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TRENDS IN BOTTLE FEEDING IN AN URBAN SLUM
Rb Gurav*, S Kartikeyan**, Jc Kale*
*Lecturer; **Associate Professor, Department of Preventive and Social Medicine, Rajiv Gandhi Medical College, Kalwa, Thane 400 605 (Maharashtra).
The present study was conducted in an urban slum in the city of Thane (Maharashtra), with a total population of 4,311. The study population included all the 252 babies (aged 24 months or below), in this urban slum. Interviews conducted with the mothers of the babies in the study population revealed that the bottle feeding rate was 9.95%. The bottle fed babies were all in the age group of 4-12 months. 60% of the mothers who had resorted to bottle feeding were working women. The identification of the current trends in bottle feeding would enable the initiation of interventions to encourage breast feeding and to reduce bottle feeding practices so thatchild morbidity and mortality can be reduced.
INTRODUCTION
Infant’s natural food is breast milk. The World Health Organization and UNICEF have emphasised breast feeding of infants both in the interest of the health of the mother and the child. Exclusive breast feeding is a situation where the only nourishment the baby receives is the mother’s milk. In fact, breast feeding alone is adequate as the sole source of food for an infant upto the first four to six months of age. The desirability of breast feeding for at least four to six months is more important to the resources of poor countries as it protects against inter-related syndromes of marasmus and diarrhoea and offers the effect of child spacing, to some extent.[3]
In the developed countries, the downward trend in breast feeding till the 1970’s has been reversed.[4] Conversely, in many developing countries, the situation is deteriorating.[5] There has been a tendency towards an early shift to bottle feeding.[6] This was seen even among semi-literate mothers in urban areas.[12] In urban areas, almost one-third of the mothers stop breast feeding within two months,[7] inspite of advice by health care personnel to breast feed exclusively for the first four months.[8] Hence it is necessary to keep this practice under continuous surveillance, so that timely interventions could be undertaken at the earliest indication of decline.[9]
There are some superstitions regarding bottle feeding. It is believed that the feeding bottle should be covered by a napkin or a cloth to avoid ‘nazar’ (the effects of the evil eye on the infant). If the feeding bottle is properly sterilized and proper personal hygiene is practised, there is no risk of any untoward ill-effects on the child.[11]
The present study was carried with the aim of assessing the existing bottle feeding practices in an urban slum community in an industrial city, so that timely action could be taken.
MATERIAL AND METHODS
This study was conducted in an urban slum area of the industrial city of Thane (Maharashtra). This study area was the field practice area of a medical college. The total population in the area (4,311) was surveyed by personnel posted at the local Municipal health centre, using a house-to-house approach.
A child who receives any liquid or semi-solid food from a bottle with a nipple/teat was termed as ‘bottle-fed child’.[1] The bottle-feeding rate was calculated as per WHO guide and lines.[13] In the survey, 252 children below or equal to 24 months of age was reported. The respondents in the study were the mothers of these 252 children. Interviews were conducted regarding bottle feeding practices during the preceding 24 hours. During a pilot study, it was found that a period of 24 hours was considered to be adequate to get reasonably accurate recall from the respondents. The details were recorded in a close-formated pre-tested proforma. The proforma also included questions on the educational attainment and the occupation of the mother. The interviews were conducted by female health personnel. The observations were analysed, tabulated and discussed.RESULTS AND DISCUSSION
In this study, mothers of 252 children aged 24 months or less were interviewed regarding bottle feeding during the preceding 24 hours.
15 (5.95%) children out of 252, received cow’s milk and/or water through bottles, along with breast milk and other feeds. Of the 15 children, seven (46.66%) were males and eight (53.34%) were females (Table 1). All these 15 babies were in the age group of 4 to 12 months.
TABLE 1
Distribution of bottle feeding practicesAge in Months Sex of Baby Bottle feeding Bottle feeding Yes No 0-4 Males 0 34 34 Females 0 31 31 4-8 Males 2 20 22 Females 2 22 24 8-12 Males 5 17 22 Females 6 14 20 12-16 Males 0 20 20 Females 0 17 17 16-20 Males 0 17 17 Females 0 16 16 20-24 Males 0 16 16 Females 0 13 13 Total Males 7(5.34%) 124 (94.66%) 131 (100%) Females 8 (6.61%) 113 (93.39%) 121 (100%) Total 15(5.95%) 237(94.05%) 252(100%)
Pandey et al [1] observed in the rural area of West Bengal, that the proportion of children who were bottle fed (aged less than 6 months) was 17.6% and the proportion of bottle fed (aged 1 year) was 23.3%. Kushwaha et al,[2] in a peri-urban area of Gorakhpur (UP), found less than 14.8% infants above three months of age, being fed from bottles. In the present study, none of the infants below 4 months of age received bottle feeds. Compared to the results of the studies referred to above,[1,2] the bottle feeding rate was much lower in the present study. This phenomenon needs further investigation.
