INFANT FEEDING PRACTICES IN URBAN SLUMSMadhu-AgarwalObjective: To study the knowledge, beliefs and practices of mothers, i...
areas. In the ICDS area, the percentage of normal children in Grade I and Grade IIwere 52.6, 24.6 and 15.4, respectively. ...
Keeping this in view, this study was undertaken to compare the knowledge,beliefs and practices of mothers, in relation to ...
Data obtained was tabulated and statistically analysed by adoptingpercentage analysis and by applying Chi-square test, to ...
Majority of the mothers of the ICDS and the non-ICDS areas fed their infantson demand (ICDS-87.6 percent, non-ICDS-89.9 pe...
areas. Thus, majority of the mothers gave animal milk to the infants and commercialmilk was not popular in the slums. The ...
month of age. This should be discouraged in slum areas. In addition, instead ofbottle, use of cup and spoon should be enco...
infants ate and shared with other siblings or parents, without considering quantityand frequency of feeding.Regarding the ...
Thus, the findings of this study reveal that nutritional status of the children ofthe ICDS area was better, as compared to...
Advisors of Mothers Regarding Infant FeedingMajority of the mothers (ICDS-48percent, non- ICDS63.50 percent) neverreceived...
infant feeding practices is essential for improving their knowledge and skills. Inaddition, services of the non-government...
3. Gupta, R. 1982. Infant feeding patterns in urban families: A field study.Unpublished masters dissertation. Department o...
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Infant feeding practices in urban slums

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To study the knowledge, beliefs and practices of mothers, in relation to initiation, duration and type of breastfeeding, introduction and type of complementary food and other infant feeding practices.

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Infant feeding practices in urban slums

  1. 1. INFANT FEEDING PRACTICES IN URBAN SLUMSMadhu-AgarwalObjective: To study the knowledge, beliefs and practices of mothers, in relation toinitiation, duration and type of breastfeeding, introduction and type of complementaryfood and other infant feeding practices. Also, to assess the impact of Nutrition &Health Education on the infant feeding practices and suggested relevant need-basedmessages, which could be used for imparting nutrition & health education to themothers of the ICDS and the non-ICDS areas. Subject and Methods: A sampleconsisting of 400 households was covered ,from the Aliganj ICDS project (urban)and the non-ICDS slum areas in the neighbourhood of the ICDS project of Lucknowdistrict of Uttar Pradesh, having the youngest child within the age group of a year.Data obtained was statistically analysed by adopting percentage analysis and byapplying Chi-square tests to compare the infant feeding practices in the ICDS andthe non-ICDS areas. Observations: The Chi-square analysis (X2=15.94, p=0.003)on the practice of initiation of breastfeeding shows a highly significant association,i.e., initiation of breastfeeding differs in the ICDS and the non-ICDS areas. It wasanalysed that, more mothers in the ICDS area (63.5 percent) had fed colostrum totheir infants than those in the non-ICDS area (48.2 percent). The Chi-squareanalysis (X2=8.77, p=0.012) also corroborates the above analysis. The practice ofgiving the new-borns some pre-lacteal feeds, after birth and before commencementof breastfeeding, was prevalent in both. the areas as the Chi-square analysis showsthat it was not significant (X2=7.28, p=0.0!?4). About 51 percent mothers in the non-ICDS area and 35 percent in the ICDS area initiated breastfeeding from the third dayonwards. Majority of the mothers of the ICDS and the non-ICDS areas fed theirinfants on demand (ICDS-87.6 percent, non-ICDS-89.9 percent). Forty one percentof the infants in the ICDS area and 42.5 percent of the infants of the non-ICDS areawere receiving top milk by six months of age. It was found that the percentage of theinfants receiving commercial milk was very less, in both the areas (ICDS-10.5percent, non-ICDS-5.5 percent). Further, around 80 percent of the mothers in theICDS and 83.8 percent in the non-ICDS areas were diluting milk before boiling. Amajority of the mothers (ICDS-44 percent, non-ICDS-61.8 percent) used 50 percentdilution ratio. Around 47 percent mothers in the ICDS and 41.7 percent mothers inthe non-ICDS area had introduced solids even before six months of age. On theother hand, the percentage of infants receiving semi-solid foods during 6-9 months ofage was almost identical in the ICDS and the non-ICDS areas (ICDS-48 percent,non-ICDS-45.8 percent). The Chi-square analysis (X2=16.0, p=0.005) reveals thatthe two populations differ with regard to the introduction of semi-solid foods. It wasfound that nearly 87 percent of the ICDS