Pediatrics Research International Journal

Vol. 2014(2014), Article ID 790373, 34 minipages.

DOI:10.171!2014.790373
""".i#imap$#lis%ing.com



Copyiight 2u14 Saiia Tasnim, Syeua Nazia Akhtai anu F N Anamul
Baque. Bistiibuteu unuei Cieative Commons CC-BY S.u








Research Article
Nutritional Status and Breast Feeding Practice among
Mothers Attending Lactation Management Centre

Authors

Saria Tasnim
Bepaitment of 0bs & uynae. Institute of Chilu anu Nothei Bealth, Bhaka,
Banglauesh

Syeda Nazia Akhtar and F M Anamul Haque
Institute of Chilu anu Nothei Bealth, Bhaka, Banglauesh






Receiveu Bate: 2 Novembei 2u1S; Accepteu Bate: 12 }anuaiy 2u14;
Publisheu Bate: S1 Naich 2u14

Acauemic Euitoi: Yuichiio Yamashiio

Cite this Article as: Saiia Tasnim, Syeua Nazia Akhtai anu F N Anamul
Baque (2u14), "Nutiitional Status anu Bieast Feeuing Piactice among
Notheis Attenuing Lactation Nanagement Centie," Peuiatiics Reseaich
Inteinational }ouinal, vol. 2u14 (2u14), Aiticle IB 79uS7S, B0I:
1u.S1712u14.79uS7S








Astract

Bieast feeuing is univeisally piacticeu in Banglauesh howevei,
the iecommenueu piactice of exclusive bieast feeuing foi 6
months is not followeu optimally.

Notivation-The puipose of this stuuy was to assess nutiitional
status of motheis attenuing the lactation management centie,
anu to finu out theii bieast feeuing piactices anu the ieason foi
attenuing lactation management centie.

Besign-This was a cioss sectional stuuy conuucteu at the institute
of Chilu anu Nothei Bealth (ICNB) fiom Naich to Apiil 2u12
among the motheis attenuing lactation management centie. Bata
weie collecteu using stiuctuieu questionnaiie.


Finuings-A total 1u6 motheis weie inteivieweu. Among them
8.S% weie auolescents. Nost of the infants weie below 6 month
olu, anu S8.7% weie <Su uays olu. Exclusive bieast feeuing was
iepoiteu by S2%. Regaiuing the type of feeuing in the last 24
houis, 6u% ieceiveu only bieast milk S2.4% anu hau bieast
feeuing anu aitificial milk, anu only 2.9% ieceiveu
complementaiy feeuing Bieast feeuing. The main ieason foi
attenuing LNC was not enough milk (2S%), bieast pioblem
(26%) anu 21.2% stateu lack of knowleuge. About 7u.9% hau
aveiage bouy builu, anu only 4.9% have a bouy mass inuex <
18.S. Theie was no ielation between bouy mass inuex of the
mothei anu the exclusive bieast feeuing. Exclusively,
bieastfeeuing was moie among motheis who took antenatal caie
in last piegnancy



Implication-Lactation pioblems aie moie likely in the fiist month
of the baby, anu feeling of insufficient milk in the bieast is a
majoi thieat to sustenance of exclusive bieast feeuing. Nateinal
nutiitional status uoes not ielate with bieast feeuing piactices.

!ey"ords# Exclusive bieast feeuing, nutiitional status, bieast
feeuing piactice.










$ntroduction

Bieast feeuing is a common piactice in Banglauesh. Ninety eight
peicent of chiluien aie bieast feu at some time. Bowevei, the
iecommenueu piactice of exclusive bieast feeuing foi 6 months is
not followeu optimally (BBBS, 2uu9). The tienu of EBF, as
eviuenceu thiough Banglauesh uemogiaphic anu health suivey
(BBBS), shows moie oi less static figuie thiough 199S to 2uu7
anu it was 46%, 42% anu 4S%, iespectively (BBBS, 199S, BBBS,
2uuS, BBBS., 2uu9) anu theie has been maikeu impiovement to
64% in 2u11 (BBBS, 2u11).

