Assessing knowledge and attitude regarding exclusive breast feeding among primipara mothers

INTRODUCTION

According to WHO (2012); breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infant; it is also an integral part of the reproductive process with important implication for the health of the mother.¹ According to WHO and UNICEF; exclusive breastfeeding means infant only receives breast milk without any additional food or drink, not even water. Just as there is no substitute for mother’s love, there is no substitute for mother’s milk. Exclusive breastfeeding shortly after birth reduces risk for infant mortality and morbidity.²

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Breast milk is a readily available food to the newborn at body temperature and without any lost.³ Benefits of exclusive breastfeeding are bonding; skin to skin contact of mother and baby stimulates breastfeeding behavior in the baby, hormone release oxytocin and prolactin hormones, weight loss, long term health effect, less risk of breast cancer, ovarian cancer, and reduced risk of metabolic syndrome and reduced risk of postpartum bleeding.⁴

The prevalence of exclusive and adequate breastfeeding practice is still lower in many countries. Inadequate knowledge and inappropriate practice of breastfeeding is a major issue and it may cause undesirable consequences. Proper breastfeeding is on the decline due to several factories; the impact of knowledge about breastfeeding practice i.e, duration of breastfeeding, proper techniques, and proper time of weaning is poorly understood.⁵

Exclusive breastfeeding is the best nutrition for children during the 1st six month of the life; however exclusive breastfeeding remains a challenge.⁶ Adequate breastfeeding support for mother and families could save many young lives.⁷ Breastfeeding is the prime important responsibility involved in nurturing baby and experience a sense of accomplishment. The baby is provided a close and comfortable contact with the mother leading to the growth of a mutual love and affection.⁸

There has been a decline in infant mortality rate (IMR, death per 1000 live birth of children under one year of age) from 78.5 in 1992-93 to 57 in 2005- 06 and 41 in 2015-16 due to the increase in early breastfeeding, according to National Family Health Survey-4 (NFHS-4) data. In the first 6 month of an infant life, in low and middle income countries, infant who received liquid and foods apart from breast milk were up to 28 times more likely to die than those that were exclusively breastfeed; according to this 2016 report by The United Nations Children Fund (UNICEF).⁹

Agostonic et al conducted a study in Italy to compare the growth pattern of breastfed and formulated infant in the 1st 12 months of life. Study done with 73 breastfeed infants and 65 formula fed infants showed that breast fed infants had significantly higher growth inclines.¹⁰

A cross sectional study was conducted to determine the knowledge, attitudes and practices (KAP) of nursing mothers in Osogbo, Nigeria. A total of 328 nursing mothers attending infant welfare clinics were recruited from selected four health centres in Osogbo Local Government Area. Semi-structured questionnaires were used to collect data on the Knowledge, Attitudes and Practices of respondents. Data were analyzed using Statistics Package for Social Scientists (SPSS) version 16. About 97.6% of the respondents were aware of EBF, but only 64.6% had adequate knowledge. Majority of the respondents (92.7%) learnt about EBF from health workers. Attitude to EBF was good as reported by 75.6% of respondents who practiced EBF on demand. About 73.8% of respondents practiced EBF. The respondents have good knowledge and attitude of EBF. The practice of EBF was equally good however less than one third used either water or herbs during EBF before six months.¹¹

OBJECTIVES

1. To determine the knowledge and attitude regarding exclusive breast feeding among primipara mothers.

2. To find the association between the level of knowledge and attitude regarding exclusive breast feeding among primipara mothers with the selected socio demographic variables.

METHODOLOGY

A non experimental Quantitative approach was selected for the present study. A non-probability convenient sampling technique was used to select samples. Ethical clearance was obtained from Institutional Ethical committee and formal permission obtained from authorities of the Hospital. Data was collected from 60 primipara mothers having infants aged between birth to one year, who visited OBG OPD and ward in the selected hospital, Bangalore. Pre validated structured knowledge questionnaire and attitude scale was used to collect data from mothers after obtaining informed consent. Tool consisted of three sections. Section I with base line data and section II knowledge questionnaire with 21 items and section III structured attitude scale. Total knowledge score was categorized and interpreted as adequate knowledge (>75%), Moderately adequate knowledge (50-75%), and Inadequate knowledge (<50%). The scoring of the attitude scale ranged from 1 to 5 and consisted of 10 items. Score were awarded for the category strongly agree 1, agree 2, neutral 3, disagree 4, and strongly disagree 5.and was categorized and interpreted as positive attitude (>75%), neutral attitude (50-75%), and negative attitude (<50%). validity and reliability of the tool was done before administration of the tool.

