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ORIGINAL ARTICLE
Year : 2015  |  Volume : 5  |  Issue : 3  |  Page : 103-107

Infant and young child feeding practices - insights from a cross-sectional study in a hilly state of North India


1 Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India

Date of Submission27-Jan-2015
Date of Acceptance05-Apr-2015
Date of Web Publication8-Jun-2015

Correspondence Address:
Dr. Anupam Parashar
Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0738.158372

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   Abstract 

Introduction: Optimal infant and young child feeding (IYCF) practices are the key to improving child survival rates. Aims and Objectives: This study was done to assess the IYCF practices in Shimla district of Himachal Pradesh. Materials and Methods: A cross-sectional survey was carried out in selected Anganwadi centers of Shimla district. In each center, a convenience sample consisting of mothers of infants and children younger than 24 months presenting at the Anganwadi centers and who agreed to participate in the study, was recruited and interviewed. Data were analyzed using Epi Info software for Windows. Results: Out of the 200 mothers interviewed, 101 (50.5%) initiated breastfeeding their child within the first hour of birth. Fewer than one-third of mothers in urban and rural areas (29.6%) fed their child a diet having the recommended minimum dietary diversity. Recommended dietary diversity was evident more in urban areas [unadjusted odds ratio (OR) = 2.1] compared to rural areas. Fewer mothers from the urban areas initiated breastfeeding within 1 h from birth (unadjusted OR = 0.6) and practiced exclusive breast feeding till 6 months (unadjusted OR = 0.4). Bottle-feeding of children was practiced by 22% of mothers. Conclusion and Recommendation: Health care workers can tackle the issue of minimum dietary diversity by addressing the cultural myths and harmful beliefs of the people. To increase exclusive breastfeeding and continued feeding in urban areas, on-site creches at work and flexible working hours for working mothers can be implemented.

Keywords: Infant, young child, feeding practices


How to cite this article:
Parashar A, Sharma D, Thakur A, Mazta SR. Infant and young child feeding practices - insights from a cross-sectional study in a hilly state of North India. Int J Nutr Pharmacol Neurol Dis 2015;5:103-7

How to cite this URL:
Parashar A, Sharma D, Thakur A, Mazta SR. Infant and young child feeding practices - insights from a cross-sectional study in a hilly state of North India. Int J Nutr Pharmacol Neurol Dis [serial online] 2015 [cited 2019 Sep 20];5:103-7. Available from: http://www.ijnpnd.com/text.asp?2015/5/3/103/158372


   Introduction Top


A child's initial years of life are considered to be the most critical period for growth and development. Good nutrition during these years can have a significantly positive impact on the cognitive and vital functions of children. Globally, efforts to scale up nutrition programs are working and benefiting children in many countries. Despite India's progress over the past few decades, childhood malnutrition still continues to haunt its citizens. [1] Though this may be attributed to lack of food, equally important are the existing suboptimal child care practices. [2]

Recognizing the fact that investing in nutrition is a key way of advancing child welfare, the Government of India implemented the Infant and Young Child Feeding (IYCF) strategy. This strategy stresses efforts to promote, protect, and support appropriate IYCF. However, a recent United Nations Children's Fund (UNICEF) report observed that at the national level, IYCF practices in India appear to be only "fair" and thus may require additional attention. [3],[4]

The existing literature in India reveals that IYCF practice studies have mostly focused on breastfeeding practices only. The lack of comprehensive data using World Health Organization (WHO) IYCF standard indicators may hamper progress in measuring and improving feeding practices. With this background, the present study was designed to assess the status of IYCF practices using standardized IYCF indicators in Shimla district of Himachal Pradesh.


   Materials and methods Top


A community based, cross-sectional study was conducted in selected Anganwadis of Shimla district of Himachal Pradesh during the months of June-July 2011. For calculating sample size, in the absence of any previous study in the district, the lowest figure of all the IYCF indicators as reported in the 2005-06 National Family Health Survey (NFHS-3), i.e., 27.1% for children aged 0-5 months exclusively breastfed in Himachal Pradesh, was used. Considering the 95% confidence level, 10% absolute precision, and 20% nonresponse rate, the sample size yielded was 92. Based on this it was decided to interview 100 mothers in urban and 100 in rural areas.

A list of Anganwadi centers in the urban and rural areas of Shimla was obtained from the Child Development Project Officer (CDPO). Out of this list, 10 Anganwadi centers were selected in an urban area (Boileauganj) and 10 in a rural area (Mashobra Block) by the simple random sampling method. In each Anganwadi center, a convenience sample consisting of mothers of infants and children younger than 24 months presenting at the Anganwadi center who agreed to participate in the study, was recruited. A trained field investigator from the Department of Community Medicine interviewed the mothers using a predesigned and structured questionnaire. If more than one child less than 24 months of age was accompanying a mother, the information was collected for all of them.

