A Quasi Experimental study to Evaluate the Effectiveness of Structured

Teaching Programme on Knowledge and Attitude regarding Wet Nursing

and Human Milk Banking among Postnatal Mothers at Selected Hospitals,
Jalandhar, Punjab, 2021.

A synopsis

Submitted for the partial fulfilment of the requirement for the degree of

MASTER OF SCIENCE IN NURSING

(Obstetric and Gynaecological Nursing)

Of

Baba Farid University of Health Sciences,

Faridkot, Punjab

2020

Ritu kataria

Lala Lajpat Rai Institute of Nursing Education, Gulab Devi

Hospital, Jalandhar, Punjab (India)

A Quasi Experimental study to Evaluate the Effectiveness of Structured
Teaching Programme on Knowledge and Attitude regarding Wet Nursing
and Human Milk Banking Among Postnatal Mothers at Selected Hospitals,
Jalandhar, Punjab, 2021.

A synopsis

Submitted for the partial fulfillment of the requirement for the degree of

MASTER OF SCIENCE IN NURSING

(Obstetric and Gynecological Nursing)

Of

Baba Farid University of Health Sciences,

Faridkot, Punjab

2020

Ritu kataria

Name & Signature of Supervisor Name & Signature of Co- Supervisor

Mrs. Ramandeep kaur Mrs. Dalbir Kaur

M.sc (N) Associate Professor M.sc (N), Assistant Professor,

Obstetric and Gynaecological Nursing Mental Health Nursing

LLR INE, GDH, Jalandhar LLR INE, GDH, Jalandhar

Lala Lajpat Rai Institute of Nursing Education,

Gulab Devi Hospital Jalandhar, Punjab (India)
SYNOPSIS OF THE RESEARCH STUDY
STATEMENT OF PROBLEM: A Quasi Experimental study to Evaluate the

Effectiveness of Structured Teaching Programme

On Knowledge and Attitude regarding Wet Nursig

And Human Milk Banking Among Postnatal

Mothers at Selected Hospitals, Jalandhar,

Punjab,2021.

SUPERVISOR Mrs. Ramandeep Kaur

M.Sc (N) Associated Professor

Obstetric and Gynaecological

LLR Institute of Nursing

Education, Gulab Devi Hospital, Jalandhar

CO-SUPERVISOR Mrs. Dalbir Kaur

M.Sc (N), Assistant Professor

Mental Health Nursing

LLR Institute of Nursing Education,

Gulab Devi Hospital, Jalandhar.

SUBMITTED BY Ms. Ritu Kataria

M.Sc (N) 1st Year

Obstetric and Gynaecological Nursing

LLR Institute of Nursing Education,

Gulab Devi Hospital Jalandhar

Lala Lajpat Rai Institute of Nursing Education,

Gulab Devi Hospital Jalandhar, Punjab (India)

 ABSTRACT OF PLAN OF THESIS

Title A Quasi Experimental study to Evaluate the Effectiveness of

Structured Teaching Programme on Knowledge and Attitude
regarding Wet Nursing and Human Milk Banking Among
Postnatal Mothers at Selected Hospitals, Jalandhar, Punjab, 2021.

For the degree of M.Sc Nursing( Obstetric and Gynaecological Nursing)

Name of candidate Ritu Kataria

Supervisor Mrs. Ramandeep kaur

M.Sc (N) Associate Professor,
Obstetric and Gynaecological Nursing
Lala Lajpat Rai Institute of Nursing Education, Gulab Devi
Hospital, Jalandhar, Punjab

Co- Supervisor Mrs. Dalbir Kaur

M.Sc(N) Assistant Professor,
Mental Health Nursing
Lala Lajpat Rai Institute of Nursing Education, Gulab Devi
Hospital, Jalandhar.

Institute Lala Lajpat Rai Institute of Nursing Education, Gulab Devi

Hospital Jalandhar, Punjab.

