in family: Refers to the children between 0 to 2 years of age. (a) One (b) Two 6. Type of Employment: Refers to their occupation and work. (a) Health workers (b) Teachers (c) Others 7. Monthly income of family: It refers to the monitoring earning of the parents. (a) Less than Rs. 1,000/- (b) Rs. 1,001 – Rs 3,000/- (c) Rs 3,001 – Rs 5,000/- (d) Rs 5,001 – Rs 7,000/- (e) Rs 7,001 and above 8. Source of information: It refer to the media through which the information was gathered. For the present study it is categorized as (a) News papers (b) Television (c) Radio (d) Family members (e) Friends (f) Partner 7.2 Method of Data Collection. Data collection instrument: The investigator planned to assess the knowledge and attitudes of employed mothers regarding breast feeding through structured interview schedule and breast feeding practices of employed mothers by check list. Section 1 – deals with the socio demographic data. Section 2 - deals with the assessment of knowledge and attitude related to employed mothers regarding breast feeding. Section 3 – deals with the items related to breast feeding practices among employed mothers.

Data collection method: Prior permission will be obtained by the significant authorities and the subjects. Then face to face interviews with subjects will be conducted by the investigator personally by using the structured interview schedule to assess the knowledge and attitudes regarding breast feeding where as checklist will be used to assess the breast feeding practices.

7.3 Projected Outcomes: The present study will help the employed mothers to gain knowledge, develop positive attitudes and follow safe and good practices of breast feeding and hence preventing infant mortality and morbidity rates. 7.4 Does the study require any investigation or intervention to be conducted on patients or other human or animals? If so, please describe briefly? Since, It’s a descriptive survey the study does not require any intervention or investigation.

7.5 Has ethical clearance been obtained from institution in of 7.4? Ethical clearance is obtained from the institutional ethical committee and consent will be obtained from all the subjects. 8. LIST OF REFERENCES:

1. Dr .M. Gandhimathi. NIGHTINGALE NURSING TIMES. 2007 August: 6-13. 2. Rinda John. KNOWLEDGE, ATTITUDE AND PRACTICES OF EMPLOYED MOTHERS ABOUT BREAST FEEDING. 2005 April; Vol XCVI. No. 4. 3. Mallika, Katiyar. CULTURAL BELIEFS AND PRACTICES OF BREAST FEEDING. 1999 June. 4. UNICEF. PROTECTING, PROMOTING AND SUPPORTING BREAST FEEDING. THE NURSING JOURNAL OF INDIA. 2003 June; Vol-5 No. 11, 3-7. 5. J Obstet Gynecol. NEONATAL NURSES BREAST FEEDING AND EMPLOYMENT. 1991 Nov- Dec; 20(6): 471-80. 6. UNICEF. NURSING TIMES. 2007 Aug. 7. Dr. S. Kalavathi. NIGHTINGALE NURSING TIME. 2007. August: 12. 8. Katiyar. BREAST FEEDING PRACTICES OF POST NATAL MOTHERS. THE NURSING JOURNAL OF INDIA. Vol. 8 No.36: 22-25. 9. Pinto. A. BREAST FEEDING AND PRACTICES OF POST NATAL MOTHERS. THE AMERICAN JOURNAL OF MATERNAL AND CHILD NURSING. 2001 June; Vol. 55 No. 56: 27-28. 10.Bhatia. BREAST FEEDING AND WEANING PRACTICES. WHO. REGIONAL PUBLISHERS. 2001 Aug. 11.Ortiz J, M. C. Gilligan. K. DURATION OF BREAST MILK EXPRESSION AMONG WORKING MOTHERS ENROLLED IN AN EMPLOYER SPONSERED LACTATION PROGRAM. 2004 Mar-Apr; 30(2): 1119-1122. 9. Signature of the Candidate :

10. Remarks of the Guide :

11 Name & the Designation of :

11.1 Guide : Mrs. Sreelekha. C

Asst Professor, . DEPT.OF OBSTETRICS AND GYNAECOLOGY NURSING. 11.2 Signature :

11.3 Co-guide (if any) :

11.4 Signature :

11.5 Head of the Department :Mrs. Sreelekha .C Asst Professor, DEPT. OF OBSTETRICS AND GYNECOLOGY NURSING 11.6 Signature :

12.1 Remark of the Chairman & Principal :

12.2 Signature :