Abstract: Complementary feeding is a process of gradual introduction of semisolid foods other than breast milk to an infant to facilitate optimal growth. Complementary feeding practices are often the most important causes of malnutrition in children from 6-36 months of age. Therefore a cross- sectional study was carried out in Thakkarbapanagar ward of Ahmedabad to determine the complementary feeding practices and knowledge among mothers who have <2 year old child. House to house interviews were carried out using field tested questionnaire.. Exclusive Breast feeding was given to 61(61%) babies. Colostrum was given to 76(76%) babies. Prelacteal food was given to 39(39%) babies, out of which 29(29%) were given jaggery water and 10(10%) were given glucose water. Breastfeeding was continued in all the children till 6 months. Around 62(62%) mothers had the knowledge on initiation of complementary feeding after 6 months of age. A significant association was observed between timing of complementary feeding and illness during it as well as bottle feeding. Training programs should be arranged for the mothers in the community to increase the awareness as well as importance of timely starting complementary feeding. Keywords: Complementary feeding, mothers of <2 year old children, Breastfeeding, Colostrum
Arohi Chauhan Ex-Pg student, Community Medicine Department, Smt. NHL Municipal Medical College, Ahmedabad, India
Aparajita Shukla Associate Professor, Community Medicine Department, Smt. NHL Municipal Medical College, Ahmedabad, India
Sandeepkumar Chauhan Project Manager, MATIND Project, Indian Institute of Public Health, Gandhinagar, India
I SSN 2319-9725
November, 2013 www.ijirs.com Vol 2 Issue 11
International Journal of Innovative Research and Studies Page 23
1. Introduction: Complementary feeding is a process of gradual introduction of semisolid foods and liquids other than breast milk to an infant to facilitate optimal growth. The ideal age of complementary feeding is six months. The desirable complementary feeding food should be inexpensive, home available, clean and easily digestible. It should be rich in calories and protein with adequate amount of trace elements like iron, calcium, vitamins etc. [1] The link between malnutrition and infant feeding has been well established. Recent scientific evidence reveals that malnutrition has been responsible, directly or indirectly, for 60% of all deaths among children under five years annually. Over 2/3 of these deaths are often associated with inappropriate feeding practices and occur during the first year of life. Only 35% of infants world-wide are exclusively breastfed during the first four months of life and complementary feeding begins either too early or too late with foods which are often nutritionally inadequate and unsafe. Poor feeding practices in infancy and early childhood, resulting in malnutrition, contribute to impaired cognitive and social development, poor school performance and reduced productivity in later life. Poor feeding practices are, therefore, a major threat to social and economic development as they are among the most serious obstacles to attaining and maintaining health of this important age group. [2] Complementary feeding practices are often the most important causes of malnutrition in children from six months to three years of age. Habits of child feeding are based on the quantity and quality of food available; on beliefs about what is and isn't good for young children; on time available for food preparation; and on custom. The philosophy of complementary feeding is to let the baby do itlet him nurse until he wants to stop. A mother should be sensitive to the specific needs of her baby and not follow the rigid guidelines of any book. Just as some babies get their first tooth at only five months old and others not until they're well over a year old, some are ready to wean at younger ages then others. Therefore, a cross-sectional study was carried out to determine the complementary feeding practices and knowledge among mothers who have less than 2 year old child.
November, 2013 www.ijirs.com Vol 2 Issue 11
International Journal of Innovative Research and Studies Page 24
2. Objectives: i. To assess the knowledge and Practice regarding complementary feeding in mothers of children < 2 years old. ii. To correlate various socio-demographic factors with this knowledge and practice regarding complementary feeding.
3. Materials And Method: A cross-sectional study was carried out among 100 mothers having <2 years old children in Thakkarbapanagar ward of Ahmedabad municipal corporation during March-October, 2012.
