ABSTRACT
Exclusive
breastfeeding is the practice where a child receives breast milk only from the
mother or 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 and Sudden Infant Death
Syndrome. Despite the nutritional, economic, immunological and psychological
advantages of breast milk, breastfeeding practice appears to remain below
recommended level. The objectives of this study are to evaluate the effect of a
nurse-based intervention on exclusive breastfeeding practice among pregnant
mothers.
Quasi-experimental
design was adopted to conduct the study. The populations comprised of 40 pregnant women more than 36weeks gestation
attending Iperu primary health care center which formed the experimental group,
and 32 pregnant women attending Ilisan primary health care center which formed
the control group. Sample size was determined using Leslie Kish formula and
balloting was used to select Iperu and Ilisan Primary health care centre Iperu
primary health center and Ilisan primary health centre were selected,
convenient sampling was adopted to select 15 participants from Iperu Primary
health care center which formed the experimental group and 15 participants from
Ilisan Primary health care center which formed the control group. A designed
questionnaire was used to collect data on nursing mothers’ knowledge and
practice regarding exclusive breastfeeding practice. Face and content validity
of the instruments was ascertained by presenting them to panel of expert in the
expert. The reliability of the questionnaire was ascertained using split-half
method and the Cronbach’s alpha reliability coefficient was calculated to be
0.8. The training module were also pre-tested and found suitable for the study.
Data were processed using statistical package for social science (SPSS),
version 21. Results were tested using descriptive statistics of mean and
standard deviation and inferential statistics of student t- test at 0.05 level
of significance to answer the research question and test the hypothesis.
The
findings of the study showed that; (a) There is no difference in
pre-intervention knowledge among pregnant women in the experimental group (mean
= 0.519) and control group (mean = 0.518). (b) There is no difference in pre-intervention
practice among pregnant women in the experimental group (mean = 0.512) and
control group (mean = 0.511). (c) There
is significant difference in pregnant women's knowledge regarding exclusive
breastfeeding between the experimental and control group. (p = 0.000). (d) There is significant difference in pregnant women's
practice regarding exclusive breastfeeding between the experimental and control
group. (p = 0.009).
This
study concluded that mothers’ knowledge and practice regarding exclusive
breastfeeding can be improved as participants in the experimental group showed
improved knowledge and practice regarding exclusive breastfeeding. This study
recommended that nursing mothers should be regularly exposed to breastfeeding
readiness education which is necessary for improving mothers’ knowledge and
practice regarding exclusive breastfeeding practice.
CHAPTER ONE
INTRODUCTION
1.1
Background to the
Study
The
importance of the provision of a nursing-based intervention such as
breastfeeding-readiness education for mothers during the antenatal visits is
crucial to achieving exclusivity among them. Janson (2010) stated that, nurse- based intervention is very
important in establishing successful breastfeeding practice. Valine and Apaldia
(2014) suggested that the nursing intervention consisting of breastfeeding
education is helpful at improving early initiation and thereafter continuation
of breastfeeding for the first two months. Despite the nutritional, economic,
immunological, and psychological advantages of breast milk, breastfeeding
practice appear to remain below recommended level and one thing that plays a
role in breastfeeding success may be nursing intervention. According to World
Health Organization (WHO) all lactating mothers should exclusively breastfeed
their children for the initial six months and go on with breastfeeding up to
two years (WHO, 2010). However studies have shown exclusive
breastfeeding is practiced below WHO recommendation (Nasserpour, Nouhjak, &
Sharifat, 2010). A
target of 90% universal coverage for Exclusive breastfeeding (EBF) is
recommended by WHO to prevent 13-15% of 9 million deaths of children under-five
in low and middle-income countries annually (Jones, 2013). Reports from
Agunbiade and Agun, 2012 in Ile-Ife town also showed that only 19% of the
breastfeeding mothers practiced exclusively. On the other
hand, mother’s breastfeeding practice can be enhanced with continuous
interventions such as prenatal breastfeeding education. UNICEF, (2011)
describes that breast milk is the standard, healthiest, simplest, and not
expensive feeding way that complete all the children’s 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
The global exclusive breastfeeding
rate for children aged less than six months between the years 2000 and 2007 was
38% (UNICEF, 2008). Within the same period, only 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% was (UNICEF, 2008), in Eastern and Southern Africa; East Asia and
the Pacific; and South Asia respectively prevalence of 39%, 43% and 44% were observed (UNICEF,
2008).In
addition, 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
(Cernadas, Noceda, Barrera, Martinez, & Garsd, 2008). In Nigeria, the
practice of exclusive breastfeeding is uncommon with only 13% of infant younger
than six months are being exclusively breastfed (Nigerian Demographic and
Health Survey, 2008), while in Nigeria, between year 2000 and 2012 merely 15.1%
of babies less than six months of age were exclusively breastfed (UNICEF,
2012). Nigeria Demographic and Health Survey 2013 later on reported a a little
higher prevalence of 17% EBF rate. A study in Plateau state showed that only 6% of mothers
practiced exclusive breast feeding (Amosu, 2010). Niguse, Frehiwot , Dinu and Eyerus (2016) stated that
mothers knowlwdge and practice regarding exclusive breastfeeding as been low
despite their exposure to training programmes on exclusive programs. According
to Agunbiade and Oguunleye 2012, knowledge and practice concerning exclusive
breastfeeding among mothers has been low despite exposure to training
programmes on exclusive breastfeeding. Tyndall, Kamai, and Changchangi (2016)
stated that despite the exposure of mothers to exclusive
breastfeeding training, knowledge and practice regarding exclusive
breastfeeding among mothers as been low. Despite initiation of exclusive
breastfeeding programmes, problem associated with poor exclusive practice seems
to persist suggesting a fundamental problem. These prompted the researcher to
study the effect of nursing based intervention on exclusive breastfeeding
practice among pregnant women attending two primary health care centers in
Ikenne local government.