mothers gave homemade foods to theirchildren, as compared to around 81 percent in the non-ICDS area. In contrast,commercial foods were given to a smaller percentage of children, in both the areas(ICDS-13.2 percent, non-ICDS-19.1 percent). There was a difference between themean-weight of the infants of both the areas. It was found that mean-weight of theICDS infants (6.0 kg) was higher than the infants of the non-ICDS area (5.3 kg). Themean-weight was highest in case of the ICDS male infants (6.3 Kg), as compared tothe non-ICDS (5.8 Kg) male infants. The most revealing difference was foundbetween the mean weight of the female infant of the ICDS (5.9 Kg) and the non-ICDS (5.4 Kg) area. The female infants were behind their male peers in both the1
  2. 2. areas. In the ICDS area, the percentage of normal children in Grade I and Grade IIwere 52.6, 24.6 and 15.4, respectively. The corresponding percentage in the non-ICDS area were 42.1, 30.0 and 13.7, respectively. The non-ICDS area also recorded6.3 percent more children in Grade III category and a minor difference was noticed inthe Grade IV category of the children, in both the areas (ICDS-2.3 percent, non-ICDS-2.7 percent). A significant proportion of the mothers gave water to their child(ICDS-71 percent, non-ICDS-76.2 percent), 40 percent ICDS mothers added ghee oroil to their childs diet, whereas, this percentage in the non-ICDS area was aminuscule 28.4 percent. Conclusion: Infant feeding practices in ICDS areas werefound to be better than those in the non-ICDS areas which contributed towardspoorer nutritional status of infants in non-ICDS areas as compared to infants of ICDSarea. This signifies that nutrition and health education imparted in the ICDSprogramme has helped to some extent in enhancing the level of awareness amongmothers and brought some changes in their behaviour. Still there is need forlaunching an educational campaign on need based messages, to inform care-giversabout appropriate infant feeding practices.Key words: Colostrum feeding, pre-lacteal feeds, breastfeeding, top feeding,complementary feeding, nutritional status, Nutrition and Health Education.IntroductionIt is a well-known fact that appropriate feeding practices during infancy playan important role in the childs nutrition and also in laying a strong foundation forhis/her health and development in the later years of life. Nevertheless, experienceshows that better feeding practices can make an important contribution in reducinginfant mortality.Large number of studies conducted on infant feeding show that inappropriatefeeding practices such as, early inadequate supplementation or cessation ofbreastfeeding and inappropriate complementary feeding were the major factors forthe onset of malnutrition among children from the lower socio-economic communitiesof urban areas in India, which were due to lack of knowledge, ignorance, confidenceand misconceptions of mothers regarding feeding practices (1,2,3,4,5). In India,government and non-government agencies have initiated several programmes forimproving the knowledge of the mothers. Today, ICDS is one of the worlds largestand the most unique outreach programme for early childhood care. Nutrition andHealth Education (NHEd) is one of the most important component in the ICDSscheme. It has been established that nutrition and health education to community isa long-term measure to improve knowledge, attitude and behaviour of mothers fortaking care of their children. The scheme is now poised for a wider expansion.Considering the magnitude of foreseen expansion, it has become imperative toassess and compare the knowledge of mothers in the ICDS Projects vis-a-vis,mothers in the non-ICDS Projects on the issues of feeding practices such as,initiation and type of breastfeeding, introduction of complementary food, etc. to theinfants. This would go a long way in identifying relevant need-based messageswhich could be used for educating the community. Appropriate strategy couldaccordingly, be suggested for imparting nutrition and health education to slum-dwellers.2
  3. 3. Keeping this in view, this study was undertaken to compare the knowledge,beliefs and practices of mothers, in relation to feeding of infants of the ICDS and thenon-ICDS areas. It also assessed the impact of NHEd in reducing misconceptions ifany, prevalent among mothers of both the areas and suggested relevant need-basedmessages, which could be used for imparting NHEd to the mothers of the ICDS andthe non-ICDS areas.Subjects and MethodsEarlier research studies conducted in Uttar Pradesh (6.7) showed that theprevalence of malnutrition among women and children was higher in the beltcomprising of Gangetic plains and Terai, as compared to the other regions. Keepingthis in view, Lucknow district which is located in the central region of Uttar Pradeshwas selected for data collection. From the