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Go Back       Himalayan Journal of Nursing and Midwifery | Volume:1 Issue:4 | July 10, 2022
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A Hospital Based Study on Complementary Feeding Knowledge among Postnatal Mothers in District Kangra, Himachal Pradesh


Dr. Neha Patyal1, Dr. Adarsh kaundal2*

1District Programe Officer, District Bilaspur, Himachal Pradesh, India


2* Medical Officer Incharge, PHC Dhanot, District kangra, Himachal Pradesh, India


*Corresponding Author

Dr. ADARSH KAUNDAL


Article History

Received: 20.06.2022

Accepted: 30.06.2022

Published: 10.07.2022


Abstract: Background: For sustained growth and development, complementary feeding is necessary to supply the energy and vital nutrients. Present study was carried out to evaluate the knowledge towards complementary feeding among postnatal mothers attending Primary Health Center, Dhanot of District Kangra. Methods: This cross sectional study was conducted between January 2022- March 2022 among postnatal mothers attending Primary Health Center, Dhanot of district Kangra and selected by convenience sampling technique. Data was collected through face-to-face interview using a semi-structured questionnaire. Data was analyzed using epi info v7 software using appropriate statistical tests. Results: A total of 400 Post Natal Mothers came to OPD and having children aged less than 2 year were selected after explaining the purpose of the study. Among the total mothers, maximum 198 (49.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 166 (41.5%) Hindu 366 (91.5%), Housewife 301 (75.25%), Multigravida 285 (71.5%) and delivered in government hospitals 278 (69.5%). In the present study 9.25% (37) postnatal mothers had very good knowledge (16-20 marks) towards complementary feeding, 72.5% (290) having good knowledge (12-15 marks), 15% (60) having fair knowledge (8-11 marks) and 3.25% (13) having poor knowledge (<8 marks). Conclusions: Postpartum mothers had good knowledge of complementary feeding. For further increase in mothers' complementary feeding knowledge and feeding practices, appropriate complementary feeding education that emphasizing prompt commencement and meal variety is required.


Keywords: Complementary Feeding, Knowledge, Postnatal Mothers, District Kangra, Himachal Pradesh.


INTRODUCTION

In order to supply the necessary nutrients and energy for continuing growth and development, complementary feeding is required. The name comes from the fact that the nutrients in the suggested supplementary foods complete those in breast milk. They complement one another well and each have a certain function.1


In many developing countries, the incidence of under-nutrition usually increases during the period of complementary feeding from the age of 6 to 18 months. The occurrence of early nutritional deficits is linked with long-term impairments in child health and growth2.


Numerous studies suggest starting complementary feeding at around 6 months of age. Infants are not developmentally ready for complementary foods before the age of four months, therefore introduction before then is too early. Infants that are introduced too early are unable to get breast milk exclusively for he advised six months.3


According to many studies, More than 50% of infants are given complementary food too early and usually of poor nutritional value which don’t meet the criteria of dietary diversity and feeding frequency. Therefore, only few children receive nutritionally adequate and safe complementary food.4


Early introduction might be decreased by raising awareness of and adherence to feeding recommendations. Healthcare professionals and others who may have an impact on newborn feeding practices should inform families about the ideal time to introduce complementary foods5.


A number of studies have assessed knowledge of complementary feeding in different parts of the India; such studies are limited among postnatal mothers rural areas of District Kangra. Thus the present study was developed to examine the knowledge towards complementary feeding among postnatal mothers attending Primary Health Center, Dhanot of District Kangra, Himachal Pradesh.


OBJECTIVES OF THE STUDY:

To evaluate the knowledge regarding complementary feeding among postnatal mothers attending Primary Health Center, Dhanot of District Kangra, Himachal Pradesh.


RESEARCH METHODOLOGY:

  • Research Approach -Descriptive

  • Research Design-Hospital based cross-sectional survey design

  • Setting of the study- OPD in Primary Health Center, Dhanot of district Kangra, Himachal Pradesh

  • Study duration- between January 2022- March 2022

  • Study population- Post Natal Mothers came to OPD and having children aged less than 2 year

  • Sample size- 400 Post Natal Mothers assuming 50% mothers have adequate knowledge regarding complementary feeding, 5% absolute error, 95% confidence level, and 5% non-response rate.

  • Sampling Technique- convenience Sampling technique

  • Sampling criteria- first five post natal mothers who came to OPD and having children aged less than 2 year were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent was taken from them and confidentiality of the selected participants was also maintained

  • Inclusive Criteria- Post natal mothers who were willing to participate in the study.

