Open access peer-reviewed chapter
Number of affirmative (Yes) responses to infant and young child feeding practices (IYCF) core indicators.
Abstract
Optimal Infant and Young Child Feeding (IYCF) practices hold paramount importance for child survival, health, growth, and development. This study was done to assess the IYCF practices followed by the rural dwellers of Saharanpur, Uttar Pradesh, India. A cross-sectional survey was carried out in 18 randomly selected Anganwadi Centres of Behat Tehsil in Saharanpur district. The data were collected from 800 mothers whose children aged 1–3 years were registered in these anganwadis. Information was gathered using questionnaires and interviews. Results showed that 99.5% mothers initiated breastfeeding their infants with in first hour of birth. Minimum dietary diversity, minimum meal frequency as well as minimum acceptable diet were the three IYCF core indicators that were not followed by about 95% of mothers. Infant and young child feeding practices in the selected rural area are not satisfactory and there is not 100% compliance to something as important as exclusive breastfeeding for 6 months. There should be a more focused approach towards awareness generation, and sincere efforts should be made to improve infant feeding practices so as to make a positive impact on eradication of malnutrition amongst rural children.
Keywords
- breastfeeding
- complementary feeding
- IYCF
- infant nutrition
- malnutrition
1. Introduction
Nutrition of young children is an essential component of ensuring their growth and Infant and young child feeding (IYCF) practices have a direct effect on the health, development, and nutritional status of all children who are below 2 years of age. This, ultimately, has an impact on child survival. Improving IYCF practices in children 0–23 months of age is, therefore, crucial to improved development, nutrition, and health. World Health Organization (WHO) and UNICEF adopted the Global Strategy for infant and young child feeding in the year 2002. With the objective of reinvigorating the attention of the world to the influence that feeding practices have on the nutritional status, growth, and development, health, and survival of the vulnerable segment of infants and young children, the strategy was formulated [1].
WHO guiding principles related to complementary feeding of the breastfed child [2] along with guiding principles for feeding non-breastfed children between 6 and 24 months of age [3] provide significant evidence-based literature as well as guidance on optimal feeding practices for supporting growth, health, and behavioral development for infants and young children (IYC) aged <2 years, that can be accepted globally. The indicators that support programmatic action and contribute to monitoring progress on IYCF at both national and global levels were published in the year 2008. These indicators serve as an important tool in assessing infant and young child feeding practices. A set of eight core and seven optional indicators were recommended through this guidance document. These indicators have served as the standard for data collection and reporting on IYCF practices at a global level [3]. Below is the brief explanation of these indicators.
1.1 Breastfeeding indicators
1.1.1 Ever breastfed (EvBF)
1.1.2 Early initiation of breastfeeding (EIBF)
1.1.3 Exclusively breastfed for the first 2 days after birth (EBF2D)
1.1.4 Exclusive breastfeeding under 6 months (EBF)
1.1.5 Mixed milk feeding under 6 months (MixMF)
1.1.6 Continued breastfeeding 12–23 months (CBF)
1.2 Complementary feeding indicators
1.2.1 Introduction of solid, semi-solid, or soft foods 6–8 months (ISSSF)
1.2.2 Minimum dietary diversity 6–23 months (MDD)
1.2.3 Minimum meal frequency 6–23 months (MMF)
1.2.4 Minimum milk feeding frequency for non-breastfed children 6–23 months (MMFF)
1.2.5 Minimum acceptable diet 6–23 months (MAD)
1.2.6 Egg and/or flesh food consumption 6–23 months (EFF)
1.2.7 Sweet beverages consumption 6–23 months
1.2.8 Unhealthy food consumption 6–23 months (UFC)
1.2.9 Zero vegetables or fruits consumption 6–23 months (ZVF)
1.3 Other indicators
1.3.1 Bottle feeding 0–23 months (BF)
1.3.2 Infant feeding area graphs (AGs)
Whilst the indicators recommended above are useful for comparing population groups, targeting programmes, and evaluating progress over time, they provide a limited understanding of how population-level feeding patterns change with the age of the infant. In addition to calculating numerical indicators, presenting graphic displays of how IYC are fed is also recommended.
