Table of Contents

2016 Month : June Volume : 2 Issue : 1 Page : 11-15

BREAST FEEDING PRACTICES AMONGST CHILDREN IN SLUMS OF DIBRUGARH TOWN OF ASSAM: COMMUNITY BASED CROSS SECTIONAL STUDY .

Sultana Jesmin Ahmed1, Dimpymoni Saikia2, Mir Alam Siddique3, Tazkira Begum4, Basanta Biraj Das5, Alak Barua6

1Associate Professor, Department of Community Medicine, Assam Medical College and Hospital.
2Post Graduate Student, Department of Community Medicine, Assam Medical College and Hospital.
3Assistant Professor, Regional Institute of Ophthalmology, Gauhati.
4Assistant Professor, Department of Physiology, Assam Medical College and Hospital.
5Post Graduate Student, Department of Community Medicine, Assam Medical College and Hospital.
6Retired Professor and HOD, Department of Community Medicine, Assam Medical College and Hospital.

Corresponding Author:
Dr. Sultana Jesmin Ahmed,
Associate Professor,
Department of Community Medicine,
Assam Medical College and Hospital,
Dibrugarh.
E-mail: drjesminahmed@gmail.com

ABSTRACT

BACKGROUND

After birth the health of the baby depends upon the nurturing practice adopted by the family. The low prevalence and duration of exclusive and partial breastfeeding increase the risk of infant and childhood morbidity and mortality.

OBJECTIVE

To assess the Breast Feeding Practices amongst mothers having 12-24 months children in slums of Dibrugarh town, Assam.

MATERIALS AND METHODS

A community based, cross-sectional study was conducted for a period of 6 months, from January 2014 to June 2014 amongst 12-24 months aged children residing in slums of Dibrugarh town, Assam. 177 children were calculated for the study by standard sampling method. An interview with the help of a pre-designed pre-tested proforma was conducted by house to house survey.

STATISTICAL ANALYSIS

Statistical analysis was done using MS Excel 2007 and presented as percentages.

 

RESULTS

Majority (50%) of children belonged to upper-lower socio-economic status (IV). 65% lived in nuclear family and 35% lived in joint family. 53.13% of children were in the age group of 12-17 months and 46.88% in 18-24 months. 51.25% were male and 48.75% were females. Majority (40%) were first birth order. 85.62% had institutional delivery, of which 42.5% was delivered at tertiary level hospital. In 31.88% children breast feeding was initiated within 1 hr of birth. Colostrum was given to 63.75% of children. 35% were given pre lacteal feed. 65% had exclusive breast feeding for 6 months. Among 35% who were not exclusively breast fed, inadequate milk production (28.57%), illness of child (33.9%) and illness of mother (37.5%) were the main reasons.

CONCLUSION

Efforts to be taken to improve the practice of mothers regarding avoidance of prelacteal feeding and implementing exclusive breast feeding.

KEYWORDS

Colostrum, Prelacteal Feeding, Exclusive Breast Feeding.

How to cite this article

Ahmed SJ, Saikia D, Siddique MA, et al. Breast feeding practices amongst children in slums of Dibrugarh town of Assam: community based cross sectional study. Journal of Research in Preventive and Social Medicine 2016; Vol. 2, Issue 1, Jan-June 2016; Page: 11-16.

INTRODUCTION

After birth the health of the baby depends upon the nurturing practice adopted by the family. The ideal food for the young infant is human milk which is species specific and has been conceived by nature for the human infants. It has specific characteristics that match the growing infants’ nutritional requirements.1-2 Breastfeeding has been conclusively demonstrated as one of the important determinants for comprehensive growth and development of infants, more so among low birth weight infants.3

The United Nations Children's Fund (UNICEF) has estimated that exclusive breastfeeding in the first six months of life can reduce under-five mortality rates in developing countries by13%.4 WHO and UNICEF jointly developed the Global Strategy for Infant and Young Child Feeding whose aim is to improve - through optimal feeding - the nutritional status, growth and development, health, and thus the very survival of infants and young children.5 Two major areas of activity in support of breastfeeding were initiated within the past twenty years: The International Code of Marketing of Breastmilk Substitutes in the 1980s, and The Baby-friendly Hospital Initiative, including Step 10 in the community, in the 1990s.6

Exclusive breastfeeding should be practiced from birth till end of six months (180 days). This means that no other food or fluids should be given to the infant below six months of age unless medically indicated. After completion of six months, with introduction of optimal complementary feeding,

breast feeding should be continued for a minimum for 2 yrs. and beyond depending on the choice of mother and the baby. Even during the second year of life, the frequency of breastfeeding should be 4-6 times in 24 hours, including night feeds.7 the antenatal mother has to be motivated and prepared for breastfeeding.

