ASSESSMENT OF KNOWLEDGE

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS COLOSTRUM MILK BREASTFEEDING AMONG POSTNATAL MOTHERS INYEKATIT 12 HOSPITAL MEDICALCOLLAGEADDIS ABABA, ETHIOPIA
INVESTIGATOR: – Kalkidan Abera – Hanna Aydefruhim
– Azeb SissayAdvisor; Mr. Mulualem (BSC, MSC)
June 2018
ADDIS ABABA, ETHIOPIA

Contents
Table of content…………………………………………………………………………………………………………………………………. 2
TOC o “1-3” h z u Absract…………………………………………………………………………………………………………………………………………………. 4
Objectives …………………………………………………………………………………………………………………………………………..… 4
Methods………………………………………………………………………………………………………………………………………………… 4
Acknowledgement………………………………………………………………………………………………………………………………….5
Acronyms ……………………………………………………………………………………………………………………………………………… 6
Dummy table ………………………………………………………………………………………………………………………………………… 7
1. Back ground81.1introduction81.2 Statement of the problem91.3. SIGNIFICANCE OF THE STUDY PAGEREF _Toc482718220 h 122 LITRATURE REVIEW13 2.1knowledge of the mothers on colostrum breast milk PAGEREF _Toc482718223 h 132.2Attitude of mothers on colostrum breast milk132.3Colostrum feeding practice143. Objective of the study PAGEREF _Toc482718227 h 163.1 GENERAL OBJECTIVES PAGEREF _Toc482718228 h 163.2 SPECIFIC OBJECTIVES PAGEREF _Toc482718229 h 164. Methods and materials PAGEREF _Toc482718231 h 174.1 study design PAGEREF _Toc482718232 h 174.2 Study area and period PAGEREF _Toc482718233 h 174.3 Populations PAGEREF _Toc482718234 h 174.3.1 Source of Population PAGEREF _Toc482718235 h 174.3.2 Study Population PAGEREF _Toc482718236 h 174.4 Inclusion criteria…………………………………………………………………………………………………………………………174.4.1 Exclusion Criteria18
?Mothers who were chronically ill and unable to communicate during data collection.184.5Sampling Procedure and Sample Size184.5.1 Sample Size184.5.2 Sampling Procedure184.6 Study Variables194.6.1 Independent Variables-194.6.2 Dependent variables194.7 data collection tools and procedures194.8 Data Processing and analysis194.9 Ethical Consideration194.10 Plan for dissemination of results204.11 OPERATIONAL DEFIINITION20REFERENCE———————————————————————————————————————–33ANNEX I……………………………………………………………………………………………………………………………….……………….35
ANNEX II ..………..……………………………………………………………………………………………………………………………………42

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ACRONYMSANC Anti Natal Care
ART Anti-Retroviral Therapy
EBF Exclusive Breast Feeding
EDHS Ethiopian Demographic Health Serves
FMOH Federal Ministry of Health
HIV Human Immune Virus
ICU Intensive Care Unit
UNICEF United Nation Children’s Fund
Vit A Vitamin A
WHO World Health Organization
Back ground
1.1 IntroductionColostrum is the first milk produced by the mammary glands of mammals in late pregnancy just prior to giving birth and continuing through the early days of breastfeeding (1).

It is gold or bright yellow in color, and has a sticky, thick consistency. Because of its very rich in proteins, carbohydrates, vitamin A, and sodium chloride, but contains lower amounts of lipids and potassium than normal milk (2). Newborns have premature digestive system which suits the low-volume concentrated form of nutrient supply system of colostrum’s. The laxative effect of colostrum encourages passage of baby’s first stool, meconium. This helps to clear excess bilirubin which is produced in large quantities at birth and helps prevent jaundice. It contains various immunoglobulins like IgA (reactive to Escherichia coli virulence associated proteins), IgG and IgM (3). Other immune components of colostrum are lactoferrin, lysozyme, lacto peroxidase, complement and pralines-rich peptide (PRP). It also contains various cytokines and growth factors. PRP helps fight against various viral infections like herpes viruses and HIV, bacterial and viral infections which are difficult to treat, various cancer, asthma, allergies and autoimmune diseases. It helps to reduce one of the leading causes of death in our country like diarrhea and ARI (4).

