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MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES SCHOOL OF NURSING RESEARCH PROPOSAL TITLE

February 24, 2019 0 Comment

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING

RESEARCH PROPOSAL
TITLE: ASSOCIATION BETWEEN DEMOGRAPHIC CHARACTERISTICS OF MOTHERS AND PREVALENCE OF EXCLUSIVE BREAST FEEDING AT MBAGALA HOSPITAL
NAME: ISAKA HAROUN MLIMBO
REG NO: 20115-04-08723
PROGRAM: BACHELOR OF SCIENCE IN NURSING
SUPERVISOR: JUDITH SHAYO
COURSE COORDINATOR: DR. LILIAN MSELLE

TABLE OF CONTENTS

TITLE i
CHAPTER ONE: INTRODUCTION iii
1.1. Background iii
1.2. Problem statement iv
1.3. Research goal v
1.4. OBJECTIVES v
1.4.1. Specific objectives v
1.5. Research questions v
1.6. Hypotheses vi
1.7. Conceptual frame work vi
1.7.1. Description of the conceptual framework of the study vii
CHAPTER TWO: LITERATURE REVIEW viii
2.1. Overview of exclusive breastfeeding (EBF). viii
2.1. Relationship between demographic characteristics and the prevalence of EBF viii
CHAPTER THREE: METHODOLOGY x
3.1. Study design x
3.2. Study site x
3.3. Study setting x
3.4. Target population x
3.5. Study population x
3.5.1. Inclusion criteria xi
3.5.2. Exclusion criteria xi

CHAPTER ONE: INTRODUCTION
1.1. Background
Exclusive breastfeeding (EBF) means that the infant receives only breast milk for the first six months of life after birth(Joshi et al., 2014). To ensure successfully EBF for 6months ,WHO and UNICEF recommend initiation of breast feeding within first hour of life ,infant receive only breast milk, whenever a child want day and night and no use of bottles (Sonko & Worku, 2015).

It is one among global known and effective method for preventing infant mortality. Optimum breastfeeding practices can prevent 1.4 million deaths among under five children per year (Mekuria & Edris, 2015). In developing EBF prevent 11.6 % of all under-five deaths (Maonga, Msuya, & Damian, 2016). EBF also have great nutritional and psychological values, breast milk contains antibodies that help protect the baby against many common childhood diseases.

Globally prevalence of EBF is 35% (Maonga et al., 2016).Studies show that it varies from place to place. The prevalence of EBF in Mirzapur 36% was lower than the national figure (Bangladesh) 64% (Joshi et al., 2014).

In Africa the prevalence of EBF also varies from one population to another, a cross-sectional study conducted in Northwest Ethiopia revealed that prevalence of EBF was 68.5% (Mekuria & Edris, 2015),while South-East Nigeria 33.5% despite the fact that the level of knowledge was 82% and awareness of 95.3% .This means that there are other factors that affect EBF. In sub Saharan Africa ranges between 22 and 33 % from population to population and the prevalence of EBF in developing countries is 50% (Maonga et al., 2016).

In East Africa also it varies from one country to another, also varies within a nation. In Tanzania prevalence was found to be lower than the national prevalence in a study conducted in Muheza District Tanga where the prevalence EBF was 24.1% which was lower than the national level which was( 50%) (Maonga et al., 2016)

Despite the efforts that have been done but the prevalence of EBF is below the EBF prevalence of 90% recommended by the WHO. Variation of prevalence in different settings is one of the challenges and also several studies show that women’s have knowledge on practice of EBF ,but the prevalence have not reached to 90%.this implies that in order to reach the target ,more studies should be done so as to know several factors associated with EBF. Programs aimed to promote EBF must not rely on one factor, but rather should consider many factors.

1.2. Problem statement
In spite of the several efforts done to promote exclusive breastfeeding, the practice is not widespread in the world. Globally the prevalence of EBF is35%,in Tanzania 51%of children were breastfed within the first hour of life but (59%) children under six months are exclusively breastfed according to TDHS of 2015-2016.WHO recommended coverage of 90%) has not reached and the national target coverage (80%) (Maonga et al., 2016; Survey, Survey, ; Findings, 2015).

Suboptimal EBF is responsible for several effects such as malnutrition, increased risk of respiratory infection, and increased infant mortality and morbidity(Ali ; Ayed, 2014; Joshi et al., 2014; Maonga et al., 2016). Due to malnutrition increases a child’s risk of dying from many diseases most prominently measles, pneumonia, and diarrhea which are the highest cause (70%) of neonatal deaths (Onah, Ignatius, Osuorah, Ebenebe, & Ezechukwu, 2014).