For determining the status of IYCF practices, six core indicators were selected out of the eight core indicators as suggested by the WHO. One optional indicator, namely, bottle-feeding was also studied [Table 1]. [ 5],[6] Minimum dietary diversity was defined as the proportion of children 6-23.9 months of age who received foods from four or more food groups. The seven food groups used for this indicator were grains, roots and tubers; legumes and nuts; dairy products (milk, yogurt, and cheese); flesh foods (meat, fish, poultry, and liver/organ meats); eggs; vitamin-A-rich fruits and vegetables; and other fruits and vegetables. The consumption of any amount of food from each food group was sufficient to "count," i.e., there is no minimum quantity. Minimum meal frequency (MMF) was defined as the proportion of breastfed and nonbreastfed children 6-23.9 months of age who received solid, semisolid, or soft foods (but also including milk feeds for nonbreastfed children) the minimum number of times or more. "Minimum" was defined as 2× for breastfed infants 6-8.9 months of age and 3× for breastfed children 9-23.9 months of age.
Table 1: Definition of IYCF indicators and their overall values for the study population


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Data entry and statistical analysis were performed using Epi Info software [Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA]. Descriptive statistics were used for reporting IYCF practices. Permission was taken from the Shimla district CDPO before starting the study. Ethical approval was obtained from the Ethics Boards of Indira Gandhi Medical College, Shimla, Himachal Pradesh.


   Results Top


Out of the total 200 mothers interviewed, 101 (50.5%) initiated breastfeeding their child within the first hour of birth. Exclusive breastfeeding of their children till 5 months of age was practiced by 94.9% of mothers. Half of the 200 mothers (50.0%) continued breastfeeding their children till 1 year of age. More than three-fourth (77.8%) initiated complementary feeding at 6 months of age. Less than one-third of the children's (29.6%) daily food had minimum dietary diversity. Nearly three-fourth of the children (77.8%-78.5%) received the recommended MMF. Bottle-feeding of children was practiced by 22% of mothers [Table 1].

A geographic breakdown revealed that a comparatively lower proportion of mothers from the urban areas initiated breastfeeding within 1 h from birth [unadjusted odds ratio (OR) = 0.6], practiced exclusive breastfeeding till 6 months (unadjusted OR = 0.4), and continued breastfeeding till 1 year of the child's age (unadjusted OR = 0.4). In addition, in urban areas, more mothers provided minimum dietary diversity in food (unadjusted OR = 2.1) and initiated complementary feeding at 6 months of age (unadjusted OR = 1.3). The MMF was practiced more in urban areas compared to rural areas (unadjusted OR = 2.5, 1.9). In urban areas, more mothers practiced bottle-feeding (unadjusted OR = 3.4) compared to their rural counterparts [Table 2].
Table 2: Urban rural comparison of IYCF practices


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   Discussion Top


In the present study, the proportion of infants initiated on breast feeding within 1 h from birth is comparable to the findings of the District Level Health Services (DLHS) survey (56.8%) and the NFHS-3 survey of Himachal Pradesh (43.4%). However, in our study the exclusive breastfeeding rate is much higher than that reported by DLHS 2007-2008 data (58.1%) and NFHS 3 (27.1%) surveys. [7],[8] Studies done in other parts of India have recorded exclusive breastfeeding rates ranging 37-58%. [9],[10]

Dietary diversity relates to nutrient adequacy and diet variety, which are two of the main components of diet quality. In our study, with regard to particular groups of food consumed, few mothers fed their child a diet having minimum food diversity. Similar findings have been reported in a study done in New Delhi (32.6%). [9] On the contrary, adequate dietary diversity has been reported in surveys done in Kolkata, India (46%), Bangladesh (81%), Nepal (82%), and Sri Lanka (88.3%). [11],[12],[13],[14] This indicator is of concern in the present study because the literature suggests that lacking minimum diet diversity predisposes children to being stunted and underweight. [15]

Receiving the recommended minimum meal frequency plays a role in determining the nutritional status of the child. This critical window of opportunity ensures the child's appropriate growth and development. In our study, more than three-fourth of children received the recommended MMF. This was a better result than those from studies conducted by Khan et al. and Jain et al., which showed MMF in 48.6% and 67.6% of children. [9],[16] In our study, we observed that one-fourth of mothers in our study used bottles to feed their children. This is consistent with a study wherein 22.4% mothers were reported using bottles to feed their children. Higher bottle-feeding incidence has been reported by Rasania et al. in a study done in New Delhi. [17]

It was observed that a comparatively lower proportion of mothers from the urban areas practiced exclusive breastfeeding till 6 months and continued breastfeeding till 1 year of age. This may be attributed to the increased participation of women in the labor force, which also leads to increased adoption of bottle-feeding practices. Also, the minimum dietary diversity and MMF were less evident in rural areas. This can be attributed to cultural beliefs, myths, and age-old traditions preventing women from properly feeding their children.

A limitation of this study is the cross-sectional design, which prevented us from determining causality. Longitudinal studies are proposed to elucidate and track IYCF practices. However, despite this limitation, the present study does help to identify infant feeding practices and can thus guide policy and program implementation in the studied area.


