Gunvant
Effect of educational intervention on breast feeding practices in tertiary care hospital, Gwalior Madhya Pradesh

Das G.1, Eske G.S.2, Rai P.L.3, Gautam S.4

1Dr Ghanshyam Das, Associate Professor, 2Dr Gunvant Singh Eske, Assistant Professor, 3Dr Preeti Lata Rai, PG Student, 4Dr Shweta Gautam S.R, all authors are affiliated with Department of pediatrics GRMC Gwalior, MP, India

Corresponding Author: Dr Gunvant Singh Eske, Assistant Professor, Department of Pediatrics GRMC Gwalior, MP, India, Email: gunvant987@gmail.com



Introduction

Introduction: Evaluation of the effectof educational intervention on early initiation of breast feeding in full term normally delivered baby 1 & 6 months andfactors affectingbreast feeding. Methods: interventional study with subjects as mothers with vaginal delivered newborns excluding preterm, VLBW/ LBW / /IUGR babies, newborn with medical or surgical problems and whose child didn’t survive Cases were pregnant women attending antenatal clinic of KRH (n=124) and controls were mothers delivered at government hospital except KRH.(n=120). Mothers counseled antenatally and helped for initiation of breast feeding immediately after birth and again counseled individually at discharge, on follow up at end of1st and 6months. In control group breast feeding practices were recorded at 1 and 6 months after birth without any counseling. Results: There were 76.8% (n = 80) mothers who had early initiation of breast feedingin interventional groupcompared to 10.56% (n = 12) in non-interventional group with odds ratio of32. 93 and 83%mothers in interventional group were practicing EBF (p = 0.01)against only 63 %, and 49% mothersat 1 and 6 months respectively in non-interventional group. Effect of counseling in cases for EBF was more in primiparous(70.83% and 91.30%) than in multiparous (29.16% and 60.41%) at 1 and 6 months respectively (p = 0.01and 0.04). Conclusion: counseling antenatally and at regular intervals significantly increase early initiation and sustainedexclusive breast feeding. This influence primiparous mothers more.

Keywords: Breastfeeding, Counseling, Early Initiation



Manuscript received: 20th December 2017, Reviewed: 30th December 2017
Author Corrected: 7th January 2018, Accepted for Publication: 12th January 2018

Introduction

Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information and support of their family, the health care system and society at large. Exclusive breastfeeding is recommended up to 6 months of age. Breastfeeding is the ideal food for newborns and infants, providing them with all the nutrients they need for healthy development. If every child was breastfed within an hour of birth, given only breast milk for their first six months of life, and continued breastfeeding up to the age of two years, about 800 000 child lives would be saved every year[1]. Adequate breastfeeding counseling and support are essential for mothers and families to initiate and maintain optimal breastfeeding practices[2].Early breastfeeding within 1 hour and exclusive breastfeeding for the 6 months are the key interventions to achieve millennium development goal 1 (MDG) and MDG 4, which deal with reduction in child malnutrition and mortality. In India, effective implementations of these interventions are yet to be achieved. National Family Health Survey- 4 data show that the initiation of breast feeding within 1 hour is only 34.5% while the exclusive breast-feeding rates in children < 6 month is only 58.2%[3]. Counseling is very important in antenatal period for early initiation of breast feeding & sustained exclusive breast feeding.

Method

This study was a prospective non-randomized interventional study. Ethical approval was obtained from Ethical Committee, Gajra Raja Medical College, Gwalior. Informed and written consent of mothers was taken prior to enrollment in the study. Total 244(calculated by n=z21-@/2p(1-p)/d2) mothers were participant for study.Onegroup(n=124) was given educational intervention for breast feeding benefits(as per the IYCF Guidelines)who attended Anti natal checkupand delivered in Kamla Raja Hospital and werecalled interventional group and other group(n=120) who were delivered in another hospital(after ethical clearance) were not given any intervention taken as non-interventional group. Educational intervention was in form of counseling about the benefits and importance of early initiation of breast feedingbefore delivery in the antenatal ward in third trimesterthen after delivery and 1 month and 6 months of age, assistance in startingbreast feeding, motivation to continue exclusive breast feeding up to optimal period.This group was helped in starting breastfeeding within 1 h after delivery and during their stay at hospital and counseled at discharge. Counseling skills was adapted according to infant and young child feeding (IYCF) practice guidelines [4]. Early initiation of breastfeeding is defined as breast feeding startedwithin the first hour of life andExclusive breastfeeding is defined as the infant exclusively receives breast milk and no any additional food or drink, not even water. Follow-up was carried out in newborn well baby clinic at the end of 1st and 6 months. Effect of counseling was also compared in primiparous and multiparous mothers enrolled in interventional group [Table 3]. Non-interventional group received all the information about breast feeding as per the standard protocol of the hospital and received no counseling by the investigator at any time during the study. Support for breastfeeding in the non-interventional group included the usual verbal encouragement provided by the maternity ward staff members, a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the investigator. They were also followed at the end of 1st and 6thmonth and breast-feeding practices recorded.