4. Selection Of Subjects: 100 mothers having <2 year old children were selected by simple random sampling using lottery method at Thakkarbapanagar ward from March-August, 2012. Mothers having < 2 year old child were selected so as to minimize recall bias. Study technique was house to house interview using pre-tested questionnaire and interviews were conducted by the same researcher to ensure validity and reliability of the answers. Study tool was a field tested questionnaire containing both open and closed ended questions. Study variables were age of the baby, weight of the child, birth order, Colostrum and prelacteal history, breastfeeding history, complementary feeding history, type of complementary feeding food, illness and hospitalization during complementary feeding, etc. Answers related to knowledge and practices were evaluated as correct and incorrect. Appropriate feeding practices were defined as starting complementary feeding after 6 months along with continue breastfeeding and feeding the child with bowl and spoon.
5. Ethical Consideration: Informed verbal consent was taken from all the mothers after explaining the purpose of the study and ensuring confidentiality.
November, 2013 www.ijirs.com Vol 2 Issue 11
International Journal of Innovative Research and Studies Page 25
6. Statistical Analysis: Analysis was done in SPSS 20.0 and results were expressed as percentages. To test the association between two variables, chi-square test was used.
7. Results: Most of the families had two children and they were aware about family planning practices. Around 76 (76%) mothers had normal delivery. In the age group 6-12 months, 26 (26%) children were underweight, in 12-18 months 5(5%) were undernourished while in 0-6 and 18- 24 months, 1(1%) child each were undernourished. Immediately after birth, 5(5%) children were having jaundice, 2(2%) were having breathing difficulty and 1(1%) were having pneumonia. Exclusive Breast feeding was given to 61(61%) babies. Colostrum was given to 76(76%) babies. Prelacteal food was given to 39(39%) babies, out of which 29(29%) were given jaggery water and 10(10%) were given glucose water. Breastfeeding was continued in all the children till 6 months. In 26(26%) children it was stopped at around 12 months after birth. A total of 62(62%) mothers had the knowledge on initiation of complementary feeding after 6 months of age. Out of which 58(58%) had started complementary feeding appropriately, while 17(17%) had started early and 25(25%) had started too late. In 93(93%) children, complementary feeding food constituted of homemade as well as formula based food (Table.1). About 12(12%) babies were given bottle feeding where as 88(88%) babies were feed using bowl and spoon. When asked to mothers about the decision regarding meal quantity, 55(55%) of them couldnt answer the question, while 32(32%) replied that when the baby felt asleep they consider that the quantity was appropriate while rest answer that if the baby was calm then the quantity was sufficient. Around 36(36%) mothers were giving food twice daily and 64(64%) were giving food for 3-4 times a day. There was a significant association observed between timing of complementary feeding and illness during complementary feeding. Association between bottle feeding and illness during complementary feeding was also statistically significant. (Table.2)
November, 2013 www.ijirs.com Vol 2 Issue 11
International Journal of Innovative Research and Studies Page 26
No. Variable Male Female 1 Age 0-<6 months 0 1 6- <12 months 23 19 12- <18 months 14 9 18- 24 months 17 17 2 Weight 5-<8 Kg 18 15 8-<11 Kg 24 22 11-14 Kg 12 9 3 Birth order 1 20 20 2 28 20 3 and above 6 6 4 Type of delivery Normal 42 34 CS 12 12 5 Colostrum given Yes 39 37 No 13 9 6 Prelacteal given Yes 26 13 No 26 33 7 Exclusive Breastfeeding Yes 26 13 No 26 33 8 Complementary feeding timing <6 months 37 23 >6 months 15 20 >1 year 2 3 9 Type of complementary feeding food Homemade 4 0 Formula based 0 1 Both 50 43 10 Illness during complementary feeding Diarrhea 27 21 Fever 19 12 Cough 4 3 Constipation 1 0 Table 1: Gender wise distribution of various study variables
November, 2013 www.ijirs.com Vol 2 Issue 11
International Journal of Innovative Research and Studies Page 27