   Conclusion Top


In conclusion, this study showed a low proportion of mothers feeding their children a diet having minimum dietary diversity. This lacking dietary diversity was evident more in urban areas compared to rural areas. It is recommended that health workers be reoriented to disseminate IYCF messages in the community and dispel cultural myths and harmful beliefs. To increase exclusive breastfeeding and continued feeding in urban areas, onsite creches at work and flexible working hours for working mothers can be implemented.

 
   References Top

1.
Integrated management of neonatal and childhood illness. Training module of health workers. New Delhi: Ministry of Health and Family Welfare, Government of India; 2003. p. 74-5.  Back to cited text no. 1
    
2.
Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al.; Maternal and Child Undernutrition Study Group. What works? Interventions for maternal and child under nutrition and survival. Lancet 2008;371:417-40.  Back to cited text no. 2
    
3.
International Institute for Population Sciences. National family health survey (NFHS 3), 2005-06: India. International Institute for Population Sciences; 2007. p. 540. Available from: http://www.rchiips.org/nfhs/NFHS-3%20Data/VOL-2/Report-%20Volume-II(1632K).pdf. [Last accessed on 2015 Mar 25].   Back to cited text no. 3
    
4.
Infant and young child feeding practices programming status. Available from: http://www.unicef.org/nutrition/files/IYCF_65_country_assessment_report_UNICEF.pdf. [Last accessed on 2014 Jul 04].  Back to cited text no. 4
    
5.
World Health Organization. Global Strategy on Infant and young Child Feeding. Geneva, Switzerland: World Health Organization; 2003. Available from: http://www.who.int/nutrition/publications/gs_infant_feeding_text_eng.pdf. [Last accessed on 2015 Mar 22].  Back to cited text no. 5
    
6.
WHO/UNICEF/USAID/AED/UCDAVIS/IFPRI. Indicators for assessing infant and young child feeding practices: Part-1: Definition: Conclusions of a consensus meeting held 6-8 November 2007 in Washington DC, USA. Geneva, Switzerland: World Health Organization; 2008. Available from: http://www.whqlibdoc.who.int/publications/2008/9789241596664_eng.pdf. [Last accessed on 2015 Mar 22].  Back to cited text no. 6
    
7.
District level household survey. Himachal Pradesh. Available from: http://www.rchiips.org/pdf/rch3/report/hp.pdf. [Last accessed on 2014 Jul 04].  Back to cited text no. 7
    
8.
NFHS-3 survey Himachal Pradesh. Available from: http://www.rchiips.org/nfhs/NFHS-3%20Data/HimachalPradesh_report.pdf. [Last accessed on 2014 Jul 04].  Back to cited text no. 8
    
9.
Khan AM, Kayina P, Agrawal P, Gupta A, Kannan AT. A study on infant and young child feeding practices among mothers attending an urban health center in East Delhi. Indian J Public Health 2012; 56:301-4.  Back to cited text no. 9
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10.
Sinhababu A, Mukhopadhyay DK, Panja TK, Saren AB, Mandal NK, Biswas AB. Infant- and young child-feeding practices in Bankura district, West Bengal, India. J Health Popul Nutr 2010;28:294-9.  Back to cited text no. 10
    
11.
Roy S, Dasgupta A, Pal B. Feeding practices of children in an urban slum of Kolkata. Indian J Community Med 2009;34:362-3.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.
Kabir I, Khanam M, Agho KE, Mihrshahi S, Dibley MJ, Roy SK. Determinants of inappropriate complementary feeding practices in infant and young children in Bangladesh: Secondary data analysis of Demographic Health Survey 2007. Matern Child Nutr 2012; 8(Suppl 1):11-27.  Back to cited text no. 12
    
13.
Joshi N, Agho KE, Dibley MJ, Senarath U, Tiwari K. Determinants of inappropriate complementary feeding practices in young children in Nepal: Secondary data analysis of demographic and health survey 2006. Matern Child Nutr 2012;8(Suppl 1):45-59.   Back to cited text no. 13
    
14.
Senarath U, Agho KE, Akram DE, Godakandage SS, Hazir T, Jayawickrama H, et al. Comparisons of complementary feeding indicators and associated factors in children aged 6-23 months across five South Asian countries. Matern Child Nutr 2012; 8(Suppl 1):89-106.  Back to cited text no. 14
    
15.
Stuebe A. The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol 2009;2:222-31.  Back to cited text no. 15
    
16.
Jain S, Borle A, Agrawal SS, Mishra MK, Gupta SK, Bathma V, et al. Assessment of infant and young child feeding practices among mothers in rural Madhya Pradesh. Natl J Community Med 2014;5: 419-23.  Back to cited text no. 16
    
17.
Rasania K, Singh SK, Pathi S, Bhalla S, Sachdev TR. Breast-feeding Practices in a Maternal and Child Health Centre in Delhi. Health Popul Perspect Issues 2003;26:110-5.  Back to cited text no. 17
    



 
 
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