The global pictuie of bieast feeuing piactice shows that exclusive
bieastfeeuing iates aie low, at about 2S% in Afiica, 4S% in Asia
anu S1% in Latin Ameiica anu the Caiibbean (Lauei } A, 2uu4).


The pievalence of continueu bieastfeeuing is about 86% foi
infants 6-11 months of age in the ueveloping woilu anu foi
chiluien 12-2S months of age, it is about S7% in Latin Ameiica,
in the Caiibbean 7u% anu 72% in Afiica anu Asia (Lauei } A,
2uu4).

The pievalence anu uuiation of bieastfeeuing aie iecognizeu as
impoitant health inuicatois (WB0, 2uu1). Banglauesh is one of
the few countiies wheie most of the motheis follow the Innocenti
Beclaiations iueal of bieastfeeuing foi "two yeais anu beyonu".
uiasuuuin, et al. iepoiteu meuian uuiation of full bieast-feeuing
is S.67 months, anu mean anu meuian uuiations of total bieast-
feeuing aie S1.S anu Su months, iespectively (uiasuuuin, 2uu4)%
National suivey shows the mean uuiation of EBF was S.S month,
anu the meuian uuiation of total bieast feeuing S2.8 months


(BBBS, 2uu9).In compaiison to othei South Asian countiies like
Inuia, Pakistan anu Sii Lanka wheie aveiage uuiations of bieast-
feeuing weie 18.4, 21.8 anu 2S.2 months iespectively, bieast-
feeuing uuiation is ielatively highei in Banglauesh (Rajaietnam
T, 1994, Page B}, 1992, Nahlei K, 1996).

The giowth anu uevelopment of a chilu ciitically uepenus on
impioveu feeuing piactices (Leon-Cava N, 2uu2). Biffeient
stuuies fiom ueveloping countiies show that the iisk of
nutiitional ueficiency anu giowth ietaiuation in chiluien is
maximum between S anu 1S months of age, because this age
peiiou is vulneiable foi suboptimal bieastfeeuing anu inauequate
complementaiy feeuing piactices (Shiimpton, 2uu1). In
Banglauesh some liquiu oi soliu foou aie often given to infants
too eaily, anu stuuy shows 6% aie given soliu oi semisoliu foou


unuei 6 months age (BBBS, 2uu9). 0n the othei hanu, the uelay
in staiting complementaiy foou is also common anu only 21% of
chiluien between 6-2S month ieceive an appiopiiate uiet (BBBS,
2u11).

In most of the mateinity caie hospitals, a lactation management
centie exists to help motheis with bieast feeuing pioblems anu
to piomote, piotect anu suppoit bieast feeuing. Theie aie limiteu
uata on nutiitional status of lactating motheis in Banglauesh anu
whethei mateinal nutiition has any effect on bieast feeuing
piactices is not much exploieu. The puipose of this stuuy was to
assess the nutiitional status of lactating motheis, to finu out theii
bieast feeuing piactices anu ieasons foi attenuing the lactation
management centie. This will help to auuiess the behavioial


issues foi the piomotion of bieast feeuing piactices in the context
of Banglauesh.

Method

This was a cioss sectional stuuy conuucteu at the Institute of
Chilu Nothei Bealth uuiing Naich-Apiil 2u12. The motheis
attenuing lactation management centie weie selecteu
consecutively. Bata weie collecteu using stiuctuieu
questionnaiie anu analyzeu in SPSS piogiam.

&esults

Among a total 1u6 motheis, 8.6% weie auolescents, 61.9%
belong to 2u-2S yis, anu mean age was 2S.94yis. Nost of the


infants weie below 6 months of age anu S8.7% weie <Su uays olu
(Table-1). Exclusively, bieast feeuing was iepoiteu by S2%
(Figuie-1) Regaiuing the type of feeuing in last 24 houis, 6u%
ieceiveu only bieast milk, S2.4% hau BF anu Aitificial milk, anu
only 2.9% ieceiveu CF Bieast feeuing (Table-2). The main
ieason foi attenuing LNC was not enough milk (2S%), bieast
pioblem (26%) anu 21.2% stateu lack of knowleuge (Table-S)
About 7u.9% hau aveiage bouy builu, anu only 4.9% have a BNI <
18.S (Table-4). Theie was no ielation between the BNI of the
mothei anu the EBF (Table S) Among those who weie ueliveieu
by CS, 6u.S% weie exclusively bieastfeu (Table-6). Exclusively,
bieastfeeuing was moie among motheis who took ANC in last
piegnancy (Figuie 2).




