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\def\RunningAuthor{Kalabarathi S et al.}
\firstPage{300}
\articleType{Original Article}
\receivedDate{09 Nov 2020}
\acceptedDate{22 Dec 2020}
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\journalVolume{2020, 11 (SPL4)}
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\title{\textbf{Knowledge effect on postnatal mothers regarding Baby Friendly Hospital Initiative }}
\author{Kalabarathi~S\textsuperscript{*}, 
            Aarthi~A~\\[5pt]{Department of Obstetrics \& Gynecological Nursing, Saveetha College of Nursing, SIMATS, Thandalam, Chennai, Tamil Nadu, India}}

\begin{abstract}
Breastfeeding is the ``Gold standard'' for infant feeding. There are several areas of biological superiority of breastfeeding and breast milk over artificial (formula) milk. Exclusive breast milk feeding is the suggested diet for term and untimely children to give ideal baby nourishment, basic immunological and mitigating advantages, and prevention from ailment and illnesses. The Baby-Friendly Hospital Initiative dispatched in1991, is an exertion by UNICEF and WHO to guarantee that all maternities, whether detached or in a medical clinic, become focuses of breastfeeding support. The present study aims to assess knowledge effect on postnatal mothers regarding baby friendly hospital initiative. A one group pretest posttest research design was conducted among 60 postnatal mothers. Convenient sampling technique was used to select samples. Structured knowledge questionnaire was used to assess the effectiveness of information booklet regarding Baby-Friendly Hospital Initiative among postnatal mothers. The present study attempted to evaluate the effectiveness of information booklet on Baby-Friendly Hospital Initiative among postnatal mothers of SMCH and found that 6(10\%) had adequate, 9(15\%) had moderate adequate knowledge and also 45(75\%) had inadequate knowledge in pretest and 42(70\%) had adequate, 12(20\%) had moderate adequate knowledge and 6(10\%) had inadequate knowledge in posttest and concluded that there was a significant improvement after administration of information booklet. Thus, information booklet was effective in improving the knowledge on Baby Friendly Hospital initiative among postnatal mothers.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Baby Friendly Hospital Initiative,\newline Information booklet,\newline postnatal mothers
\end{keywords}
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\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Kalabarathi~S~\\ Phone:\ ~\\  Email:\ kalabarathi2@gmail.com
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\section{Introduction}
Breastfeeding is the ``Gold standard'' for infant feeding. There are several areas of biological superiority of breastfeeding and breast milk over artificial (formula) milk. Obstetricians and maternity specialists ought to instruct the mother during pre-birth and postnatal consideration for the usefulness of breastfeeding.\unskip~\citep{963748:21048516}

Breastfeeding has been related with a diminished danger of otitis media, atopic dermatitis, gastroenteritis, serious lower respiratory lot diseases, asthma, diabetes mellitus, leukemia, unexpected baby passing disorder, and necrotizing enterocolitis. For breastfeeding ladies, the advantages remember a decrease for the danger of bosom and ovarian cancer.\unskip~\citep{963748:21048521}

Exclusive breast milk feeding is the suggested diet for term and untimely children to give ideal baby nourishment, basic immunological and mitigating advantages, and prevention from ailment and illnesses.\unskip~\citep{963748:21048524}

Breastfeeding is the typical technique for baby taking care of, however numerous individuals decide to take care of their infants on newborn formula. While children develop a lot with one or the other technique for taking care of, there is proof of inconveniences for babies that are not breastfed and furthermore for their moms who have not fed.\unskip~\citep{963748:21048523}

The WHO suggests that for the initial a half year of life, newborn children ought to be solely breastfed to accomplish ideal development, improvement, and wellbeing. From that point, newborn children ought to get healthfully sufficient and safe integral nourishments, while proceeding to breastfeed for up two years or more.\unskip~\citep{963748:21048515}

