Download 2012 SJB COLLEGE OF NURSING BENGALURU

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
Ms. ROSE K PLACID
1st YEAR M.Sc. NURSING
CHILD HEALTH NURSING
YEAR 2011 – 2012
SJB COLLEGE OF NURSING
BENGALURU - 560060
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA
ANNEXURE-I
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1
NAME OF THE
Ms. ROSE K PLACID
CANDIDATE
SJB COLLEGE OF NURSING
AND ADDRESS
BGS HEALTH AND EDUCATION
CITY
KENGERI, BENGALURU 60
2
NAME OF THE
SJB COLLEGE OF NURSING
INSTITUTION
BGS HEALTH AND EDUCATION
CITY
KENGERI, BENGALURU 60
COURSE OF STUDY &
IYEAR M.Sc. NURSING
SUBJECT
CHILD HEALTH NURSING
4
DATE OF ADMISSION
4-07-2011
5
TITLE OF THE TOPIC
“A STUDY TO ASSESS
3
KNOWLEDGE AND ATTITUDE
REGARDING HUMAN MILK
BANKINGAMONG LACTATING
MOTHERS AT SELECTED
HOSPITALS, BENGALURU”
2
6. BRIEF RESUME OF THE INTENDED WORK
˝Mother’s milk time tested for million years is the best nutrient for babies
because it is nature’s perfect food˝
Robert S Mendelsohn
6.1 INTRODUCTION
A child is an individual who always need special care to survive and
thrive. They are the major consumers of health care. In India, about 35% of
total population are children . They are not only large in number but also
vulnerable to various health problems and considered as special risk group. 1
Breast feeding is the best natural feeding and the best.1 Breast milk is
thought to be best form of nutrition for neonates and infants. It is the
healthiest form of milk for babies. WHO recommends exclusive breast
feeding for the first six months, supplemented breast feeding is
recommended until at least two years and then as long as the mother and
child wishes.2
Breast milk it is easily digestible by the newborns intestine, offers a
variety of immunologic properties, effective in protecting the baby from
respiratory tract infection gastrointestinal infections and numerous allergies.
It has got bacteriostatic functions against gram positive bacteria and also act
as a laxative agent in neonates. Human milk contains growth modulators that
modify growth and maturation.3
The preferred food for newborn infant is the mother’s own milk irrespective
of baby’s gestational age but sometimes particularly in the case of sick and
immature infants, the mother is unable to maintain her lactation and an
alternative food is required. In 1800 BC the infant have been directly
breastfeed by wet nurse..A wet nurse is a lactatingwoman who breast feeds
another baby. While this may seem to be ataboo in our culture wet nurse was
actually popular until the invention of formulas.2
The practical alternative diet for baby who are unable to breast feed are
banked human milk or commercially available formula. The term human
milk banking refers to the collection, storage and processing of human milk
donated by lactating mothers for infants other than their own.The term some
times applied to the collection and storage of milk for a mothers own infant
when the infant is temporarily unable to suckled.2 Banked human milk is
used for the treatment of many conditions (mainly in Neonatal Intensive Care
3
Units: NICUs): prematurity, malabsorption, short-gut syndrome, intractable
diarrhea, nephrotic syndrome, congenital anomalies, formula intolerance,
failure to thrive, immune deficiencies.4
The world’s first human milk was established in 1909, in Vienna, Austria.
Asia’s first human milk bank was set up at LokmanyaTilakMuncipal
Hospital in 1989.The first human milk bank in Pune city was inaugurated in
the DeenathMangehkar Hospital. Human milk are crucial for India because
the practice of women donating milk on humanitarian grounds is common,
since then some 25 human milk banks across India – most of were located in
the western states of Maharashtra and Gujarat have been performing vital
services for premature babies requiring temporary intervention in cases of
delayed lactation abandonment or illness, these banks also been a life savers
for infants.5
6.2 NEED FOR THE STUDY
According to a joint statement by the World Health Organization and
United Nations Children's Fund in 1980. The best food for any baby whose
own mother's milk is not available is the breast milk of another healthy
mother. 6
The recently released India Report of World Breast Feeding Trends
Initiative 2008, highlights the role of breast feeding in ensuring child health
and reducing infant and child mortality. India has an infant mortality rate of
55 per 1000 live births (SRS 2008) which accounts for 72 per cent of the
country’s under-five mortality rate.7 In 2010 the infant mortality rate was
49.13% and in 2011 it is 47.57% per 1000 live birth in that males is 46.18%
and females is 49.14%.8Breast feeding is the most important intervention to
prevent newborn infections, diarrhea and pneumonia, which cause child
deaths in the month after birth till the end of the first year of life. Initial
breast feeding in the first hour after birth and exclusive breast feeding in the
first six months after birth can go a long way in preventing most neonatal and
infant deaths in India. 7
Donor milk has a broad range of therapeutic uses Common reasons for
prescribing donor milk are prematurity, allergies, feeding formula intolerance
immunologic deficiencies post operative nutrition etc. Breastfeeding is not
