ABSTRACT

CORRESPONDING AUTHOR:
Dr. K. Bhavani,
12-5-30, Flat 502, S. V. Emerald,
Behind Innova Hospital,
Tarnaka, Secunderabad, 500017.
E-mail: bhavanikenche1969@gmail.com

ABSTRACT: BACKGROUND: Breast feeding  plays an essential and  sometimes  underestimate role in the treatment and prevention of  infant  and childhood illness. Improving breast feeding  is a highly feasible and cost effective approach to reducing the number of infant  who die from infectious disease and malnutrition early in their lives. Continuing to breastfeed  alone could save 1 to 1.5 million lives a year. Well over 40% of 10.9 million deaths annually occur due to inappropriate feeding practices ,  during the 1st year of life. Lack  of  breast feeding and especially exclusive breast feeding  during the 1st year of life are important risk factors for infant and child hood morbidity and mortality  that are only compounded by inappropriate complementary feeding .  Current   evidence that Breast feeding is beneficial for infant and child health is based on exclusive observational studies. The experimental intervention increased the duration and degree of breast feeding. These results provide a solid scientific under planning for future interventions to promote Breast feeding. Breast feeding practices appear to be ineffective even in institutions due to lack of knowledge of   importance of breast milk , colostrums, and pre-lacteal feeds. In the present study an effort is made to assess the knowledge of breast feeding practices among post natal women and mothers attending   immunization clinic. OBJECTIVES: To study  the sociodemografic  factors influence on breast feeding behavior of post natal mothers and to study the awareness of benefits of colostrums, and effect of media on breast feeding practices. MATERIALS AND METHODS : The present study  is a cross-sectional,  Descriptive Hospital based ,conducted in the post natal ward at Govt Maternity Hospital, sultan Bazar, Hyderabad, A.P., participants are the Mothers who have delivered within 3days of interview, and the Mothers attending immunization clinic , having children below 1 year of age . sample size is 150 Post Natal Mothers and 100 mothers attending immunization clinic in the same hospital selected by simple random sampling technique. METHODOLOGY: interview with a predesigned and pretested semi structured questionnaire administered to 150 randomly selected mothers at the bed side in post natal ward who have delivered 3days prior to the interview.   A friendly support was maintained to elicit the response regarding breast feeding practices. the mothers  were interviewed  in  their mother tongue. Study was  conducted from November 1st to December 2004.study variables includes social demographic  factors like age, marriage, age at pregnancy, social status, literacy, and their relation to awareness on breast feeding practices etc. Analysis  mainly comprises of simple proportions and chi-square test using epi info.  RESULTS: A total of 250 respondents  breast feeding practices were studied. Their socio demographic  factors includes Residential, literacy, occupational status  etc. Among total Majority of the mothers were more than 21 yrs(61.33%to68%), belong to urban areas(78.66%, 75%), Hindus were(82.66%,66%), Nuclear families (64%,61%),and lower socioeconomic class (64%,72%). Majority of mothers  who advice on early initiation were 62%,63% of them started breast feeding  early. The difference in BFP’S among the groups is highly Significant. (p<0001). (80%) breast fed was  who delivered normally , who underwent LSCS was 12.8%,almost 88% of mothers in postnatal ward and mothers attended immunization clinic 100% was breast fed their infants at the time of interview, it universal.  Breast feeding was also universal and on demand  in both groups. only 2.66%were breast fed every 3hrs. Mothers who had not initiated and said that milk was not formed is 56%,and 44% of them had not been advised on early initiation . Duration of initiation of breastfeeding among both the groups (45.3%)were 7to24hrs.  Both the groups found  not exposed to media as the source of information on breast feeding  was 76%, 58%respectively ,about  20% of post natal ward and 41% of immunization clinic mothers  were exposed to health workers message on breast feeding, TV, news paper, contributed minimum regarding awareness of breast feeding. Majority  of the mothers were house wives 80%,84% and only 2%were working ,hence the  difference found   significant statistically(p<0.01).Mothers of lower socio economic class had exclusively breast fed for a longer time(1yr) and the habit of introducing weaning food was found late(1yr) in both the groups. CONCLUSION: To alleviate the misconception of breast milk not being formed till 3days and advice regarding early initiation of breast feeding during antenatal and post natal  visits to the hospital and also through  effective information education communication must be strengthened to improve breast  feeding practices among all the social groups.
KEYWORDS: post natal mothers Breast feeding practices, socio-demographic  factors.