1.4 Importance of infant and young child feeding
Progression related to enhancement of the “Infant and Young Child Feeding” (IYCF) practices mainly in developing countries is very slow because of various factors such as poverty and poor hygienic conditions [4]. Proper breastfeeding and practices related to complementary feeding play an essential role in both child survival and child development. Physical growth can be counted amongst the best indicator of the wellbeing of child and it is massively affected by the feeding practices. But, in spite of the theories available and work done it is hard to establish the relation between quality of feeding and the effect of feed factors on the nutritional status of children. It can vary to a great extent per se depending on the kind of living conditions and the context [5]. Adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to the potential they hold [6, 7]. The chances of getting ill are high in infants when the nutrition is poor. Moreover, research suggests that childhood obesity, a burgeoning public health problem, may also be a consequence of inappropriate nutrition [8, 9]. Early nutritional deficits have a long-term effect on growth as well as the overall health. Malnutrition during the first 2 years of life results in stunting. Therefore, as an adult such infants will not be able to attain their potential height and will remain shorter relatively. There is now enough research concluding that early childhood malnutrition impairs the child’s intellectual performance [10, 11]. Another impairment is also seen in their physical work capacity. The consequences of girl child malnutrition are graver because their reproductive capacity gets negatively affected when they grow up into adult women. Such women have higher probability to bear infants with low birth weight and they tend to suffer from more obstetric complications. In a country where many children are malnourished, it has negative implications for its national development [12, 13, 14]. Thus, the significance of investing resources as well as time in IYCF cannot be ignored, if we aspire to have a healthy society, healthy nation, and a healthy world.
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2. Review of literature
As per the 2020 report of WHO, around 144 million children below 5 years were stunted, 47 million children, and 14.3 million children were wasted and severely wasted respectively. On the other hand, 38.3 million children below 5 years were overweight or obese [15]. Even after the continuous developments made, dietary quality still remains to be suboptimal amongst the infants and young children all over the world and the improvements are not much observed since the past decade. Merely around 39% children of urban areas and 23% children of rural areas belonging to less than 5 years of age are reported of receiving a minimally diversified diet [16].
The children that were ever breastfed were approximately 91.6%. About 79.0% children were put to the breast within the time of an hour after giving birth and they (79.6%) were reported of having colostrum. From the data of children belonging to 6–8 months of age, not even half (41.5%) reported receiving semi-solid, solid, or soft foods in the previous day. Greater percentage of children continued to be breastfed during 1 year (81.7%) and 2 years (68.9%). Merely 13.6% were fed with iron-rich or iron-fortified foods developed for infants and young children. Most of the children (89.2%) belonging to 6–23 months of age had breastfeeding considered adequate as per their age [17]. It was observed that fewer mothers practiced early initiation of breastfeeding. The increase in early initiation of breastfeeding can be attributed to two primary facts. Firstly, it is a result of the sensitization and training provided to peripheral health workers and public health staff regarding various aspects of breastfeeding and secondly, the fact that most of the deliveries take place in public health facilities also contributes to the higher rates of early breastfeeding initiation [18]. This study reported very poor IYCF practices with merely 15.0% of moms who began breastfeeding within an hour of giving birth, whereas more than a third (38.3%) said they would breastfeed exclusively until their baby was 6 months old, although with pre-lacteal meals. Merely 21 (5.3%) infants were breastfed exclusively for 6 months without any pre-lacteal meals. Only 29.8% of babies started supplementary feeding at 6 months, according to the main indicator [18]. The breast milk and animal milk (cow/buffalo) were used by nearly 40.2% of women to feed their children, followed by solely breastmilk for the first 6 months (38.3%), breast milk and formula milk (10.7%), breast milk and water (4.0%), and breast milk and solid food (1.3%). Approximately 5.5% of women did not feed their children with breast milk at all [19].
Approximately 45% of children of less than 5 years of age globally have been reported of dying because of undernutrition. Undernutrition is considered to be a vital causable factor increasing susceptibility towards malaria, diarrhea, and pneumonia [20]. Poor infant and young child feeding (IYCF) practices, specifically at the time of initial thousand days, i.e., from birth till 2 years, lead to malnutrition, deprived psychosocial development, reduced school performance, and decreased productivity in later years of life, thus setting up a vicious cycle [20].
