https://doi.org/10.33698/NRF0242-Bindu Rani, Sushma K Saini, Bhavneet Bharti

ABSTRACT:

Introduction: An appropriate diet is critical in the growth and development of children especially in the rst two years of life. The World Health Organization (WHO) recommends exclusive breast feeding for the rst six months of life, with the addition of complementary feeds at six months with continued breast feeds until at least the age of two. Objective: To assess the knowledge and pattern of complementary feeding in mothers of infants in Dhanas, UT, Chandigarh. Methodology: Ethical approval was taken from Institute Ethics Committee, PGIMER, Chandigarh and written informed consent was obtained from mothers. The study was conducted in Dhanas, UT, Chandigarh during the month of August- November, 2017 on 40 infants and their mothers. Purposive sampling technique was used. Socio-demographic performa and interview schedule was used to assess the knowledge and pattern of complementary feeding among mothers. Results: The result of study had shown that 50 percent of mothers had average knowledge score and 20 percent had poor knowledge regarding complementary feeding. Some infants were started on complementary feeding later than seven months. Half of the infants were given watery food (daal water, rice gruel). Conclusion: Infants were not consuming appropriate foods and the quantity and consistency of complementary foods was not proper. Hence it is recommended that nurses and other community health workers should emphasize on introduction of complementary feeding as per the Infant and Young Child Feeding Guidelines.

Keywords: Infants, complementary feeding, knowledge, pattern.

Introduction:

Infants and young children are at an increased risk of malnutrition from six months of age onwards, when breast milk alone is no longer sufcient to meet all their n u t r i t i o n a l r e q u i r e m e n t s a n d complementary feeding should be started. Initiating complementary feeds too early or too late can lead to malnutrition1. In India, both early and late initiation of complementary feeding is common. NFHS-4 reports that only half of infants (54.9%) were on exclusively breastfed under the age of 6 months. Timely complementary feeding at age 6-8 months was started in only 42.7 % infants. It was also reported that at 6-32 months only 9.6 % children were receiving an adequate diet2. The reason for failure of complementary feeding is inadequate knowledge of mothers about the timing, what foods to be given, how these to be introduced and also the non- acceptance of foods in the infants. In a community setting, there are variations in the complementary food practices of the families as per their income, religion, occupation, education and their housing type.

Complementary feeding, if not appropriate can lead to diarrhea that will ultimately followed by growth retardation which may cause kwashiorkor, marasmus and recurrent infections in the infants. Inadequate food/nutrient intake is the major factor for malnutrition. Appropriate complementary feeding depends on accurate information and skilled support from the family, community and healthcare system. Inadequate knowledge about appropriate food and feeding practices is often a greater determinant of malnutrition than the lack of food. Knowledge of mothers about these factors will be of help in planning interventions to improve feeding practices. It has been shown in many studies that mothers in India are unable to start complementary feeding at the right time. So, the present study was undertaken with the objectives to assess the knowledge and pattern of complementary feeding practices among infants of six months of age.

Objective:

To assess the knowledge and pattern of complementary feeding in mothers of infants of six months in Dhanas, UT, Chandigah.

Material and method:

Research approach was quantitative and design was exploratory research design. Target population was comprised of infants (6-9 months) and their mothers Purposive sampling technique was used. The study was conducted in Dhanas, UT Chandigarh. During the month of July-November 2017 on 40 infants of six months of age and their mothers. Infants were identied by using a survey performa and house to house visits. Inclusion criteria was infants of 6 months of age along with their mothers who were willing to participate in the study. Exclusion criteria was infants not on breastfeed. Total 40 infants and their mothers were enrolled in the study. interview schedule was used to assess the socio-demographic data of infants and their parents. A set of questions was used to assess the knowledge of mothers and pattern of complementary feeding among infants. Assessment of the anthropometric measurement weight, height, chest and head circumference was done with the weighing scale and measuring tape. Ethical approval was obtained from Institute Ethics Committee of PGIMER, Chandigarh. Written informed consent was obtained from the mothers of infants residing in Dhanas. Interview was done as per the interview schedule to assess the knowledge of mother and pattern of complementary feeding among infants. Mothers were encouraged to continue giving complementary foods to the infant, their doubts were cleared and pattern of existing complementary feeding were observed.

