project paper

1.1 General
Malnutrition is one of the most important health and welfare problems among infants and
young children in not only Bangladesh but also worldwide. It is a result of both inadequate
food intake and illness. Inadequate food intake is a consequence of insufficient food available
at the household level, or improper feeding practices, or both. Improper feeding practices
include both the quality and quantity of foods offered to young children as well as the timing
of their introduction1
.
Adequate nutrition during infancy and early childhood is fundamental to the development of
each child’s full human potential. It is well recognized that the period from birth to two years
of age is a “critical window” for the promotion of optimal growth, health and behavioral
development. The first year of life is a period of very rapid growth. An infant's birth weight
doubles after about five months and triples by the first birthday, by which time the infant's
length increases by half. Adequate and appropriate nutrition is essential during this period,
for infants that do not receive sufficient calories, vitamins, and minerals will not reach their
expected growth. An infant's requirement for calories is determined by size, rate of growth,
activity, and energy needed for metabolic activities1
.
Infant and Young child feeding (IYCF) has the greatest single potential impact on a child’s
growth and survival2
. Breast feeding milk alone is enough to meet the nutritional needs of an
infant up to the age of six months. It is the best way of providing the ideal food for the
healthy growth and development of infants and its advantages range from physiological to
psychological for both mother and infants3
. Breast feeding lowers infant mortality, especially
that caused by diarrhea and acute respiratory infections4
. After six months of life, both
appropriate and sufficient complementary food should be added to the breast milk so as to
help it meet the nutritional requirements. The transition from exclusive breastfeeding to
family foods – referred to as complementary feeding – typically covers the period from 6-24
months of age, even though breastfeeding may continue to two years of age and beyond. This
is a critical period of growth during which nutrient deficiencies and illnesses contribute
globally to higher rates of under nutrition among children less than five years of age5, 6, and 7
.
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1.2 Aim of the study
The aim of the study was to examine the awareness of breast feeding and complementary
feeding practice of the children of urban rural area of Mirpur of Dhaka City and review the
impact of malnourishment upon the high incidence of infections and infection among
children due to lack of awareness about complementary feeding practice.
1.3 Specific Objectives
The specific objectives of the study were-
1. To assess the nutritional status of the young child (6 months-24 months) in Mirpur area
and surrounding rural area and slums of Mirpur.
2. To know the prevalence of malnutrition.
3. To find out the causes of poor nutritional status in that local areas.
4. To know the health status of the lactating mothers and the awareness about breast
feeding.
5. To find out any infectious diseases or complication associated with the pregnancy.
6. To estimate the present situation of awareness among young mothers about breast
feeding and complimentary feeding.
7. To find out the association of infections and infection with aspects of demographic,
socioeconomic, health and community factors.
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2. Literature Review
2.1 Introduction
Adequate nutrition during infancy and early childhood is fundamental to the development
of each child’s full human potential. It is well recognized that the period from birth to two
years of age is a “critical window” for the promotion of optimal growth, health and
behavioral development1
. Malnutrition is one of the most important health and welfare
problems among infants and young children in not only Bangladesh but also worldwide.
Breast feeding lowers infant mortality, especially that caused by diarrhea and acute
respiratory infections4
. After six months of life, both appropriate and sufficient
complementary food should be added to the breast milk so as to help it meet the nutritional
requirements. This transition from exclusive breast feeding to family foods, referred to as
complementary feeding 5,6,7
. Inadequate complementary feeding lacking in quality and
quantity can impair the growth of a child. Around the age of 6 months, an infant’s need for
energy and nutrients starts to exceed what is provided by breast milk and complementary
foods are necessary to meet energy and nutrient requirements. At about 6 months of age, an
infant is also developmentally ready for other foods. If complementary foods are not
introduced when a child has completed 6 months of age, or if they are given
inappropriately, an infant’s growth may falter8
.
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2.2 Global recommendations for appropriate feeding of infants and young children
 Breastfeeding should start early, within one hour after birth.
 Breastfeeding should be exclusive for six months.
 Appropriate complementary feeding should start from the age of six months with
continued breastfeeding up to two years or beyond.
2.3 Breastfeeding
Breast milk from a well-nourished mother will supply adequate amounts of most vitamins
and minerals, as will an iron - fortified formula. All professional and international health
organizations are in agreement that breastfeeding is the recommended method of infant
feeding. Although breastfeeding is clearly essential for infants born in less industrialized
countries, benefits are substantial in industrialized countries as well. In less industrialized
countries, breastfeeding reduces infant mortality and morbidity.
Breast milk is nutritionally superior to formula, and it contains antibodies that reduce the
risk of infection for the newborn baby. Breastfed infants have a decreased incidence of
respiratory, gastrointestinal, and ear infections. The cost of feeding the infant is reduced,
and the very nature of breastfeeding supports the mother-infant bond. There is also
evidence that breastfed infants develop fewer allergies, and when tested at eighteen months
of age they score higher on intelligence tests.
It is not advisable for an infant to receive whole cow's milk before one year of age. Feeding
cow's milk before one year has been associated with the development of iron deficiency. If
breastfeeding is discontinued before one year of age, an iron-fortified, commercially
prepared infant formula is recommended.
2.4 Advantages of Breastfeeding
Breastfeeding can be extremely rewarding and emotionally satisfying for both mother and
baby. It has definite physical and emotional health benefits for both.
2.4.1 Benefits for Baby
• Mother’s milk is the most nutritious food for baby, helping ensure their best growth and
development.
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• It is easily digested by the immature digestive and excretory systems.
• It contains antibodies and living cells that provide protection and immunity against
many types of infection.
• It contains unique proteins and fatty acids that stimulate brain development.
• It lowers risk of allergies.
• It is constantly available at the right temperature and cannot be contaminated.
• Promotes proper jaw and teeth development.
• Long-term health benefits—lessens the risk of being overweight and developing heart
disease in adulthood.
• Breastfeeding enhances bonding by the warmth and security of skin, eye and voice
contact, as well as stimulating baby’s sense of taste and smell.
2.4.2 Benefits for Mother
• Oxytocin is a hormone released when breastfeed, causing the uterus to contract,
minimising bleeding and returning the uterus to its pre-pregnant state faster.
• As the milk production process burns calories, it helps you get back to pre-pregnant
figure, providing eat healthily.
• Promotes bonding with baby, emotional satisfaction and a feeling of well-being.
• Decreases the risk of pre-menopausal breast cancer.
• Convenient and readily available, requires less preparation and equipment, and makes
socialising and traveling easier.
• Economical – no need to buy infant formula, bottles or sterilizing equipment11
.
2.5 Exclusive Breastfeeding
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Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or
solids are given – not even water – with the exception of oral rehydration solution, or
drops/syrups of vitamins, minerals or medicines18
. The advantages of exclusive
breastfeeding compared to partial breastfeeding were recognized in 1984, when a review of
available studies found that the risk of death from diarrhea of partially breastfed infants 0–6
months of age was 8.6 times the risk for exclusively breastfed children. For those who
received no breast milk the risk was 25 times that of those who were exclusively
breastfed19
. A study in Brazil in 1987 found that compared with exclusive breastfeeding,
partial breastfeeding was associated with 4.2 times the risk of death, while no breastfeeding
had 14.2 times the risk20
. More recently, a study in Dhaka, Bangladesh found that deaths
from diarrhea and pneumonia could be reduced by one third if infants were exclusively
instead of partially breastfed for the first 4 months of life21
. Exclusive breastfeeding for 6
months has been found to reduce the risk of diarrhea22
and respiratory illness 23
compared
with exclusive breastfeeding for 3 and 4 months respectively. If the breastfeeding technique
is satisfactory, exclusive breastfeeding for the first 6 months of life meets the energy and
nutrient needs of the vast majority of infants24
. No other foods or fluids are necessary.
Several studies have shown that healthy infants do not need additional water during the first
6 months if they are exclusively breastfed, even in a hot climate. Breast milk itself is 88%
water, and is enough to satisfy a baby's thirst25
. Extra fluids displace breast milk, and do not
increase overall intake26
. However, water and teas are commonly given to infants, often
starting in the first week of life. This practice has been associated with a two-fold increased
risk of diarrhea27
. For the mother, exclusive breastfeeding can delay the return of fertility28
,
and accelerate recovery of pre-pregnancy weight29
. Mothers who breastfeed exclusively and
frequently have less than a 2% risk of becoming pregnant in the first 6 months postpartum,
provided that they still have amenorrhea.
2.6 Complementary Feeding
Complementary feeding is defined as the process starting when breast milk alone is no
longer sufficient to meet the nutritional requirements of infants, and therefore other foods
and liquids are needed, along with breast milk. The transition from exclusive breastfeeding
to family foods – referred to as complementary feeding – typically covers the period from
6-24 months of age, even though breastfeeding may continue to two years of age and
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beyond. This is a critical period of growth during which nutrient deficiencies and illnesses
contribute globally to higher rates of under nutrition among children less than five years of
age. A number of successful strategies have been developed to improve complementary
feeding practices in low and middle-income countries, where practical difficulties can limit
adherence to complementary feeding guidelines10
.
2.6.1 Appropriate Complementary Feeding is
 timely – meaning that foods are introduced when the need for energy and nutrients
exceeds what can be provided through exclusive and frequent breastfeeding;
 adequate – meaning that foods provide sufficient energy, protein, and micronutrients
to meet a growing child’s nutritional needs;
 safe – meaning that foods are hygienically stored and prepared, and fed with clean
hands using clean utensils and not bottles and teats;
 properly fed – meaning that foods are given consistent with a child’s signals of
appetite and satiety, and that meal frequency and feeding method – actively
encouraging the child to consume sufficient food using fingers, spoon or self-feeding
are suitable for age 9
.
2.6.2 Importance of Complementary Feeding
From 6 months of age your baby needs breast milk and solid foods to promote health,
support growth and enhance development. This is called complementary feeding. From the
age of 6 months a baby needs more energy and nutrients than can be provided by breast
milk alone. At this age a baby’s digestive system is mature enough to digest a range of
foods. Complementary feeding is needed to provide energy and essential nutrients required
for continued growth and development. The nutrients in recommended complementary
foods complement those in breast milk, hence the name. Complement means they go well
together, each have a role to play. The recommended feeding practices during this time
ensure that child receives all the necessary nutrients, including those that are sometime
missing for many babies (iron, zinc and vitamin A). Contrary to popular practice,
introducing foods like meat, eggs and liver in the early stages of complementary feeding is
recommended, because these foods are good sources of these nutrients12
.
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2.6.3 Complementary Feeding from 6 months
From the age of 6 months, an infant's need for energy and nutrients starts to exceed what is
provided by breast milk and complementary feeding becomes necessary to fill the energy
and nutrient gap15
. If complementary foods are not introduced at this age or if they are
given inappropriately, an infant's growth may falter. In many countries, the period of
complementary feeding from 6–23 months is the time of peak incidence of growth
faltering, micronutrient deficiencies and infectious illnesses16
.
Even after complementary foods have been introduced, breastfeeding remains a critical
source of nutrients for the young infant and child. It provides about one half of an infant's
