lndlan Journal of Community Medicme Vol XXVI, No.

3, Jul -Sept (2001

NUTRITIONAL STATUS AND FEEDING PRACTICES OF CHILDREN

ATTENDING MCH CENTRE
Rasania SK, Sachdev TR
Deptt of Commumty Me&me,
Lady Hardmge Me&al College, New Delhi
Abstract:
Research question What IS the effect of feedmg practices on the nutritional status of children?
c3 bjectlve To assess the nutntlonal status and breast-feeding practices among children and to correlate the finchngs wrth some potential
determinants
Study’deslgn Cross-sectIonal
Settmg A maternal and child health centre, Mehrauh, Delhi
Participants Mothers and underfive children attending lmmumzation chmc
Study vanables Anthropometrlc measurement of children, breast-feeding practices and other feeding practlys
Statistical analysis Proportions, chl-square test
Results A total of 354 children were included m the study, of which 187(52 8%) were male and 167(47 2%) were female children
1 l4(32 2%) children belonged to IllIterate mothers while only 31(8 8%) children belonged to educated mothers beyond school level
Anthropometnc exammatlon of children revealed mean weight of 6 87+2 47 Kg and mean height of 64 73flO 13 ems 71 5% children
were underwelght as per weight for age while 70 1% and 62 7% of children had deficit m height for age (stunting) and weight for height
(wasting) respectively The mother’s report on breast-feeding revealed that 92 37% children were breast fed Children who were not breast
fed were found to be slgmficantly more underweight and stunted Out of total 354 children, weaning was started at the time of
only In I47 children Prevalence of malnutntlon was higher m bottle fed children (83%) than children on Katon/Cup feeding (55

Key words: Anthropometric measurement, Breast feeding practices, Weaning practices,

Container for top feeding

Introduction: young children, IS associated with a web of factors

Nutrition and InfectIon are the two most Important
factors that affect growth of the chddren Among children,
malnutrltlonespecially strikes those, who lack nutrItionally
adequate &et, not protected from frequent Illnesses and do
not receive adequate care’ Momtormg of children under
five years of age, using anthropometric parameters was
found to be most effective method of determmmg health
status and can be used to screen these children m order to
determine their nutrltlonal status2 Poor nutrltlonal status
can be measured usmg three types of anthropometric
mdlcators, each of these mchcators gives different
mformatlon about the growth and body composmon of
children3 ’
W H O a n d o t h e r InternatIonal agencres h a v e
recommended exclusive breast feeding m the mltial four
months and to continue breast feeding supplemented by
other appropriate foods upto second year of hfe6’
Malnutntlon, a public health problem among infants and
mcludmg Insufficient food intake. mcorrect feeding
practices, frequent mfectlons and literacy status of parents
etc’ Vaccine preventable diseases and faulty feeding
p r a c t i c e s a r e a s s o c i a t e d with profound growth
retardation’ “’ Keeping these aspects of nutrition m view,
this study was undertaken
Material and Methods:
A chmc based observational study was conducted m
the month of October 1999, m a Maternal and Child Health
Center, Mehrauh, Delhi and two subcentres under its
supervision Ctnldren not accompamed by their mothers or
with some serious or chrome dlness were not included m the
study All underfive children attenchng these centres, on
lmmumzatlon days were assessed anthropometxally
Children were welghed on the portable mfant welghmg
scale, wrth mmimumclothingand to the nearest of 100 gms
Recumbent length was obtamed for younger children
Standing height was measured for older children, to the

145
 Indian Journal of Community Medicine Vol. XXVI, No.3, Jul.-Sept., 2001

nearest of 0.5 cm. Anthropometric data was classified as per
Gomez classification for weight for age, Kanawati and
McLaren classification for height for age and Waterlow
c l a s s i f i c a t i o n f o r weigh f o r height3*4. A g e a n d
immunization status of child was determined from the
immunization card. The additional data obtained included
mother’s literacy status and her occupation. Information
was also collected on feeding practices of the child, breast
feeding status, initiation and duration of breast feeding etc.
The collected data was analyzed using SPSS software.
Categorical data was evaluated by chi square test comparing
normal and malnourished children.

Results:
Table I: Nutritional status of children.

Variables Sex Child breast fed Total

i Male Female Yes No

Weight for age (Under weight)
Normal 68(36.4) 33( 19.8)** 96(29.4) 5(18.5)* lOl(28.5)
Mild 76(40.6) 80(47.9) 146(44.6) lO(37.0) 156(44.1)
Moderate 27( 14.4) 39(23.4) 60( 18.3) 6(22.2) 66( 18.6)
Severe 16(08.6) 15(09.0) 25(07.6) 6(22.2) 31(08.8)
Height for age (Stunting)
Normal 65(34.8) 41(24.6)* lOl(30.9) 5( 18.5)* 106(29.9)
Mild gO(48.1) 81(48.5) 160(48.9) 1 l(40.7) 171(48.3)
Moderate 23( 12.3) 32( 19.2) 49( 15.0) 6(22.2) 55( 15.5)
Severe g(O4.8) 13(07.8) 17(05.2) 5(18.5) 22(06.2)
Weight for height (Wasting)
Normal 79(42.2) 53(31.7) 123(37.6) 9(33.3) 132(37.3)
Mild 78(41.7) 77(46.1) 145(44.3) lO(37.0) 155(43.8)
Moderate 23( 12.3) 29( 17.4) 47( 14.4) 5(18.5) 52( 14.7)
Severe 7(03.7) 8(04.8) 12(03.7) 3(11.1) 15(04.2)

Figures in parentheses indicate percentages; *significant; **highly significant.