Tale'# (istriution according to Age o) Mother and Child
*n+ ',-.

Age o) Mother No /
< 19 S 8.S
2u-2S S7 61.7
> 2S 18 Su
Nean 2S.99 4.uS (iange 17-42)
Age o) Bay
< Su Bays 61 S8.7
S1-9u uays SS S1.7
91-18u uays 6 S.7
> 18u uays 4 S.8





Tale 0# (istriution according to Ty1e o) Feeding in Last 02
Hours

Type of foou Numbei Peicentage
0nly bieast milk 6S 6u
Bieast milk anu aitificial milk S4 S2.4
0nly aitificial milk S 4.8
Bieast milk anu complementaiy foou S 2.9


Tale 3# (istriution according to &easons )or Attending LMC
*n+',-.

&easons )or attending LMC No /
Not enough milk 26 2S
Bieast pioblem 27 26
Lack of knowleuge 22 21.2
Refusal to bieast 6 S.8
Relactation 9 8.7
0theis 8 7.S

Tale 2# Nutritional Status o) Mothers according to BM$ and M4AC

BNI Numbei Peicentage
<18.S S 4.9
18.S-22 S2 S1.1
22-26 41 S9.8
>26 2S 24.S
N0AC
21-2S cm 18 17.6
>2S cm 84 82.4


Tale 5# &elation et"een BM$ and 6BF under - Months
Bay *N+ 78.

EBF No (%) Not EBF%
BNI< 18.S 2 (S.8) S (6.7)
BNI > 18.S Su (96.2) 42(9S.S)
P value u.4S1

Tale -# &elation et"een Mode o) (eli9ery "ith 6BF
:n+',-;

Noue of ueliveiy EBF % Not EBF%
NvB Su Su
CS S8.S 41.7
P value u.2SS




Figure 0# &elation et"een ANC in last 1regnancy and 6BF
*n+',-.



(iscussion

The assessment of exclusive bieast feeuing status baseu on a 24-
houi iecall may not always iepiesent a tiue pictuie, especially
when theie is chance of ovei iepoiting, as Lauei founu that
infants consuming watei oi watei-baseu uiinks along with bieast
milk aie also classifieu as exclusive bieast feeuing (Lauei } A,
2uu4, Aimitage, 2uu2). Routine feeuing piactices of infants may
also change when ill oi if the mothei is not available at the time
of feeuing. Some community-baseu stuuies have founu that
infants classifieu as exclusively bieastfeeuing with 24-houi iecall
ieceive othei liquius anu even soliu foous on a less-than-uaily
basis (Aimitage, 2uu2, Baiuai, 2uuu). In this stuuy, 9u% weie
within S months of age but only 6u% weie exclusively bieastfeu,
anu this is consistent with national uata (BBBS, 2u11). In


compaiing the iecoius of 24-houi iecall anu those fiom motheis'
uaily iecoius, it was founu that 24-houi iecall oveiestimateu
exclusive bieastfeeuing iates by about 4u% at both two anu foui
months of age (Baiuai, 2uuu).



Nalnutiition is a common pioblem in Banglauesh. Suivey shows
S9% of women (1S-49 yeai) have noimal BNI, Su% hau <18.S,
anu 12% have BNI 2S oi above (BBBS, 2uu9). A pievious stuuy
showeu S4% of women hau BNI< 18.S (BBBS, 2uu4)The
quantitative ielationship between mateinal nutiitional status
anu uietaiy intake with the volume anu composition of the
mothei's milk has been stuuieu. }elliffe, 1978 founu the
composition of the mothei's milk of maiginally nouiisheu
motheis is geneially maintaineu within oi neai the iange
iepoiteu foi well nouiisheu women, but piotein anu fat


concentiation aie influenceu by mateinal nutiitional status anu
uietaiy intake (Boeima, 199S).

