ABSTRACT
This
study focused on the effect of nursing intervention on breastfeeding related
problems among nursing mothers in two selected primary health care centers in
Kaduna south, Nigeria. Breastfeeding is a process of feeding babies with breast
milk from the mothers’ breast and that does not mean it is always easy. It was
observed during the clinical posting that many breastfeeding mothers that
attended this primary health care centers encountered a lot of challenges in
the course of breastfeeding their babies hence many stopped breastfeeding at
early stage .The broad objective of this study therefore is to determine the
effect of nursing intervention on breastfeeding related problems among nursing
mothers.
The
study adopted a pretest posttest quasi experimental design. The population of
the nursing mothers is 185 on the average per visit. The sample size consists
of 36 nursing mothers, which was determined using Lesley Kish formula while the
sampling technique used was simple random technique and purposive sampling
technique. Simple random technique was used to select the Southern senatorial
district from the three senatorial districts in Kaduna State which are Kaduna
North, Kaduna South and Kaduna Central. There after purposive sampling technique
was used to select two primary health care centers among the twenty PHCS in
Kaduna South. Data was collected with the use of a reliable self-constructed
questionnaire before and after the training.Cronbach Alpha was used to
determine the reliability of the questionnaire (r=0.990)The training Programme
consists of four modules and the training lasted for four weeks. The training
comprises of four stages: pre-intervention stage, week 1, week 2, week 3, week
4 and administration of post-test. The study generated four research questions
and the three hypotheses which were tested at 0.05 alpha levels. Data were
analyzed using descriptive statistics, and t-test.
Demographic data of participants showed that
majority of the maternal respondents with children numbering between 1 and 2
were 28(77.75%) had the highest percentage.
The highest educational attainment of the respondent was secondary school
(100%). The Igbo’s 16, (44.4%) had the
highest percentage among the tribes. Majority (52.8%) of the nursing mothers have poor knowledge on adequate breastfeeding positioning, 14 (38.8%) of the participants had moderate
level of knowledge on procedure for breastfeeding. 17 (47.2%) of the
participants had moderate knowledge level of breast engorgement,). Majority 21
(58.4%) of the participants had moderate level of knowledge on sore
nipples. Significant differences were found
between the pre and post intervention in the following areas; on adequate
positioning for effective latch-on (p=0.009), on procedure for breastfeeding (p=0.011),
on breastfeeding problems (p=0.001).
In conclusion, the training was effective in
improving the level of knowledge of breastfeeding mothers on breastfeeding
related problems and its prevention. Based on the findings, it is recommended that
the government should help in minimizing this breastfeeding related problems by
organizing seminars, workshop and extension services to enlighten women on
breastfeeding problems and early prevention.
CHAPTER ONE
INTRODUCTION
1.1
Background to the Study
Breastfeeding is the act of milk
transference from mother to baby that is needed for the survival and healthy
growth of the baby into an adult (United Nations Children’s Fund (UNICEF),
2009; Heckman, 2011). Breastfeeding provide infant with essential calories and
nutrients to nourish the baby (National Institute of Child Health & Human
Development, 2009).According to the American Academy of Pediatrics (AAP) policy Statement on Breastfeeding,
women who do not have health problems should exclusively breastfeed their
infants for at least the first six months of life (AAP,2012). The importance of appropriate infant feeding
and the vital role played by breastfeeding in child survival, growth and
development cannot be over-emphasized (AAP,
2012). The World Health Organization (WHO) has recommended two years
breastfeeding; first sixmonths exclusive breastfeeding; more than eight times
breastfeeding per day in the first three months of an infant’s life. The AAP
suggested that a woman should try to breastfeed her infant for the first twelve
months of life.
Despite
the documented value of exclusive breastfeeding during the first months of a
child’s life and struggles for promoting this practice, rates for exclusive
breastfeeding in Nigeria are below those recommended by the World Health
Organization (WHO), which advocates exclusive breastfeeding during the first
six months of baby’s life. Breastfeeding a baby exclusively for the first six
months and then continued breastfeeding in addition to appropriate solid foods
until twelve months and beyond has health benefits for both mother and the child and these
include; reduction of the risk of
mothers from developing gestational diabetes, osteoporosis, and breast cancer.
It can also assist the women to lose weight after delivery, and also help the
uterus of the women to return fast to pre-pregnant state. Advantages to the
babies may also include: reduced risk of development of gastro intestinal
illness, allergies, asthma, diabetes, obesity, some childhood cancer, respiratory
infections and diarrhoea.
