Place: Bellary

Date: 09.12.2010

From,
Meenakshi. N,
Ist year M. Sc. Nursing Student,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.

To,
The Principal,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.

THROUGH PROPER CHANNEL

Respected Sir/Madam,

Sub: Submission and forwarding of synopsis for Registration of

Dissertation topic.

****

In accordance with the subject cited above, I the undersigned studying in I st year
M.Sc. Nursing in Obstetrics and Gynaecology have been allotted the dissertation topic “A
STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF POSTNATAL
MOTHERS REGARDING BREAST FEEDING AT VIJAYANAGAR INSTITUTE
OF MEDICAL SCIENCES, BELLARY” under the guidance of MRS.
SARVAMANGALA, Prof., Dept. of OBG, Sharabeshwara College of Nursing Bellary.
I request you to kindly forward the dissertation topic in the prescribed form to the
registrar Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka for Approval.

Thanking you,

Signature of Guide: Yours faithfully,

MRS. SARVAMANGALA. S, PhD (MEENAKSHI. N)

Professor and Head,
From,
The Prof. & Head,
Dept. of OBG,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.

To,
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka.

THROUGH PROPER CHANNEL

Respected Sir/Madam,

As per the regulations of the University for Registration of Dissertation topic, the
following Ist year M.Sc. Nursing student in Obstetric and Gynaecology has been allotted the
dissertation topic as follows by the official registration committee of all qualified and
eligible guides of the department of Obstetric and Gynaecology.

Name Topic Guide

Meenakshi. N, “A STUDY TO ASSESS THE
Ist year M. Sc. Nursing KNOWLEDGE AND
student, PRACTICE OF POSTNATAL
Sharabeshwara College MOTHERS REGARDING
of Nursing, BREAST FEEDING AT
Guggarahatti, Bellary. VIJAYANAGAR INSTITUTE
OF MEDICAL SCIENCES,
BELLARY”
Prof. Sarva Mangala. S, PhD
Dept. of Obstetrics &
Gynaecology,
Sharabeshwara College of
Nursing,
Guggarahatti, Bellary.

Therefore, I kindly request you to communicate the acceptance of the dissertation

topic allotted to the PG student at an early date.

Thanking you,

Yours faithfully,

MRS. SARVA MANGALA. S, PhD

Professor,
Dept. of Obstetrics & Gynaecology,
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE KARNATAKA
PROFROMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the candidate and MEENAKSHI. N

Address
2 Name of the Institution
3 Course of study and Subject
4 Date of Admission
5 Title of the Topic
M.Sc Nursing 1st year student,
Sharabeshwara College of Nursing Bellary.
Sharabeshwara College of Nursing,
Guggarahatti, Bellary.
I year M. Sc. Nursing
Obstetrics and Gynaecology Nursing – 1.
16 -06 -2010
“A STUDY TO ASSESS THE KNOWLEDGE &
PRACTICE OF POSTNATAL MOTHERS
REGARDING BREAST FEEDING AT
VIJAYANAGARA INSTITUTE OF HEALTH
SCIENCE, BELLARY”.
6 Brief Resume of the intended work
6.1 Need for the study
Breast feeding is the normal way of providing young infants with the
nutrients they need for healthy growth and development1.
Breast milk the preferred method of feeding a newborn because it
provides numerous health benefits to both the mother and infant. It remains
the ideal nutritional source for infants through the first year of life2.
The United Nations International Children’s Education Find
(UNICEF) describes the need to better promote, support and protect breast
feeding world wide3.
The breastfed infant is the reference or normative model against
which all alternative feeding methods must be measured with regard to
growth, health development and all other short and long term out comes4.
In our country child deaths account for two third of total morality, half
of the pediatric death (one third total mortality in the population) occurred
in infancy, in 1992, the infant mortality rate in India was 79 per 1000 live
birth, two fifth of infant death fall in the first month of life and nearly half
of them occur in the first week of life5.
Immediately after a normal un medicated delivery the mother and
child are wide awake for a longtime. In this situation, the baby is very
eager to suck although the baby may get very little milk. Sucking on the
nipple causes oxytocin to be released from Pituitary gland and helps the
uterus to contract and this may help the delivery of placenta & reduces
bleeding6.
The Healthy People 2010 goal for Breast feeding is to increase at
least 75% of the proportion of mothers who breast fed their babies in the
early post partum period and increase to at least 50% of the proportion of
mothers who continue breast feeding until their babies are five to six
months old7.