  • Exclusion Criteria: Post natal mothers who were not willing to participate in the study

  • Description of Tool-

  • Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income, delivery pattern, ANC Checkup and many more.

  • Questionnaire: The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know). The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

  • Validity of tool - by the experts in this field

  • Data collection by under the guidance of supervisors and Post natal mothers were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time

  • Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage.


RESULTS:

Present study was developed to evaluate the knowledge towards complementary feeding among postnatal mothers attending Primary Health Center, Dhanot of district Kangra, Himachal Pradesh. A total of 400 Post Natal Mothers came to OPD and having children aged less than 2 year were selected after explaining the purpose of the study. Among the total mothers, maximum 198 (49.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 166 (41.5%) Hindu 366 (91.5%), Housewife 301 (75.25%), Multigravida 285 (71.5%) and delivered in government hospitals 278 (69.5%).


Table 1: Socio demographic characteristics of the participants

Maternal Age

Frequency

Percent

<20

11

2.75

21-25

118

29.5

26-30

198

49.5

31-35

64

16

>35

9

2.25

Maternal education



No education

12

3

Primary (1–8 yrs)

52

13

Matric & Senior Secondary

166

41.5

Graduate

146

36.5

Post graduates

24

6

Religion



Hindu

366

91.5

Muslim/others

34

8.5

Employed



No(Housewife)

301

75.25

Yes

99

24.75

Household income, INR



<10,000

22

5.5

10,000 -20000

109

27.25

20,000-40000

175

43.75

>40000

94

23.5

Gravida



Primigravida

115

28.75

Multigravida

285

71.25

Infant gender



Girl

190

47.5

Boy

210

52.5

Birth weight



Normal weight( >  2500 g)

321

80.25

Low birth weight (≤ 2500 g)

79

19.75

Antenatal visits



0

4

1

2-3

22

5.5

3-4

283

70.75

>4

91

22.75

Delivery place



Home

6

1.5

Sub-center/PHC/District Hospital (Government)

278

69.5

Nursing Maternity/Private Home

116

29

Delivery type



Vaginal

325

81.25

Caesarian

75

18.75


Table 2: Responses of the participants to various statements

S. No.

Statements

Frequency

Response

1.

Complementary feeding should be start at 6 month of age.

315

78.75

2.

Complementary foods introduced too early are of little benefit to the infant and may even be harmful due to the possibility of choking, developing food allergies

288

72

3.

Introducing complementary foods too late may cause an infant to develop nutritional deficiencies and/or miss that period of developmental readiness

323

80.75

4.

Infant may have difficulties learning to eat complementary foods when they are introduced late

266

66.5

5.

When complementary foods are introduced appropriate to the

developmental stage of the infant, nutritional requirements can be met and eating and self-feeding skills can develop properly.

334

83.5

6.

Complementary foods should be introduced with spoon and bowl.

234

58.5

7.

The texture of foods can progress from pureed to ground to

fork-mashed and eventually to diced.

232

58

8.

Infants should only be given foods that are appropriate for their developmental age.

313

78.25

9.

Infants should not be non-vegeatarin food.

256

64

10.

Junk food should not be given to infants.

332

83

11.

Iron-fortified infant rice cereal is a good choice as an infant’s first complementary food

199

49.75

12.

The quality of children’s diets is more important before age 2 than at any other time in life

212

53

13.

Appropriate complementary foods and feeding practices contribute to child survival, growth and development

315

78.75

14.

Appropriate complementary Foods prevent micronutrient

deficiencies, morbidity and obesity later in life

219

54.75

15.

An adequate diet during the complementary feeding period should be nutrient rich, without excess energy, saturated and trans fats, free sugars or salt.

189

47.25

16.

Young children need to consume a variety of foods to meet their nutrient needs and expose them to various tastes and textures

256

64

17.

Children should continue frequent, on-demand breastfeeding until 2 years of age or longer

189

47.25

18.

Three meals a day of solid, semi-solid or soft foods for breastfed children aged 9–23 months is Age-appropriate meal frequency

193

48.25

19.

¾ cup to 1 cup per meal to children aged 12–23 months is

Age-appropriate amounts

197

49.25

20.