Amongst the core indicators for assessing IYCF practices, it was observed that only 65.0% of mothers started breastfeeding within 1 hour of birth [21]. The infant feeding methods, which include both breastfeeding and supplemental feeding, have a significant impact in defining a child’s nutritional health. Adequate nutrition in infancy and early childhood is precious in supporting children’s growth, development, and health to fullest. Merely 34.8% of infants worldwide are exclusively breastfed for the initial 6 months of life, with the remainder receiving additional foods or liquids in the interim. The initial 2 years of life are a key time for ensuring children’s proper growth and development through adequate eating. Optimal breastfeeding could result in the prevention of 13% deaths amongst children below the age of 5 years, globally, whilst proper supplemental eating could reduce under-5 mortality by another 6% [22]. Breastfeeding is beneficial not only to a young child’s survival, health, nutrition, and the developing baby’s trust and sense of security, but it also helps with brain development and learning preparation. Breastfed babies have an IQ that is about 8 points greater than non-breastfed babies. The connection between starvation and baby feeding has long been known. According to current scientific research, malnutrition results in 60% of all deaths in children below 5 years, either directly or indirectly. Over two-thirds of these overall deaths occur within the 1 year of life and are generally linked to improper feeding practices. Only 35% of infants globally are nursed exclusively for the initial 4 months of their lives [23].
An evaluation depicted that proper breastfeeding and complementary feeding related practices could solely lead to prevention of deaths by 19% in under five children [24]. Every year, above 9 million children below 5 years die around the world. Malnutrition is the foremost cause of death in children below the age of five, with 70% of deaths occurring in the initial 1 year of life. Feeding strategies for infants and young children have a direct impact on their nutritional health and, ultimately, their survival [25]. Optimal infant feeding practices include the initiation of breastfeeding within an hour of birth, exclusive breastfeeding during the initial 6 months of life, and continuous breastfeeding for 2 years accompanied by appropriate complementary feeding.
As per the data from India, only 46% of children in the age group of 6–9 months in Uttar Pradesh are consuming semi-solid or solid foods along with breastmilk [26]. In India, child feeding appears to be prejudiced by traditional and economic structures. Poor beliefs and fads towards child feeding practices have been recognized to be amongst the chief reasons for health amongst the children, mostly in developing nations. Insufficient nutrition knowledge and adherence to social practices lead to low-quality feeding practices. Social variables and taboos strongly influence the feeding practices and eating patterns.
With this backdrop, a need to observe the compliance to IYCF was felt and an attempt was made to study the adherence to IYCF core indicators amongst 1–3 years old children registered in anganwadis (an anganwadi centre is set up by the central or state government in India to implement the Integrated Child Development Scheme. The main purpose of anganwadis is to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education) at rural Saharanpur in India. The study presented below is a part of a comprehensive project undertaken to assess the nutritional status and dietary diversity of rural children from Saharanpur, India.
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3. Materials and methods
3.1 Research design and locale
This study was a cross-sectional descriptive study without any intervention. The setting of the study was Muzaffarabad block of Behat Tehsil of Saharanpur, a district in the north Indian state of Uttar Pradesh which is also the most populated state of the country.
The 3410 anganwadi centres in Saharanpur district (Uttar Pradesh) cater to the nutritional needs of infant and school going children in the age group of 6 months to 6 years. Muzaffarabad block is located under the Behat Tehsil of Saharanpur. As of the 2011 India census, the Muzaffarabad block of Saharanpur district had a population of 303,055. Out of this, 162,641 are males, and the female count was 146,414 [27]. This block has 50,478 children in the age bracket of 0–6 years. Amongst them, 26,484 are boys, and 23,994 are girls. The total number of anganwadis present in the Muzaffarabad block is 111. The anganwadis of Muzaffarabad block were selected for this study. In the Muzaffarabad block there are 164 villages. Nine villages were selected through the simple random sampling technique. The names of the selected villages were as follows: Khushalipur, Satpura, Badshapur, Mirzapur-Grant, Kaluwala-Jahanpur, Jayantipur, Hamirpur, Raheempur, and Ahmadpura. Out of the 9 selected villages 3 villages, namely, Kaluwala-Jahanpur, Khushalipur, and Ahmadpura villages had four anganwadi centres each. The remaining six villages have one anganwadi centre each. Thus, the total number of anganwadis which became a part of the study were 18. The total number of registered children varied from 40 to 60 in each of these anganwadis.
3.1.1 Ethical considerations
In accordance with the guidelines given in Handbook on National Ethical Guidelines for Biomedical and Health Research Involving Human Participants [28], written informed consent for participation of children in the study was obtained from the mother/father of the children. Only non-invasive data was collected from the subjects with utmost care.
3.2 Sampling
To select eligible children of age group 1 to 3 years, multi-stage random sampling was used in which, first we selected Tehsil (T) randomly from Saharanpur district, then at second stage Block (B) was selected randomly amongst the available blocks within Tehsil. Now, within a selected block, 34 anganwadi centres available in the villages of that block were selected.
