A Cross Sectional Study to Evaluate the Complementary Feeding Knowledge among Reproductive Age Group Females in Himachal Pradesh

doi:10.47310/hjcmph.2022.v03i02.031

Contents

Abstract
Keywords
Introduction
Research Methodology
Results
Discussion
Discussion
Conclusion
Conflict Of Interest:
Funding:
Ethical Approval:
References

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Research Article | Volume 3 Issue 2 (July-Dec, 2022) | Pages 1 - 4

A Cross Sectional Study to Evaluate the Complementary Feeding Knowledge among Reproductive Age Group Females in Himachal Pradesh

A B Kiran

M Tenzin

Dr Kiran Bala Azad, MO Pediatrics Civil Hospital Manali Distt, Kullu (H.P), 175131 India

Dr Tenzin Mentok, MO Pediatrics Regional Hospital Kullu Distt. Kullu (H.P), 175101 India

Under a Creative Commons license

Open Access

DOI : 10.47310/hjcmph.2022.v03i02.031

Received

Aug. 10, 2022

Revised

Aug. 20, 2022

Accepted

Sept. 20, 2022

Published

Oct. 20, 2022

Abstract

Background: In order to supply the necessary nutrients and energy for continuing growth and development, complementary feeding is required. The current study was conducted in Himachal Pradesh to assess the understanding of complementary feeding among females of reproductive age. Methods: This cross-sectional survey of females in the state of Himachal Pradesh who are of reproductive age was carried out between July 2022 and September 2022 using Google forms. Until 400 replies were gathered, the google form was distributed among female residents of the state in the reproductive age group for responses via online means including email and social networking sites like Whatsapp groups, Facebook, Instagram, and Linkedin. We gathered details about their sociodemographic make-up and their understanding of complementary feeding. Epi info v7 software was used to evaluate the data using the necessary statistical tests. Results: A total of 400 females were participated in the survey. Among them, maximum 196 (49%) were having age between 26-30 years, educated up to Matric & Senior Secondary 160 (40%), Hindu 378(94.5%) and housewife 361 (90.25%). In the present study 7.75% (31) participants had very good knowledge (16-20 marks) towards complementary feeding, 71.5% (286) having good knowledge (12-15 marks), 17% (68) having fair knowledge (8-11 marks) and 3.75% (15) having poor knowledge (<8 marks). Conclusions: Participants in the study had adequate knowledge of complementary feeding. To increase mothers' complementary feeding knowledge and feeding practises, appropriate complementary feeding education that emphasises prompt commencement and meal variety is required.

Keywords

Complementary Feeding

Knowledge

Females of reproductive age

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 has a certain function.[1]

The incidence of under nutrition often rises in many developing nations throughout the period of supplemental feeding from the age of 6 to 18 months. Early dietary deficiencies are associated with long-term harm to children's health and development.[2]

Numerous studies suggest starting supplemental 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 the advised six months. [3]

Numerous studies have found that more than 50% of newborns receive supplemental food too early, often with little nutritional value, and infrequently enough to meet the requirements of dietary diversity and feeding frequency. Consequently, very few children receive supplemental food that is both safe and nutritionally adequate. [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 practises should inform families about the ideal time to introduce supplemental foods. [5]

A number of studies have assessed knowledge of complementary feeding in different parts of the India; such studies are limited in Himachal Pradesh. Thus the present study was developed to examine the knowledge towards complementary feeding among reproductive age group females in Himachal Pradesh.

Objectives of the Study

To evaluate the knowledge regarding complementary feeding among reproductive age group females in Himachal Pradesh

RESEARCH METHODOLOGY

Research Approach -Descriptive
Research Design- Cross-sectional survey design
Study area: Whole state of Himachal Pradesh
Study duration- between July 2022 to September 2022
Study population: All reproductive age group females who were staying in the Himachal Pradesh for 12 months or more.
Sample size- 400 reproductive age group females, assuming 50% have adequate knowledge regarding complementary Feeding, 5% absolute error, 95% confidence level, and 5% non response rate.
Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding complementary feeding was created. The questionnaire was initially pre-tested on a small number of females to identify any difficulty in understanding by the respondents.
Description of Tool-

Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.
Questionnaire: The questionnaire contains 20 structured complementary feeding 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- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among reproductive age group female residents of the state for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected.
Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage.
Ethical Considerations- Participants confidentiality and anonymity was maintained.