Several studies suggested ways of promoting EBF practices which involve antennal care and post natal care education on the benefit of EBF, government must guarantee that workplace is free of harassment and discrimination against women who prefer to breastfeed their babies through appropriate mechanisms and employers, promotion programs must that take into consideration the ecological setting, extending maternity leave to six months for all working mothers could promote exclusive breastfeeding for six months.
Several studies show that mothers have knowledge but knowledge is not translated into practice, leading to sub-optimal breastfeeding practices which implies that there may be other factors that might affect EBF, There is limited information in Tanzania on factors influencing EBF apart from information specific for HIV positive women, so it is very important to conduct this study in Tanzania so as to know the effect demographic factors on the prevalence of EBF practices and to compare the prevalence with the nation prevalence, this will be helpful in promoting EBF.

1.3. Research goal
To promote exclusive breast feeding and reducing infant mortality rate.

1.4. OBJECTIVES
To describe the association between demographic characteristics and the prevalence of exclusive breast feeding before March 2019.

1.4.1. Specific objectives
1. To determine the relationship between maternal age and the prevalence of EBF.
2. To determine the relationship between employment or occupation and the prevalence of EBF.
3. To determine the effect of marital status on the prevalence of EBF.
4. To determine the effect of parity on the prevalence of EBF.

1.5. Research questions
1. Is there any relationship between maternal age and prevalence of EBF?
2. Is there any relationship between prevalence of EBF and employment status or occupation?
3. Is there any relationship between marital status and prevalence of EBF?
4. is there any relationship between parity and prevalence?

1.6. Hypotheses
1. Women who are unemployed are less likely to stop breastfeeding early when compared with women working as administrators and in manual jobs.
2. Single mothers are less likely to breastfeed sufficiently and longer due to absence of partners’ support and confidence compared with married mothers.
3. Primaparous women are more likely to desire or plan to breast feed than multiparous women.

1.7. Conceptual frame work
This conceptual framework has been constructed with reference to different literatures that describe the factors affecting prevalence of EBF practices.

1.7.1. Description of the conceptual framework of the study
The figure above shows both dependent and independent variables of the study.The dependent variable is the prevalence of EBF Practices. The independent variables are Demographic factors such as maternal age, occupation, employment, marital status, parity and level of education. Therefore, the independent variables have a direct influence on the dependent variable, where they can affect the prevalence in negative way or positive way.

CHAPTER TWO: LITERATURE REVIEW
2.1. Overview of exclusive breastfeeding (EBF).
EBF relates with demographic characteristics such maternal age, occupation, employment, marital status and parity, this results to variation of the prevalence of EBF from one setting to another. Awareness among health workers regarding to variations is helpful in planning better health promotion intervention.
2.1. Relationship between demographic characteristics and the prevalence of EBF
In Tanzania, a study a conducted in Muheza Tanga which involved total of 316 women with infants aged 6–12 months, participants were interviewed using a questionnaire and 12 key informants using in-depth interview guide. It was found that prevalence of EBF was 24.1% which was lower compared to the prevalence of Tanzania which was 50%.The association between advanced maternal age was statistically significant with the EBF practices (Maonga et al., 2016).
A cross sectional study which included total of 600 mothers, who have a child aged 6-12 months, attending primary health care centers within the Abha city. Their age ranged between 18 and 47 years. It was found that governmental workers had significant double probability of not practicing exclusive breast feeding as opposed to house wives. Work related problems (46.2%) is one among of the barriers for EBF.This study depicted the association between demographic characteristics such as employment status, occupation and prevalence EBF practices(Ali ; Ayed, 2014).but another study conducted among 121 mothers of infants aged 0–6 months in rural Bangladesh( Mirzapur Upazill) revealed that there is no statistical significant association between demographic characteristics of the mother and prevalence of EBF practices(Joshi et al., 2014).
A study conducted among 400 mother-infant pairs attending the infant welfare clinic of the Nnamdi Azikiwe University teaching hospital (NAUTH) in South East Nigeria data on breastfeeding were based on infant feeding practice in the previous 24 hour. It was found that Practice of EBF was ( 33.5%).Increased likelihood of EBF practice was seen in mothers who gave their infants breast milk as their first feed, while decreased likelihood of EBF practice was found among mothers of lower educational level, and higher social economic status (Onah et al., 2014).
A community based cross sectional study among 422 women with infants aged less than 6 months aimed at assessing the prevalence and predictors of exclusive breastfeeding with in the first six months of life among women in Halaby special woreda in Ethiopia. It was found that EBF prevalence was ( 70.5%),awareness about antenatal care follow up was (94.2%) ,also it was found that mothers who attended formal school showed statistically significant association with the EBF practices (Sonko ; Worku, 2015). This statistics suggest that strategies of increasing EBF practices should not only focus on improving awareness but also considering demographic characteristics especially the level of education and other factors such as employment, occupation, maternal age, parity, marital status and type of delivery.