Young children move from eating mashed foods, to finger foods, to family foods by the time they reach their first year

278

69.5


Table 3: Knowledge towards complementary feeding among postnatal mothers’

Category (Marks)

Number of postnatal mothers (n=400)

percent

V. Good (16-20)

37

9.25

Good (12-15)

290

72.5

Fair(8-11)

60

15

Poor(<8)

13

3.25

Maximum =20 Minimum=6


In the present study 9.25% (37) postnatal mothers’ had very good knowledge (16-20 marks) towards complementary feeding, 72.5% (290) having good knowledge (12-15 marks), 15% (60) having fair knowledge (8-11 marks) and 3.25% (13) having poor knowledge (<8 marks).


DISCUSSION:

The WHO defines complementary feeding as the transitional stage from family meals to exclusive nursing while breastfeeding is still being done. The World Health Organization advises feeding infants at least twice a day between the ages of 6 and 8 months, and at least three times a day between the ages of 9 and 12 months.6,7


NFHS 5 data on complementary feeding in District kangra showed that there was only 15.5% Breastfeeding children age 6-23 months receiving an adequate diet. Also, in total only 18.6% children age 6-23 months receiving an adequate diet.8 (Table-4).


Table 4: NFHS-5 data on complementary Feeding in District Sirmaur

Sl. No.

Indicator

NFHS-5 2019-20

NFHS-4 2015-16

1.

Breastfeeding children age 6-23 months receiving an adequate diet (%)

15.5

8.3

2.

Total children age 6-23 months receiving an adequate diet (%)

18.6

10.5


Literature has shown that socio-demographic characteristics have an impact on knowledge of baby feeding. Ample complementary meals, appropriate supplementary feeding techniques, and adequate nutrition services are the determinants of young children's diets during the complementary feeding phase. These drivers—also known as socio-demographic factors—have an impact on these determinants. The ability of early children to have nourishing, secure, cheap, and sustainable diets that safeguard, promote, and support survival, growth, and development is determined by the determinants and drivers of young children's diets.6,9


Reduction of child malnutrition through appropriate complementary feeding remains an important global health goal. Complementary feeding education targeting behavioral change especially among mothers in developing countries is important to reduce child morbidity and mortality4.


LIMITATIONS OF THE STUDY:

The present study has certain limitations such as cross sectional in nature, all the participants were at postpartum having children aged less than 2 years and small sample size that made difficult to generalize the findings. Future research should be focused on larger sample and qualitative studies such as focus group interviews to identify barriers to promote appropriate complementary feeding knowledge and practices among postnatal mothers.


However, despite of these limitations, the present study findings may be helpful to the health professionals and policy makers in designing the interventions to promote age appropriate complementary feeding practices.


CONCLUSION:

The current study comes to the conclusion that mothers were well-versed in complementary feeding. Even yet, there was a sizable knowledge gap in supplemental feeding since it did not meet WHO criteria at the recommended level.


It's crucial to provide supplemental feeding education that focuses on behavioural modification to lower child morbidity, mortality, and undernutrition. To increase mothers' complementary feeding knowledge and feeding practises, appropriate complementary feeding education that emphasises prompt commencement and meal variety is required.


REFERENCES:

  1. Nutrition week. Available at: https://www.nutritionweek.co.za/20compfeeding.html#:~:text=Complementary%20feeding%20is%20needed%20to,have%20a%20role%20to%20play.(Accessed on 17 June 2022)

  2. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 1, The importance of infant and young child feeding and recommended practices. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148967/(Accessed on 13 June 2022)

  3. Chiang KV, Hamner HC, Li R, Perrine CG. Timing of introduction of complementary foods—United States, 2016–2018. Morbidity and Mortality Weekly Report. 2020 Nov 27;69(47):1787–1791.

  4. Olatona FA, Adenihun JO, Aderibigbe SA, Adeniyi OF. Complementary feeding knowledge, practices, and dietary diversity among mothers of under-five children in an urban community in Lagos State, Nigeria. International Journal of MCH and AIDS. 2017;6(1):46-59.

  5. Center for Disease Prevention & Control. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6947a4.htm (Accessed on 17 June 2022)

  6. World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding (Accessed on 13 June 2022)

  7. World Health Organization. Available at: https://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf (Accessed on 15 June 2022)

  8. NFHS-5. Available at: http://rchiips.org/nfhs/NFHS-5_FCTS/HP/Kangra.pdf (Accessed on 19 June 2022 )

  9. Gewa CA, Leslie TF. Distribution and determinants of young child feeding practices in the East African region: demographic health survey data analysis from 2008-2011. Journal of Health, Population and Nutrition. 2015 Dec;34(1):1-4.

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