University Baba Farid University of Health Sciences, Faridkot, Punjab

Breast milk is universally accepted as the best nutritional source for the first 6 months of life
and a dietary part of a healthy baby for ≥2 years. Breast milk is specific to humans; therefore,
it is superior to all other alternatives for new born nutrition. The present study will be
conducted to evaluate the effectiveness of Structured Teaching Programme on Knowledge
and Attitude regarding Wet Nursing and Human Milk Banking among Postnatal Mothers at
Selected Hospitals, Jalandhar, Punjab. The sample size will be 100 postnatal mothers. Non
probability convenience sampling technique will be used to select sample. Data will be
obtained by using structured tool consists of four parts. Part1: it consists of selected socio
demographic variables. Part2: structured teaching programme regarding wet nursing and
human milk banking. Part 3: self-structured knowledge questionnaire. Part 4: structured
attitude scale. Analysis and Interpretation of Data will be done according to objectives of the
study by using descriptive and inferential statistics.
 BACKGROUND OF THE STUDY

INTRODUCTION
“Being a full-time mother is one of the highest salaried jobs in my field, since the payment is
pure love.”

-Mildred B. Vermont

Breast milk or mother's milk is milk produced by mammary glands located in the breast of

a human female to feed a child. Milk is the primary source of nutrition for new born. Wet
nurse is the name the women are called who give her breast milk to a baby other than of her
own.
Breast milk is universally accepted as the best nutritional source for the first 6 months of life
and a dietary part of a healthy baby for ≥2 years. Breast milk is specific to humans; therefore,
it is superior to all other alternatives for new born nutrition. Breast milk is effective in new
born both in short term health outcomes and in long term growth and development.
Conditions such as diarrhoea, allergies, sudden infant death syndrome and diabetes are
observed less in infants who are breastfed. But when there is not enough mothers ‘milk
available due to some reasons like mother has insufficient milk glands, has had past breast
surgery or is taking medication (e.g. chemotherapy for cancer) and has an infection that could
spread to her baby through breast feeding. For these babies an alternative must be sought.
Continuing breastfeeding in the first couple of years of life when growth and development are
so rapid will positively affect the physical and mental health of the child in the following
years.1

 Premature infants constitute the largest and most important group of infants where milk from
other women is needed because their own mothers' milk is not available or is not available in
sufficient quantity. The first human milk bank was founded in 1909 in Vienna, Austria. A wet
nurse is a woman who breast feeds and cares for another's child. Wet nurses are employed if
the mother dies, or if she is unable or elects not to nurse the child herself. Wet-nursed
children may be known as "milk-siblings", and in some cultures the families are linked by a
special relationship of milk kinship. His tradition has been in practice since time immemorial.
Even in the Code of Hammurabi, which dates back to 2250 BC, we can come across the
concept of wet nursing.1

Wet nursing was widely practiced in Europe during the 19th century in order to provide
human milk for infants whose mothers were unable to provide milk for their infants. It lists
33 countries with milk bank programs. The World Health Organization (WHO) states that the
first alternative to a biological mother not being able to breast feed is the use of human milk
from other sources.2
In the past, the practice of Wet nursing provided an alternative to maternal breast feeding for
those who could access it. When a wet nurse was not available, milk from goat, sheep and
other mammals were also used as substitute nourishment for babies, often with fatal results.
But in late 1950’s the concept of human milk banking started. In 1980’s at the World Health
Assembly, the WHO and UNICEF jointly declared, Where it is not possible for the biological
mother to breast feed, the first alternative, if available, should be the use of human milk from
other sources. Human milk banks should be made available in appropriate situations.3

Factors identified in the review that facilitate wet nursing include wide acceptance within
society, culture and religion; knowledge of the importance of breast milk; when wet nurses
and mothers/caregivers know each other; availability of milk-sharing websites; appropriate
support from health facilities and authorities; access to lactation consultants or nurses
equipped to provide support for wet nursing; and breast-milk screening. Factors identified
that hinder wet nursing include availability and promotion of artificial feeding; fear of disease
transmission; practical limitations for wet nurses (such as cost of travel); unwillingness to wet
nurse outside known relationships; lack of facilities (milk banks; milk storage;
pasteurisation); and lack of protocols and support from health authorities.4