Illness Total Chi-square P value Complementary feeding Yes No 22.793 <0.0001 Appropriate 19 35 54 Inappropriate 38 8 46 Total 57 43 100 Bottle feed 16.513 <0.001 Yes 10 2 12 No 22 66 88 Total 32 68 100 Table 2: Association between illness during complementary feeding and timing of complementary feeding as well as bottle feeding
8. Discussion: It is believed that the awareness of mothers regarding feeding practices affect the nutritional status and health of infants. [3] Complementary feeding is extremely essential from six months of age while continuing breastfeeding, to meet the growing needs of the growing baby. Infants grow at a very rapid rate. The rate of growth at this stage is incomparable to that in later period of life. The purpose of complementary feeding is to complement the breast milk and make certain that the young child continues to have enough energy, protein and other nutrients to grow normally.[4] According to WHO guidelines, children should be exclusively breastfeed for the first 6 months, then complementary feeding should be started along with breastfeeding upto 2 years or more.[2] In the present study, 62(62%) mothers had the correct knowledge regarding initiation of complementary feeding i.e. after 6 months of age, whereas Ananda et al observed in his study that 43.6% mothers had the correct knowledge regarding initiation of complementary feeding.[1] Chatterjee et al reported that 52.7% mothers had correct knowledge about complementary feeding.[5] The single most effective measure for the prevention of malnutrition and protection against infection in infancy is breastfeeding. [6] In the present study, exclusive breast feeding was given to 61% babies; colostrum was given to 76% babies and prelacteal feed to 39% babies respectively. In a study conducted at Kolkota by Chatterjee et al, exclusive breast feeding was given to 26.9% babies; colostrum was given to 96.3% babies and prelacteal feed to 54.5% babies respectively. [5] Chaudhary et al observed that colostrum was given to 95% babies in their study. In the present study, prelacteal feed consist of jaggery water in 29% babies and November, 2013 www.ijirs.com Vol 2 Issue 11
International Journal of Innovative Research and Studies Page 28
glucose water in 10% babies. Chaudhary et al reported that 10% babies were given glucose water as prelacteal feed. [7] Adequate complementary feeding from six months of age while continuing breastfeeding is extremely important for sustaining growth and development of the infant.[4] Complementary feeding was started after 6 months in 58% babies in the current study. Chatterjee et al reported that 70.5% mothers started complementary feeding in their children after 6 months.[5] In present study, 36% babies were given complementary feeding food twice daily while Ananda et al reported that 45.9% babies were given food twice daily in their study.[1]
9. Conclusion: The present study highlights the need for health education program regarding exclusive breastfeeding, timing of complementary feeding, complementary feeding foods, etc. Training programs should be arranged for the mothers in the community with the locally available foods to increase the awareness as well as importance of timely complementary feeding.
November, 2013 www.ijirs.com Vol 2 Issue 11
International Journal of Innovative Research and Studies Page 29
References: 1. Ananda Kumar, TS., Rangaswamy, KB., Viswanatha Kumar, HM.(2013) Complementary feeding practices in rural Tumkur. Curr Pediatr Res, 17(2),115-117. 2. Global Strategy for Infant and Young Child Feeding. WHO (WHO, Geneva,2003). 3. Guiding principles for complementary feeding of the breastfeed child. Pan American Health Organization and World Health Organization, 2003. 4. National Guidelines on Infant and Young Child Feeding, Ministry of Women and Child development (Food and Nutrition Board), Government of India, 2006. 5. S, Chatterjee., S, Saha.(2013) A study on knowledge and practice of mothers regarding Infant Feeding and nutritional status of under-five children attending Immunization Clinic of a Medical College. Internet Journal of Nutrition and Wellness. 5(1). 6. I, Pant., K, Chothia.(1990) Maternal Knowledge regarding breast feeding and complementary feeding practices. Indian Journal of Pediatrics, 57(3),395-400. 7. R, N, Chaudhary., T, Shah., S, Raja.(2011) Knowledge and Practice of mothers regarding breast feeding : a hospital based study. Health Renaissance, 9(3),194-200.