International Journal of Medicine and

Pharmaceutical Sciences (IJMPS)

ISSN(P): 2250-0049; ISSN(E): 2321-0095
Vol. 6, Issue 2, Apr 2016, 13-18
TJPRC Pvt. Ltd.

EFFECT OF HEALTH EDUCATION INTERVENTION ON AWARENESS

REGARDING BREASTFEEDING PRACTICES AMONG
WOMEN OF RURAL KANPUR
SURUCHI GUPTA1, SEEMA NIGAM2 & TANU MIDHA3
1
2

Junior Resident, Department of Community Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India

Professor and Head, Department of Community Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India

Associate Professor, Department of Community Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India

ABSTRACT
Background
Breast feeding provides ideal food for growth and development of infant by providing adequate nutrition and
boosting immune system, thus protects the infant against infections. Early initiation of breast feeding lowers the
mothers risk of postpartum haemorrhage, anemia, osteoporosis and delays next pregnancy.

To study the level of awareness regarding breast feeding practices among study subjects.

To assess improvement in knowledge and awareness regarding breast feeding practices following health
education.

Material and Methods

Original Article

Objectives

A longitudinal study was conducted among females in the rural areas served by RHTC, Kalyanpur, Kanpur.
A sample of 384 females with at least 1 child(<5year) was selected. All females were informed about the purpose of
study and consent was taken for the same. Following a base line survey regarding awareness of breast feeding
practices, health education was imparted through charts and illustrations to all the study subjects. The awareness level
was reassessed after one month. The data collected was compiled using MS Excel and analysed using SPSS 20.0
software. Percentages were used to analyse categorical variables.
Results
Only 32.72%mothers knew about disadvantages of prelacteal feed, but after health education, awareness
rose to 81.81%. The awareness regarding correct time of initiating breast feed was 10.9% & 63.63% before & after
intervention respectively. Around 29.09% knew about benefits of colostrum, 54.54%were aware of exclusive breast
feeding(EBF) up to 6 months,41.81%were aware of importance of BF and 23.63%were aware that breastfeed should
be continued till 2 years of age. After intervention, these results were 74.54%, 83.63%, 76.36% & 67.27% respectively.
Thus, there was significant improvement in level of awareness after health education.
Conclusions
The study clearly highlights the increase in the awareness of breast feeding practices after health education.
KEYWORDS: Breast Feeding, Health Education, Awareness; Knowledge

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Suruchi Gupta, Seema Nigam & Tanu Midha

Received: Feb 10, 2016; Accepted: Feb 25, 2016; Published: Mar 02, 2016; Paper Id.: IJMPSAPR20163

INTRODUCTION
Breast feeding (BF) is a way of providing ideal food for the growth and development of infant, thus protect the
infant against infection and chronic diseases[1]. Early initiation of breast feeding lowers the mothers risk of postpartum
haemorrhage, anemia, protects from breast cancer, osteoporosis and delays next pregnancy.[1] Breastfeeding provides
significant health benefits for infants and mothers. It has also been found to protect against delays in young childrens
language and motor skill development. Thus, there is a need for promotion and protection of optimal infant feeding
practices for improving nutritional status of children[4]. In India, the practice of breastfeeding is almost universal, but
initiation of breastfeeding is generally quite late and colostrum is discarded. In 1991, Breastfeeding Promotion Network of
India (BPNI) was born to protect, promote and support breastfeeding. Recently, the Government of India has undertaken
National Rural Health Mission (NRHM), which intends to implement Integrated Management of Neonatal and Childhood
Illnesses (IMNCI) through the existing healthcare delivery system. The IMNCI strategy recommended systematic
assessment of breastfeeding and emphasized counseling of the mother on proper positioning and attachment of infant to the
breast. The prevailing breast feeding practices in our society, especially in the rural India are inappropriate. Percentage
ever breast fed in rural(India) was 95.7, percentage who started breastfeeding with in half hour of birth was 21.4, within 1
hour of birth was 22.4 and within 1day of birth was 51.9, percentage who received prelacteal feed was 59.8, median
duration of exclusive breast feeding was 2.1 months.[2]Still there are several myths and taboos that are limiting the
effectiveness and outcome of the efforts which are being made to implement the correct breast feeding practices. So, this
study was planned to improve awareness regarding breast feeding practices among rural women of Kanpur with following
objectives to study the level of awareness regarding breast feeding practices among study subjects and to assess
improvement in knowledge and awareness regarding breast feeding practices following health education.

