Effect Of Nursing Based Intervention On Exclusive Breastfeeding Practice Among Pregnant Women Attending Two Primary Health Care Centers

Effect Of Nursing Based Intervention On Exclusive Breastfeeding Practice Among Pregnant Women Attending Two Primary Health Care Centers

Abstract

Exclusive breastfeeding is the practice where a child receives breast milk only from the mother, a wet nurse or expressed breast milk for the first six month of baby life. It is associated with reduction in risk of childhood urinary tract infections, bacterial meningitis, diarrheal diseases, respiratory tract infections and sudden infant death syndrome. Despite the nutritional, economic, immunological and psychological advantages of breast milk, knowledge and practice of exclusive breastfeeding has remained below recommended level. The study evaluated the effect of a nurse-based intervention on exclusive breastfeeding practice among pregnant mothers attending antenatal clinic in two primary heath care centres in Ikenne Local Government Area of Ogun state, Nigeria.

Two groups pre-test, post-test quasi-experimental study was adopted. Researchers included 30 pregnant mothers attending antenatal clinic using purposive sampling. Participants completed a developed questionnaire to test knowledge and practice regarding exclusive breastfeeding pre- intervention and six weeks post-intervention at postnatal clinic visit. Data were analysed using descriptive and inferential statistics at 0.05 level of significance. The mean difference in knowledge among participants in the control group was 0.065 while the experimental group was 0.116. The mean difference in practice among participants in the control group was 0.056 while the experimental group was 0.291. Results showed significant difference in effect of a nursing-based intervention on knowledge and practice concerning exclusive breastfeeding among pregnant mothers in the experimental and control group (P =.000).

In Conclusion Pregnant mothers’ knowledge and practice regarding exclusive breastfeeding can be improved through a nursing based intervention. The study recommended that pregnant mothers should be regularly exposed to breastfeeding readiness education which is necessary for improving mothers’ knowledge and practice regarding exclusive breastfeeding.

The global exclusive breastfeeding rate for children aged less than six months between the years 2000 and 2007 was 38%, 23% of infants less than six months were breastfed

Chapter One

Introduction

1.0 Background to the Study

The importance of the provision of a nurse-based intervention such as breastfeeding- readiness education for mothers during the antenatal visits is crucial to achieving exclusivity among them. All lactating mothers should exclusively breastfeed their children for the initial six months and go on with breastfeeding up to two years. Despite the nutritional, economic, immunological and psychological advantages of breastfeeding, its knowledge and practice appear to remain below recommended level .

Refusing to breastfeed extensively increases the vulnerability of the child to illness from communicable diseases, however for every extra month of exclusive breastfeeding, 30.1% of hospitalizations resulting from infection may perhaps have been prevented. An estimate of 53% of diarrhea hospitalizations and 27% of lower respiratory tract infections may be prevented monthly by exclusive breastfeeding. Study have shown exclusive breastfeeding is practiced below WHO recommendation. A target of 90% universal coverage for exclusive breastfeeding is recommended by WHO to prevent 13-15% of 9 million deaths of children under-five in low and middle-income countries annually.

The global exclusive breastfeeding rate for children aged less than six months between the years 2000 and 2007 was 38%, 23% of infants less than six months were breastfed exclusively in West and Central Africa while Middle East and North Africa recorded a little higher rate of 26%. Eastern and Southern Africa, East Asia and the Pacific; and South Asia respectively had a prevalence of 39%, 43% and 44%. A study in England showed that infants’ exclusive breastfeeding rate was low, and only 25% of babies remain breastfed until 6 to 8 weeks after birth and 16% of mothers continued breastfeeding for three to five months after birth.

In Nigeria, exclusive breastfeeding is uncommon with only 13% of infants younger than six months being exclusively breastfed. Between 2000 and 2012, 15.1% of babies less than six months of age in Nigeria were exclusively breastfed. A study in Nigeria showed that only 19% of the breastfeeding mothers practiced exclusively. These reveal a high incidence and prevalence of poor exclusive breastfeeding which may be due to low knowledge and practice concerning exclusive breastfeeding among pregnant mothers.