A cross-sectional study conducted among 1000 profession professional working mothers, aged 40 or younger, who were in full-time employment and working in Kumasi metropolis of Ghana. It was found that the prevalence of EBF among professional workers was 42%, while 58% of professional women could not practice EBF according to WHO recommendations of EBF (Danso, 2014).Extending maternity leave to six months for all working mothers could promote exclusive breastfeeding for six months in professional working mothers.

CHAPTER THREE: METHODOLOGY
3.1. Study design
Study design is an overall plan for addressing a research question and for handling various challenges to the worth of the study evidence (Polit, D.,;Beck, 2014). This study will employ a descriptive cross-sectional study design involving the use of quantitative approach of data collection. This study design is suitable for this study mainly because the researcher seeks to know the relationship between demographic characteristics of mothers and prevalence o f EBF Practice at a particular point in time.

3.2. Study site
Is the overall location for research (Polit ; Beck, 2013).This study will be conducted at Mbagala hospital found in Dar es Salaam, Tanzania. The study site is selected for the study because of easiness on accessing the study participants.
3.3. Study setting
The specific location where data will be obtained (Polit, D.,;Beck, 2014).The study will be conducted at Mbagala postnatal clinic. This setting is chosen because the sample for study will be obtained from mothers with infants under 24 months who attend to that clinic.
3.4. Target population
Target population is the entire population in which the researcher is interested and to which he or she would like to generalize the results of a study (Polit, D.,;Beck, 2014). The target population of this study is all lactating women attending at Mbagala postnatal clinic.

3.5. Study population
Study population is the population from which the sample for the study is chosen (Polit ; Beck, 2013). This study will involve lactating women with children aged 0 to 24months who will be attending at Mbagala postpartum clinic. This is because under this period the maternal recall of
EBF practice is expected to be reliable and valid.

3.5.1. Inclusion criteria
These are specific characteristics that participants/subjects need to possess so as they can be qualify to be included in the research study. The population under this study will involve all lactating mothers with infants aged 0to 24months who are mentally and or physically capable and who will be attending at Mbagala postnatal clinic.
3.5.2. Exclusion criteria
These are criteria that specify characteristics that disqualify the subject to participate in the study. Participants that will be excluded from the study are: those having contraindication for breast feeding, not willing to participate and lactating mothers who will not be available at the day of data collection.

English questionnaire

1. Age_______________
2. Age of a child_______________

3. Level of education:
a) None ( )
b) Primary ( )
c) Secondary ( )
d) College ( )

4. Marital status;
a) Married.
b) Single.
c) Divorced.
d) Cohabiting.
e) Widowed.

5. Occupation;
a) Employed ( )
b) Self-employed ( )
c) Peasant ( )
d) House wife ( )
e) Student ( )
f) Others ( )

6. Type of delivery
a) SVD ( )
b) CS ( )

7. Do you breast feed your baby?
A) Yes ( )
(b) No ( )

8. Do you started to breast feed in the first hour of life?
a) Yes ( )
b) No ( )

9 Are you doing EBF?
a) Yes ( )
b) No ( )
Dodoso la Kiswahili

1. Umri wako ………….
2. Umri wa motto …………..
3. Kiwango chako cha elimu
a) Hujasoma ( )
b) Shule ya msingi ( )
c) Shule ya sekondari ( )
d) Chuo ( )

4. Hali yako ya ndoa

b )Umeolewa ( )
b) Hujaolewa ( )
c) Mmetengana ( )
d) Umefiwa ( )
e)Munaishi bila ndo

5. Kazi unayofanya
a) Umeajiriwa ( )
b) Umejiajiri ( )
c) Mkulima mdogo mdogo ( )
d) Mama wa nyumbani ( )
e) Mwanafunzi ( )
f) kazi nyingine ( )
6. Ulijifungua kwa njia gani
a) Kawaida.
b) Upasuaji.
7. Unanyonyesha mtoto wako?
a) Ndiyo ( )
b) Hapana( )
8. je uliweza kumnyonyesha mtoto ndani ya muda wa saa moja baada ya kujifungua ?
a) Ndiyo ( )
b) Hapana ( )