Lucknow district, Aliganj ICDS Project(urban) that was sanctioned during the year 1979 was selected as it is one of theoldest urban block in the district. Since, there was no pre-project informationavailable in the ICDS area, so it became imperative to select a non-ICDS area forcomparison purpose. A non-ICDS area where ICDS was not in operation wasselected, in the neighbourhood of the ICDS Project, to compare the ICDS and thenon-ICDS areas for studying its impact.A two-stage sampling design was adopted. Selection of slums in the firststage and households in these selected slums in the second stage. Ten slumshaving Anganwadi centres, from the Aliganj ICDS Project were selected. From eachsector, two-three centres were taken randomly in the ICDS area. Purposive samplingwas done to select the households as the study required only such families whichhad at least one child aged less than 12 months of age. From each slum, 20 motherswere contacted who had male/female child upto 12 months of age for eliciting theinformation.A sample consisting of 200 households, was covered from the Aliganj ICDSProject having the youngest child within the age group of a year. The procedure wassimilar in the non-ICDS area. In this area also, 200 households from 10 slumsscattered in the different areas of Lucknow city, where ICDS or any other nutritioneducation intervention was not in operation, were contacted for data collection. In all,400 mothers belonging to 20 slums from the ICDS Project and the non-ICDS areawere studied from different localities of Lucknow city.The data was obtained by interviewing the mothers of the children and alsothe heads of the households using a questionnaire. Two types of questionnaireswere canvassed- Interview and Observation. The questionnaires were pretested inthe slum areas of Lucknow city, covering 25 families each, in both the areas. Fromthe pretesting of the questionnaires, it was ascertained that the responses elicitedthrough the questionnaire were more or less in keeping with the objectives of thestudy. The questionnaires were modified on the basis of responses obtained in thefield.Data Analysis3
  4. 4. Data obtained was tabulated and statistically analysed by adoptingpercentage analysis and by applying Chi-square test, to compare the infant feedingpractices in the ICDS and the non-ICDS areas. Suitable graphs were also used toderive inter-relationships.Results and DiscussionBreastfeedingSeveral studies have confirmed that colostrum is the best food for neonatesfrom the nutritional, psychological and immunological points of view. But in thepresent study, it was found that some mothers rejected this precious material. TheChi-square analysis (X2=15.94, p=0.003) on the practice of initiation of breastfeedingshows a highly significant association, i.e., initiation of breastfeeding differs in theICDS and the non-ICDS areas. It was analysed that, more mothers in the ICDS area(63.5 percent) had fed colostrum to their infants than those in the non-ICDS area(48.2 percent). The Chi-square analysis (X2=8.77, p=0.012) also shows that,colostrum feeding differs in the two target populations (Fig. 1). This finding is similarto the findings of several studies (8,9,10) which reported that the colostrum feedingpractices in the ICDS areas are better than those in the non-ICDS areas. Thereasons cited by most of the mothers for rejecting colostrum were almost identical inboth the areas. They were, inadequate quantity of milk as considered by the mothersand advice of the relatives not to feed colostrum, or to feed only after the ritual bath(see Table A). This finding is in conformity with the results obtained by the previousstudies (1,2,3,4,5,8,11).The practice of giving the new-borns some pre-lacteal feeds, after birth andbefore commencement of breastfeeding, was prevalent in both the areas as the Chi-square analysis shows that it was not significant (X2=7.28, p=0.064). The commonprelacteal feeds offered were sweetened water (ICDS-37.04 percent, non-ICDS-29.13 percent), diluted animal milk (ICDS-30.09 percent, non-ICDS-31.49 percent)and honey (ICDS-28.9 percent and non-ICDS-19.69 percent) (Fig. 2). This finding isalso in accordance with the earlier reports (1,2,3,4,5,8,10). Some mothers reportedthat, pre-lacteal feed was given with a belief that, it helps to loosen meconium beforeestablishment of lactation and acts as a tonic and a source of nutrition until milk issecreted. These feeds were given by a cotton swab (ICDS-33 percent and non-ICDS-55.3 percent) or with a spoon (ICDS-31.8 percent and non-ICDS-38.2percent). The use of bottle for giving pre-lacteal feeds was also common in both theareas (ICDS-27.8 percent and non-ICDS-6.5 percent) (Fig. 3). It was observed thatthese feeds were administered under unhygienic conditions, which may causediarrhoea to slum-dwelling children.About 51 percent mothers in the non-ICDS area and 35 percent in the ICDS areainitiated breastfeeding from the third day onwards. The present study shows that,delayed breastfeeding was more common in the non-ICDS area as compared to theICDS area. The number of never breastfed infants was very small (ICDS-1.5percent, non-ICDS-1 percent) in both the areas. It is gratifying to note that, theincidence of lactation failure was very rare in the surveyed areas.4