Nursing-based intervention is very important in establishing successful breastfeeding practice. Nursing intervention consisting of breastfeeding education is helpful at improving early initiation and continuation of breastfeeding for the first two months. One of the mainly helpful strategy intended for reducing infant morbidity and mortality in a resource insufficient settings is the exclusive breastfeeding promotion intended for the initial six months of the infant’s life. Breast milk is the standard, healthiest, simplest and cheapest way of meeting children’s feeding needs. Knowledge, expertise and advice of nurses are very vital in creating awareness, education and support for mothers and their babies to achieve exclusivity. Nursing intervention strategies is a significant approach to some of the challenges of breastfeeding practice, making mothers informed of the cost effective benefit of exclusive breastfeeding. Despite trainings and health education on exclusive breastfeeding, its knowledge and practice among pregnant mothers has been low. These suggest a fundamental problem. Likewise, the researcher through clinical experience has observed high incidence and prevalence of low exclusive breastfeeding among pregnant mothers attending antenatal clinic. These may be attributed to low knowledge and practice concerning exclusive breastfeeding among pregnant mothers. These may also be attributed to a gap in the type of training or education offered to pregnant mothers on exclusive breastfeeding as no previous quasi-experimental study combined lecture and demonstration method. Hence, the need to evaluate the effect of a nursing based intervention on exclusive breastfeeding among pregnant mothers attending antenatal clinic in Ikenne Local Government area, Ogun State, Nigeria.

1.2 Statement of the Problem

On a global scale, WHO, UNICEF, USAID and SIDA co-hosted and supported the Innocenti Declaration in the 1990s – a global action to reverse declining breastfeeding rate. In spite of the concerted efforts, available data shows that globally, less than 40% of infants under six months of age are exclusively breastfed, despite the documented benefits of breastfeeding. In addition, only 38% of infants aged less than six months in the developing world, Africa included, are exclusively breastfed4

Like in many of the sub-Saharan African countries, the practice of breastfeeding in Nigeria has been a major aspect of infant feeding but exclusive breastfeeding practice is poor. Presently in Nigeria it has been shown by the Multiple Indicator Cluster Survey (MICS 2007) data and National Demographic Health Survey (NDHS, 2008) that only 13% of nursing mothers practiced exclusive Breastfeeding, this is a decline from 17% reported in NDHS (2004).This is far below the 90% level recommended by the WHO

Malnutrition has been implicated in about 40% of the annual under two mortality rates of 11 million and lack of immediate and exclusive breastfeeding in infancy is said to cause another 1.5 million of these deaths2. Available data indicates that a third of children in developing countries are malnourished, 150 million are underweight and 175 million are stunted due to chronic illness and poor diet.

National Demographic and Health Survey (NDHS) 2003 indicates that 40% of under-two children in Nigeria are stunted, almost 10% are wasted and 29% are underweight. Malnutrition is increasingly recognized as a prevalent and important health problem especially in the developing countries. This problem has serious long-term consequences for the child and adversely influences their development.

In Nigeria, the poor practice of exclusive breastfeeding is influenced by various socio-economic, beliefs and cultural factors such as unhealthy hospital practices, unemployment, lack of support for breastfeeding mothers, perceived lactational insufficiency, illiteracy and ignorance of the benefits of EBF. Others are adverse cultural practices, resistance to change, fear of maternal depletion syndrome, urbanization, working mothers, poor attitude of health workers, beliefs relating to the use of colostrum and sexual practices during breast feeding as well as aggressive advertising and marketing of breast milk substitutes.

In view of the above statistics and the aforementioned restraints, this project work attempts to ascertain the knowledge, attitude and practice regarding exclusive breast feeding of infants by mothers in Ikenne Local Government Area in order to sensitize them on the usefulness of exclusive breast feeding; the anthropometric assessment of their under-2 children and association between practice of exclusive breast feeding and infant anthropometry.

