CHAPTER – I

INTRODUCTION

Newborn baby has only three demands.

They are warmth in the

arms of its mother, food from her breasts,

and security in the

knowledge of her presence.

Breastfeeding satisfies all three.

- Grantly Dick

In Christianity, Adam ana Eve were said to be the first man and the first

women adam was created first, and Eve from Adam’s rib. Then life of women has

established with the accomplishment of different roles in which the vital act is the

motherhood and thus the commencement of the generations has instituted. Pregnancy

is a unique ,exciting and often joyous time in a woman’s life, as it highlights the

woman’s amazing creative and nurturing powers while providing a bridge to the

future .pregnancy comes with some cost, however ,for a pregnant woman needs also

to be a responsible woman so as to best support the health of her future child. The

growing fetus depends entirely on its mother’s healthy body for all needs.

consequently, Pregnant women must take steps to remain as healthy and well

nourished as they possibly can so that mothers can meet all the needs of the upcoming

baby main breastfeeding and bonding. Breastfeeding meets both the nutritional and

nurturing needs. Nursing is a learned skill for both mother and baby that requires time

and patience.

In pregnant, body was preparing a very special blend of nutrients to meet the

baby’s needs.Colostrum is the perfect starter food for the baby. This yellowish,

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creamy substance is found in the breasts during pregnancy and for a few days after

delivery.Colostrum acts as natural laxative (something that makes it easier to have

bowel movements)to help clear the meconium from the baby’s intestine.

Breastfeeding is the feeding of an infant or young child with breast milk directly from

female human breast. Breast milk is made of nutrients from the mother bloodstream

and body sores. Breast milk has just the right amount of fat ,sugar ,water and protein

required for the growth and development of a baby. A major advantages to the mother

is that breastfeeding uses an average of 500 calories a day, which help her lose

weight after giving birth.

Breast feeding is a mother’s privilege, a baby’s right. From the beginning of

human civilization , generation after generations have grown up on mothers milk,

nature’s complete diet for the new born. Nothing can compare with the breast milk.

Over the last couple of decades, there has been an increasing interest in the

promotion of exclusive breastfeeding as the ‘best’ feeding method for newborns. This,

to a large extent, has been inspired by mounting scientific evidence on the importance

of exclusive breastfeeding in reducing infant morbidity and mortality. In resource

limited settings where poor and sub-optimal breastfeeding practices frequently result

to child malnutrition which is a major cause of more than half of all child deaths

(Sokol et al. 2007), exclusive breastfeeding is regarded as imperative for infants’

survival. Indeed, of the 6. 9 million under five children who were reported dead

globally in 2011, an estimated 1 million lives could have been saved by simple and

accessible practices such as exclusive breastfeeding (WHO, 2012). Consequently, the

WHO and UNICEF (1990) have recommended exclusive breastfeeding for six

months, followed by introduction of complementary foods and continued

breastfeeding for 24 months or more.1

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 BACKGROUND OF THE STUDY

Breastfeeding is a mother's gift to herself, her baby

and the earth.

Pamela K. Wiggins

Breast feeding is an extra ordinary gift of nature and a reward for both babies

and mothers in many aspects. It is globally accepted to be the best and complete food

for the new born as it satisfies the specific nutritional needs. Widespread evidences

are there to support the advantages of the breast feeding to the infants, mothers,

families and society. These also include physical, emotional, psychological,

developmental, nutritional, immunological, social, economic and environmental

benefits2.

WHO defines exclusive breastfeeding as the practice of feeding only breast

milk (including expressed breast milk) and allows the baby to receive vitamins,

minerals and medicines. Water, breast-milk substitutes, other liquids and solid foods

are excluded. World Health Assembly in 2001 resolved that exclusive breastfeeding

for the first six months is the most appropriate infant feeding practice3.

The Government of India recommends that initiation of breastfeeding should

begin immediately after childbirth, preferably within one hour. Early initiation of

breastfeeding is encouraged for a number of reasons. Mothers benefit from early

suckling because it stimulates breast milk production and facilitates the release of

oxytocin, which helps in contraction of the uterus and reduces postpartum blood loss4.

Exclusive breastfeeding is recommended because breast milk is

uncontaminated and contains all the nutrients necessary for children in the first few

months of life. In addition, the mother’s antibodies in breast milk give immunity to

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the child. Early supplementation is discouraged for several reasons. First, it exposes

infants to pathogens and increases their risk of infection, especially disease. Second, it

decreases infants’ intake of breast milk and therefore suckling, which reduces breast

milk production. Third, in a harsh socioeconomic environment, supplementary food is

often nutritionally inferior 5.

The universally recommended feeding practices are from birth to the age of

six months exclusive breast feeding and it constitutes appropriate feeding for the

infants for the development5. The introduction of breast milk is especially encouraged

immediately after birth and until the third day, when the mother secrets colostrums.

Colostrums provides all the nutrients that are needed by the infant in this early period.

