Infant And Young Child Feeding (IYCF) Education Program For Reducing Child Mortality In Aboriginal Community

Importance of breastfeeding in Aboriginal women

Discuss about the Health Promotion for Infant Mortality in Aboriginal Population.

Infant and young child feeding (IYCF) will provide the necessary information through education required to address breastfeeding problems such as retarded growth and mortality in Aboriginal women in Australia.

Through this program awareness will be increased on the knowledge, attitude as well as understanding about breastfeeding among Aboriginal women. It can also be helpful in finding impact of mother’s education on breastfeeding. Potential problems related to breastfeeding can be identified through this programme. It can be helpful in improving health and well-being of entire society.

Inadequate breast feeding is the most significant reason for approximately 60 % of infant and child mortality globally. It has been established that two-thirds of the undernutrition children feature is present in the first year of their life. Children’s growth, development and survival can be effectively improved by Exclusive breastfeeding (EBF) in the first six months of their life. It has been estimated that EBF can reduce children’s mortality by 20 %. EBF has been proved as the effective preventive strategy for child mortality (Arimond et al., 2008). World Health Organization (WHO) gave importance to address this issue because inadequate breastfeeding can negatively influence socioeconomic development and it can augment poverty.  WHO recommended to initiate breastfeeding within first four hours after birth.  In Aboriginal people mortality rate of child is higher and it is at 25 per 1000 live births. In these Aboriginal people, this mortality rate is still higher in children who received breastfeeding after 24 hours after birth (McLachlan et al., 2017).

From the studies, it has been demonstrated that only 65 – 75 5 of the women breastfed new-born in first four hours after their birth (Khan et al., 2014). Educational level of women plays important role in initiation of breastfeeding, exclusive breastfeeding practice (EBF) and duration of breastfeeding (Daelmans et al., 2009). However, there is less evidence for establishing relationship between educational status of Aboriginal women and breastfeeding. This issue is less addressed because educational status of Aboriginal women is less as compared to other women.

Surely, improvement in the educational status of the women in Aboriginal community can be helpful in improving breastfeeding status and reduction in the mortality rate of infants. Multiple health and social determinants can influence health and quality of life in Aboriginal children. It is necessary to explore influence of educational status of Aboriginal women on breastfeeding and mortality rate of infants and children (Barnes and Rowe, 2013).

Impact of mother’s education on breastfeeding in Aboriginal community

Goal :

Aim of this study is to evaluate effect of Infant and young child feeding (IYCF) education programme on reducing mortality rate in infant and children in Aboriginal community.

Objectives :

Can IYCF education programme in Aboriginal mothers lessen child mortality ?

Is IYCF programme in Aboriginal mothers is cost effective?

What is effectiveness and efficiency of IYCF programme through retired healthcare professionals?.

Study design:

In this health promotion programme, randomised controlled trial will be implemented. In randomised controlled trial, subjects get randomised in different groups (Cook et al., 2015). One group would be intervention group; study group and another group would be without intervention; control group. Aboriginal women selected in this would be from the low socioeconomic class. Educational status of these women is low in comparison to the women in the high socioeconomic class.

Time frame:

Work to be accomplished

Quarter 1 Months

Quarter 2 Months

Quarter 3 Months

1

2

3

4

1

2

3

4

1

2

3

4

Ethics clearance

X

Project set-up

X

Formative research

X

Develop intervention

X

Develop study instruments

X

Pilot study

X

Enrolment of study subjects

X

X

X

X

Implementation of intervention

X

X

X

X

X

X

X

X

Evaluation Surveys

X

X

X

X

Follow up of mother & infants

X

X

X

X

X

X

X

X

Data entry & cleaning

X

X

X

X

X

X

X

Data analysis of trial

Preparation of scientific papers

Sampling method implemented in this study will be purposive sampling method. This sampling method is based on characteristics of the participants. It is judgemental, selective and subjective (Palinkas et al., 2015). Data will be collected from the various hospitals in the Australia.

Inclusion criteria for the women will be:

• Women having first pregnancy,
• Women without complications,
• Women with single fetus,
• In 24 to 28 weeks of gestation,
• Women having phone connectivity,
• Women whom didn’t attended breastfeeding promotion programmes.

• Women from the areas which cannot be reached.

Target population :

600 women will be included in this study. 300 will be from the study group and 300 will be from control group. Recruitment will start from third trimester and it will continue upto 6 months of child age. 

Declaration of Helsinki will be considered for carrying out this study. Prior to initiation of the study, ethical approval for the conduct of the study will be taken from Human Research Ethics Committee (HREC). Study proposal will be presented to the ethics committee of the Primary health centre and their suggestions will be considered. Written informed consent will be taken from women and their family members prior to enrolment in the study. These consent forms will be documented. Participated women will be allowed to withdraw from the study at any point of time prior to initiation and during conduct of the study. Confidentiality will be maintained for the participated women.

