A Study on the Feeding Practices among Under-Five Children in Urban Slum dwellers of District Dehradun ,

A Study on the Feeding Practices among Under-Five Children in Urban Slum dwellers of District Dehradun, India Sinha R1, Kakkar R2, Kandpal SD3 Abstract: Background: Breast milk feeding is the first fundamental right of the child. However, there are many cultural practices associated with infant feeding of which certain undesirable practices need to be discouraged. Objectives: To assess the feeding practices of under five year children in urban slum and to determine the factors influencing it, if any. Methodology: Community based analytical cross sectional study was conducted in urban slums amongst mothers over one year period. A house to house survey was conducted and Data was collected using a pre-tested, structured questionnaire on breastfeeding practices & data pertaining to breastfeeding practices was asked in detail from mothers of babies who were breastfed. Results: A total of 381 children were studied. A total of 87.0% of the children were delivered at health facilities and the rest at home. 65.9% received prelacteal feed in the form of water, infant milk formula, cow milk and honey. Most of the children (54.1%) received breast milk within 24 hrs of birth. 95.0% received colostrum and 67.2% received exclusive breast feeding for 6 months. It was observed that children who were exclusively breastfed for six months were found to be better nourished (51.3%). Conclusions: Majority of the mothers were practicing exclusive breast feeding, however a significant proportion of children was deprived of timely initiation of breast feeding. About 2/3 of the mothers were still practicing pre-lacteal feeds to their children. The study documents that there was significantly increased risk of PEM if the child is not exclusive breastfed for 6 months.


Introduction
Breast milk feeding is the first fundamental right of the child.The initiation of breast feeding and the timely introduction of adequate , safe and appropriate complementary foods in conjunction with continued breast feeding are of prime importance for the growth, development, health and nutrition of infants and children everywhere.However, there are many cultural practices associated with infant feeding of which certain undesirable practices need to be discouraged.One in every third malnourished children in world lives in India.(1) Optimal breastfeeding of infants under two years of age has the greatest potential impact on child survival of all preventive interventions, with the potential to prevent over 800,000 deaths (13 per cent of all deaths) in children under five in the developing world (2).Hence, an effort was made to assess the feeding practices of under five year children in urban slum and to determine the factors influencing it, if any.

Materials and methods
This community based analytical cross sectional study was conducted amongst mothers over one year period.The study was carried out for a period of one year i.e.May 2011 till April 2012 amongst 381 children from 381 mothers in the age group of 0-5 years of age in the Sheesham Jhadi and Chandreshwar Nagar urban slums under the jurisdiction of Urban Health Training Center, field practice area of the Department of Community Medicine, HIMS, Dehradun, India A house to house survey was conducted and Data was collected using a pre-tested, structured questionnaire on breastfeeding practices & hence data pertaining to breastfeeding practices was asked in detail from mothers of babies who were breastfed.Informed verbal consent was taken from each of the participants.Ethical approval was taken prior study.Factors related to feeding practices were analysed statistically to draw out conclusion.For assessment of nutritional status: a child who was either wasted, stunted or underweight or a combination of any of these was considered as Undernourished (< -2 Z score) and a child who was neither wasted, stunted nor underweight as Well nourished (-2 < Z-score < +2).Percentages were calculated for all the variables.Chi square was applied for categorical variables; Fischer Exact Test was applied where sample size was < 30.Significant level was assumed at p<0.05.

Discussion
In this study majority of the children (67.2%) were exclusively breast fed, while only 27.6% of the mother's do not exclusively breast fed their children (Table 3) which is very high in comparison to 46.0% according to NFHS-3, India (3) & 31.2 % according to NFHS-III, Uttarakhand (4).In comparison to this study  another study by Panda et al (1993) at Ludhiana observed a higher number (89 %) of the children were exclusively breast-fed for six months (5).However Bagul A (2012) conducted a study in Nagpur and observed that EBF was practiced in 36.84%children (6).Tiwari R,(2008) at Gwalior observed that very less number of children i.e.only 7.8% actually practiced EBF , 63.8% and 212 i.e. 76.0% newborns were given pre-and post-lacteal feeds with 26.2% discarding colostrum (7).
It was also observed in the present study that only 51.3% children were found to be well nourished who were exclusively breast fed for six months, in comparison to 28.8% children who were exclusively breast fed for more than six months (Table 4).Anderson et al (2010) at Ghana observed in his study that children who were exclusively breastfed for the first 6 months after birth had lower prevalence rates of stunting than those either mixed fed or formula fed for the same period (8).In present study it was also observed that males (61.0%) were found to be more undernourished in comparison to females (44.3%).
Another observer Tamoghna B (2011) at Kolkata found that the proportion of exclusively breast fed children were only 18.1% and 80.3% children did not receive timely complementary feeding (9).According to DLHS III it was observed that (52.6%) children in the age of 0-5 months were exclusively breastfed (10).In this study it was observed that in most of the children (53%) weaning was started after six months of age (Table 3).Findings can be corroborated with NFHS-III, Uttarakhand (2006), according to which, 51.6% children in 6-9 months of age had started receiving semisolid food apart from breast milk (4).Similarly, according to NFHS-III (2006) India, fifty three percent of the children were given complementary feeding (breast milk and complementary food) at the age of 6-8months i.e.>6 months (3).The proportion of children was further higher according to DLHS-III, Uttarakhand (2007-08), in which, sixty four percent children in 6-9 months of age had started receiving semisolid food apart from breast milk (10).

Conclusion
Regarding feeding practices in study area, majority of the children were given colostrum and timely breast feeding was initiated.However a significant proportion (one fifth) of children was deprived of

Table 5 : Gender wise Nutritional Status of Study Population According to Duration of Exclusive Breast Feeding
(*Figures in parenthesis indicate percentage) Undernourished 2 10.3 df3, p< 0.05