3.2.1 Sample size calculation
A random sampling technique using Slovin’s formula [29] was used to calculate the sample size for the present study which was computed to be 793.17. It was rounded off to 800.
3.2.2 Participant recruitment
Amongst the selected anganwadis, the beneficiaries in the age group of 1–3 years were listed and data was collected after seeking requisite permission of Data Protection Officer (D.P.O) from Vikas Bhawan. The officer certified the data collection after due vigilance and conformity to ethical and other guidelines. The purpose and details of the study were explained and written informed consent was obtained from the guardian of the children who were a part of the study.
3.3 Data collection procedure
The data collection was conducted from January 2019 to October 2020. A majority of data were collected using questionnaires. The questionnaires for present study were designed in Hindi language, so that native people can understand the questions. Face-to-face interviews were conducted with mothers at their homes in Hindi/local dialect. All the relevant information about infants was collected with the support of Asha Sahyoginis (grass root functionaries associated with anganwadis) which were present at specified anganwadis along with mothers. Interview took 30–40 minutes for each subject. Data collection was usually done between 10:00 am and 5:00 pm every day barring Sunday.
3.4 Background information and socioeconomic status (SES)
A self-designed and semi-structured questionnaire was used to collect the socio-demographic information from the mothers or caregivers of the subjects through the personal interview method. The data included information regarding background information of subjects and parents/caregivers. Information included name, age, gender, family type, occupation, family income, education of parents, and the like. Questionnaire was prepared in Hindi. Information was collected by the interview technique.
3.5 Infant and young child feeding practices (IYCF)
A well-structured and pretested questionnaire based on IYCF practices was used for data collection. These questions provide the information needed to calculate the key indicators given by WHO about IYCF, outlining exclusive breastfeeding and complementary feeding [30]. This questionnaire was adapted from the standardized questionnaire of World Health Organization and UNICEF [31]. There are eight feeding indicators which are closed-ended questions with two options of “Yes” and “No”. The indicators are the initiation of breastfeeding within 1 hour of birth, exclusive breastfeeding for 6 months, continued breastfeeding for 1 year, initiation of complementary feeds after six to 8 months, minimum meal frequency, minimum meal diversity, minimum acceptable diet, and consumption of iron-rich foods. The questions related to these indicators were included in the questionnaire for IYCF indicators, a scoring system was established. Indicator with the appropriate response was given a score of 1 and if inappropriate it was marked as 0. A score of 7–8 was considered as excellent, 4–6 as good, and < 4 as poor.
3.6 Statistical analysis
All the data were recorded in the software Statistical Package for Social Sciences (SPSS) Version 20. To describe the data, descriptive statistics mainly frequency analysis, percentage analysis, mean, and SD were used. Chi-square was used to find the associations of age and gender with different IYCF indicators and p < 0.05 was considered as significant.
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4. Results
The mean age of the children was 24.0 ± 6.97 months. Out of 800 children whose data were collected 53.5% were boys and 46.5% were girls. About two-thirds (67.2%) of the children came from nuclear families, 24.1% from joint, and remaining 8.6% from extended families. With respect to education of parents, 65.5% mothers and 35.7% fathers were illiterate. Family income of 81.1% families was less than Rupees 1865 per month. Most of the fathers were poor, marginal farmers whilst mothers were housewives spending much time working in their fields. More than half of the children were following non-vegetarian food habits (53.7%), 37.5% were lacto-vegetarians, and 8.7% were lacto-ovo vegetarian.
Retrospective data collection was done to get an insight into adherence to IYCF practices, the results of which are presented in Table 1. The early initiation of breastfeeding, exclusive breastfeeding till 6 months, and consumption of iron-rich or iron-fortified food was practiced by nearly 90% of the mothers, the optimal feeding practices related to minimum dietary diversity, minimum meal frequency, and minimum acceptable diet were followed by nearly 5% mothers only.
| s. no | Core of indicators | “Yes”, as response N (%) |
|---|---|---|
| 1 | Early initiation of breastfeeding | 796 (99.5) |
| 2 | Exclusive breastfeeding till 6 months | 755 (94.3) |
| 3 | Continued breastfeeding at 1 year | 699 (87.3) |
| 4 | Introduction of solid, semi-solid, or soft foods | 70 (8.7) |
| 5 | Minimum dietary diversity | 41 (5.5) |
| 6 | Minimum meal frequency | 40 (5.0) |
| 7 | Minimum acceptable diet | 44 (5.5) |
Table 1.