energy needs up to the age of one year, and up to one third during the second year of life.
Breast milk continues to supply higher quality nutrients than complementary foods, and
also protective factors. It is therefore recommended that breastfeeding on demand continues
with adequate complementary feeding up to 2 years or beyond17
.
Complementary foods need to be nutritionally-adequate, safe and appropriately fed in order
to meet the young child's energy and nutrient needs. However, complementary feeding is
often fraught with problems, with foods being too dilute, not fed often enough or in too
small amounts, or replacing breast milk while being of an inferior quality. Both food and
feeding practices influence the quality of complementary feeding, and mothers and families
need support to practice good complementary feeding17
.
2.7 Early & Late Introduction of Complementary Foods
Timing of the first introduction of solid food during infancy may have potential effects on
life-long health30
. It can be seen that very often solid foods are either given too early or too
late. According to UNICEF31
, the frequency and amounts of food that is given may be
insufficient hence; hindering the normal growth of the child or their consistency or energy
density may be incorrect in relation to the child’s needs.
2.7.1 Early Weaning
Some studies have shown that giving solid foods too early may lead to increased risk of
chronic diseases such as islet autoimmunity (the pre-clinical condition leading to Type 1
diabetes), obesity, adult-onset celiac disease, and eczema30
. Nevertheless, it was affirmed
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there is no evidence of harm even within populations that begin weaning within a few days
of birth32
.
2.7.2 Late Weaning
A study by Kuo et al.30
has shown that late weaning may cause deficiencies of zinc, protein,
iron and vitamins B and D that leads to the suppression of growth and cause feeding
problems. Iron deficiency anemia and rickets are also found to be more prevalent among
infants who are weaned after 6 months32
.
2.8. Mixed feeding: Combining Breastfeeding and Bottle Feeding
Mixed feeding may be defined as the addition food that is fed to baby with the breast milk.
The additional food may have any of this one like pasteurized milk, cows’ milk or goats’
milk and powder milk or even the combination of these before the 6th
months of child. It
supposed to use when mother feel that breast milk is not fed her baby properly. Due to
some chronic illness mother may stopped breast feeding and use mixed feeding. Mixed
feeding may be used to following:
• Illness, health conditions, or if you or your baby needs surgery
• Needing to take medication that is contraindicated with breastfeeding
• Postnatal depression
• Breast or nipple problems
• Personal choice
• A return to paid work
• A need for flexibility
• Physical separation
2.9. Formula Feeding
The governments of most countries have developed nutrient standards for commercial
infant formulas. These guidelines ensure that a formula has nutrients similar to the breast
milk from a well-nourished woman. Most infant formulas are made from either modified
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cow's milk or soy, and both types will meet an infant's nutritional requirements. Standard
infant formula comes in both a low-iron and iron-fortified form. Iron-fortified formula is
always recommended, except in very specific circumstances. A third category of formulas
has been developed for children with severe allergies, gastrointestinal problems, or other
medical complications. These are classified as elemental formulas, and are prescribed when
an infant cannot tolerate any other type of formula.
The newborn infant will feed between eight to twelve times a day. As weight is gained, the
infant will take more at each feeding and the number of feedings per day will decrease. An
infant who is receiving adequate feeds will have at least six wet diapers a day, will appear
satisfied after a feeding, and will follow the established growth curve.
In less industrialized countries, or in situations where formula costs are too high, infant
formulas made from evaporated milk have been used. This is not recommended, however,
since an infant would require more vitamin and mineral supplementation, and there is also a
risk of incorrectly prepared formula. When any type of formula is prepared, it is essential
that the water, bottles, and all the equipment used are sanitized, that hands are washed
during preparation, and that the formula is kept refrigerated14
.
2.10. Recommended Food Intake for Infants and Toddlers
Good nutrition during infancy and toddlerhood is best achieved through a healthy diet.
Daily caloric requirements and feeding frequencies change at different age levels. Each
infant and toddler has different caloric requirements, appetite levels and energy levels. The
following age-appropriate feeding requirements list the average feeding times and
quantities; feeding schedules and amounts may need to be adjusted for a particular child:
2.10.1 0 - 4 to 6 Months
Infants should only be fed breast milk or iron-fortified formula for the first 4 to 6 months of
life. Newborn breastfed infants should be fed on demand or about 8 to 12 times a day.
Newborn infants fed iron-fortified formula should be fed 2 to 3 ounces of formula, 6 to 8
times a day. Once a baby reaches about 2 months old the amount of feeding times a day
decreases, while the amount fed at each meal increases. Breasted babies will determine how
much to eat per feeding. After 2 months of age, bottle fed babies should be offered a bottle
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4 to 6 times a day or more often if the baby demands it and will gradually increase to eating
6 to 8 ounces of formula per feeding.
2.10.2 4 to 6 Months
At 4 to 6 months of age, infants have higher energy requirements and become capable of
swallowing simple foods. Feed babies at this age baby cereal, mixed with breast milk or
formula, twice a day. Start with 2 tablespoons of dry cereal mixed with enough breast milk
or formula to hydrate the cereal. Gradually increase the amount of cereal to 4 tablespoons,
mixed with breast milk or formula.
2.10.3 6 to 8 Months
At between 6 to 8 months of age, start introducing new foods such as mashed fruits and
vegetables. Gradually introduce one new food every three days. Feed four - 2 to 3
tablespoon servings of fruits and vegetables over the course of a day, divided into 3 meal
times. Continue to breast or bottle feed 3 to 5 times a day. Between meals, limited amounts
of appropriate age-based finger foods, such as baby biscuits can be offered.
2.10.4 8 to 12 Months
Between 8 and 12 months of age, infants should breast or bottle feed 3 to 4 times a day.
Fruit and vegetable intake should increase to a 3 to 4 tablespoon size serving four times a
day. In addition, one - 3 to 4 tablespoon serving of pureed meat should be fed a day.
Gradually introduce meats into the diet, one at a time, once a week. Egg yolks can be fed as
a meat replacement 3 to 4 times a week.
2.10.5 1 to 2 Years
Once a baby reaches one year old, solid foods should make up the majority of caloric
requirements. After one year old, formula should be discontinued and water placed in the
bottle if necessary. Breastfed babies can continue to breastfeed along with solid foods. The
types of solid foods should be varied to include whole grains (wheat bread and oatmeal),
dairy products (whole milk, cheese and yogurt), fruits and vegetables and meat. Toddlers
tend to eat small amounts per meal and require 4 to 6 feedings a day, meaning they should
be fed 2 to 3 snacks a day, in addition to meals13
.
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3. Methodology
3.1 Study Area
The survey was conducted among the children living in Mirpur, Dhaka, Bangladesh. At the
2000 census of Bangladesh, Mirpur had a population of 1,074,232, of which males
constituted 54.15% and females 45.85%.( 2000 Census of Bangladesh). Bauniabadh,
Shawrapara, Shanpara, Paikpara, Manikdi, Tularbag & Horirampur area were selected from
Mirpur city for this study.
3.2 Study Period
The study was conducted from 5th
October to 10th
November, 2015
3.3 Study Design
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It was a cross sectional study.
3.3.1 Study Population
The family of different class of people of Mirpur Area (Bauniabadh, Shanpara,
Shawrapara) was enumerated first. Then only those area like Manikdi, Kalshi, Kollanpur,
Horirampur, Tularbag having 6-24 months children who represents the nutritional status of
the community.
3.3.2 Sample Size
Total 100 samples were studied. 33 sample for Urban and 67 sample data were collected for
study.
3.3.3 Development of Questionnaire
A questionnaire was developed to obtain relevant information on anthropometric data,
dietary information, health information, socio-economic condition. All questions were
designed, pretested, modification and resettled to obtain and record information easily. Any
modification necessary were then made, and a final questionnaire was drawn up. The study
consisted of 4 set of precoded questionnaire to various aspects of the subjects under study
in accordance with the objectives of the survey. The questionnaire was first pretested on
Mirpur-11.
3.4 Collection of Data
Both quantitative (anthropometric data) & qualitative data (socioeconomic data, dietary
data etc) were collected.
3.4.1 Anthropometric data
To assess he nutrition status, the anthropometric measurement such as height, weight,
MUAC, were taken by the following standard methods.
3.4.2 Weight
The subjects were weighted while wearing normal clothing without shoes, to the nearest
0.1kg with a Bathroom scale. Human weight varies extensively both individually and
across populations.
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3.4.3 Measurement of weight for infant
The sample baby weight is calculated by a simple method.
 First, mother weight is taken by a weight machine.
 Secondly, mother weight with her baby is taken by weight machine.
 Thirdly, the difference between mother weight with baby and mother weight is
calculated by subtraction.
3.4.4 Measurement of weight for mother
 The mother stands in the centre of the platform, weight distributed evenly two both feet.
Standing off-centre may affect measurement.
 The weights are moved until the beam balances (the arrows are aligned).
 Then the weight is recorded to the resolution of the scale.
3.4.5 Height
Human height varies greatly between individuals and across populations for a variety of
complex biological, genetic, and environmental factors, among others. Due to
methodological and practical problems, its measurement is also subject to considerable error
in statistical sampling.
3.4.6 Measurement of height for infant
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 Remove the child or teen's shoes, bulky clothing, and hair ornaments, and unbraid hair
that interferes with the measurement.
 Take the height measurement on flooring that is not carpeted and against a flat surface
such as a wall with no molding.
 Have the child or teen stand with feet flat, together, and against the wall. Make sure legs
are straight, arms are at sides, and shoulders are level.
 Make sure the child or teen is looking straight ahead and that the line of sight is parallel
with the floor.
 Take the measurement while the child or teen stands with head, shoulders, buttocks, and
heels touching the flat surface (wall). Depending on the overall body shape of the child
or teen, all points may not touch the wall.
 Use a flat headpiece to form a right angle with the wall and lower the headpiece until it
firmly touches the crown of the head.
 Make sure the measurer's eyes are at the same level as the headpiece.
 Lightly mark where the bottom of the headpiece meets the wall. Then, use a metal tape
to measure from the base on the floor to the marked measurement on the wall to get the
height measurement.
 Accurately record the height to the nearest 1/8th inch or 0.1 centimeter34
.
3.4.7 Measurement of height for mother
 Remove the mother's shoes, bulky clothing, and hair ornaments, and unbraid hair that
interferes with the measurement.
 Take the height measurement on flooring that is not carpeted and against a flat surface
such as a wall with no molding.
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 Have mother stand with feet flat, together, and against the wall. Make sure legs are
straight, arms are at sides, and shoulders are level.
 Make sure mother is looking straight ahead and that the line of sight is parallel with the
floor.
 Take the measurement while the mother stands with head, shoulders, buttocks, and
heels touching the flat surface (wall). Depending on the overall body shape of the
mother, all points may not touch the wall.
 Use a flat headpiece to form a right angle with the wall and lower the headpiece until it
firmly touches the crown of the head.
 Make sure the measurer's eyes are at the same level as the headpiece.
 Lightly mark where the bottom of the headpiece meets the wall. Then, use a metal tape
to measure from the base on the floor to the marked measurement on the wall to get the
height measurement.
 Accurately record the height to the nearest 1/8th inch or 0.1 centimeter.
3.4.8 BMI
The Body Mass Index (BMI), or Quetelet Index, is a value derived from the mass (weight)
and height of an individual. The BMI is defined as the body mass divided by the square of the
body height, and is universally expressed in units of kg/m2
, resulting from mass in kilograms
and height in metres. The BMI may also be determined using a table or chart which displays
BMI as a function of mass and height using contour lines or colors for different BMI
categories, and may use two different units of measurement.
The BMI is an attempt to quantify the amount of tissue mass (muscle, fat, and bone) in an
individual, and then categorize that person as underweight, normal weight, overweight, or
obese based on that value. However, there is some debate about where on the BMI scale the
Page | 16