INTRODUCTION: Breast feeding   plays an essential and  sometimes  under estimate role in the treatment and prevention of  infant and childhood illness.  Improving breast feeding  is a highly feasible and cost effective approach to reducing the number of infant  who die from infectious disease and malnutrition early in their lives. Continuing to breast feed   alone could save 1 to 1.5 million lives a year. Well over 40% of 10.9 million deaths annually occur due to inappropriate feeding practices,   during the 1^st year of life. Lack of  breast feeding and especially exclusive breast feeding  during the 1^st year of life are important risk factors for infant and childhood morbidity and mortality  that are only compounded by inappropriate complementary feeding. The executive board of WHO at it’s 101 session in January 1998 called for revitalization of the Global Commitment to appropriate infant and young child nutrition ,and in particular Breast feeding and complimentary feeding. Subsequently, in close collaboration with United   Nation’s  Children’s Fund. WHO Organized a consultation (Geneva, 13^th to17th march,2ooo)to access infant and young child feeding practices.(1)

1^st breast milk containing colostrums is rich in protein ,immunoglobulin’s, vitamins, minerals, lysozymes , lactoferrin and living cells. Breast feeding protects mother’s health too, reduces the risk of introducing infection into infants’s elimentary canal. Breast milk contains all the water a baby needs .practice of giving pre-lacteal feeds  as ritual food or hospital practice routinely has to be discouraged.  Inaddition to the risk of diarrhea,  decreased effectiveness of suckling. exclusive breast feeds can meet the nutrient needs during the 1^st 6 months of life and strongly associated with weight for length and weight for age. appropriate complimentary feeds have to be introduced at around six months of age, while on demand breast feeding is continued. Cultural beliefs are important determinants of health care behavior. Nurses have an important role on infant feeding practices. According to a study conduted  by Kaewsara P. Moyle W Creedy(2) some traditional beliefs like discarding colostrums, and giving boiled water to neonates-was supported by nurses. Current  evidence that Breast feeding is beneficial for infant and child health is based on exclusive observational studies. The experimental intervention increased the duration and degree of B.F. These results provide a solid scientific under planning for future interventions to promote breast feeding.

Breast feeding practices appear to be ineffective even in institutions due to lack of knowledge of importance of breast milk , colostrums, and pre-lacteal feeds. In the present study an effort is made to assess the knowledge of breast feeding practices among post natal women and mothers attending immunization clinic.

MATERIAL AND METHODS:  The present study  is a cross-sectional,  Descriptive Hospital based ,conducted at Govt. Maternity Hospital, sultan Bazar, Hyderabad, A.P., participants are the Mothers who have delivered within 3days of interview, and the Mothers attending immunization clinic , having children below 1 year of age . sample size is 150 Post Natal Mothers and 100 mothers attending immunization clinic in the same hospital selected by simple random sampling technique.

METHODOLOGY: Interviewed with a predesigned and pretested semistructured questionnaire administered to 150 randomly selected mothers at the bed side in post natal ward who have delivered 3days prior to the interview.   A friendly support was maintained to elicit the response regarding breast feeding practices. The mothers were interviewed in their mother tongue. Study has been conducted from November 1^st to December 2004.study variables includes socio-demographic  factors like age, marriage,  social status, literacy, and their relation to awareness on breast feeding practices etc. Analysis  mainly comprises of simple proportions and chi-square test using epiinfo. The  collected was compiled and consolidated to get required out put. Appropriate statistical tests significance were done.