Table 2 reveals the core indicators of age-wise association of children (1–3 years aged) with infant and young child feeding practices. Results showed that there was no significant association of age and early initiation of breastfeeding, exclusive breastfeeding under 6 months, minimum diversity, and consumption of iron-rich foods. However, the continued breastfeeding at 1 year, the introduction of solid, semi-solid food, minimum meal frequency, and minimum acceptable diet were significantly associated with age.
| Core indicators | Status | All children | 1–2 | 2–3 | Chi-square | p-value |
|---|---|---|---|---|---|---|
| Early initiation of breastfeeding | Yes | 796 (99.5) | 447 (99.1) | 349 (100.0) | χ2 = 3.11 | 0.07NS |
| No | 4 (0.5) | 4 (0.8) | 0 (00.0) | |||
| Exclusive breastfeeding under 6 months | Yes | 755 (94.3) | 430 (95.3) | 325 (93.1) | χ2 = 1.82 | 0.17NS |
| No | 45 (5.6) | 21 (4.6) | 24 (6.8) | |||
| Continued breastfeeding at 1 year | Yes | 699 (87.4) | 411 (91.1) | 288 (82.5) | χ2 = 13.22 | 0.00* |
| No | 101 (12.6) | 40 (8.8) | 61 (17.4) | |||
| Introduction of solid, semi-solid, or soft foods | Yes | 70 (8.7) | 28 (6.2) | 42 (12.0) | χ2 = 8.36 | 0.00* |
| No | 730 (91.2) | 423 (93.7) | 307 (87.9) | |||
| Minimum dietary diversity | Yes | 41 (5.1) | 21 (4.6) | 20 (5.7) | χ2 = 0.46 | 0.49NS |
| No | 759 (94.8) | 430 (95.3) | 329 (94.2) | |||
| Minimum meal frequency | Yes | 44 (5.5) | 15 (3.3) | 25 (7.1) | χ2 = 6.09 | 0.01* |
| No | 756 (94.5) | 436 (96.6) | 324 (92.8) | |||
| Minimum acceptable diet | Yes | 44 (5.5) | 21 (4.7) | 23 (6.5) | χ2 = 1.41 | 0.02* |
| No | 86 (10.7) | 430 (95.3) | 44 (12.6) | |||
| Consumption of iron-rich or iron-fortified foods | Yes | 714 (89.2) | 409 (90.6) | 305 (87.3) | χ2 = 2.22 | 0.13NS |
Table 2.
Age-wise association of children with infant and young child feeding practices (IYCF) core indicators.
Statistically significant (p < 0.05).
Non-significant.
Table 3 shows the gender-wise association of children with infant and young child feeding practices core indicators. The results demonstrated that there was no association of gender with any of the IYCF core indicators.
| Core indicators (IYCF) | Status | All children | Boys | Girls | Chi-square | p-value |
|---|---|---|---|---|---|---|
| N (%) | ||||||
| Early initiation of breastfeeding | Yes | 796 (99.5) | 425 (99.2) | 371 (99.7) | χ2 = 0.747 | 0.387NS |
| No | 4 (0.5) | 3 (0.7) | 1 (0.2) | |||
| Exclusive breastfeeding under 6 months | Yes | 755 (94.3) | 403 (94.1) | 352 (94.6) | χ2 = 0.081 | 0.776NS |
| No | 45 (5.6) | 25 (5.8) | 20 (5.3) | |||
| Continued breastfeeding at 1 year | Yes | 699 (87.3) | 373 (87.1) | 326 (87.6) | χ2 = 0.042 | 0.837NS |
| No | 101 (12.6) | 55 (12.8) | 46 (12.3) | |||
| Introduction of solid, semi-solid, or soft foods | Yes | 70 (8.7) | 37 (8.6) | 33 (8.8) | χ2 = 0.013 | 0.910NS |
| No | 730 (91.2) | 391 (91.3) | 339 (91.1) | |||
| Minimum dietary diversity | Yes | 41 (5.1) | 23 (5.3) | 18 (4.8) | χ2 = 0.117 | 0.732NS |
| No | 759 (94.8) | 405 (94.6) | 354 (95.1) | |||
| Minimum meal frequency | Yes | 40 (5.0) | 21 (4.9) | 19 (5.1) | χ2 = 0.017 | 0.896NS |
| No | 756 (94.5) | 407 (95.0) | 353 (94.8) | |||
| Minimum acceptable diet | Yes | 44 (5.5) | 23 (5.3) | 21 (5.6) | χ2 = 0.028 | 0.867NS |
| No | 756 (94.5) | 405 (94.6) | 351 (94.3) | |||
| Consumption of iron-rich or iron-fortified foods | Yes | 714 (89.2) | 379 (88.5) | 335 (90.0) | χ2 = 0.468 | 0.494NS |
| No | 86 (10.7) | 49 (11.4) | 37 (9.9) | |||
Table 3.
