Study setting
The study was conducted in Gondar town which is 747 km away from a capital city Addis Ababa. Ethiopia.
Study design and period
A cross sectional institution-based study design was employed to assess overweight and associated factors of lactating mothers at Gondar town health facilities.
Source population
All Lactating mothers on post-partum period visiting expanded program of immunization /EPI/, post-natal care /PNC/ in health facilities Gondar town, were considered as the source of population.
Study population
Postpartum mothers who were visiting for the expanded program of immunization /EPI/ service during their post-natal care /PNC/in the randomly selected health facilities in Gondar town were the study population.
Inclusion Criteria
All lactating mothers during post-partum period and available during the study period at health facilities in Gondar town.
Exclusion criteria
Lactating mothers and who are critically ill, had physical deformity (that causes difficulty during anthropometric measurements at the time of data collection) were excluded in the study.
Variables
Dependent Variables
Overweight (Yes/No)
Independent variables
Socio-demographic & economic characteristics like: religion of lactating mothers and occupational status, head of household, Income, wealth index,
Maternal and obstetric histories. Birth interval, parity, breast feeding duration
Health related and practice: Obesity Family history, exercise
Other factors (Nutrition information, Frequency of listening radio/television, Source of nutritional information help family food security, meal variety (eaten cereal food, eaten whole grain, eaten whole grain, eaten fatty foods, milk and dairy food, meat and fish, egg foods, bright green vegetables, rich in vitamin A, foods made from different herbs, a variety of fruits).
Operational definition
- Post-partum period –a mother who comes at 3month after birth.
- Overweight: if BMI>= 25.00 Kg/m2
- Not overweight=if BMI < 25.00 kg /m2
Sampling technique
The sample size for this study was estimated by using single population proportion formula by considering the following statistical assumption. Confidence level (CI) =95%= 1.96for
specific Marginal error 0.05%, P1= prevalence of overweight among lactating mothers P= 50%,
Design effect = 1.5
n = 614 Where, n = sample size
= Precision level or level of significance
P = Population proportion regular physical exercise
w = Marginal error
Zα/2 = The value under standard normal table
Sampling procedures
The calculated sample size was allocated proportionally to the hospital and other health institutions based on their population size and according to the average number of clients registered prior to the study period in the respective institutions.
Data collection tools and procedure
A structured questionnaire was first prepared in English and translated to Amharic and then back to English to check its consistency. Assistants who are fluent in the local language administered the pre-tested questionnaire to selected lactating mothers in the hospital and health institutions. For administering the structured questionnaire, four nurses were recruited from the study area to conduct exit interview. Training was given for two days (including half day of pretest) on the objective, relevance of the study, confidentiality of information, respondent’s right, informed consent and techniques of interview. Moreover, class room practical demonstration of the interview was carried out. Two Supervisors who has first degree in nursing have supervised. Closely followed up the data collection process throughout the data collection period 14weeks of after birth. Along with the principal investigator data was collected from the field has got revised every day with data.
Anthropometric Measurements
Weight was measured by weight scale (seca) in kilograms without shoes and with light clothing to the nearest 0.1 kg and height of the study participants was measured to the nearest 0.1 cm using Standiometer (seca) with positioning the study subjects at the Frankfurt Plane and the four points (heel, calf, buttocks and shoulder) touching the vertical stand and their shoes taken off. BMI was calculated as weight/height2in kg/m2 and used to categorize BMI-measured weight status: underweight (BMI ≤ 18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25.0– 29.9) and obese (BMI ≥ 30) based on WHO classification parameters(19).
Data processing and analysis
Data was checked, coded and entered to Epi-data 4.6 version and was exported to SPSS version 20.0 for analysis. Reliability for analysis was performed to ensure that items within each factor are kept consistent. Internal consistency was checked by calculating Cronbach’s alpha for each of the items to examine the extent to lactating mothers answered consistently to the items in each of the three factors. Descriptive and analytical statistics including bivariable and multi variable analyses is employed. All variables with a P value of less than 0.2in bi variable analyses were entered to multi variable analysis to control the possible effect of confounders. Both crude and odds ratio (COR) and adjusted odds ratio (AOR) were estimated to show the strength of association. In multi variable analysis, variables with a P value of ≤0.05 consider as statistically significant.
Data quality control
Different measures were taken in order to assure the completeness and quality of the data. First, training was given to supervisors and data collectors on how to collect data from respondents by interviewing based on the prepared questionnaire. To assess the validity and reliability of the questionnaire and clarity of the variable, pre-test was done on 5% of total sample respondents. After the pre- test unclear questions were collected and then corrective measures were be taken. During the data collection process, regular monitoring and supervision of the overall activity done by the supervisors and principal investigator to check for completeness and in order to ensure the quality of data. Besides, data cleaning and coding was carried out during data entry before the analysis.
The Ethical clearance was obtained from ethical review committee public institute on behalf of the institutional review board of University of Gondar. A permission letter was also being obtained from the University of Gondar Comprehensive Specialized Hospital management office and from health center. Written consent was taken from respondents about their agreement to give information and take part in this study. In order to keep confidentiality, the names, and addresses of participants were not included or recorded on the data collection questionnaire. Acquired information from participants was not disclosed to any external subject(s).