RESULTS

I. Socio demographic characteristics of primipara mothers

Findings showed that majority of primipara mothers 28(46.66%) were in the age group of 26-30years, majority 40(66.66%) had completed Graduation, majority 54(90%) belongs to Hindu religion, majority 38(63.33%) were home makers, majority 48(80%) resided in urban area, majority of the subjects 35(58.33%) belongs to the nuclear family and majority 34(56.66%) had monthly family income between Rs.25,000- Rs.50,000, majority 48(80%) of them had information and source of information, majority 30(62.50%) of them got information from family, majority of them 33(55%) had normal vaginal delivery.

II. Overall mean and standard deviation of knowledge and attitude regarding exclusive breastfeeding among primipara mothers.

Findings reveals the mean and standard deviation of knowledge where mean is 12.35, with a standard deviation of 3.56 and Attitude regarding exclusive breastfeeding among primipara mothers where mean is 38 with a standard deviation of 4.66. (Table 1)

III.Association between socio-demographic variables and knowledge and attitude regarding exclusive breast feeding among primipara mothers.

Findings of the study results revealed that there is significant association between knowledge regarding exclusive breast feeding among primipara mothers and sociodemographic variable income (chi square value=0.021, df=4). No association was found between knowledge regarding exclusive breast feeding among primipara mothers with age, religion, education, occupation, residence, type of family, mode of delivery.

Findings also revealed that there is no significant association between attitude regarding exclusive breast feeding among primipara mothers and sociodemographic variables.

DISCUSSION

The present study shows that the overall assessment of knowledge indicated that 21.66% of subjects had adequate knowledge. 48.3% of subjects had moderately adequate knowledge, 30% of subjects had inadequate knowledge. The overall assessment of attitude indicated 57% of subjects had positive attitude and 43% of subjects had neutral attitude towards exclusive breast feeding practices among primipara mothers.

This is supported by the survey that was conducted to assess the knowledge, attitude and practice of breast feeding among employed mothers who were attending the paediatric OPD’s in Salem. 60 mothers were selected by convenient sampling method and the findings revealed that majority of the mothers have average knowledge and 67% had positive attitude towards breast feeding but the practices were partially adoptive for 52% and completely adoptive for 43% of mothers. The study concluded that mothers had positive attitude towards exclusive breast feeding up to 6 months but practice is poor related to their ignorance.

NURSING IMPLICATION

Nurses can expand and extend her practice beyond the hospital and share her knowledge with the public. Nurses can provide CME and motivate the primipara mothers regarding exclusive breast feeding, this may enhance the knowledge regarding exclusive breast feeding among public. Nurses have a very important role in bringing about the public awareness by educating them regarding breast feeding practices.

The finding of the present study revealed the need for emphasizing the education of nurses regarding the breast feeding practices. The nurse administrator should organize health awareness programme to improve the knowledge, practice and attitude of primipara mothers regarding exclusive breast feeding. The nurse practitioner and educationist self learning module can be prepared to teach exclusive breast feeding practices to mothers.

Findings of the present study suggest that nurse education and nurse administrator should encourage nurses to read discuss and conduct research studies on exclusive breast feeding to improve the knowledge and attitude and bring about the public awareness.

CONCLUSION

The present study assessed the knowledge and attitude regarding exclusive breast feeding among primipara mothers. Among 60 primipara mothers 30% had inadequate knowledge, 48.3% had moderate knowledge and 21.66%had adequate knowledge. For the attitude majority of the samples, 57% had positive attitude and 43% had neutral attitude.

With regards to association between the socio demographic variables with level of knowledge and attitude regarding exclusive breast feeding among primipara mothers, there was a significant association found between knowledge and socio demographic variable of mothers regarding exclusive breast feeding.