Babies who are feed nothing but breast milk from birth through the first six months of life get the best start. Colostrum provides babies the perfect nutrition and everything they need for healthy growth and brain development. However, there is a lack of understanding of the importance of and poor adherence to exclusive breastfeeding for the first six months postpartum among mothers.Colostrumshould be made a baby’s first taste and there should be no prelacteal feeds such as fenugreek water, water with sugar, thin gruel, other liquids, or ritual foods. In Ethiopia, colostrum (Inger) and breast milk were seen as different substances. Colostrum was said to cause abdominal problems, but discarding a portion wassufficient to mitigate this effect. A majority of mothers discarding colostrum and breast-feeding within 24 hour of birth. Attention to feeding practices is important because inadequate knowledge about appropriate foods and feeding practices is more often a cause of malnutrition than lack of food (5).

1.2 Statement of the problemColostrum is an importance topic in health education because of the many benefits that can be gained for babies, mothers, and communities. For example, the components of Colostrum provide the needed nutrition for babies and boost the baby’s immune system.

Also practicing colostrum fed helps mothers stimulates the uterus to return to its previous position before pregnancy (6).

The importance of colostrum is known to the limited population. There are still many
people who believe that colostrum is a harmful substance which should be discarded. It is thought to be an unwanted substance related with ill health. There are certain barriers
perverting the feeding of colostrum to the new born babies. Maternal barriers – Many mothers lack knowledge about the importance of early initiation of breastfeeding and the benefits of colostrum feeding (7).

Some mothers dislike the color of colostrum. They even discard it themselves and also on the advice of in-laws. There is also misinterpretation that breast milk doesn’t come in the first few days after delivery and it is insufficient for the baby’s needs. Prolonged labor and surgical deliveries are also the hindrance to colostrum feeding. Neonatal barriers- Neonatal illness is one of the major barriers to colostrum feeding. Some babies are not able to suck breast milk due to illness, deformities or other reasons (8).
Bathing baby and mother after birth delays initiation of breastfeeding. Lack of family support, discouragement for early initiation of breastfeeding by traditional birth attendants, decision made by family members to give other fluids are some important barriers to colostrum’s feeding. This study was initiated to assess the knowledge, attitude and practice of colostrum feeding in postnatal mothers who have visited a teachinghospital. The study will also do with an aim to create awareness regarding importance of colostrum’s feeding among the postnatal women. The objective of the study was to find awareness of the importance of colostrum feeding for postnatal mothers (9).

The World Health Organization (2003) described that malnutrition has been responsible, directly or indirectly for 60% of the 10.9 million deaths annually among children under five worldwide. Over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life (10).

Although breastfeeding is practiced by 96% of children in Ethiopia as stated by the Federal Ministry of Health, Family Health Department (2005), studies found that the practices were not optimal. For instance, practice of pre-lacteal feed was common. Similarly, Mussie et al. (2014) stated that 45% of respondents did not feed colostrum and 72% were giving other than breast milk in the first three days of birth. In addition, the Federal Ministry of Health, Family Health Department (2005) also stated that the median duration of exclusive breastfeeding in Ethiopia was 2.5 months, varying from 1.8 months in urban to 2.6 months in rural area (8).

Several reasons for these poor practices of breastfeeding in Ethiopia were identified by United Nations Children’s Fund (2004), which included the traditional and cultural beliefs of the society, low education levels, heavy workload of mothers and poor sanitary conditions and poverty. However, Tan (2009) said that in order to improve the rates of colostrum breastfeeding, specific information about the beliefs and practices that influence this outcome was needed (9) .IN NEPAL Teaching hospital studiesfrom100 antenatal mothers were interviewed during the study represents about 90% women have heard about colostrum among which 15% received information through media. 30% got to know about it from family and friends. Antenatal visits helped 35% of them, and10% of women got to know about it from other sources and 10% of them did not know about colostrum feeding.

