PRESENTATION OF THE THESIS

PROPOSAL
FACTORS ASSOCIATED WITH THE
NUTRITIONAL STATUS OF LACTATING
MOTHERS IN KILEMBE SUB COUNTY
KASESE DISTRICT
 Chapter one
Background of the study
• During lactation, women are more vulnerable to under nutrition than others at
reproductive age, due to increased energy and nutrient requirements (Desalegn, Lambert,
Riedel, Negese, &Biesalski, 2018). During lactation period, mothers are at an increased
risk of nutritional deficiencies due to feeding behaviours and social economic factors
(Demissie, Mekonen&Haider, 2012).
• Nutritional requirements during lactation are greater than during pregnancy (Asha&bSalil,
2015). A lactating mother will need to take some extra care to assure that she produces
and provides to her infant high-quality breast milk (Bitew et al., 2015).
• It is reported that a lactating woman should produce about 700 to 800ml of milk per day
and this requires an extra energy need of about 500 calories per day (Sylvia and Mary,
2016).Women who are under nourish ed have reduced lactation performance thus, the
quantity of milk produced depends a lot on the feeding practices (Allen, 2015).
• Lactating mothers with low levels of income and education are likely to lack daily
additional meals, regular meals and a balanced diet yet during lactation, maternal stores
of energy, protein, and other nutrients needs to be established, conserved, and
replenished to ensure both the health of the mother and adequate levels of
micronutrients in her breast milk (WHO, 2019).
• Globally, about 14 million women become lactating mothers each year and more than
90% of mothers live in developing world where behaviours like alcoholism, smoking, poor
feeding practices prevail and the social economic status is low. (Nigussie and Abebe,
2017). This is the underlying cause of 20% of maternal death among lactating women in
low and middle income countries of the world (World Bank, 2017). In most countries,
maternal under nutrition (MUAC less than 23cm) ranges from 10% to 19%.
• The 2018 global nutrition report showed that China still experiences the burden of under
nutrition among adult women. Approximately 26.4% of women of reproductive age have
anaemia. Some studies in China have reported that lactating mothers had a significant
lower intake of nutrients and behaviours like alcoholism and smoking thus did not reach
the recommended levels for many essential micronutrients (Warren et al. 2019).
• In India, 33% of lactatingmothers are too thin, according to the body mass index (BMI), an
indicator derived from height and weight measurements. Underweight is most common
among the poor, the rural population, adults who have no education and abuse drugs
(India National health survey, 2019).

• According to the 2020 World Health Organization (WHO) African region data, between
2000 and 2020, nine countries in Africa had a prevalence rates of under nutrition above
15%. Maternal underweight exceeds 20% in Ethiopia, Madagascar and Senegal while the
lowest rates of underweight among lactating mothers are found in Benin, Cameroon,
Ghana, Lesotho, Rwanda, Swaziland, and Togo .For example, the current prevalence of
undernourishment among lactating mothers range from 20 to 67% (Berihun et al.,
2017;Abeya et al., 2018; Temesgen et al., 2015).
• The health statistics from Kasese District health facilities show
that 47.2% of malnourished lactating mothers were from
Kilembe Sub County which is higher compared to Bugoye and
Buhuhira Sub Counties where it stands at 23% and 28%
respectively (District health report, 2019). The actual
information regarding the factors influencing nutritional
status of lactating mothers in the study area is scarce to guide
comprehensive interventions. This study is therefore set to
investigate the factors influencing the nutritional status of
lactating women so as to provide solutions that are aimed at
improving maternal nutrition in Kilembe Sub County,
Busongora South County, Kasese District.
 Statement of the Problem
• Nutritional requirements during lactation are greater than during pregnancy. There are high levels
of Underweight among lactating mothers at 39.7% in KaseseDistrict which is the highest in the
country compared to 29% national average (Uganda health and demographic survey, 2016). The
district health statistics show that there is an estimate of 47.2% underweight rate of lactating
mothers in KilembeSub Countywhich is higher compared to Bugoye and Buhuhira Sub Counties
where it stands at 23% and 28% respectively(District health report, 2019). Under nutrition among
lactating mothers in KilembeSub County KaseseDistrict could be so due to feeding behaviours and
low social economic status (District health report 2019).