Results

In interventional group out of 124 enrolled, 28 were excluded based on exclusion criteria and 96 mothers participated in study. Out of96, 6 and 8 were lost tofollow-up at 1 month and 6 months respectivelyso finally 82 mothers were taken for final analysis [Fig.1]. Innon-interventional group, out of 120 enrolled mothers, 32 were excluded. 88 mothers were taken in study but9 and 12 were lost to follow up at 1 and 6 months respectively so in group II finally 67 mothers were taken for final analysis [Fig.1].

figure01
Figure-1: Study groups flow diagram, intervention group &non intervention group

Participantsflow diagram, 96 mothers were in included in interventional group and 88 in non- interventional group

figure02
Figure-2: Effect of counseling in interventional group for EBF was more in primiparous mothers
 
In present study we observed that effect of counseling was more significant in primiparous mothers

Table-1: Base line demographic data of study groups showing educational status, parity and exclusive breastfeeding of mothers

Base line demographicof study groups

Intervention group (n=96) (%)

Non intervention group (n=88) (%)

p value

Education of mothers

Above high school

 

18 (18.75)

 

10 (11.36)

 

0.001

High school

26 (27.08)

16 (18.18)

0.002

Below high school

28 (29.1)

18 (20.45)

0.001

Total literate Mothers

72 (75)

44 (50)

Illiterate

24 (25)

44 (50)

Parity

Primiparous

Multiparous

 

68(70.83)

28 (29.16)

 

42 (47.72)

46 (52.27)

EBF

1 month

6 month

 

93 (96.8)

83 (86.4)

 

63 (71.6)

49 (55.6)

 

0.01

0.002


There were 76.8% (n= 80) mothers who had early initiation of breast feeding in interventional group compared to 10.56% (n = 12) in non-interventional group with odds ratio of 32. 93% and 83% mothers in interventional group were practicing EBF at 1and 6 monthsrespectively(p = 0.01)against only 63 % and 49% motherswere practicingEBFat 1 and 6 months respectively in non-interventional group. Effect of counseling in interventionalgroup for EBF was more in primiparous mothers (70.83% and 91.30% at 1and 6 months, respectively) than in multiparous (29.16% and 60.41% at 1 and 6 months, respectively) (p = 0.01 and 0.04)[fig 2]. Analysis showed that literacy rate in mothers in interventional group was more (75%) compared to those in non-interventional group (50%). [Table-1].

Table-2: Distribution pattern of mean weight gain on follow up significant in interventional group

Weight (in kg)

Birth

1 month

6 month

Interventiongroup

2.66±0.39

3.61±0.48

5.79±0.52

Noninterventiongroup

2.49±0.36

3.07±0.41

4.86±0.78

Mean weight gain

0.27±0.03

0.54±0.07

0.93±0.26

p value

0.01

0.0006

0.00001

t value

2.78

4.93

5.45


In interventional group weight gain in new born at 1 month 3.61±0.48 (in kg), was significantly higher ascompared to weight gain in non-intervention group at 1 month(3.07±0.41) with P value 0.0006, and at 6 months weight gain washigher in interventional group with p value 0.00001[Table 2]

Discussion

The present study was undertaken to observe the morbidity pattern and breast-feeding practices in 244 newborns in Kamla Raja Hospital as well as other government maternity homes of Gwalior divided in to 2 groups intervention group an non-intervention group The infants, so registered were periodically followed at 1 month and 6 month of age. At each follow up there feeding history was reviewed, nutritional status was assessed through anthropometry and clinical examination was done to discover any disease present and history regarding breast practices was recorded. We observedin this studyintervention group primiparous mothers were more effectively counseled for early initiation of breast feeding as comparison to multiparous mothers. Dedicated lactation specialists may play a role in providing education and support to pregnant women and new mothers wishing to breastfeed to improve breastfeeding outcomes [5].

According to National Family Health Survey-3 data, about 20 million children are not able to receive exclusive breastfeeding (EBF) for the first six months, and about 13 million do not get good, timely and appropriate complementary feeding along with continued breastfeeding [3]. Over the past several years, India has failed to witness any remarkable progress in infant feeding practices, with only a small increment being recorded in EBF rates amongst infants 0-6 months of age – from 41.2% in 1998-99 (NFHS-2) to 46.3%% in 2005–2006 (NFHS-3)to 58.2% in 2015-2016 (NFHS-4)[3]. In over study this 93% and 83%mothers in interventional group were practicing EBF at 1and 6 monthsrespectively(p = 0.01)against only 63 % and 49% motherswere practicingEBF at 1 and 6 months respectively in non-interventional group. In other study the rate of early initiation of breastfeeding stands abysmally low at 24.5%, while the median duration of EBF among last-born children is as brief as two months. Further, the rate of EBF drops progressively from 51% at 2-3 months of age to 28% at 4-5 months of age [4].

