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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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