Nurses’ Knowledge about availability and utilization of facilities related to promotion of breastfeeding

http://doi.org/10.33698/NRF0082  – Suksham Chopra, Raman Kalia, Indarjit Walia

Abstract :The study was carried out in :NSICU of APC of PGIMER, Chandigarh, during 2007- 2008. A group of 26 nurses (respondents) were interviewed about their knowledge and ‘available facilities related to promotion of breastfeeding. Age – wise, more than sixty percent were in the age group 31-45 years and and 73.1 percent were working in the NSICU for more than two years. All of them were of the view that colostrum should be given to the infant and bottle feeding should be avoided. Only 65.4 percent stated that child should be exclusively breastfed for six months. More than seventy percent were not aware that breastfeeding provides protection against occurrence of breast and ovarian cancer among mothers. Three – fourths of them were also not aware that child gets protection from asthma and middle ear infections. In order to improve overall environment of NSICU for promotion of breastfeeding factor of privacy should be given more importance. There is also need to organize inservice training for nurses and health education programmes for the mothers, and other caregivers to the neonates.

Key Words :

Breastfeeding, Awareness Promotion

Correspondence at : Suksham Chopra,

NINE, PGIMER, Chandigarh

Introduction

Breastfeeding is well accepted natural food for infant throughout the world because of its advantages to both mother and child l-2. Promotion of breastfeeding therefore remains a global priority, among health professionals. Nurses can play an impor tant role in the promotion of breastfeeding. For achieving the goal of reducing the infant mortality rate to 30/1000 by the year 2015, a great deal of attention needs to be paid especially to reduce the neonatal mor tality rate3. It has been reported that a majority of the neonatal deaths occur in developing countries, including India, where more than 26 million children are born every year and of these, 1.2 million die during the neonatal period.4 Infant mortality rate can be reduced substantially, if the children are exclusively breastfed up to six months. Even in low-income countries, 13 to 15 percent of child deaths can be prevented if children are breastfed exclusively for six months.5-6 WHO – UNICEF have set-up special guidelines for breastfeeding, which include: (i) begin breastfeeding   as  soon   as  possible; (ii) breastfeed exclusively until the baby is six months; and (iii) start complementary feeding after six months along with breastfeeding for one to two years6-7. Nurses who remain in close contact with the mothers of the neonates, can play an impor tant role in encouraging them, for not only exclusive breastfeeding but also for its continuation for a longer duration. In developing countries, breastfeeding is considered to be universal but early introduction of supplementary food increases the chances of occurrence of various diseases, including diarrhea among infants which adversely affect their growth8-9. Nurses, therefore, are in a good position to encourage mothers of the neonates for exclusive breastfeeding, apart from providing them psychological support and taking care of their  other needs.  With these considerations in mind, the present study was under taken to explore nurses’ knowledge about availability and utilization of facilities related to promotion of breastfeeding in the NSICU. This study was an integral part of the main study of evaluation of activities related to promotion of breastfeeding among neonates, admitted to NSICU and was sanctioned by PGIMER, Chandigarh.

Material and Methods

The study was carried out during 2007- 2008, in the NSICU Advance Paediatric Centre of PGIMER, Chandigarh. A group of 26 nurses, working in the unit during the study period, were selected for inclusion in the study. Neonates from neighbouring states of Panjab, Haryana, and Himachal Pradesh are admitted to this unit for management of various surgical disorders. Care is provided to the neonates by the trained nurses and resident doctors. Data were gathered with the help of a semi-structured interview schedule after a thorough pretesting. Respondents (Nurses) were explained the objectives of the study in an easy-to-understand language and they were asked to return the filled-in- questionnaire within the specified period. Only those nurses were included in the study who were willing to participate in the study and filled the questionnaire within the specified period.

Results

Age-wise, nearly one-fifth of the respondents were below 30 years and 64.4 percent were in the age group 31-45 years. Religion-wise, a majority of them were either Hindus or Sikhs (92.7%). As regard their professional background, nearly seventy percent of them had passed General Nursing Midwifery (GNM) course and 30.7 percent of them were either graduates or postgraduates in nursing. Experience-wise, more than three fourth of them had acquired more than two years of experience of working as a nurse (76.9%) and 15.4 percent had less than two years of experience. As regard their work experience within the present ward (NSICU), more than seventy percent of them had worked for two to five years (73.1 %) and 26.9 percent for less than two years. (Table – I)

Table-1 : Distribution of nurses according to their socio demographic and educational charateristics

