1. Supervisor: PROF. J. K. IMUNGI, PhD
FACTORS ASSOCIATED WITH FEEDING PRACTICES OF 0-6 MONTHS OLD INFANTS AMONG PRIMIPAROUS MOTHERS BY
WACHIRA 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

5. CHAPTER ONE: INTRODUCTION Background of the Study
The 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 life

6. 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.

7. 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).

8. 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.

9. 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.

10. Study Aim
The 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

11. Study Purpose
This 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.

12. Objectives General 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.

13. 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

14. Study Benefits Infants
Gertrude’s Children’s Hospital and Exclusive Breastfeeding Promoters
The Government (policy makers)
Mothers
Future Researchers

15. Limitations of the Study
The 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.

16. 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

17. 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.

18. CHAPTER THREE-RESEARCH DESIGN AND METHODOLOGY
3.1 Study setting
3.1.1 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 years

19. 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.

20. 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

21. 3.3 Target Population
The 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 The study will also focus on professionals offering health and nutrition services at the clinic to include doctors, nurses and nutritionists.

22. 3.4 Sample Size Deteron
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:
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
10% attrition was done to give 191 primiparous mothers.

23. Sampling Procedure on Mothers
Convenience sampling
Proportionate sampling
Linear sampling

24. 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.

25. 3.7 Data Reliability and Validity Measures Be Taken
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.
Selection of the Field Assistant
Registered nutritionists as per the Kenya Nutritionists and Dieticians Act of 2007.

26. 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

27. 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.

28. .

29. Cont……

30. Log Frame

31. Budget

32. THE END QUESTIONS AND COMMENTS?????