1.3 Objective of the Study

The main objective of this study is to evaluate the effect of a nursing based intervention on exclusive breastfeeding among pregnant mothers attending antenatal clinic.

The specific objectives are to:

1. To assess the knowledge of the women of child bearing age on exclusive breastfeeding in Ikenne Local Government Area, Ogun State.
2. To assess the attitude of the women of child bearing age on exclusive breastfeeding in Ikenne Local Government Area, Ogun State
3. To assess the practice of exclusive breastfeeding among under-two children in Ikenne Local Government Area, Ogun State .
4. To assess relationship between nurses based intervention on exclusive breast feeding and anthropometric status of children in Ikenne Local Government Area, Ogun State .

1.4 Research Questions

1. What is the extent of knowledge of exclusive breastfeeding in Ikenne Local Government Area, Ogun State?
2. What is the attitude of mothers to exclusive breastfeeding in Ikenne Local Government Area, Ogun State?
3. What is the extent of practice of exclusive breastfeeding in Ikenne Local Government Area, Ogun State?
4. Is there any significant difference in anthropometric measure and practice of exclusive breastfeeding in, Navy Town, hospital ,Ojo, Ogun State?

1.5 significance of the Study

The study embarked upon is significant in that:

1. The study will go a long way to determine the knowledge, attitude and practice rate of exclusive breast feeding in Navy town Ojo and Ogun state at large. This could be achieved by helping health workers to knowing how and where to channel her education programmes in Ojo Town and Ogun state at large.
2. Reduce the mortality rate of infants/children due to diarrhoea and other infectious disease, if appropriate intervention strategies are embarked upon.
3. The study will also help the Government implement her policies towards achieving the 2015 Millennium Development Goals (MDGs) 4 and 5 of reducing under-five mortality and maternal mortality in the state
4. It will also serve as a guide for further research either for improvement on the work already carried out or otherwise.

1.6 Hypothesis

Ho1: There is no significant relationship between knowledge and practice of nurse based intervention on exclusive breastfeeding.

1.6 Scope of the Study

The study focused on the effect of a nursing based intervention on exclusive breastfeeding among pregnant mothers attending antenatal clinic, one secondary Healthcare facility and two primary Healthcare facilities were used.

Chapter Five

Discussion of Finding, Conclusion and Recommendation

5.1 Discussion of Findings

There were more participants between 20-29 years during data collection. This finding agrees with a previous quasi experimental study in which there were more participants between 20-29 years during data collection. There were more secondary school certificate holders during data collection. This finding supports a previous quasi experimental study in which there were more secondary school certificate holders during data collection. There were more civil servants during data collection. This finding disagrees with previous quasi experimental study in which result showed more self employed participants during data collection. There were more participants with 1-2 previous babies during data collection. This finding disagrees with a previous quasi experimental study in which there were more participants with 2-3 previous babies during data collection. There were more participants with gestational age between 36-42weeks during data collection. This finding agrees with a previous quasi experimental study in which there were more participants with gestational age between 36-42weeksduring data collection.
Result reveals that pre-intervention, there was no difference in pre-intervention mean knowledge regarding exclusive breastfeeding among participants in the experimental and control group as judged from pre-intervention mean knowledge scores of the experimental and control group. Post-intervention, there was a difference in mean knowledge regarding exclusive breastfeeding in the experimental group when compared with control group. This is due to the level of exposure to exclusive breastfeeding education among participants in the experimental and control group. This finding supports a previous quasi-experimental study in which result also showed difference in experimental group post-intervention mean knowledge score when compared with control group.

Result reveals that pre-intervention, there was no difference in practice concerning exclusive breastfeeding among participants in the experimental and control group as judged from pre-intervention mean practice scores of the experimental and control group. Post-intervention, there was a difference in mean practice regarding exclusive breastfeeding among participants in the experimental group when compared with control group. This is due to the level of exposure to nursing-based interventions on exclusive breastfeeding among participants in the experimental and control group. This finding supports a previous quasi experimental study in which result also showed difference in experimental group post-intervention mean practice score when compared with control group.