Highlights the myths and misconception of women regarding colostrum feeding. 40% women answered that breast milk is not enough to satisfy the baby, 37% said that gutty is the part of our tradition and better than first milk, 12% women said due to nipple pain theydon’t like to feed. 6% women said that baby is not able to suck properly and not satisfied and 6% women said that they do not like the color of colostrum and need to give supplement feeding. We have lower percentage of women who have knowledge on the importance of colostrum compared to few other studies done in this region (10).

The knowledge of the mother regarding the importance of colostrum feeding. 10% women
answered that this is just a 15% asked first breast milk to be discarded, only 25% women said that this is the milk to be fed the new born, whether 35% women perceived that there is something which is harmful for the new born, only 15% women asked that there is something extra for good health and it also prevent the neonate from infectious diseases.

Only 14% percent of the women knew that the appropriate time for feeding colostrum
is immediately after the birth (1/2 – 1 hour), Whereas 86% of women starts feeding within 6 – 24 hrs (7).

There is a huge gap in the practices of colostrum feeding. Special attention is needed by the health care workers for pregnant women.

IN ETHIOPIA East Gojam zone Debremarkos Town health institution research About 290(76.72%) of mothers have good knowledge about colostrum breast milk. About 299(79.10 %) women heard about colostrum from various sources. Majority of heard about colostrum and its importance from health institutions. About 298 (78.84%) had favorable attitude towards colostrum breast milk. And 50(13.23%), 65(17.20%), 72(19.05%) believed that colostrum causes intestinal obstruction, diarrhea and it is difficult to digest which needs to be discarded respectively. And 293 (77.51%) have good practices of colostrum feeding. While 299(79.10%) feed colostrum for their babies, 79(20.9%) did not feed their babies colostrum but other pre-lacteal feeds (6).

Colostrum milk Breastfeeding is associated with a lower incidence of infant diarrhea and respiratory disease, particularly in less developed countries. An ecological study on colostrum breastfeeding showed that more than half of all infant deaths from diarrhea disease and acute respiratory infections are preventable by colostrum milk breastfeeding in infants.’WHO 1996′
As far as the literature search showed there are very limited study done KAP of colostrum feeding among postnatal mothers. Majority of the findings are focused on complementaryand exclusive breast feeding practices. Therefore, this cross-sectional study will be conductedto assess knowledge, attitude and practice of post-natal mothers towards colostrum breast milk feeding in Yekatit 12 Hospital.

1.3. SIGNIFICANCE OF THE STUDYThe extent level of knowledge, attitude and practice towards colostrum breast milk among mothers may vary by individual, social and demographic characteristics are not well understood. So that our study will contribute to understand level of knowledge, attitude and practice towards colostrum breast milk among mothers which is useful for program designing by addressing pertinent information. The information generated by this study will be used by policy makers, local managers, health professionals to promote and provide good awareness for mothers about the benefit of colostrum breast milk for their infants.

Therefore, the aim of this study is to assess the current knowledge, attitude and practice of colostrum’s breast feeding in yekatit 12 Hospital and the significance of this research is to identify mothers gap regarding colostrum’s breast feeding practice and to recommend the woreda health office, sub cities and the health center on formulation of appropriate interventions on factors contributing to low prevalence of colostrum’s breast feeding practices.

2. LITRATURE REVIEWThe overall breastfeeding prevalence rate to the index child in the study subjects was 96.1 % (393); among them, 84.5 % of the mothers fed colostrum to their children and pre-lacteal feeding was practiced by 16.1 % of mothers. Regarding time of breastfeeding initiation, only 256 (62.6 %) of mothers have initiated breastfeeding immediately within one hour following their delivery. Whereas, the rest 153 (37.4 %) of participants did not initiate breastfeeding timely, since about 97 (23.7 %) initiated breastfeeding after one hour up to one day followed by after one day to three days 23 (5.6 %), after three days 17 (4.2 %) and 16 (3.9 %) of participants never initiated breastfeeding until the time of data collection(8)
.