Gender-wise association of children with infant and young child feeding practices (IYCF) core indicators.
Statistically significant (p < 0.05).
Non-significant.
Table 4 presents the mean of infant young and child feeding practices (IYCF) scores of age and gender-wise categorized children. Based on the results, the characteristics of IYCF are classified in three ways, excellent, good, and poor. Only one boy had a mean score of 7.0 ± 0.0 and two girls also had a mean score of 7.0 ± 0.0 who belonged to the 1–2 year age group and had an excellent level of IYCF. Similarly, 48.42% (n = 200) and 43.82% (n = 181) were boys and girls having mean intake values of 4.06 ± 0.27 and 4.04 ± 0.26, respectively of 1–2 year age groups who had the good level of IYCF, whilst 5.08% (n = 21) boys exhibiting mean intake of 2.33 ± 0.47 and 1.93% (n = 8) girls exhibiting mean intake of 2.38 ± 0.51 demonstrated poor level of IYCF under same age groups children. The children from 2 to 3 year age groups were 0.51% (n = 2) boys demonstrating a mean intake 7.0 ± 0.0 and 0.77% (n = 3) girls demonstrating the mean intake 7.0 ± 0.0, which showed the excellent practices of IYCF, whereas 48.57% (n = 188) boys presenting mean intake 4.06 ± 0.26 and 40.31% (n = 156) girls presenting mean intake 4.08 ± 0.38 demonstrated the good level of IYCF. Further, amongst the children who were aged 2–3 years, 4.13% (n = 16) were boys and had a mean 2.44 ± 0.51 and 5.68% (n = 22) were girls who had a mean of 2.45 ± 0.51 reflecting the poor level of IYCF. Moreover, overall, 1.0% (n = 8) children exhibiting a mean intake 7.00 ± 0.0 showed an excellent level of IYCF and 90.62% (n = 725) exhibiting a mean of 4.06 ± 0.26 had a good level, whilst 8.37% (n = 67) showing mean 2.40 ± 0.49 had poor level of IYCF.
| Characteristics | Age (years) | N | Mean ± SD | ||
|---|---|---|---|---|---|
| All children | Boys | Girls | |||
| Excellent (7–8) | 1–2 | 428 | 7.00 ± 0.00 | 7.00 ± 0.00 | 7.00 ± 0.00 |
| Good (4–6) | 4.05 ± 0.24 | 4.06 ± 0.27 | 4.04 ± 0.26 | ||
| Poor (<4) | 2.34 ± 0.48 | 2.33 ± 0.47 | 2.38 ± 0.51 | ||
| Excellent (7–8) | 2–3 | 372 | 7.00 ± 0.00 | 7.00 ± 0.00 | 7.00 ± 0.00 |
| Good (4–6) | 4.07 ± 0.28 | 4.06 ± 0.26 | 4.08 ± 0.30 | ||
| Poor (<4) | 2.45 ± 0.50 | 2.44 ± 0.51 | 2.45 ± 0.51 | ||
| Excellent (7–8) | All children | 800 | 7.00 ± 0.00 | 7.00 ± 0.00 | 7.00 ± 0.00 |
| Good (4–6) | 4.06 ± 0.26 | 4.06 ± 0.26 | 4.06 ± 0.25 | ||
| Poor (<4) | 2.40 ± 0.49 | 2.38 ± 0.49 | 2.43 ± 0.50 | ||
Table 4.
Age- and gender-wise mean infant and young child feeding practices (IYCF) scores of children.
