|BRIEF RESEARCH ARTICLE
|Year : 2013 | Volume
| Issue : 3 | Page : 169-172
Association of child feeding practices with nutritional status of under-two slum dwelling children: A community-based study from West Bengal, India
Dipta K Mukhopadhyay1, Apurba Sinhababu2, Asit B Saren3, Akhil B Biswas4
1 Assistant Professor, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, India
2 Professor, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, India
3 Associate Professor, Department of Community Medicine, Bankura Sammilani Medical College, Bankura, India
4 Professor, Institute of Health and Family Welfare, Kolkata, India
|Date of Web Publication||14-Oct-2013|
Dipta K Mukhopadhyay
Assistant Professor, Department of Community Medicine, Bankura Sammilani Medical College, Lokepur, Near N.C.C. Office, Bankura - 722 102, West Bengal
Source of Support: IAPSM (WB Chapter) Research Grant 2010-11, Conflict of Interest: None
| Abstract|| |
A cross-sectional study was conducted among 245 under-two slum-dwelling children in Bankura town, West Bengal, to assess their feeding practices and its association with nutritional status. Child's gender, number of family members, standard of living (SLI), and household food security (HFS) were assessed through interview of mothers/ caregivers. Child feeding practices were measured with Composite Child Feeding Index comprising of age-appropriate, multiple, infant and young child feeding (IYCF) indicators and expressed in standardized IYCF score. Weight and length of the children were measured and the nutritional status was assessed using World Health Organization Growth Standard 2006. Standardized IYCF score was significantly lower in undernourished children than those with normal grades. Per unit increase in standardized IYCF score was likely to reduce the prevalence of underweight, stunting and wasting by 2-3% after adjusting for other variables. Low/ very low HFS, low SLI and female gender were associated with underweight and stunting.
Keywords: Child feeding index, India, Infant and young child feeding practices, Infant, Nutritional status, Young children
|How to cite this article:|
Mukhopadhyay DK, Sinhababu A, Saren AB, Biswas AB. Association of child feeding practices with nutritional status of under-two slum dwelling children: A community-based study from West Bengal, India. Indian J Public Health 2013;57:169-72
|How to cite this URL:|
Mukhopadhyay DK, Sinhababu A, Saren AB, Biswas AB. Association of child feeding practices with nutritional status of under-two slum dwelling children: A community-based study from West Bengal, India. Indian J Public Health [serial online] 2013 [cited 2019 Nov 13];57:169-72. Available from: http://www.ijph.in/text.asp?2013/57/3/169/119819
Adequate nutrition in first 24 months through optimal infant and young child feeding is fundamental for development of a child to its fullest potential.  Studies have demonstrated adverse consequences of inappropriate feeding practices on growth, development, and survival of infants and children. ,
World Health Organization (WHO) recommends initiation of breast feeding within 1 hour of birth, exclusive breast feeding for first 6 months of life and continued breast feeding for 2 years or more together with age-appropriate, nutritionally adequate complementary feeding initiated after 6 months of age as Optimum Infant and Young Child Feeding (OIYCF) practices and formulated key indicators for assessment. ,
Assessment of Infant and Young Child Feeding (IYCF) practices using composite child feeding index based on key indicators identified by WHO and its relation with nutritional status of young children, not extensively studied in India, is the topic of recent interest. ,
Against this background, the study was undertaken in the slums of Bankura Municipal area, West Bengal to assess the feeding practices among children below 2 years and to find out association between child feeding practices and their nutritional status.
A cross-sectional, community-based study was conducted in slums of Bankura town among children aged 0-23 months. Those having any congenital or metabolical diseases influencing growth, history of acute respiratory infection/diarrhea in preceding 15 days, or measles in 3 months prior to the date of survey were excluded.
Using the proportion of children fed with at least three IYCF practices in West Bengal (28.5%) as per National Family Health Survey (NFHS-3), considering 20% relative precision, 95% confidence level, and 10% non-response rate, the sample size was worked out as 264.  Two-stage random sampling technique was used to select slums in the first stage and eligible children in the second stage.
The study obtained clearance from Institutional Ethics Committee, B. S. Medical College, Bankura. Informed consent was taken from each respondent.
Information regarding socio-demographic variables like gender, total family members, standard of living index, household food security, and child feeding practices were collected through interviewing mothers/responsible caregivers of the participants at their household with a pre-designed, pre-tested, and semi-structured questionnaire. Age of the child was ascertained from birth certificate, hospital discharge certificate, mother and child card, or local event calendar prepared for this purpose.
Validated Bengali version of six-item Household Food Security Scale (HFSS) was used in this study.  Based on raw score, households were categorized into three groups: high/marginal food security (score 0-1), low food security (score 2-4), and very low food security (score > 4). 
Socio-economic status was assessed with Standard of Living Index (SLI) as used in National Family Health Survey (NFHS-2) and households were divided into three categories based on total score for the household assets: low (score 0-14), medium (score 14-24), and high (score > 25). 
Standardized procedure was followed to measure weight by Digital Child Weighing Scale with a precision of 5 g and length by Infantometer with a precision of 0.5 cm. 
Z-score was used to determine underweight, stunting, and wasting based on WHO Growth Standard-2006 using Anthro2005 software.
Operational definition of indicators for measuring IYCF practices as recommended by WHO was followed. ,
Two separate scales were prepared to assess age-specific child feeding practices for age groups of 0-5 month and 6-23 month based on OIYCF guidelines. ,, Feeding practices were rated in a dichotomous scale answer being yes or no. Early feeding practices initiation of breast feeding and pre-lacteal feeding were included in both the scale.
