A community-based cross-sectional study was conducted in Anakaputhur, the urban field practice area attached to a medical college in Kanchipuram district, Tamilnadu. It has 18 wards with a population of 48,050 (males: 24,158; females: 23,892). This study was conducted for 3 months from November 2018 to January 2019 among mothers residing in the study area for 1 year or more. The sample size was calculated based on the study conducted by Prabu PM et al., in Maharashtra [3] which reported the knowledge of expression and storage of breast milk among mothers was 64%, the sample size was calculated at a 95% confidence interval and keeping the precision as 5. After accounting 10% for non-response, the final sample size was estimated to be 368 which is rounded off to 400. Systematic random sampling was used to identify the study participants. Sampling interval was calculated as follows: Total number of households in Anakaputhur (N) = 1851, Sample size (n) = 400, Sampling interval= N/n= 1851/400= 4.6. Thus every 5th household was selected for identifying a subject. If there was no eligible respondent in the selected household, the next house with the eligible study subject was selected. From that house, the next 5th household was selected. This procedure was followed till the desired sample size was reached. Mothers having a child of 2 years of age and less than 2 years were included after obtaining the informed consent. Mothers with children more than 2 years of age, had child expired and who were not willing to participate in the study were excluded from the study.
Data were collected from the consented participants using a pre-tested, structured questionnaire by the investigator. The questionnaire consisted of details regarding the sociodemographic characteristics and the knowledge, attitude, and practice regarding breast milk expression and storage of breast milk. The three main outcome variables in this study were knowledge, attitude, and practice regarding the expression and storage of breast milk among the study participants. These variables are composite scores and each outcome was measured using answers given by the study participants to several sets of questions.
The content of the question for each outcome and how these outcomes were scored are summarized below.
Knowledge of the study participants on expression and storage of breast milk (6 questions)
Each component was given a score of 1 for correct response and 0 for an incorrect response/answer not known. The scores were then added to generate a total score of 6 maximum. If the total score obtained by a study participant is ≥ 3 then the individual is categorized as having “adequate knowledge”, otherwise the individual is categorized as having “inadequate knowledge”.
Attitude of the study participant on expression and storage of breast milk (10 questions)
Each response consistent with a positive attitude towards expression and storage of breast milk was given a score of 1 and 0 for a response with a negative attitude. The total score (out of the maximum score of 10) was calculated by adding the scores to individual questions. If the total score exceeds 50% the participant is classified as having a positive attitude and if not the participant is classified as having a negative attitude.
Practices towards expression and storage of breast milk (4 questions)
Practices towards expression and storage of breast milk were assessed using the following components – whether the study participants have expressed breast milk and if so how did they express it manually or with the help of an instrument, whether they stored the breast milk before feeding it to the baby. Each response consistent with good practice was given a score of 1 and if otherwise a score of 0. The composite score of each individual was categorized using the cut off of 50% with scores above the cut off as “good practice “and if otherwise as “poor practice”
The data were entered in Microsoft (M.S.) Excel and analysed using SPSS software version 16.0. The results were obtained by applying appropriate descriptive and analytical statistics.
Ethical Approval: The study proposal was approved by the Institutional Ethical Committee of Sree Balaji Medical College and Hospital. Informed written consent in local language was obtained from all study participants before administering the study questionnaire.