Knowledge, Attitude and Practice on Exclusive Breastfeeding Among Antenatal Mothers at an Urban PHC

Exclusive breastfeeding for the first six months — no water, honey, gutti, formula or animal milk — is one of the most effective, lowest-cost ways to prevent infant diarrhoea, pneumonia and undernutrition. National programmes such as MAA (Mothers' Absolute Affection) promote early initiation within one hour of birth and exclusive breastfeeding, yet prelacteal feeds, discarding colostrum and early top feeds are still common because of family advice and misconceptions. Antenatal visits are the ideal time for community health nurses to correct this, but first they need to know what mothers already believe.

This B.Sc Nursing NRST 405 group research project is a descriptive cross-sectional KAP survey of about 100 antenatal mothers attending the antenatal clinic of an urban primary health centre (UPHC). A validated structured interview schedule measures knowledge (early initiation, colostrum, exclusive breastfeeding, positioning and attachment, expressing milk), a 5-point Likert scale measures attitude, and a practice checklist records previous feeding practices (for multigravidae) or intended practices (for primigravidae).

Scores are categorised as adequate, moderate or inadequate, and associations with age, education, parity, family type and occupation are tested with the chi-square test; correlation between knowledge and attitude is tested with Karl Pearson's coefficient. The findings feed directly into a health-education session for the UPHC, which the group delivers at the end of data collection — combining research with the community health-nursing role.

Abstract

A descriptive cross-sectional study was conducted to assess knowledge, attitude and practice regarding exclusive breastfeeding among antenatal mothers at an urban primary health centre. One hundred mothers were selected by convenience sampling on antenatal clinic days. Data were collected by structured interview using a knowledge questionnaire, an attitude scale and a practice checklist validated by experts and tested for reliability. Descriptive statistics, chi-square test and Pearson's correlation were used.

Introduction

Breast milk meets all nutritional needs of an infant for six months and provides antibodies that protect against infection. Colostrum, the first thick yellow milk, is rich in immunoglobulins and is often called the baby's first immunisation. Despite this, many Indian families still give prelacteal feeds such as sugar water or honey, discard colostrum, and start top feeds early. National Family Health Survey data show that early initiation and exclusive breastfeeding remain below desired levels in many states. Community health nurses meet mothers repeatedly during antenatal care and are well placed to change these practices.

Need for the study

During community postings, students observed mothers-in-law advising prelacteal feeds and mothers unsure about positioning and attachment. Understanding the level of knowledge and the attitudes of antenatal mothers helps target health education to the actual gaps rather than delivering a generic talk.

Hypotheses (at 0.05 level)

• H1: there is a significant association between knowledge scores and selected demographic variables.
• H2: there is a significant correlation between knowledge and attitude scores.

Feasibility

• Setting: UPHC used for the community health nursing posting; permission from the Medical Officer.
• Time: 40 hours of NRST 405 lab time plus posting days, spread over three weeks of data collection.
• Cost: printing and translation under ₹2,000.
• Ethics: institutional ethics committee approval and informed consent; no invasive procedure.

Although exclusive breastfeeding for six months and early initiation within one hour of birth are promoted by national maternal and child health programmes, prelacteal feeding, discarding of colostrum and early introduction of water and formula continue in many urban low-income families. Antenatal mothers may lack accurate knowledge or hold attitudes shaped by family traditions, and health-education sessions at primary health centres are often generic rather than based on identified gaps.

Statement of the problem: "A descriptive study to assess the knowledge, attitude and practice regarding exclusive breastfeeding among antenatal mothers attending the antenatal clinic of a selected urban primary health centre, with a view to developing an information leaflet."

In scope

• Antenatal mothers aged 18–40 attending the antenatal clinic of one UPHC during the data-collection period.
• Structured interview for knowledge, Likert attitude scale and practice checklist.
• Descriptive and inferential statistics.
• An information leaflet and a health-education session after data collection.

Out of scope

• Measuring the effect of the education session (a pre–post design would be needed).
• Postnatal follow-up of actual feeding practice after delivery.
• Mothers with medical contraindications to breastfeeding.

Research approach: quantitative. Research design: descriptive cross-sectional survey.

Setting: antenatal clinic of a selected urban primary health centre.

Population: antenatal mothers attending the UPHC. Sample: antenatal mothers who meet the inclusion criteria.

Sample size: 100. Using n = Z²pq/d² with p = 50% (no reliable local estimate), Z = 1.96 and d = 10%, n ≈ 96, rounded to 100 to allow for incomplete responses.

Sampling technique: non-probability convenience sampling on antenatal clinic days.

Inclusion criteria: antenatal mothers aged 18–40, in any trimester, able to understand the local language or English, willing to participate.

Exclusion criteria: mothers who are health professionals; mothers with conditions in which breastfeeding is contraindicated; mothers too unwell to be interviewed.

Tool:

• Section A — demographic data (age, education, occupation, family type, income, parity, source of information).
• Section B — 25-item structured knowledge questionnaire (1 mark each): adequate > 75%, moderate 50–75%, inadequate < 50%.
• Section C — 15-item 5-point Likert attitude scale with positive and negative statements: favourable, moderately favourable, unfavourable.
• Section D — 10-item practice checklist (previous practice for multigravidae, intended practice for primigravidae).

Validity and reliability: content validity by seven experts (community health nursing, OBG nursing, child health nursing, paediatrician, statistician); translation and back-translation; reliability by split-half (Spearman–Brown) for knowledge and Cronbach's alpha for attitude; pilot on 10 mothers at another health centre.

Ethics: approval from the institutional ethics committee; permission from the Medical Officer of the UPHC; written informed consent (thumb impression with witness for non-literate mothers) following the ICMR National Ethical Guidelines (2017); confidentiality by code numbers.

Data analysis: frequency and percentage for demographic data and KAP levels; mean, SD for scores; Karl Pearson's correlation between knowledge and attitude; chi-square test for association with demographic variables; p < 0.05; SPSS.