A total of 354 children were included in the study, of
which 187(52.8%) were male and 167(47.2%) were female
children. Anthropometric examination of these children
revealed mean weight of 6.87k2.47 Kg. (7.02+2.53 for male
and 6.69k2.39 for female children) and mean height of
64.73k10.13 ems. (65.57f10.26 for male and 63.77f9.85
for female children). 71.5% children were underweight as
per weight for age while 70.1% and 62.7% of children had
deficit in height for age (stunting) and weight for height
(wasting) respectively. Female children were significantly
more underweight (p<O.OOl) and stunted (~~0.05). Severe
degree of stunting and wasting was observed more in the
female children. 327(92.37%) children were breast fed.
Non-breast fed children were found to be significantly more
underweight and stunted (~~0.05).

Nutritional status and feeding practices 146 Rasania SK et al

 Indian Journal of Community Medicine Vol. XXVI, No.3, Jul.-Sept., 2001

Table II: Nutritional status of children according to breast feeding practices.

Variables Normal Mild Moderate Severe Total

(n=96) (n=146) (n=60) (n=25) (n=327)
When breast-feeding started**
Within 2 hrs 37(51.4) 22(30.5) 12(16.7) l(1.4) 72
2-6 hrs 3 l(46.3) 27(40.3) 7( 10.4) 2(3.0) 67
6-12 hrs 9(20.0) 24(53.3) lO(22.2) 2(4.4) 45
12-24 hrs 9(19.1) 24(51.1) 9(19.1) 5(10.6) 47
24-48 hrs 5(12.5) 23(57.5) g(20.0) 4( 10.0) 40
>4g hrs 5(8.9) 26(46.4) 14(25.0) 1 l( 19.6) 56
How often breast-fed
l-4 times 16(20.8) 3 l(40.2) 21(27.3) 9(11.7) 77
5-8 times 46(30.9) 71(47.6) 23( 15.4) g(6.0) 149
9- 12 times 27(35.1) 33(42.8) 12(15.6) 5(6.5) 77
>12 times 7(29.2) 1 l(45.8) 4(16.7) 2(8.3) 24
How long breast-fed*
l-6 months 8 l(33.6) 103(42.7) 41(17.0) 16(6.6) 241
7-12 months 15(2 1.4) 35(50.0) 13(18.6) 7( 10.0) 70
13-18 months wu 5(55.6) 3(33.3) l(11.1) 9
19-24 months o(O). 3(42.9) 3(42.9) l(14.2) 7
Breast-feeding according to
Fixed time 30(28.0) 42(39.3) 24(22.4) 1 l(10.3) , 107
On demand 66(30.0) 104(47.3) 36( 16.4) 14(6.3) 220
Any problem in breast feeding*
Yes 4(11.8) 13(38.2) 9(26.5) g(23.5) 34
No 97(30.3) 143(44.7) 57( 17.8) 23(7.2) 320

Figures in parentheses indicate percentages; *significant; **highly significant.

Only in 72(20.3%) children breast-feeding was was observed (pcO.001). The duration of breast feeding was
initiated within two hours of birth while in 56(15.82%) found to be significantly associated with malnutrition
children it was delayed beyond two days of delivery. These (p<O.O5), however, the frequency of breast feeding was
were the children in whom severe degree of malnutrition found to be insignificant.

Nutritional status and feeding practices 147 Ftasania SK et al

 lndlan Journal of Communrty Medicine Vol XXVI No 3, Jul -Sept 2001

Table III: Nutritional status of children according to the initiation of weaning.

Weanmg started* Normal Mild Moderate Severe Total

(n=41) (n=66) (n=27) (n=13) (n=147)

c4 months 13(36 1) 16(44 4) 6(16 7) 1(2 7) 36

4-6 months 21(33 3) 30(47 6) 1 l(17 5) I(1 6) 63
6-8 months 6(24 0) 8(32 0) 6(24 0) 5(20 0) 25
8-10 months I(6 7) 7(46 7) 3(20 0) 4(26 7) 15
lo-12 months O(O) 5(83 3) I(16 7) O(O) 6
>12 months O(O) WV O(O) 2(100 0) 2

Figures m parentheses indicate percentages, *significant.

Severity of malnutrltlon was more m children where children, started early (~4 months) in 24 5% children while
mother had some problem m breast-feeding Weaning was m rest it was delayed beyond SIX months Severe
started, at the time of observation, only m 147 children It malnutrltlon was significantly higher (p<O 05) m children
was started at optimum age of 4-6 months m 42 9% where weaning was delayed

Table IV: Nutritional status according to top feeding practices.