MATERIALS AND METHODS

A longitudinal study was conducted at the rural area served by the Rural Health Training Centre(R.H.T.C.)
Kalyanpur, Kanpur. Duration of the study was from 15 july 2015 to 15 december 2015. Sample size was calculated
assuming 50% awareness regarding breast feeding practices, and taking absolute error as 5%. The sample size came out to
be 384. Population served by RHTC is approximately 6000. Population of under five children in rural areas is
approximately 13%, therefore number of under five children in this population is 780. Line listing of all mothers of under
five children was done. The first subject was selected by lottery method and then every second subject was selected
systematically for the study. A sample of 384 females with at least one under five child was selected. All the females were
informed about the purpose of study and consent was taken for the same. A pretested questionnare was prepared and
distributed to 10 women to know the general breastfeeding practices and on the basis of their knowledge preformed
questionnare was further improved. This will increase the authenticity of the questionnaire. The questionnaire consisted of
following parts: Biosocial factors, awareness regarding prelacteal feed, colostrum, Initiation, Duration, Importance and
Techniques of breast feeding. Then this questionnaire was used to collect the data from the mothers(pre test), followed by
an education session at RHTC in a small group of 3-4 mothers with the help of charts and illustrations regarding breast
feeding practices on the same day. Health education were mainly focused on disadvantages of prelacteal feed, advantages
of colostrum, exclusive breast feeding, onset of weaning, influence of breast feeding on babys and mothers health. Then,
after 1 month the same group of women were revisited and same questionnaire was filled again. The data collected was
Impact Factor (JCC): 5.4638

NAAS Rating: 3.54

Effect of Health Education Intervention on Awareness Regarding

Breastfeeding Practices among Women of Rural Kanpur

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compiled using MS Excel and analysed using SPSS 20.0 software. Percentages were used to analyse categorical variables.
McNemar test using Graphpad software was used to analyse pre and post test differences.

RESULTS
Among the study subjects 56% were from nuclear families, all were house wives,6% were post graduate,8%
graduate,18% intermediate, 22% illiterate and 46% were high school passed.(Table 1)
Before the intervention only 126(32.7%) of the study subjects aware about the disadvantages of prelacteal feed,
but after the education session 314(81.8%) knew about the disadvantages of prelacteal feed; before the education session
only 42(10.9%) of the study subjects aware about the correct timing of initiation of breast feeding, and after the
intervention awareness raised in 244(63.6%) of study subjects and112(29.1%) of the study subjects knew about the
benefits of colostrum before the intervention, but after the education session 286(74.5%) knew about it. (Table 2)
Before the intervention209(54.5%) of the study women aware about benefits and duration of exclusive breast
feeding but after the education session 321(83.6%) aware about it,161(41.5%) of the study women aware about the
importance of breast feeding before the education session, but after the intervention 293 (76.3%) of study subjects aware
about it, before the intervention 91(23.6%) of the study subjects knew about the correct duration of breast feeding, but after
the education session knowledge raised in 258(67.2%) of study subjects and 140(36.3%) of the study women aware about
correct technique of breast feeding, but after the education session 272(70.9%) knew about the correct technique. (Table 3)
Table 1: Demographic Characteristics of Study Subjects (N=384)
1. Type of Family
a. Nuclear
b. Joint
c. Three generation
2. Education
a. Illiterate
b. High school
c. Intermediate
d. Graduate
e. Post graduate
3. Occupation
a. Working
b. Housewife

215(56%)
157 (41%)
12(3%)
85(22%)
177(46%)
69(18%)
31(8%)
22(6%)
4(1%)
380(99%)

Table 2: Pre and Post Intervention Levels of Awareness Regarding Advantages of Breast Feeding (N=384)

Disadvantages of prelacteal feed

Correct timing of initiation of
breast feeding
Benefits of colostrums

Pre Test Intervention

No.
%

Post Test Intervention

No.
%

P value

126

32.72%

314

81.81%

P<0.05

42

10.90%

244

63.63%

P<0.05

112

29.09%

286

74.54%

P<0.05

Table 3: Pre and Post Intervention Levels of Awareness Regarding Advantages of Breast Feeding (N=384)
Pre Test Intervention
No.
%
Benefits and duration of Exclusive
Breast feeding
Importance of breast feeding
Duration of breast feeding
Techniques of breast feeding