In the last trimester of pregnancy, breast and nipple should be examined for retracted and cracked nipples and correction should be done accordingly.8 globally, slums have been recognized as neglected communities with limited access to health services. These settings are compounded by inhabitation by migratory population living under stressful conditions. In India, there has been an alarming increase in the slum population where the most deprived urban population live.9 Although breastfeeding is nearly universal in India, only 46 percent of children under 6 months are exclusively breastfed.10 Based on the above situation the present study was carried out in urban slum.

OBJECTIVE

To assess the Breast Feeding Practices amongst mothers having 12-24 months children in slums of Dibrugarh town, Assam.

MATERIALS AND METHODS

The present study was undertaken to assess the breast feeding practices of the mothers having 12-23 months children in the slums of Dibrugarh Town. There are 10 registered slums of Dibrugarh town. Most of the slum dwellers are daily wage labourers and majority of them are migrant population. The study was carried out for 6 months from January 2014 to June 2014. All children in the age group of 12-23 months and their mothers residing in the study area were considered as Study Universe.

 

Study Design

Community based cross-sectional study.

Sample Size

Was calculated to be 177 using standard formula.

Sampling Design

Out of 10 slums of Dibrugarh town, 5 were selected by simple random sampling. Then the children of 12-23 months were enumerated and listed with the help Anganwadi and ASHA worker. Children to be selected from each slum are determined by proportionate allocation and data was collected by house to house visit till the required sample in each slum area was obtained. Data were collected using pre-designed, pre-tested Schedule. The respondent was the mother of the child. Informed written consent was taken from the mother.

Statistical Analysis

Done using Microsoft Office Excel 2007 and presented as percentages.

Inclusion Criteria

All children aged 12 months to 23 months and their mothers were included.

Exclusion Criteria

  1. Mothers of the children who did not give consent were excluded.
  2. In case of death of mother or absence of mother at home were excluded.
  3. Mothers having very sick children.

 

RESULTS

Out of 177 children, mothers of 160 children gave consent to participate in the study. Response rate was 90.39%. Out of the study subjects 53.13% children belonged to the age group of 12-17 months and 46.88% belonged to 18-23 months age group. 51.25% children were males and 48.75% were females. Majority (50%) of the children belonged to upper-lower socioeconomic group. 33.13% mothers belonged to the 15-19 years age group. 18.75% were illiterate. All the mothers were unemployed. 37.5% mothers were married in their teenage period (Table 1). Majority (40%) of children infants belonged to first order. 42.5% mothers delivered in tertiary level hospital while 14.38% delivered at home. 36.25% mothers had delivered by caesarean section                   (Table 2). 31.88% children were initiated breastfeeding within one hour of birth and 25.63% were initiated breast feeding after 24 hours. 63.75% children received colostrum. 35% received prelacteal feed.

Out of 160 children, 65% were exclusively breastfed for six months. Of the 35% children who were not exclusively breastfed, 28.57% cases were due to inadequate milk production, 37.5% was due to the illness of the mother and 33.9% was due to the illness of the child. 47.5% were breastfed for less than 8 times per day. 68.75% children were breastfed for as long as the baby sucked, 17.5% for less than 15 minutes and 13.75% for more than 15 minutes. 21.88% children received breast milk from a single breast in a single episode, 46.25% received breast milk from both the breast in a single episode without completing from one breast and 31.88% received from both the breasts in a single episode after completing from one breast. Good attachment while feeding their children was seen in 46.25%. While position of breast feeding assessed, poor positioning was seen in 45% children (Table 4).