9.Unafanya unyonyeshaji wa maziwa ya mama pekee ?
a) Ndiyo ( )
b) Hapana ( )

REFERENCE
Ali, A., ; Ayed, N. (2014). Knowledge, attitude and practice regarding exclusive breastfeeding among mothers attending primary health care centers in Abha city, 3(11), 1355–1363. https://doi.org/10.5455/ijmsph.2014.140820141
Danso, J. (2014). Examining the Practice of Exclusive Breastfeeding among Professional Working Mothers in Kumasi Metropolis of Ghana. International Journal of Nursing, 1(1), 11–24. Retrieved from www.aripd.org/ijn
Joshi, P. C., Angdembe, M. R., Das, S. K., Ahmed, S., Syed, A., Faruque, G., ; Ahmed, T. (2014). Prevalence of exclusive breastfeeding and associated factors among mothers in rural Bangladesh?: a cross-sectional study, 9(1), 1–8. https://doi.org/10.1186/1746-4358-9-7
Maonga, A. R., Msuya, S. E., ; Damian, D. J. (2016). Factors Affecting Exclusive Breastfeeding among Women in Muheza District Tanga Northeastern Tanzania?: A Mixed Method Community Based Study. Maternal and Child Health Journal, 20(1), 77–87. https://doi.org/10.1007/s10995-015-1805-z
Mekuria, G., ; Edris, M. (2015). Exclusive breastfeeding and associated factors among mothers in Debre Markos , Northwest Ethiopia?: a cross-sectional study, 1–7. https://doi.org/10.1186/s13006-014-0027-0
Onah, S., Ignatius, D., Osuorah, C., Ebenebe, J., ; Ezechukwu, C. (2014). Infant feeding practices and maternal socio-demographic factors that Ali, A., ; Ayed, N. (2014). Knowledge, attitude and practice regarding exclusive breastfeeding among mothers attending primary health care centers in Abha city, 3(11), 1355–1363. https://doi.org/10.5455/ijmsph.2014.140820141
Danso, J. (2014). Examining the Practice of Exclusive Breastfeeding among Professional Working Mothers in Kumasi Metropolis of Ghana. International Journal of Nursing, 1(1), 11–24. Retrieved from www.aripd.org/ijn
Joshi, P. C., Angdembe, M. R., Das, S. K., Ahmed, S., Syed, A., Faruque, G., ; Ahmed, T. (2014). Prevalence of exclusive breastfeeding and associated factors among mothers in rural Bangladesh?: a cross-sectional study, 9(1), 1–8. https://doi.org/10.1186/1746-4358-9-7
Maonga, A. R., Msuya, S. E., ; Damian, D. J. (2016). Factors Affecting Exclusive Breastfeeding among Women in Muheza District Tanga Northeastern Tanzania?: A Mixed Method Community Based Study. Maternal and Child Health Journal, 20(1), 77–87. https://doi.org/10.1007/s10995-015-1805-z
Mekuria, G., ; Edris, M. (2015). Exclusive breastfeeding and associated factors among mothers in Debre Markos , Northwest Ethiopia?: a cross-sectional study, 1–7. https://doi.org/10.1186/s13006-014-0027-0
Onah, S., Ignatius, D., Osuorah, C., Ebenebe, J., ; Ezechukwu, C. (2014). Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria?: a cross-sectional and analytical study, 9(1), 1–10.
Polit, D.,;Beck, C. . . (2014). Essentials of Nursing Research seventh edition:Appraising evidence for nursing practice. Lippincott Williams ; Wilkins.
Polit, D. F., ; Beck, C. T. (2013). Nursing Research principles and method. Nursing Research Principles and Method, 310.
Sonko, A., ; Worku, A. (2015). APrevalence and predictors of exclusive breastfeeding for the first six months of life among women in Halaba special woreda , Southern Nations , Nationalities and Peoples ‘ Region / SNNPR /, AEthiopia?: a community based cross-sectional study. Archives of Public Health, 73(1), 1–11. https://doi.org/10.1186/s13690-015-0098-4
Survey, H., Survey, M. I., & Findings, K. (2015). Tanzania. Tanzania 2015-16 Demographic and Health Survey and Malaria Indicator Survey.