Biomedical & Pharmacology Journal Vol.

9(1), 195-199 (2016)

Knowledge, Attitude and Practices of Mothers

Regarding Breastfeeding in a South Indian Hospital
BALAJI CHINNASAMI1*,SUBASH SUNDAR2*, JAGATHIS KUMAR3*,
KANIMOZHI SADASIVAM4# and SEKAR PASUPATHY5*

1
Department of Pediatrics,4#Associate Professor of Physiology,
SRM Medical College, Hospital & RC, Potheri, Kattankulathur, India.
*Corresponding author E-mail: [email protected]

http://dx.doi.org/10.13005/bpj/926

(Received: February 10, 2016; accepted: March 15, 2016)

ABSTRACT

Study was conducted to assess the knowledge, attitude and practices of mothers attending
a south Indian hospital towards breastfeeding. This cross sectional study was conducted on
mothers of children, attending outpatient department of a tertiary care hospital, SRM Medical
College, Tamil Nadu. They were administered a pre-designed questionnaire of twenty questions
related to breastfeeding. A total of 200 mothers were interviewed over a period of two months.
Though many mothers (47.5%) were illiterate their knowledge to start early breastfeeding was
good (80%). However, only 34.5% initiated breastfeeding within one hour. Twenty five percentage
of mothers felt that colostrum is bad and 10.5% gave prelacteals. Exclusive breastfeeding was
given for six months by 72% of mothers. Cow’s milk was the most commonly used top milk
(23.5%). Knowledge about weaning was good but about demand feeding was poor. Doctors were
the preferred counselor (87.5%) and not enough breast milk was the main reason for discontinuing
breastfeeding. Mothers had good knowledge about breastfeeding practices. But there is a gap
between knowledge and practice which needs to be addressed. Doctors should play a key role in
educating nursing mothers as nursing mothers rely heavily on doctors for consultation.

Key words: Infant feeding, KAP, weaning.

INTRODUCTION In spite of this many beneficial effects of

breast milk breastfeeding rates in India are
Exclusive breastfeeding for six months as abysmally low4. Infant mortality rate (IMR) in India
recommended by WHO & American Academy of is 47/1000 live births with 1.4 million babies dying
Pediatrics (AAP) has a number of benefits to the every year due to poor care and infant feeding
growing infant. Breast milk in addition to calories practices. A lot of factors ranging from customs,
and proteins contain bioactive factors like IgA, practices, education of parents, support from family
lactoferrin, K-casein, cytokines, growth factors, and health workers play a role in successful
glutathione peroxides etc which have anti-infective, breastfeeding practices as recommended. Through
antioxidant, growth promoting properties1. Human this study we aim to assess the knowledge, attitude
milk protects from various acute and chronic and practices of mothers attending our hospital
conditions like diarrhea, otitis media, necrotizing regarding breast feeding. This information will help
enterocolitis, obesity, allergies, cancers etc us in devising specific interventions to promote
avoiding hospitalizations and reducing infant breastfeeding rates.
mortality 2 . Breast milk improves significantly
Intelligence Quotient, Brain size compared to
artificial feeds3.
196 CHINNASAMI et al., Biomed. & Pharmacol. J., Vol. 9(1), 195-199 (2016)

MATERIAL AND METHODS hourly (24.5%), two hourly (45%) intervals or

whenever required (17.5%).
After obtaining Institutional ethical
clearance, we conducted this observational study Table 4 caters data about breastfeeding
in SRM hospital, Tamilnadu from November 2015 problems and consultations. Preferred counselor
to December 2015. Two hundred mothers attending for breastfeeding issues was usually a doctor
pediatrics outpatient department were randomly (87.5%). Similarly 96% of times consultation during
selected. A structured questionnaire of twenty sickness was a doctor. Not enough breast milk
questions was prepared based on infant and young (37%) was the main reason for discontinuing
child feeding guidelines issued by Indian breastfeeding. Personal satisfaction about
government. After obtaining informed consent breastfeeding was very good for mothers (73%).
parents were asked to fill up this questionnaire.
Table 1: Demographic Details
Illiterate mothers were interviewed by volunteers
and their responses were filled up in the
Demographics Number
questionnaire. All the data were tabulated and
(Percentage)
analysed.

Age of Child <6mths 111(55.5%)

Questionnaire
>6mths 89(44.5%)
A questionnaire for assessing knowledge,
Gender of Child Male 101(50.5%)
attitude and practice of mothers on breastfeeding
Female 99(49.5%)
was prepared. Most of the questions were based
Type of delivery Vaginal 118(59%)
on the questionnaire used in the study of Sushma
Caesarean 82(41%)
et al5 and a total of twenty questions were included.

