There after purposive sampling technique was used to select two primary health care centers among the twenty PHCS in Kaduna South. Data was collected with the use of a reliable self-constructed questionnaire before and after the training.Cronbach Alpha was used to determine the reliability of the questionnaire (r=0.990)The training Programme consists of four modules and the training lasted for four weeks. The training comprises of four stages: pre-intervention stage, week 1, week 2, week 3, week 4 and administration of post-test. The study generated four research questions and the three hypotheses which were tested at 0.05 alpha levels. Data were analyzed using descriptive statistics, and t-test.
Demographic data of participants showed that majority of the maternal respondents with children numbering between 1 and 2 were 28(77.75%) had the highest percentage. The highest educational attainment of the respondent was secondary school (100%). The Igbo’s 16, (44.4%) had the highest percentage among the tribes. Majority (52.8%) of the nursing mothers have poor knowledge on adequate breastfeeding positioning, 14 (38.8%) of the participants had moderate level of knowledge on procedure for breastfeeding. 17 (47.2%) of the participants had moderate knowledge level of breast engorgement,). Majority 21 (58.4%) of the participants had moderate level of knowledge on sore nipples. Significant differences were found between the pre and post intervention in the following areas; on adequate positioning for effective latch-on (p=0.009), on procedure for breastfeeding (p=0.011), on breastfeeding problems (p=0.001).
In conclusion, the training was effective in improving the level of knowledge of breastfeeding mothers on breastfeeding related problems and its prevention. Based on the findings, it is recommended that the government should help in minimizing this breastfeeding related problems by organizing seminars, workshop and extension services to enlighten women on breastfeeding problems and early prevention
TABLE OF CONTENTS
Content                                                                                                                 Page
Title Page                                                                                                  i
Certification                                                                                               ii
Dedication                                                                                               iii
Acknowledgements                                                                                       iv
Abstract                                                                                                   v
Table of Contents                                                                                     vi
List of Tables                                                                 vii
List of Figures                                                                                                     ix
Appendices                                                                                                               x  Â
CHAPTER ONE: INTRODUCTIONÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
1.1 Background to the Study                                                                             1
1.2   Statement of the Problem                                                                       2
1.3   Objective of the Study                                                         2
1.4   Research Questions                                                         3
1.5   Hypotheses                                                         3
1.6   Scope of the Study                                                                                3
1.7 Significance of the Study                                                                                   3
1.8 Operational Definition of Terms                                                               4
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction5
2.1 Importance of breastfeeding to infants and mothers5
2.2   Implications of knowledge of nursing mothers on breastfeeding techniques                                                                           6   Â
2.3   Causes, treatment and remedies for nipple pain                                   11
2.4 Good techniques and proper positioning for good latch-on16
2.5   Impact of breastfeeding interventions on breastfeeding related problem                                                                                     19
2.6Conceptual Model                                                                                    24
CHAPTER THREE: METHODOLOGY
3.0 Introduction 26
3.1   Research Design                                                                                   26
3.2Population                                                                                               27
3.3Sample size and sampling Technique                                              28
3.4   Instrumentation                                                                               28
3.5 Validity and Reliability of the Instrument                                   28
3.6Method of Data Collection                                                              29
3.7Method of Data Analysis                                            30
3.8 Ethical Consideration                                                              31
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.0:   Introduction                                                                                             32
4.1:  Demographic Data of Participants                                               33
4.2:  Discussion of Research Questions                                         34
4.3:  Discussion of Hypotheses                                                            36
CHARPTER FIVE: SUMMARY CONCLUSION AND RECOMMENDATIONS
5.1:  Summary                                                                                         42
5.2:  Conclusion                                                                                      42
5.3: Recommendations                                                                     43
5.4:  Limitation of Study                                                                       43
5.5:  Suggestion for Further Studies                                                    44
REFERENCES 45
APPENDICESÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â 48
LIST OF TABLES
Table                                                                                                          Page
4.1 Demographic data of the maternal respondents                                     33
 4.2   Descriptive statistics showing the existing knowledge of nursing mothers on adequate breastfeeding positioning               34
 4.3 Descriptive statistics showing the knowledge level of mothers on procedure for breastfeeding before intervention                     35
 4.4 Descriptive statistics showing the level of knowledge of mothers on breast engorgement                                                                                  36
4.5  Descriptive statistics showing the level of knowledge of mothers on sore   nipples before intervention                                        37
4.6 T-test showing differences between the knowledge level of mothers on adequate positioning for effective latch on pre and post intervention      38 Â
 4.7T-test showing the differences between the knowledge level of participants on procedure for breastfeeding pre and post intervention           39      Â
4.8T-test showing the difference between the pre and post intervention knowledge of nursing mothers on breastfeeding problems               39
LIST OF FIGURE
 Figure 1 Conceptual model adapted from DoreathyOrem’s theoryself care deficit            24     Â
APPENDICES
- Informed Consent Form
- Questionnaire
- Teaching Modules
- BUHREC Permission to conduct research work
- Introduction Letter to PHC where the research work was done.