recommended for mothers who have certain health problems such as active
herpes lesions on the breast, active untreated tuberculosis, human
immunodeficiency virus infection, nephritis, serious illnesses, heart disease
or cancer, severe malnutrition.9
4
In the absence of the infant’s own mother’s milk, donor milk offers the
benefits of human milk for the infant including optimal nutrition, easy
digestibility, immunological protection against many organisms and diseases
infection-fighting components such as immunoglobulin. Human milk also
contains growth factors that can protect immature tissue, promote maturation,
particularly in the gastrointestinal tract, promote healing of tissue damaged
by infection. 9
A study was conducted to determine the composition of donated milk from a
large number of banked donor milk samples and compared it to the reported
values for macronutrients in mature breast milk. During a 9-month sampling
period (May 2006 through February 2007) from a nationwide milk bank
network, 415 sequential samples from 273 unique donors were analyzed for
fat, protein, and lactose content, as well as energy density. Descriptive
statistics were computed, including mean, standard deviation, coefficient of
variation, median, and range. A ninety-five percent confidence interval was
computed using standard, large sample (Gaussian) methods. Banked donor
milk mean values (in weight/volume) were found to be 1.16%+/-0.25% for
protein, 3.22%+/-1.00% for fat, 7.80%+/-0.88% for lactose, and mean total
energy was 65+/-11 kcal/dl. Banked donor milk macronutrient content was
found to differ from the values reported in the literature for mature human
milk formulated banked donor milk was found to be a better choice for
preterm infants than bovine-based formulas when mother's milk is
unavailable.10
Breast milk is a natural, easily digestible and cost effective food necessary
for the child’s entire growth and development. Thus, with the above view,
the investigator felt the need to assess the knowledge and attitude of the
lactating mothers regarding human milk banking and develop an information
booklet on it. This will help the mothers to enhance their knowledge
regarding human milk banking and to develop a positive attitude toward it.
6.3REVIEW OF LITERATURE
The related literatures are presented in the following subheadings
1.
2.
3.
Literature related to knowledge regarding human milk banking
Literature related to attitude regarding human milk banking
Literature related to importance of human milk banking
5
Literature related to knowledge regarding human milk banking
An descriptive study was conducted to assess the characteristics of donation
behavior and identify reasons, beliefs and feelings to donation of breast milk
with women donors at two breast-milk banks. Data was collected from 36
women, aged 14 to 33 years with different levels of schooling. 58.3% of
subjects participated were first-time mothers. Data was collected thorough
interviews carried out during home visits. The study concluded that , the
most frequently reported reasons for donating breast milk were altruism and
excess milk production. 11
Literature related to attitude regarding human milk banking
A study was conducted to assess the attitude of giving breast milk , sharing
of breastfeeding or expressed breast milk by Australian women in a recent
thirty-year period, 1978-2008. The objective of this study was to explore the
mothers' experiences of sharing breastfeeding or human milk. The study
report shows that the reason for the sharing of breastfeeding or breast milk
was the desire of mothers to provide human milk to their babies, exclusively,
including while they were absent or temporarily unable to breastfeed. Most
mothers were selective about those with whom they would share
breastfeeding or breast milk.12
A study was conducted among breast feeding mothers to assesstheir
attitudes regarding breast milk banks and offering stored breast milk to their
babies. Data was collected from 680 breast-feeding mothers by using a
structured pretested questionnaire. Study report shows that about 71 percent
would not accept donated breast milk for their baby while the rest would
consent only if the donor were a close family relative, owing to fear of
transfer of diseases (28 percent), fear of transfer of genetic traits (22 percent),
and religious and cultural taboos (14 percent). However, 60 percent were
willing to donate breast milk 38 percent would accept milk from a breast
milk bank.13
A study was conducted to assessthe attitudes towards donated breast
milk among mothers, families and healthcare providers of potential recipient
infants. The qualitative data was derived from eight focus group discussions
which included four groups with mothers, male partners grandmothers,
nurses and doctors about their attitudes towards donated breast milk.Each
6
group had between four and eleven participants, leading to a total of 48
participants. Although breast milk was important to child health there were
concerns about undermining of breast milk because of concerns about HIV
and marketing and promotion of formula milks. In addition there were
concerns about the safety of donor breast milkand discomfort about using
