E-ISSN:2349-4166
P-ISSN:2349-4158

Research Article

Complementary

Public Health Review - International Journal of Public Health Research

2020 Volume 7 Number 1 January-February
Publisherwww.medresearch.in

Study on factors affecting complementary feeding practices in infants and young children in a rural area of Bihar

Kumar A.1, Kumar L.2*, Kumar T.3, Roy C.4, Jha H.5, Kumar Lal P.6
DOI: https://doi.org/10.17511/ijphr.2020.i1.01

1 Akhilesh Kumar, Tutor, Department of PSM, Vardhman Institute of Medical sciences, Pawapuri, Bihar, India.

2* Laxman Kumar, Associate Professor, Department of PSM, Vardhman Institute of Medical sciences, Pawapuri, Bihar, India.

3 Tushar Kumar, Tutor, Department of PSM, Government Medical College, Bettiah, Bihar, India.

4 Chittaranjan Roy, Professor, Department of PSM, Darbhanga Medical College, Darbhanga, Bihar, India.

5 Hem Kant Jha, Associate Professors, Department of PSM, Darbhanga Medical College, Darbhanga, Bihar, India.

6 Prabhat Kumar Lal, Associate Professors, Department of PSM, Darbhanga Medical College, Darbhanga, Bihar, India.

Introduction: Proper infant and young child feeding practices are essential for the prevention of childhood morbidity and mortality. NFHS-4 reported that about half of the children in Bihar are not receiving complementary foods timely. The present study was conducted to assess the factors affecting the complementary feeding of infants and young children. Methods: The present cross-sectional study was conducted upon mothers/ caretakers of 400 children age 6-24 months. Sociodemographic details and complementary feeding practices were noted. Results: The mean age of initiation of complementary feeding was 5.2 months. Cereals were the most common complementary food given while only 19% of children received food from all the food groups. Half of the children (50.8%) were given food of appropriate consistency and 41% were given the proper amount. 53.8% were given marketed foods. A significant association was seen between ideal practices and type of family (p=0.002), mother’s education (p=0.000), socioeconomic status (p=0.000) and IYCF related advice given during immunization sessions (p=0.000). Conclusion: Appropriate feeding practice is very low and effort should be made to increase the appropriate feeding practices.

Keywords: Complementary feeding, Cross-sectional study, Factors

Corresponding Author How to Cite this Article To Browse
Laxman Kumar, Associate Professor, Department of PSM, Vardhman Institute of Medical sciences, Pawapuri, Bihar, India.
Email: 		Kumar A, Kumar L, Kumar T, Roy C, Jha H, Lal PK. Study on factors affecting complementary feeding practices in infants and young children in a rural area of Bihar. Public Health Rev Int J Public Health Res. 2020;7(1):1-6.
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https://publichealth.medresearch.in/index.php/ijphr/article/view/131

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2020-01-10 2020-01-20 2020-01-25 2020-02-01
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
No Nil Yes 7%

© 2020 by Akhilesh Kumar, Laxman Kumar, Tushar Kumar, Chittaranjan Roy, Hem Kant Jha, Prabhat Kumar Lal and Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Kumar A. et al: Study on factors affecting complementary feeding

Introduction

Different reports have repeatedly emphasized the role of proper infant and young child feeding practices for prevention of childhood morbidity and mortality and ensuring adequate nutrition. Globally, one-third of the estimated 9.5 million deaths that occurred in 2006 in children less than five years of age were attributed directly or indirectly to undernutrition [1]. Infant and young child feeding (IYCF) practices recommend exclusive breastfeeding up to the age of six months; timely initiation of feeding solid, semisolid foods after six months onwards. It also recommends feeding small amounts, increasing the number of foods and frequency of feeding as the child gets older while maintaining breastfeeding as demanded by the child. In Bihar, the percentage of children who received complimentary food at 6-7 months of age increased from 31% in the NFHS-3 to 54% in the NFHS-4. Still, about half of the children are not receiving complementary foods timely [2]. Knowledge on feeding practices of infants and young children n is crucial for undertaking or improving health and nutrition programs in the country. Different studies have tried to explore the reasons behind improper complementary practices. Such studies have not been done in this area. Hence, this study was conducted.

Aims and objectives

The present study was conducted to assess the factors affecting complementary feeding of infant and young children, attending OPD of RHTC Kalyanpur attached to Darbhanga Medical College.