  5. 5. Majority of the mothers of the ICDS and the non-ICDS areas fed their infantson demand (ICDS-87.6 percent, non-ICDS-89.9 percent). There was an insignificantdifference in the values (X2=3.91, p=0.271) which shows that there was no differencebetween breastfeeding schedules of both the areas (Fig. 4). The data suggests thatfeeding on demand is by far the most popular practice among the urban poormothers. Maximum number of mothers felt that they breast-fed the child as long asthe child demanded, in both the areas (ICDS-48.5 percent, non-ICDS 66 percent).Thus, in both the areas, mothers believed in prolonged breastfeeding.Mothers who discontinued breastfeeding reported some reasons which were,insufficient milk - as perceived by the mother, mothers next pregnancy, mothers illhealth, etc. Insufficiency of milk was the most common pretext for discontinuingbreast milk. It is suggested that attempts must be made to improve the lactation ofthe mother through nutritional supplementation and counselling. Majority of themothers of both the areas, ICDS as well as the non-ICDS expressed their opinionabout the value of breastfeeding. They considered breast milk to be nutritious andgood for the child. However, 14.5 percent in the ICDS and 27 percent mothers in thenon-ICDS area did not express their opinion. Thus, the mothers perception aboutthe breastfeeding practices was better in the ICDS project in comparison to the non-ICDS area.Complementary FeedingTop-feedingThe age at which top milk was introduced was almost identical in both theareas. Forty one percent of the infants in the ICDS area and 42.5 percent of theinfants of the non-ICDS area were receiving top milk by six months of age. However,the insignificance of the Chi-square analysis (X2=2.31, p=0.510) shows no differencebetween the ICDS and the non-ICDS areas with regard to the initiation of top milk(Fig. 5). The more disturbing finding is that, among those infants who received topmilk, around 60 percent of the infants in both the areas had received top milk beforeone month of age. The present study indicates that initiation of the first top milk feedwas much earlier in both the areas. Mothers opted for bottle-feeding mainly due tothe reasons of employment or insufficient milk supply as perceived by the mothers.Most of the mothers in the studied population were predominantly using buffalosmilk, but it was used more in the non-ICDS area as compared to the ICDS area(non-ICDS-65.4 percent, ICDS-52.8 percent). Cows milk (ICDS-29.2 percent, non-ICDS-14.9 percent) and Parag milk packet (ICDS-16.7 percent, non-ICDS-11.1percent) was used more by the ICDS mothers, as compared to the non-ICDSmothers (Fig. 6). The mothers reported that as buffalos milk was easily available, sothey were using it. Thus, the choice for the type of top milk was largely influenced byits availability.It was found that the percentage of the infants receiving commercial milk wasvery less, in both the areas (ICDS-10.5 percent, non-ICDS-5.5 percent) (Fig. 7).However, the percentage of the mothers using commercial infant milk was higher inthe ICDS area than in the non-I CDS area. Amongst the brands of commercial milkused, the use of Amul Spray was more popular among the mothers, in both the5
  6. 6. areas. Thus, majority of the mothers gave animal milk to the infants and commercialmilk was not popular in the slums. The study reveals that top milk was most popularamongst the mothers in both the areas. Keeping in view the family constraints, topmilk would impose a massive strain on the familys budget.Further, around 80 percent of the mothers in the ICDS and 83.8 percent in thenonICDS areas were diluting milk before boiling. The dilution ratio varied from familyto family. A majority of the mothers (ICDS-44 percent, non-ICDS-61.8 percent) used50 percent dilution ratio (1 part of milk with 1 part of water) (Fig. 8). More mothers ofthe non-I CDS area diluted the milk by 50 percent, as compared to the mothers ofthe ICDS area. Thus, in both the areas complementary milk feeds were given in fartoo dilute composition. The mothers reported that dilution of milk was done tofacilitate digestion and to increase the quantity of milk. Thus, ignorance and povertyseem to be the underlying reasons.It was found that 55.8 percent mothers in the ICDS and 80.2 percent in thenon- ICDS areas prepared milk feed once, for the whole day. In contrast, 39percent of the mothers of the ICDS and only 