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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 211-217

“Mothers knowledge and attitude on feeding of banked human milk among infants” with view to develop an information booklet”


Department of Child Health Nursing, KAHER Institute of Nursing Sciences, Belagavi, Karnataka, India

Date of Submission06-May-2020
Date of Acceptance15-Oct-2020
Date of Web Publication31-May-2021

Correspondence Address:
Prof. Gavishiddhayya B Salimath
Department of Child Health Nursing, KAHER Institute of Nursing Sciences, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_123_20

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  Abstract 


INTRODUCTION: Donor breastfeeding is the best natural feeding. Especially in high-risk and preterm infants, donor breast milk is the best source of nutrition. The benefits of breastfeeding for the neonates are already known; when mother breast milk is not flowing due to some medical conditions, then the alternative best source donor breast milk.
OBJECTIVES: The objective of the study was to assess the knowledge and attitude of mothers on feeding of banked human milk among infants and also to find out associations with sociodemographic variables.
METHODOLOGY: The study was conducted at KLE'S Dr. Prabhakar Kore Hospital among 100 postnatal mothers with a convenient sampling method. A self-structured questionnaire was prepared on knowledge and attitude among mothers of infants regarding feeding of banked human milk.
RESULTS: The results revealed that 9 (9%) mothers had high knowledge, 42 (42%) mothers had medium knowledge, and 49% of them had low knowledge, and 66% of the mothers had medium attitude, 21% mothers had low levels of attitude, and 13% of mothers had a high attitude toward feeding of banked human milk among infants.
CONCLUSION: Our study assessed different levels of knowledge and attitude and created awareness on donating and accepting of breast milk from milk banks among the mothers of infants toward feeding of banked among infants.

Keywords: Attitude, feeding of banked human milk, knowledge, mothers


How to cite this article:
Tahasildar HA, Salimath GB. “Mothers knowledge and attitude on feeding of banked human milk among infants” with view to develop an information booklet”. Indian J Health Sci Biomed Res 2021;14:211-7

How to cite this URL:
Tahasildar HA, Salimath GB. “Mothers knowledge and attitude on feeding of banked human milk among infants” with view to develop an information booklet”. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Jun 17];14:211-7. Available from: https://www.ijournalhs.org/text.asp?2021/14/2/211/317395




  Introduction Top


A newborn infant needs appropriate nutritional feeds in the form of breastfeeding till 6 months exclusively for the all-round growth and development of the baby. Newborn infant constitutes about 35% of the total Indian population. As the results, they become victim of various problems in the early age and the results in fatal disorders in later age. Donor breastfeeding is the best natural feeding in the absence/inadequacy of mother's breastfeeding.[1] Especially in high risk and preterm infant's donor, breast milk is the best source of nutrition. The benefits of breastfeeding for the neonates are already known; when mother breast milk is not flowing due to some medical conditions. then the alternative best source donor breast milk.[2]

Breast milk is easily digestible by the infant's intestine, offers a variety of immunologic properties, effective in protecting the baby from respiratory tract infection gastrointestinal infections,[3] and numerous allergies. It has got bacteria static functions against Gram-positive bacteria and also acts as a laxative agent in neonates. Donor's breast milk contains growth modulators that modify growth and maturation.[4] The results are already revealed that the duration of hospitalization and frequent visiting of the doctors' high prescription has been seen among those babies who were not breastfed properly compared to the babies who were exclusively started breastfeeding. According to the 2011 Census report, a more number of babies with low birth weight and neonatal mortality were 28 deaths/1000 live births in India. The National Health Mission, Government of India, the main goal is to reduce neonatal mortality rates in India. To reduce the neonatal mortality rates in India, the best method for feeding babies is through the donor mother's milk which has similar nutritional factors when babies mother milk is not available; this method has high importance in reducing neonatal death rates.[5] The use of donor human milk is increasing for high-risk infants, primarily for infants born weighing <1500 g or those who have severe intestinal disorders.

The Baby-Friendly Hospital Initiative has formulated ten steps to successful breastfeeding, by a joint UNICEF and WHO in 1989, in the step 2 of the policy, it has been suggested about how to use donor milk in the hospital, how to store, freeze, and thaw it as appropriate, and how to document its use, etc., The policy also recommended that all the staff that comes in contact with these mothers and their babies must be trained so that they support the breastfeeding process and the use of donated human milk. In India, the first human milk banking was started under the name of Sneha, founded by Dr. Armeda Fernandez, on November 27, 1989, at Dharavi, in Mumbai.