Results:

Ta b l e 1 d e p i c t s t h e s o c i o – demographic prole of parents of the infants. The age of mothers was in the range of 20 – 41 years with mean age of 27.15+4.90. About 45% of mothers were in the age group of 20-25 years. The age of fathers was in the range of 20-48 years with mean age of 30.58+5.16. About 50% of fathers were in the age group of 25-30 years. About 40 % of mothers and fathers had educational qualications of graduate and above. Occupation wise, all the fathers were employed and working and 87.5 % mothers were housewives. More than 70% families were Hindus and 25% families came under lower middle class (as per BG Prasad SES Scale 2016).

Table 2 shows the age of infants was in the range of 6- 7.27 months with mean age of 6.53 + 0.45 months. Majority of infants (75%) were between 6-7 months of age. 42.5% infants were females, 57.5% infants were males. Birth order of 45% infants was rst child. Birth weight of infants ranged between 1.5-4.0 kg with mean weight of 2.69 + 0.51 kg.

Table 3 shows the practices of breastfeeding and complementary feeding. Majority of infants (82.5 %) were not given anything (honey, ghutti) before the initiation of breast feeding. All the infants were breastfed. Frequency of breastfeeding during day time was more the 6 times in

Table 1: Socio-demographic profile and dietary pattern of parents of infants

N=40

Variables N=40(%)
Age of mother (years)
18(45.0)
20-25
26-30 15(37.5)
>30 7(17.5)
Age of father (years)
4(10.0)
20-25
25-30 20(50.0)
>30 16(40.0)
Education of mother
2(5.0)
Illiterate
Upto Primary 8(20.0)
Middle school completed 4(10.0)
Senior secondary 10(25.0)
Graduate and above 16(40.0)
Education of father
Illertate
Upto primary 7(17.5)
Middle school completed 6(15.0)
Senior secondary 11(27.5)
Graduate and above 16(40.0)
Occupation of father
11(27.5)
Private job
Self employed 10(25.0)
Government job 8(20.0)
Others(labourer) 11(27.5)
Occupation of mother
35(87.5)
Unemployed
Private job 2(5.0)
Government job 3(7.5)
Religion
28(70.0)
Hindu
Muslim 6(15.0)
Sikh 5(12.5)
Christian 1(2.5)
*Socio-economic status (BG
Prasad SES Scale 2016)
Lower class(<951)
Lower middle class (952-1903) 10(25.0)
Middle class ( 1904-3172) 16(40.0)
Upper middle class (3173-6345) 7(17.5)
Upper class(> 6346) 7(17.5)
Dietary pattern

Vegetarian

Non-vegetarian             

 

  

16(40.0)
24(60.0)

Age of mothers, mean+ SD= 27.15+4.90(20-41) Age of fathers, mean+ SD=30.58+5.16(23-48) 62.5 % infants. Frequency of breastfeeding at night was three to six times in 85% infants. Only 42.5% mothers emptied one breast before shifting the infant to another one. Complementary feeding was started after completion of 6 months of age in most of infants (87.5%). Half of infants received complementary foods ( Khichri, dalia, daal, aloo, curd and supplementary diet distributed by Anganwadis. Half of infants received watery food only (daal soup, chawal soup) etc.

Table 2: Profile of infants

N=40

Variable N=40(%)
Age of child (months)

6-7

7-8

 

30(75.0)

10(25.0)

Gender of child

Female Male

 

17(42.5)

23(57.5)

Birth order

1st child 2nd child

3rd child or more

 

18(45.0)

15(37.5)

7(17.5)

Birth weight(kg)  

5(12.5)

25(62.5)

9(22.5)

1(2.5)

1-2
2-3
3-4
>4
Number of siblings
One 18(45.0)
Two 14(35.0)
Three 6(15.0)
Four 2(5.0)

Age of child (months) Mean + SD (range)= 6.53 + 0.45 (6.0-7.27) Birth weight (kg) Mean + SD (range)= 2.69 + 0.51(1.5-4.0)

Table 4 shows the mother’ s knowledge regarding importance of breastfeeding and complementary feeding. 60% of mothers knows that breastfeeding is important as it provide all nutrition baby requires till six months. 65% of mothers knows what is complementary feeding. And only 62.5% of mothers knew about the complementary foods.