6.2 Review of Literature:

Millennium Development Goal 4 (MDG-4) aims at reducing under –
five child mortality by two thirds by 2015. According to global data, out of
all 10.9 million under five deaths, roughly 4 million babies die during the
first month of life. In India, this means out of 11 lakhs new born (up to
28days) deaths 2,50,000 lives can be saved annually by just this ONE act.
This means that deaths will have to be brought down appreciably with first
month to a make significant dent on the child mortality rates.

A recent study from rural Ghana, based on 10,947 breastfed

singleton infants has shown that if all women began breast feeding within
the 1st hour it would save one million of the 4 million newborn deaths. On
other hand, there was a marked increase in risk with increasing delay in
initiation, overall late initiation (after day one) was associated with a 2-4
fold increase in risk. Giving pre-lactal feeds, that is something other than
mother’s milk before beginning to breast feed also increased the risk of
neonatal mortality.
The study clearly showed that 22% of all newborn deaths from
0-28days could be reduced. For all countries combined, it was estimated
that neonatal mortality could be reduced by 24% if 99% of infants initiated
breast feeding on day 1 of life and by 31% if 99% of initiation was within
the 1st hour. Numbers of lives saved were estimated to be 8,67,000 and
1,117,000 in these two cases. Initiation of breast feeding within the first
hour of birth is thus the first and most vital step towards reducing infant and
under-five mortality8.

A Review by Donath et al found that Maternal infant feeding

intention was a stronger predictor of breast feeding initiation duration than
the standard demographic factors combined. There is evidence to suggest
that many women decide how they will feed their babies before they are
pregnant or in very early pregnancy and that the earlier the decision to
breastfeed is made, the more likely breast feeding will be initiated early. A
decision to breast feed made before pregnancy may be even more
predictive. In general, breast feeding initiation is closely related to Social
class, Income, Education and as stated in the 2003.

Cochrane Meta – analysis interventions used to promote breast

feeding, “despite the widely documented health benefits of breast feeding,
initiation rates remain relatively low in many high-income countries,
particularly among women in lower income groups”9.

The World Health Organization (WHO) recommends that all infants

be exclusively breastfed from birth to 6 months of age, followed by the
gradual introduction of other forms of nutrition and continued breastfeeding
into the second year and beyond. In the United States, approximately 70%
of women initiate breastfeeding, but by 6months, less than 40% feed their
infants any breast milk at all. The US Healthy People 2010 initiative has
set objectives that 75% of babies are to be breastfed initially, that 50%
receive some breast milk by 6 months of age and that 25% of babies receive
some breast milk by 12months of age9.
 A case study of Bhavan Singh, it has been observed that breast feed
duration varies from one country or geographic region to another. Study in
Eldoret Dist. Hospital, Kenya by Esmai et al found only 32% who breast for
their children up to 2yr, 33% upto 12 months and 13% stopping at 6 month.
In Bangkok and Bogota the median duration for lactation was less
than 7 months. Nairobi exhibited a longer duration of 16 months and in
same range, median duration was 20 months. In Latin America and
Caribbean only 35% to 60% their children continued being breast fed upto
an age of 6 months and with in Latin America in Mexico, frequency of
breast feeding has declined notably. A study by Maria et al showed only
34.8% of the study infant breastfed for not more than 1 month10.

Sai Sunil Kishore. M, study was conducted in a rural population of

the state to study their breastfeeding practices, knowledge regarding
usefulness of breast feeding and factors influencing the breast feeding
practices.
Out of the 77 mothers 30% and 10% exclusively breastfed their
infants till 4 and 6 months of age respectively. There was “Good
attachment” in 42% mother-infant pair and infants were held in “correct
position” by 60% mothers. Thirty-nine percent of the mothers had
“Satisfactory” Breast feeding knowledge. On multi-variate logistic
regression analysis is lack of breast feeding counseling was significantly
associated with decreased rates of EBF at 4 months and 6 months and full
breast feeding at 6 months of age11.

Madhu K 29 th August 2009, Breast feeding practice and newborn care

in rural areas. This study was aimed to describe the breast feeding practices
prevalent in rural areas. The study was conducted in primary heath centre
that is attached to a medical college in Kengeri, rural, Bangalore. Mothers
with children who were 9 months old who came to the PHC for measles
vaccination were included in the study and data was collected using the pre-
tested questionnaire on breast feeding and newborn practices. The study
shows 97% of the mothers initiated breast feeding 19% used pre lacteal
feeds 90% had hospital deliveries and 10% had home deliveries & 50%
used a house knife to cut the umbilical cord among home deliveries. This
study emphasizes the need for breastfeeding intervention programmes
especially for the mothers during Antenatal and Postnatal check-ups and
practices like discarding the Colestrum and early / late weaning are still
widely prevalent and need to be addressed12.