dividing lines between categories should be placed. Commonly accepted BMI ranges are
underweight: under 18.5, normal weight: 18.5 to 25, overweight: 25 to 30, obese: over 30.35
3.4.9 Dietary Information
Food frequency questionnaire was used to assess food intake dietary pattern by interviewing
the mother of the children, the questionnaire uses different food groups such as carbohydrate,
protein, vitamin, minerals etc in terms of frequency per day or week.
3.4.10 Socio-economic Data
Socio-economic data were also obtained through age, occupation and maternal education etc.
3.5. Data analysis
After collection of raw data through interview and observation, it was cleaned and checked
analysis. Data entering into the computer were processed. All variables were checked for
distribution. Appropriate statistical tests were performed to verify the results.
4. Result
Table-4.1: Knowledge About Complementary Feeding of Lactating Mother
Have any Idea Number Total (n=100) Percentage
Urban (n=33) Rural (n=67)
Yes 33(100%) 67(100%) 100 100%
No 0 (0%) 0 (0%) 0 0%
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Table 4.1 indicates the idea about complementary feeding of 100 surveyed lactating
mother. It shows that among 100, 100 mothers has idea about complementary feeding. This
idea of information comes from the elder member of their family, neighbor, book and
television/mass media and importantly from NGO’s.
0
20
40
60
80
100
120
yes No
Idea about complementary
feeding
Series1
Figure 4.1: Graphical representation of table 4.1
Table 4.2: Initiation of Complementary Feeding
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This table presents crucial data and carries important information about complementary
feeding. It is really important to initiate the complementary feeding in a right time. The table
shows that 76% mothers start their babies complementary feeding in right time, 13% mother
gives their baby complementary feeding before 6 months, 8% mothers start their babies
complementary feeding after 6 months of their ages and 3% mothers do not yet start the
practice to give complementary feeding to their babies.
13%
76%
8% 3%
Initiation of complementay
feeding
Before 6 month
At6 month
After 6 month
Not yet
Figure 4.2 Graphical representation of table 4.2
Table 4.3 Reason of Being Late to Initiate Complementary Feeding
Reason for delay Number Total(n=100
)
Percentage
Urban(n=33) Rural (n=67)
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Period Number Total(n=100
)
Percentage
Before 6 month 4 (12.12%) 9 (13.43%) 13 13%
At 6 month 27(81.82%) 49(73.13%) 76 76%
After 6 month 2 (6.06%) 6 (8.96%) 8 8%
Not yet 0 (0%) 3 (4.48%) 3 3%

