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
Keywords: Knowledge, Effectiveness, Breastfeeding related problems, Latching-on
Word Count: 450
TABLE OF CONTENTS
Content                                                                                                                                  Page
Title Page                                                                                                                               i
Certification                                                                                                                           ii
Dedication                                                                                                                             iii
Acknowledgements                                                                                                               iv
Abstract                                                                                                                                 v
Table of Contents                                                                                                                 vi
List of Tables                                                                                                                         vii
List of Figures                                                                                                                        ix
Appendices                                                                                                                            x
CHAPTER ONE: INTRODUCTIONÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
1.1 Background to the Study                                                                                                1
1.2   Statement of the Problem                                                                                               2
1.3   Objective of the Study                                                                                                    2
1.4   Research Questions                                                                                                        3
1.5   Hypotheses                                                                                                                     3
1.6   Scope of the Study                                                                                                          3
1.7 Significance of the Study                                                                                                   3
1.8 Operational Definition of Terms                                                                                        4
CHAPTER TWO: REVIEW OF LITERATURE
2.0   Introduction                                                                                                                     5
2.1   Importance of breastfeeding to infants and mothers                                                       5
2.2Â Â Â Implications of knowledge of nursing mothers on
Content                                                                                                                                    Page
breastfeeding techniques                                                                                                           6
2.3   Causes, treatment and remedies for nipple pain                                                              11
2.4   Good techniques and proper positioning for good latch-on                                            16
2.5Â Â Â Impact of breastfeeding interventions on breastfeeding
related problem                                                                                                                        19
2.6Conceptual Model                                                                                                              24
 CHAPTER THREE: METHODOLOGY
3.0  Introduction                                                                                                                     26
3.1   Research Design                                                                                                             26
3.2Population                                                                                                                          27
3.3Sample size and sampling Technique                                                                                  28
3.4   Instrumentation                                                                                                               28
3.5 Validity and Reliability of the Instrument                                                                        28
3.6Method of Data Collection                                                                                                29
3.7Method of Data Analysis                                                                                                   30
3.8 Ethical Consideration                                                                                                        31
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.0:   Introduction                                                                                                                    32
4.1:  Demographic Data of Participants                                                                                  33
4.2:  Discussion of Research Questions                                                                                   34
4.3:  Discussion of Hypotheses                                                                                               36
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Content                                                                                                                                     Page
CHARPTER FIVE: SUMMARY CONCLUSION AND RECOMMENDATIONS
5.1:  Summary                                                                                                                          42
5.2:  Conclusion                                                                                                                       42
5.3: Recommendations                                                                                                            43
5.4:  Limitation of Study                                                                                                      43
5.5:  Suggestion for Further Studies                                                                                       44
REFERENCESÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 45
APPENDICESÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 48
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LIST OF TABLES
Table                                                                                                                                        Page
4.1 Demographic data of the maternal respondents                                                            33
4.2 Â Â Descriptive statistics showing the existing knowledge of nursing
mothers on adequate breastfeeding positioning                                                       34
4.3 Descriptive statistics showing the knowledge level of mothers
on procedure for breastfeeding before intervention                                                 35
4.4 Descriptive statistics showing the level of knowledge of mothers
on breast engorgement                                                                                             36
4.5Â Â Descriptive statistics showing the level of knowledge of mothers on sore
nipples before intervention                                                                                       37
4.6 T-test showing differences between the knowledge level of mothers on
adequate positioning for effective latch on pre and post intervention                      38
4.7T-test showing the differences between the knowledge level of participants on
procedure for breastfeeding pre and post intervention                                              39
4.8T-test showing the difference between the pre and post intervention knowledge
of nursing mothers on breastfeeding problems                                                          39
LIST OF FIGURE
Figure 1Conceptual model adapted from DoreathyOrem’s theoryself care deficit            24
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APPENDICES
- Informed Consent Form
- Questionnaire
- Teaching Modules
- BUHREC Permission to conduct research work
- Introduction Letter to PHC where the research work was done.
- Reliability Result
- Picture taken during the research work with participants.
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                                                CHAPTER ONE
                                               INTRODUCTION
- 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 six months 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 StudyÂ
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:
- determine the existing knowledge level of nursing mothers on adequate positioning for effective latch-on.
- determine the knowledge level of nursing mothers on the procedure for breastfeeding;
- determine the knowledge level of nursing mothers on breast engorgement and
- determine the knowledge level of nursing mothers on sore nipple and its prevention
1.4 Â Â Â Â Â Research Questions
- What is the existing knowledge level of nursing mothers on adequate breastfeeding positioning?
- What is the knowledge level of nursing mothers on the procedure for breastfeeding?
- What is the knowledge of level of nursing mothers on breast engorgement
- What is the knowledge level of nursing mothers on sore nipple and its prevention
- 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.
- 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 Â Â Â Â Â 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.