Table 5 shows the association of children’s background information with factors influencing the continuation of breastfeeding for up to 1 year. From the results, no significant association was found amongst religion, type of family, place of delivery, education of mother, and occupation of the mother with factors influencing the continuation of breastfeeding for up to 1 year. Whereas, the birth order of the children was significantly found associated with factors, which were influencing the continuation of breastfeeding for up to 1 year.
| Parameters | Variables | All children | Yes | No | Chi square | p-value |
|---|---|---|---|---|---|---|
| N (%) | ||||||
| Religion | Hindu | 377 (47.1) | 339 (42.3) | 38 (4.7) | χ2 = 0.74 | 0.10NS |
| Muslim | 421 (52.6) | 358 (44.7) | 63 (7.8) | |||
| Sikh | 2 (0.2) | 2 (0.2) | 00 (0.0) | |||
| Type of family | Nuclear | 538 (67.2) | 488 (61.0) | 70 (8.7) | χ2 = 1.05 | 0.58NS |
| Joint | 193 (24.1) | 168 (21.0) | 25 (3.1) | |||
| Extended | 69 (8.6) | 63 (7.8) | 6 (0.7) | |||
| Place of delivery | House | 104 (13.0) | 95 (11.8) | 9 (1.1) | χ2 = 1.70 | 0.19NS |
| Govt. hospital | 696 (87.0) | 604 (75.5) | 92 (11.5) | |||
| Birth order | First | 150 (18.7) | 133 (16.6) | 17 (2.1) | χ2 = 8.75 | 0.03* |
| Second | 376 (47.0) | 317 (39.6) | 59 (7.3) | |||
| Third | 188 (23.5) | 167 (20.8) | 21 (2.6) | |||
| Above third | 86 (10.7) | 82 (10.2) | 4 (0.5) | |||
| Education of mother | Illiterate | 516 (64.5) | 442 (55.2) | 74 (9.2) | χ2 = 4.38 | 0.35NS |
| Primary | 216 (27.0) | 197 (24.6) | 19 (2.3) | |||
| Intermediate | 29 (3.6) | 26 (3.2) | 3 (0.3) | |||
| High school | 16 (2.0) | 14 (1.7) | 2 (0.2) | |||
| College | 23 (2.8) | 20 (2.5) | 3 (0.3) | |||
| Occupation of mother | Housewife | 714 (89.2) | 649 (81.1) | 95 (11.8) | χ2 = 4.72 | 0.19NS |
| Informal work | 23 (2.8) | 23 (2.8) | 0 (00.0) | |||
| Own work | 20 (2.5) | 17 (2.1) | 3 (0.3) | |||
| Formal | 13 (1.6) | 10 (1.2) | 3 (0.3) | |||
Table 5.
Background information of children associated with factors influencing continuation of breastfeeding up to 1 year.
Statistically significant (p < 0.05).
Non-significant.
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5. Discussion
In the present study, primary breastfeeding introduction (within 60 minutes of birth) has been observed in 99.5% of children that is much greater than found in a report of the NFHS-5 [32] for India (42%) and Uttar Pradesh (23.9%). Another study revealed that the breastfeeding introduction by 85% mothers has been observed within 60 minutes or just after the birth. The intense increment in the number of mothers whose delivery was done at a health central is mainly caused by the persistent promotion of the free delivery services in the country resulting in a great chance for the health specialists to stimulate the breastfeeding introduction within 60 minutes of birth [33].
According to a study conducted by Gaurav et al. [34] on the children of less than 2 years of age in Uttar Pradesh, 65% of the subjects had initiated breastfeeding within an hour. The increment in the number of mothers adopting early breastfeeding could be because of the awareness and training of health workers related to health facilities and of public health workers related to several aspects of breastfeeding. Furthermore, it could also be because of greater number of births taking place in public health facilities. Another study by Patel et al. [35] showed that introduction of breastfeeding was primarily done by 57.5% of mothers in Gujarat.
About 94.3% of mothers who have children under the age of 6-months exclusively breastfed their infants. This practice is much higher compared to that reported by NFHS-5 [32] for Uttar Pradesh being 59.7%. This variation could be owing to the cultural and socioeconomic differences amongst the studied subjects.