Table 5 depicts the knowledge of mothers regarding introduction of complementary feeding. Only 30% of mothers knew why complementary feeding should be started at six months. Nearly half of mothers knew about the risks of starting complementary feeding too early or too late. Only 17.5% of mothers knew that mashed food item should be given as complementary foods. Nearly half (47.5%) mothers knew about the frequency of complementary food to be given.

Table 6 depicts the knowledge of mothers r e g a r d i n g t h e p r e p a r a t i o n o f complementary foods. 70 percent of mothers knew that it is important to enrich or make infant’s food more energetic and nutrient dense but only 32.5 percent of mothers knew how to make the infants’ food energy and nutrient dense. Only 35% of  m o t h e r s k n e w a b o u t t h e t i m e o f introduction of animal source food in infant’s diet. 60 percent of mothers believed that sick and recovering infants should be given complementary foods along with breast milk while rest of 40 % saiud that only breast milk should be given. More than half (70%) of the mothers knew that feeding bottles and sippers are not good option for

Table 3: Breastfeeding and complementary feeding practices of mothers of infants

N=40

Variables N=40(%)
Any food item given before breastfeed

Ø  Nothing

Ø  Milk other than breast milk

Ø  Honey

 

33(82.5)

6(15.0)

1(2.5)

Frequency of breastfeeding during day time

Ø  3-6

Ø  >6

 

15(37.5)

25(62.5)

Frequency of breastfeeding during night time

Ø  <2

Ø  3-6

 

6(15.0)

34(85.0)

Empty one breast before shift to other one.
Ø  Yes

Ø  No

Ø  Sometimes

17(42.5)

19(47.5)

4(10.0)

Timing of starting complementary feeding
Ø  After complete 6 months

Ø  After 7 months

35(87.5)

5(12.5)

Foods given for complementary feeding
Ø  Complementary foods(Khichri, dalia, daal,aloo, curd , Anganwadi food) 20(50.0)
Ø  Watery food( daal soup, rice gruel) 20(50.0)

Table 4: Mother’s knowledge regarding importance of breastfeeding and

complementary                                    N=40

Sr. Variables N(%)
1 Breastfeeding is important as it provide all nutrition baby needs

in rst six months

24(60.0)
2 Baby can survive on only breast milk up to 6 months 38(95.0)
3 Breastfeeding should be continued for 2 years or more 14(35.0)
4 Complementary feeding refers to foods given to infants after 6

months

26(65.0)
5 Complementary feeding is important as mother’s milk is not

sufcient to meet demands after 6 months

14(35.0)
6 Complementary feeding should be started after 6 months of

age

33(82.5)
7 Know about the food items to be given as complementary foods (Khichri, dalia, daal, aloo, curd, mashed potato, mashed fruits

,kheer, halwa )

25(62.5)

 

Table 5 : Mother’s knowledge regarding introduction of complementary feeding

N=40

Sr.No. Variables N(%)
1. Complementary feeding should be started at 6 months because of Increased nutrition demand of infants 12(30.0)
2. If complementary feeding started too early there will be Increased risk of infection, choking 22(55.0)
3. If complementary feeding too late, the infant will get weak and malnourished 17(42.5)
4. Complementary food should be given 2-3 times to infant in a day at 6 months 19(47.5)
5. Amount of complementary food given to infant at one time should be 1-3 spoons at starting 25(62.5)
6. Mashed food item should be given as complementary foods 7(17.5)
7. It is advisable to add ghee or oil to infants’ porridge 22(55.0)
8. It is  advisable to add  ghee or oil to infants’ porridge because less amount of food will provide more energy 15(68.1)
9. It is important to ensure high standards of hygiene when preparing complementary feeds 40(100.0)
10. It is important to ensure high standards of hygiene when preparing complementary feeds to prevent the infant from infection as they have low immunity 28(70.0)

Table 6 : Mother’s knowledge regarding preparation of complementary foods

N=40

Sr.No. Variables N(%)
1. It is important to enrich or make infant’s food more energetic and nutrient

dense.