17.3 percent mothers of the non-I CDSarea prepared fresh milk each time. The Chi-square value (11.4) was highlysignificant (p=0.022) showing that, the practice of reconstitution of milk differs in boththe areas.The majority of the infants were receiving 2-3 top milk feeds per day in boththe areas. The statistical analysis (X2=6.37, p=0.364) also shows no difference in theICDS and the non-ICDS areas (Table 9). Although there was no difference betweenthe ICDS and the non-ICDS areas with regard to the number of feeds, the twopopulations differed significantly on the mode of the feeding (X2=17.25, p=0.028).Larger number of the mothers of the ICDS area (63.7 percent) offered top milk in thecommercially available feeding bottles, as compared to the mothers of the non-ICDSarea (40.7 percent). The practice of feeding with the traditional utensil was veryuncommon amongst the mothers of both the areas.Since the risk of infection is the highest with bottle-feeding, due to impropercleaning, so the data was collected to know how the bottles were being actuallycleaned. The majority of the mothers (ICDS-70 percent, non-ICDS-63 percent)cleaned the bottle with water like any cooking utensil, using mud or soap powder inboth the areas. Only 15.6 percent mothers in the ICDS and 6 percent mothers of thenon-ICDS area reported that they sterilised the bottles before use. It was observedthat bottle and nipple were handled with dirty hands, which were a source of infectionfor the baby. It should thus be made clear that the conditions under which bottle-feeding is practised favour infections, especially in communities whereenvironmental sanitation is poor and safe drinking water is not accessible. Thus if themothers have to use top milk for feeding, the preparation of milk under hygienicconditions must be stressed.Regarding the storage of the animal milk, only one fifth of the mothers of boththe areas reported that they boiled the milk and stored it in clean covered utensils.Majority of the mothers initiated top feeding before the infant reaches six months ofage. Infact some mothers initiated this practice when the infant was even below one6
  7. 7. month of age. This should be discouraged in slum areas. In addition, instead ofbottle, use of cup and spoon should be encouraged, as bottles are difficult to cleanand can cause infection to the infant. Further, preparation of milk under hygienicconditions and correct formulations should be stressed. Mothers must be madeaware that nursing the infant for around six months will provide the nutrient needs ofthe child. Mothers must be persuaded to eat nutritious meals, in order to ensuregood quality and quantity of her milk flow and to keep herself healthy.Semi-solid FoodsIntroduction of the first semi-solid foods to the infant was reported over an agerange of 3 months to one year. Around 47 percent mothers in the ICDS and 41.7percent mothers in the non-ICDS area had introduced solids even before six monthsof age. On the other hand, the percentage of infants receiving semi-solid foodsduring 6-9 months of age was almost identical in the ICDS and the non-ICDS areas(ICDS-48 percent, non-ICDS-45.8 percent). The Chi-square analysis (X2=16.0,p=0.005) reveals that the two populations differ with regard to the introduction ofsemi-solid foods (Fig. 10). Thus, both early and delayed introduction of first semi-solid foods, were prevalent in the surveyed areas. The introduction of supplementaryfoods at an early age, may put infants at the risk of malnutrition because other liquidsand solid foods are nutritionally inferior to breast milk. It also increases childrensexposure to pathogens and consequently puts them at a greater risk of gettinginfected with diarrhoea.Regarding the number of feeds per day, majority of the mothers occasionallygave semi-solid foods to their infants i.e., 2-3 times a day (ICDS-55 percent and non-ICDS-61.7 percent). The X2 value (X2=13.30, p=0.021) is highly significant. Thisshows that ICDS and non-ICDS areas also differ with regard to the number of feedsgiven to the infants.The mothers who delayed introduction of the first semi-solid foods, reportedsome misconceptions like - the child cannot chew the food or the child cannot digestit, the child does not accept or not allowed by the elders, etc. Wrong perceptions andignorance about the introduction of semi-solid foods appear to have strong influenceon the mothers, in both the areas. Thus, knowledge and access to informationshould be strengthened for improving feeding practices.The type of semi-solid foods offered as supplementary food was almostidentical in both the areas. It was found that nearly 87 percent of the ICDS mothersgave homemade foods to their children, as compared to around 81 percent in thenonICDS area. In contrast, commercial foods were given to a smaller percentage ofchildren, in both the areas (ICDS-13.2 percent, non-ICDS-19.1 percent). Largerproportion of the mothers from both the areas gave biscuits (ICDS-33.8 percent,non-ICDS-39.6 percent) to satisfy hunger of their child. Other foods offered werecereal-pulse preparations (ICDS-24.7 percent, non-ICDS-25 percent) and cooked dal(ICDS-29.8 percent, non-ICDS-29.2 percent) to their child. Fruits, cooked vegetablesand commercial infant food were introduced to a very few infants although in smallamounts, in both the areas (Fig. 11). It was observed that semi-solid foods offered tothe children were inadequate in quality and quantity. In majority of the cases, the7