Pientice et al. founu a positive ielationship between mateinal in
tiiceps skin folu thickness measuiement anu fat concentiation in
uambian women (Pientice, 1981). Banafi et al. founu a significant
ieuuction in the concentiations anu amounts of eneigy anu
piotein in the milk of malnouiisheu motheis (Banafi, 1972).
Biown et al iepoiteu that the inciease in tiiceps skin folu
thickness of motheis was associateu with incieases in fat anu
eneigy concentiation of bieast milk, anu incieases in bouy
weight weie associateu with the inciease in the amount of milk
anu all its majoi nutiients (Biown, 1986). In the cuiient stuuy,
the majoiity of motheis weie well nouiisheu howevei, a quaitei
of them complaineu of insufficient milk piouuction.


0ne common pioblem foi bieast feeuing peiceiveu by lactating
mothei is low milk piouuction. Stuuy founu S4% lactating
motheis mentioneu that theii babies uo not get sufficient bieast
milk, anu theii complaint was moie pievalent among uiban than
iuial motheis (Akhtai, 1998). Foi sustenance of exclusive bieast
feeuing in the fiist S months it is most ciucial anu is vulneiable to
uistoitions uue to the peiception of not enough milk. A stuuy
shows that the common peiception of not enough milk is the
most impoitant factoi that hampeis exclusive bieast feeuing anu
tiiggei the intiouuction of aitificial milk (Baiuai, 2u1u).

Bieast pioblems weie the cause foi attenuing lactation
management centie in about one fouith of the motheis. Caie
seeking piactices of motheis attenuing the lactation management
centie of ICNB was compaieu between 2uuu anu 2uu6. It was


founu that bieast pioblems weie mentioneu by S2.S% vs. 4u%
anu not enough milk was complaineu of in 2u% vs. 27.S% of
motheis attenuing the centie uuiing 2uuu anu 2uu6 iespectively
(Tasnim, 2uu7). In a stuuy at Rajshahi meuical college, it was
founu that 12% of the motheis hau uiffeient types of bieast
pioblems. The most impoitant pioblem was bieast engoigement,
next was soie nipples, flat nipple, ciackeu nipple anu bieast
abscess (Bossain, 2uuS). The examination of bieast foi the
iuentification of any pioblem like ietiacteu nipple may help to
piepaie motheis foi exclusive bieast feeuing. At the same time,
ioutine examination of bieast uuiing postnatal peiiou is
manuatoiy to boost up mateinal confiuence anu uetect any
bieast pioblem like ciack nipple, soie nipple eaily, anu pievent
complications.



Stiategies foi the piomotion of bieastfeeuing incluue a
combination of factois like hospital noims anu seivices,
legislation anu institutional policies, health woikei tiaining, mass
meuia campaigns, peei counseling anu euucation, anu mothei-to-
mothei suppoit gioups (uieen, 1999, Bill, 2uu4). Suppoit foi
bieast feeuing uuiing immeuiate postpaitum peiiou is ciucial to
boost up the mothei's confiuence anu sustaining bieast feeuing.
Bowevei, high iates of initiation of exclusive bieast feeuing anu
low sustenance often co-exist. Rooming in anu beuuing in uuiing
hospital stay has a positive effect in sustaining exclusive bieast
feeuing. It is often saiu motheis aftei caesaiean section face moie
uifficulty in eaily initiation anu exclusive bieast feeuing because
of pain anu othei pioblems. Bowevei, they can successfully
initiate bieast feeuing soon aftei opeiation anu can ioom in with
theii infants if piopei suppoit is given. The cuiient stuuy founu


that EBF was moie among motheis who unueiwent caesaiean
section. This might be the effect of hospital policy in accoiuance
with baby fiienuly hospital.