 

Baseline Parameters of Children

No. of Children (N = 160)

Percentage

Type of Family

 

 

Nuclear

104

65.00

Joint

56

35.00

Religion

 

 

Hindu

126

78.75

Muslim

34

21.25

Age (in months)

 

 

12-17

85

53.13

18-23

75

46.88

Sex

 

 

Male

82

51.25

Female

78

48.75

Socio-Economic Status

 

 

Upper-Middle(II)

20

12.50

Lower-Middle(III)

45

28.13

Upper-Lower(IV)

80

50.00

Lower(V)

15

9.38

Education of Mothers

 

 

High School Certificate

23

14.38

Middle School Certificate

32

20.00

Primary School Certificate

75

46.88

Illiterate

30

18.75

Age at Marriage of Mothers

 

 

15 -19

60

37.50

20 – 24

57

35.63

25 – 29

23

14.38

30 – 35

20

12.50

Age of the Mothers

 

 

15 -19

53

33.13

20 – 24

58

36.25

25 – 29

26

16.25

30 – 35

23

14.38

Table 1: Socio –demographic profile of children

 

 

Birth Order

No. (160)

Percentage

First

64

40.00

Second

51

31.88

Third

28

17.50

Others

17

10.63

Place of Delivery

 

 

Tertiary level Hospital

68

42.50

State Health Dispensary

25

15.63

At Home

23

14.38

Private Nursing Home

44

27.50

Mode of Delivery

 

 

Normal

102

63.75

caesarian

58

36.25

Table 2: Distribution of children

according to their birth history

 

Parameters

No. (Total 160)

Percentage

Breast Feeding Initiation within

 

 

<1 Hour

51

31.88

1-4 Hours

29

18.13

4 – 24 Hours

39

24.38

>24 Hours

41

25.63

Prelacteal Feeds

 

 

Received

56

35.00

Not received

104

65.00

Colostrum

 

 

Received

102

63.75

Not received

58

36.25

Exclusive Breastfed for 6 Months

 

 

Yes

104

65.00

No

56

35.00

Duration of Breast feeding (in months)

 

 

0-2

4

2.50

2-4

16

10.00

4-6

36

22.50

6 Completed

104

65.00

Reason of not Exclusively Fed

 

 

Illness of mother

21

37.50

Illness of child

19

33.93

Inadequate milk production

16

28.57

Any difficulty in BF

 

 

Yes

59

36.88

No

101

63.13

Milk Substitutes

 

 

Infant Milk Formula

20

35.71

Animal Milk

22

39.29

Others

14

25.00

Frequency per day

 

 

>8

84

52.50

<8

76

47.50

Duration of Breast Feeding per feed

 

 

As long as baby sucked

110

68.75

<15 mins

28

17.50

>15 mins

22

13.75

Breast Feeding Habits of Mother

 

 

From single Breast in a single episode

35

21.88

From both the Breast in single episode without completing from one Breast

74

46.25

From both the Breast in a single episode after completing from one Breast

51

31.88

Table 3: Breast feeding practices of mother

 

Attachment of Children

No. of Children (160)

Percentage

Good Attachment

74

46.25

Poor Attachment

86

53.75

Position of Children

 

 

Good Positioning

88

55

Poor Positioning

72

45

Table 4: Distribution of the children according to their attachment and position of breast feeding

 

DISCUSSION

Early breastfeeding within one hour and exclusive breastfeeding for the first six months are the key interventions to achieve MDG 1 and MDG 4, which deal with reduction in child malnutrition and mortality, respectively. In a study conducted at rural community of Maharashtra, 57.84% of mothers delivered in hospital as compared to 42.15% delivered home.11 In our study 85.62% had institutional delivery, and 14.38% was delivered at home. In a study conducted at Pondicherry, vaginal delivery and caesarean section were 70.3% and 29.7% respectively.12 In the present study 63.75% mothers had normal delivery and 36.25% had caesarean section. Prasad K et al found initiation of breast feeding among 75.4% babies within 1 hour and 24.6% babies after 1 hour.12

In the present study 31.88% babies were initiated within 1 hour, 18.13% were initiated after 1 to 4 hour of birth, 24.38 %were initiated 4- 24 hours and 25.63% were initiated breast feeding after 24 hours. Colostrum is rich in protein and immunoglobulin.12 Feeding this is extremely important immunologically (Rich in antibodies and protective substances) nutritionally (Toprovide vitamins and minerals) and developmentally (To ensure maturation of intestinal mucosa). The prominent areas of concern is discarding of colostrum by 36.25% of mothers. In a study conducted in rural Northern India 40.1% mothers gave prelacteal feeding to their children.