Of the 15 mothers who were feeding their babies with bottles, seven (46.66%) were working in the non-organized sector, two (13.33%) were working in the organized sector. Six mothers (40%) were housewives (Table 2). In case of the working mothers, the babies were bottle fed in the absence of the mother, by the child’s grandmother or older siblings. Six mothers who were housewives fed their babies using bottles, on their own, or sometimes by other family members. All the mothers or the relatives discarded the remaining feeds in the bottle. In each case, fresh cow’s milk and/or water was used for each feed.
TABLE 2
Occupation of mothers and bottle feedingOccupation Bottle Feeding Total Yes No Non- Organised Sector 7 61 68 (46.66%) (25.74%) (26.59%) Organised Sector 2 22 24 (13.33%) (9.28%) (9.92%) Housewives 6 154 160 (40.00%) (64.98%) (63.49%) Total 15 237 252 (100%) (100%) (100%) Chi Square = 4 P > 0.05
The educational attainment of the 15 mothers in the present study was as follows : illiterate - 20.0%, primary schooling 46.66%, secondary schooling and above - 33.33% (Table 3).
TABLE 3
Educational status of mothersEducation Bottle Feeding Total Yes No Illiterate 3 18 21 (20.00%) (7.59%) (8.33%) Primary 7 143 150 (46.66%) (60.34%) (59.52%) Secondary and above 5 76 81 (33.33%) (32.07%) (32.14%) Total 15 237 252 (100%) (100%) (100%) Chi Square=3.03 P > 0.05
None of the respondents in the present study had two children, both below or equal to 24 months of age. 12 out of 15 (80%) washed and boiled the feeding bottles before each feed.
The most common reason given (by 85.34% of the housewives) for bottle feeding was that their breast milk was inadequate. Some housewives also felt that bottle feeding was a convenient method of feeding.CONCLUSION
In the present study, out of 252 children aged below or equal to 24 months, 9.95% received cow’s milk and/or water through bottles. This category of babies belonged to 4 to 12 months age group. The bottle feeding rate of 9.95% was much less than the findings in other studies. 60% of the mothers who resorted to bottle feeding, were working. Periodic surveys would be necessary to pinpoint causes for the current trends in bottle feeding. This would enable initiation of interventions to encourage breast feeding and to reduce bottle feeding practices so that child morbidity and mortality can be reduced. Though laws have been enacted to regulate the promotion of baby foods,[10] their enforcement seems to be lax. Well planned educational interventions can counter the effect of advertisements on the mothers.
REFERENCES :
1.Pandey GK, Hazra S, Vajpayee A, Chatterjee P. Breast feeding indicators from a rural community in West Bengal. Indian Journal of Public Health 1997; 41 (3) : 71-4.
2.Kushwaha KP, Mathur GP, Om Prakash. Infant feeding practices in peri-urban areas of Gorakhpur. Indian Paediatrics 1987; 24 : 899-901.
3.Mehendale AM. Exclusive breastfeeding - The need for promotion. Swasth Hind 1995; 39 (10-12) : 159-60.
4.Taitz LS. Breast feeding trends in sheffield (1976-82). British Medical Journal 1983; 287 : 648.
5.World Health Organization : Protecting, Promoting and Supporting Breast feeding. The Special Role of Maternity services. A Joint WHO/UNICEF Statement, Geneva. 1989.
6.Dutta R, Shobana G. Trends in Breast feeding impression from an urban educated community. Indian Paediatrics 1981; 18 : 655-60.
7.Kumar S, Nath LM, Reddiah VP. Breast feeding practices in a re-settlement colony and its implications, for promotional activities. Indian Journal of Paediatrics 1989; 56 : 239-42.
8.IAP. Special Committee Recommendations on Breast Feeding. Indian Paediatrics 1994; 21 : 83-4.
9.World Health Organization : Prevalance and duration of breast feeding - Critical Review of available information. World Health Statistics 1982; 35 : 92-116.
10.CMAI : Breast feeding is a Human Right. Health Dialogue. Christian Medical Association of India, New Delhi. 2000; 22 : 171-73.
11.Sachdeva NL. Social Aspects of Milk. Swasth Hind 1995; 39 (10-12) : 171-73.
12.Kartikeyan S, Arekar AS. Comparative Study on Infant Feeding Practices among Non-Working Mothers. Indian Journal of Occupational Health 2000; 43 (3) : 141-45.
13.World Health Organization. Indicators for assessing breast feeding practices. WHO, Geneva. 1991.
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