COMMUNITY MEDICINE

PROJECT

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3RD PROFESSIONAL MBBS PART-I

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© Swarnadeep Mani Mani
Location: Kolkata
Date: 2017-05-11 13:38:12
 An epidemiological study on assessment of
awareness of breast feeding among ante-natal
mothers in Medical College & Hospital, Kolkata.

Guided by:
Prof. (Dr.) Krishnadas Bhattacharyya
Dr. Debasis Das
Dr. Arup Chakraborty
Dr. Saikat Bhattacharya
Dr. Pampa Basu

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Introduction
“Breastfeeding is a mother’s gift to herself, her baby and the earth”
-Pamela K. Wiggins
It has been already well established that appropriate bf practices reduce child
morbidity and mortality; improve immunity in children besides being essential
for their optimal growth and development. On the other hand, it decreases
incidence of certain diseases like breast cancer in the mother. Ideally breast
milk should be given to infants exclusively for 6 months and thereafter
continued for at least 2 years with other food. But due to lack of awareness such
an invaluable gift is still not being properly used by all.
Benefits of breastfeeding for the child:
• Improved nutritional status.
• Less incidence of infection.
• Lower risk of chronic disease.
• Lower risk of overweight.
• Improved cognitive development.
• Better bonding between mother and child.
Benefits of breastfeeding for the mother:
• Mother less likely to become pregnant in early months.
• Lower risk of maternal cancer.
• Less post-partum depression.
• Faster maternal recovery.
According to UNICEF, the World children report 2011, 136.7 million babies are
born worldwide and only 32.6 %of them are breastfed exclusively at the first six
months. (1)
Bangladesh demography and health survey (BDHS) reported exclusive breast
feeding in Bangladesh is 64 %( 2011) and early initiation is 43 %( 2007). (2)
The Norwegian infant nutrition survey has shown breast feeding contribution to
reduce child mortality and improve maternal health. (3)
According to the Pan America Health Organisation Research:
• Breast feeding can also reduce the risk of type 1 diabetes, childhood
leukaemia and atopic dermatitis in babies.
• Breast feeding can also lower the risk of SIDS.
• Formula fed babies also have higher risk of necrotizing enterocolitis, lower
respiratory tract infection, asthma, obesity etc.(4)
A study done in NRS Medical College, in 2015 showed that
 • 86.5% of the study population were aware about benefits of breast feeding.
• Overall awareness score was satisfactory only in 32.3% cases.
• Higher level of awareness found in mothers: Aged ≥ 20, Muslims, From
nuclear family and Multi-gravid
Despite the presence of so many similar studies, this new study is performed
because:
• Medical college, Kolkata is a tertiary hospital. Antenatal mothers visiting
here are from different parts of West Bengal.
• Most rural patients who come to Medical College are from Howrah &
Hooghly which is somewhat different from NRS medical College.
• As the awareness level is dynamic, the present level of awareness amongst
the mothers may be altered as compared to the previous study.
Hence, this study is being conducted to assess the current status of knowledge
about breastfeeding among antenatal mothers of 3 rd trimester attending the
Antenatal OPD of Medical College & Hospital, Kolkata.

Objectives
1. To describe socio-demographic characters of antenatal mothers under
study.
2. To assess the level of awareness on breastfeeding among them.
3. To find out the sources of information regarding breastfeeding among
antenatal mothers under study.

Methodology
The project had following methodology:
 Type of study: It was an observational descriptive type of
epidemiological study.
 Study design: It was cross-sectional in design.
 Place of study: The study was conducted at Antenatal Clinic of Medical
College, Kolkata.
 Period of study: The study extended from 23/02/2017 to 05/04/2017.
 Population under study: All the pregnant mothers who attended at the
Antenatal Clinic of Medical College, Kolkata, during the period of study
 and who fulfilled the inclusion and exclusion criteria, constituted the
study population.
o Inclusion criteria: the antenatal mothers of third trimester.
o Exclusion criteria: those mothers who refused to participate in the
study.
 Sampling:
o Sample size:
Sample size was calculated from the formula (Where, p=
prevalence from a previous study, q= 100 - p and l = allowable
error.)
Values obtained from the previous studies were:
p=83%, q= (100-83) = 17%, l = 5% of p = 4.15
So the sample size = (4x83x17)/4.152 = 327.7≈ 328.
Considering a 10% of the mothers who would not co-operate the
sample size was finally calculated as 328+ 33= 361.

o Sampling technique:
Systematic random sampling was used.
Information obtained from the department of gynaecology revealed
that everyday 300 mothers (approximately) visited the OPD from 9am
to 12pm. Out of them 50% (approximately) of the mothers belonged
to third trimester of pregnancy. As the tenure of data collection was of
10days, total population came = (50% of 300) X 10 = 1500.
Sampling interval = 1500/359=4.18≈4
From 1-4, a number was chosen by a lottery and it was found to be ‘3’
So, 1st chosen mother was 3rd mother and after that every 4th mothers
were selected. So, next selected mothers were 3+4=7th mother,
7+4=11th mother and so on.
 Tools: A predesigned and pre-tested schedule was used as data collection
tool.
 Technique: Data was collected by interviewing the mothers.
 Development of schedule: A number of questions fulfilling the
objectives of the study were put together to prepare the schedule. Both
open-ended and closed-ended questions were there.
o Pre-testing: It was carried out in the antenatal clinic of Lady
Duffrin Victoria hospital, an annex of Medical College and
Hospital, Kolkata. After that, the problems and doubts that were
 encountered in pre-testing were cleared and final schedule was
prepared.