RESULTS Table 2: Education level of mothers

Table 1 shows the demographic details of Education Number (Percentage)

parents interviewed with 55.5% of their children
less than six months and equal representation from Illiterate 95(47.5%)
both sexes. Most of their children (59%) were born School education 101(50.5%)
vaginally. Table 2 describes the educational status Graduation 4(2%)
of mothers. A high percentage of them (47.5%) were
illiterate. While 50.5% of mothers finished their DISCUSSION
schooling, only 2% completed their college
graduation. In our study almost half of the mothers who
participated were illiterate but their knowledge to
KAP of breastfeeding is given in table 3. start early breastfeeding (80%) was good. Probable
Although 80% had the knowledge to initiate reason could be the positive impact of doctors being
breastfeeding within one hour of delivery, only the preferred choice as counselors (87.5%). Since
34.5% started giving breastfeeding so. A good mothers also rely on doctors for consultation during
number of parents (25%) felt that colostrum is bad sickness, doctors play an important role in
and 10.5% gave prelacteals before starting promoting good breastfeeding practices by setting
breastfeeding. A satisfactory 89% of mothers gave aside some time for health education. Just like our
exclusive breastfeeding and most of them (72%) study Oomen et al (2009)4 in their study found that
for six months. Those who didn’t practice exclusive doctor’s reinforcement was an important factor for
breastfeeding gave mainly cow’s milk (23.5%). continuation of breastfeeding.
Weaning as recommended was started from six
months of age by 91.5% of mothers. They also A Ghana based study5,6 has shown that
continued breastfeeding in addition to breastfeeding within one hour of delivery reduces
complimentary feeds. They gave breastfeeding at mortality by 22%. In our study although 80% had
 CHINNASAMI et al., Biomed. & Pharmacol. J., Vol. 9(1), 195-199 (2016) 197

the knowledge to start breastfeeding within one in Rajasthan8 66% of doctors preferred initiating
hour, only 34.5% initiated so early. Most of them breastfeeding on day one while 60% of nurses and
(57.5%) started breastfeeding 1-4 hours after 96% of class IV workers preferred on second or
delivery. There is a gap between knowledge and third day. Kumar et al (2006)9 in their study found
practice about initiation of breastfeeding. Health that 58.9% of mothers initiated breastfeeding before
programmes that only impart knowledge are not completion of six hours after birth.
enough.
Colostrum has been considered bad by
According to Karnawat et al (2015)7 only 25% of mothers and 10% have given prelacteals
about 50% had correct knowledge about timing of like sugar, honey. This increases the chances of
initiation of breastfeeding. In a hospital based study infection to babies. According to Yadav et al10 two

Table 3: Breastfeeding KAP

Attribute of Breastfeeding Number(Percentage)

Knowledge of time Within 1hr 160 (80%)

of starting BF 1-4 hrs 27(13.5%)
1-3 days 9(4.5%)
1 week 4(2%)
Practice of Time Within 1hr 69 (34.5%)
of starting BF 1-4 hrs 115(57.5%)
1-3 days 13(6.5%)
1 week 3(1.5%)
Knowledge about Good 150(75%)
colostrums Bad 50(25%)
Whether Prelactealsgiven? Given 21(10.5%)
Not given 179(89.5%)
Whether exclusive Yes 178(89%)
breastfeeding given No 22(11%)
Duration of exclusive 3 months 34(17%)
breastfeeding given 6 months 144(72%)
9 months 9(4.5%)
12 months 11(5.5%)
18 months 2(1%)
Top feeding used Packaged milk 17(8.5%)
Fresh Cow’s milk 47(23.5%)
Fresh Goat’s milk 10(5%)
Formula milk 10(5%)
None 116(58%)
When was Weaning 6 months 183(91.5%)
started 1 year 15(7.5%)
2 years 2(1%)
Was BF continuedafter Yes 187(93.5%)
weaning No 13(6.5%)
Frequency of 1 hr 49(24.5%)
Breast feeding 2 hrs 90(45%)
3 hrs 22(11%)
4 hrs 4(2%)
Whenever required 35(17.5%)
198 CHINNASAMI et al., Biomed. & Pharmacol. J., Vol. 9(1), 195-199 (2016)

thirds of nursing mothers didn’t give colostrums. fact that breastfeeding can be given ad libitum
15.9% of respondents in Kumar et al (2006)9 study should also be taught as only 17.5% knew this. In a
threw away colostrums and 40% of them gave Delhi based study Taneja et al (2003)12 reported
prelacteals. 43% of mothers in Ben Slama et al11 that although 90.6% of mothers breastfed their
study didn’t have any knowledge about colostrum. infants till six months, exclusive breastfeeding was
not practiced in majority (26.4%). Medhi & Mahouta
Eleven percentage of mothers didn’t (2004) et al13 reported 100% breastfeeding rates
exclusively breastfeed their child and 17% of them with 69.35% of it being exclusive for six months.
gave breast milk exclusively only for three months. Exclusive breast feeding rates by foreign studies
Mothers should be educated about the benefits of were 36.8% (Ben Slama et al11) in Riyadh and 22.4%
exclusively breastfeeding till six months. Also the (Yesildal et al14) in Turkey. According to Karnawat et

Table 4: Breast feeding problems

Question Number (Percentage)

Counsellor to disccuss BF issues Doctor 175(87.5%)