Tried but failed as children
vomit
2(25%) 4(50%) 6 75%
Have no idea about how to start 0(0%) 1(12.5%) 1 12.5%
Scared of giving new food 1(12.5%) 1 12.5%
Table 4.3 presents important data about reasons for delay of initiation of complementary
feeding. Tried but failed as child vomit percentage is 75% where urban percentage is 25% and
rural is 75%. Have no idea about how to start and scared of giving new food both reason for
rural population is 12.5% for each.
0%
20%
40%
60%
80%
100%
Tried but
failed as
child vomit
Have no
ideaabout
how to start
Scared of
giving new
food
Total
Rural
Urban
Table 4.4: Age Grouped of Sampled Children
Age of children
(months)
Male Female Total (n=100) Percentage
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6-10
Urban Rural Urban Rural 49 49 %
2 20 9 18
11-15 8 6 5 9 28 28 %
16-20 2 2 2 8 14 14 %
21-24 0 2 5 2 9 9 %
This table shows the distribution of children in both male and female of the total number of
survey sample. Among 6-10 months of age there is 22 male and female children is 27 and the
percentage of children is 49%. Percentage of children in age group of 11-15 months, 16-20
months and 21-24 months are 28%, 14% and 9% respectively.
22
14
4 2
27
14
10
7
49
28
14
9
0
10
20
30
40
50
60
6-10
month
11-15
month
16-20
month
21-24
month
male
female
total
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Table-4.5: Level of Education of Young Mother
Level of Education Number Total(n=100
)
Percentage
Illiterate 0(0%) 4(5.97%) 4 4%
Primary 0(0%) 10(14.93%) 10 10%
Secondary 13(39.39%) 41(61.19%) 54 54%
Higher Secondary 6(18.18%) 11(16.42%) 17 17%
Graduate 14(42.42%) 1(1.49%) 15 15%
The table represents that 4% of lactating mothers are below education level that mean they are
totally illiterate. Like this, I found 10% mothers are primary going, 54% are below S.S.C, Up to
H.S.C are 17% and 15% are graduate. I also found that there are some mothers who are
continuing their study after marriage even after baby birth.
0
10
20
30
40
50
60
70
Illiterate Primart Secondary Higher
Secondary
Graduate
Urban
Rural
Total
Page | 22