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Post Test Intervention

No.
%

P value

209

54.54%

321

83.63%

P<0.05

161
91
140

41.81%
23.63%
36.36%

293
258
272

76.36%
67.27%
70.90%

P<0.05
P<0.05
P<0.05

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Suruchi Gupta, Seema Nigam & Tanu Midha

DISCUSSIONS
In this present study 67.3% of study subjects had given prelacteal feed and 10.90% of rural women knew correct
timing of initiation of breast feeding. Kulkarni RN et al showed in their study that % of illiterate mothers was 68.7% had
given pre-lacteal feed to their children and 61.3%of literate mothers while 43.7% of illiterate mothers initiated breast
feeding within 6 hrs of delivery. Only 15.1% of literate mothers while 31.2 % of illiterate mothers initiated breast feeding
24 hrs after delivery. Food given to a newborn before mothers milk is prelacteal feed. Food that are usually given to
newborn during prelacteal feed includes honey, sugar water, water, powder milk, cows milk etc. as a ritual or to clear
meconium. Disadvantages: infection to the newborn eg. respiratory tract infections, diaarhoea, etc., decreases suckling
capacity, fills stomach and decreases colostrum intake, decreases immunity, increases risk of aspiration. It is usually given
due to lack of awareness of hospital staff, illiteracy and home deliveries. The initiation of breast feeding and the timely
introduction of adequate safe and appropriate complementary foods in conjunction with continued breast feeding are of
prime importance for the growth, development, health and nutrition of infants and children everywhere. Delays in the
initiation of breast feeding are known to be detrimental to the health of infants and children and leads to malnutrition. This
explains higher prevalence of malnutrition in children where breast feeding was initiated late. In our study only 29.09%of
the mothers knew about the benefits of colostrum. Jugal Kishore et al in their study in resettlement colony of Delhi showed
that colostrum was given to babies by 59%. Colostrum is the first collection of a thick creamy liquid, without blood and
infection, produced by the mammary gland of a parturient mother shortly after birth, usually with in the first 6 hrs. IT IS
BENEFICIAL TO CHILD AND MOTHER. Benefits to child: colostrum cleans the newborns stomach, provides passive
immunity, provides warmth due to close contacts, increases efficacy of drinking water. Benefits to mother: reduces post
partum blood loss, increases milk production, bonding with mother. Breast feeding should be initiated with in half hr in
home deliveries and within 4 hrs in cesarean deliveries. In this present study EBF practices in rural women was about
54.54%. Kameswararao AA et al showed in their study that exclusive breast feeding(EBF) practices in urban mothers was
49% as compared to practice in rural mothers which was 37%. EBF duration is 6 months, it is the optimum duration for
proper growth and development of the child. Complementary feeding should be started after 6 months of life. Exclusive
breast feeding takes care of two essential elements of newborn- nutrition and infection control. It can save many lives by
preventing malnutrition and reducing the risk of infections and hypothermia.
In this study 41.81% of rural mothers aware about the importance of breast feeding. Benefits for Infants: Superior
Nutrition, Higher intelligence, less chances of developing Diabetes Mellitus, reduces risk of extreme obesity, low risk of
developing asthma, diarrhoeal diseases, middle ear infections and other allergies. Benefits for Mothers: Reduced risk of
heart diseases, Lower risk of endometrial, ovarian, breast cancer or osteoporosis, Diabetic mothers require less insulin,
Less chances of getting Rheumatoid Arthritis, strengthen the maternal bond, hormone release- Oxytocin and Prolactin.
In our study only 23.63% mothers knew about the correct duration of breast feeding. Chidozie E Mbada et al in a
study reported that 32.9% of study subjects knew about it. Duration of breast feeding is defined as the childs age(in
months) at the time of complete weaning, regardless of when consumption of other food begins. Normal duration of breast
feeding should be at least 2 year. Duration of breast feeding is inversely proportional to frequency of childhood illness.
In this study 36.36% of study subjects knew about the correct technique of breast feeding. Correct positioning and
technique for latching on can prevent nipple soreness and allow the baby to obtain enough milk. The "rooting reflex" is the
baby's natural tendency to turn towards the breast with the mouth open wide; mothers sometimes make use of this by
Impact Factor (JCC): 5.4638

NAAS Rating: 3.54

Effect of Health Education Intervention on Awareness Regarding

Breastfeeding Practices among Women of Rural Kanpur

17

gently stroking the baby's cheek or lips with their nipple in order to induce the baby to move into position for a
breastfeeding session, then quickly moving baby onto the breast while baby's mouth is wide open. After the education
session,81.81% aware about the disadvantages of prelacteal feed,63.63% knew about correct timing of initiation of breast
feeding,74.54% knew about benefits of colostrum,83.63% aware about the benefits and duration of EBF,76.36% knew
about importance of breast feeding,67.27% aware about the correct duration of breast feeding nd 70.90% of them knew
about correct technique of breast feeding.