another mother's milk. Participants believed that education on the importance
of breast milk and transparency on the processes involved in sourcing and
preparing donor milk would improve the acceptability. 14
Literature related to importance of human milk banking
A study was conducted to assess the growth and clinical evolution
of very low birth weight infants fed during hospital stay with milk from a
human milk bank according to the caloric-protein value. Forty very low birth
weight infants were included: 10 were fed milk from their own mothers (GI),
and 30 were fed human milk bank > 700 cal/L and 2 g/dl of protein. Growth
curves were adjusted using nonlinear regression to the measured growth
parameters. full enteral diet was reached in 6.3 days by GI and in 10.8 by
GII; a weight of 2 kg was reached in 7.3 weeks for GI and in 7.8 for GII. In
GI, 3/10 (33.3%) and in GII, 7/30 (23.3%) developed sepsis. Necrotizing
enterocolitis did not occur in GI, but in 3/30 (10.0%) in GII. GI presented
with urinary calcium > 4 mg/L in 1/10 (10.0%), urinary phosphorus (Pu) <1
mg/L in 10/10 (100%), and Ca/Cr >0.6 ratio in 1/10 (10.0%) of the cases; in
GII, no children presented alterations of the urinary calcium or the Ca and Cr
ratio, and Pu was <1 mg/L in 19/30 (63.3%). In terms of growth the 50th
percentile for GI was a weight gain of 12.1 g/day (GI) vs. 15.8 g/day (GII), a
length gain of 0.75 cm/week (GI) vs. 1.02 cm/week (GII), and a head
circumference gain of 0.74 cm/week (GI) vs. 0.76 cm/week (GII). Human
milk bank allowed a satisfactory growth and good clinical evolution for very
low birth weight infants. 15
A observational longitudinal was conducted to assess the feasibility of
providing donor breast milk to infants after pasteurization.191 low birth
weight infants were selected for the study, out of them 96 infants received
their own mother’s milk.. Other 95 infants who were potentially eligible to
receive donor milk, only 40 did in fact receive donor milk. Above study
reported that it is feasible to supply donor milk to and there was no evidence
of bacterial contamination in the samples analyzed, and no adverse events
from feeding with donor breast milk. 16
A study was conducted to assess the impact of opening a milk bank in the
neonatal unit on the proportion of infants receiving exclusive breast milk at
discharge.50 infants born before the opening of milk bank and 54 infants
7
born after the opening of a milk bank were selected as samples. The data was
collected about the hospital stay, hours of stay, hours of life when feeding
was started, hours of life when full enteral feeding was attained, type of milk
received during admission and type of feeding on dicharge.The results shows
that proportion of infants receiving exclusive breast milk in first group was
54% and second group was 56%The study concluded that opening of a
donor milk banking in a neonatal unit did reduce the proportion of infants
exclusively feed with breast milk at discharge but did reduce the proportion
of infants that received infant formula during the first four weeks of life.17
STATEMENT OF THE PROBLEM
“A study to assess knowledge and attitude regarding human milk banking
among lactating mothers at selected hospitals Bengaluru, with a view to
develop an information booklet.
6.4 OBJECTIVES OF THE STUDY
1.
To assess knowledge regarding human milk banking among lactating
mothers at selected hospitals Bengaluru.
2.
To assess attitude regarding human milk banking among lactating
mothers at selected hospitals Bengaluru.
3.
To determine the association on knowledge score
with selected
demographic variables.
4.
To determine the association on attitude score with selected
demographic variables.
5.
To find the co-relation between knowledge and attitude regarding
human milk banking among lactating mothers at selected hospitals
Bengaluru.
6.4.1 HYPOTHESIS
H1: There will be significant association between the knowledge score of
lactating mothers regarding human milk banking.
H2 : There will be significant association between the lactating mothers
regarding human milk banking
8
6.5 OPERATIONAL DEFINITIONS
a) Assess: It refers to appraise value or evaluate or judge the quality of
something.
b) Knowledge :It refers to level of understanding or familiarity of lactating
mothersregarding human milk banking.
c) Attitude: It refers to way of opinion or view of lactating mothers
regarding humanmilk banking.
d) Human milk banking :It refers to collection, storage and processing of
donatedhuman milk
e)Lactating Mothers: It refers to mother who breast feed her baby.
f) Information booklet: It refers to carefully prepared concise and
comprehensiveinformation material regarding human milk banking.
6.6 ASSUMPTIONS
1.
Lactating Mothers may not have knowledge regarding human milk
banking.
2.
Information booklet may improve the knowledge of lactating mothers
regarding human milk banking.
7.MATERIALS AND METHODS
7.1 SOURCES OF DATA :Lactating mothers at selected hospitals,Bengaluru.
7.1.1 RESEARCH APPROACH :Descriptive Design.
7.1.2 RESEARCH DESIGN
: Explorative approach
7.1.3 SETTING : Selected hospitals Bengaluru
7.1.4 SAMPLE SIZE
:100 lactating mothers at selected hospitals Bengaluru.
9
7.1.5 INCLUSION CRITERIA
Lactating mothers,