Table 4.6: Frequency of Breast Feeding Per Day
The table express that the number of times of breast feeding per in the range of 1th-5th
times are
38% and respectively 6th
-10th
times are 53% and more than 10th
are 9%.
0
10
20
30
40
50
60
1th - 5th 6th - 10th More than
10th
Urban
Rural
Total
Page | 23
Number of times of
B.F.
Frequency Total(n=100
)
Percentage
Urban(n=33
)
Rural(n=67)
1th – 5th
18(54.55%) 20(29.85%) 38 38%
6th
-10th
13 (39.39%) 40(59.70%) 53 53%
More than 10th
2(6.06%) 7(10.45%) 9 9%

Table 4.7: Types of Breast Feeding Practice
Types of B.F. Frequency Total(n=100
)
Percentage
Urban(n=33
)
Rural(n=67)
Exclusive 27(81.82%) 36(53.73%) 63 63%
Mixed 6(18.18%) 31(46.27%) 37 37%
Never breast feed 0(0%) 0(0%) 0 0%
This table shows the amount of exclusive feeding during 6th
months of age of children is 63%.
So, these babies are fed breast milk without any extra food consumed. The survey shows, the
result of mixed feeding 37% and never breast feed is happily 0%. So, all these indicate that the
amount of exclusive breast feeding is in high amount and it is increasing day by day.
81.82
18.18
0
53.73
46.27
0
63
37
0
0
10
20
30
40
50
60
70
80
90
Exclusive feeding Mixed feeding Never breast fed
Urban
Rural
Total
Page | 24

