RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE- KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

SANTHI K SAHADEVAN, M.Sc. NURSING, I YEAR, OBSTETRICS AND GYNAECOLOGICAL NURSING YEAR 2009-2011.

DHANWANTHARI COLLEGE OF NURSING, 41/3, VINAYAKANAGAR, HESSARGHATTA ROAD CHIKABANAVARA, BANGALORE-90.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

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NAME OF THE CANDIDATE AND ADDRESS

Ms. SANTHI K SAHADEVAN, I year M.sc.Nursing, Dhanwanthari College of Nursing, Vinayakanagar, chikabanavara, Bangalore-90.

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NAME OF THE INSTITUTION

Dhanwanthari College of Nursing

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COURSE OF THE STUDY M.Sc. Nursing , AND SUBJECT Obstetrics & Gynaecological Nursing

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DATE OF ADMISSION OF THE COURSE 31-09-2009

A study to assess the effectiveness of structured teaching programme on postnatal mothers regarding the knowledge and practice of colostrum feeding in selected Government hospitals at Bangalore.

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TITLE OF THE STUDY

6. BRIEF RESUME OF THE INTENTED WORK 6.1. INTRODUCTION

Colostrum is the first milk and the best start in newborn -Dharitri Swain .Nursing times. Colostrum is a liquid with high content of nitrogen, antibodies and vitamins that is secreted from the mammary gland just after giving birth. The change of secretion from colostrum to proper milk takes place gradually during the day after birth. (A dictionary of biology 2004). Colostrum feeding is an unequalled way of providing ideal food for the health growth and development of the newborn baby and has unique biological and emotional influence on the health of both mother and child. Dharitri Swain.1 A thin, clear, viscous secretory material can be found in the acini cells by the third month of gestation. The precolostrum thickens as term approaches and is then known as colostrum. Colostrum, the creamy, white to yellowish to orange premilk fluid ,may be expressed from the nipple as early as 16 weeks of gestation-.Dona.L.Wong Colostrum contain vitamin A twice the amount present in mature human milk and it gives colostrum in yellow colour.Colostrum contain nearly three times the amount of protein that is present in mature milk and contain all the amino acids. Colostrum have sufficient nutrients to satisfy the infant until milk is established in 2-4 days.- Ladewig(1999).

Colostrum and breast milk contain a mucosal growth factor that is important in the maturation of intestinal mucosal epithelial cells, allowing control over bacterial and viral proliferation in the intestinal tract to be maintained. The current World Health Organization (WHO) recommendations on breastfeeding stipulate that the breastfeeding should start immediately following delivery for the baby to get colostrum.2

6.2. NEED FOR THE STUDY

Breast feeding is traditional in our country and has been practiced through out the countries. In recent years, there has been a decline in the practice due to various reasons.It has also been associated with myths and superstitions like colostrum being bad for the baby and insufficient milk during the first 3 days. SRIVASTAVA S.P, SHARMA V K, KUMAR V (2000) conducted a study on Breast feeding pattern in Neonates. In the study, only 17% mother fed their baby with colostrum and even they are ignored of its advantage and 82.89% of mother discarded3 A study on colostrum feeding practice in Uttaranchal and Uttar pradesh was

undertaken by Regional centre Lucknow. The study found that around 80 90% as mother believe that the first milk, which is watery and light yellowish in colour and is the secretion collected over nine months , will be harmful to the neonate. Hence they squeeze the

colostrum and discarding till the milk comes in.4 - P.ERGENEKON- OZELCI et.al (2001) stated in his study about breast feeding beliefs and practice that women had negative attitude about giving colostrum to the newborn. They believe that the colostrum is always produced within first three days at birth and that it should not be given to newborns and some reported that it causes stomach ache and infants
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dislikes this milk. In this study he found out that, mother squeeze their breast to get a rid of the first milk until while milk is produced. They made correlations between meconium and colostrum, indicating they are similar in their unwanted characteristic, because both of them lasted around the same time. Some others believed that milk produced while the mother was still pregnant, because it stayed in the breast for a long time, was stale and dirty.5 DHARITRI SWAIN in her studies showed that overall knowledge score and practice were 63.38% and 76.5% colostrum as a first feed was discarded by 20% of mothers. This suggest that nurses can play important role for further improvement of knowledge and promotion of colostrum feeding initiation. DAFTUARY & DUTTA (2006) explained that colostrum has got a higher specific gravity, a high protein vitamin A , sodium and chloride content. The antibodies humoral factors provide immunological defence to the newborn. Studies showed that colostrum has an anti diarrheal action in some patient with chronic diarrhea of infective origin. Due to the inadequate knowledge and poor practice many mothers discard colostrum and give pre lacteal feeding which results potential risk of infection and promotes neonatal mortality and morbidity. So the source of evidence encouraged to select the study.