The Baby Friendly Hospital Initiative was dispatched in 1991 by the World Health Organization and the United Nations Children's Fund.\unskip~\citep{963748:21048522} BFHI advances a staggered, multi-area approach which, along with enactment in regards to legal maternity leave and insurance of the breastfeeding privileges of ladies in the working environment and requirement of the code of advertising of breastmilk substitutes, is fundamental to successfully advance, secure and uphold breastfeeding.\unskip~\citep{963748:21048517}

A proof survey of 430 fundamental audits, subjective and quantitative examinations facilitated by the Sax Institute in 2018 additionally detailed the BFHI to be the best intercession to improve paces of any breastfeeding and basic for breastfeeding only and duration.\unskip~\citep{963748:21048518}

BFHI advances ideal newborn child taking care of practices in clinics all through the world by giving complete rules to make emergency clinics focuses of help for breastfeeding.\unskip~\citep{963748:21048525} It additionally builds up the essential political and specialized help for breastfeeding advancement exercises, draws on the experience of breastfeeding moms for mother-to-mother uphold gatherings and the abilities of wellbeing experts and examination to challenge winning clinical practice.\unskip~\citep{963748:21048520}

The purpose of the study [1] to assess the existing level of knowledge on baby friendly hospital initiative among postnatal mothers. [2] to evaluate the effectiveness of an information booklet on knowledge of baby friendly hospital initiative among postnatal mothers. [3] to find out association between knowledge of postnatal mothers regarding baby friendly hospital initiative with selected socio demographical variables.
    
\section{Materials and Methods}
A one group pretest-posttest research design with convenient sampling technique was used to conduct the study in selected hospital in Saveetha Medical College Hospital. 60 samples were selected by convenient sampling technique. The data collection period was done with prior permission from the HOD of Obstetrics and Gynecology department and ethical clearance was obtained from the institution. The purpose of the study was explained to the samples and written informed consent was obtained from them. 

The investigators then provided instructions for filling the questionnaires and then guided postnatal mothers. The pre-test was finished by utilizing the information survey followed by that data booklet was given to the moms. A time of 7 days was given to the moms for perusing the data booklet. A post evaluation was finished by re-administering the same knowledge questionnaire. The effectiveness of the information booklet was then determined by comparing the pretest and posttest scores on the level of knowledge of the mothers. Chi-square was used to associate the posttest knowledge level with the selected demographic variables. 
    
\section{Results and Discussion}
\textbf{Sample characteristics}

Among 60 samples, majority of the postnatal mothers 35(58\%) belongs to 20 to 30 years, 25(42\%) had primary education,30(50\%) are daily workers, 35(58\%) were Primigravida, 40(67\%) undergone LSCS. 

Regarding feeding starting time 30(50\%) were started breast feeding in 3 hour, 20(33\%) were feeding started in 1-2hour, 10(17\%) were started feeding within 1 hour. Regarding feeding duration 35(58\%) were feed her baby 0-10minutes, and 15(25\%) were feed her child in 11-20 minutes, and also 15(25\%) were feed her baby in 21-30 minutes.

\textbf{Level of knowledge on Baby Friendly Hospital Initiative among postnatal mothers in the pretest and posttest}

Level of knowledge scores on Baby Friendly Hospital Initiative among postnatal mothers in the pretest, 6(10\%) postnatal mothers belongs to adequate knowledge, 9(15\%) had moderate adequate knowledge and also 45(75\%) postnatal mothers had inadequate knowledge. 