Maternal and child health (MCH) programme will be implemented for the women in control group. MCH programme along with IYCF programme will be implemented for women in the intervention group. Both MCH and IYCF programme will be implemented at the community centres. IYCF education and training programme will be implemented for the duration of two weeks. Retried health care professionals will be recruited for providing training and education because they are more experienced in these training and educational programmes. Training and educational programme by these retired health care professionals will be provided both in practical and theoretical form. Importance of breastfeeding on child health, importance of breastfeeding on mother’s health and different techniques of breastfeeding will be incorporated in the theoretical aspects of training and education. Different techniques of breastfeeding will be demonstrated by senior and retired nurses and elder members of the family. This practical training might be more beneficial for first-time mothers because these others might not be aware of correct technique of breastfeeding. After 1 week of implementation of the programme, evaluation will be carried out for assessing benefit of the implemented programme. Women with below level of skills need to be provided with training for the second time. Second time training is important for these women because these women are with less educational status and low socioeconomic class. Both children and mothers of both control and intervention group will be assessed for the duration of 12 months (Hmon et al., 2016).

Total Number of Women with infants N = 10,221

Included in our study N = 600

Randomisation

Intervention Group N = 300

Control Group N = 3000

Recruitment of pregnant women                                                                    Baseline

Retired Healthcare Professional & Usual MCH Programmes

Usual MCH Programmes

Assessment of infants every month until 12 months

Assessment of infants every month until 12 months

Significance of exclusive breastfeeding (EBF) in reducing child mortality

In this intervention, data will be collected in the form of exclusive breastfeeding rate, duration of breastfeeding, health status of child and mortality rate of child. Semi-structured interviews will be implemented in this study because in this type of data collection; interview questions can be altered depending on the characteristics of the person. Questionnaires will comprise of questions related to exclusive breastfeeding rate, duration of breastfeeding, health status of child and mortality rate of child. Approximately 3 – 4 questions will be prepared for each of these aspects. Experts in the breastfeeding will be incorporated in the preparation of questions and standard guidelines will be used for these questions. Data will be collected from the women who stay near to hospitals and data will be collected through telephone those who stay away from the hospitals. 10 research nurses will be incorporated in the collection of data. Data will be collected twice a month and it will be collected for upto 12 months of child age. This type is considered as quantitative data. Moreover, qualitative will also be collected in the form of cost effectiveness of breastfeeding promotion programme (Braun, 2017).   

Collected data through telephonic interviews will be transcribed verbatim in English in Microsoft Excel. Data Collected by face-to face interviews will be entered in the excel sheet and mean and standard deviation will be calculated for each data. Collected data and its calculation will be reviewed by two research assistance and approved by research scientist. Coding will be given to the individual women’s data to sustain privacy of the data. Collected data will be presented in tabular and graphical form. These graphs and table will present comparative data between intervention group and control group. Data for each time point will be documented in paper form and electronic form. Data compilation and analysis will be performed by the research assistance and research scientist respectively. Qualitative data will be analysed by summarising the data and interpreting the data. Biasness in the data collection will reduced by giving codes to the individual women data (Braun, 2017). 

Power calculation will be performed on 300 participants each from the intervention and control group. Mean difference values between the intervention group and control group will be determined.

Power calculation will be performed on 300 participants each from intervention group and control group. Difference in the mean vales between intervention group and control group will be calculated. SPSS statistical software package version 18.0 (SPSS Inc., Chicago, IL, USA) will be used for the statistical analysis. ‘t’ test and one-way repeated measures ANOVA will be used for intergroup comparisons based on its suitability. Tukey test will be used for post hoc comparisons and Pearson’s coefficients will be implemented for identifying correlation among different variables (Petrie and Sabin, 2016).

Goals and objectives of the study

We anticipated that frequency of breastfeeding will become double in intervention group in comparison to the control group. This planned intervention will offer valid evidence for role of women’s education in lessening children and neonates mortality in Aboriginal community. Outcome of this intervention will be beneficial in promoting child growth in Aboriginal community. This intervention will be beneficial in finding impact of mother’s education on breastfeeding in first four hours of child birth. We are anticipating, mothers with education and training will increase frequency of breastfeeding in first four hours of child birth in comparison to the mothers without education. Duration of EBF can be effectively improved by providing education and training to the mothers. This intervention will also be helpful in promoting Baby Friendly Hospital Initiative in primary health centre. Outcome of this study will be compared with other studies conducted by Government and non-government organisations. Confidence of mothers in breastfeeding can be effectively improved by providing education and training to the mothers. It is evident that mothers undergone caesarean deliveries with reduced frequency and duration of breastfeeding in comparison to the normal delivery. Hence, impact of mother’s education on frequency and duration of breastfeeding will be determined in this intervention. Guidelines for improving frequency and duration of breastfeeding can be prepared by using outcome of this intervention. Potential problems specific to Aboriginal people during breastfeeding can be identified through this study. Identifying these problems can be helpful in planning effective intervention for improving breastfeeding and reducing mortality rate in Aboriginal children (Wen et., 2009; Jiang et al., 2012). 

Relation between socioeconomic factor like education and breastfeeding can be identified through this intervention. This intervention can also be helpful in identifying potential gaps in providing healthcare services at the primary healthcare centres. Hence, these gaps can be effectively addressed to improve healthcare services at the primary healthcare centres. Support from family and community members is most important factor for promotion of breastfeeding in Aboriginal population.