- Reliability Result
- Picture taken during the research work with participants.
CHAPTER ONE
INTRODUCTION
- Background to the Study
Breastfeeding is the act of milk transference from mother to baby that is needed for the survival and healthy growth of the baby into an adult (United Nations Children’s Fund (UNICEF), 2009; Heckman, 2011). Breastfeeding provide infant with essential calories and nutrients to nourish the baby (National Institute of Child Health & Human Development, 2009).According to the American Academy of Pediatrics (AAP) policy Statement on Breastfeeding, women who do not have health problems should exclusively breastfeed their infants for at least the first six months of life (AAP,2012). The importance of appropriate infant feeding and the vital role played by breastfeeding in child survival, growth and development cannot be over-emphasized (AAP, 2012). The World Health Organization (WHO) has recommended two years breastfeeding; first sixmonths exclusive breastfeeding; more than eight times breastfeeding per day in the first three months of an infant’s life. The AAP suggested that a woman should try to breastfeed her infant for the first twelve months of life.
Despite the documented value of exclusive breastfeeding during the first months of a child’s life and struggles for promoting this practice, rates for exclusive breastfeeding in Nigeria are below those recommended by the World Health Organization (WHO), which advocates exclusive breastfeeding during the first six months of baby’s life. Breastfeeding a baby exclusively for the first six months and then continued breastfeeding in addition to appropriate solid foods until twelve months and beyond has health benefits for both mother and the child and these include; reduction of the risk of mothers from developing gestational diabetes, osteoporosis, and breast cancer. It can also assist the women to lose weight after delivery, and also help the uterus of the women to return fast to pre-pregnant state. Advantages to the babies may also include: reduced risk of development of gastro intestinal illness, allergies, asthma, diabetes, obesity, some childhood cancer, respiratory infections and diarrhoea.
Based on the WHO Global data on infant and young Child Feeding in Nigeria, 22.3% of children were exclusively breastfed for less than 4 months, while 17.2% were exclusively breastfed for less than 6 months, in the year 2003. According to the Nigerian Demographic and Health Survey (NDHS), in 2008 17% of children were exclusively breastfed for less than 4 months, while 13% were exclusively breastfed for less than 6 months. The median exclusive breastfeeding period in Southwest Nigeria by months in the year 2003 was 7 months. In the year 2008, it was 6 months. Within the same period, early initiation of breastfeeding among women in the region was 12.7% in 2003, but increased to 35.5% in the year 2008. All these figures are far below the 90% level recommended by the WHO. Child mortality therefore remains high in low and middle-income countries. Nigeria has the highest under-five rural mortality rate of 242.7 per 1,000 among selected sub-Saharan Africa countries. (NDHS, 2008; NPC, 2009; WHO, 2010)
The technique used in breastfeeding, especially mother-infant positioning and attachment or suckling by the infant, has been shown to be important for the effective transfer of milk from the breast to the child as well as for preventing nipple damage. Heckman (2011) evaluated mother-infant pairs in a maternity ward and observed that only 2% of pairs achieved optimal latch performance (chin touches the breast, mouth opens wide, lower lip flared outward ,moderate lip tension, and infant grasps the areola), and only 0.2% achieved optimal mother-infant positioning (mother in a comfortable position, C-hold of the breast [leaving the areola free and making gentle compression of the breast tissue between the thumb and fingers]. infant’s head and body aligned facing the mother and in close contact with the mother’s body, infant’s arm not between the mother and infant, infant’s head and neck supported, infant’s mouth facing the nipple, and infants nose free for breathing).
1.2 Statement of the Problem
Breastfeeding is the natural way to feed a baby but that does not always mean it is easy. Many breastfeeding mothers encounter a few challenges in the course of using one breastfeeding technique or the other (Finello, 2015). According to National Health Service U.K (2013), most breastfeeding mothers have experienced variety of difficulties as a result of some of the techniques used both to the baby and themselves as mothers. It was observed during the child welfare Clinic that many of the nursing mothers failed to practice exclusive breastfeeding as a result of some of the breastfeeding related problems they encountered while breastfeeding. Considering that breastfeeding technique seems to be important for maintaining successful breastfeeding, this project will explore effect of nursing intervention on breastfeeding-related problems among nursing mothers in selected Primary Health Clinics in Kaduna South, Nigeria.
1.3 Objective of the Study
The main objective of this study is to determine the effect of nursing intervention on breastfeeding-related problems among nursing mothers in selected Primary Health Clinics in Kaduna State, Nigeria, in the first six months postpartum. The specific objectives are to:
