|Year : 2015 | Volume
| Issue : 1 | Page : 16-19
Time to initiation of breastfeeding among newborns in the postnatal ward of a tertiary care hospital
Pukhrambam Romola, Shantibala Konjengbam, Avinash Keisam, Akoijam Swaruprani, Yengkhom Niveda, Payal Asem
Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||17-Jun-2015|
Dr. Shantibala Konjengbam
Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur
Source of Support: None, Conflict of Interest: None
Background: Breast milk is the ideal food for a normal infant. Growing evidence points to the impact of early initiation of breastfeeding on neonatal mortality. Neonatal and postneonatal deaths were around five to six times lower in those infants who were fed colostrum than those who were not. Objectives: The study was conducted to determine the time to initiation of breastfeeding in the postnatal ward of a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted from August 2013 to October 2013 among the mothers in the postnatal ward of a tertiary care hospital. The sample size was calculated based on a prevalence rate of 50%, with an allowable error of 6% at 95% confidence level. Assuming a nonresponse rate of 10%, the calculated sample size was 304. A pretested semistructured interview schedule was used for data collection. Ethical approval was taken from the Ethics Subcommittee of the institute. Results: A total of 303 mothers were studied. Only seven (2.3%) mothers gave prelacteal feeds to their newborns. Of the 303 mothers, 35 (11.6%) discarded colostrum and only 53 (17.5%) initiated breastfeeding within 1 h of delivery. Colostrum was given more by the literate mothers than the illiterate ones, and the finding was statistically significant. More mothers from nuclear families initiated breastfeeding within the 1st h of delivery as compared to those from joint families. Majority of the mothers did not receive advice on breastfeeding during antenatal visits and almost all the mothers were not told about positioning and attachment. Conclusion: Even though practices like avoidance of prelacteal feeding and feeding of colostrum were good in this study, the practice of early initiation was quite low. The support system prevailing in the hospital was also unsatisfactory. These observations will help in planning strategies for the promotion of breastfeeding to reduce neonatal morbidity and mortality in the community.
Keywords: Breastfeeding, Colostrum, Prelacteal feeding
|How to cite this article:|
Romola P, Konjengbam S, Keisam A, Swaruprani A, Niveda Y, Asem P. Time to initiation of breastfeeding among newborns in the postnatal ward of a tertiary care hospital. J Med Soc 2015;29:16-9
|How to cite this URL:|
Romola P, Konjengbam S, Keisam A, Swaruprani A, Niveda Y, Asem P. Time to initiation of breastfeeding among newborns in the postnatal ward of a tertiary care hospital. J Med Soc [serial online] 2015 [cited 2019 Dec 11];29:16-9. Available from: http://www.jmedsoc.org/text.asp?2015/29/1/16/158922
| Introduction|| |
Breast milk is the ideal food for a normal infant. As a global public health recommendation, infants should be exclusively breastfed for the first 6 months of life to achieve optimal growth and health. Thereafter, to meet their evolving nutritional needs, infants should receive safe and nutritionally adequate complementary foods while breastfeeding continues for up to 2 years of age or beyond. The 2003 landmark Lancet Child Survival Series assigned the topmost rank to exclusive breastfeeding up to 6 months of age and breastfeeding up to 12 months, and the 3 rd rank to complementary feeding starting at 6 months. These two interventions alone were estimated to prevent almost one-fifth of under-five mortality in developing countries. 
Growing evidence points to the impact of early initiation of breastfeeding on neonatal mortality. A 2006 study in rural Ghana  showed that early initiation within the 1st h of birth could prevent 22% of neonatal deaths and initiation within the 1st day could prevent 16% of deaths, while a study in Nepal  found that approximately 19.1% and 7.7% of all neonatal deaths could be avoided with universal initiation of breastfeeding within the 1st h and 1st day of life, respectively. A study in India showed that neonatal and postneonatal deaths were around five to six times lower in those infants who were fed colostrum than those who were not.  However, in the world's most affluent societies, breastfeeding appears to be a disappearing art and the feeding bottle has replaced the breast. When the standard of environmental sanitation is poor and education low, the content of the feeding bottle is likely to be nutritionally poor as well as bacteriologically dangerous. 
According to the National Family Health Survey 3 (NFHS-3) (2005-6), while breastfeeding is nearly universal in India, very few children are put to the breast immediately after birth. Only one-quarter (24.5%) of last-born children, who were ever breastfed, started breastfeeding within half an hour of birth, as is recommended, and nearly half (45%) did not start breastfeeding within 1 day of birth. Most mothers (57%) gave their last-born child something to drink other than breast milk in the 3 days after delivery. Slightly less than half of the children who were under 6 months of age (46.3%) were exclusively breastfed. 