Composite child feeding index for 0-5 month age group was constructed by: any breast feeding, exclusive breast feeding/breast feeding eight times or more/intake of liquid food other than breast milk/ intake of solid, semi-solid, soft food and bottle feeding.
For 6-23 months age group the index was constructed by: continued breast feeding/introduction of solid, semi-solid, soft food/minimum meal frequency/minimum amount per meal/minimum dietary diversity/active feeding/ consistency and safety of food.
An age-appropriate IYCF practice as per WHO guidelines, received a score of '1' and the inappropriate practices were given a score of '0'. Practices, considered particularly important for a given age group namely exclusive breast feeding and breast feeding for eight times or more in 0-5 month age group and minimum meal frequency, minimum dietary diversity, and minimum amount per meal in 6-23 month age group received a score of '2'. This scoring pattern was followed in a similar study in Bangladesh by Saha et al. 
Proportions were calculated for IYCF practices and the nutritional status of the study children. Score in age-specific Composite Child-feeding Index was standardized by expressing it in percentage of maximum attainable score of the particular index. Differences of Standardized IYCF scores among different grades of underweight, stunting and wasting were tested with Kruskal-Wallis Test followed by Mann-Whitney 'U' test. Logistic regression technique was used to find out the strength of association of Standardized IYCF scores with nutritional status after adjusting other socio-demographic variables.
Baring unwilling or absent caregivers of 19 children, 245 under-two children participated in the study. Out of these 245 study children, 19.6% were below six months, 32.2% were 6-11-months old and 48.2% were in 12-23-months age group. More than half (52.2%) were male children. Majority (43.7%) households had medium SLI, followed by low SLI (37.1%). HFS was high or marginal in 69.0% households whereas 5.7% households had very low HFS.
In 0-5 month age group, 39.6% children were put to breast within 1 hour of birth whereas 38.1% mothers did so in 6-23-month age group. Pre-lacteal feeding was received by 27.1% children of 0-5 month and 25.4% children of 6-23 months.
Exclusive breast feeding and breast feeding for eight times or more in last 24 hours were noted in 52.1% and 68.8% below 6-month children, respectively. One-fourth infants were bottle-fed and 12.5% received solid/semi-solid food before 6 months.
Among 6-23 months children, 95.9% children continued breast feeding. Age-appropriate minimum meal frequency was found in 67.0% children whereas intake of minimum amount per meal and minimum dietary diversity were 31.5% and 24.4%, respectively. Consistency was just right in 70.1% and feeding was safe in 48.7% cases. 76.1% mothers reported active feeding.
As shown in [Table 1], 35.9% children were underweight and 15.9% severely underweight. Stunting was found in 31.4% children and 15.1% were severely stunted. The prevalence of wasting was 20% and 4.9% were severely wasted.
|Table 1: Standardized IYCF score and nutritional status based on weight for age, length for age, and weight for length|
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There was linear relation between standardized IYCF scores and grades of undernutrition (normal, moderate, and severe) with severe grades having the lowest score [Table 1]. It was also noted that the difference in standardized score between any two grades was statistically significant (Mann-Whitney U; P < 0.05) except between normal and moderate grades (P = 0.063) of stunting. The standardized IYCF score was significantly higher in normal than undernourished children (moderate and severe grades together) in all three indicators (P < 0.001), and, the age group of 0-5 months than 6-23 months (P = 0.023).
Per unit increase in standardized IYCF score, undernutrition by all three indicators was likely to be reduced by 2-3% and the association was significant after adjustment for the studied independent variables. Besides, underweight and stunting were significantly associated with female gender, low/very low HFS, low SLI while wasting was associated significantly with low/very low HFS [Table 2].
|Table 2: Logistic regression showing association between nutritional status and IYCF practices after adjusting socio-demographic|
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Individual IYCF practices related to early feeding, breast feeding and complementary feeding in both the age groups of 0-5 months and 6-23 months, though poor, were comparable to what was reported in NFHS-3 for India and West Bengal. An earlier study on IYCF practices in Bankura district also depicted similar picture. 
Significantly higher standardized IYCF score in normal than undernourished children as noted in the present study was in line with two earlier studies in India. Significantly lower standardized IYCF score among 6-23-month-old children compared to 0-5 months pointed toward the need for more attention toward inappropriate complementary feeding.
A number of interrelated socio-economic and cultural factors were known to be associated with feeding practices and nutritional status of under-two children. Significant negative association of standardized IYCF score with undernutrition among under-two children after adjusting for other related factors highlighted its crucial role in child nutrition especially in resource-constrained setting like the present one.  Studies in Latin America and Burkina Faso reported positive association between child feeding index and HAZ score whereas Ntab et al. failed to find any such relation. ,, In India, Garg et al. reported association between child feeding index score and undernutrition whereas Srivastava et al. failed to find so. ,
Causal relationship could not be elicited by the cross-sectional study. The methodology of assessing IYCF, though widely accepted internationally, has its own limitations. The advantages of composite index were that it was age-specific and could capture multiple key dimensions of IYCF practices considering possible combined influence.
The present study might add to the evidence in favor of implementing IYCF practices for reducing under-nutrition among young children in the Indian context.
| Acknowledgment|| |
Authors gratefully acknowledge the financial assistance of IAPSM (WB Chapter) for conduction of the study. Authors would like to thank Dr. Sujishnu Mukhopadhyay Assoc. Professor, Community Medicine, Burdwan Medical College, Burdwan for his kind review of the draft.
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[Table 1], [Table 2]
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