In a recent Annual Health Survey conducted in India from 2010 to 2013 covering all the 284 districts (as per 2011 census) of 8 Empowered Action Group (EAG) States (Bihar, Uttar Pradesh, Uttarakhand, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha and Rajasthan and Assam) [6], the percentage of children breastfed within one hour of birth was observed to vary from 30% in Bihar and Uttar Pradesh to around 70% in Assam and Odisha. Children exclusively breastfed for at least 6 months ranged from 17.7% in UP to 47.5% in Chhattisgarh [4]. In this study early initiation of breast feeding in interventional group was more (76.8%) compared to those in non-interventional group (10.56%). Early breastfeeding within 1 h and exclusive breastfeeding for the first 6 months are the key interventions to achieve millennium development goal 1 (MDG 1) and MDG 4, which deal with reduction in child malnutrition and mortality respectively [7]. In India, effective implementation of these interventions is yet to be achieved. National Family Health Survey-4 data show that the initiation of breastfeeding within 1 hour is only 41.6% while the exclusive breastfeeding rates in children <6 month is only 54.9% [3]. It has been estimated that initiation of breastfeeding within an hour of birth can save 1 million babies [8]. Promotion of early initiation of breastfeeding has potential to make a major contribution in achievement of healthy child survival MDG. About 16% of neonatal lives could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the 1st hour [1]. This has particular relevance in our country, where neonatal and infant morbidity and mortality rates are high.

Counseling has an inevitable role in successful and sustained exclusive breastfeeding along with early initiation of breastfeeding. Therefore, this study was planned to assess the effect of counseling on breast feeding practices, especially early initiation and sustained exclusive breast feeding (EBF). Every mother, especially the primipara, should receive support from doctors, nursing staff or community health workers (in case of non-institutional birth) with regard to correct positioning, latching and treatment of problems, such as engorgement, nipple fissures and delayed ‘coming-in’ of milk. If available, dedicated skilled supports like Lactation Consultants/ Mother Support Counselors/ Peer Counselors should be facilitated to support the mother in the antenatal, immediate postnatal period, post discharge follow-ups and in neonatal care units. Mothers need skilled help and confidence-building during all health contacts and at home through home visits by trained community worker, especially after the baby is 3 to 4 months when a mother may begin to doubt her ability to fulfill the growing needs and demands of baby[4]. Early initiation and EBF was strikingly more in primiparous, which showed that these mothers could be easily motivated when approached during antenatal and immediate postnatal period to emphasize and teach them the importance of early initiation and sustained EBF along with technique of breast feeding. Multiparous mothers, due to their previous experience in breast feeding, are difficult candidates for counseling for early initiation of breast feeding and also for sustained EBF in later life. A previous study also reported same results [9]. Similarly, a study of selected Mexican hospitals showed that counseling combined with babies staying with their mothers, significantly increased full breastfeeding among primiparous mothers [10]. Similar results were obtained in study done by Agre et aland Holmes et al. [11,12]. However, Ekström et al. concluded that parity had no significant influence [13].

common reasons for early breastfeeding discontinuation was early discharge from hospital. Which could be overcome if the woman was informed antenatally and onperiodic basisabout the benefits of breastfeeding and prepared mentally for exclusive breastfeeding. This studyrevealed that antenatal breastfeeding education and postnatal lactation support, can significantly improve rate of early initiation of breast feedingand rates of exclusive breastfeeding for optimum period. Existing support for breastfeeding is inadequate in the population studied and needs to be strengthened. Informing all pregnant women about the benefits and management of breastfeeding should be a priority during antenatal visits. Primipara mothersare mostimportant target group for counseling because they are more adaptive. The group counseling was foundmore effective than individual mother counseling.

Conclusion

Early initiation of breast feeding after birth i.e. 1 hr prevents morbidities and promote healthy survival of infant & optimal weight gain in infants. Counseling in antenatal periodis very effective in early initiation of breast feeding. Primiparous mother are more energetic as comparison to multiparous mother about breastfeeding

What this study adds: Mothers/ caretakers/attenders should be counselled in antenatal period to ensure hundred percent early initiation of breastfeeding.

Regular and periodic counselling forsustained breastfeeding upto six months of life and beyond that.

Funding: Nil, Conflict of interest: None initiated.
Permission from IRB: Yes

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How to cite this article?

Das G, Eske G.S, Rai P.L, Gautam S. Effect of educational intervention on breast feeding practices in tertiary care hospital, Gwalior Madhya Pradesh. Int J Pediatr Res. 2018;5(1):7-12.doi:10.17511/ijpr.2018.1.3.


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