• Though the government of Uganda through the ministry of health has designed interventions to
address issues concerning feeding practices and nutritional status of lactating mothers through
providing free antenatal care services to all women, Building capacities among local leaders and
district level service providers to trigger and maintain demand for intra household dietary diversity
at scale , Promoting behavioural change at intra household level through communication targeted
on the benefits of dietary diversity, the nutritional status of lactating women still has challenges
because Uganda is one of the countries that have failed to meet the development millennium goal
five which calls for improvement of maternal health (WHO, 2016). Information on the, nutritional
status of lactating women from mostcommunities is lacking. Thus, this study will be carried out to
provide information regarding the factors associated with the nutritional status of lactating
mothers in the study area.
• Research Questions
• What are the factors related with the nutritional status of lactating mothers in KilembeSub- County
KaseseDistrict?
• What is the prevalence of nutritional status of lactating mothers in KilembeSub-County KaseseDistrict?
• What is the association between different factors and nutritional status of lactating mothers in Kilembe
Sub-County Kasesedistrict?
• General Objective
• To assess the factors associated with the nutritional status of lactating mothers in KilembeSub County
KaseseDistrict so as to provide information for decision making to make this action oriented.
• Specific Objectives
• To describe factors related with nutritional status of lactating mothers in KilembeSub-County
KaseseDistrict.
• To determine the prevalence of nutritional status of lactating mothers in KilembeSub-County
KaseseDistrict.
• To establish the association between the different factors (Individual/Behavioral) andnutritional status of
lactating mothers in KilembeSub-County KaseseDistrict
• Hypothesis
• The null hypothesis of the study is; there is no statistically significant association between the different
factors and nutritional status of lactating mothers in Kilembe sub-county Kasese district.
 Significance of the Study
• Information on the, nutritional status of lactating women from mostcommunities is lacking
yet we are living in the era of aiming at achieving goals like the millennium development
goal five which calls for improvement of maternal health by 2030. Therefore, the results of
this study will be significant in different ways to the following stakeholders as herein below,
• Ministry of Health. The findings of this study will provide empirical evidence to step up the
implementation of policies aimed at improving the nutritional statutes of lactating mothers.
• Ministry of Labour Gender and Social Development. The findings of this study will act as an
eye opener to the ministry of gender labour and social development to collect information
concerning the nutritional status of lactating mothers and the associated challenges so that
solutions to those challenges are found and implemented.
• Public Health Practice:the study results will provide insights on which initiatives ought to be
adopted by public health practitioners to improve the nutritional status of lactating mothers
as well as ensuring the health of their babies.
• Scholars:The results of this study will add to the bank knowledge on the factors associated
with nutritional status of lactating mothers
• Lactating Mothers: The results of this study will help lactating mothers to improve their
nutritional status through adopting the recommended feeding practices
• Health facilities: The results of the study will help health facilities to improve maternal
health services and provide more support to lactating mothers.
 Conceptual frame work
The following framework illustrates the various factors associated with the nutritional status of lactating mothers. It
shows the interconnection between these factors and the ultimate level of nutritional status of lactating mothers

• Dependent variables independent variables

• Behavioural Factors:
• Balanced Diet
• Number of meals per day
• Frequency of Meals
• Smoking
• Alcohol use
•
 METHODOLOGY
Research Design
• . The study will adopt a population based cross sectional study design in which both quantitative and
qualitative research approaches will be adopted in investigating the factors associated with the nutritional
status of lactating mothers in Kilembe Subcounty, Kasese district.
• The motivation for a cross-sectional study design is because it will be used as descriptive and analytical in
the objective of determining the factors associated with the nutritional status of lactating mothers. In
addition, the design requires fewer resources and characterised by less attrition rates (Setia, 2016). The
design will also allow describing of situations in the way they exist (Setia, 2016).