28(70.0)
2. Infants’ food should be energy dense as little amount of food will cover energy gap 8(28.6)
3. Infant’s food can be made energy and nutrient dense by adding vegetables

/fruits/pulses/ghee/oil/jaggery.

13(32.5)
4. Animal source(egg, chicken, sh, mutton ) food should be introduced in infant’s diet after 9 months of age 14(35.0)
5. Sick and recovering infant’s should be given complementary foods along with breast milk 24(60.0)
6. Sick and recovering infant’s should be given complementary foods along with breast milk for early recovery and to meet nutrition demands 23(95.8)
7. Feeding bottles and sippers are not the good option for feeding infants 28(70.0)
8. Feeding bottles and sippers are not the good option for feeding infants because

Cause infection

Not recommended by doctors Cause dental problems

 

16(57.2)

6(21.4)

6(21.4)

feeding infants.

Table 7 depicts the nutritional status of infants as per weight for age chart by WHO. It shows that ve percent infants were severely undernourished, 32.5 percent were moderately undernourished, 62.5 percent were normally nourished.

Table 7: Nutritional status of infants

N=40

Nutritional status N (%)
As per Weight for Age chart:
Normal 25(62.5)
Moderately under-nutrition 13(32.5)
Severe under-nutrition 2(5.0)

DISCUSSION

Complementary feeding is an essential aspect of infant nutrition. Inadequate complementary feeding practices are the major cause of malnutrition in the developing countries. Literature reveals that one of the major reasons for inappropriate complementary feeding is inadequate knowledge of mothers regarding infant feeding practices. Mothers are not aware which food is benecial for physical, cognitive and intellectual development of their infants. Most of the mothers don’t know about the quantity, frequency and consistency of foods that are to be given to their infants.

It was important to assess the current practices before implementing any strategies. In the present study semi- structured interview schedule was used to obtain the data related to the current feeding practices of the mothers because researcher wanted to explore the problem areas for which open ended questions was included. The reason for using interview schedule was that it is easy to administer and even for the mothers having low literacy. Similarly a research undertaken in rural Vadodara used individual semi-structured interviews to assess knowledge, attitude and practices of the mothers regarding complementary feeding3.

Breast milk is the complete food for the infants up to 6 months of age as it provides all the essential nutrients required by the baby. So it is recommended to give exclusively breast feeding to the baby up to 6 months and continue to breastfed up to two years or beyond and avoid pre lacteal feeds. Breastfeeding on demand both day and night satisfy the hunger of infant. Normally 8-12 times a infant should be  breastfed day and night. In present study, all infants were started complementary feeding after six months, some of the infants who were enrolled before completion of six months of age, their mothers were reinforced to continue exclusive breastfeeding up to completion of s i x m o n t h s b e c a u s e a s p e r t h e recommendations of WHO and National IYCF complementary feeding should be started after complete 6 months of age4. In the present study, more than 80 percent of infants were not given any other liquid before breastfeeding and nearly 20 percent of infants were given pre lacteal feeds and the reason for giving pre lacteal feeds was insufcient breast milk. Similarly in a study conducted on breast feeding practices and newborn care in rural Bangalore, Karnataka states that 19% of the mothers gave pre lacteal feeds. Total 13% of the babies were fed with sugar water alone for more than 48 hours. Honey (6%) and ghee (3%) were also commonly used pre lacteal feeds5.