Sociodemographic characteristics	Number	Percentage
A) Age group (in years)
a. Less than 30	05	19.2
b. 30-35	08	30.8
c. 36-40	07	26.9
d. 41 and above	06	23.1
B) Religion/Caste
a. Hindus	10	38.5
b. Sikhs	14	53.8
c. Others	02	07.7
C) Professional Qualifications
a. GNM	18	69.3
b. B.Sc. & M.Sc.	08	30.7
D) Total Experience (in years)
a. Less than 5	04	15.4
b. 6-10	02	07.7
c. 11-15	08	30.8
d. 16 and above	12	46.1
E) Experience within NSI CU(in years)
a. Less than 2	07	26.9
b. 2-5	09	34.6
c. 6 and above	10	38.5

Total Number of Respondents = 26

Awareness about breast. feeding and related aspects and about availability of facilities

For providing adequate information to the mothers, nurses are supposed to be well aware of various aspects of breastfeeding, including initiation, giving of colostrum, duration of exclusive breastfeeding, introduction of supplementary foods, taking care of soreness of nipples, engorgement of breasts. The findings of the present study show that all nurses were aware that colostrum (yellowish milk) should be given to the infant as it contains a high concentration of carbohydrates and protein which provides enough strength to the infant to fight against various diseases. Similar views were also expressed regarding introduction of bottle feeding as they opined that bottle feeding should be avoided to prevent diarrhoeal diseases among infants. Review of literature concerning other countries with low infant mortality rate, also revealed that infants fed on artificial milk or other products require hospital treatment five times more than those who were partially or fully breastfed and that maximum protection was provided by exclusive breastfeedinglO-ll. As regard initiation of breastfeeding, more than eighty percent of them (80.7%) were aware that infant should be given breastfeed within one hour after delivery, but only 65.4 percent of them were of the view that the child should be breastfed exclusively for six months. Nearly, one third of them also stated that infant should be breastfed for more than one year (30.8%), but majority of them were of the view that supplementary food should be started after six months (84.6%). More than eighty percent were also aware that breastfeeding protects the mother from next pregnancy. However, more than thir ty percent of them were not aware that breastfeeding also protects the mother against ovarian and breast cancer. Simialrly, more than three-fourth of them were not aware that breastfeeding protects the child from asthma and middle ear infection. Although more than eighty percent (88.5%) were aware that breastfeeding protects the child from diarrhoea (Table – II). Available literature provides enough evidence about advantages of breastfeeding for mother and child. Worldwide, only 37 percent of the infants are breastfed for six months and a half of world’s children are breastfed at the age of 20-23 months12. As regard the type of supplementary foods, a majority of them (73.1 %) were of the view that the child should be given soft foods in the form of Dalia, Khichri, Cerelac (53.8%) and mashed fruits and vegetables including banana and potatoes (34.6%). Even juices, rice water, soups and biscuits were also mentioned by one-fourth of the respondents. Nurses, therefore can play an important role in providing correct information regarding supplementary foods as per their seasonal availability and nutritive value to the mothers.

Table-II : Nurses awareness about various aspects of breastfeeding

Sr. no.	Aspects of Breastfeeding	Awareness
		Yes	No	Do not Know
I	Colostrum should be given	100.0	–	–
II	Bottle feding should be avoided	100.0	–	–
III      Initiation of breastfeeding after delivery (within one hour)		80.7	19.3	–
IV	Breastfeeding beneficial for the growth of child	88.4	11.6	–
V	Exclusive breastfeeding for six months	65.4	19.3	15.3
VI	Breastfeeding for one or more than one year	30.8	42.3	26.9
VII     Initiation of supplementary food after six months		84.6	15.4	–
VIII Water should be given along with breastfeeding		7.7	92.3	–
IX       Breastfeeding provides protection against: – a)   Next Pregnancy b)   Breast Cancer c)   Ovarian Cancer		84.6 65.4 46.2	15.4 3.8 15.4	– 30.8 38.4
X	Breastfeeding protects the child against: – a)   Diarrhoea b)   Acute Respiratory Infection c)   Asthma d)   Middle Ear Infection	88.4 53.8 26.9 19.3	3.8 3.8 – 3.8	7.8 42.4 73.1 76.9

Total number of the Respondents = 26

Awareness about available facilities and role of health professionals for promotion of breastfeeding.