Access to infoimation anu motivation on BF uuiing pienatal
peiiou is an impoitant pieuictoi of postnatal successful lactation
peifoimance. Community baseu behavioi change piogiams
focusing on hospital noims anu seivices, legislation anu
institutional policies, health woikei tiaining, mass meuia
campaigns, peei counseling anu euucation, mothei to mothei
suppoit anu a combination of these stiategies has shown maikeu
incieases in exclusive bieastfeeuing of infants u to 6 months in
uiffeient countiies of Afiica (Quinn, 2uuS). Although antenatal
caie was ieceiveu by most of the motheis in this stuuy exclusive


bieast feeuing was not optimum inuicating some gaps in the
counseling, anu theie shoulu be moie emphasis on this issue.

Conclusion

Lactation pioblems aie moie likely in the fiist month of the baby
anu the feeling of insufficient milk in the bieast is a majoi thieat
to sustenance of exclusive bieast feeuing.

About one fifth of motheis peiceiveu to have lack of knowleuge
which inuicates people's concein foi bieast feeuing. Nateinal
nutiitional status uoes not ielate with bieast feeuing piactices.
Exclusive bieast feeuing was moie among those ueliveieu by
caesaiean section, piobably uue to gieatei contact with health
caie pioviueis anu theii active suppoit.


&e)erences

Akhtei, B. B., Akhtei, N. & Azau, K. N. (1998). "A National
Baseline Suivey to Assess the Bieastfeeuing Piactices in
Banglauesh," &I'()'*+.

Aimitage, P., Beiiy, u. & Natthews, }. N. S. (2uu2). "Nouelling
Categoiical Bata," In Statistical Nethous in Neuical Reseaich, 4th
euition, 0xfoiu, Englanu: &lac,"ell; 48S-Su2.

Banglauesh Bemogiaphic anu Bealth suivey 199S-94. (199S).
'Extenueu Analysis. National Institute of Population Reseaich anu
Tiaining,' -itra an. associates.



Banglauesh Bemogiaphic anu Bealth suivey (2u11). "National
Institute of Population Reseaich anu Tiaining," -itra an.
associates.

BBBS (2uu1). "Banglauesh Bemogiaphic anu Bealth Suivey
1999-2uuu," National Institute of Population Reseaich anu
Tiaining, -itra an. associates.

BBBS (2uuS). 'Banglauesh Bemogiaphic anu Bealth Suivey
2uu4,' National Institute of Population Reseaich anu Tiaining,
-itra an. associates.

BBBS. (2uu9). 'Banglauesh Bemogiaphic anu Bealth Suivey
2uu7,' National Institute of Population Reseaich anu Tiaining
(NIP0RT). -itra / associates.


Boeima, }. T. & Sommeifelt, A. E. (199S). 'An Assessment of the
Quality of Bieast-Feeuing Bata in BBS-I Suiveys,' 0al1erton,
-ar2lan., 34A: -acro International.

Biown, K. B., Akhtai, N. A., Robeitson, A. B. & Ahmeu, N. u.
(1986). "Lactational Capacity of Naiginally Nouiisheu Notheis:
Relationships between Nateinal Nutiitional Status anu Quantity
anu Pioximate Composition of Nilk," (e.iatrics, 78: 9u9

uiashuuuin, N. S. & Kabii, N. (2uu4). "Buiation of Bieast-Feeuing
in Banglauesh," In.ian 5o$rnal o6 -e.ical 'esearc%; 119: 267-272

uieen, C. P. (1999). "Impioving Bieastfeeuing Behaviois:
Eviuence fiom Two Becaues of Inteivention Reseaich," ($#lis%e.
6or 34AID #2 t%e 7I89A:)4 (ro;ect, Washington, BC;


Baiuei, R., Ashwoith, A., Kabii, I. & Buttly, S. R. A. (2uuu). "Effect
of Community-Baseu Peei Counselois on Exclusive Bieastfeeuing
Piactices in Bhaka, Banglauesh: A Ranuomizeu Contiolleu Tiial,"
7ancet, SS6:164S-1647. PubNeu Abstiact | Publishei Full Text