Variables Normal Mild Moderate Severe Total

Container used for top feeding*
Katon/cup 40(44 9) 31(34 8) 13( 14 6) 5(5 6) 89
Bottle 29( 17.0) 80(46 8) 41(24 0) 21(12.3) 171
Method used for cleaning feeding container*
Water only lO( 17 5) 24(42 1) 13(22 8) lO( 17.5) 57
Soap 21(23 9) 44(50 0) 19(21 6) 4(4.5) 88
Boiling 32(42 66) 27(36 0) lO(13 3) 6(08 0) 75
Ash 6(15 0) 16(40 0) 12(30 0) 6(15 0) 40

Figures m parentheses indicate percentages, *highly slgmflcant

In addmon to breast milk, 260 mothers were Discussion:

supplementing with top milk and among them 65 8% were
using bottle for feeding top milk 62 7% mothers cleaned
the contamers used for top feedmg, either by soap or by
bolllng Even some mothers used ash (15 4%) or water only
(21 9%) Overall malnutrltlon prevalence was higher
(p<O 001) m bottle fed children (83%)
The study, carried out m a Maternal and Child Health
center, situated m the capital, consisted of children from
health conscious mothers, coming to the center for
lmmumzatlon A small sample size and selection bias due
to chmc based nature of study, are some of the hmltatlons
of our study.

NutrItIonal status and feeding practices 148 Rasanla SK et al

 Indian Journal of Community Medicine Vol. XXVI, No.3, Jul.-Sept., 2001
One of the major advantage of defining problem of
malnutrition in children in terms of “stunting”,
“underweight” and “wasting” is that it distinguishes
between types of malnutrition i.e. whether it is chronic or
acute”. Height for age i.e. stunting, is the sign of chronic
malnutrition. Weight for age (under-weight), is quite often
used as an indicator of malnutrition in the surveys, for
_ nutritional assessment. Weight for height i.e. wasting, is an
age independent index and reflects the nutritional
deprivation of shorter duration”. The present study
revealed that chronic malnutrition was more prevalent than
acute malnutrition and findings are similar to those of
others”“‘. Prevalence of malnutrition was also comparable
to other studtes”‘*“. However, prevalence of severe
malnutrition was lower than that observed by Ray13. Female
children were more malnourished than male children and
severe degree of stunting and wasting was observed more in
female chtldren, findings simrlar to that of Hossain”’ and
Ray”; however, Sastry” observed no sex difference.
Breast milk is the best available food for infants and
those who have been deprived of this, are expected to show
a greater prevalence of malnutrition. The present study also
reinforced this fact with the observation of significant
association of breast-feeding and higher prevalence of
underweight and stunting among non breast fed children.
Frozani14. while observing the effect of breast feeding
education, also found nutritional status of breast fed
children to be significantly better than non-breast fed
children. Delays in the initiation of breast-feeding are
known to be detrimental to the health of infants and children
and lead to malnutrition. This explains higher prevalence of
malnutrition in children where breast-feeding was initiated
late. But the duration of breast-feeding showed indirect
relation to the nutritional status, longer the duration of
breast feeding higher the prevalence and the severity of
malnutrition. A number of studies reported that prolonged
breast feeding is associated with increase in weight for age
after 6- 12 months of age’5*‘h. Other studies, however, found
increase in mild to severe malnutrition in children who were
breast-fed during second year”.“. One may expect
breast-fed children receiving complementary foods to be
Nutritional status and feeding practices a 149
protected against growth retardation from illness and poor
weaning diet. Yet this has not been observed consistently.
Prolonged breast feeding may reduce the consumption of
complementary foods without an equivalent increase in
human milk intake, thereby, diminishing total energy
intake”. Assenso”‘, while assessing the effect of prolonged
breast feeding on the nutritional status, observed
considerably lower nutritional status of children who
continue to receive the breast milk upto 2nd and 3rd year of
life in comparison with fully weaned children in the same
year. Higher prevalence of malnutrition, in the present
study, with prolonged breast-fed children is because
weaning is delayed or supplementary feeding is not given to
these children at appropriate time. The association of severe
degree of malnutrition with prolonged breast-feeding is also
in agreement with the findings of Hossain”’ and Jahan’.
Delayed weaning is also detrimental to health. This
explains the significantly higher prevalence of malnutrition
in children, who were weaned late, i.e. beyond 6 months of
age. This also explains higher prevalence of malnutrition in
children where breast-feeding was continued for longer
period, because as the age advances, breast milk remains
inadequate for the children. A significantly higher
prevalence of malnutrition among bottle fed children can be
because they are more prone to get infection due to poor
hygienic conditions of both bottle and nipple. Moreover,
even ash or plain water were also observed to be common
methods of cleaning these containers. It shows that mothers
are not adequately aware of the importance of cleanliness of
containers used for feeding.
Conclusion:
The study was carried out to know the feeding
practices and their effect on nutritional status of children.
Study clearly highlights the need of nutrition education to
the mothers for promotion of breast-feeding, appropriate
weaning education and education for hygiene maintenance
in feeding of child, so that childhood malnutrition can be
reduced.
Rasania SK et al

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