India still accounts for the highest prevalence of child under-nutrition in the world. This further contributes to high morbidity and mortality, especially among the under 5 children [1]. India State-Level Disease Burden Initiative Malnutrition Collaborators states that undernutrition is the leading risk factor for mortality among children under 5 years of age, in 2017. It stated that child stunting in India in 2017 was 39.3%; while the prevalence of child wasting and child underweight was 15.7% and 32.7% respectively. The prevalence of overweight among children aged 2–4 years was 11.5% [2]. Appropriate feeding practices are a basic fundamental need for the survival, growth, and development of infants and young children. Studies suggest that optimal feeding of a young child, increases his potential to survive by six-folds. Hence, it is estimated that, one can prevent over 800,000 under-five deaths (almost 13 per cent of all deaths) in developing countries, just by improving the child feeding practices [3]. Several studies have suggested that exclusive breastfeeding in the initial six months of life, act as preventive interventions in the prevention of several diseases. As per NFHS-4, data suggests that in urban areas of Madhya Pradesh, only 54.2% of children under age 6 months are exclusively breastfed [4]. The objective is to study various feeding practices prevalent among children up to 6 months of age in an urban slum of Bhopal and to access various socio-demographic factors affecting exclusive breastfeeding and appropriate breastfeeding practices.

The study was conducted in the Satnami Nagar, Indrapuri, an urban slum area of Bhopal, Madhya Pradesh. This community based cross-sectional analytical study was conducted in children up to six months of age, from October 2018 to February 2019. Line-listings of all the children up to 6 months of age, were obtained from the local Anganwadi centre. A universal sample was taken. All the children, who were born singleton and full-term (greater than 37 weeks), and whose mothers were willing to participate in the study, were included in the study. A child born with any physical or congenital abnormality and those suffering from any prolonged or contagious illness, were excluded. Prior informed consent was obtained from the mothers.

Figure-1: Children receiving Exclusive Breastfeeding

Table-2: The age group of mothers.

Figure-2: Children receiving Colostrum

Figure-3: Time initiation of Breastfeeding

(85.71%) and 16 (84.2%), on the other hand, 6 (54.54%) out of 11 illiterate mothers were inappropriate feeding their children.

Table-4: Factors associated with infant feeding practices

Bar chart 1. Trends between mother’s education and her knowledge of EBF

Bar chart 2. Trends between feeding practices and type of family

Appropriate feeding practices as per WHO norms are highly dependent on the educational status of the mother. Bar chart 1 shows the trends between a mother’s education and her knowledge of EBF.

Moestue H., also mentioned in his study that a child’s better nutritional status is associated with parents’ and grandparents’ education levels [15]. In the current study, appropriate breastfeeding was prevalent in both institutional well as home-based deliveries. This was in contrast to the findings of Liaquathali F, where, mothers who delivered by caesarean section, the prevalence of appropriate Infant and young children feeding practices were higher [16]. Kogade P, stated in his study that family size and type major determinants of IYCF practices in rural India [17]. This was further strengthened by our study, where, it was remarkable that appropriate feeding practices are more prevalent in joint families and extended families irrespective of their social status.

It is commendable to note that breastfeeding is universally accepted as an essential component of child survival, and most of the mothers are breastfeeding their newborns. By large, it is noticed that the majority of mothers are practising exclusive breastfeeding. Most of the children have received colostrum. A large scope of improvement in the timely initiation of breastfeeding is seen in this study. A mother’s adherence to appropriate feeding practice is greatly determined by her education status, type of family, and the place where she delivered the baby. Even the mothers with basic primary education and above, have a better insight into appropriate breastfeeding. Better adherence to appropriate breastfeeding practice in joint and extended families are suggestive of better childcare and child-rearing guidance provided to the mothers. Also it is noted that institutional deliveries provide an opportunity to sensitize the mothers for timely initiation of breastfeeding. Also it gives a chance to improve the breastfeeding technique among the new mothers so that babies are not fed with animal milk. Strengthening healthcare facilities as well as communities to provide guidance and support to the mothers is a key to further improve the IYCF practices. This can be done by sensitizing the mothers about colostrum and breastfeeding, right from their first ANC visit. There is an urgent need to improve the IYCF practice in the identified community. This can be achieved by conducting outreach programs with the help of the ASHA and Aanganwadi workers. Periodic training of the grass-root level workers will help in sustaining the improvement in IYCF practice and reducing the burden of infant morbidity and mortality.