Hence, this study was conducted among the postnatal mothers of a tertiary care hospital in Manipur to determine the time to initiation of breastfeeding among the newborns in the postnatal ward of a tertiary care hospital.
| Materials and Methods|| |
This cross-sectional study was conducted from August 2013 to October 2013 among the mothers who delivered in the postnatal ward of a tertiary hospital in Manipur. Applying the formula 4pq/l 2 and considering P = 50% (allowable error of 6%), the calculated sample size was 304, expecting a nonresponse rate of 10%. The mothers who were sick or had lost their babies, or whose babies were very sick or had very low weight, and those who were not willing to participate were excluded from the study. The mothers were interviewed using a semistructured interview schedule after obtaining informed verbal consent from them. The data were collected by the 1st year postgraduate trainees (PGTs). There were, on an average, 800 deliveries every month in the hospital. Therefore, every fourth case entered in the register maintained in the postnatal ward who fulfilled the eligibility criteria were included in the study. If the selected case was not available, then we went on to the next fourth case and continued till the required sample size was met. Ethical approval was obtained from the Ethics Subcommittee of the institute for conducting the study. Each respondent was informed about the objectives of the study with an assurance of confidentiality. After data collection, the questionnaires were edited and coded, and then entered and processed by using SPSS for Windows, version 16.0 Chicago, SPSS Inc. Descriptive statistics like percentages, mean, and standard deviation were used to describe the study population in relation to the sociodemographic and other relevant variables. The chi-square test was used to identify the variables, which have association with breastfeeding practices.
| Results|| |
A total of 303 postnatal mothers were studied. Their age ranged 16-42 years, with an average of 26.3 (±4.9) years. Among the mothers, 27 (8.9%) were illiterate. Majority of them (223, 73.6%) were housewives and 160 (52.8%) were living in joint families. Of the mothers, 194 (64%) were from rural areas and majority of them (220, 72.6%) were Hindus.
Only seven (2.3%) mothers gave prelacteal feeds to their newborns. A little more than 1/10th of the study population did not give colostrum. However, more than 4/5th of the mothers initiated breastfeeding after the recommended 1 h [Table 1].
Majority of the mothers (253, 83.5%) expressed that breastfeeding was not discussed during their antenatal visits. However, 167 (55.1%) mothers said that they would continue exclusive breastfeeding upto 6 months. Rooming-in was observed in almost all the 301 (99.3%) cases. Almost all the mothers, i.e., 301 (99.3%) were not told about positioning and attachment while breastfeeding. Of the six mothers who did not know how to express breast milk, only one (16.7%) was taught by the hospital staff.
[Table 2] showed that majority of the literate mothers (253, 91.7%) gave colostrum as compared to the illiterate ones (15, 55.6%), and the finding was statistically significant.
|Table 2: Association between literacy status and breastfeeding practices|
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[Table 3] showed that 34 (23.8%) mothers from nuclear families initiated breastfeeding within 1 h of delivery as compared to only 19 (11.9%) from joint families, and this difference was statistically significant.
| Discussion|| |
The use of colostrum and avoidance of prelacteal foods are the cornerstones in early infant nutrition, and may be prerequisites for the establishment of future exclusive breastfeeding. In this study, the practice of postnatal mothers regarding breastfeeding in some areas was very good. Of all the mothers, 296 (92.3%) did not give prelacteal feeding and a majority of them (268, 88.4%) gave colostrum. Slightly higher findings were reported in studies conducted by Chaudhury et al.  and Mamtarani et al.  where 95% and 89.5% of the mothers, respectively, gave colostrum. However, in contrast to the finding of this study where only 7.7% gave prelacteal feeds, one-third of the mothers gave prelacteal feeding in both the studies. Another study conducted in Pakistan by Memon et al.  showed that 71% of the mothers discarded colostrum. This shows the importance of early education regarding optimal breastfeeding by the hospital staff to mothers who deliver in hospitals. Admission to hospitals for delivery purposes provides an opportunity to counsel the mothers about nutrition of the young child and the importance of breastfeeding.
In this study, only 53 (17.5%) mothers initiated breastfeeding within 1 h. Compared to this finding, a study conducted in a tertiary care hospital showed that 32.6% of mothers initiated breastfeeding within 1 h of delivery.  A study conducted by Kulkarni showed that 70.2% of mothers practiced early breastfeeding.  Another study conducted in South India also showed similar findings, with 28% of mothers initiating breastfeeding within 1 h.  This very low percentage of the practice, which has a significant impact on neonatal mortality, is a matter of concern. Regarding the initiation of breastfeeding, a statistically significant difference was observed among the mothers in nuclear and joint families. More mothers from nuclear families initiated breastfeeding within 1 h as compared to those from joint families. This might be due to the influence of the other members in the family, particularly the mother-in-law. This highlights the importance of counseling on breastfeeding, not only to the pregnant woman but also to the other members in the family who might influence her. Almost all the mothers (299, 98.7%) breastfed on demand, which was a good practice. In this study, a statistically significant difference was found between illiterate and literate mothers regarding the feeding of colostrum. A similar finding was also observed in a study conducted by Shafee et al., where 33% of the literate mothers gave colostrum as compared to only 27% of illiterate mothers. 
In this study, 83.5% of the mothers gave the response that breastfeeding was not discussed during antenatal visits and almost all the mothers in the postnatal ward were not told about positioning and attachment. Only a little more than half of the mothers expressed that they planned to continue exclusive breastfeeding up to 6 months. Similarly, in a study conducted in Nepal, none of the mothers received breastfeeding advice during antenatal visits.  However, another study conducted in a baby-friendly teaching hospital showed that 84.0% of the mothers were told about the techniques of breastfeeding. 
| Conclusion|| |
The present study concluded that even though breastfeeding practices like avoidance of prelacteal feeding and feeding of colostrum were good in this study, the practice of early initiation was quite low. The support system prevailing in the hospital was also observed to be unsatisfactory. These observations will help in planning strategies for the promotion of breastfeeding practices to further reduce neonatal morbidity and mortality in the community.
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[Table 1], [Table 2], [Table 3]