Problems induced by mother or baby during lactation negatively affect exclusive breast
feeding and duration of total lactation. In such cases, to milk, wet-nursing, human milk
banking applications in order to feed babies with breast milk can be put into use. A wet-nurse
is a woman who breastfeeds a child of another mother who cannot breastfeed. For ages, “wet-
nurses” were applied when human milk could not be provided. Human milk bank is an
institution that has been constituted to collect, process, store, and distribute donated human
milk for meeting specific requirements of whom licensed health care professionals prescribed
human milk . Human milk banking actually had been started in Hammurabi’s time with wet-
nurses. After Theodor Escherich, who discovered Escherichia coli, recognized that the
mortality rates of babies who were given food except for human milk were high, he founded
the first human milk bank in 1909 in Vienna.5

The first human milk bank in the USA was founded in 1919 in Boston as a house designed
for lactating mothers who were wet-nursing for money. While there were 30 human milk
banks in the USA in the early 1980s, this number has decreased to seven because they were
closed due to the fear of human immunodeficiency virus transmission. The Human Milk
Banking Association of North America (HMBANA) was founded in 1985. Currently, there
are 24 non-profit milk banks associated with the HMBANA in the USA.6

The first breast milk bank in India was set up in 1989 in Mumbai. As human milk is the best
and safest feed for a baby, infants who don’t have access to mother’s milk are benefitted by
the milk banks. In India, breastfeeding appears to be influenced by social, cultural, and
economic factors. In 1991, Breastfeeding Promotion Network of India (BPNI) was born to
protect, promote and support breastfeeding.  Further, the Government of India has undertaken
National Rural Health Mission, which intends to implement Integrated Management of
Neonatal and Childhood Illnesses (IMNCI) through the existing healthcare delivery
system. Poor practices and attitudes toward exclusive breastfeeding have been reported to be
among the major reasons for poor health outcomes among children, particularly in
developing countries. Nonetheless, the promotion and acceptance of practices, such as
exclusive breastfeeding, are especially important in developing countries with high levels of
poverty, and that are characterized by a high burden of disease and low access to clean water
and adequate sanitation.8(12)

85% of milk banks in India have been established by nongovernment organizations, and only
a handful had been supported by the government. (38) However, within the last2 years nearly
50% of milk banks have been supported by the state governments. Rajasthan, one of the
states with a high neonatal mortality rate, has supported the setting up of 10 milk banks
during the last year. Similarly, the state government of Tamil Nadu has supported setting up 7
milk banks. The recur-ring cost of most milk banks is managed through hospital fund.7

There is a need for rigorous implementation, process research, and technology innovation,
along with a robust regulatory framework to prevent commercialization. In addition, attitude
changes of mothers, maternal influencers, and health-care providers are all essential to
successfully expand the CLMC (Comprehensive Lactation Management Center) models.7

Even though Asia’s first milk bank was set up in Mumbai in 1989, there were only 40 odd
banks in India as of 2017. Presently, there are around 14 such banks in India. Their
availability has helped reduce infant mortality rate by 73% but in recent years, there has been
an effort to increase the number of banks in India. Chandigarh’s first human milk bank has
come up at government medical college and hospital (GMCH), sector 32. 9

The government of India has acknowledged the role that human milk banking can play in
reducing neonatal mortality and morbidity, and launched the “National Guidelines on
Lactation Management centre in Public Health Facilities “in 2017 with a vision to make
breast milk universally available for all infants. The government is now working on2016 an
implementation strategy to scale up the lactation management centre model (promotion of
breastfeeding, kangaroo mother care, and donor human milk) for all new born care units and
delivery centers in the country. 10

NEED OF THE STUDY

“A journey of a thousand miles begins with a single step” this proverb reminds us that
each single step of our work help us to reach the final destination. Today’s children are
tomorrow’s citizen, so it is always better to begin with the neonates, who are at high risk
cases. Patience, observation and understanding the child are the pillars of good parenting.
Young kids in their growing age are like saplings, very delicate. Any harsh treatment
damages the sapling and retards its proper growth. So is with kids. They have to be guided
with love and lots of understanding. A majority of the problems in neonates arises due to
inadequate breastfeeding and decreased knowledge among postnatal mothers.11

First and foremost thing is that, the mother should have a vast idea about the importance of
breastfeeding. Breastfeeding is an effective way to prevent or reduce neonatal mortality rate.
The implementation of this task is very important for the maintenance and protection of
children, especially in the early days of growth.

