BYWACHIRA DANIEL NGARI (BSc. Food Nutrition and Dietetics)

 

Supervisor: PROF. J. K. IMUNGI, PhD  

A RESEARCH PROJECT PROPOSAL SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF

MASTER OF SCIENCE IN APPLIED HUMAN NUTRITION OF THE UNIVERSITY OF NAIROBI.

2014 

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CHAPTER ONE: INTRODUCTIONBackground of the StudyThe World Health Organization (WHO)

recommends Exclusive breastfeeding (EBF) of

infant where they receives only breast milk

without other liquids or solids are given (not

even water) with the exception of drops/syrups

of vitamins, or oral rehydration solution,

minerals and or medicines for the first six

months of life5

Cont…

This is because breast milk is known to

protect against common childhood diseases

such as diarrhea and pneumonia, the two

primary causes of child mortality worldwide.

It is also believed to have long term benefits

such as lowering mean blood pressure and

cholesterol, and reducing the risk of type-2

diabetes and obesity.6

Cont….Globally, EBF rate is just under 40% . Analysis

of nutrition indicators show highest rates of

EBF are currently found in Eastern/Southern

Africa (49%) and South Asia (45%), and the

lowest in West/Central Africa (24%)

(UNICEF,2013).

In developing countries, the rate of exclusive

breastfeeding for infants less than six months is

only at 39% with Kenya’s rate being at only

32% (UNICEF, 2009).7

Problem Statement Diarrhea and acute respiratory infections remain

to be the leading causes of infant mortality in

Kenya despite the evidence of effects of EFB

countering the risk of acquiring the diseases in

infants. The UNICEF reported that by the year

2012, only 32% of infants were exclusively

breastfed. Increasing this rate is however

expected to lower the infant mortality rates from

diarrhea and acute respiratory infections.

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Justification Being a new experience among primiparous

mothers, EBF, is perceived to be a challenge to

many of them and therefore the need to identify

the factors influencing the practice in this

group in order to device better approaches to

promoting the practice. This study seeks to

identify these factors and make

recommendations on how to address them.9

Study AimThe study aims at contributing towards the

improvement of health status of infants which

will in turn reduce the mortality rates. This is

in line with achieving the United Nation’s

MDG number four which targets to reduce

the under-five mortality rate by two thirds

between 1990 and 2015

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Study PurposeThis study is to collect and analyze data on the

challenges faced by primiparous mothers in

practicing EBF. The results will be useful in

making informed decision by EBF promoters

will develop more result oriented strategic

approaches to achievement of program

objectives aimed at increasing EBF rates.

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ObjectivesGeneral Objective

Assess the factors associated with feeding practices of

infants 0-6 months among primiparous mothers.

Specific Objectives

To determine the socioeconomic characteristics of

primiparous mothers

To determine the socio-demographic characteristics of

primiparous mothers

To determine the EBF knowledge, attitude and skills (KAP)

of primiparous mothers.

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Hypothesis Socioeconomic factors influence EBF practice

among primiparous mothers

Socio-demographic factors influence EBF

practice among primiparous mothers

KAP influence EBF practice among

primiparous mothers

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Study BenefitsInfants

Gertrude’s Children’s Hospital and Exclusive

Breastfeeding Promoters

The Government (policy makers)

Mothers

Future Researchers

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Limitations of the StudyThe study may face the limitation of lack of

cooperation from the study population with

refusal to participate, non response and bias from

incorrect feedback.

The researcher intends to overcome this by

assuring respondents that names will not be used

in the reporting and that personal information

will not be disclosed.

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CHAPTER TWO- LITERATURE REVIEW

2.1 Overview of Exclusive Breastfeeding

2.2 Status of Exclusive Breastfeeding in the Developing

World

2.3 Exclusive Breastfeeding Programs in Kenya

2.4 Barriers to Exclusive Breastfeeding

2.4.1 Socioeconomic Factors affecting Breastfeeding

2.4.2 Breastfeeding Knowledge, Attitude and Practice (KAP)

2.4.3 Socio-Demographic Characteristics and Breastfeeding

2.5 Gaps in Knowledge

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Gaps in Knowledge A number of studies have addressed

breastfeeding in different parts of Kenya in

respect of relevant statistics, and the factors

influencing breastfeeding and attitudes towards

breastfeeding, however, limited information has

been reported on factors influencing

breastfeeding among first time mothers.