RESULTS AND DISCUSSION: 

Table-1 Socio-Demographic profile of study population:                     

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   Post natal mothers (%)             immunization clinic (%)          total (%) 

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Age group(years) :                

<21                                                        58 (38.66)                                   32 (32)                                       90 (36)    

>21                                                        92 (61.34)                                   68 (68)                                     160 (62)

Residential status :                

 Urban                                         118 (78.66)                                     75 (75)                                     93 (77.2)

Rural                                             32 (21.34)                                      25 (25)                                     57 (22.8)

Religion

Hindus                                                 124 (82.66)                                    66 (66)                                    190 (76)

Muslims                                                26 (17.34)                                    34 (34)                                       60 (24)

Type of family:

Nuclear                                                96 (64)                                           61 (61)                                   57 (62.8)

Joint                                                      30 (20)                                              6 (6)                                     36 (14.4)

Ext.joint                                              24 (16)                                            33 (33)                                  57 (22.8)

Occupation  :                  

Housewives                                       120 (80)                                           84(84)                                  204 (81.6)

Agriculture                                            3   (2)                                                0                                             0

Business                                              1   (0.66)                                              3 (3)                                      4 (1.6)

Others                                  26 (17.33)                                         13(13)                                  39 (15.6)  

Literacy status:

Illiteracy                                             54 (36)                                             31 (31)                                   85 (34)

Primary                                              36 (24)                                             30 (30)                                   66 (26.4)

Secondary                                          35 (23.3)                                          27 (27)                                   62 (24.8)

Higher                                  25 (16.67)                                        12 (12)                                   37 (14.8)

Social Economic:

Upper                                                   20 (13.34)                                           3 (3)                                     23 (9.2)

Middile                                                33 (22)                                               25 (25)                                  58 (23.2)

Lower                                                  97 (64.66)                                         72 (72)                                 169 (67.6)

Mode of delivery  :

Normal delivery                              200 (80)                                             12 (4.8)                                 212 (84.8)

LSCS                                                      32 (12.8)                                              6 (2.4)                                    38 (15.2)

Frequency of breast feeding:

On demand                                        146 (97.33)                                       100 (100)                                246 (98.4)     

Timely                                                      4 (2.66)                                               0                                            4 (0.16)

Duration of initiation of Breast feeding after delivery:

<1hour                                 3 (2)                                                      1 (1)                                           4 (1.6)

1-6 hours                           50 (33.34)                                         41 (41)                                     91 (36.4)

7-24 hours                                         82 (54.66)                                         31 (31)                                    113 (45.2)

<24 hours                          15 (10)                                               27 (27)                                     42 (16.8)

Effect of Media :

T V                                           4 (3)                                                     0                                                4 (1.6)

News paper                        2 (1)                                                   1 (1)                                         3 (1.2)

Health worker                               30 (20)                                             41 (41)                                     71 (28.4)

None                                             114 (76)                                                        58 (58)                                   172 (68.9)

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A total of 250 respondents for breast feeding practices were form post natal ward (150), and mothers attending the immunization clinic(100) were interviewed in the study. Percentage distribution of mothers socio demographic profile depicted in the table 1 by age group,  residential, literacy ,occupation etc…majority of the  mothers were more than 21 yrs(61.33%to68%), belong to urbanareas(78.66%,75%),Hindus(82.6%,17.3%),nuclearfamilies,(61%,64%),and lowersocioeconomicclass (64%,72%).majority of mothers(80%) breast fed was  who delivered normally , who underwent LSCS was 12.8%,almost 88% of mothers in postnatal ward and mothers attended immunization clinic 100% was breast fed their infants at the time of interview, it universal. Similar findings have been reported in the study conducted by Jaegar MC, Lawson M ,Filteau S etal.(3). in contrast , study conducted by  Barton SJ(4), Breast Feeding Practices found to be less. Frequency of breast feeding was also universal and on Demand  in both groups. only 2.66%were breast fed every 3hrs. Mothers who had not initiated breast feeding said that milk was not formed is 56%,and 44% of them had not been advised on early initiation of breast feeding. duration of initiation of breastfeeding among both the groups (45.3%)were 7to24hrs.  Both the groups found  not exposed to media as the source of information on breast feeding  was 76%, 58%respectively ,about  20% of post natal ward and 41% of immunization clinic mothers  were exposed to health workers message on breast feeding, TV, news paper, contributed minimum regarding awareness of breast feeding. Many studies have shown similar findings i.e. the positive impact  of advice and information regarding breast practices on mothers . some of them are –studies conducted by GrosssmenLK  Fitzsimmons SM, etal…(5)but the study conducted by Mathews K,Webber J etal(6).found that there was no significant influence of health professionals on the breast feeding practices of mothers.