The milk produced in the first days after birth has a different composition than later milk.
Colostrum contains high levels of immunoglobulin A, or IgA, a type of immune factor.
Colostrum also has more antibodies and disease-fighting white blood cells than mature milk,
so it offers protection during the early days before your baby's immune system is well-
developed.12

“World Breastfeeding Week - 1–7 August” is initiated with a goal to boost the health of
neonates and infants worldwide and encourage mothers to breastfeed, nearly 6 120 countries
around the world celebrate World Breastfeeding Week from 1-7 August every year.13

“Breast Milk Nature’s Protection for the Baby” One million infant lives can be saved by
just breast feeding in the 1st Hour following the birth of the child. If mothers and families
comprehend the benefits of breast feeding for six months, it can save the life of 250,000
babies annually. Breastfeeding offers new born all the nutrition required and therefore the
WHO recommends exclusive breastfeeding till the baby is six months old.13

The most important nutritional source for an infant is its mother's breast milk. When we look
back on history, in situations where this is not possible the concept of wet nursing is
employed particularly in various countries. Neonatal mortality accounts for a large proportion
of child deaths in many countries, especially in low-income settings such as India, Africa etc.
In the year 2006, in United States, nearly 19,000 babies died in the first month. Neonatal
deaths are a serious national health concern, especially in developing countries where 96% of
the world’s approximate 5 million annual neonatal or below one year deaths occur. 14

In many countries, breast milk banks were established to solve this problem. The first breast
milk bank that was established (1909) is in Vienne. This bank was followed by many other
breast milk banks established in countries such as Germany, USA, Australia, Norway and
Spain.

A recent study found that if all premature infants born in

the United Kingdom in 2013 were provided with mother’s
milk in the NICU, the total lifetime cost savings to the
National Health System would be an estimated $46.7 million
(£30.1 million in the first year) as a result of improved health
outcomes. The total lifetime quality-adjusted life-year gain
was calculated to be 10,594 years. There would be 238 fewer
deaths caused by neonatal infections and sudden infant death
syndrome, leading to a savings of approximately £153.4
million in lifetime productivity.
A recent study found that if all premature infants born in
the United Kingdom in 2013 were provided with mother’s
milk in the NICU, the total lifetime cost savings to the
National Health System would be an estimated $46.7 million
(£30.1 million in the first year) as a result of improved health
outcomes. The total lifetime quality-adjusted life-year gain
was calculated to be 10,594 years. There would be 238 fewer
deaths caused by neonatal infections and sudden infant death
syndrome, leading to a savings of approximately £153.4
million in lifetime productivity.
A recent study found that if all premature infants born in the United Kingdom in 2013 were
provided with mother milk in the NICU, the total lifetime cost savings to the National Health
System would be an estimated $46.7 million (£30.1 million in the first year) as a result of
improved health outcomes. The total lifetime quality-adjusted life-year gain was calculated to
be 10,594 years. There would be 238 fewer deaths caused by neonatal infections and sudden
infant death syndrome, leading to a savings of approximately £153.4million in lifetime
productivity.15

Providing donor human milk to vulnerable neonates without access to MOM not only saves
lives but also enhances awareness about breastfeeding and improves breastfeeding rates. This
increase in breastfeeding rates is important because it has the potential to prevent 820,000
“under-5”deaths (death before age 5 years), of which 87% are infants younger than 6 months
of age. (28) Improving breastfeeding rates worldwide is a fundamental driver to achieve
Sustainable Development Goals by 2030.

Breastfeeding has a pertinent and important role to playin improving the status of neonatal
health in India. Thisemphasizes the need to universalize access to human milkas an integral
component in the country’s health-care sys-tem, especially in all newborn units that provide
care to sickinfants. Providing human milk through human milkbanks can work only if it is a
part of the larger objectiveof promoting breastfeeding. 16

It is worth noting that 85.7% of mothers who have knowledge regarding breast milk banks
have acquired this information from sources other than health personnel. In a study carried
out outside of Turkey. It was reported that although more than 90.0% of nurses and midwives
think breast milk donation is important, only 71.0% lean towards establishment of breast milk
banks. In a study made in Turkey, it was determined that health personnel have a positive
opinion regarding breast milk banks but their level of knowledge is low. The studies made
suggest important responsibilities fall to health personnel in order for breast milk banks to be
adopted by the society.17