2.1knowledge of the mothers on colostrum breast milka cross-sectional study, conducted in Combined MilitaryHospitalRawalpindi of Pakistan and shows the knowledge of the mother regarding the importance of colostrum feeding. 10% women answered that this is just a 15% asked first breast milk to be discarded, only 25% women said that this is the milk to be fed the new born, whether 35% women perceived that there is something which is harmful for the new born, only 15% women asked that there is something extra for good health and it also prevent the neonate from infectious diseases (8).

2.2 Attitude of mothers on colostrum breast milkThe importance of colostrum is known to the limited population. There are still many people who believe that colostrum is a harmful substance which should be discarded. It is thought to be an unwanted substance related with ill health. There are certain barriers perverting the feeding of colostrum to the new born babies9,10. Maternal barriers – Many mothers lack knowledge about the importance of early initiation of breastfeeding and the benefits of colostrum feeding. Some mothers dislike the color of colostrum. They even discard it themselves and also on the advice of in-laws. There is also misinterpretation that breast milk doesn’t come in the first few days after delivery and it is insufficient for the baby’s needs. Prolonged labour and surgical deliveries are also the hindrance to colostrum feeding. Neonatal barriers- Neonatal illness is one of the major barriers to colostrum feeding. Some babies are not able to suck breast milk due to illness, deformities or other reasons (10).