After data collection 12 schedules were found incomplete. Sample

size came out to be 349.

 Data analysis: Collected data was entered, analyzed and adorned with
tables and diagram using MS Excel 2010 in computer.
Result:
Analysing data collected from 349 eligible mothers following result came:
Summary
An observational, descriptive, cross-sectional study titled ‘An Epidemiological
study on assessment of awareness of breast feeding among ante-natal mothers in
Medical College & Hospital, Kolkata’ was conducted over a period of 6 weeks.
The study population consisted of antenatal mothers of third trimester attending
the study setting i.e. antenatal OPD of Medical College & Hospital, Kolkata.
This project had the objectives of assessing the socio-demographic status, level
of awareness and source of information regarding breastfeeding among ante-
natal mothers under study.
The following summary result was found:
Majority of mothers (84.82%) belong to age group 20-29 yrs.
Majority of mothers (51.29%) belong to the religion Hinduism followed by
Islam (47.28%).
Majority of mothers (52.15%) live in urban residence and 59.03% belong
to joint family.
Majority of mothers (40.97%) have middle school education while 8.6%
are illiterate.
Majority of mothers (93.12%) are homemakers and the rest are involved in
some occupation and the largest portion (31.81%) belongs to lower middle class
[per capita monthly income ₹949-1834] as per modified B. G. Prasad scale
(Dec,2016).
Majority of mothers (44.7%) have 1 living issue while 32.95% of them are
primigravida.
Majority of mothers (86.53%) are aware that breastfeeding is advantageous
because baby stays healthy, strong and immune to diseases.
Majority of mothers (96.27%) are unaware of any contraindications of
breastfeeding.
Majority of mothers (52.01%) are aware that ideal time of starting
breastfeeding is within 1st hour or as soon as possible without any pre-lacteal
food.
Majority of mothers (84.48%) are aware that they should feed colostrum to
their babies.
Only 1 out of 349 mothers has said that she will not breast feed her child.
Majority of mothers (91.37%) are aware that they should exclusively
breast feed their babies for at least 6 months after birth.
 Majority of mothers (83.04%) are aware that they should feed their babies
timely (i.e. they opt to be timed feeders) including night (90.80%).
Majority of mothers (79.02%) are aware that they should continue
breastfeeding after the period of exclusive breastfeeding.
Majority of mothers (63.61%) received information regarding
breastfeeding from their family members.

Hence, we come to a conclusion that majority of mothers are aware of proper

breastfeeding practices. However, there is a small portion of them who still do
not have proper information on breastfeeding and we have devised certain
recommendations for them.

Recommendation
This project analyses the awareness on breastfeeding among antenatal mothers.
From the results, we have got a socio-demographic character of antenatal
mothers, an idea about their level of awareness about breast feeding and the
sources of information regarding breast feeding.
However, we must keep in mind that we have to reach those mothers who are
backward and lack knowledge however small the number might be. Even if a
single mother is lacking in knowledge we must pay enough attention so that we
may reach her.
These results can be implemented to take necessary measures to improve the
mothers' knowledge. Every mother should receive advice on breast feeding both
verbally and through health education materials like pamphlets and charts in the
hospital premises, preferably in antenatal clinic.
In spite of numerous advertisements in television and radio, a handful of
mothers have said that they have not received any information regarding breast
feeding. Some of them have said about giving honey as prelacteal feed. Some of
them don't know the correct timing and duration of breast feeding. These issues
can be resolved through specific health education on these issues.
Limitations
1. As the study was Hospital based and not community based, study
findings cannot be generalized.
2. Further studies are needed to explore whether awareness and intention of
breastfeeding can be translated to further breastfeeding practices.

References
1. International Breastfeeding Journal 2011.
2. Bangladesh Demographic and Health Survey 2011. National Institute of
Population Research and Training Dhaka, Bangladesh Mitra and
Associate Dhaka, Bangladesh.
3. Infant feeding practices and associated factors in the first 6 months of
life: The Norwegian Infant Nutrition Survey.
4. Quantifying the benefits of breastfeeding: a summary of the evidence.
Washington: Pan America Health Organization, 2002.
4. UNICEF, The World’s Children Report, 2011.

Acknowledgement
My sincere thanks & deepest gratitude to our Principal, Prof. (Dr.) Tapan
Kumar Lahiri and MSVP of Medical College Kolkata, Prof (Dr.) Sikha
Bandyopadhyay.
I would like to thank Prof. (Dr.) Salil Kumar Bhattacharya, HOD Dept. of
Community Medicine; Prof. (Dr.) Partha Mukherjee, HOD Dept. of
Gynaecology and our guides Prof. (Dr.) Krishnadas Bhattacharyya, Dr.
Debashish Das, Dr. Arup Chakraborty, Dr. Saikat Bhattacharya and Dr.
Pampa Basu.
Last but not the least; I would like to thank all the mothers who cooperated with
us in finishing this project.