who can read and write Kannada & English.

who are present at the setting during the time of data collection.

who is willing to participate in the study.
7.1.6 EXCLUSION CRITERIA

Non lactating mothers
7.2 METHOD OF DATA COLLECTION
7.2.1 SAMPLING TECHNIQUE :Non probability purposive sampling
technique
7.2.2 TOOLS OF RESEARCH
: Structured questionnaire
Structured questionnaire consist of three parts,
Part I – The demographic variables
Part II – Knowledge based questionnaire regarding human milk banking.
Part III – Attitude based questionnaire regarding human milk banking.
7.2.3 COLLECTION OF DATA
The investigator collects data from lactating mothers

The written consent will be obtained from the authority prior to the
data collection

Investigator introduces herself to the subject and notifies about aims,
objectives, steps of the study and takes written consent.

Selection of samples.

Assess the knowledge and attitude of lactating mothers regarding
human milk banking using structured questionnaire.

Duration of data collection will be four weeks.
10
7.2.4 METHOD OF DATA ANALYSIS AND PRESENTATION

The investigator uses descriptive and inferential statistical techniques
for data analysis.

The analyzed data will be presented in the form of tables, diagrams,
and graphs based on finding.
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE
CONDUCTED ON PATIENTS OR OTHER HUMAN OR
ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY?
Yes, the study will be conducted on lactating mothers at selected
hospitals regarding human milk banking.
7.4
HAS ETHICAL CLEARENCE HAS BEEN OBTAINED FROM
YOUR INSTITUTION?