Baiuei, R., Rasheeu, S., Sangvi, T. u., Bassan, N., Pachon, B., Islam,
S. & }alal, C. S. B. (2u1u). "Bieastfeeuing in Infancy: Iuentifying the
Piogiam-Relevant Issues in Banglauesh," International
&reast6ee.ing 5o$rnal; S:21-S2

Banafy, N. N., Noisey, N. R. A., Seuuick, Y., Babib, Y. A. & El Lozy,
N. (1972). "Nateinal Nutiition anu Lactation Peifoimance,"
5o$rnal o6 +ropical (e.iatrics; 18:187-191



Bill, Z., Kiikwoou, B. & Eumonu, K. (2uu4). "Family anu
Community Piactices that Piomote Chilu Suivival, uiowth anu
Bevelopment: A Review of the Eviuence," ueneva, Switzeilanu:
<orl. *ealt% Organi=ation;

Bossain, N. A., Baque, N. I., Siuuiqui, A. B. & Baii, N. I. (2uuS).
"Activities of Lactation Nanagement Centie of Rajshahi," 5o$rnal
o6 +eac%ers Association, Becembei; 18 (2)

}elliffe, B. B. & }elliffe, E. F. P. (1978). Buman Nilk in the Nouein
Woilu, O>6or., O>6or. 3ni1ersit2 (ress,

Lauei, }. A., Betin, A. P., victoia, C. u., ue 0nis, N. & Baiios, A. }. B.
(2uu4). "Bieastfeeuing Patteins anu Exposuie to Suboptimal
Bieastfeeuing among Chiluien in Beveloping Countiies: Review


anu Analysis of Nationally Repiesentative Suiveys," &-0
-e.icine 2:26 uoi:1u.11861741-7u1S-2-26

Leon-Cava, N., Luttei, C., Ross, }. & Naitin, L. (2uu2). Quantifying
the Benefits of Bieastfeeuing: A Summaiy of the Eviuence,
($#lis%e. #2 (A*O an. #2 t%e 7I89A:)4 (ro;ect 6or 34AID,
Washington, BC;

Nahlei, K. (1996). "Women Bieast-Feeuing Infants Longei in
Nany Beveloping Countiies," International ?amil2 (lanning
(erspecti1es 22: 1S4-S.

Page, B. }., Lesthaeghe, R. }. & Shah, I. B. (1982). "Illustiative
Analysis: Bieastfeeuing in Pakistan," <?4 4cienti6ic 'eports 8o.
37. Voor#$rg, 8et%erlan.s: International 4tatistical Instit$te; 11S.


Pientice, A., Pientice, A. N. & Whiteheau, R. u. (1981). "Bieast-
Nilk Fat Concentiations of Ruial Afiican Women: 2 Long Time
vaiiations within a Community," &ritis% 5o$rnal o6 8$trition@ 4S:
49S-SuS

Quinn, v. }., uuyon, A. B., Schubeit, }. W., Stone-}imnez, N.,
Bainswoith, N. B. & Naitin, L. B. (2uuS). "Impioving
Bieastfeeuing Piactices on a Bioau Scale at the Community Level:
Success Stoiies Fiom Afiica anu Latin Ameiica," 5o$rnal o6 *$man
7actation 21(S).

Rajaietnam, T. (1994). 'Tienu anu Biffeientials in Bieast-Feeuing
anu Amenoiihea Buiations in a Ruial Aiea in south Inuia,'
Demograp%2 In.ia 2S: 8S-9S.



Shiimpton, R., victoia, C. u., ue 0nis, N., Costa Lima, R., Blossnei,
N. & Clugston, u. (2uu1). "Woiluwiue Timing of uiowth
Falteiing: Implications foi Nutiitional Inteiventions," (e.iatrics.
2uu1; 1u7:E7S.

Tasnim, S. & Banu, L. P. (2uu7). 'Caie Seeking foi Bieast Feeuing
in a Peiiuiban Bospital,' &angla.es% -e.ical 5o$rnal; S6 (1): 4-6

WB0 (2uu1). 'Resolution WBAS4.2: Infant anu Young Chilu
Nutiition (WBAS4.2) ueneva,' 4"it=erlan.: <orl. *ealt%
Organi=ation.