According to PATH (Prioritizing Human Milk to save lives), a leader in global health innovation has estimated that 30%–50% of babies in neonatal intensive care units and 10%–15% of term healthy babies are in need of donor human milk. Increasing access to human milk through human milk banking has the potential to reach 5 million babies in India annually. Indications for donor milk to the newborn are because of preterm birth failure to thrive malabsorption syndromes, allergies, and feeding/formula intolerance immunologic deficiencies pre- or post-operative nutrition infectious diseases. Donor milk can be given to babies till they reach target weight up to 2.2 kg–2.5 kg in preterm babies.

Pasteurized Donor Human Milk Bank (PDHMB) is an institution that screen the mothers who donate breast milk, collects, process, and stores and distribute to the infants who are actually in need of it. The purpose this organization (PDHMB) is to protect and promote, and supports exclusive breast feeding up to 6 months of babies, whose mothers were unable to feed their own.[4]

On March 1, 2018, KLE Dr. Prabhakar Kore Hospital and MRC, Belagavi, has started donor milk banking facility for the mothers and neonates who are sick due to medical and other conditions. In India, even though we have 14 centers of human milk banks are serving the society, still the growth of these centers is still slow; the main factors for this poor growth are regarding lack of knowledge and positive attitude toward breast milk banks.[5]

In 1909, Vienne, Austria, has started donor breast milk bank, and also in the USA, it has started in 1919. Total > 517 centers are providing those donor milk facility across the world. In India, in 1989, Mumbai hospital has opened its first donor milk bank center. To create human milk banks, knowledge and awareness in the society are very important for the present situations. With the breastfeeding policies, HMB also must be included in the care of newborn, and it should be communicated to each and every level of health-care professionals.[6]

There is a huge number of reports stated about preterm newborn mortality rates to 49.13% in 2011, across the world according to the data in 2014, it was 9.57%, and now, it has increased to 9.62% in 2015.[6]

As milk which is donated by others also consider as natural and healthy to protect against infectious diseases as mother milk has good immunoglobulins to fight against infectious diseases, mother milk plays very important role lives of the babies.[7] Hence, the investigator has decided to assess the knowledge and attitude about banked human milk among the mothers of the neonates.


  Methodology Top


Facility-based cross-sectional study with a convenient sampling technique was used to collect the data from 100 postnatal mothers admitted at KLE Dr. Prabhakar Kore Hospital and MRC, Belagavi. The sample size was estimated by considering the previous study conducted by Rajeesha et al. The data collection was done for 2 weeks at the selected hospital, Belagavi. A formal written permission was obtained from the medical director of KLE Dr. Prabhakar Kore Hospital and MRC, Belagavi. The ethical clearance certificate was obtained by institute ethical committee on 13-3-2018 reference KAHER/INS/EC/05, and written informed consent from all the study participants was obtained. The timeline of data collection was from July 13, 2019, to July 27, 2019. Descriptive statistics such as frequency and percentage to describe the demographic characteristics of the participants; mean, mean percentage, and standard deviation were used to describe the knowledge and attitude of mothers regarding donor human milk bank. Chi-square test will be used to find out the association between selected demographic variables and knowledge and attitude of mothers regarding feeding of banked human milk in infants.

Inclusive criteria

(1) Postnatal mothers, (2) mothers who can read Kannada and English, and (3) the mother who are admitted in KLE Dr. Prabhakar Kore Hospital and MRC, Belagavi.

Exclusive criteria

(1) the Mothers where the feeding is contraindicated due to medical condition such as HIV, HBSAg, and tuberculosis. And (2) Mothers who do not wish to participate in the study.

Pilot study

A pilot study was conducted at KLE Centenary Charitable Hospital at Yellur, Belagavi, and these study participants were not included in the main study. The pilot study helped the investigator to find out the feasibility of carrying out the main study.

Content validity of the instrument

Validity of the tool was done after expert's opinion from five nursing experts, medical persons, two members, and statisticians. The final instruments were reframed after consulting with guide and statistician. Then, the tool and information booklet were edited in Kannada and English language by experts.