\begin{table*}[!htbp]
\caption{\boldmath {Frequency and percentage distribution of knowledge on Baby Friendly Hospital initiative among postnatal mothers in the pretest and posttest. N = 60} }
\label{tw-ec75492a22c3}
\def\arraystretch{1.1}
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\tbltoprule \rowcolor{kwdboxcolor}Level of knowledge & \multicolumn{2}{p{\dimexpr(.3485\linewidth-2\tabcolsep)}}{\cAlignHack  Pretest} & \multicolumn{2}{p{\dimexpr(.33019999999999996\linewidth-2\tabcolsep)}}{\cAlignHack  Posttest}\\
\rowcolor{kwdboxcolor} & \cAlignHack Frequency & \cAlignHack Percentage & \cAlignHack Frequency & \cAlignHack Percentage\\
\tblmidrule 
Adequate knowledge &
  \cAlignHack 6 &
  \cAlignHack 10\% &
  \cAlignHack 42 &
  \cAlignHack 70\%\\
Moderate adequate knowledge &
  \cAlignHack 9 &
  \cAlignHack 15\% &
  \cAlignHack 12 &
  \cAlignHack 20\%\\
Inadequate knowledge &
  \cAlignHack 45 &
  \cAlignHack 75\% &
  \cAlignHack 6 &
  \cAlignHack 10\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Effectiveness of information booklet on Baby friendly hospital initiative among postnatal mothers. N=60} }
\label{tw-d3742f551e77}
\def\arraystretch{1.1}
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\begin{tabulary}{\linewidth}{p{\dimexpr.083\linewidth-2\tabcolsep}p{\dimexpr.13700000000000003\linewidth-2\tabcolsep}p{\dimexpr.08450000000000001\linewidth-2\tabcolsep}p{\dimexpr.15699999999999996\linewidth-2\tabcolsep}p{\dimexpr.08050000000000002\linewidth-2\tabcolsep}p{\dimexpr.226\linewidth-2\tabcolsep}p{\dimexpr.232\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}S.No & Knowledge aspect & Mean & Standard deviation & Df & Standard error of difference & Paired `t' test\\
\tblmidrule 
1 &
  Pretest &
  7.77 &
  3.71 &
  59 &
  \multicolumn{1}{p{\dimexpr(.226\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{\cAlignHack 0.459}} &
  t=18.31*\\
2 &
  Posttest &
  16.17 &
  3.27 &
  59 &
   &
  p{\textless}0.001 \mbox{}\protect\newline S***\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
In posttest majority of postnatal mothers belongs to 42(70\%) adequate knowledge, 12(20\%) had moderate adequate knowledge and 6(10\%) had inadequate knowledge. (Table~\ref{tw-ec75492a22c3})

The present study was supported by \unskip~\citet{963748:21048519} conducted study to assess the knowledge and practice of staff nurses regarding the implementation of Baby Friendly Hospital Initiative in selected Hospital in Mangalore. 

In this study 53.33\% were having good knowledge and 41.66\% of them have satisfactory knowledge regarding BFHI. The majority of subjects 78.33\% had good knowledge in the area of breastfeeding and 60\% of them have satisfactory knowledge regarding BFHI.

\textbf{Effectiveness of information booklet on Baby Friendly Hospital Initiative among postnatal mothers}

The present study depicts that the pretest knowledge, mean score was (7.77) and standard deviation (3.71). The posttest mean knowledge score was (16.17) and standard deviation (3.27). The table shows that there was a significant increase in knowledge level from pretest compared to post-test. 

The statistical t-test shows a highly significant difference (t=18.31) existing between the pretest and posttest on the overall mean knowledge level scores. It was found that there was a significant increase of knowledge level in the post test after an intervention of information booklet. (Table~\ref{tw-d3742f551e77})

The present study was supported by \unskip~\citet{963748:21048514} conducted a study to assess the effect of self-instructional module on knowledge of staff nurses regarding baby friendly hospital initiative policy. 

The study was conducted on 60 samples selected purposive sampling technique. In control group there was no significant (cal 0.67 less than tab 2.05 at {\textless}0.05) difference between pretest (12.50 \ensuremath{\pm} 2.29) and posttest (12.67 \ensuremath{\pm} 2.19) knowledge regarding Baby friendly hospital initiative policy. 
    
\section{Conclusions}
The present study concluded that postnatal mothers have low knowledge about Baby Friendly Hospital Initiative. Creating awareness about importance of exclusive breastfeeding is very important. Execution of the worldwide BFHI was related with a measurably critical yearly expansion in paces of restrictive breastfeeding among babies 0 to 2 months old enough and among newborn children 0 to a half year old enough in the 14 nations considered.\ensuremath{^{}}

\textbf{Conflict of interest}

The authors declare that they have no conflict of interest for this study.

\textbf{Funding support}

The authors declare that they have no funding support for this study.
    

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