In present study 35% received prelacteal feed. 40.1% mothers gave prelacteal feeding to their children.13 Arun Gupta and Y. P. Gupta showed that more than half the children (54%) in the age group of 0-3 months were exclusively breastfed whereas this percentage was much lower (26%) for children in the age group of 4-6 months.14 Prevalence of exclusive breast feeding for 4 months in a study conducted in rural community of Maharashtra was only 28.43%.11In the present study 10% were exclusively breastfed fed for 2 -4 months, 22% for 4-6 months and 65%for completed 6 month.

Out of this 35% infants who were not exclusively breastfed, 28.57% cases were due to inadequate milk production, 37.5% was due to the illness of the mother and 33.9% was due to the illness of the child. A study by R. Parmaret al. stated the various reasons for starting bottle feeding before six months, which were: insufficient milk (59.7%), working mother (13%), to habituate the baby to bottle (12%) maternal illness and child illness (6.5%).15A study by Aggarwal et al. concluded that the most common reason for early food supplementation was insufficient breast milk (49.4%).16Sucking should be continued as long as the baby desires to suck. This will satisfy the sucking instinct of the baby and will express the “hind milk” which is thicker and full of fat. The fore milk (at the start of breast feed) is thin and

contains less fat.2,8 This will satisfy only the thirst of the baby. In this study 46.25% received breast milk from both the breast in a single episode without completing from one breast which did not satisfy the required nutrient of the children.

 

CONCLUSION

Universal practice of early initiation of breast feeding within one hour of birth is necessary as a routine practice for all types of deliveries irrespective of health status of the mothers. Thus there is a need to educate the adolescent girls and mothers and train the health care workers including the ASHA, ANM about the advantages of establishing early breastfeeding, advantages of colostrum, exclusive breastfeeding, avoidance of harmful practices like prelacteal feeds and pacifiers.

REFERENCES

  1. Chaudhary RN, Shah T, Raja S. Knowledge and practice of mothers regarding breast feeding: a hospital based study. Health Renaissance Nepal Journals 2011;9(3):194-200.
  2. Sachdev HPS. Infant feeding:major practical considerations. In Sachdev HPS, Choudhury P. Nutrition in children developing country concern. BI Publication PVT Ltd 2004.
  3. Radhakrishnan S, Balamuruga SS. Prevalence of exclusive breastfeeding practices among rural women in Tamil Nadu. International Journal of Health & Allied Sciences, Year 2012;1(2):64-7.
  4. United nations children's fund: progress for children: a child survival report card 2004;1.
  5. World health organization, UNICEF. Global strategy for infant and young child feeding 2003:30

  6.  UNICEF. Global strategy for infant and young child feeding: policy and advocacy 2003.

  7. Infant and young child feeding & human milk banking guidelines 2015. Formulated &recommended by. Infant and young child feeding chapter of indian academy of paediatrics & human milk banking association.www.iapindia.org/HBA2015.

  8. Elizabeth KE. Nutrition and child development. 4th ed. Paras Medical Publisher, p:1-63.

  9. Hazarika I. Women's reproductive health in slum populations in India: evidence from NFHS-3. Journal of Urban Health 2009;87(2):264-77. doi:10.1007/s11524-009-9421-0.

  10. National family health survey (NFHS-3). Factsheets 2005-2006. Available at URL:\ http://mohfw.nic.in/nfhsfactsheet.

  11. Satish WK, Vallabh YB. Determinants of exclusive breast feeding in a rural community of Maharashtra. International Journal of Recent Trends in Science And Technology 2012;4(1):9-13.

  12. Prasad KN, Ahamed N. Community based study on initiation of breast feeding and determining factors in rural area of Pondicherry. International Journal of Contemporary Pediatrics 2015;2(3):208.

  13. Roy MP, Mohan U, Singh SK, et al. Determinants of prelacteal feeding in rural northern India. Int J Prev Med 2014;5(5):658-63.

  14. Gupta A, Gupta YP. Status of infant and young child feeding in 49 districts (98 blocks) of India. A national report of the quantitative study. Breastfeeding promotion network of India 2003:14-8.
  15. Parmar VR, Salaria M, Poddar B, et al. Knowledge, attitudes and practices regarding breast feeding at Chandigarh. Indian J Public Health 2000;44(4):131-3.
  16. Agarwal A, Arora S, Patwari AK. Breastfeeding among urban women of low-socioeconomic status: factors influencing introduction of supplemental feeds before four months of age. Indian J Pediatr 1998;35:269-73.

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