CONCLUSIONS
The present study clearly highlights that with health education intervention, the level of awareness of mothers
regarding breast feeding practices improved significantly. So, there is need of providing education to the mothers for
promotion of exclusive breast feeding, emphasizing the importance of colostrum and correct techniques of breast feeding.
The information regarding the advantages and duration of breastfeeding needs to be provided to the community as a whole.
REFERENCES

1.

K. Parks textbook of preventive and social medicine, 23rd edition.

2.

National Family Health Survey-III, Vol-I 2005-06.

3.

K Madhu, Sriram Chowdary. Breast feeding practices and newborn care in rural areas. Indian J of Community
Med 2009; 34:243-246.

4.

AR Dongre, PR Deshmukh. Where and How breastfeeding promotion initiatives should focus its attention?Indian
J of Community Med 2010;35:226-229.

5.

Rasania SK, Sachdev TR. Nutritional status and feeding practices of children attending MCH centre. Indian J of
Community Med 2001; 26:3-7.

6.

Kulkarni RN, Anjeneya S, Gujar R. Breast feeding practices in urban community of Kalamboli, Navi Mumbai.
Indian J Community Med 2004;29:46-51

7.

Kameswararao AA. Breast feeding behaviour of Indian women. Indian J Community Med 2004; 29:23-25.

8.

Gupta A. 10 years of its work. J Indian Med Assoc 2002;100:512-5

9.

Khan ME. Breastfeeding and weaning practices in India. Asia Pac Population J 1990; 5:71-88.

10. Sharma M, Kanani S. Grandmothers influence on child care. Indian J of Pediatr 2006; 73:295-8.
11. Chandrashekar S, Chakladar BK, Rao RS. Infant feeding--knowledge and attitudes in a rural area of Karnataka.
Indian J Pediatr 1995; 62:707-12.
12. Chandrashekhar TS, Joshi HS, Binu V, Shankar PR, Rana MS, Ramachandran U. Breast-feeding initiation and
determinants of exclusive breast-feeding: A questionnaire survey in anurban population of western Nepal. Public
Health Nutr, 2007;10:192-7.
13. Wambach KA, Cole C. Breastfeeding and adolescents. J Obstet Gynecol Neonatal Nurs 2000; 29:282-94.
14. Prasad B, Costello AM. Impact and sustainability of a baby friendly health education intervention at a district
hospital in Bihar, India. BMJ, 1995; 310:621-3.
www.tjprc.org

editor@tjprc.org

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Suruchi Gupta, Seema Nigam & Tanu Midha

15. Neifert MR. Clinical aspects of lactation: Promoting breastfeeding success. Clin Perinatol 1999; 26:281-2.
16. Osrin D, Tumbahangphe KM, Shrestha D, Mesko N, Shrestha BP, Manandhar MK, et al. Cross sectional,
community based study of care of newborn infants in Nepal. BMJ 2002;325:1063
17. Davies MC, Arinolan G, Sanusin R, Osotimehin B. Immunoglobulin classes and nutritional factors in plasma and
breast milk of lactating mothers in Nigeria. Iran J Immunol 2006; 3:181-6.
18. Sharma M, Kanani S. Grandmothers influence on child care. Indian J Pediatr 2006; 73:295-8.
19. Chidozie E Mbada, Adekemi E Olowookere, Joel O Faronbi. Knowledge, attitude and techniques of breast
feeding among Nigerian mothers from a semi-urban community. BMC Pub Health 2013; 6:552.
20. Zhou Q, Younger KM, Kearney JM: An exploration of the knowledge and attitudes towards breastfeeding among
a sample of Chinese mothers in Ireland. BMC Pub Health 2010, 10:722.

Impact Factor (JCC): 5.4638

NAAS Rating: 3.54