In this study, most of the participants were housewives that can enhance the probability of breastfeeding to their child as it is less expensive when they have poor level of economic status. The proportion of the children was found 72.5%, which were absolutely breastfed; it has been confirmed by a report of NFHS-4 [36]. The prevalence of exclusive breastfeeding was found to be 75.0% [37]. The major cause for this observation could be the usual perception of mothers related to breast milk not being enough and needs to be supplemented with other milk sources such as animal or formula milk. Additionally, some of the mothers do not have proper knowledge about the accurate positioning and attachment to the breast that also results in hindering the practice of exclusive breastfeeding. Amongst the children of 6–12 months of age, 87.3% had continued breastfeeding up to 1 year. The percentage (72.1%) is nearly similar to a study conducted in Delhi [38] but lesser than the study of West Bengal in which 91.1% of the children of 12–23 months of age were breastfed till 1 year of age [39]. Another study conducted by Gupta et al. [40] reported that 71.5% of mothers continued breastfeeding for 1 year or more. The widely prevalent practices of extended breastfeeding in rural part of India must be protected. Only 8.7% mothers had knowledge about the complementary feeding of food such as liquid, semi-solid, and solid food must be started with breastfeeding after the age of 6-months. The children will vomit all after feeding, which was the common cause of the postponed complementary feeding. The ignorance has been found as another significant reason for the same. The enhancement in feeding practices was probable via appropriate utilization of current health facilities facilitating the mothers to appreciate the rationale of the practices so that worthy feeding practices could be continued [41].
Amongst the seven food groups utilized for assessing the minimum diversity, 5.5% of the children consumed foods from 4 or more groups in the present study. As observed in some other studies, a smaller number of children were receiving foods from four or more groups like 32.6% by Khan et al. [42], 30.0% by Das et al. [43], 15.7% by Chaudhary et al. [18], and 37.7% by Arzu et al. [44] respectively. Contrary to these studies, 79.6% children belonging to urban Meerut were having a diverse diet to desirable level [11]. Lower dietary diversity could be due to lack of knowledge and awareness related to appropriate complementary feeding habits in rural areas. Additionally, the lower socioeconomic status, excessive indulgence of mother in daily work activities, and lower birth gap may also be the causes of inadequate complementary feeding-related practices.
The minimum meal frequency observed in the present study was in 5% of children. This proportion was lesser in comparison to other studies such as 89.3% reported by Satija et al. [45]; 70.0% by Das et al. [43]; and 72.5% by Arzu et al. [44] respectively. The lowest meal frequency reported was 43.4% in a study conducted in urban Meerut by Singhal et al. [19]. The reason behind the lower percentage of minimum meal frequency in the present study could be because of the predominant consumption of animal milk as the major feed for the infants after the age of 6 months.
In the present study, minimum acceptable diet was given to 5.5% of children which was lesser than the report of the NFHS-5 [32] for India (11.1%) and Uttar Pardesh (6.1%). Another study [46] in West Bengal has shown that minimum acceptable diet was given to 7.5% of children due to the lack of postnatal counseling by the health workers as well as infrequent antenatal health clinics and maternal illiteracy. Contrary to these, two more findings were also reported by Das et al. [35] and Singhal et al. (19) who showed that 36.8% and 37.7% respectively of children received minimum acceptable diet which was much higher than the data of present study as well as data of NFHS-5 [32].
The prevalence related to good intake of iron-rich or iron-fortified foods in the present study is greater than the prevalence shown in other studies like 33.1% in Zambia, [47] 21.4% in Ethiopia [48], and 19.6% in Madagascar (19.6%) [49]. The difference in the results could be because of the variation seen in socioeconomic status, norms, beliefs, and cultural practices related to the feeding of children. Animal sources of foods are usually consumed only at the time of holidays in Ethiopia because of the reason that they are included as luxury foods in the diet and not to fulfill the daily requirements [50]. In this study done in rural Saharanpur, large proportion of subjects were non-vegetarians and, in these families, meat is cooked at least once in a week.
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6. Conclusion
It could be concluded from the study that minimum dietary diversity, minimum meal frequency, and minimum acceptable diet are the core IYCF indicators that are least complied with. Most of the mothers adhered to early initiation of breastfeeding. This promising finding could be attributed to large number of deliveries taking place at hospitals/health centres against home deliveries which has long been a trend in rural India. Exclusive breastfeeding for 6 months was also practiced by the major part of the study population. It has been observed in India that in poor families, infants usually live on breastfeeding only. This practice, a boon for 6 months, becomes a detriment to infant growth and development as nearly one-thirds of the mothers comprising study group failed to initiate complementary feeding at 6 months of age. Poverty alleviation programmes, adult education programmes, and a more focused behavior change communication approach by Anganwadi workers hold the potential to enhancing the compliance to IYCF indicators.
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Acknowledgments
We acknowledge the cooperation received from study participants, anganwadi workers, and the authorities of Uttar Pradesh who permitted to undertake the data collection.
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