• A quantitative approach will be used to provide access to the participants’ individual and behavioural
factors that are associated with nutritional status of lactating mothers by using a semi-structured
questionnaire. In addition, a quantitative research allows a rigorous assessment of the magnitude and
frequency of the study constructs. The qualitative research approach is chosen because it enables a deeper
explanation of the quantitative results (Plack, 2005).
• Study Population
• The target population of the study will comprise of all potential mothers living in KilembeSub County,
Kasese district. According to Kasese District Health Report (2022), 148,929 potentials (females mothers in
the reproductive age of 15 – 49 years) (Kasese District Health Report, 2022).
• Whereas, the study population will comprise of only lactating mothers aged 15-49 years in six parishes of
Kilembe sub county, having less than or equal to 24 months old child(Kasese district maternal health
report, 2020).
• Inclusion criteria: All lactating mothers who will be found to have lived for six months and above in the study area and, having a child of breastfeeding
less than or equal to 2 years old will be included in the study.
• Exclusion criteria: Lactating mothers with pregnancy, mothers having more than two years old child, physical deformities and critically ill during the
time of data collection will be excluded from the study.
• The justification for choosing this study population is based on the fact that these mothers together with their babies are so vulnerable with several
nutritional requirements that require special attention. However, the population of lactating mothers aged 15-49 years in KilembeSub County is
unknown.

• Sample Size
• In this study, being that the total population of lactating mothers in Kilembesub county is unknown, the sample size of the study will be determined
using the Kish Leslie formula (1965) for simple random sampling for single proportions ( ).
• Where,
• n = Sample size
• z = z value corresponding to a 95% level of significance = 1.96
• p = Prevalence of undernutrition, p = 47.2% (or p = 0.472) (UBOS, 2018)
• q = estimate of variance (1-p)
• e = margin error
• q = (1 - p) = (1-0.472) = 0.528
• d = absolute precision (5%)
• Therefore, from the above the sample size will be:
• n =1.962X 0.472 (0.528)
• 0.052
• n =382.955
• n = 383 respondents
• Hence a total of 383 lactating mothers will be sampled in the study.
• Using purposive sampling technique, 15 key informants will be sampled. These will all be health workers (nurses and midwives) in MCH department in
Kilembe mines hospital.
Data Collection Methods and Instruments
• The study will employ various data collection methods and instruments.
Data Collection Methods
• The study will use questionnaire survey and key informant interview methods for data collection.
• Questionnaire Survey: According to Roopa and Rani (2012), questionnaire surveys are a technique for gathering statistical information about the
attributes, attitudes, or actions of a population by a structured set of questions. In this study, the questionnaire survey method will be used to collect
data from respondents, who will be lactating mothers in KilembeSub County.
• Key informant interviews: According to Kun et al. (2013), Key informant interviews are qualitative in-depth interviews with people who know what is
going on in the community. The purpose of key informant interviews is to collect information from people with special knowledge including
community leaders, professionals, or residents who have first-hand knowledge about the community (Kun et al., 2013). In this study, the key
• Sampling Procedure
• Cluster sampling and simple random sampling techniques will be employed in the selection of the study
participants. Cluster sampling is a technique that involves dividing the entire population into sections or
clusters that represent a population and take a systematic sampling to choose the participants in each
cluster (Taherdoost, 2017). Kilembesubcounty consists of four parishes, that is, Kibandama, Bunyandiko,
Nyakazinga and Mbunga. Each of the parishes will act as an individual cluster. From each parish, two
villages will be randomly selected using lottery method.
• From each of the selected villages, a total of 48 lactating mothers will be randomly selected into the study.
These will be selected from the households in the respective villages. Using systematic random sampling, a
sampling interval (k) will be determined for each village, obtained by dividing the entire total number of
HHs by the sample size.
• Sampling interval = total number of HHs in a cluster / needed sample number of HHs in that stratum
• Data Collection Instruments
• A researcher-administered questionnaire and a key informant interview guide will be developed to collect
data from the respondents.