Other barriers: Bathing baby and mother after birth delays initiation of breastfeeding. Lack of family support, discouragement for early initiation of breastfeeding by traditional birth attendants, decision made by family members to give other fluids are some important barriers to colostrum’sfeeding. This study was initiated to assess the knowledge, attitude and practice of colostrum feeding in pregnant women who have visited a teaching hospital. The study was also done with an aim to create awareness regarding importance of colostrum feeding among the pregnant women. The objective of the study was to find awareness of the importance of colostrum feeding in pregnant women.(9)
2.3Colostrumfeeding practice
Though colostrum has been proved beneficial to the new born babies, studies have revealed that breast feeding mothers and the other family members do not have adequate knowledge about it, thus, preventing the infants from acquiring this nutritional food.  A study in India revealed that mothers were unaware about the time of initiation of breastfeeding and colostrum feeding (7). Only 92% and 70% women undergoing normal delivery and caesarean section respectively gave correct response about time of initiation of breastfeeding. Though 92% of the mothers knew that breastfeeding should be initiated within one hour after delivery, only 36% of them had actually done so. It also showed that 52% of the mothers did not receive any advice on breastfeeding during antenatal period. A similar study conducted in the eastern part of Nepal on knowledge, attitude and practice of mothers regarding breast feeding showed that though all mothers knew that they had to breastfeed their babies, they did not have knowledge about the appropriate timing for breastfeeding and colostrum feding. None of the mothers got advice regarding breast feeding and colostrum feeding during ANC visits. Forty-four percentages of the respondents had previous children out of which 80% fed their previous children with colostrum and 90% of those children have not suffered from any serious illness (8).
Accordingto a study of Bhaktapur, Nepal 91% was given colostrum. In the study from Dharan, though only 25% mothers had knowledge on benefits of first milk, in practice nearly 95% fed colostrum to their babies. Colostrum feeding rate in Nepal was 69% according to data given by NDHS 2006. The Kuwait study shows that less than 1 in 5 infants (18.2%) received colostrum as their first feed.  According to the study from southern Zambia, none of the urban mothers reported having expressed and discarded the colostrum. In the rural focus groups, a few of the mothers reported having expressed the colostrum and discarded it; however, most of the rural mothers claimed that they gave the colostrum (11).
Regarding views on comparison of children fed with colostrum with those not fed, 56% felt that colostrum fed children are healthier while 8% said that it doesn’t make any difference. Some of the women (8%) were aware about the diseases that can be transmitted through breastfeeding. Majority of the women (89%) said that they would feed their upcoming child with colostrum while the remaining replied it would depend on the situation at that time and would do what the doctors, nurses or relatives suggest. Efforts made by the Government of Nepal to create awareness about importance of colostrum feeding were appreciated by some 27 % women while the rest 73% suggested for further improvements. Every respondent of the study assured that they would put some efforts to create awareness about colostrum feeding to the expecting mothers in the family and community as they have realized colostrum is essential to feed. Knowledge on colostrum feeding correlated with higher age of marriage, higher age of pregnancy, better maternal education, higher socioeconomic status and antenatal care from tertiary care centers and private practitioners. Working women had better knowledge on colostrum feeding and maternal education remained important with regard to awareness about the importance of colostrum feeding (12).
There is still a need for programs which support and encourage colostrum feeding particularly at a primary care level, focusing more on younger, less well-educated women and those from lower socioeconomic class because several barriers to colostrum feeding still exist. Many mothers lack knowledge about the importance of early initiation of breastfeeding and are not aware about the advantages of colostrum feeding. Some feel that colostrum looks bad. They even discard it on the advice of mothers-in-law. There is also misinterpretation that breast milk doesn’t come in the first few days. Some mothers feel that it is insufficient for the baby’s needs and water is necessary. Prolonged labor and unconscious state are also the hindrance to colostrum feeding.  Neonatal illness is also one of the main barriers to colostrum feeding. Some babies are not able to suck breast milk due to illness, deformities or other reasons.  Bathing baby and mother after birth also delays initiation of breastfeeding. Lack of family support, discouragement for early initiation of breastfeeding by traditional birth attendants, decision by family members to give other fluids are some important barriers to colostrum feeding (10).
The study shows that many Nepalese women were aware about colostrum feeding practice which is appreciable.  This study has been conducted in a tertiary level teaching hospital located in Kathmandu and the sample size is also limited as it was a part of the research training of the undergraduate medical students. We could get different results if we had conducted the same study in the rural hospitals as there are still many women who lack idea regarding colostrum, majority being uneducated and unaware about colostrum feeding practice. Many women receive the information about colostrum via various Medias and during their ANC visits in various hospitals through doctors and health workers which might be the reason of improved practice of colostrum feeding in urban areas. Similarly, in rural areas Female Community Health Volunteers could contribute for the improvement in knowledge, attitude and practice towards colostrum feeding. Government is trying to create awareness about the importance of colostrum through various Medias but still has not reached in rural parts of Nepal (9).

3. Objective of the study3.1 GENERAL OBJECTIVESThe general objective of this study is to asses’ knowledge, attitude and Practice towards colostrum’s breast –feeding among postnatal mothers in Yekatit 12 hospital, Addis Ababa, Ethiopia
3.2 SPECIFIC OBJECTIVESTo determine knowledge of postnatal mothers towards colostrum’s breast –feeding in Yekatit 12 hospital
To asses attitude of postnatal mothers towards colostrum’s breast –feeding in Yekatit 12 hospital
To determine practice of postnatal mothers towards colostrum breast –feeding in Yekatit 12 hospital
4. Methods and materials4.1 Study designA Cross Sectional study was conducted to asses’ knowledge, attitude and practice towards colostrum milk breast- feeding among postnatal mother in Yekatit 12 hospital
4.2 Study area and periodThe study was conducted inYekatit 12 hospital medical college. Which provides Health services, maternal and child health program ranging from prenatal, delivery and Postnatal maternal cares, including intensive care unit (ICU)for new born baby (neonates) in the woreda. Among these unit (wards) postnatal ward provide safe feeding and maternal checkup for the last 6hours after delivery.
Yekatit 12 Hospital medical college is one of the referral hospital in Ethiopia. Found around 6 Kilo and have a lot of department like Gynecology and obstetrics, NICU unit, pediatrics, medical surgical, dental, burn unit, physiotherapy and so on…Especially specialized in burn unit and Gyn and obstetrics department.

