Study Area
This study is to be conducted in Kapsabet Hospitals Nandi County that record a very
high number of births, antenatal care and post-natal care attendance within the region.
Nutritionist therefore have a role to promote breastfeeding and adhere to the code. Kapsabet
Hospital is a public health facility under the County Government of Nandi Department of Health
Services. Kapsabet County Referral Hospital is located in Nandi County, Nandi Central district
in Kapsabet town. It lies approximately 300km North West of Nairobi, 46km south west of
Eldoret along Eldoret-Kisumu road.
Study design
The study used a cross sectional survey which employed both qualitative and quantitative
methods in data collection in the entire population or a subset thereof is selected, and from these
individuals, data are collected to help answer research questions of interest. It is called cross-
sectional because the information which is gathered represents what is going on at only one point
in time. The study aims at collecting information from respondents on care givers knowledge on
the Ten Steps to successful breastfeeding, the attitude of the lactating mothers on the Ten Steps
to successful breastfeeding and the practices of the care givers on the Ten Steps to successful
breastfeeding. Additionally, the knowledge of the MCH clinic nurse on the Ten Steps to
successful breastfeeding was also explored.
Target population
The study targeted mothers with their infants 0<24 months old residing within Nandi county by
accessing post-natal care at Kapsabet county mothers responded during the study. All
breastfeeding mothers visiting the MCH clinic at Kapsabet County Referral Hospital were
invited to participate in filling the questionnaires. The respondents of the study are to be
mothers/caregivers and their children 0-24months age who lives in Nandi during survey and to
be given consent of participation to the study. The study will exclude mothers/caregivers of
children aged 0-24months who will meet the inclusion criteria but will not have consent to
participate in the study and mothers/caregivers to children aged 0-24months who will chronically
ill, physically deformed and mentally challenged (based on medical records or the child health
card) as it would affect their anthropometric measurements and they need special care in terms of
feeding.
SAMPLING.
Sampling techniques
random sampling was used to include mothers/caregivers in the study. Specifically, lottery
method using Microsoft excel will be employed. In this technique, a list of all the mothers
/caregivers in the facilities will be made in Microsoft excel.
Sample size determination
n=N / 1+N(e)^2
n =sample size
N -population size of target place
e is the level of significance 95% /0.05
n = 400/1+400(0.05) ^2
n =200
*10% of sample size for non-participants
10/100×200=20
n =200+20=220
n =220
Study variables
Dependent variables
Nutritional status
Wasting Underweight Stunting
Independent variables.
Breastfeeding practices
Positioning and attachment Socio-demographic factors
Early initiation Education status
Bottle feeding Attitude
Data tools
A standardized questionnaire on infant and young child feeding practices is the main
tool to be used in collection of data in this study (appendix I).
The questionnaire is to be validated. It will be used to collect data on Breastfeeding practices,
socio-demographic characteristic of the mothers/caregivers, morbidity patterns, anthropometric
data. On complementary feeding practices, it collected data on introduction of solid foods, meal
frequency and dietary diversity. Data on dietary diversity was collected by use of 24-hour recall
Anthropometric data was collected using weight SECA scale and height board. Two focused
group discussions with eight to twelve mothers /caregivers each will be conducted using the
focused group discussion guide (appendix II). Each focused group discussion will take between
45th to 60 minutes and data on positioning and attachment during breastfeeding., the challenges
experienced during practice. In ensuring that relevant information on the variables collected in
the study, the purpose of the study, objectives and hypotheses of the study will be taken into.
Observation checklist will also be used to check on mothers Breastfeeding practices, on
positioning and attachment of breast, and breastfeeding behavior on demand (appendix 111).
PRE TESTING
Pre-testing of the questionnaire will be conducted in Kapsabet Hospital. A study sample size of
10% of the children aged 0 to 24 months old and their mothers / caregivers will interviewed and
the clarity and accuracy of questions and time taken in carrying out one interview will be
determined. Consistency in the interpretation of questions and ambiguity will also established.
The instruments will be reviewed and the corrections made before the actual study. Those who
will participate in this pretest will not be included in the actual study.
Validity
Validity is the degree to which a research tool measures accurately what it “meant to measure in
the study the questions on focused group discussion will pretested and validity and accuracy of
the focused group discussion guide will be determined. The SECA scale and the height board
will be pre-tested to ascertain the degree of error.
Data analysis
The data will be cleaned and entered into excel and exported to SPSS version 22. ENA for
SMART software version will be used to analyze anthropometry data. Descriptive
statistic will be used to describe social and demographic characteristics of the study
population, nutritional status, and breastfeeding feeding practices. Socio economic
characteristics will be analyzed by the principal component analysis (PCA). The
relationship between breastfeeding practices and nutritional status will be assessed inferential
statistics. Interpretation on the prevalence of malnutrition will have done using WHO/UNICEF
(2019) report on recommendations for data collection, analysis and reporting on anthropometric
indicators in children between 0 to 24 months
Objectives Indicators Statistical set
To establish socio- Education level, Mean, percentages
demographic characteristics
Attitude Median
Marital status
Breastfeeding practices Positioning and attachment Mean percentages
Early initiation
Relationship between Frequency of breastfeeding Pearson, correlation
Breastfeeding and nutritional
Weight/ height Chi -square
status
Asses the nutritional status of Weight/height Mean percentages
children
Height/ age
Weight/ age
Ethical considerations
Permission to conduct research will soughted from Kisii University while ethical clearance will
be from Kisii University Ethical review commission (KUERC). A research permit will be
soughted from National Commission for Science Technology and innovation (NACOSTI). The
study permission will be obtained from local administrative leaders. Informed consent will be
soughted from the respondents before participating in the study. Risks of participating in the
study will unlikely and low. In taking child weight and height, the measurements will be done in
an enclosed room so as to avoid exposure of the child to cold weather which may have some
health implications. Also, new hand cloves will be used in every child. The respondents will be
assured of confidentiality as their names and other identifying information will be not attached to
answers. All codes and data will kept in a password protected computer. The privacy of
respondents will be maintained in all written data and published papers.