Result shows that in the experimental group, knowledge concerning exclusive breastfeeding was improved by the nursing-based intervention judging from the increase in post intervention mean knowledge score when compared with the pre-intervention mean knowledge score. Student t-test was further used to show that there is a significant difference in effect of a nursing-based intervention on knowledge concerning exclusive breastfeeding among participants in the experimental and control group (P = 0.000). The finding reveals that prior to the training; there was no difference in knowledge concerning exclusive breastfeeding among nurses in the two groups as judged from pre-intervention mean knowledge scores. Six weeks post-intervention, the training programme was found to be effective in allowing participants in the experimental group have higher mean knowledge score post-intervention compared with pre-intervention. The finding supports previous quasi-experimental study in which interactive lecture was used to increase mean knowledge score concerning exclusive breastfeeding among pregnant mothers which also supported the use of a nursing-based intervention to improve knowledge concerning exclusive breastfeeding among pregnant mothers .

Result shows that in the experimental group, practice concerning exclusive breastfeeding among participants was improved by the training programme judging from the increase in post-intervention mean practice score when compared with the pre-intervention mean practice score. Result showed that there is significant difference in effect of a nurse-led training programme on practice concerning exclusive breastfeeding among participants in the experimental and control group (P = 0.000). The finding of this investigation revealed that prior to the training; there was no difference in practice concerning exclusive breastfeeding among participants in the two groups as judged from pre-intervention mean practice scores. Two weeks post-intervention, the training programme was found to be effective in allowing participants in the experimental group have higher mean practice score post-intervention when compared with pre-intervention. The finding supports previous quasi-experimental study in which lecture and demonstration method was used to increase mean practice score concerning exclusive breastfeeding among participants which also supported the use of nursing-based intervention to improve practice concerning exclusive breastfeeding among pregnant mothers.

5.2 Summary of the Study

The effect of a nursing-based intervention on exclusive breastfeeding among pregnant mothers attending antenatal clinic in two primary healthcare centres in Ikenne Local Government area, Ogun State was the focus of this study. Post-intervention, there was a difference in mean knowledge and practice regarding exclusive breastfeeding among participants in the experimental group when compared with control group. The nurse-led training programme was effective in improving knowledge and practice concerning exclusive breastfeeding among pregnant mothers as participants in the experimental group showed significant improvement in knowledge and practice when compared with the control group.

5.3 Conclusion

Based on findings of this study, there was a difference in post-intervention mean knowledge and practice regarding exclusive breastfeeding among participants in the experimental group when compared with control group. Nursing-based interventions on exclusive breastfeeding enhances knowledge and practice concerning exclusive breastfeeding among pregnant mothers as this study achieved a difference in post-intervention mean knowledge and practice concerning exclusive breastfeeding between the control and experimental group. The study also achieved a significant difference in the effect of nursing-based intervention on knowledge and practice regarding exclusive breastfeeding among pregnant mothers in the control and experimental group. Hence, the nurse-led training programme has significantly improved knowledge and practice concerning exclusive breastfeeding among pregnant mothers.

5.4 Recommendations

Based on findings of the study, the following recommendations are made:

1. Pregnant mothers should be regularly exposed to trainings on exclusive breastfeeding by nurses to improve their knowledge and practice regarding exclusive breastfeeding which is necessary to improve mothers knowledge and practice regarding exclusive breastfeeding.
2. Hospitals should regularly review their protocols and policies on breastfeeding to ensure latest approaches is being implemented by nurses and made available to mothers.
3. Private and government owned hospitals should create more awareness on exclusive breastfeeding by organizing education and training programmes for mothers which is necessary to improve their knowledge and practice regarding exclusive breastfeeding.

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