Yekatit 12 Hospital medical college have more than 500 workers and 13 health center catchments like kebena, kotebe, janmeda, michew, shiromeda, afinchober, bahta, and so on….

4.3 Populations4.3.1 Source of PopulationAll mothers who are in the postnatal ward of Yekatit 12 Hospital
4.3.2 Study PopulationAll mothers who are in the postnatal ward of Yekatit 12 Hospital,
Study unit
Postnatal mothers at Yekatit 12 Hospital are randomly selected.

4.4 Inclusion criteriaAll Postnatal Mothers in Yekatit 12 hospital,
4.4.1 Exclusion CriteriaMothers who were chronically ill and unable to communicate during data collection.Mothers who did not give their consent for participation
4.5Sampling Procedure and Sample Size4.5.1 Sample SizeSample size is calculated using the single population proportion formula
n= (Z/2)2 P (1-P)
d2
n= (1.96)2 *0.5 (0.5) = 384, in consideration with five percent non-respondent rate the sample size become
(0.05)2
= 403
Where= P= Proportion of mothers who presumed to feed their babies a colostrum
d= Margin of error (5%)
z/2= Critical value at 95% confidence level (1.96)
n= Calculated sample size
4.5.2 Sampling ProcedureA simple random technique was used to select volunteer mothers till sufficient numbers of respondents are got.

4.6 Study Variables4.6.1 Dependent variablesKnowledge of mothers regarding colostrum feeding
Attitude of mothers regarding colostrum feeding
Practice of mothers regarding colostrum feeding
4.6.2 Independent Variables-
Age, Religion, Ethnicity, Educational Status, Marital Status, Economic Status, Occupational Status, Parity, History of ANC follow up, Mode of delivery and History of Abortion are our independent variables
4.7 data collection tools and proceduresA structured questionnaire which contains questions with sub sections of socio demographic data, obstetric history, knowledge about colostrum milk feeding, attitude about colostrum milk feeding and colostrum feeding practice will be used to collect data from respondents. The questionnaires are prepared in English and translated to Amharic. The study team was collected the data from the mothers after making sure that they are willing and got a verbal consent. In order to collect a quality data an interviewer was collect a data from a mother at a time.

4.8 Data Processing and analysisAfter the Data is collected it will be checked for completeness, consistency and cleanness on a daily basis. Data Processing werebedone manually by using scientific calculators. For analysis, descriptive quantitative Statistics was used and presented by tables, charts with numbers and percent.

4.9 Plan for dissemination of results Overall result was disseminated to Addis Ababa university department of nursing and midwiferyand copy of the research will be given to Yekatit 12 hospital medical college and for anyone interested.

4.10 Terms and operational definition
Knowledge – is a familiarity, awareness or understanding about colostrum breastfeeding which is acquired through experience or education.
Attitude – a predisposition or a tendency to responds positively or negatively towards a certain idea/situation (regarding colostrum breastfeeding).
Practice – a method, process and rules that mothers implemented on colostrum breastfeeding of their babies regarded as the standards.
postnatal Mother – a mother who is registered, delivered in yekatit 12 Hospital.
Initiation – the term used to describe starting colostrum breastfeeding with in one hours after delivery.

REFERENCE
Dr. Sunil Kumar Joshi , Ms. BinuragBarakoti, Ms. SudeshnaLamsal. Knowledge, Attitude and Practice in Pregnant Women in a Teaching Hospital in Nepal01 Aug 2012.Rifat Aisha, FakharBatool, Saema Sultana. Knowledge, Attitude and Practices about Colostrum Feeding among Pregnant Women in Military Hospital Rawalpindi of Pakistan28 December 2015; accepted 25 April 2016; published 28 April 2016.

