Comparative study of feeding practices among children less than two years attending rural and urban primary health centers, Mysuru, Karnataka

INTRODUCTION

Breastfeeding is considered one of the most significant aspects of a child's health and survival. During the first six months of life, the newborn's only source of sustenance is the mother's milk.¹ WHO and UNICEF advise that mothers should start breastfeeding within the first hour of delivery and continue to exclusively breastfeed for the initial six months of the infant that is, consuming no other foods or liquids. Newborns should be breastfed on demand, which means whenever the child wants, day or night.² The WHO and the AAP advocate exclusive nursing for the initial 6 months of infant life, nutritively appropriate and prudent complementary foods, and lactation should be continued until two years or longer. Breastfeeding should be started as soon as feasible, according to baby-friendly approach guidelines, because it's essential to numerous objectives for the infant, the mother.³ Inadequate feeding patterns of behavior that are inconsistent with child health and child feeding recommendations. The key suggested infant and young child feeding behaviors encompass starting breastfeeding for newborns within the first hour of life, continuing breastfeeding for two years and even beyond, with nutrient and appropriate safe supplementary feedings introduced during the sixth month.⁴

Exclusive breastfeeding indicates that the infant only consumes mother milk and no additional fluids or solids, including plane water, with the exemption of oral rehydration remedy, syrup, or drops of essential vitamins, minerals, or medicine. The WHO (World Health Organization) strongly recommends exclusive breastfeeding for 6 months, with supplementary foods introduced at 6 months of age although the mother continues to feed her infant up to two years of age. Breastfeeding exclusively offers numerous established benefits for both the infant and the mother.⁵ Any food provided to neonates before breastfeeding begins in the first three days of life is referred to as pre-lacteal foods.⁶

Delayed breastfeeding initiation, colostrum deprivation, supplemental trying to feed mothers milk substitutes, advanced initiation of complementary feeding, with improper weaning from mother milk are all regular occurrences around the world.⁷ So it is necessary to know about the feeding practices among children less than two years in both rural and urban areas.

In this context, the present study will be held to determine the feeding practices among young children under the age of two and to compare the feeding practices among children less than two years attending the urban and rural Primary health centers under the Department of Community Medicine, JSS Medical College, Mysuru.

METHODS

This analytical comparative cross-sectional study was conducted in the primary health center in urban and rural field practice areas of the department of community medicine, JSS Medical College, Mysuru for 6 months from January to June 2022 among mothers with children less than two years after obtaining ethical clearance from the institutional ethical committee. Based on the prevalence of exclusive breastfeeding among children less than 2 years as per NFHS-5 to be 79.1 percent with 5% absolute allowable error, an alpha level of 5 percent, and a 95% confidence level, the sample size calculated is 254.⁸ Considering a 10% non-response rate, the study sample size would be 279 which was rounded off to 280.

The sampling technique used in this study is purposive sampling with children less than two years of age and their mothers are included in the study. Mothers not consenting to participate in the study were excluded. 280 consecutive Children less than two years of age and their mothers attending these Primary Health Centres (140 in rural and urban areas each) were interviewed after taking written informed consent using a pre-tested structured questionnaire.

The questionnaire included sociodemographic characteristics like age of the child, gender, age of the mother, education status of the mother, occupation of mother and father, socio-economic status, BPL card, type of family, family size, birth order, birth weight of the baby, type of delivery, place of delivery and feeding practices of children as per IYCF like pre lacteal feeds, initiation of breastfeeding, colostrum feeding, exclusive breastfeeding, duration of feeding, demand feeding, weaning practices, and complementary feeding practices were collected.⁹

Data analysis

The data was imported into Microsoft Excel and analyzed with the Statistical Package for Social Sciences (SPSS) version 23. (Licensed to JSSAHER). Descriptive statistics like percentages, mean, and standard deviations are applied for socio-demographic characteristics. To examine the comparison of feeding practices among study subjects in rural and urban areas, inferential statistics methods such as the chi-square test/fisher exact test will be used. At p less than 0.05, the link was deemed statistically significant. The data were presented as tables where appropriate.