Obtaining wet-nurses for requiring infants is thought as an alternative for human milk
banking. Wet-nursing is a traditional practice especially in rural areas when the mother
cannot breastfeed for a reason. In the present study, 5.0% of the mothers wet-nursed, 10.9%
had a wet nurse and 5.2% had her child’s wet-nurse. In a study con-ducted in the rural part of
Denizli, 8.7% of women had wet-nursed, 12.5% had her own, and 7.2% had her child’s wet-
nurse.
In a study in Erzurum, a similar finding was found that although 64% of the mothers could
donate their own breast milk, 48.6% would not get the donated human milk from these banks
when needed. Of the mothers, 36.3% have stated that human milk banks were not on
religious grounds. In a study in Denizli, the ratio of mothers who approved founding a human
milk bank (22.9%) and who wanted to donate milk (19.1%) was found to be low, in which
the main reason for not donating was shown as forbidden marriage between milk siblings
according to religion.18

In clinical setting and community I found that the mother has less knowledge regarding wet
nurse and human milk. Specially, mothers who are working in private job they are not able to
provide breast milk to their infants which further increases the neonatal morbidity and
mortality rate. Therefore, there is a need to educate the postnatal mothers regarding wet
nursing and human milk banking through structured teaching programme in order to change
their knowledge and attitude and further promote exclusive breastfeeding and reduce the
neonatal morbidity and mortality rate.19

STATEMENT OF PROBLEM

A Quasi Experimental study to Evaluate the Effectiveness of Structured Teaching

Programme on Knowledge and Attitude regarding Wet Nursing and Human Milk Banking
Among Postnatal Mothers at Selected Hospitals, Jalandhar, Punjab, 2021.

AIM OF THE STUDY

To Evaluate the Effectiveness of Structured Teaching Programme on Knowledge and
Attitude regarding Wet Nursing and Human Milk Banking among Postnatal Mothers in order
to reduce neonatal morbidity and mortality.

OBJECTIVES
1. To assess pretest knowledge & attitude regarding wet nursing and human milk
banking among postnatal mothers in control and experimental group.

2. To plan and implement structured teaching programme on knowledge and attitude

regarding wet nursing among postnatal mothers in experimental group.

3. To assess posttest knowledge and attitude regarding wet nursing and human milk banking
among postnatal mothers in control and experimental group.
4. To evaluate the Effectiveness of Structured Teaching Programme on Knowledge and
Attitude regarding Wet Nursing and Human Milk Banking Among post natal mothers in
control and experimental Group.

5. To find out relationship between knowledge and attitude regarding wet nursing and human
milk banking among postnatal mothers in control and experimental group.

6. To find out the association between post test knowledge and attitude regarding wet nursing
and human milk banking among postnatal mothers in control and experimental group.

OPERATIONAL DEFINITIONS:

1. Evaluate: It refers to the measurement of knowledge and attitude regarding wet

nursing and human milk banking among postnatal mothers by using appropriate
tools, developed by the investigator.
2. Effectiveness: It refers to extent to which structured teaching programme will
produce desired effect on knowledge and attitude regarding wet nursing and human
milk banking among postnatal mothers.
3. Structured Teaching Programme regarding wet nursing and human milk
banking. It refers to a systematically developed instructional programme using
instructional aids, designed to provide information regarding wet nursing and human
milk banking among post natal mothers.
4. Knowledge: It refers to the information given by postnatal mothers regarding wet
nursing and human milk banking which will be assessed by using self-structured
knowledge questionnaire.
5. Attitude: it refers to thinking of postnatal mothers regarding wet nursing and human
milk banking which will be assessed by structured attitude scale.
6. Post natal mothers: it refers to the women who have delivered recently and admitted
in postnatal wards of selected hospitals of Jalandhar, Punjab.

HYPOTHESIS
H0.1:There will be no significant difference between post test knowledge score regarding wet
nursing and human milk banking among post natal mother in control and experimental group.

H1.1:There will be significant difference between post-test knowledge score regarding wet
nursing and human milk banking among post natal mother in control and experimental group
(P<0.05 level).

H0.2: There will be no significant difference between post test attitude regarding wet nursing
and human milk banking among postnatal mothers in control and experimental group.
H1.2: There will be significant difference between post test attitude regarding wet nursing and
human milk banking among postnatal mothers in control and experimental group.
(p<0.05level).