Mother’s education for the improvement of breastfeeding is a long duration process; hence, beneficial results of this intervention will be helpful for improvement of health and well-being of the entire society. Augmentation in frequency and duration of breastfeeding can be helpful in improving overall growth and development of children (Santo et al., 2007; Jiang et al., 2012). It can be helpful in improving health of future generations. It can result in reducing health expenditure of Aboriginal people. It can produce positive impact on economy of Australia for the longer duration. Health of future generations of Aboriginal people can improve their productivity and it can result in social and economic growth and development of Australia. This study enrolled large number of Aboriginal women; hence these results can be extrapolated to other population also. Results of this study produced data related to women with low socioeconomic class; hence, this data would get more significance because breastfeeding promotion is required more in low socioeconomic class women as compared to the high socioeconomic class women (Senarath et al., 2010).

Study design and sampling method

Implemented IYCF intervention programme will have fixed budget. This fixed budget comprises of administrative cost, travel cost, material cost and staffing cost. Administrative cost comprises of institutional Review Board fees, courier expenses, phone lines, long distance charges, and storage expenses and photocopying. Travel cost comprises of transportation and accommodation expenses cost which is required for visits to the different hospitals and different houses of the women. Staffing cost comprises of salaries for retired health care professionals, research assistance, research scientist, nurses, consultants and statistician. Materials cost comprises of cost for paper, pens, folders, binders and labels cost. Cost effective analysis will be carried out by comparing incurred cost and outcome observed. Cost incurred in the study will be gathered from financial record of primary healthcare facilities  (Gerrish and Lathlean, 2015).        

Summary		$
(a)	Staff salaries	8000
(b)	Materials and consumables	1500
(c)	Equipment	5500
(d)	Travel and communication	1500
(e)	Miscellaneous	500
	Total direct costs	17000
	Indirect costs (15% of subtotal)	2550
	GRAND TOTAL	$ 19550

References:

Arimond, M., Daelmans, B., Dewey, K. (2008). Indicators for feeding practices in children. Lancet, 371(9612), 541–2.

Barnes, M., and Rowe, J. (2013). Child, Youth and Family Health: Strengthening Communities. Elsevier Health Sciences.

Braun, V. (2017). Collecting Qualitative Data: A Practical Guide to Textual, Media and Virtual Techniques. Cambridge University Press.

Cook, J.A., Hislop, J., Altman, D.G., Fayers, P., Briggs, A.H., Ramsay, C.R., and Norrie, J.D. (2015). Specifying the target difference in the primary outcome for a randomised controlled trial: guidance for researchers. Trials, 16, 12. doi: 10.1186/s13063-014-0526-8.

Daelmans, B., Dewey, K., and Arimond, M. (2009). New and updated indicators for assessing infant and young child feeding. Food and Nutrition Bulletin, 30(2), S256.

Gerrish, K., and Lathlean, J. (2015). The Research Process in Nursing. John Wiley & Sons.

Hmone, M.P., Dibley, M.J., Li, M., and Alam, A. (2016). A formative study to inform mHealth based randomized controlled trial intervention to promote exclusive breastfeeding practices in Myanmar: incorporating qualitative study findings. BMC Medical Informatics and Decision Making, 16, 60. doi: 10.1186/s12911-016-0301-8.

Jiang, H., Li, M., Yang, D., Wen, L.M., Hunter, C., He, G., and Qian, X. (2012). Awareness, intention, and needs regarding breastfeeding: findings from first-time mothers in Shanghai, China. Breastfeeding Medicine, 7(6), 526–34.

Khan, J., Vesel, L., Bahl, R., and Martines, J.C. (2014). Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity-a systematic review and meta-analysis. Maternal and Child Health Journal, 19, 468–79.

McLachlan, H.L., Shafiei, T., and Forster, D.A. (2017). Breastfeeding initiation for Aboriginal and Torres Strait Islander women in Victoria: analysis of routinely collected population-based data. Women Birth, 30(5), 361-366.

Palinkas, L. A., Sarah, M. H., Carla, A. G., Jennifer, P. W., Naihua, D., and Kimberly, H. P. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health, 42(5), 533–544.

Petrie, A., and Sabin, C. (2009).  Medical Statistics at a Glance. John Wiley & Sons.

Santo, L.C.E., De Oliveira, L.D., and Giugliani, E.R.J. (2007). Factors Associated with Low Incidence of Exclusive Breastfeeding forthe First 6 Months. Birth, 34(3), 212–9.

Senarath, U., Dibley, M.J., and Agho, K.E. (2010). Factors associated with nonexclusive breastfeeding in five East and Southeast Asian countries: a multilevel analysis. Journal of Human Lactation, 26(3), 248–57.

Wen, L.M., Baur, L.A., Rissel, C., Alperstein, G., and Simpson, J.M. (2009). Intention to breastfeed and awareness of health recommendations: findings from firsttime mothers in southwest Sydney, Australia. International Breastfeeding Journal, 4(1), 9–9.