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CHAPTER THREE-RESEARCH DESIGN AND METHODOLOGY

3.1 Study setting3.1.1 Nairobi County

Part of the study will be carried out in Nairobi County

that had total population of 3,135,798 as at the 2009

population census.

The survey will specifically be conducted in Gertrude’s

Children’s Hospital which provides paedriatic health

care in East and Central Africa exclusively to children

from birth to 21 years18

Cont…3.1.2 Kirinyaga County

The study will also be carried out in Kirinyaga County

that has had a population of 528,054 as at the 2009

population census.

The study will specifically be carried out at Kimbimbi

Sub-Districts Hospital is located in Mwea East District.

The hospital has a catchment population of 21,617

persons and offers outpatient, inpatient, maternity, MCH,

psychiatric, comprehensive care clinic among others.

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3.2 Study Design A descriptive cross sectional study design will

be used in which all the different branches of

the Well Baby Clinics shall be the study focus.

It will involve Key Informant interview on the

health professionals (nurses and nutritionists)

as well as questionnaire interview on first

time mothers attending for the CWP

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3.3 Target PopulationThe study population will consist of primiparous

mothers visiting Gertrude’s Children’s Hospital’s

Well Baby clinics and those visiting Kimbimbi Sub-

district Hospital’s MCH clinic between the months

May and August 2014. The study will also focus on

professionals offering health and nutrition services

at the clinic to include doctors, nurses and

nutritionists.

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3.4 Sample Size Deteron

Where:

n- Is the desired sample size

z- the standard normal deviation at 95% confidence interval

which is 1.96

p- the proportion expected to be exclusively breastfed which is

32%

q- proportion not expected to be exclusively breastfed which is

68% (q=1-p)

d-the expected difference at a 0.05 level of significance

According to the KDHS report of 2008/09 (2010), percentage number

of children under 6 months in Kenya who suffered from diarrhea was

13%. Using fischer’s formulae, sample size was determined as follows:

10% attrition was done to give 191 primiparous mothers.

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Sampling Procedure on Mothers

Proportionate sampling

Linear sampling

Convenience sampling

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3.6 Data Collection Methods and Instruments Semi Structured Questionnaire

They will be self administered on primiparous mothers. Will

contain open and closed ended questions on demographic

characteristics, maternal socio-economic characteristics

maternal KAP, and infant and maternal morbidity.

Key Informant Question Guide

The question guide will contain questions on views and

comments on challenges faced in promoting EBF, feedback and

comments received from the clients and suggestions on

possible solutions to challenges faced in promoting exclusive

breastfeeding. 24

3.7 Data Reliability and Validity Measures Be Taken

•Selection of the Field Assistant

• Registered nutritionists as per the Kenya

Nutritionists and Dieticians Act of 2007.

•Sampling method and instrument

Procedures used to sample will ensure minimum

sampling error and therefore of minimal sample bias.

Ambiguous or technical questions on the

questionnaire will be avoided to ensure respondents

understand and give the intended information.

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Cont…..Training of the Field Assistants

Thorough training of the field assistants will be done on

research ethics, identification of respondents, questionnaire

presentation and crosschecking of questionnaires.

Lecture and discussion teaching method will be used.

They will take part in the pretesting of the questionnaire

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3.8 Data Analysis Methods and Procedures

Descriptive data analysis procedures will be employed

IBM Statistical Package for Social Sciences version 20

(IBM SPSS v.20) will be used for analysis.

Student t test and analysis of variance was used as

test of significance at 5% level.

Graphical representation of the analysis using

Microsoft Excel 2010.

A report on the KII will be prepared.

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Cont……

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Log FrameLog Frame

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BudgetBudget

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THE END

QUESTIONS AND

COMMENTS?????

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