Kuzma J (2013) Knowledge, attitude and practice related to infant feeding among women in rural Papua New Guinea: a descriptive, mixed method study. International breastfeeding journal 8(1): 1
Gualu T, Adugna H, Dilie A (2017) Assessment of Knowledge, Attitude and Practice ofPost Natal Mothers towards Colostrum Breast Milk in DebreMarkos Town Governmental Health Institutions East Gojjam Zone, Amhara Regional State, Ethiopia. Nurse Care Open Acces J 2(2): 00034. DOI:10.15406/ncoaj.2017.02.00034
Maeza Mitiku Asfaw, Mesele Damte Argaw and Zelalem Kebede Kefene. Factors associated with exclusive breastfeeding practices in DebreBerhan District, Central Ethiopia: a cross sectional community based study, International Breastfeeding Journal6 August 2015
Legesse M, Demena M, Firehiwot M. Factors associated with colostrum avoidance among mothers of children aged less than 24 months in Raya Kobo district, north-eastern Ethiopia: community-based cross-sectional study. J Trop Pediatr. 2015;61(5):357–63.View ArticlePubMedPubMedCentralGoogle Scholar Heather Fisher Senior Thesis Project (2000) Colostrum: Properties, Functions, and Importance: The Relationship between the Immunoglobulin Concentration in Holstein Colostrum and the Total Senlm Protein in Holstein Heifer Calves.

Rogers NL, Abdi J, Moore D, Ndiangui S, Smith LJ, et al. (2011) Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in ruraRogers NL, Abdi J, Moore D, Ndiangui S, Smith LJ, et al. (2011) Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia. Public Health Nutr 14(11): 2029-2036
Joshi SK, Barakoti B, Lamsal S (2012) Colostrum feeding: knowledge, attitude and practice in pregnant women in a teaching hospital innepalHolman DJ, Grimes MA (2001) Colostrum feeding behaviour and initiation of breast-feeding in rural Bangladesh. J BiosocSci 33(1):139-155
Science Daily (Homepage on the Internet). Colostrum. http://www.sciencedaily.com/articles/c/colostrum.html Science Daily (Homepage on the Internet). Colostrum.http://www.sciencedaily.com/articles/c/colostrum.htmlwww.sceince daily.com/articles/c/colstrum.hml
Amy Gates (2014) Multicultural Beliefs About Colostrum. Pediatrics
feeding among women in rural Papua New Guinea: a descriptive,
Kulski, J.K. ; Hartmann, P. E. (1981).Australia Journal of experimental biology and Medical Science 59.

Rattigan, S., Ghisalberti, A. V. ; Hartmann, P.E. (1981). British Journal of Nutrition 45, 243-249.

Whiteheads, R.G. 91982). Maternal Diet, Breastfeeding capacity and Lacrationalinfertility.The United Nations Whiteheads, R.G. ; Paul, A.A. (1981).Lancet ii, 161-163.

Krammer MS, et al. proton of breast feeding intervention trial (PROBIT). A randomize trial in the Republic of Belarus. JAMA 2001; 285:413-20.

Annex I Questionnire (English)
Instructions
Hello, we are fourth year degree BSC nurse students at Rift Valley university. We do our research only on women at post natal ward about Colostrums milk use and practice. To make this study useful please answer each question carefully. Your answer will be kept confidentially. No need of mentioning your name on this questionnaire. Be sure for your reading instructions correctly before giving answer for each question. This questionnaire is not examination. There is right or wrong answer. But make sure that you have read the question and circle each answer correctly. Thank you for your corporation.

Are you willing to answer the questions
Yes……………………..Go to next page
No……………………….Thank you
Part one: – Below socio demographics questioner
Your Age
1. 15-20 3. 26-40
4. above 41
2. 21-25
Educational status
Can read and righting3. Primary school
Cannot writing and reading4. Secondary school5.above Other__________
Marital status
Married 3. Divorced
Unmarried4. Widowed 5. Other____________
Religion
Orthodox3. Protestant
Catholic4. Muslim5. Other___________
Ethnicity
Amhara3. Tigre
Oromo4.Gurage5. Other____________
With whom you are now living
With parents (father ; mother)3. With friends
With relatives4. With hath band
5. Other _______________
Occupation status
House wife Governmental employee
Non-Gov’t employee3. Governmental employee 4. Unemployed 5. Other__________