Material and Methods

Study setting: The present study was conducted at the Darbhanga Medical College, Darbhanga, Bihar. The rural training center of this institute covers a population of 3,27,653 population with 3 additional PHC and 38 sub-centers under its jurisdiction. Large numbers of mothers with children from the PHC area attend OPD for immunization and treatment of illness. The staff nurse posted at this center has already been trained for IYCF.

Duration and type of study: The present study was conducted between Dec 2014 to Nov 2016. Data collection was done between March 2016 to Aug 2016.

Study subjects: Children of 6 to 24 months of age

who attended the outpatient department of Primary health center, Kalyanpur were included. Mothers/caretakers of children were interviewed.

Inclusion criteria: Children aged 6 months to 24 months attending the OPD of Primary Health Centre, Kalyanpur were included in the present study.

Exclusion criteria: Children with known anomalies and who were very sick needing emergency care were excluded.

Sampling: The sample size was determined by using the formula: (Za)2pq/D2. 57.0% of children are fed according to a recommendation by IYCF in terms of foods from recommended food groups and are fed at least the recommended minimum number of times. Considering allowable error to be 5%. Size of sample= (1.96)2X 0.57X 0.43/ (0.05)2 = 376. A total of 400 study subjects were included. Systematic random sampling was used for data collection amongst the cases attending OPD.

Data collection procedure: A semi-structured questionnaire was used to collect the data with the mother. Before the data collection process, permission was taken from the hospital authority for the study. Mothers of consecutive children fulfilling the inclusion criteria were enrolled in the study until the required sample size was reached. Mothers were informed about the study and consent was taken. Then, data were collected by personal interview. Intern, staff-nurse and medical social worker (MSW) helped in data collection.

Data analysis: Data was entered in Microsoft Excel and Data was entered and analyzed using Medcalc software. Percentage, proportions, and contingency tables were used for the description of the data. Association of inappropriate feeding practices with socio-demographic characteristics was analyzed using the chi-square test. P-value <0.05 was considered as statistically significant.

Ethical consideration and permission: Approval from the Institutional Ethics Committee was obtained. Informed consent was taken from the patients. The confidentiality of records was maintained.

Results

A total of 400 mothers/ caretakers were interviewed in the present study. Table-1 shows the background characteristics of the study population. 62.5% of children were males, 63.3% of them belonged to the nuclear family, 93% of them were Hindus. The


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Kumar A. et al: Study on factors affecting complementary feeding

mean age of children was 12.9 months. 19% of mothers were illiterate and 70% of them were housewives.

Table-1: showing background characteristics of the study population

Background characteristics Values Frequency %
Age (in months) - 12.9±5.2
Sex Male 250 62.5
Female 150 37.5
Type of family Nuclear 253 63.3
Joint 147 36.7
Mother’s education Illiterate 76 19
Primary 60 15
Secondary 124 31
Intermediate 100 25
Bachelor and above 40 10
Mother’s occupation Housewife 280 70
Agriculture 60 15
Business 24 6
Service 24 6
Skilled work 12 3
Socioeconomic status A 68 16.5
B 25 6.3
C 179 44.8
D 112 28
E 16 4
Religion Hindu 372 93
Muslim 28 7

Table-2 shows awareness of mothers regarding complementary feeding. 88% of mothers knew when to start complementary feeding, 87.8% knew what foods to give but only 36.8% were aware of the correct frequency.

Table-2: showing awareness of mothers regarding complementary feeding

Characteristics Values Frequency %
When to start complementary feeding Yes 352 88
No 48 12
What foods to be given Yes 351 87.8
No 49 12.2
Correct frequency Yes 147 36.8
No 253 63.2

Table-3 shows the complementary feeding practices. The mean age of initiation of complementary feeding was 5.2 months. Cereals were the most common complementary food given while only 19% of children received food from all the food groups. Half of the children (50.8%) were given food of appropriate consistency and 41% were given the proper amount. 53.8% were given marketed foods.