RESULTS

Of the 280 mothers who were interviewed, 140 (or 50%) were from urban regions and 140 (or 50%) were from rural ones. Participants in the study were on average 25±3 years old. The majority of the 280 children involved in the study, 142 (50.71%), were female, and 138 (49.29%) were male. Among them, 82 (29.29%) belonged to the 19-24 month age group, 71 (25.36%) to the 0-6 month age group, 67 (23.9%) to the 7-12 month age group, and 60 (21.4%) to the 13-18 month age group.

Out of 280 study participants, 12 (4.29%) were illiterates and 99 (35.36%) had degrees. 263 (93.93%) of the mothers did not have jobs, while 17 (6.07%) did.

Among 280 subjects, 157 (56.07%) were delivered through full-term normal vaginal delivery, and 123 (43.93%) were delivered by lower-segment cesarean section. And among those, 251 (89.64%) children had normal birth weight, and 29 (10.36%) has low birth weight (Table 1).

Comparison of feeding practices between rural and urban women

In this study, 98.6% in rural areas and 100% in urban areas had breastfed their children (Table 2). 73.6% of women residing in rural areas and 71.4% in urban areas had exclusively breastfed their children. 37.1% of mothers breastfed their child on demand and 62.9% of mothers breastfed at times decided by themselves. The frequency of breastfeeding and the residence were statistically significantly correlated. Additionally, it was noted that 30% of the infants were bottle-fed. 34.3% of urban women and 25.7% of rural women have breastfed their infants in a bottle.

In a sample of 280 mothers, 52.5% began breastfeeding within 30 minutes of delivery and 5% did so after two hours. It was noted that 97.5% of the infants ingested colostrum. Colostrum was given to 94.6% of babies in cities and 98.6% of babies in rural areas.

In the three days following delivery, 16.1% of the women were found to have fed their children. In the first three days following delivery, 26.4% of babies living in urban areas and 5.7% of babies living in rural regions respectively received pre-lacteal feed. Pre-lacteal feeding and place of residence are statistically significantly related. In our study, 41.4% of them in the rural area got breastfeeding education from a nurse and 46.4% in urban areas got breastfeeding education from doctors (Table 3).

From Table 4, it has been observed that among 140 each rural and urban populations 72.8% and 76.4% of mothers started to give fortified food. Among them, in rural, all the children, and in urban 96.3% of children got fed with porridge, ragi, bread, rice, or any other food made from grains. 98% of the rural and 94.4% of urban children got fed pumpkin carrots, squash, or sweet potatoes. In rural 97% and 94.4% of the urban children had any green leafy vegetables. 67.6% and 60.7% of the rural and urban children had eggs. 67.6% and 86% of rural and urban children did not have liver, kidney, heart, or any other organ meat. There was a statistically significant association between any fortified food and foods made from grains given to the babies at their place of residence. Also, there is a significant association between meat and sea foods in the place of residence (Table 4).

From Table 5, it has been observed that, overall, 27.1% of women had poor, 56.1% average and 16.8% had good infant and early child feeding practices. The association between the locality and overall feeding practices was found to be statistically significant. Among 140 women included in rural areas, 35% had poor, 57.1% had average and 7.9% had good infant and early child feeding practices on the other hand, in urban areas, 19.3% had poor, 55.0% had average and 25.7% had good infant and early child feeding practices (Table 5).

DISCUSSION

In rural 60% of the mother got normal delivery and 40% had a cesarean and in urban 52% of women got normal delivery and 48% had a cesarean delivery. A study done in the rural area of north India by Mahmood et al reported that about 94.3% of the deliveries were normal.¹⁰ According to a study done by Bagul et al in the urban slum area of Nagpur, India reported that cesarean sections were done in 21.66%.¹¹In our study 10.3% of the babies are underweight. 10.7% and 10% of rural and urban newborns are measured as underweight. The study done by Kaur et al on Malaysian women reported that in urban areas 2% and in rural 9.8% of babies are underweight.¹²

In our study, breastfeeding practices in rural and urban areas were compared. Among 140 women from both rural and urban areas, 98.6% in rural areas and 100% in urban areas breastfed their children. The study done by Gao et al reported that nearly 98.0% of urban and 99.0 % of rural mothers started breastfeeding.¹³

Also in the present study, 72.5% of the mothers exclusively breastfeed their children in the study. 73.6% of rural women and 71.4% of urban women exclusively breastfed their children for six months.