Nurse 20(10%)
Relative 5(2.5%)
If stopped BF early, reason for stopping No breast milk 74(37%)
Baby didn’t drink 26(13%)
Mother became pregnant 6(3%)
Baby became sick 2(1%)
Mother became sick 6(3%)
Didn’t stop BF 86(43%)
Consultationduring sickness Doctor 192(96%)
Relatives 6(3%)
Friends 2(1%)
Mother’s Satisfaction about BF Fully Satisfied 146(73%)
First satisfied, now not 42(21%)
Initially not, but later yes 4(2%)
Satisfied 8(4%)
Duration of Burpingafter BF 5 min 87(43.5%)
15 min 38(19%)
30 min 7(3.5%)
Till burping 68(34%)

al (1987)8 demand feeding was preferred by 77% of weaning like type of foods, quantity and frequency
of lower class workers while 62% of doctors which we didn’t include would have been more
preferred timed feeding. useful. Oomen et al (2009)4 in his study found 55%
usage of formula feeds which was much higher
When top feeding was used, mothers than our study (5%). According to Karnawat et al
relied on cow’s milk (23.5%), formula milk (5%) and (2015)7 20% of all mothers had correct knowledge
packaged milk (8.5%). Hence health education about weaning age and in Yadav et al’s study
should also include appropriate and safe usage of (2004) 10 only 55% correctly practiced weaning
artificial feeds. Weaning was started appropriately between six to twelve months. While Taneja et al
after six months in 91.5% of infants and breast (2003) 12 showed 40% of mothers improperly
feeding was continued even after weaning by weaning before infant reaches four months.
93.5% of mothers. Study probing further into details
 CHINNASAMI et al., Biomed. & Pharmacol. J., Vol. 9(1), 195-199 (2016) 199

Not enough breast milk (37%) and baby (2009)4 similar to our study reported that perceived
didn’t drink well (13%) were the main reasons for insufficiency of milk was the main factor behind
stopping breastfeeding. This could have been discontinuation of breastfeeding.
tackled by giving hands on practical training through
lactation workshop and appropriate support by ACKNOWLEDGEMENTS
health workers during the time of need. Overall 73%
of mothers were satisfied with the way they provided We would like to express our gratitude to
breastfeeding to their children. Our aim should be the mother who enthusiastically participated in filling
to reach 100% satisfaction of mothers. Oomen et al up the questionnaire.

REFERENCES

1. Hamosh M. Bioactive factors in human milk. Chaudhary SP. Knowledge and attitudes of
Pediatric Clinics of North America 48(1):69- hospital employees regarding infant feeding
86 (2001). practices. Indian Pediatr 24: 939-48 (1987).
2. Hanson LÅ. Human milk and host defence: 9. Kumar D, Agarwal N, Swami HM. Socio-
immediate and long term effects. Acta demographic correlates of breastfeeding in
Paediatrica 88(s430): 42-6 (1999). urban slums of Chandigarh. Indian J Med.
3. Isaacs EB, Fischl BR, Quinn BT, Chong WK, Sci 60:461-66 (2006).
Gadian DG, Lucas A. Impact of breast milk 10. Yadav RJ and Singh P. Knowledge attitude
on intelligence quotient, brain size, and white and practices of mothers about breast
matter development. Pediatric research feeding in Bihar. Indian J Community Med
2010;Apr 1;67(4):357-62. 29(3):130-31 (2004).
4. Oommen A, Vatsa M, Paul V, Aggarwal R. 11. Ben Slama F, Ayari I, Buzini F, Belhadj O,
Breastfeeding practices of urban and rural Achour N. Exclisive breastfeeding and mixed
mothers. Indian Pediatr 46: 891–4 (2009). feeding- knowledge, attitudes and practices
5. Sriram S, Soni P, Thanvi R, Prajapati N, of premiparous mothers. East Mediterr
Mehariya KM. Knowledge, attitude and Health J 16(6): 630-35 (2010).
practices of mothers regarding infant feeding 12. Taneja DK, Saha R, Dabas P, Gautam VP,
practices. National Journal of Community Tripathy Y, Mehra M. Study of infant feeding
Medicine 3(2) (2013). practices and the underlying factors in a rural
6. Edmond KM, Zandoh C, Dingley MA, areas of Delhi. Indian J Community Med 28:
Amenga Etega S, Weesee Agyei S, 107-11 (2003).
Kirkwood BR. Delayed breastfeeding 13. Medhi GK and Mahauta J. Breastfeeding
initiation increases risk of neonatal mortality. weaning practices and nutritional status of
Pediatrics 117: e380-86 (2006). infants of tea gardens of Assam. Indian
7. Divya Karnawat, B S Karnawat, Avadhesh Pediatr 41: 1277-78 (2004).
Joshi, G. Kalsi Kohli Knowledge, attitude & 14. Yesildal N, Aytar G, Kocabay K, Mayda AS,
practices about infant feeding among Dagil SC and Bahcebasi T. Breastfeeding
mothers of urban & rural areas of Ajmer practices in Duzce Turkey. J Hum Lact 24:
district J. Med. Res 1(3): 90-94 (2015). 393-400 (2012).
8. Kar nawat BS, Singh RN, Gupta BD,