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Indian Journal of Community Medicine

Breast Feeding Practices in the Rural Community of District Darjeeling, West Bengal

Author(s): (Mrs.) Rama Ram, M.N. Ghosh, J.B. Saha*, S.K. Bhattacharyya, Anima Halder (Biswas), Chitra Chatterjee

Vol. 25, No. 2 (2000-04 - 2000-06)

Department of Community Medicine, Calcutta National Medical College, Calcutta. *Department of Community Medicine, North Bengal Medical College, Calcutta.

Abstract:

Research question: What is the pattern and influence of socio-cultural factors on breast feeding practices in the rural mothers of Darjeeling district?

Objectives: To find out the pattern of breast feeding practices in the rural mothers of Darjeeling district and influence of socio-cultural factors with special reference to occurrence of diarrhoea.

Study design: Cross-sectional study.

Setting: Immunization clinic, department of Community Medicine, North Bengal Medical College.

Sample size: 1200 mothers attending the clinic for immunization having babies 6 weeks to 24 months.

Study variables: feeding practice, time of initiation, duration of breast feeding, literacy, socio-economic status, source of knowledge, episode of diarrhoea, etc.

Method: Interview technique.

Statistical analysis: Percentages, Z-test.

Results: 85.5% of the mothers initiated breast feeding within 7-18 hours after delivery, 55% of mother got information about breast feeding from their family members. Education and socio-economic status had a significant association with duration of breast feeding. Babies of both the bottle feeding and complimentary feeding groups had significantly higher average number of episodes of diarrhoea than that of exclusively breast fed children.

Keywords: Exclusive breast feeding, diarrhoea.

Introduction:

The nutritional and health status of the infants mainly depends on the feeding practices of the community. It is seen that the child rearing practices differ in different states, districts and in the people living in different regions in the same state. Superiority of breast feeding over bottle feeding has been established almost as an exiomatic feature. During the last decade, this has received a renewed thrust and emphasis for being used as an effective tool in improving the survival, morbidity and the health status of children.

This study was conducted with an objective to find out the pattern of breast feeding practices in the rural mothers of Darjeeling district and influence of socio-economic and cultural factors with special reference to association with occurrence of diarrhoea.

Materials and Methods:

The study was undertaken in the Immunization clinic run by the department of Community Medicine of North Bengal Medical College, among the mothers having children 6 weeks - 24 months of age, attending the clinic with their babies for vaccination.

By interviewing these mothers, information about socio-cultural factors, practices of feeding etc. were collected on a pre-tested and pre-designed proforma. Mothers were divided into two sub-groups: i) those having children aged 6 weeks to 4 months and ii) those having children aged 12 months to 24 months.

The former group was specially interviewed for any episode of diarrhoea during previous 2 weeks period and the later group was enquired whether they were continuing breast feeding and if not, then the time and reasons of discontinuation. Data was statistically analysed.

The study period was from January 1992 to December 1994:

Results and Discussion:

There were 1200 mothers in the study group, out of which 600 had their babies aged upto 12 months and the number of mothers having their children aged 6 weeks to 4 months was about 180.

Table I: Distribution of all mothers according to time of initiation of breast feeding (n=12-00).

Time of hours Number Percentage
0-6 47 3.9
7-12 416 34.7
13-18 610 50.8
19-24 127 10.6
Total 1200 100.0

Table I shows that 85.5% of the mothers initiated breast feeding between 7-18 hours after delivery and it was started by 100% mothers within 24 hours. Kar et al1 and Dutta Banik2 have reported that 51.3% and 42.9% of infants were put to breast within a span of 24 hours after delivery.

Table II: Distribution of all mothers according to source of knowledge of breast feeding (n=1200).

Source Number Percentage
Family members 660 55.0
Doctors 195 16.3
Paramedical staff 211 17.5
TBA/AWW/VHG 125 10.4
Others 9 0.8
Total 1200 100.0

Table II shows that 55% of the mothers got information about breast feeding from their family members, 17.5% from paramedical staff and 16.3% from doctors. So far as source of advice regarding breast feeding is concerned, Dutta Banik2 also observed that in Indian society the grandmothers of infants play a dominant role in advising the daughters or daughter-in-laws regarding breast feeding (42.9%).