Based on the WHO Global data on
infant and young Child Feeding in Nigeria, 22.3% of children were exclusively
breastfed for less than 4 months, while 17.2% were exclusively breastfed for
less than 6 months, in the year 2003. According to the Nigerian Demographic and
Health Survey (NDHS), in 2008 17% of children were exclusively breastfed for
less than 4 months, while 13% were exclusively breastfed for less than 6
months. The median exclusive breastfeeding period in Southwest Nigeria by
months in the year 2003 was 7 months. In the year 2008, it was 6 months. Within
the same period, early initiation of breastfeeding among women in the region
was 12.7% in 2003, but increased to 35.5% in the year 2008. All these figures
are far below the 90% level recommended by the WHO. Child mortality therefore
remains high in low and middle-income countries. Nigeria has the highest
under-five rural mortality rate of 242.7 per 1,000 among selected sub-Saharan
Africa countries. (NDHS, 2008; NPC, 2009; WHO, 2010)
The technique used in
breastfeeding, especially mother-infant positioning and attachment or suckling
by the infant, has been shown to be important for the effective transfer of
milk from the breast to the child as well as for preventing nipple damage.
Heckman (2011) evaluated mother-infant pairs in a maternity ward and observed
that only 2% of pairs achieved optimal latch performance (chin touches the
breast, mouth opens wide, lower lip flared outward ,moderate lip tension, and
infant grasps the areola), and only 0.2% achieved optimal mother-infant
positioning (mother in a comfortable position, C-hold of the breast [leaving
the areola free and making gentle compression of the breast tissue between the
thumb and fingers]. infant’s head and body aligned facing the mother and in
close contact with the mother’s body, infant’s arm not between the mother and
infant, infant’s head and neck supported, infant’s mouth facing the nipple, and
infants nose free for breathing).
1.2 Statement
of the Problem
Breastfeeding is the natural
way to feed a baby but that does not always mean it is easy. Many breastfeeding
mothers encounter a few challenges in the course of using one breastfeeding
technique or the other (Finello, 2015). According to National Health Service
U.K (2013), most breastfeeding mothers have experienced variety of difficulties
as a result of some of the techniques used both to the baby and themselves as
mothers. It was observed during the child welfare Clinic that many of the
nursing mothers failed to practice exclusive breastfeeding as a result of some
of the breastfeeding related problems they encountered while breastfeeding.
Considering that breastfeeding technique seems to be important for maintaining
successful breastfeeding, this project will explore effect of nursing
intervention on breastfeeding-related problems among nursing mothers in
selected Primary Health Clinics in Kaduna South, Nigeria.
1.3 Objective of
the Study
The main objective of this study is
to determine the effect of nursing intervention on breastfeeding-related
problems among nursing mothers in selected Primary Health Clinics in Kaduna
State, Nigeria, in the first six months postpartum. The specific objectives are
to:
1.
determine the existing
knowledge level of nursing mothers on adequate positioning for effective
latch-on.
2.
determine the
knowledge level of nursing mothers on the procedure for breastfeeding;
3.
determine the
knowledge level of nursing mothers on breast engorgement and
4.
determine the
knowledge level of nursing mothers on sore nipple and its prevention
1.4 Research Questions
1.
What is the existing knowledge level of nursing mothers on
adequate breastfeeding positioning?
2.
What is the knowledge level of nursing mothers on the procedure
for breastfeeding?
3.
What is the knowledge of level of nursing mothers on breast
engorgement
4.
What is the knowledge level of nursing mothers on sore nipple and
its prevention
1.5 Hypotheses
Ho 1.There is no significant difference between the pre and
post knowledge level of participant on adequate positing for effective latch-on
after four weeks of training.
Ho 2. There is no significant difference between the pre
and post knowledge level of participant on breastfeeding procedure after four
weeks of training.
Ho 3. There is no significant difference between the pre
and post knowledge level of participant on breast problems after four weeks of
training.
1.6 Scope of the
Study
This study determined the
effectiveness of breastfeeding intervention among breastfeeding mothers in the
first six months postpartum in selected PHCs in Kaduna State.
1.7 Significance of the Study
Breastfeeding provides infants with superior nutritional content
that is capable of improving infant immunity and possible reduction in future
health care spending. At the Innocenti Declaration in 1990, the WHO/UNICEF
called for policies that would cultivate a breastfeeding culture that
encourages women to breastfeed their children exclusively for the first 6
months of life and then up to 2 years of age and beyond. However, a recent
estimate by the WHO showed that worldwide only 35% of children between birth
and their 5th month are breastfed exclusively. The technique used in
breastfeeding, especially mother-infant positioning and attachment or suckling
by the infant, has been shown to be important for the effective transfer of
milk from the breast to the child as well as for preventing nipple damage.
Breastfeeding technique seems to be important for maintaining successful breastfeeding.
1.8 Operational Definition of Terms
Knowledge: understanding gained from information or instruction on
breastfeeding
technique
Effectiveness: This refers to the positive impact of a training programme on
different
breastfeeding techniques.
Breastfeeding: this is when a woman feeds her baby from her breast.
Latching on: To effectively turn the baby’s mouth to the breast for adequate
sucking.
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