6.3 REVIEW OF LITERATURE

Review of literature is an essential step in research project. A literature review helps to lay the foundation for the study and also inspire new research ideas. In this chapter an attempt has been made to bring out the available literature related to this study , which helps in projecting the wide perspective of the study. It includes
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1. Studies related to knowledge of colostrum feeding 2. Studies related to practice of colostrum feeding 3. Studies related to importance of colostrum feeding. 1 . Studies related to knowledge of colostrum feeding. YANIKKEREM.E, TUNCER.R, YILMAZ.K (2009) conducted a study on Breast feeding :knowledge and practice among mother in Manisa, Turkey. Findings showed that 10.8% of women were not aware that they should offer colostrum to their babies. Breast feeding counseling should be offered particularly during the pregnancy and early postpartum period6. S.KANNAN, B.CURRUTH, J.SKINNER in(2009) published a study on Neonatal feeding practices of Anglo- American mothers and Asian Indian mothers living in US and India in Journal Of Nutrition Education And Behavior volume 36. The objective of the study is to compare the colostrum and pre lacteal feeding practice of Anglo American mothers and Indians. Asian Indian women who came to live in US demonstrate different feeding practices that their Indian counterparts. Nutritionists are encouraged to understand the maternal reasons for withholding colostrum and prelacteal feeding to give compatible message targeted at women 7. MADHU K, RAMASH MASTHI, SRIRAM CHOWDARY (2006). The study was conducted on Breast feeding practices and new born care in rural areas at Bangalore. This study was aimed to describe the breast feeding practice prevalent in rural areas. Most 96.5% mothers reported giving colostrum to the baby. This study emphasis the need for breast feeding intervension programmes especially for the mothers during antenatal

and postnatal check-up and practice like discarding the colostrum, and early or late weaning are still widely prevalent and need to be addressed.8 2. Studies related to practice of colostrum feeding. GUPTA D, SRIVASTAVA V.K, KUMAR.V, JAIN.S MASOOJI AHMAD N, SRIVASTHAVA JP (2009) done a study on New born care practices in urban slums of Lucknow city,UP to identify critical behavior, practices and barriers that influences the survival of new born. Study finding showed that only 36.6% mothers initiated breast feeding with in 1 hour of brith and 30.2% initiated after to one day. The mothers who have not given colostum to their baby, in majority the reason was customs9. DINESH KUMAR, NK GOEL, MEENU KALIA, H.N SWAMI, RUCHI SINGH (2008) published a research article regarding Gap between awareness and practice and regarding maternal and child health among women in urban slum community, Knowledge regarding optimal infant and young child feeding was very poor. Initiation of breast feeding within six hours(17.4%) and colostrum feed was 34.8%.10 KUMAR DINESH, AGARWAL NEERAJ, SWAMI HM (2006) conducted a study on Socio- demographic correlation of breastfeeding in urban slums of Chandigar. Out of all 270 respondents, 43 (15.9%) discarded colostrum and 108 (40%) mothers gave pre lacteal feed. Illiterate mothers found high risk of delay in initiation of breastfeeding.11 3. Studies related to importance of colostrum feeding. Science Daily May 13,2010 published an article Why is breast milk best?Its all in the Gene.Is Breast milk so different from infant formula ? The ability to track which genes are operating in an infants intestine has allowed university of Illinois
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scientists to compare the early development of breast fed and formula fed babies .They the difference is very real.12 KUNAL SAHA, NARESH DUA AND KAMLESH CHOPRA (2005) done a study on Use of Human colostrum in the management of chronic infantile diarrhea due to entero pathogenic E-coli infection with associated intestinal parasite infestation and under nutrition. This study reports the management of infants with chronic diarrhoea by colostrum feeding. Results indicated affective anti diarrhoeal action of colostrum in some patient with chronic diarrhoea of infective origin.13 BREF RATNER, HOLMES, C.JACKSON and HELEN LEE GRUEHL,NEWYORK UNIVERSITY(2005) conducted a study on Transmission of protein hypersensitiveness from mothers to offsprings The role of colostrum . In this study they find that colostrum play a great role in the transmission of hemolysin immunity to the offspring than the placenta14. I.A ELEGBE,E.O OJOFEIFIMI(2000) Nigeria conducted a study on the effects of early initation of colostrum feeding on proliferation of intestinal bacteria in neonates. The result of the study indicated that eary initiation of colostrum feeding to neonates will suppress the proliferation of bacteria in the neonates.15

6.4 STATEMENT OF THE PROBLEM

A study to assess the effectiveness of structured teaching programme on postnatal mothers regarding the knowledge and practice of colostrum feeding in selected Government hospitals at Bangalore.