DELIMITATIONS
The study will be limited to 100 postnatal mothers admitted in postnatal wards of selected
hospitals of Jalandhar, Punjab.

REVIEW OF LITERATURE

The literature reviewed has been presented under the following:

Lakshmi P.P (2018) conducted a quasi-experimental study to evaluate the effectiveness of

donor breast milk bank feed among 60 preterm new born at, Rio Children’s, Christian
Mission Hospital centres,Madurai. The result showed that in experimental group 3.3% had
Mild effect, 23.3% had moderate effect, 50% effect on donor breast milk bank feed among
preterm new born. There was no significant association between the pretest on donor breast
milk in control group and there was a significant association between the pretest on donor
breast milk bank feed of preterm new born in experimental group.20

Yılmaz M, Aykut M, Şahin H.et al. (2018) performed a descriptive study to determine the
knowledge, attitude and practice of mothers about wet nursing and human milk banking in Kayseri,
Turkey. The study was conducted in family health care centre (FHCs) 625 mothers. Data was
collected by using structured interview schedule face to face. The result showed that the mothers,
88.9% had heard about wet-nursing, 10.9% had a wet nurse of her own, 5.2% had a wet nurse of
her child, and 5.0% had been a wet-nurse of another child. More than half of the mothers (61.6%)
thought human milk banking and 56.2% identified that they could donate breast milk to the human
milk bank. Study finding revealed that more than half of the mothers thought that milk banking was
a correct application. Mothers who were opposed to milk banking showed religious justifications as
reasons.21

Mankar A, Mourya A (2016) carried out a descriptive study to assess the Knowledge and Attitude
Regarding Human Milk Banking among conveniently selected 100 Postnatal Mothers in Wardha city
hospital. The result showed that55% of postnatal mother had good level of knowledge 37%
them had average level of knowledge. There was poor positive correlation between
knowledge and attitude of postnatal mothers regarding human milk banking.22

Ghuge S, Aghamkar J (2016) conducted a pre experimental study to assess the knowledge
and attitude regarding donating milk to the human milk bank among 60 postnatal mothers of
Bhosari hospital. The samples were in the age group of 20-30 years and 35% belonged to 31-
40 years of age.31.7% of the samples were house wives. Highest percentage 50% of level of
knowledge score, 21.67% had good level of knowledge score.53.33% of the samples had
good level of attitude score and 46.67% had excellent level of attitude score. Its shows that
postnatal mothers were having adequate knowledge and positive attitude towards the
donating milk to the Human Milk Bank.22

Joshi V (2016) did pre experimental study to assess the effectiveness of structured teaching
programme on knowledge regarding human milk banking among 50 student of B.sc 4 th year
nursing of, Sinhgad college of Dehradun, Uttarakhand. The pre-test mean knowledge score
of the respondents was 11.9 (35%) and post-test knowledge mean was 27.5(80.88%). The
difference between pre-test and post-test knowledge scores shows difference at the level of
p<0.05. It was interpreted that post-test knowledge score is statistically significantly higher
that the pre-test knowledge score regarding knowledge on Human milk Banking.23

Rojjanasrirat, Wilaiporn (2014) carried out a cross sectional survey to determine the
knowledge and the views of the mothers towards milk banking among 404 mothers in
maternity hospital in Bihar. The result showed that the mothers’ mean age was 28.4 years
(16–46 years). Of the mothers, members of a nuclear family birth by caesarean section,
Mothers, 41.6% were aware of milk banking, 71.3% were willing to receive milk bank
services and 68.8% were willing to donate breast milk.24
 RESEARCH METHODOLOGY

Research approach
Quantitative Research Approach

Research Design
Quasi experimental Research design non-equivalent control group design will be used in the
study.

Experimental group O1  X  O2

Control group  O1  O2

O1 Pretest knowledge and attitude

X Structured teaching programme regarding wet nursing and human milk banking

O2 Posttest knowledge and attitude

Research setting
This study will be conducted at postnatal wards of selected hospitals of Jalandhar ,Punjab.

Population
Population will be all the postnatal mothers of Jalandhar, Punjab.

