|Year : 2012 | Volume
| Issue : 4 | Page : 301-304
A study on infant and young child feeding practices among mothers attending an urban health center in East Delhi
Amir Maroof Khan1, Priscilla Kayina2, Paras Agrawal3, Anita Gupta4, Anjur Tupil Kannan5
1 Department of Community Medicine, Assistant Professor, UCMS & GTB Hospital, Delhi, India
2 Department of Community Medicine, Assistant Professor, JNIMS, Imphal, India
3 Department of Community Medicine, Senior Resident, MAMC, Delhi, India
4 Department of Community Medicine, Chief Medical Officer of UHTC, Delhi, India
5 Department of Community Medicine, Professor and Head, UCMS & GTB Hospital, Delhi, India
|Date of Web Publication||24-Jan-2013|
Amir Maroof Khan
Assistant Professor, Department of Comunity Medicine, Room no. 409A, University College Medical Sciences and Guru Teg Bahadr Hospital, Delhi-95
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A cross sectional study was conducted to study the diet pattern of children less than 2 years with regard to certain infant and young child feeding (IYCF) indicators. A total of 374 children less than 24 months of age coming to the immunization clinic were studied using a standard pretested and prevalidated questionnaire. Exclusive breastfeeding was followed by 57.1% of children under 6 months of age. Minimum dietary diversity, minimum meal frequency, and minimum acceptable diet were seen adequate in 32.6%, 48.6%, and 19.7% of children between 6 months and 2 years of age, respectively.
Keywords: Breast feeding, Feeding practices, Infant and young child feeding indicators, Infant and young child feeding
|How to cite this article:|
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
|How to cite this URL:|
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 [serial online] 2012 [cited 2017 Mar 30];56:301-4. Available from: http://www.ijph.in/text.asp?2012/56/4/301/106420
It is estimated that 10.9 million children worldwide under the age of 5 years die every year, of which 2.4 million deaths occur in India alone.  More than half of all deaths in young children are attributable to undernutrition. Problems such as malnutrition in children, poor maternal and adolescent nutrition, gender discrimination, all continue to be major challenges in our country. Nearly 67% of the child deaths in India are due to the potentiating effects of malnutrition. 
In India, while the infant mortality rate (IMR) has declined to 47,  but there still remains the need to accelerate improvements in infant and neonatal survival to achieve Eleventh Plan goal, to reduce IMR to 28 by 2012.  Infants aged 0-5 months who are not breastfed have 7-fold and 5-fold increased risks of death from diarrhea and pneumonia, respectively, compared with infants who are exclusively breastfed.  At the same age, nonexclusive rather than exclusive breastfeeding results in more than 2-fold increased risks of dying from diarrhea or pneumonia. 
The World Health Organization (WHO) and UNICEF have developed the Global Strategy for Infant and Young Child Feeding (IYCF), which recognizes appropriate infant feeding practices to be crucial for improving nutrition status and decreasing infant mortality in all countries. WHO offers three recommendations for IYCF practices for children aged 6-23 months: Continued breastfeeding or feeding with appropriate calcium-rich foods if not breastfed; feeding solid or semi-solid food for a minimum number of times per day according to age and breastfeeding status; and including foods from a minimum number of food groups per day according to breastfeeding status. 
Most of the studies conducted in India have focused on mainly the breastfeeding aspects and not the dietary diversity and diet frequency aspects, which are important in IYCF. The objective of the study was to assess the IYCF practices among the children attending the immunization clinic at the Ghazipur urban health and training center (UHTC) of University College of Medical Sciences (UCMS), Delhi.
This cross sectional study was conducted at one of the urban health centers of the department of Community Medicine of UCMS, Delhi. This UHTC is in East Delhi district and it caters to about 15000 population of the field practice area by providing primary and promotive healthcare. Most of the population in this area belongs to lower socio-economic group, which are residing here as tenants and mainly belong to the neighboring states of Delhi.
A pretested questionnaire mainly based on the standard questionnaire on IYCF practices given by WHO was used for data collection.  These questions provide the information needed to calculate the 10 key indicators of IYCF. As per WHO recommendations, information was collected about the child's diet in the previous 24 hours, which included the type of food items and the number of times they had consumed. Food items were categorized in seven types, that is, cereals, legumes and nuts, dairy products, meat products, egg, vitamin A rich fruits and vegetables, and other fruit and vegetables. Children less than 24 months were included in the study after obtaining verbal informed consent from the mother. Those children not accompanying their mother, for whatsoever reason, were excluded, as it would have given incorrect result regarding the feeding practice of the child.
Immunization clinic for children is used to be held every Wednesday at this UHTC and all the mothers coming for immunization with their children on these days were included in the study. If more than one child less than 24 months was accompanying with the mother, the information was collected for all the children. From the past records it was revealed that the number of immunizations done every Wednesday ranged from 30 to 40, it was decided to collect data from a minimum of 30 mothers per immunization session; at least 15 mothers to be interviewed by the first and the second author themselves. The total number of children whose data was collected was 374 during the 3 months of data collection, that is, September to November 2010. Data was entered in Microsoft Excel and analyzed using R software version 15.0. 