Table-3: Showing complementary feeding practices

Characteristics Values Frequency %
Age at initiation of complementary feeding (in months)   5.2±1.6
Types of complementary foods given Cereals 112 28
Milk product 28 7
Cerelac 32 8
Vegetables and fruits 100 25
Egg, meat or fish 20 5
Pulses 32 8
All 76 19
Amount of complementary foods given Inappropriate 236 59
Appropriate 164 41
Consistency of complementary foods given Thick 124 31
Thin 73 18.2
Appropriate 203 50.8
Separate container used Yes 268 67
No 132 33
Use of marketed foods Yes 215 53.8
No 185 46.2

Table-4: Showing association between background factors and complementary feeding

Characteristics Values Not ideal practice Ideal practice Significance
Type of family Nuclear 222 31 X2=9.9843 p=0.00157
Joint 111 36
Mother’s education Illiterate 69 7 X2=39.1685 p=0.00001
Primary 52 8
Secondary 111 13
Intermediate 81 19
Bachelor and above 20 20
Mother’s occupation Housewife 232 48 X2=5.5416 p= 0.23609
Agriculture 54 6
Business 19 5
Service 11 1
Skilled work 17 7
Socio-economic status A 59 9 X2= 43.980 p=0.00001
B 21 4
C 168 11
D 72 40
E 13 3
Advice received during immunization Yes 106 56 X2=61.9886 p<0.00001
No 227 11

Table-4 shows the association between background


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Kumar A. et al: Study on factors affecting complementary feeding

factors and complementary feeding. A significant association was seen between ideal practices and type of family (p=0.002), mother’s education (p=0.000), socioeconomic status (p=0.000) and IYCF related advice given during immunization sessions (p=0.000).

Discussion

Infant and young child feeding practices include early initiation of breastfeeding within one hour of life, no bottle feeding and exclusive breastfeeding thereafter up-to 6 months and timely introduction of solid/semi-solid foods from the age of six months increasing in amount and frequency over time along with breastfeeding as demanded by the child [3,4]. The National family health survey 2015-16 has shown that IYCF practices are still low in India.

Only 30.7% of the children are fed according to the IYCF practices; that is feeding milk and milk products and food items from the recommended food groups and at the minimum recommended frequency [2]. Hence, the present study explored the factors influencing the appropriateness of complementary feeding, to assess the knowledge of mothers regarding complementary feeding and to evaluate the practices of complementary feeding in terms of quantity, quality, and timing.

A total of 400 mothers/ caretakers were interviewed in the present study. The mean age of children was 12.9 months. 62.5% of them were males, 63.3% belonged to the nuclear family and 93% were Hindus. 19% of mothers were illiterate and 70% of them were housewives. Javalkar et al found that 49.5% of mothers were Hindus, 43.4% were Muslims and 7.1% belonged to Christian and other religions. There were 35.1% of women educated till secondary school, with only 5.1% illiterate. The majority of the women (78.2%) were housewives and only 21.8% of them were employed and contributing to the family income among them.

A majority (83.8%) of them belonged to socio-economic classes II and III, according to Modified BG Prasad’s Socioeconomic Classification. The majority of the mothers (66.9%) belonged to nuclear families, 18.4% belonged to joint families, and only 4.5% belonging to Three generation family [5]. Rao et al observed that the majority of children (41%) belonged to the 6–12 months age group, 56.5% were male children and 52% belonged to a joint family. Most of the mothers (81%) were homemakers [6].

88% of mothers knew when to start complementary feeding, 87.8% knew what foods to give but only 36.8% were aware of the correct frequency. The mean age of initiation of complementary feeding was 5.2 months. Cereals were the most common complementary food given while only 19% of children received food from all the food groups. Half of the children (50.8%) were given food of appropriate consistency and 41% were given the proper amount. 53.8% were given marketed foods. Javalkar et al reported that 69.3% of mothers in the rural area and 30.6% of mothers in the urban area started complementary feeds at the age of 6 months. 35.2% started complementary feeds before 6 months of age; the most common reason for starting the complementary feeds before 6 months of age was advice by family members/friends followed by the belief that breast milk alone is not sufficient for the child. The most common complementary food given first was rice and dal cooked together by 29.2% mothers followed by readymade baby feeds (20%). The number of meals per day given to the child varied from 2-4/day, both in an urban and rural area [5].