Jayanth Deshpande. D Feb.-2009, Socio-cultural practices in relation

to breast feeding, weaning among Indian mothers. The study was
conducted at Pravara rural hospital Maharasthra. A structured
Questionnaire was used to interview 300 mothers of children between age
groups 0-5yrs attending Immunization Clinic & Pediatric OPD.
Information was collected on socio-demographic characteristics, breast
feeding & weaning practices.
There were 61.3% male children & 37.3% female children. Observed
that only 43% children could be labeled as normal while 57% fell in various
grades of malnutrition.
The critical window of the first five years of life high light the
importance of appropriate feeding and weaning practices in infants and
toddlers. For most problems related to malnutrition may be tackled by
engendering awareness in rural mothers and there by promoting healthy
eating13.
Juliff, Dianne Therese 2005 comparison of breast feeding knowledge
and of selected adolescent males and females from rural & metropolitan
secondary schools. Research has indicated that adolescents hold both
negative and positives and have common misconceptions about breast
feeding that appear to result from their limited knowledge and reduced
exposure to breast feeding. This quantitative descriptive study using a
cross-sectional design, involved consenting secondary school students
completion a self-report questionnaire. The study employed purposive
sampling and included 1845 males and females in both year-9 and year-12
at designated metropolitan and rural secondary schools in 2001.

The study results indicated that overall western Australian adolescent

secondary school students have less than ideal knowledge of breast feeding
which is consistent with finding from other studies. For both year groups
females student had higher breast feeding knowledge scores than male
students. With regards to attitude towards breast feeding, students had a
tendency for neutral responses to questions14.
6.3. Statement of Problem; Assess knowledge, practice of postnatal
mothers regarding breastfeeding VIMS Hospital, Bellary.
6.4 Objectives of the Study:
1. To Assess Knowledge, and Practice of Postnatal mothers
regarding breast feeding.
2. To Find association between Knowledge, and Practice of
Postnatal Mothers regarding breast feeding in selected demographic
variables.
6.5 Variables
Independent Variables : - Postnatal mothers age, parity, educational
quality.
Dependent Variables :- Knowledge & practice about breastfeeding.

6.6 .Operational Definitions

Assessment: It refers to measurement of knowledge and practice of
postnatal mothers regarding breastfeeding.
Knowledge: It is the correct response of the mother to the knowledge items
regarding initiation, duration, benefits of breast feeding and techniques of
breast feeding.
Expressed opinion of mothers regarding breast feeding as stated in the
interview schedule.
Practice: Verbal responses of the mothers to practice items related to
initiation, duration of breast feeding and techniques of breast feeding.
Postnatal mother: Mother, period not less than 10 and not more than 28
days after the end of labour.
.

6.7. Assumptions:
1. The mothers will have some knowledge regarding breast
feeding
2. Mothers might be practicing breast feeding.
6.8. Delimitations;
1. Mothers who are feeding in post natal ward
2. Mothers who are willing to participate in the study
 3. Mothers who are present during the period of data collection.
6.9 Materials & Methods:

7. SOURCE OF DATA : Data will be collected from mothers in

 Post natal ward at VIMS hospital.
7.1 Method of Collection of data : Through Structured interview schedule
7.2. 1. Research Design : Descriptive design
7.2. 2.Research Approach :
In view of the nature of the problem under study and to accomplish the
objectives of the study, Descriptive survey approach was found to be
appropriate to describe knowledge and practice of post natal mothers
regarding breastfeeding.
7.2.3.Research Setting : VIMS Hospital,
It is a RCH unit consists of 1000 beds, 6 km from Guggarahatti, 300-400
patients month are admitted in Obstetrical ward, 200-300 patients are
delivering in this hospital.
7.2. 4.Population : Mothers in post natal ward
7.2. 5. Sample size : 100 mothers who are in the postnatal ward at
VIMS Hospital.
7.2. 6.Sampling Technique ;
Purposive sampling technique, a type of non - probability
sampling approach was found to be appropriate for the present study.