It is compositionally distinct, with the concentration of protein, Vitamin A and B12

being higher than the mature milk. Colostrums also contains a high concentrate of an

immunoglobulin’s especially immunoglobin A(IgA) which has a protective role

against pathogens in gut6.

Early initiation of breast feeding enhances “Maternal- Infant Bonding” “

Maternal-Infant bonding” means the development of the core relationship between

mother and child. The bonding process occurs in both infant and mother and has

tremendous implications for the child’s future development7. The benefits of

breastfeeding for the health and wellbeing of the mother and baby are well

documented. 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% 8, 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

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1.45 million lives each year by reducing deaths mainly due to diarrhoeal disorders and

lower respiratory tract infections in children8.

The primary causes of neonatal deaths are: neonatal infections (52%),

asphyxia (20%), and low birth weight (17%). Most of the infectious deaths are from

diarrhea and pneumonia. These all the risks can be reduced by the exclusive breast

feeding9.

NEED FOR THE STUDY

“A baby nursing at a mother’s breast is an undeniable affirmation of our

rootedness in nature”

-Grantly Dick

The National Family Health Survey-3 for India observed that only a quarter

newborns were breastfed within an hour of their birth, almost 60 per cent received

pre-lacteal feeds, exclusive breastfeeding rate at 6 months was just under 30 per cent

with a median duration of exclusive breastfeeding of 3.7 months and predominant

breastfeeding of 6.4 months. Breastfeeding is a public health issue and could have

large impact on several of our MDG goals. Optimal and exclusive breastfeeding in

early infancy enables children to grow better and is a step towards reducing child

undernutrition (MDG-1: hunger and poverty) 12 ; it also empowers women to be in

control of their reproductive life (MDG-3: gender equality); it is an important strategy

for reducing child mortality (MDG-4: reduce child mortality) 12 ; early initiation of

breastfeeding reduces maternal risk of post-partum haemorrhage and breastfeeding

reduces the risk of ovarian and breast cancer (MDG-5: maternal health)10.

According to World Breastfeeding Trends Initiative report in daily news, New

Delhi (December 6, 2012), Only eight million of the 26 million babies born in India

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every year are breastfed within an hour of birth. In South Asia, 24%–26% of babies

born in Bangladesh, India and Pakistan are breastfed within the first hour of birth,

whereas the corresponding rate for Sri Lanka is 75% 14. The effect of these

breastfeeding patterns is reflected in the neonatal mortality rates for these countries:

40–50 per 1000 live births for Bangladesh, India and Pakistan, while in Sri Lanka the

rate is as low as 11 per 1000 live births.11

Globally, over one million newborn infants could be saved each year by

initiating breastfeeding within the first hour of life 9. In Bangladesh only, 43% of

children are breastfed within 1 hour of birth and only 43% of children are exclusively

breastfed16.Some previous observational studies showed that the growth of LBW

infants is strongly associated with exclusive breastfeeding, Another observational

study found that exclusive breastfeeding was enough for LBW babies to gain normal

weight. Exclusive breastfeeding is the only practice that is not only naturally

available, but also sufficient to overcome the growth, morbidity and mortality of

LBW babies 12.

Bader Ebrahim, Hadel Alenzi, Mohammed AlTurki et al.,revealed the

misconceptions of the mothers about breastfeeding. Three fifth of the mothers said to

stop breast feeding in case of fever, skin rash or sore throat. 20 per cent thought that

mothers should stop breastfeeding if the child is having vomiting, diarrhoea and skin

rash13.

A study in Aljamahiriya and Alfateh Hospital in 6 Different studies from

various areas had shown limited knowledge of exclusive breast feeding. Yadavannar

and Shailaja in Bijapur revealed 81.9 per cent of the mothers had low knowledge. Sai

sunil Kishore, Praveen Kumar and Arun in Haryana revealed that only 10 per cent of

the mothers practiced exclusive breast feeding up to 6 months14.

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 Studies showed that medical staff support could determine the women's

decision concerning breastfeeding. The influence of the nurses played vital role in the

decision of women about breastfeeding. The health care system is planning in a

numerous ways to tackle the situation. They are taking steps to overcome the issues.

However, still India is in 31stplace among the 51 countries survey by the world breast

feeding trends initiative. Many studies from the India also highlighted the lack of

awareness among the mothers regarding exclusive breast feeding and timely initiation

of breast feeding. Towards the end of antenatal period the mother should be having

the appropriate knowledge to initiate breast feeding and exclusive breastfeeding.

Hence, the Investigator was much interested to focus on the postnatal group to assess

the effectiveness of structured teaching programme.

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STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programme on knowledge

regarding ‘exclusive breastfeeding’ among lactating mothers at selected hospitals

of vadodara.”

OBJECTIVES OF THE STUDY:

1. To assess the existing knowledge of lactating mothers regarding exclusive

breast feeding at selected Hospitals of Vadodara.

2. To determine the effectiveness of structured teaching programme on

knowledge regarding exclusive breastfeeding among lactating mothers.