Reliability of the tool

The reliability of the knowledge and attitude of mothers regarding banked human milk among the infants was tested by the retest method and Cronbach's alpha method, respectively, r = 0.81, which was found to be reliable with positive correlation. A total of 12 knowledge and 12 attitude questions were included in the tool. The information booklet consisted of basic information about importance of breastfeeding, and who can donate and receive donated breast milk, process of storage and pasteurization, and its advantages for both the mother and the baby.

The study attempted to test the following hypothesis:

H1– There will be significant association between the knowledge scores and attitude.

H2 – There will be significant association between knowledge score and selected baseline variables.

H3 – There will be a significant relationship between attitude and selected baseline variables.


  Results Top


This section deals with data collection from the respondents, and the data were organized, tabulated, analyzed, and included applying descriptive and inferential statistics based on the objectives.

  • To assess the knowledge of mothers regarding feeding of banked human milk among infants
  • To assess the attitude of mothers regarding feeding of banked human milk among infants
  • To find out the association between knowledge and attitude of mothers, regarding feeding of banked human milk among infants with selected baseline variables.


The majority (53%) of mothers were in the age group of 20–24 years, 40% of participants were in the age group of 25–29 years, and 7% of participants were in the age group ≥ 30 years [Table 1]. Majority (56%) of participants belonged to joint family and remaining 44% of mothers are belonged to nuclear family. The majority (74%) of mothers are belonged to Hindu religion, 18% were Muslim, and the remaining 8% were Christian. The majority (57%) of mothers reside in rural area and the remaining 43% mothers were in an urban area. The majority of mothers had primary education, 30% have completed secondary education, 7% of them completed higher secondary and above, and 14% were graduates. Among mothers of infants, 40% were housewives, 27% were working in labor sector, 15% were self-employed, and 18% in the service sector. Majority (53%) of mothers got information from television, 34% of them got information through newspaper, and 5% of them got information through the health professionals. Among the participants, 91% of the mothers had a previous experience and the remaining 9% mothers had no experience as donor. Among the mothers, 75% of mothers were belonged to low socioeconomic status and the remaining 25% had > 10,000 thousand income. Among the mothers, 67% of participants were primi and 33% were multipara.
Table 1: Sociodemographic characteristics of study participants

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[Table 2] depicts that 9 (9%) of mothers had high knowledge, 42 (42%) of mothers had medium knowledge, and 49% of them had low knowledge toward feeding of banked human milk among neonates [Figure 1].
Table 2: Distribution of mothers by level of knowledge regarding feeding of banked human milk among infants (n=100)

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Figure 1: Distribution of mothers by levels of knowledge toward feeding of banked human milk among infants

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[Table 3] depicts that the majority (66%) of the mothers had medium attitude, 21% mothers had low levels of attitude, and 13% of mothers had high attitude toward the feeding of banked human milk among infants [Figure 2].
Table 3: Distribution of mothers by levels of attitude toward feeding of banked human milk among infants

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Figure 2: Distribution of mothers by levels of attitude toward feeding of banked human milk among infants

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[Table 4] represents the mean knowledge score of the samples was found 7.53, with standard deviation of 1.88. The mean attitude score for the sample was found to be 41.29, with a standard deviation 5.74. The minimum score of knowledge about feeding of banked human milk among mothers were 3, and maximum score was 18. The minimum score of attitude about feeding of banked human milk among mothers was 25 and the maximum score was 58.
Table 4: Summery of knowledge and attitude scores of mothers toward feeding of banked human milk among infants

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[Table 5] represents the association between the level of knowledge and sociodemographic variables of mothers of infants regarding feeding of banked human milk among the infants. The finding of the study revealed that there was no significant association between the level of knowledge and the sociodemographic variables. As P > 0.05, hence H2 rejected.
Table 5: Association between levels of knowledge of mothers toward feeding of banked human milk among infants with demographic characteristics

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[Table 6] represents the association between level of attitude and sociodemographic variables of mothers regarding feeding of banked human milk among infants. The findings of the study revealed that there was no significant association between the level of attitude and sociodemographic variables. As P 0.0.05, hence H3 is rejected.
Table 6: Association between levels of attitude of mothers toward feeding of banked human milk among infants with demographic characteristics

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[Table 7] represents that the correlation between the level of knowledge and attitude scores was done using Karl Pearson coefficient relation. The correlation coefficient r = 0.1137 is a positive level of correlation, but statistically, it was not significant (P > 0.05).
Table 7: Correlation between knowledge and attitude scores of mothers toward feeding of banked human milk among infants by Karl Pearson's correlation coefficient