Breast Feeding Practices  in relation with their :

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Occupation :                                  Yes(%)                        No(%)                                         Total(%)

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Housewives                                  193(83.18)                  11(61.12)                                   204(81.6)

Working women                            39(16.82)                      7(38.88)                                     46(18.4)

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Literacy :

Illiterate                                             82(96)                          3(4)                                            85(34)

Literate                                            150(91)                        15(9)                                          165(66)

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Advice received Regarding early Initiation of  Breast feeding in:

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Immunization clinic:                      (yes) (B.F)                 (no)(B.F)                                      (total)

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Yes                                                           59(63)                        34(37)                                         93(37.2)

No                                                           20(35)                         37(37)                                         57(22.8)

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Advice given  by whom in hospital :

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Doctors                                              87(58)

Nurses                                                  2(1)                           57(38)                                      

Others                                                   4(3)

Total                                                   93(62)                         57(38)

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Pre -lacteal feeds to the new born:

Post natal ward                             82(54.6)                        68(45.33)                                         150 (60)

Post Natal Mothers knowledge regarding Benefits of Colostrum  to babies:

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Rich in nutrients:                           30(20)                          19(19)                                        49(19.6)

Prevents infections                          2(1)                              0                                                    2 (0.8)

Don’t know                                   118(79)                          81(81)                                     199 (79.6)

Total                                               150(100)                     100(100)                                   100

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Whether they fed Colostrum or not to their babies  :

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Post natal ward                            98(65.33)                   52(34.67)                                     150(100)

Immu clinic                                  72(72)                         28(28)                                          100(100)

The above table refers to percentages of various  factors like occupation, literacy ect. in relation with the breast feeding practices . Majority  of the mothers were house wives 80%,84% and only 2%were working ,hence the  difference found   significant statistically(p<0.01)  , similar findings were  reported in studies by Mattews K ,WebberKJ, Etal…(6).majority of the mothers (93%) had breast fed  irrespective of their literacy status hence statistically not significant. The study conducted by   Barton(4) also reported  similar findings. Equal percentages of mothers found to practice pre-lacteal feeds in both categories. Honey was the common prelacteal  feed found to be given and glucose water, top milk,  were also preferred as prelacteal feeds Mothers who advice on early initiation were 62%,63% of them started breast feeding  early. The difference in BFP s among the groups is highly significant.(p<0001) . similar findings were found in  studies conducted by Rogers IS, Emmett PM etal(7).  colostrums feeding habit was found to be present in 65.3%, 72% and knowledge regarding benefits of colostrums was very poor (79%,81%)in both groups respectively.

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Duration of Exclusive Bereast Feeding Practices in relation to the Socio-Economic status:

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Social economic :                      4mons                   6Mon                  1yr                  2Yrs               Total

Upper                                           2 (2)                         1 (1)                          0                        0                        3 (3)

Middle                                             0                             9 (9)                16(16)                0                     25 (25)

Lower                                           1 (1)                      20 (20)             35 (35)            16 (16)             72 (72)

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Social class and weaning period:

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Upper                                           1 (1)                        2 (2)                     0                         0                       3 (3)

Middle                                           0                            11 (11)               14 (14)                 0                     25 (25)

Lower                                           0                            27 (27)               44 (44)                 1                     72 (72)     

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The above table shows that mothers of lower-socio economic class had exclusively breast fed for a longer  time when compared with upper class. And also the habit of introducing weaning food found to be late in lower socio economic class (1yr) in both groups.