6.5 OBJECTIVES
1. To assess the existing level of knowledge regarding colostrum feeding among postnatal mothers. 2. To assess the practice of postnatal mothers regarding colostrum feeding. 3. To compare the effectiveness of structured teaching programme regarding colostrum feeding among postnatal mothers. 4. To find out the association of knowledge of postnatal mothers regarding colostrum feeding with selected socio demographic variables. 5. To find out association of practice of postnatal mothers regarding colostrum feeding with selected socio demographic variables.

6.6 RESEARCH HYPOTHESIS:

H1: There will be a significant difference between pre test and post test knowledge regarding
colostrum feeding among postnatal mothers.

H2: There will be a significant difference between pre test and post test practice of colostrum
feeding and among postnatal mothers. H3: There will be a significant association between the level of knowledge of colostrum feeding and selected demographic variables. H4: There will be a significant association between the practice of colostrum feeding and selected demographic variables.

6.7 OPERATIONAL DEFINITIONS

6.7.1 EFFECTIVENESS It refers to the efficiency of the structured teaching in increasing the knowledge of postnatal mothers regarding colostrum feeding which is measured in terms of significant gain in Post test knowledge score. 6.7.2 STRUCTURED TEACHING PROGRAMME Refers to prepared teaching programme with systematically developed instructions for a group of post natal mothers regarding knowledge on colostrum feeding. 6.7.3 KNOWLEDGE. It is the correct verbal response by the postnatal mothers regarding the colostrum feeding which is measured by the knowledge questionnaire. 6.7.4 COLOSTRUM FEEDING Colostrum is the initial yellowish sticky milk produced from mothers breast for the first 24- 48 hours following delivery which has to be fed to the baby. 6.7.5 POSTNATAL MOTHERS Refers to mothers after child birth.

6.8 ASSUMPTIONS
1. Mothers may not have adequate knowledge regarding the colostrum feeding. 2. Mother may not practicing colostrum feeding properly.

3. Postnatal mothers are in need of proper information regarding the importance of colostrum feeding. 4. The structured teaching programme will helpful to improve the knowledge and practice of post natal mother regarding colostrum feeding. 5. The demographic variables may influence the knowledge and practice of postnatal mother regarding colostrum feeding.

6.9 DELIMITATION
1. The sample size is limited to 60 postnatal mothers. 2. The study is limited only to normally delivered mothers. 3. The study is limited to postnatal mothers in the age group 19-35 years admitted in selected government hospitals at Bangalore. 4. The postnatal mothers those who are available during the data collection period.

7. MATERIALS AND METHODS

7.1 RESEARCH APPROACH
The research approach for this study is evaluate approach.

7.1.1 SOURCE OF DATA

The source of data for this study is postnatal mothers admitted in selected government hospitals at Bangalore.

7.1.2 RESEARCH DESIGN

The quasi-experimental design is selected for this study.

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7.1.3 SETTING OF THE STUDY This study will be conducted in selected government hospitals at Bangalore. 7.1.4 POPULATON The target population of the present study includes normally delivered mothers of age group 19-35 years admitted in selected government hospitals at Bangalore. 7.1.5 SAMPLE The sample for this study is 60 normally delivered postnatal mothers at the age group 19-35 years in selected government hospitals at Bangalore. 7.1.6 SAMPLE SIZE The sample size is 60 postnatal mothers. 7.1.7 SAMPLINGTECHNIQUE Simple random sampling technique will be using for this study.

7.2

METHOD OF DATA COLLECTION

Data will be collecting from the postnatal mother by structured interview schedule.

7.3

SAMPLING CRITERIA

7.3.1 INCLUSION CRITERIA 1. Postnatal mothers at age group 19-35 yrs admitted in selected government hospitals. 2. Postnatal mothers who are willing to participate in this study. 3. Normally delivered mothers are included in this study.

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4.Mothers who will be available at the time of data collection. 5.Postnatal mothers who knows Kannada and English. 7.3.2 EXCLUSION CRITERIA: 1. Postnatal mothers who are at age of 18 years and below and above 35 years. 2. Postnatal mothers undergone other than normal delivery like caeserian section forceps delivery etc. 3. Postnatal mothers who are contraindicated for breastfeeding their babies like breast cancer,hepatitis etc. 4. Postnatal mothers who are not willing to participate in this study.

7.4 TOOL FOR DATA COLLECTION:

A semi-structured questionnaire will be used for data collection procedure.

7.5 DATA COLLECTION PROCEDURE

Prior to data collection, written permission will be obtained from the consent authorities. The data will be collecting by interview schedule with semi structured questionnaire. The investigator herself will collect the data. For each samples around 15-20 minutes will be spending. Pre- test and post test will be conducted.