Although, more than seventy percent (73.2%) of the nurses (respondents) were working in NSICU for more than two years, their awareness about availability of various types of facilities related to promotion of breastfeeding, was grossly inadequate. Nearly one fourth of them were not aware of mothers’ room where mothers’ or their relatives could stay or keep their personal belongings (26.9%). Moreover, only 53.8 percent of them knew about the availability of trained staff for health check up of mothers. Hardly one-third of them knew that mothers could provide self- care to their neonates, which helps the in relieving their stress. Again, only 15.4 percent of them were aware about the availability of various types of posters or char ts for educating the mothers on different aspects of breastfeeding and immunization. As regard nurses opinion regarding utilization of available facilities in the NSICU for the mothers of the neonates, it was repor ted that the mothers’ room was utilized by less than fifty percent of the mothers. Nearly thirty percent of the mothers were supervised by the trained staff for health related problems (30.8%) and one four th of the mothers were wearing aprons/gowns during breast feeding (26.9%) (Fig.- I). Certain factors responsible for under

Figure – I: Nurses awareness about availability and utilization of facilities related to promotion of breastfeeding.

utilization of available facilities included: uncleaniriess and overcrowding of mothers room (used by other caregivers also); shortage of time; non availability of gowns/ aprons and illiteracy (mothers) – unable to read or understand written posters and charts. Apart from providing medical care to the neonates of ,the NSICU, more than one third respondents had talked about various other aspects of breastfeeding to the mothers which included: taking care of engorged breasts, soreness of nipples, inadequacy of milk, washing of hands before and after breastfeeding, expressing breastmilk, and positioning of infant while breastfeeding. Nearly forty percent of the nurses had talked about various aspects of breastfeeding to 6-15 mothers in the last one month but more than one-four th (26.9%) of them did not respond. At the same time, 23.1 percent of them had talked to less than five mothers in the last one month..

In order to improve the overall environment of NSICU for promotion of breastfeeding among neonates, nearly seventy percent of the respondents were of the view that the factor of privacy should be given more importance (69.2%) and that there should be separate beds for the mothers of the neonates so that they could be able to take proper rest after taking care of the neonates. More than’ forty five percent of them were also of the opinion that there should be a separate washroom within ICU so that the mothers could express the breastmilk for feeding the infant in a clean environment. A need for health education programme emphasising the advantages of breastfeeding and personal hygiene was also expressed by more than fifty percent of the respondents (Table – III). Thus, for proper orientation, a well conceived educational programme for mothers is badly needed.

Table – III : Distribution of nurses according to their suggestions regarding promotion of breastfeeding

Suggestion	Number	Percentage
Suggesions Regarding promotion of Breastfeeding*
1) Need for more privacy for mothers	18	69.2
2) Separate beds for mothers	16	61.5
3) Health education for mothers/relatives	14	53.8
4) Separate washroom within ICU	12	46.1
5) Follow – up visits of mothers	08	30.7

Dissucssion

Breastfeeding, no doubt, is widely practiced in India, yet early and exclusive breastfeeding is not common. It has been highlighted that exclusive breastfeeding for the first six months of life is an highly effective way to reduce child mortality. The practice of giving prelacteal feed, discarding colostrum, introducing foods or fluids b’1fore the age of six months is still quite prevalent among the mothers. This is attributable to various cultural beliefs and taboos related to initiation of breastfeeding13-15. In the present study, all the respondents were aware of the advantages of giving colostrum and avoidance of bottle

Total Number of Respondents = 26

* Multiple responses feeding, but 34.6 percent of them were not aware of the appropriateness of the duration of exclusive reastfeeding upto six months. More than one third were also not aware that the breastfeeding provides protection against occurrence of ovarian and breast cancer among mothers. Nearly three -fourths of them were also not aware of the fact that breastfeeding protects the child against asthma (73.1%) and middle ear infections (76.9%). Their knowledge about available facilities related to the promotion of breastfeeding was also inadequate as more than one fourth of them were not aware of the provision of the mothers’ room, availability of posters/charts, and health check – up/ health talk by trained staff. More than thir ty percent of the respondents. also stressed the need for more privacy to the mothers of the neonates apart from providing separate beds, for proper rest. The need for providing health education to mothers, as well as other caregivers in the family was also expressed. Thus, trained nurses can play an important role in providing health education to their clients. A study from Brazil reports that, mothers who delivered in the hospitals and talked to health workers during early postpartum period, were likely to practice exclusive breastfeeding for more than three months than those who had no contact or support from the health workers 16. Even in USA, breastfeeding rates had increased when women were counselled during the lactation period. Review of literature also suggests that counselling on infant feeding is either unavailable or is often of poor quality, and breastfeeding pattern established during early postpartum period also influences long.- term breastfeeding practices17-18. Thus there is an urgent need to organize inservice training programme for the nurses so that they are able to provide correct information to the mothers related  to all aspects of Breastfeeding.

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