7.2.7 Sampling Criteria :

Inclusion Criteria:-
1. Mothers who are recovering in postnatal ward
2. Mothers who are willing to participate in the study.
3. Mothers who are available at the time of data collection.
Exclusion criteria:-
1. Mothers who are not willing to participate in the study.
2. Mothers who are not present at the time of data collection.
8 LIST OF REFERENCE
1. World Health Organization. The World Health Report 2010,
www.who.int/topitcs/breastfeeding/en/.
2. Tripathy A.K, Mishra L, Bakshi S, Arya L.S, Breastfeeding and
childhood hematological malignancy. Indian J Pediatrics 2004; 417-
419.
3. State of Worlds children UNICEF 2007.
www.unicef.org/india/health .
4. American Academy of Pediatrics 1997. “Breastfeeding and the use
of Human Milk” Pediatrics 1035-1039.
5. WHO 1995 “Protecting promoting and supporting breastfeeding; the
special role of maternity service”. A joint WHO/UNICEF
statement. World Health Organization, Geneva.
6. Old B Sally., Marcia L London and Patricia W Ladewig, maternal –
Newborn Nursing A Family centered Approach, Addison Wesley
Nursing Cummings published company 1992; 926-928.
7. Healthy People 2010 (HP2010) 1999 “Health People 2010
objectives”. Draft Retrieved January 19th 1999 from the world wide,
http//web.health.gov/healthy 2010draft/object.htm.
8. Karen M Edmond, Breastfeeding Promotion of India (BPNI) 2007
“Breastfeeding, The Ist hour save one million babies” Risk of
Neonatal mortality 380-386.
9. Della A, Forster, RN, RM PhD. Journal of midwifery & women’s
Health Breastfeeding Initiation and Birth setting practices 2007,
273-280.
10.Bhavan Singh, knowledge, and Practice of Breastfeeding, European
Journal of Scientific Research 2010, 404-422.
11.Sai Sunil Kishore Breastfeeding, knowledge and practices amongst
mothers in a rural population of North India 2008, Published by
Oxford University Press 183-188.
12.Madhu K. Sriramchowdary “Breastfeeding practices and newborn
care in rural areas” Indian Journal of Community Medicine 2009
243-246.
13.Jayanth Deshpande D, Socio-Cultural practices in relation to
breastfeeding weaning and child rearing in rural India. Australasian
Medical Journal Published July 28th 2010.
14.Juliff, Dianne Therese, comparison of breastfeeding knowledge and
of selected adolescent males and females 2005
http/espace.library.cutin.edu.au
 9 Signature of the Candidate
10 Remarks of the Guide
11 Name & Designation of
(In Block Letters)
11.1 Guide Prof. SARVA MANGALA. S, PhD

11.2 Signature

11.3 Co-Guide (If any) Prof. A. JAGADESHWARI. M Sc. (N)

11.4 Signature

11.5 Head of the Department Prof. SARVA MANGALA S PhD Dept.

of Obstetrics & Gynaecology,
SHARABHESHWARA College of
Nursing,
GUGGARAHATTI, BELLARY.
11.6 Signature

12 12.1 Remarks of the Chairman

and the
Principal

12.2 Signature
 ETHICAL COMMITTEE CLEARANCE

1. TITLE OF THE DISSERTATION : “A Study to assess the

2. NAME OF THE CANDIDATE
AND ADDRESS
3. SUBJECT
4. NAME OF THE GUIDE
5. APPROVED/NOT APPROVED
(If not approved, suggestion)
Knowledge and Practice of
Postnatal Mothers Regarding
Breast feeding at Vijayanagar
Institute of Medical Sciences,
Bellary”.
: Meenakshi. N,
Ist year M. Sc. Nursing student,
Sharabeshwara College of
Nursing, Guggarahatti, Bellary.
: M. Sc. Nursing
Obstetrics & Gynaecology,
: Prof. Surva Mangala. S, PhD
Dept. of OBG,
Sharabeshwara College of
Nursing, Guggarahatti, Bellary.
: Approved

1. CHAIRMAN : Prof. Sarvamangala. S. PhD,

Principal/HOD (OBG. Dept.)
2. MEMBERS :
1. HOD of OBG Dept.
2. HOD of Medical Surgical Nursing Dept.
3. HOD of Psychiatric Nursing Dept.
4. Pediatric Nursing Dept.
5. HOD of Community Health Nursing Dept.

Remarks with Signature :

Of the Principal