  8. 8. infants ate and shared with other siblings or parents, without considering quantityand frequency of feeding.Regarding the preparation of homemade foods for their child, it was found thataround 55 percent mothers in the ICDS area gave regular adult family food to theirchildren, as compared to nearly 66 percent in the non-ICDS area. In addition, nospecial foods were prepared by mothers in the non-ICDS area, where as around 14percent mothers in the ICDS area prepared special foods for their children.About 52 percent of the mothers in the ICDS area and 70 percent of themothers in the non-ICDS area enlisted various constraints in introducing adequateamount of semi-solid foods such as, cost of semi-solid foods, employment of women,ignorance of the ways of preparing baby foods, etc. Thus, more mothers in the non-ICDS area than the ICDS area expressed constraints in introducing semi-solid foods.The issues such as, the right time of the introduction of the complementaryfoods, good quality and adequate quantity, the frequency of feeding, the techniquewith which they are provided must be stressed while imparting nutrition and healtheducation to the community. Mothers must be convinced through education thatsupplementary foods be given in conjunction with nursing and be prepared in a formthat is easily acceptable to the child and should be rich in both, calories and proteins.It should be suitable as per their age with slight modifications in the normal existingadult diet. The suitable recipes without adding any extra expenditure should bedeveloped and disseminated among the community.Nutritional StatusThere was a difference between the mean-weight of the infants of both theareas and it was found that mean-weight of the ICDS infants (6.0 kg) was higherthan the infants of the non-ICDS area (5.3 kg). The mean-weight was highest in caseof the ICDS male infants (6.3 Kg), as compared to the non-ICDS (5.8 Kg) maleinfants. The most revealing difference was found between the mean weight of thefemale infant of the ICDS (5.9 Kg) and the non-ICDS (5.4 Kg) area. The femaleinfants were behind their male peers in both the areas.Differences of mean-weight were tested through t-test. It shows that all the t-values are highly significant (P-value smaller than 0.01). It is therefore evident thatthere is a significant difference between the mean-weight of the male and femaleinfants of the ICDS as well as of the non-I CDS areas (see Table B). More attentionand better impetus is required to be given to improve the nutritional status of the girlchild in both the areas.In the ICDS area, the percentage of normal children in Grade I and Grade IIwere 52.6, 24.6 and 15.4, respectively. The corresponding percentage in the non-ICDS area were 42.1, 30.0 and 13.7, respectively. The non-ICDS area also recorded6.3 percent more children in Grade III category and a minor difference was noticed inthe Grade IV category of the children, in both the areas (ICDS-2.3 percent, non--ICDS-2.7 percent) (Fig. 12).8
  9. 9. Thus, the findings of this study reveal that nutritional status of the children ofthe ICDS area was better, as compared to that of the non-ICDS area. This finding isconsistent with the study conducted by NIPCCD (1992) which showed that, thenutritional status of the children was better in the ICDS, as compared to the non-ICDS children. The analysis suggests that the ICDS has the potential to improve thenutritional status of the children, which although is not optimal but is better than thatof children of the non-ICDS area.The Chi-square test was applied to ascertain whether there is a significantassociation between the nutritional status (grades of malnutrition) and the age of theinfants. The calculated Chi-square value at 65 of was 86.4 for the ICDS area and at60 of was 80.59 for the non-ICDS area, which were significant (p=0.039). This showsa strong association between age (months) and grades of malnutrition among theinfants of both the ICDS and the non-ICDS areas. This finding is consistent with thestudies conducted by the Department of Women and Child Development (1999),National Family Health Survey-I (1992-93) and NFHS-II (1998-99), which state thatthe proportion of the malnourished children increases rapidly with the