Yes, Consent will be obtained from concerned subjects and authority of
institution.

Scientific objectivity of the study will be maintained with honesty and
impartial.
11
8. LIST OF REFERENCES
1. DuttaParul, Paediatric Nursing. 2nd ed.NewDelhi, Jaypee
Brothers Medical Publishers; 2009. p. 2,51.
2. Willams A.F, Fisher C, GreasleyV,TraylerH,Woofride MW,
Human milk banking. Journal of tropical peadiatrics. 31(4).
185-190.
3. Hockenberry, Wilson, Winkelstein, Kline. Nursing care of
infants and children. 7th ed. India, Elsevier; 2003. p. 273-4.
4. Dr Carolyn, Dr Lisa Amir, the Maternal and Child Health Subcommittee. [online] 2009 [cited 2011 Sep 14]. Available From:
URL: http://www.breastfeedingindia.org.
NeetaLal, Growing pain in India. [online] 2008 [cited 2011 Sep
20]Available from:URL: http:// www.breastfeedingindia.org
Arnold LDW, Human milk banking in North America .Journal of
Human Lactation. 1997 13(2) . 159–162.
Alex George. To save the child’s life. The Hindu 2009 Jan 11; (col.4)
Infant mortality rate demographics. [online] 2011 [cited Oct 22]
Avaiable from:URL: http://www.indexmundi.com/ India/ infant
mortality rate html.
Marea Ryan, Why we need a mothers milk bank. [online] 2010 [cited
Sep 5] Available from:URL: http://www.bendigobank.com.
Wojick KY, Rechtman, Lee ML, Montova A, Medo ET.
Macronutrtient analysis of donor breast milk. [online] 2002 [cited Sep
14] Available from:URL: http://www.ncbi.nlm.gov./pubmed.
Alencar LC, Seidl EM. Breast milk donation. [online] [cited Sep 5]
Available from: URL: http://www.ncbi.nlm.gov./pubmed.
Thorley V, Mothers experience of sharing breast milk. [online] [cited
Sep 5] Available from:URL: http://www.ncbi.nlm.gov./pubmed.
IghobojaIS,Olarewaju RS, OdumoduCU,Okuonghre. Mothers attitude
towards donors milk.[online] 1995 [cited Sep 6] Available From
URL: http://www.ncbi.nlm.nib.gov/pubmed.
12
.AprileMda, Feterbaum R, AndreassaN,Leonac. Growth and clinical
evaluation of low birth weight infants. [online] 2010 [cited Sep 14]
Available from:URL: http://www.ncbi.nlm.nib.gov/pubmed.
Coustodis, Adihikari, Nair N, Coustoudis A. feasibility and setting up
of a donor milk bank. [online] 2011 [Sep 15] Available from:
URL:http://www.ncbi.nlm.nib.gov/pubmed.
Utrera Torres, Medina Lopez,Vazquez Roman, Alonso Diaz, Cruz
Rojo,Fernandez Cooke. Beneficial effects of human milk. [online]
2010 [cited Sep 16]. Available from:
URL:http://www.ncbi.nlm.nib.gov/pubmed.
.
13
9
Signature of Candidate
10
Remarks of the Guide
The study is feasible and of genuine interest of
the student
11
Name & Designation Of
11.1
Guide
Mr. Hanock Reuben, M.Sc (N).
Professor/ Principal
HOD, Child Health Nursing.
SJB College of Nursing.
Bengaluru-60.
11.2
Signature
11.3
Co-Guide
MrsRoseline Reddy, M.Sc (N).
Professor,
SJB College Of Nursing
Kengeri, Bengaluru-60.
11.4
Signature
11. Head of the
Mr. Hanock Reuben, M.Sc (N).
Department
Professor/ Principal
Department of Child Health Nursing.
SJB College Of Nursing
Kengeri, Bengaluru-60
11.6
12
Signature
12.1
Remarks of the The topic for the study is relevant and
forwarded for needful action.
Principal
12.2Signature
14