Table III: Period of continuation of breast feeding according to literacy status of mothers (having children aged 12-24 months) (n=600).
Literacy status Before 6 months
No.(%)
6-12 month
No.(%)
After 12 months
No.(%)
Total
Illiterate 109 (27.2) 242 (60.3) 50 (12.5) 401
Primary/Middle 43 (32.6) 74 (56.0) 15 (11.4) 132
High school 20 (41.7) 25 (52.0) 3 (6.3) 48
College/University 9 (47.4) 7 (36.8) 3 (15.8) 19
Total 181 (30.2) 348 (58.0) 71 (11.8) 600

df= 6, X2=57.4, p<.001

Table IV: Period of continuation of breast feeding according to socio-economic status of mothers (n=600).

Literacy status Before 6 months
No.(%)
6-12 month
No.(%)
After 12 months
No.(%)
Total
I & II 81 (39.1) 94 (45.4) 32 (15.5) 207
III 83 (33.7) 146 (59.3) 17 (7.0) 246
IV 17 (11.6) 108 (73.5) 22 (14.9) 147
Total 181 (30.2) 348 (58.0) 71 (11.8) 600

df= 4, X2= 43.18, p<.001

Table III and IV show that socio-economic and educational status of the mothers have a significant association with duration of breast feeding. Shorter duration was noted among mothers with higher education and socio-economic status, prolonged duration among poor and illiterate mothers. Similar finding were observed by Kar et al1.

Table V: Reasons of discontinuation of breast feeding in relation to duration (n=600).

Reasons Duration of breast feeding
Before 6 months
No.(%)
6-12 months
No.(%)
Total
No.(%)
Insufficient milk 112 (61.9) -   112 (21.2)
Breast infection 60 (33.1) -   60 (11.3)
Weaning -   278 (79.9) 278 (52.6)
Pregnancy -   55 (15.8) 55 (10.4)
Illness of baby 9 (5.0) 15 (4.3) 24 (4.5)
Total 181 (100.0) 348 (100.0) 529 (100.0)*

*Mothers of 71 children continued breast feeding after 12 months.

Table V shows that out of mothers who discontinued before 6 months, 61.9% had insufficient milk and 33.1% had developed breast infections. After 6 months, discontinuation was mostly a part of the weaning process (79.9%), pregnancy (15.8%), and babies' illnesses (4.3%).

Kar1 and Kumar3 also commented insufficient milk to be the commonest reason of discontinuation.

The help of WHO criteria4 of indicators of breast feeding practices was taken for categorising the feeding practices and accordingly the children aged 6 weeks to 4 months have been divided into three groups, (i) exclusive breast feeding, (ii) complimentary feeding and (iii) bottle feeding.

Table VI: Association between prevalence of diarrhoea and breast feeding practices in children aged 6 weeks to 4 months (n=180).

Feeding practices No. of
children
experiencing
diarrhoea
Total no. of episodes Mean SD Z value
Exclusive breast feeding 133 0 0 0 0
Complimentary feeding 15 10 0.66 0.14 18.7(p<.001)
Bottle feeding 32 40 1.25 0.4 17.8(p<.001)
Total 180 50 0.27    

Table VI shows that the mean number of episodes of diarrhoea among exclusively breast fed children was nil and that of bottle fed was 1.25, the difference between them being highly significant (Z = 17.8, p<.001). Similarly, the mean number of episodes in case of complimentary feeding group was 0.66, which was also significantly different from that of exclusively breast fed children (Z=18.3, p<.001).

Similar observations were also made by Kaur4.

The study shows that there needs a lot to be done to improve the feeding practices in all sections of the society, particularly the mothers having higher education and socio-economic status. The health education to the pregnant women should be particularly focussed in avoiding non-human milk with or without bottle upto the age of 4 months and also on timely weaning practices.

References:

  1. Kar M, De R: Breast feeding practices-impression from an Urban Community. Indian Journal of Public Health 1991; 35(4): 93-5.
  2. Dutta Banik ND: Breast feeding and weaning practices of Indian pre-school children. Indian Journal of Community Medicine, 1987; 12(3): 109-16.
  3. Kumar S, Singh S, Nath LM et al: Changing trends in breast feeding attitude and practices in India - need for appropriate intervention. Indian Journal of Community Medicine, 1987; 12(3): 124-36.
  4. Kaur P, Kaur N: Breast feeding practices in Varanasi District (U.P.). Indian Journal of Public Health, 1996; 40(4): 52-53.
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