Balogun et al reported that in rural 79.8% of participants had used or were practicing exclusive breastfeeding.¹⁴ The study done in the rural area of north India by Mahmood et al reported that 22.8% of the newborns have not been exclusively breastfed.¹⁰ Jennifer et al reported that 68.4% of children had received exclusive breastfeeding.¹⁵

In our study, 62.9% of study participants practiced on regular schedules determined by them. In rural 80.7% of women feed on regular timings as decided by them and 55.0% in urban areas have practiced demand breastfeeding. It shows statistically significant p<0.05 concerning the frequency of breastfeeding and residence. The study done by Ashwini et al shows that 38.75% and 67.89% of urban and rural women practiced on-demand feeding and it shows statistically significant.¹⁶ In the study done by Ausvi et al, 66% and 64% of urban and rural mothers practiced on-demand feeding practiced.¹⁷

With regards to the initiation of breastfeeding 52.5% of the study participants started breastfeeding in less than 30 minutes of delivery. 55% of women residing in rural areas breastfeed in less than 30 minutes of delivery and 50% in urban areas start breastfeeding within 30 minutes of delivery. It was not statistically significant initiation of breastfeeding and place of residence. The study done by Yadav et al reported that in rural 54.2% and urban 71.8% initiated breastfeeding in less than one hour and it is statistically significant.¹⁸ According to the study done by Senanayake et al reports that overall, 41.5% of mothers initiate breastfeeding in the first hour of birth. And in the rural population, the prevalence of early breastfeeding initiation was 41.0%, and 42.9% in the urban. Population.¹⁹ According to Hitachi et al study reported that 90.5% and 69.2% of urban and rural mothers initiated breastfeeding in the first hour of birth.²⁰

25.7% of women residing in rural have given bottled feed and 34.3% in urban areas have given bottled feed to their children. The study done by Ausvi et al reported that 19% of urban and 26% of rural women practiced bottle feeding.¹⁷ The study done by Yadav YS et al reported that in rural 35% of babies received bottle feeding and in urban 19.4% of babies received bottle feeding.¹⁸

Overall, in the study 97.5% of the babies received colostrum. 98.6% and 96.4% of babies received colostrum concerning rural and urban areas. Hitachi et al reported that colostrum was given to 98.7% of in urban and 97.9% of rural areas children, and it shows a similar finding to our study.²⁰

Related to pre-lacteal feeding in our study, 5.7% of babies in rural areas and 26.4% of babies in urban areas are fed by any pre-lacteal feed in the first three days after delivery. P value is significant. The study done by Yadav et al reported that in rural 50.2% and in urban 18.4% of babies received pre-lacteal feeding.¹⁸ According to a study done by Bansal et al in an urban district of India, 25% gave prelacteal feeds which are nearly similar to our study.²¹

In the present study, 66.3% of women in the rural area start supplementary feeding after six months and 67.6% of urban women start supplementary feeding after six months. The study done by Ausvi et al reported that 68.5% and 65% of urban and rural women started supplementary feeding after six months.¹⁷

In our study, the questionnaire was used to collect the data on feeding practices which is subjected to recall bias. This is considered a limitation of the study.

CONCLUSION

This study concludes that in urban areas, demand feeding, pre-lacteal feeding, and bottle feeding were more common. Nearly 33% of both rural and urban were started supplementary foods before 6 months of age. The frequency of breastfeeding practices and pre-lacteal feeding were significantly associated with place of residence. There was a statistically significant association between any fortified food, foods made from grains, meat, and sea foods given to the babies, and place of residence. It also observed that in rural areas, 35% had poor, 57.1% had average and 7.9% had good infant and early child feeding practices on the other hand, in urban areas, 19.3% had poor, 55.0% had average and 25.7% had good infant and early child feeding practices. The association between the locality and overall feeding practices was found to be statistically significant. From this study, though pre-lacteal feeding and bottle feeding were more in urban areas, the overall feeding practices were poorer among rural than urban, so it is important to take necessary steps to improve feeding practices among rural populations.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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