In the  present study ,only 33% of them had exclusively breast fed ,similar findings were quoted in studies conducted by Chan SC, Tsai JS King NM (8)by Bland RM etal…(9)but the study conducted  by Lindgren C. Thompson JM, Haggblom  L etal (10).found that the  over  all prevalence of Exclusive breast feeding was 70.4%.

CONCLUSIONS: The total respondents of breast feeding practices are from post natal wards and mothers attending immunization clinic. From the total of 250 mothers, majority  were more than 21 years(61.33%-68%).Most of them were from urban areas(78.66%-75%) . In relation to the religion, Hindus were 82.6%, 17.4% were Muslims. Most of the mothers were from nuclear families (61-64%). 80% of mothers who had delivered normally were breast fed and  only 12.8% of mothers who underwent LSCS  breast fed their babies. Breast feeding practices among post natal mothers and mothers attending immunization clinic was found to be universal. Majority of mothers were housewives(80-94%),agricultural laborers were 2% and 13-17% of them were either servants or vendors. Breast feeding practices were found to be more in non working group.(77%).The difference was  statistically significant( X2=4.72, p<0.01).Most of the mothers were illiterates(31-36%),only 1-2% were higher educated. Though there are literates, they do not have knowledge about early initiation of breast feeding.72% of literates started breast feeding after 6 hours of delivery. Majority (93%) had breast fed  irrespective of their literacy status. Majority(64% post natal & 72%of immunization clinic) of the mothers were from lower socio economic class. Only 13% of the post natal mothers were from upper class & 3% were attending the immunization clinic. Out of 150 post natal mothers ,only 2% of them had started breast feeding within 1 hour of delivery.54.6%  started between 7-24 hours. Equal percentage of mothers were found to practice pre lacteal feeds in both categories . Mothers of lower socio economic status had exclusively breast fed for a longer time and late weaning period when compared with upper class. About 38% of mothers did not receive any advice on early initiation of breast feeding. Among those who received(62% and 63%) the advice given by doctors(58%),nurses and others contributed only 4%.The difference in breast feeding practices among the groups were statistically significant(X2=14.6, p=0.0001) Colostrum  feeding habit was found to be present in 65.3% of post natal mothers & 72.1% from immunization clinic. Knowledge regarding benefits of colostrums was very poor among both the groups(44%).Frequency of breast feeding practices among both the groups were universal & on demand. Majority of mothers had no exposure to media as source of information on breast feeding(76% & 58%).

To elevate the misconception of breast milk not being formed till 3 days& regarding advice during ante natal &post natal visits on early initiation of breast feeding may be achieved through effective IEC.The role of media in spreading the message of early initiation of lactation, exclusive breast feeding & colostrums feeding must be strengthened to improve breast feeding practices among all social groups.

REFERENCES:

1. The executive board of WHO at it’s 101 session in January 1998 called for revitalization of the Global Commitment to appropriate infant and young child nutrition ,and in particular Breast feeding and complimentary feeding. Subsequently, in close collaboration with United   Nation’s  Children’s Fund. WHO Organized a consultation (Geneva, 13^th to17th march,2ooo)to access infant and young child feeding practices.(1)
2. Kaewsarn P,Moyle W, Creedy D. Thai nurses belief about  Breast feeding and post partum practices. J,Clin Nurs, 2003 July;12(4):467-75.
3. Jaeger MC, LowsonM, Filteau S The impact of prematurity and neonatal illness on the decision to breast fed. J Adv Nurs, 1997 Apr, 25(4):729-37.
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13. Duncan B, Ey J Holeberg CJ , Etal..excusive breast feeding for 4 months protects against otitis media. Pediatrics 91;867 -872,1993.
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