7.6 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER ANIMALS? IS SO PLEASE DESCRIBE?
No, the study does not require any investigation or intervention .

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7.7

HAS ETHICAL CLEARANCE BEEN OBTAINED FOR YOUR

INSTITUTIONS IN CASE ABOVE?

Not Applicable

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8. LIST OF REFERENCE:
BOOKS: Donna.L.Wong, Maternal and Child Health Nursing, Mosby Publication, St Louis, Missouri, 1998. Myles, Textbook of Midwives, Church chill Livingston Publication, UK, 14 Editions, 2003 page number:- 751-754. Annaamma Jacob, A Comprehensive Textbook of Midwifery, Jaypee Brothers, Medical publishers(P)Ltd, edition 2005, page number:- 485-496. Lade wig. Essential of Maternal Newborn Nursing, Benjamin publishing company inc, California, 1994, page number:- 643-645. Dorothy R.Marlow, Textbook of Pediatric Nursing, Published Elsevier printers private ltd, New Delhi, 6th edition, 2004, page number:- 372-374 D.c.Dutta, Textbook of obstetrics including perinatology and contraception, 6th edition, published by new central agency (P) Ltd, 2006. Shirish N Daftary, Manual of obstetrics, Published Elsevier printers private ltd, New Delhi, 1th edition, 2004, page number:- 307. BT. Basavanthappa, nursing research (2005), Jaypee Publication, New Delhi. Maharjan, B.K. (1997), Methods in bio- statistic, 6th Edition, Jaypee Publication, New Delhi.

JOURNALS: 1. Dharitri Swain, Nightingale Nursing Times, C 23, Institutional Area, sector -62, Noida , volume: 5, February. 2010. 2. Ampeire Issac Petit, perception and knowledge on exclusive breastfeeding among women,

a study from Mlbarara hospital, Uganda, Aug 2008, official publication of the Tanzania medical students association 3. SRIVASTAVA S.P, SHARMA V K, KUMAR V (2000) , Journal of Indian Pediatrics, September- 31(9) 1079-82 4. Abstract of research studies completed by NIPCCD 2004-2005. 14

5. P.Ergenekon-Ozelci. Et.al. Breast Feeding Beliefs And Practice Among Migrant Mothers Turkey , 2001, The European Journal Of Public Health, volume: 16, page number:- 143-148. http://eurpub.oxfordjournals.org 6. YANIKKEREM.E, TUNCER.R, YILMAZ.K , Journal of midwifery, volume: 25, issue 6, December- 2009, page number:- e19-e32. 7. S.KANNAN, B.CURRUTH, J.SKINNER , (2009), Journal of Nutrition Education and Behaviour, volume: 36, issue 6, page number:- 315-319. 8.

MADHU K, RAMASH MASTHI, SRIRAM CHOWDARY, (Indian Journal Of

Community Medicine, volume: 34, issue 3,july 2009.

9. GUPTA D, SRIVASTAVA V.K, KUMAR.V, JAIN.S MASOOJI AHMAD N,

SRIVASTHAVA JP , Indian Journal Community Medicine , 2010, 35:82-5,

www.ijcm.org.in 10. DINESH KUMAR, NK GOEL, MEENU KALIA, H.N SWAMI, RUCHI SINGH, Indian journal of pediatrics (2008), volume:75, issue 5, page number:-455-458,(under www.ncbi.nlm.nb.gov 11. KUMAR DINESH, AGARWAL NEERAJ, SWAMI HM , Indian Journal Of Medical Science, Volume:60, no11, Nov 2006,page number:- 461-466. 12. University Of Illinois College Of Agriculture, Consumer And Environmental Science Daily May 13, 2010.under www.sciencedaily.com 13. KUNAL SAHA, NARESH DUA AND KAMLESH CHOPRA , Journal Of Tropical Pediatric, Oxford University Press, page number:- 247-250. 14. BREF RATNER, HOLMES, C.JACKSON and HELEN LEE GRUEHL,NEWYORK

UNIVERSITY(2005) , The journal of immunology, by the American association of

immunologists, tnc. Volume: 14, page number:- 267-278 15. I.A ELEGBE,E.O OJOFEIFIMI (2000) , Clinical Pediatrics, volume: 21, page number:39 -42.

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WEBSITES:

Dictionary of biology 2000(under www.pubmed.com) Gale Encyclopedia of Alternative Medicine 2005.(under Wikipedia)

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Signature of the Candidate 10 Remarks of the guide

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Name and designation

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Head of the Department

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Signature

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Remarks of the Principal

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Signature

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