Table 4.8: Presence of Anemia of Lactating Mother
Presence Frequency Total Percentage
Yes 3(9.09%) 11(16.42%) 14 14%
No 30(90.91%) 56(83.58%) 86 86%
This table shows the presence of anemia of lactating mother. In the survey study, I found 14%
are the presence of anemia after giving the child birth. Severe to mild disease are observed in
those days of study. However, most of them, number of percentage, 86% are free from disease.
0
10
20
30
40
50
60
70
80
90
100
AnemiaPresent
AnemiaAbsent
9.09
90.91
16.42
83.58
14
86
Urban
Rural
Total
Page | 25

Table 4.9: Types of Mixed Feeding
Types of food Number Total(n=37) Percentage
Urban(n=33
)
Rural(n=67)
Powder milk 4(12.12) 26(38.81%) 30 81.08%
Cow’s milk 0(0%) 5 (7.46%) 5 13.51%
Suji 2(6.06%) 0(0%) 2 5.41%
This table presents three type of mixed feeding. These are powder milk, cow’s milk, sabu &
suji. 81.08% mothers give their baby powder milk as mixed feeding. Powder milk is used
as supplementary food with breast milk before 6 months as this study overlook to this
period of time. Here, the percentage of used cow’s milk is 13.51% and other like sabu and
Suji percentage is only 5.41%.
Page | 26

12.12
0
6.06
38.81
7.46
0
81.08
13.51
5.41
0
10
20
30
40
50
60
70
80
90
Powder milk cows' milk suji
urban
rural
total
Table 4.10: Comparison of Different Type of Mixed Feeding Between Urban & Rural
Population
Type of food Urban (n=6) Rural (n=31)
Powder milk 4 (66.67%) 26(83.87%)
Cows’ milk 0 (0%) 5(16.02%)
Suji 2 (33.33%) 0(0%)
Page | 27

66.67
0
33.33
83.87
16.02
0
0
10
20
30
40
50
60
70
80
90
powder milk cows'milk suji
urban
rural
Table 4.11: BMI of Lactating Mother
BMI Range Number Total(n=100
)
Percentage
Urban(n=33
)
Rural(n=67)
Below 18.5 3(9.09%) 9(13.43%) 12 12%
18.5-24.9 21(63.64%) 55(82.09%) 76 76%
25-29.9 8(24.24%) 3(4.48%) 11 11%
30 and above 30 1(3.03%) 0(0%) 1 1%
Page | 28

The table expresses the BMI range of the lactating mother. BMI is used to measure the health
condition of a person. Below 18.5 represent that person is underweight, 18.5-24.9 is count for
normal range, 25-29.9 is for overweight and 30 and above 30 is for obese. Here in study I
found 12% are underweight, 76% are in normal condition, 11% are in mild risk of health status
as overweight and 1% is obese.
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
Below 18.5 18.5-24.9 25-29.9 30 & above 30
9.09%
63.64%
24.24%
3.03%
13.43%
82.09%
4.48%
0%
12%
76%
11%
1%
urban
rural
total
Table 4.12: Source of Information About Complementary Feeding
Source Number Total(n=100) Percentage
Urban(n=33) Rural(n=67)
Book/media/internet 22(66.67%) 17(25.37%) 39 39%
Medical people/
nutritionist/NGO
7(21.21%) 28(41.79%) 35 35%
Elder in family/Neighbor 0(0%) 10(14.93%) 10 10%
Friend 4(5.97%) 12(17.91%) 16 16%
Page | 29

Table 4.12 shows the source of information about complementary feeding to lactating mother.
Here 39% are from book/ media, 35% are from NGO or nutritionist, 10% are from elder in
family and 16% are from friend.
5. Discussion
Improper complementary feeding (CF) practice is one of the main reasons for malnutrition
among Bangladeshi children aged less than two years. In this context, using the guidelines of
the World Health Organization (WHO), this study assessed the CF practices among mothers
from Bauniabadh, Shawrapara, Shanpara, Paikpara, Manikdi, Tularbag & Horirampur area of
Mirpur city, Dhaka, Bangladesh. The community based cross sectional study was conducted on
100 children among 6 months to 24 months of children of young mother. Among the surveyed
sample, 33 was from urban area and rural area sample was 67 in number. From the survey area,
anthropometric data like height and weight was collected for both mother and children and only
BMI for the lactating mothers. Table 1 indicates the idea about complementary feeding of 100
Page | 30