• Research-Administered Questionnaire:According to Roopa & Rani (2012), a questionnaire is a research
instrument that consists of a set of questions or other types of prompts that aims to collect information
from a respondent.For this study a researcher-administered questionnaire will be used to collect
quantitative data from the respondents, who will be lactating mothers in KilembeSub County. The
questionnaire tool will use both open-ended and closed questions. The open-ended questions will allow for
stimulating thought, probing for complex questions, and for those questions where the researcher cannot
anticipate respondents’ responses. Whereas the closed-ended questions will help the respondents make
quick decisions and also this will help the researcher to code information easily from subsequent analysis.
• Key Informant Interview Guide
• A Key informant interview guide is an instrument used to collect data using qualitative in-depth interviews
with people who know what is going on in the community (Young, 2019). In this study, the key informant
interview guide will be used to collect qualitative data from 15 key informants, who will be nurses and
midwives in the maternal section atKilembe mines hospital.
• Validity
• Validity refers to the extent to which a measurement procedure measures what is intended to
measure rather than measuring something else, or nothing at all (Amin, 2005).Content validity
will be used because it focuses on the extent to which the content of an instrument
corresponds to the content of the theoretical concept it is designed to measure (Boud et al.,
2016). To ensure validity, the research tools will be given to two supervisors who will
proofread and check the relevance of each question in the tool in providing answers to the
study objectives and appropriate modifications will be made. Following this, a content validity
index (C.V.I) will be computed using the formula.
• The minimum value of CVI required will be 0.6 and above. Polit& Beck (2006) argue that
instruments with validity index greater than 0.6 are accepted as valid in the research. Hence,
the instrument will be valid for use in the study.
• Reliability
• Reliability is defined as the degree to which a measurement technique can be depended upon
to secure consistent results when applied repeatedly (Weiner, 2007). It is the extent to which a
research tool can consistently produce the same results on different yet similar
settings/situations/circumstances, this is also a determinant of generalizability (Stephens et al.,
2007). Before using the questionnaire, a pilot study will be carried out first to pre-test the
questionnaire and determine its reliability. The pilot study will be done with selected lactating
mothers in KatweKabatoro Town Council. For this study, 38 lactating mothers from Kilembe
mines hospital will be involved in the pilot study. The sampled respondents will be asked to fill
the questionnaire, each at a time. Each respondent will be asked to think loud when answering
the questionnaire. They will be asked to identify those questions that could attract
uncomfortable responses and will be asked to provide their options for such questions. They
will be also asked whether they understand the questions, and whether they could find the
next question and section easily.
• Data Analysis
• The questionnaires and consent forms will be stored separately to ensure that there is
no leakage of identifying information. Editing will be done by the research assistants
to ensure that all questionnaires are well filled so as not to give out sub-standard
results and errors of omission will be handled.
• The data from the field will be edited to detect errors, cleaned daily, sorted and
questionnaires will be given numbers for identification. The data will be entered into a
data sheet and analysed in computer using the statistical package for social scientists
(SPSS) version 27.0 while ensuring accuracy and consistency of data.
• Objectives 1 and2 will be analysed using descriptive statistics such as frequency
counts, percentages, mean and standard deviations, and the distribution of data will
be presented in frequency tables and/or pie chart. For objective 3, Pearson Chi-
squared test and Logistic Regression analyses will be appropriate for testing for
association between nutritional status of lactating mothers and the categorical
factors. This will be done 5% level of statistical significance. Crude odds ratios will
also be processed before controlling for confounding through subjecting the data
collected on the factors in the conceptual framework to Bivariate Binary Logistic
Regression Analysis. This will help to compare the observed values in the data to the
expected values that we would see if the null hypothesis is true (Ugoni & Walker,
1995). A Multivariate Logistic Regression model will be finally fitted for all factors with
p-values less with at most 10%(0.1) cut off as to control for confounding. All factors
with the p-value of ≤ 0.05 will be considered as significantly associated with
nutritional status among lactating mothers, and the Null hypothesis will be rejected.