Your monthly income
—————————————————————
Part Two: – Past obstetrics history questioner
Number of pregnancy
————————————————————-
Including this neonate how many child you have?
One child3. Three children
Two children4. Four and above children
Other/specify__________________________
During this pregnancy did you have Antenatal care (ANC)?
Yes
No
4 for how many times ? 1 one 3 three
2 two 4 four and above

5 From Que. 3 in no, what was the reason?
1ack of health facility in my living area
Afraid of visiting health facility
Lack of knowledge
Other/specify_______________________
6 During this pregnancy with what kind of mode of delivery your give birth?
Spontaneously vaginal delivery
Instrumental delivery
3 Caesarean section (operation)7Did you have history of still birth?
Yes 2. No
8 From Que. 9 if yes, what was the reason for still birth?
Fetal distress during labourIntra uterine fetal death (IUFD)
Fetal hypothermia
Lack of breast after birth
Part 3 – Knowledge, Practice, and attitude of mothers towards colostrums milk
(Knowledge)
Did you know the advantage of breast-feeding?
Yes2. No
2 did u know in what time interval u have to give breast feeding?
1 3times per day 3 on demand
2 8 times per day 4 with in 2 hour
3 did you know the pre condition before you giving breast feeding?
4 how do you know your baby is not oniy feeding and also getting complementary foods?
——————————————————————————————————–
5From where did you get information about breast-feedings?
From mass media3. From health facility
From friends4. From reading
6 Do you know not give any other complementary food before 6 month for your baby?
Yes2. No
7 Do you have knowledge about colostrums milk breast-feeding?
Yes2. No
8 when did you give colostrums milk breast feeding?
1 with in 1 hour 3 with in 4-6 hour
4 after 8 hour
2 with in 2-3 hour
9 if your answer is yes do you know what kind of minerals have in colostrums milk?
1 carbohydrate 3 vitamin
2 protein 4 all of the above
10 do you know what kind of color have colostrums milk?
1 golden color 3 yellow color
2 white color 4 1 and 3 are answers
11 do you know after delivery giving breast milk with in one hour is one of the protection of post partum bleeding?
1 Yes 2 No
12 what is the main use of colostrums breast feeding?
1 protections of disease 3 use for agile
2 protection of vomiting and diarrhea 4 use for fast growth
(Practice)
13 After delivery when colostrums breast-feeding practice?
Yes2. No
14 If yes when you have to start colostrums breast feeding practice?
Within 1 hr after delivery3. Within 4-6hrs after delivery
Within 2-3hrs after delivery4. After 8hrs of delivery
15 How frequent feed for your baby?
3 times a day3. 8 times a day
5 times a day4. On demand
16 Did you feed your baby until know?
Yes 2. No
17 If no what is the reason not breast-feeding your baby?
I am HIV infected patient and don’t want transmitted to my baby
My baby is unable to suck my breast nipples
My breast does not have sufficient milk secretion
My baby is referred to neonatology care unit
(Attitude)
18 Do you agree on the attitude of not give any other nutritious but only breast-feeding application for your baby before 6 month age of the baby?
Yes (agree)2. No (disagree)
19 Do you agree giving breast feeding have dis advantage for mother and baby?
1 Yes (agree) 2. No (disagree)
20 Do you agree until 6 month giving breast milk with in 6 -8 times per day?
1 Yes (agree)2. No (disagree)
21 Do you think traditional believe have negative impact on how breast-feed your baby?
Yes 2. No
22 Do you agree that colostrums milk can prevented serious health problems and increase the immunity to fight infection in the future like of your baby?
Agree2. Disagree
23 is there any difference between a child taking formula milk and breast feeding ?
1 yes 2 No
24 Do you support the attitude of towards breast-feeding can serve as contraceptive method and prevent bleeding after delivery?
I support2. I don’t support
Annex II Questionnire (Amharic)
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