surveyed lactating mothers. It shows that among 100, each and every mother has idea about
complementary feeding. This idea of information comes from the elder member of their family,
neighbor, book, television/mass media and importantly from NGO’s. Table 4.2 presents crucial
data and carries important information about complementary feeding. It is really important to
initiate the complementary feeding in a right time. The table shows that 76% mothers start their
babies complementary feeding in right time. 13% mother gives their baby complementary
feeding before 6 months. Before 6 months of age, children who had started complementary
feed in urban was 4% and in rural population the percentage was higher than urban (9%). In
rural population 3% mother did not start complementary feeding after 6 months whereas in
urban area there was not any baby who was not even start complementary feeding after 6
months (table 4.2), it may suggested that complementary feeding practice is better in urban
than rural. It might be reason of the education level of the lactating mother in urban area.
Table 4.3 presents important data about reasons for delay of initiation of complementary
feeding. Tried but failed as child vomit percentage is 75% where urban percentage is 25% and
rural is 75%. Have no idea about how to start and scared of giving new food both reason for
rural population is 12.5% for each. Percentage of children in age group of 11-15 months, 16-20
months and 21-24 months are 28%, 14%, 9% respectively which has shown in table 4.4. From
analyzing the education level of mother (table 4.5), it was found that most of the mothers
(54%) were educated up to secondary level. There were 5.97% illiterate mother and 14.93%
were from primary level educated in rural area where 0% and 0% in urban area respectively.
And there were graduate mother 15% and among them most were from urban (42.42%). It
shows that the picture of education level is higher in urban area than rural area. Table 4.6
express that the numbers of times of breast feeding per in the range of 1-5 times, 6-10 times,
and more than 10 times were 38%, 53%, and 9% respectively. The percentage value of
frequency of breast feeding practice per day was higher in rural area than mother of urban area.
There was a high percentage of mothers (63%) who started the complementary feeding at the 6
months age of their baby. 37% mothers feed their children mixed feeding before 6 months as
they feel breast milk is not enough for their baby whereas never breast feed was 0% (table 4.7).
In rural area, the use of exclusive breast feeding is importantly increasing. This result from the
nutritional programme of many NGO’s who have working very positively.
Anemia is chronic diseases that occur rapidly after pregnancy in women. Risk may reduce
before and after pregnancy with some preventive measures. Table 4.8 shows the presence of
Page | 31

anemia of lactating mother. It was found that presence of anemia after giving the child birth
was 14%. However, most of them, 86% are free from anemia. What type of mixed feeding was
practiced was also surveyed. Table 4.9 presents the type of mixed feeding. These are powder
milk, cow’s milk, sabu & suji. 81.08% mothers give their baby powder milk as mixed feeding.
Powder milk is used as supplementary food with breast milk before 6 months as this study
overlook to this period of time. Here, the percentage of used cow’s milk is 13.51% and other
like sabu and Suji percentage is only 5.41%. There is some commercial power milk that is used
by doctors’ prescription and also from elders’ suggestion of relatives. Lactogen-1, Nestle NAN,
Nestle-1(three fruits supplement), Biomeal-1, Baby Care-1, Cerelac-Stage-1, Mother Smile
(Prima, 0-6 months) & Baby Meal Cereal are some powder milk commonly taken by child in
that area.
BMI is used to measure the health condition of a person, that’s why BMI of lactating mother
was also surveyed. Among the mothers 12% were underweight, 76% were in normal condition,
11% are in mild risk of health status as overweight and 1% is obese (table 4.11). Table 4.12
shows the source of information about complementary feeding to lactating mother. Here 39%
are from book/ media, 35% are from NGO or nutritionist, 10% are from elder in family and
16% are from friend.
.
6. Conclusion
In the present study, mothers had good knowledge about infant feeding practices. Among the
100 lactating mothers, 76% received complementary feeding at 6 months, only 3% had not
started on complementary foods at all. Most common reason for inappropriate practices who
delayed complementary feeding was “tried but failed as child vomits or throws out food”
(75%). 37% used mixed feeding and among them 81.08% used commercial powder milk as
supplementary food. Knowledge regarding appropriate timing of initiation of complementary
feeding and feeding commercial infant foods did not vary with maternal education.
However maternal knowledge had a significant impact on the consistency of the feed that was
offered to infants. Regarding feeding practices by food groups, rice with vegetable (76%) was
predominantly given. only 9% of children fed breast milk more than 10 times per 24 hrs.
Page | 32

Inspite of good knowledge there are lacunae in the practices of mothers due to social and
economic reasons. Level of education has positive impact on infant feeding practices.
Counselling by doctors had a better impact on the attitude and practices of mothers.
Knowledge, attitudes and practices associated with infant and young child feeding forms an
essential first step for any ‘need-felt’ for an intervention programme designed to bring about
positive behavioral change in infant health. The interaction during the study with the mothers
was utilized as an opportunity to educate them regarding the importance and the recommended
infant feeding practices.
The communities’ knowledge, attitude and practice on complementary feeding were relatively
good in the study area. The majority of the lactating mothers started the complementary diet at
appropriate age to their children. Good nutrition forms the basic foundation of health
throughout the life. Most mothers and health workers know little about how much food an child
needs for adequate growth and development. Hence the advice given is often inaccurate and
conflicting. Also there is a heavy influence of advertisements and internet on day to day life.
There is a need for parental education for sound and correct child rearing practices and in
particular advice on how, when and why and with to feed the child from what is easily
available in the household. The gap between knowledge and practice should be filled with
proper interaction and education.
Breast-feeding has declined worldwide in recent years, as a result of urbanization, marketing of
infant milk formulae and maternal employment outside the home. It is important to provide
appropriate health education and utilize every opportunity of contact with the mother to counsel
them regarding the appropriate feeding practice.
Page | 33

7. References
1. American Dietetic Association (1997). "Promotion of Breastfeeding." Journal of the
American Dietetic Association 97:662–666.
2. Programming Guide: Infant and Young child feeding. New York: Nutrition Section
Programmes, UNICEF.
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infants in a developing country: a national survey in Lebanon, public health nutrition 2005;
9(3):313-319.
4. Al-saira M, Al-dallal Z and khairya M. Breast feeding patterns and practices in the kingdom
of Bahrain (children aged 0-24). 2002. Bahrain Nutrition Prole-Nutrition and Consumer
Protection Division, FAO, 2007.
Page | 34