Target Population
Target Population will be post natal mothers admitted in postnatal wards of selected
Hospitals of Jalandhar, Punjab.

Sample Size
Sample size will be 100 postnatal mothers i.e. 50 in Experimental group and 50 in control
group

Sampling Technique
Non probability convenience of sampling technique will be used to select the sample.

Sampling Criteria

Inclusion Criteria
1. Post natal mothers who will be present at the time of data collection.
2. Post natal mothers who will be willing to participate in the study.

Exclusion Criteria
1. Post natal mothers with any postnatal complication.
2. Post natal mothers who have already attended teaching regarding the topic.

Selection and Tool development of

The tool will be divided into four parts:

Part 1: Performa for selected Socio demographic variables.

Part 2: Structured teaching programme regarding wet nursing and Human milk banking.

Part 3: Self Structured knowledge questionnaire.

Part 4: Structured attitude scale.

Validity of Tool
The tool will be validated by obtaining valuable opinions and suggestions from experts.

Pilot Study
Pilot study will be conducted on minimum 10% of target population to find reliability of tool
and feasibility of study.
Reliability of tool:
The reliability of the tool will be checked by test-retest method by using Karl pearson’s
confficient of correlation formula.

Data collection Procedure

The data will be obtained from the postnatal mothers admitted in postnatal wards of selected
hospitals of Jalandhar, Punjab by using appropriate tool developed by investigator. Priorly,
permission from the concerned authorities will be taken. Written informed consent will be
taken from the postnatal mothers. Firstly pretest knowledge and attitude regarding wet
nursing and human milk banking will be assessed among postnatal mothers in control and
experimental group. A structured teaching programme regarding wet nursing and human milk
banking will be implemented to the postnatal mothers in experimental group. After seven
days, postest knowledge and attitude will be assessed among postnatal mothers in control and
experimental group.

Ethical Consideration

1. Written permission will be obtained from Principal, Lala Lajpat Rai Institute of nursing
education, Gulab Devi Hospital Jalandhar, Punjab.

2. Ethical clearance will be taken from Ethical clearance Committee of Lala Lajpat

Rai Institute of Nursing Education Gulab Devi Hospital Jalandhar,Punjab.

3. Written permission will be taken from concerned authorities of selected Hospitals of

Jalandhar, Punjab.

4. Written Informed Consent will be taken from each study sample Confidentiality and
Anonymity of each sample will be assured and maintained throughout the study.

Plan of Data Analysis

Analysis and Interpretation of Data will be done according to objectives of the study by

using descriptive and inferential statistics.

 REFERENCES

1. Deniz Y, Dilek S and Ayfer A. journal of patient care,” Wet nurse and breast milk
bank”(2018), volume 4. www.longdom.com.
2. Azzalli, Laguardia C M, Rizzo V,et al.” development of a donor human milk bank”
M. Bufalini hospital, Cesena, Italy(2013).
https://doi.org/10.1016/j.earlhumdev.2013.07.005.
3. Ashwini Mankar , Archana Mourya. A international journal of science and Research,
“Knowledge and Attitude Regarding Human Milk Banking among Postnatal Mothers
in Selected Hospitals”, Volume 7 Issue 10,(2018). www.ijsr.net.
4. Müge Y , Mualla A , Habibe Ş,et al.” Knowledge, Attitude, and Practices About Wet-
Nursing and Human Milk Banking in Kayseri, Turkey”(2018) ; 40(4): 204-9 • DOI:
10.5152/etd.2018.18080. https://www.researchgate.net/publication/328775865.
5. Human Milk Banking Association of North America (HMBANA) Active Milk Banks.
https://www.hmbana.org/locations
6. Horta BL, Victora CG. “Long-term effects of breastfeeding”: A systematic review.
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7. Breastfeeding. Wikipedia.[Online]. [Cited 2011. December
5]URL:http://en.wikipedia.org/wiki/Breastfeeding.

8. Muppala C S.”World Breastfeeding Week” - 1–7.[CitedAugust2011].

http://www.medindia.net/news/World-Breastfeeding-Week17-August-2011-88472-
1.htm
9. WHO, “Identifies Five Major Causes Of Premature Death”.[Cited 29 Oct 2009].
http://www.medicalnewstoday.com/releases/1691 32.
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