1.2 Statement of the Problem
The rate of infant morbidity and
mortality as a result of poor exclusive breastfeeding among mothers as been
high (Onah , Osuorah , Ebenebe , Ezechukwu , Ekwochi & Ndukwu,
2014). The incidence of of childhood communicable disease and infection
in infants has significantly increased as a result of poor exclusive
breastfeeding knowledge and practice among mothers (Talayero, Lizan-Garcia,
Puime, Muncharaz, Soto, Sanchez-Palomares, Serrano & Rivera, 2006). The
incidence of diarrhea and lower respiratory tract infections has been
persistently high due to poor knowledge and practice regarding exclusive
breastfeeding among mothers (Rivera, 2006). According to UNICEF (2013),
exclusive breastfeeding knowledge and practice in Nigeria is significantly low.
Knowledge and practice of mothers regarding exclusive breastfeeding as been low
(Chola, 2011; Rea, 2009). Problems
associated with poor exclusive breastfeeding practice such as infections,
diarrhea, upper respiratory tract infections, childhood obesity, low immunity,
sudden infant death syndrome and malnutrition has significantly increased due
to poor knowledge and practice regarding exclusive breastfeeding among mothers.
The researcher through clinical experience as observed high incidence of
malnutrition, childhood obesity and infection and diarrhea. These may be
attributed to poor knowledge and practice regarding exclusive breastfeeding and
it may also be attributed to a gap in the type of training programme offered to
mothers on exclusive breastfeeding. Hence the need for a study on the effect of
nursing based intervention on exclusive breastfeeding practice among pregnant
women attending two primary health care centers in Ikenne local government
Objective of the Study
The main objective of this study is
to evaluate Nurse-based intervention on exclusive breastfeeding practice among
pregnant mothers attending Antenatal clinic in Ikenne LGA of Ogun state
Nigeria. The specific objectives are to:
1.
assess
level of knowledge of pregnant mothers on exclusive breastfeeding pre
intervention;
2.
determine
the baseline practice of exclusive breastfeeding among pregnant mothers;
3.
determine influence of nurse-based
intervention on the practice of exclusive breastfeeding among pregnant women
post intervention and
4.
determine influence of nurse-based
intervention on the knowledge of exclusive breastfeeding among pregnant women
post intervention.
1.4
Research Questions
In order to acquire data for this
work, the Research questions were posed.
- What is the level
of knowledge of pregnant women on exclusive breastfeeding pre
intervention?
- What is the baseline practice of exclusive breastfeeding among pregnant mothers attending Antenatal clinic in Ikenne LGA of Ogun state?
1.3 Hypotheses
The following research hypotheses were tested:
HO1 There is a significant difference in
pregnant mother’s knowledge level of exclusive
breastfeeding practice pre and post intervention between control and
experimental
group.
HO2 There is a significant difference in
pregnant mothers practice level of exclusive
breastfeeding pre and post intervention between control and experimental
group.
1.4 Scope of the Study
The researcher studied the effect of a nurse-based intervention on the knowledge and
practice regarding exclusive breastfeeding among pregnant women.
1.6
Significance
of the Study
- The
findings of this study may reveal the effect of nursing based intervention
on exclusive breastfeeding practice.
- Information from this study
may be useful in planning strategies and intervention to improve mother
and child's health
- The study may be beneficial to nurses because the training program
may help translate available knowledge into clinical decision making
during antenatal clinic visit
- The study may be of great benefit to nurses as the outcome may increased time required for nurses' to
give quality nursing care to patient.
- It may also
provide data for further studies
1.8
Operational Definitions of Terms
Effect: Outcome of a nursing
based program on exclusive
breastfeeding measured by knowledge and practice score of
mothers.
Nursing
Based intervention: This is
educating and counseling pregnant mothers on definition of exclusive
breastfeeding, benefit of exclusive breastfeeding to mother, child and the
community as a whole and also the involvement of support group like husband
involvement, involving of previously exclusively breastfed mothers to encourage
new mothers to exclusively breastfeed for the first six months of life and
continue for the next two years.
Breastfeeding: is the feeding of infants and little children
with milk from a woman's breast
Exclusive breastfeeding:
feeding the baby with only the breast milk, no addition of any other food or
water, for the first 6months of life
Pregnant
women:
multiparous women within 36 gestational weeks and above in Ikenne local
government
Practice: initiation of breastfeeding within 30miutes to one hour of
delivery, Frequency of breastfeeding, breastfeeding on demand, expressing
breast milk to feed baby when not around
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