Out of the total 374 children, a majority, that is, 86.9% were tenants whose mean duration of living in that area was 5.85 years (range 0-35 years). Half of the subjects were male and half were female. Majority 213 (57.0%) belonged to middle class and 157 (42.0%) belonged to lower class of the modified Kuppuswamy socioeconomic status scale  and only 1% belonged to upper class. Nearly 37.1% of the mothers were illiterate, 46.3% were educated less than intermediate, whereas 16.6% were educated intermediate and above. Out of the total 374 children, 101 (27.0%) of the children were of birth order three or more, whereas the remaining 273 (73.0%) were of birth order less than three. [Table 1] shows the status of IYCF practice indicators.
Out of the total studied children, only 37.2% were put on breastfeeding within one hour of birth. National Family Health Survey - 3 (NFHS-3) data at the national level  and also at Delhi  showed it as 23.4% and 21.7%, respectively, for children aged under 3 years. Study from West Bengal  had shown it much lower as 13.6%. An epidemiological evidence of a causal association between early initiation of breastfeeding and reduced infection-specific neonatal mortality has also been documented. 
In our study, prelacteal feed was given to 38% (142/374) of the studied children, which was seen much lower compared with NFHS-3 data at the national level  (57.2%), Delhi State  (45.7%), and a study at Uganda  (43%), which was higher than the study from West Bengal  (26.7%).
Although this practice has been found to be prevalent across the cultures, there is an international consensus that providing other liquids in addition to breast milk in the first 6 months of life is unnecessary and harmful. 
Exclusive breastfeeding was done by 89 (57.0%) of 156 children under 6 months of age. This was better than the figures reported by NFHS-3 data, both at national level  (46.4%) and also from Delhi  (34.5%) and comparable (57.1%) to the study from West Bengal.  A study from slum of Delhi has shown that only 20% of the children below 6 months were exclusively breastfed.  Studies have reported that about one-fourth of the children who received liquids and solids, along with breastfeeding at 0-6 months of age, remained at risk for infectious diseases and undernutrition. ,
Out of the 66 children aged between 6 and 9 months, about three-fourths (72.7%) were having complementary feeding. Of the 32 children aged 6-8 months, 20 (62.5%) were taking solid, semi-solid, or soft foods. This was found to be higher than that reported by NFHS-3 data at national level (44.2%).  A wide variation in the proportion of children who received complementary feeding at 6-9 months of age was reported from two other studies done in India, that is, 71.7% in Kolkata  and 38.7% in Allahabad. 
Continued breastfeeding at one year was being done by 93 (72.1%) of 129 children between 12 and 23 months. This was lower as compared with a study from West Bengal, which showed that 91.1% of children between 12 and 23 months were continuing breast feeding. 
Minimum dietary diversity (MDD) indicator is the proportion of children 6-23 months of age who receive foods from 4 or more food groups from a total of 7 food groups, namely, dairy products, legumes and nuts, flesh foods, eggs, vitamin A rich fruits and vegetables, cereals and tubers, and other fruits and vegetables.  This indicator reveals whether the child is receiving a complete and balanced diet or not. MDD was observed in only 32.6% of the children between 6 and 23 months.
Minimum meal frequency (MMF) indicator is the proportion of breastfed and nonbreastfed children aged 6-23 months who receive solid, semi-solid, or soft foods (but also including milk feeds for nonbreastfed children) the minimum number of times or more.  For breastfed children the minimum number of times varies with age (two times if 6-8 months and three times if 9-23 months). For nonbreastfed children, the minimum number of times does not vary by age (four times for all children aged 6-23 months). MMF was observed in about one-half (48.6%) of children aged 6-23 months.
Minimum acceptable diet (MAD) indicator is the proportion of children aged 6-23 months who receive at least the MDD as well as at least the MMF according to the definitions mentioned above.  This was found to be adequate only in 19.7% of the 6- to 23-month-old children.
NFHS-3 finds that only 44% of breastfed children are fed at least the minimum number of times recommended and only half of them also consume food from three or more food groups. Feeding recommendations are followed even less often for nonbreastfeeding children. Overall only 21% of breastfeeding and nonbreastfeeding children are fed according to the IYCF recommendations. 
NFHS-3 data from Delhi have reported that only 55% of children aged 6-23 months are fed the recommended minimum times per day and 48% are fed from the appropriate number of food groups. Only 34% are fed according to all three recommended practices. 
Bottle feeding was observed in 26.5% of all the children studied. Other studies from India ,, and abroad  have reported lesser prevalence of bottle feeding as compared with our study.
The difference in proportions between male and female children was not significant at the level of 0.05 by Chi- square test for any of the IYCF practice indicator status.
Limitations: The study, carried out at an UHTC, situated in the capital, and it included children from health-conscious mothers, coming to the center for immunization. Also the sample size was not large especially when it came to finding the proportions for children of various age groups. Hence, a small sample size and selection bias due to clinic-based nature of study limits its representativeness.
The status of IYCF practices was very poor. Especially the MAD indicator is very poor and it shows the inadequacy of MDD combined with MMF among the children studied. Educating the families about correct IYCF practices is the need of the hour in order to combat child malnutrition.
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