childs age.This could be explained as, delayed introduction of semi-solid foods, inadequate inquantity and quality.Other Feeding PracticesDespite the fact that water should not be given to the child before six monthsof age, still a significant proportion of the mothers gave water to their child (ICDS-71percent, non-ICDS-76.2 percent) (Fig. 13). The addition of water can introducecontaminants and reduce nutrient intake. Thus, there is a need to educate the care-givers about exclusive breast-feeding and not to give water for about the first sixmonths.Only 40 percent mothers in the ICDS area were providing oil or ghee to theirchildren between 6 months to one year of age. The corresponding figure in the non-ICDS area was nearly 28.4 percent. Less number of mothers in the non-ICDS areawere including ghee or oil in the diet of their children. There were two main reasonsreported by the mothers for not providing ghee or oil to their children, firstly, theycant afford and secondly, they are unaware of the importance of giving such foods.Thus, poverty and ignorance were the main reasons for not providing ghee or oil totheir children.Gender Bias in Relation to Food AllocationThere was a slight discrimination of food allocation between the male and thefemale infants of both the areas. It was found that only 2 percent of the mothers inthe ICDS and 2.5 percent of the mothers in the non-ICDS area reported that, theygave more food to the male infants as compared to the female infants. However,statistical analysis reveals a different picture (X2=1.07, p=0.585) with regard to foodallocation. The insignificance of the Chi-square values indicates that there is nogender bias with regard to food allocation, among male and female infants of boththe areas.9
  10. 10. Advisors of Mothers Regarding Infant FeedingMajority of the mothers (ICDS-48percent, non- ICDS63.50 percent) neverreceived any advice from their relatives or thefield functionaries. Out of those who receivedadvise, maximum advisors were relatives(ICDS-27.5 percent, non-ICDS-18 percent) inboth the areas. However, 5.5 percent mothersof the non-ICDS area than 5.0 percent of theICDS area were benefited by the doctors also.It was gratifying to note that in the ICDS area16.5 percent mothers received the advice from the Anganwadi Workers also. Thus,the mothers of the ICDS area were benefited relatively more as compared to theircounterparts in the non-ICDS area. As maximum number of the mothers benefitedfrom their relatives advice, so educational messages should be imparted not only tothe mothers but also to the other family members, providing counselling to themothers. The application of correct knowledge through community education mustbe stressed in both the areas.Faulty feeding practices were due to lack of knowledge, confidence,ignorance and misconceptions among the care-givers. Although this is true of themothers of both the ICDS and the non-ICDS areas, but it is more so in the case ofthe mothers of the non-ICDS area. This signifies that nutrition and health educationimparted in ICDS programme has helped to some extent in enhancing the level ofawareness, among mothers and brought some changes in their behaviour. This hasalso been observed by others concerned (5,8,10,13,14). Still, there is a need forlaunching an educational campaign on need based messages to inform care-giversabout early initiation of breastfeeding practices in both the areas.ConclusionSince NHEd service is expected to support or have a positive influence oninfant feeding practices, the findings show that there is a need to strengthen NHEdcomponents of the ICDS scheme, for community empowerment and behaviourchange. The focus should be more on knowledge, which the care-givers alreadyhave and strive to support it and build on it.In order to ensure desirable behavioural change in the community and toreinforce desirable infant feeding practices, the care provider should make moredoor to door visits for imparting NHEd to the mothers. She should also, frequentlyorganise mothers meetings or community meetings for this purpose, for influencingthe social behaviour with particular reference to the feeding practices.In the non-ICDS areas, doctors, nutrition experts, social activists and healthproviders can encourage appropriate feeding practices. Firstly, they may educateand motivate the care-givers for adoption of healthy infant feeding practices.Secondly, they may alter hospital and health-centre policies that discouragebreastfeeding. In this connection, capacity building of care-providers on appropriate10Thus, in urban areas, the prominentareas of concern including discarding offeeding of colostrum or delayed initiationof breast-feeding, non-exclusive breast-feeding, early and over dilution of topfeeding, premature or delayedintroduction of semi-solids low in caloricdensity and feeding less frequently.