One breast should be emptied rst while shifting to other breast. This will help the baby to get nutritious  “hind  milk”.  W h e n m o t h e r p u t s t h e c h i l d o n breastfeeding the milk that comes rst is the fore milk. It has more water content whereas hind milk rich in fat. If mother shift the child to other breast without empting the rst breast then the child get only fore milk. This will affects growth and development of child. Hence mothers were educated to empty one breast rst before shifting the infant to other breast. In present study nearly half of mothers in both the groups had not emptied one breast before shifting to other. After six months breast milk is not sufcient for the infant to provide adequate energy. Breast milk alone is inadequate for proper growth and development. Early initiation of complementary feeding at 4-6 months and late initiation has deleterious effect on the health of infant. In present study complementary feeding was started at 6 months in majority of the infants in both the groups. A study was conducted on effect of complementary feeding practices on nutritional status of child6. The results of study revealed that the children for whom weaning was started at 6 months were found less malnourished then those who were earlier weaned.

Inappropriate feeding is emerging as one major cause for malnutrition in children. Even if the food is available children are still underweight. Mothers are h a v i n g l a c k o f k n o w l e d g e a b o u t complementary feeding i.e. when to initiate, what food items to give, how to make them more nutritious, how frequently it should be given and what should be consistency of foods at different ages. Many efforts have been put by the government in improving the infant and young child feeding practices, still mothers are not aware about the concept of complementary feeding. In the present study, 12% mothers said that no one have told them about the complementary feeding. The results of the study showed that majority of mothers in experimental group and have poor knowledge of complementary feeding. Less than half of mothers had knowledge regarding type of complementary foods, consistency and frequency of complementary foods. A study was also conducted to assess the knowledge of complementary feeding among mothers in Lahore. Only 54% of mothers has knowledge of time of initiation of complementary feeding7.

The result of study had shown that half of mothers had average knowledge score and 20% had poor knowledge regarding complementary feeding. Half of the infants were given watery food (daal water, rice gruel). It was seen that nearly half of the mothers had lack of knowledge regarding complementary feeding and patterns of complementary feeding and b r e a s t f e e d i n g w e r e n o t a s p e r recommended guidelines.  Infants  were u n d e r n o u r i s h e d d u e t o i m p r o p e r complementary feeding practices. the study recommends that more emphasis should be given on educating mothers regarding breastfeeding and complementary feeding and regular nutritional assessment of infants should be done.

References:

  1. World Health Organization. Complementary feeding – Report of the global consultation Summary of Guiding principles Geneva. 2001. Available from: who.int/entity/nutrition/ publications/infantfee ding/Complementary_Feeding.pdf
  2. National Family Health Survey [Internet]. Pib.nic.in. 2017 [cited 22 March 2018]. Available from: http://pib.nic.in/newsite/mbErel.aspx? relid=169905
  3. Sharma Breastfeeding, Complementary Feeding and Care Practices in Rural Vadodara.[Internet]. 2017 [cited 7 March 2018]; Available from: http://shodhganga.inibnet.ac.in/bitstr eam/10603/59146/10/10_chapter%20 3.pdf
  4. Infant and Young Child Feeding – UNICEF data [Internet]. UNICEF data. 2018 [cited 16 March 2018]. Available from: https://data.unicef.org/topic/nutrition/ infant-and-young-child-feeding/
  1. Madhu K, Chowdary S, Masthi R. Breast feeding practices and newborn care in rural areas: A descriptive cross-sectional Indian Journal of Community Medicine [Internet]. 2009 [cited 23 March 2018]

;34(3):243. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC2800906/

  1. Shamim S. Effect of weaning period on nutritional status of children. – PubMed – NCBI [Internet]. Ncbi.nlm.nih.gov. 2018 [cited 21 August 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubme d/16899182.
  2. Hasnain S, Ashraf M, Anjum R. Knowledge and practices of mothers for complementary feeding in babies visiting pediatrics outpatient department of Jinnah Hospital, Lahore. Biomedical [Internet]. 2013 [cited 14 March 2018];Vol. 29:221-
  3. Available from: https://www.researchgate.net/publicat ion/286246352_knowledge_and_ practices_of_mothers_for_compleme ntary_feeding_in_babies_visiting_pe diatrics_outpatient_department_of_ji nnah_hospital_lahore