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  Discussion Top


The present study was conducted to assess the knowledge and attitude of mothers regarding feeding of banked human milk among neonates. In our study, we found that 9 (9%) mothers had high knowledge, 42 (42%) mothers had medium knowledge, and 49% of them had low knowledge toward feeding of banked human milk among neonates. About attitude of mothers, the majority (66%) of the mothers had medium attitude, 21% mothers had low levels of attitude, and 13% of mothers had a high attitude toward the feeding of banked human milk among infants. A similar study has conducted by Veena Melawni et al. at Bhopal among 246 postnatal mothers; the study revealed that the knowledge about the existence of breast milk bank was 10%, while willingness to accept the milk was 85.4%. In our study, we found that 9 (9%) mothers had high knowledge, 42 (42%) mothers had medium knowledge, and 49% of them had low knowledge toward feeding of banked human milk among neonates. The study conducted by Manvindar Kaur et al. The study results revealed that the level of knowledge was not associated with age, education, occupation, religion, income, and type of feed. There was a significant association of attitude with education (χ2 = 22.7, P = 0.005), where the majority of respondents were educated till middle level (84%), followed by matric (54%), and in relation to either of these education categories, most of the respondents were bearing neutral attitude. In our study, we did not found any association with knowledge and attitude among feeding of banked human milk among infants with sociodemographic variables at P < 0.05. In our study, 66% of the mothers had medium attitude about the acceptability and ready for donating milk 21% mothers had low levels of attitude about acceptability and ready for donating milk, and only 13% of mothers had high attitude toward donating and acceptability of the feeding of banked human milk among infants. In our study, we found a significant positive correlation with knowledge and attitude scores about banked human milk among mothers of infants (r = 0.1137), but statistically, it was not significant as calculated value was P > 0.05 (P value was 0.2601) [Figure 3].
Figure 3: Diagram: Scatter diagram of a correlation between knowledge and attitude scores of mothers toward feeding of banked human milk among infants. However, no statistical significance association found between knowledge and attitude score with sociodemographic variables at 0.05 level

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Recommendations

  • A similar study can be replicated on a large sample to generalize the findings
  • A similar study can be conducted in a different setting
  • A comparative study can be done in both antenatal and postnatal mothers to assess the knowledge regarding human milk banking
  • Awareness can be given among postnatal mothers.
  • Awareness can be brought among health personals.



  Conclusion Top


Our study assessed different levels of knowledge and attitude toward feeding of banked among infants. Our study has created awareness among the mothers of infants regarding donating and acceptance of banked human milk to feed the infants who are actually in need. The information booklet helped the mothers to know about advantages of banked human milk than the formula feeds. All the maternity hospitals should have the breast milk bank facility and should create awareness regarding human milk banking, and its uses among the mothers of infants.

Acknowledgments

The authors are grateful for the hospital administration and postnatal mothers for their support and participation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martin CR, Ling PR, Blackburn GL. Review of infant feeding: Key features of breast milk and infant formula. Nutrients 2016;8:279.  Back to cited text no. 1
    
2.
National Guidelines on Infant and Young Child Feeding. Available from: https://www.extranet.who.int/nutrition/gina/sites/default/files/IND%202004%20National%20Guidelines%20on%20IYCF.pdf. [Last accessed on 2020 Jan 06].  Back to cited text no. 2
    
3.
Breastfeeding Benefits Your Baby's Immune System. Available from: https://www.healthychildren.org/english/agesstages/baby/breastfeeding/pages/breastfeeding-benefits- your-babys-immune-system.aspx. [Last accessed on 2020 Jan 06].  Back to cited text no. 3
    
4.
Kaur M, Raghuvanshi S, Kang HK. Knowledge and attitude of Indian parous women toward human milk banking. Indian J Community Med 2019;44:175-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
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Kim J, Unger S. Human milk banking. Paediatr Child Health 2010;15:595-602.  Back to cited text no. 5
    
6.
Priya PL. A Study to Evaluate the Effectiveness of Donor Breast Milk Bank Feed among Preterm Newborns from selected centres at Madurai (Doctoral Dissertation, CSI Jeyaraj Annapackiam College of Nursing, Madurai).  Back to cited text no. 6
    
7.
Rajesh CH, Sahana KS, Saldanha PR. Knowledge and attitude of post-natal lactating mothers regarding human milk donation in our hospital. Indian J Appl Res 2018;8:34-5.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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