5. Lodha S, Bharti V. Assessment of Complementary Feeding Practices and Misconceptions
regarding foods in Young mothers. International Journal of Foodand Nutritional Sciences 2013;
2: 85-90.
6. UNICEF. Statistics on Breastfeeding in Ethiopia. Basic Indicators on Nutrition, Health,
HIV/AIDS, Education, Demographic Indicators, Economic Indicators, Women, Child
Protection. 2009.
7. World Health Organization (WHO); Global Strategies for infant and young child feeding
2003
8. The optimal duration of exclusive breastfeeding. Report of an Expert Consultation. Geneva,
World Health Organization, 2001.
9. Report of the global consultation (Complementary feeding) Geneva, 10-13 December 2001
10. http://www.who.int/elena/titles/complementary_feeding/en/
11. www.nestle.co.nz/nhw/nutritionlifestage/babynutrition/nutritionalneedsofinfants
12. http://www.nutritionweek.co.za/20compfeeding.html
13. Bhatnagar, Shinjini, Taneja, Sunita; Zinc and Cognitive Development; British Journal of
Nutrition 85, Suppl. 2, S139-S145; All India Institute of Medical Sciences; 2001
14. Roberts, Susan B.; Heyman, Dennis M.; and Tracy, Lisa (1999). Feeding Your Child for
Lifelong Health: Birth through Age Six. New York: Bantam.
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young children in developing countries and implications for intervention programs. Food and
Nutrition Bulletin. 2003;24:5–28.
16. Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and effectiveness of
complementary feeding interventions in developing countries. Maternal and Child Nutrition.
2008; 4(s1):24–85.
17. PAHO/WHO. Guiding principles for complementary feeding of the breastfed child.
Washington DC: Pan American Health Organization/World Health Organization; 2002.
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18. http://www.who.int/elena/titles/exclusive_breastfeeding/en/
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children: promotion of breastfeeding. Bulletin of the World Health Organization. 1984;
62:271–291.
20. Victora C, et al. Evidence for protection by breastfeeding against infant deaths from
infectious diseases in Brazil. Lancet. 1987;330:319–322.
21. Arifeen S, et al. Exclusive breastfeeding reduces acute respiratory infection and diarrhoea
deaths among infants in Dhaka slums. Pediatrics. 2001;108:1–8.
22. Kramer M, et al. Infant growth and health outcomes associated with 3 compared with 6
months of exclusive breastfeeding. American Journal of Clinical Nutrition. 2003;78:291–295.
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respiratory tract infection in US children. Pediatrics. 2006; 117:425–432.
24. Butte N, Lopez-Alarcon MG, Garza C. Nutrient adequacy of exclusive breastfeeding for the
term infant during the first six months of life. Geneva: World Health Organization; 2002.
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Sheet 5 Frequently Asked Questions. Washington DC: Academy for Educational Development;
2002.
26. Sachdev H, et al. Water supplementation in exclusively breastfed infants during summer in
the tropics. Lancet. 1991;337:929–933.
27. Brown K, et al. Infant feeding practices and their relationship with diarrhoeal and other
diseases in Huascar (Lima) Peru. Pediatrics. 1989;83:31–40.
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28. The World Health Organization Multinational Study of Breast-feeding and Lactational
Amenorrhea. III. Pregnancy during breast-feeding. World Health Organization Task Force on
Methods for the Natural Regulation of Fertility. Fertility and sterility. 1999; 72:431–440.
29. Dewey KG, et al. Effects of exclusive breastfeeding for 4 versus 6 months on maternal
nutritional status and infant motor development: results of two randomized trials in Honduras.
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15, 1185 (2011).
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[online]. Available from: http://www.unicef.org/programme/breastfeeding/food.htm
32. More J., Jenkins C., King C. and Shaw V., Brit. Diet. Assoc., 1 (2010).
33. https://en.wikipedia.org/wiki/Kushtia_District
34. http://www.wikihow.com/Weigh-and-Measure-Children
35. "BMI Classification". Global Database on Body Mass Index. World Health Organization.
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“A Study on Assessment of Complementary Feeding Practice & Conception
Regarding Foods of Young Mother”
Information Form
Name of the child: Name of the mother:
Age: Age:
Sex: weight:
Weight: Height:
Height/Length: BMI:
Occupation:
Address:
Page | 37

Contract number:
A. Maternal Variables
1. Breast Feeding Practices 2. Bottle Feeding
Exclusive breastfed for 6 months Yes
Mixed feeding No
Never breast fed
3. Still breast Feed Yes No (Stopped after ___ month’s age of child)
4. Frequency of breast feeding Once/Twice/Thrice/Fourth/___times a day.
5. Maternal Education 5. Type of milk used during mixed feeding
Illiterate Pasteurized milk ( _________ )
Primary School Cows’ milk
High School Goats’ milk/Buffalo milk
Up to Intermediate/ HSC Powder milk (_________ )
Graduate
Post Graduate
6. Have any disease
Yes (Anemia/ constipation / hypertension/ (_____________)
No
B. Information About Complementary Feeding Practices
1. Have any idea about complementary feeding Yes No
2. Source
Page | 38

Self Friends
Book/ media/ internet Medical people/ Nutritionist
Elder in Family (mother/ Mother in law/ Grandmother/ (_____)
Husband Neighbors
3. Initiation of complementary feeding
Before 6 months (___________)
At 6 months
After 6 months (___________)
Not yet started
4. Reason for delayed introduction of complementary feeding
Tried but failed as child vomit
Had no idea how/ what to start
Mother felt that her milk was sufficient
Family elders say that kid may not digest solid foods
Mother working had no time
Milk acceptance was good
Scared of giving new foods
5. Consistency and frequency of complementary foods
Liquid (Once/ Twice/ Thrice/ fourth/___________)
Semi-solid (Once/ Twice/ Trice/ fourth/___________)
Solid (Once/ Twice/ Trice/ fourth/___________)
Page | 39

6. Time duration of complementary feeding ___________hours later.
7. Types of complementary foods
Biscuit Cake
Egg Other confectionary products (__)
Dal water Suji
Fruits Cows’ milk
Fruit Juice Vegetables
Kichuri/ Hotchpotch Commercial foods (Horlicks/Bonvita/
Seralak/(__)
Rice
Soup Chips
Bread/ Ruti/ Chapatti Chocolate
Tea Noodles
Signature
Page | 40

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