  11. 11. infant feeding practices is essential for improving their knowledge and skills. Inaddition, services of the non-government organisations, community level workers,media and involvement of formal and non-formal education are suggested to beutilised for imparting nutrition and health education. The non-governmentorganisations can network and liaison with the government, judiciary, medicalprofession and with all the groups interested in the promotion of early initiation ofbreastfeeding. They can discuss the benefits of breastfeeding with the familymembers and have good contacts with the people at the grass-root level.Thus, an effort should be made to incorporate a very strong nutritioneducation input, in the various developmental programmes for improving nutritionalstatus of the children. Although the observations cannot be generalised, due to smallsample size of this study, however, the results are encouraging in the ICDS area ascompared to the non-ICDS area. Lastly more studies with bigger sample spread aretherefore, needed to be undertaken for designing suitable policies.AcknowledgementThe author thanks Dr. Surendra Singh, Professor and Head, Department ofSocial Work and Dean, Faculty of Arts, Lucknow University, Mr. Muttoo, Director,NIPPCD, New Delhi, Dr. Sheila Vir, Project Director, UNICEF and Dr. ShellyAwasthi, Professor, Paediatric Department, KGMC for their constant guidance andinvaluable suggestions without which this endeavour would have never beencompleted.Contributors: Dr. A.K. Nigam, Director, Institute if Applied Statistics and DevelopmentStudies deserves to be highly appreciated for the data-analysis and Mr. A.K.Dwivedi, Director, Academy of Management Studies (AMS) for his help and supportrendered for completing the task.Funding – NoneCompeting Interests: None statedREFERENCES1. Dutta Banik, N.D. 1977. Some observations on feeding Programmes, Nutritionand Growth of Pre-school Children in an Urban Community. Indian JournalPaediatrics. 1977 44: 139.2. Rebello L.M., Srivastava V., Juneja S., 1997. Infant feeding and weaningpractices in the Katras of Delhi. Research and Evaluation Division, CentralHealth Education Bureau, New Delhi.11
  12. 12. 3. Gupta, R. 1982. Infant feeding patterns in urban families: A field study.Unpublished masters dissertation. Department of Child Development, LadyIrwin College, University of Delhi.4. Dutta, R.1982, Infants and Mothers: Feeding Practices of Domestic Workers.Unpublished masters disseration. Department of Child Development, LadyIrwin College, University of Delhi.5. Shekhar, M. 1983. Infant feeding practices in an urban slum. A report byNational Institute of Public Cooperation and Child Development.6. Institute of Applied Statistics and Development Studies, Lucknow, 1999.7. Nutritional status of Children and Women in U.P. : Department of Women andChild Development, 1998.8. Agarwal, M.; Infant feeding practices in ICDS and non-ICDS rural areas ofUttar Pradesh - A comparative study, NIPCCD, Regional Centre, Lucknow,2000.9. Ananthakrishna, Suseela : A comparative study of Infant feeding practices inan ICDS area. Madras (Tamil Nadu), Kilpauk Medical College, Department ofPaediatrics, 1984.10.National Evaluation of Integrated Child Development Services Scheme,NIPCCD, New Delhi, 1992.11.Narayanan L. Prakash, K. Prabhakar, A.K. and Gujral, V.v. 1980 : A plannedprospective evaluation of anti-infective property of varying quantities ofexpressed human milk, Acta. Pediatric, Scand., 71 441.12.Nutritional Status of Children and Women in U.P., Department of Women andChild Development, 1998.13.Barua, Alok and Patowary : A comparative study of nutritional status ofchildren below six years of age in ICDS and non-ICDS blocks of KamrupDistrict, Guwahati (Assam) Medical College, Guwahati, Department of Socialand Preventive Medicine (1987).14.Prasad K.R. and Nath L.M.; A controlled study of socio-culturally determinedchild feeding habits in relation to protein-calorie malnutrition. IndianPaediatrics, 1976.12

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