Yadav et al found in the urban and rural areas of Bihar that 17.70% urban and 13.10% rural mothers started complementary foods before 6 months of age, the reason for early weaning being mothers felt that breast milk was not sufficient. The most common food given first as weaning food both in urban as well as rural areas was rice [7]. Rao et al found that 77.5% of mothers had started complementary feeding at the recommended time and 12% of children had delayed complementary feeding. The most common reason given for the delayed introduction of complementary feed was that mothers felt their milk was enough for baby. Only 32% of mothers practiced the adequate quantity of complementary feeds. The majority (82%) mothers had initiated weaning with home-made food. Around 22% of children were bottle-fed. Ragi, wheat, and rice were the most common home-made complementary food used [6].

A significant association was seen between ideal practices and type of family (p=0.002), mother’s education (p=0.000), socioeconomic status (p=0.000) and IYCF related advice given during immunization sessions (p=0.000). Javalkar et al reported that statistical association between socio-demographic variables and initiation of complementary feeding was not significant in the rural area. However, in the urban area,

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Kumar A. et al: Study on factors affecting complementary feeding

socioeconomic status had a significant association (p<0.05) [5]. Rao et al also found in the univariate analysis that the practice of complementary feeding at the recommended time of six months was significantly associated with socioeconomic status (p=0.036), birth order (p=0.013), place of delivery (0.033), maternal education (p=0.038) but not with the gender of the child, maternal age, maternal employment status, type of family and advice about complementary feeding during immunization [6].

Dhami et al analyzed NFHS-4 data and observed a wide variation in the prevalence of introduction of solid, semi-solid or soft foods (complementary foods) among infants aged 6–8 months in regional India; highest in the South (61%) and lowest in the Central and Northern regions (38%). Minimum dietary diversity (MDD) was highest in the South (33%) and lowest in the Central region (12%). The factors associated with complementary feeding practices also differed across Indian regions.

Significant modifiable factors associated with complementary feeding practices included higher household wealth index for the introduction of complementary foods in the North and Eastern India; higher maternal education for MMF and MDD in the North and Central regions; and frequent antenatal care visits (≥4 visits) for all indicators but for different regions [6,8].

Limitations

The present study was descriptive in nature and generates hypotheses only. An analytical study is needed to test the hypothesis and calculate the risk. It covered a population of rural centers of DMCH, Darbhanga. Studies covering a larger area are needed to generalize the findings.

Conclusion

It is seen in the present study that ideal feeding was practiced only in a minority of children. Some of the mothers used cereals as a weaning food but a few mothers knew the proper method of its preparation. The frequency of complementary feeding given to children was good in the majority of the children but its consistency and amount were found to be not appropriate as per recommendation by IYCF Guidelines in more than half of the children.

There was an association of appropriate feeding practices with mother’s education, type of family, family income (SES) and feeding advice during

immunization. The findings highlight the importance of the mother's education, profession and giving education in the immunization clinic for the infant and young child feeding.

Appropriate feeding practice is very low and effort should be made to increase the appropriate feeding practices by putting more effort inconsistency of food and timing of feeding. The immunization clinic is the best place and vaccination time is the ideal time for educating mothers about appropriate feeding practices.

What does the study add to the existing knowledge

This study gives insight into the factors associated with complementary feeding practices in infants and young children of Bihar.

Author’s contribution

Dr. Akhilesh Kumar is the principal author and conducted this study. Dr. Laxman Kumar and Dr. Tushar Kumar reviewed the literature and assisted in finalizing the study design. This study was conducted under the supervision of Dr. Chittaranjan Roy who was the study guide. Dr. Hem Kant Jha edited this article and Dr. Prabhat Kumar Lal assisted in data analysis.

Reference

  1. Black R. Maternal and child undernutrition- global and regional exposures and health consequences. Lancet. 2008;371(9608)243-260.
  2. Goverment of India. State Fact Sheet Bihar. National Family Health Survey- 4. 2015-2016. Available at
  3. Aggarwal A, Verma S, Faridi MMA, Dayachand. Complementary feeding- Reasons for inappropriateness in timing, quantity and consistency. Indian J Pediatr. 2008;75(1)49-53.
  4. Ahmad I, Khalique N, Khalil S, Urfi, Maroof M. Complementary feeding practices among children aged 6–23 months in Aligarh, Uttar Pradesh. J Family Med Prim Care. 2017;6(2)386-391.

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Kumar A. et al: Study on factors affecting complementary feeding
  1. Javalkar SR, Aras RY. A study on complementary feeding practices among mothers in urban and rural areas. Int J Comm Med Public Health. 2018;5(3)1162-1166.
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