3. To find out association between post test knowledge score regarding

exclusive Breastfeeding among lactating mothers with selected demographic

variables such as age ,education, occupation , religion, residence , parity.

RESEARCH HYPOTHESIS

H1: There will be significant difference in level of knowledge regarding

exclusive breastfeeding before and after structured teaching programme among

lactating mothers at selected hospital of vadodara.

H2: There will be significant association between selected demographic variables

and post-test knowledge of lactating mother regarding exclusive breast feeding .

ASSUMPTIONS:

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 1. Lactating mother will have limited knowledge regarding exclusive

breastfeeding.

2. Structured teaching programme may enhance the knowledge of lactating

mother regarding exclusive breastfeeding.

OPERATIONAL DEFINITIONS

ASSESS

It is the organized systemic and continues process of collecting data from

lactating mothers regarding exclusive Breast feeding.

EFFECTIVENESS

It is the extent to which an action produces an intended (or) desired outcome.

In this study effectiveness refers to the extent to which the Structured teaching

programme on exclusive breast feeding as achieved the desired effect in improving

the knowledge of Lactating mother as evident from gain in knowledge score.

STRUCTURED TEACHING PROGRAMME

It refers to a systematically organized teaching and learning process between

the investigator and study subjects, which is intended to increase the knowledge of

study subjects regarding Exclusive Breastfeeding.

KNOWLEDGE

It refers to correct written responses or level of awareness of lactating mothers

regarding exclusive breast feeding.

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EXCLUSIVE BREAST FEEDING

It refers that the infant receives only breast milk. No other liquids or solids are

given not even water – with the exception of oral rehydration solution, or

drops/syrups of vitamins, minerals or medicines

LACTATING MOTHERS

It refers to a mother who breastfeed her baby.

CRITERIA FOR SELECTION OF SAMPLES

¾ INCLUSION CRITERIA

-Mother who are willing to participant.

-Mother who can read and understand English, Hindi or Gujarati.

¾ EXCLUSION CRITERIA

-Mother who are not present at the time of data collection.

-Mother who having any complication.

CONCEPTUAL FRAMEWORK

A conceptual framework is a group of concepts and a set of propositions that

spells out the relationship between them. Conceptual framework plays several

interrelated rolls in the progress of science; their overall purpose is to make specific

findings meaningful and Generalizable15.

Conceptual framework facilitates communication and provides for a

systematic approach to nursing research, education administration and practice16.

Wood and Haber (1994) stated that, when conducting research, a theoretical

framework serve as a guide or map to systematically identify a logical, precisely

defined relationship between variables.

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 Open system model by J.W .Kenny the present study is based on open system

model for development of learning material for continuing education of health

worker.

“Open system model is a set of related definitions, assumptions ,and

propositions which deals with reality as an integrated hierarchy” systems models

focuses in each system as a whole ,but pays particular attention to the interaction of its

part or subsystems. A system is a set consisting of integrated and interacting parts that

functions as a whole. The conceptual framework is divided in to 3 process Input,

Throughput and Output17.

INPUT-

Input has been defined as any form of information and material that enters in

to system through a boundary. In this study input refers to knowledge of lactating

mothers regarding exclusive breastfeeding influence by many demographic variables

like age, education, occupation, religion, residence, parity. In this study the initial

knowledge will be assessed by the pre-test based on a structured questionnaire in

group.

THROUGHPUT

According to this theory throughput is a process that occurs at some point

between the input and output process and enables the input to be transferred in such a

way that it can be used readily by the system.In this study , A structured teaching

programme on knowledge regarding exclusive breastfeeding among lactating mothers

will be prepared and administered to the group.

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OUTPUT-

Is any information or material that is transferred to the Environment? In this

study output refers to gain in knowledge scores in post-test in the group .The post-test

will be conducted 7 days after dissemination of the structured teaching programme on

knowledge related exclusive breast feeding to the group.

FEEDBACK-

Differences in pre and post test scores were observed from knowledge scores

of the samples, In the present study, the feedback was considered as a process of

maintaining effectiveness of structured teaching programme, it was assessed by

comparing the pre and post test scores, through ‘t’ test. The effectiveness of the

structured teaching programme was also tested between the obtained scores of the

sample with their demographic variable through chi square.

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 INPUT 
11111111 THROUGHPUT
OUTPUT

Demographic
data:
Structured
PROCESS OF
Teaching ADEQUATE
-Age of TRANSFORMA P
P Programme KNOWLEDGE
mother TION OF
Regarding KNOWLEDGE O
R
-Mother’s Exclusive REGARDING
education E Breast S
EBF TO
-Mother’s Feeding LACTATING T
T MODERATE
occupation Among MOTHERS
E Lactating T KNOWLED
-Religion
Mothers E
S
-Residence
T S
-Parity INADEQUATE
T  KNOWLEDGE

FEEDBACK

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Fig: 1 – Modified conceptual framework based on Ludwig Von Bertalanffy
 
general system theory (1968)