RESULTS

Present study was developed to evaluate the knowledge towards complementary feeding among reproductive age group females of Himachal Pradesh. A total of 400 females were participated, maximum 196 (49%) were having age between 26-30 years, educated up to Matric & Senior Secondary 160 (40%), Hindu 378(94.5%) and housewife 361 (90.25%).

Table 1. Socio demographic characteristics of the participants

Age group		Response	Percent
<20	12		3
21-25	118		29.5
26-30	196		49
31-35	67		16.75
>35	7		1.75
Education
No education	14		3.5
Primary (1–8 yrs)	52		13
Matric & Senior Secondary	160		40
Graduate	138		34.5
Post graduates	36		9
Religion
Hindu	378		94.5
Muslim/others	22		5.5
Employed
No(Housewife)	361		90.25
Yes	39		9.75

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.	304	76
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	270	67.5
3.	Introducing complementary foods too late may cause an infant to develop nutritional deficiencies and/or miss that period of developmental readiness	290	72.5
4.	Infant may have difficulties learning to eat complementary foods when they are introduced late	247	61.75
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.	304	76
6.	Complementary foods should be introduced with spoon and bowl.	200	50
7.	The texture of foods can progress from pureed to ground to fork-mashed and eventually to diced.	228	57
8.	Infants should only be given foods that are appropriate for their developmental age.	304	76
9.	Infants should not be non-vegeatarin food.	276	69
10.	Junk food should not be given to infants.	314	78.5
11.	Iron-fortified infant rice cereal is a good choice as an infant’s first complementary food	185	46.25
12.	The quality of children’s diets is more important before age 2 than at any other time in life	200	50
13.	Appropriate complementary foods and feeding practices contribute to child survival, growth and development	309	77.25
14.	Appropriate complementary Foods prevent micronutrient deficiencies, morbidity and obesity later in life	204	51
15.	An adequate diet during the complementary feeding period should be nutrient rich, without excess energy, saturated and trans fats, free sugars or salt.	185	46.25
16.	Young children need to consume a variety of foods to meet their nutrient needs and expose them to various tastes and textures	214	53.5
17.	Children should continue frequent, on-demand breastfeeding until 2 years of age or longer	181	45.25
18.	Three meals a day of solid, semi-solid or soft foods for breastfed children aged 9–23 months is Age-appropriate meal frequency	185	46.25
19.	¾ cup to 1 cup per meal to children aged 12–23 months is Age-appropriate amounts	181	45.25
20.	Young children move from eating mashed foods, to finger foods, to family foods by the time they reach their first year	266	66.5

Table 3: Knowledge towards complementary feeding among Study participants

Category (Marks)	Frequency (n=400)	Percent
V. Good (16-20)	31	7.75
Good (12-15)	286	71.5
Fair(8-11)	68	17
Poor(<8)	15	3.75

Maximum =20 Minimum=6

In the present study 7.75% (31) participants had very good knowledge (16-20 marks) towards complementary feeding, 71.5% (286) having good knowledge (12-15 marks), 17% (68) having fair knowledge (8-11 marks) and 3.75% (15) having poor knowledge (<8 marks).

DISCUSSION

Table 1. Socio demographic characteristics of the participants

Age group		Response	Percent
<20	12		3
21-25	118		29.5
26-30	196		49
31-35	67		16.75
>35	7		1.75
Education
No education	14		3.5
Primary (1–8 yrs)	52		13
Matric & Senior Secondary	160		40
Graduate	138		34.5
Post graduates	36		9
Religion
Hindu	378		94.5
Muslim/others	22		5.5
Employed
No(Housewife)	361		90.25
Yes	39		9.75

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.	304	76
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	270	67.5
3.	Introducing complementary foods too late may cause an infant to develop nutritional deficiencies and/or miss that period of developmental readiness	290	72.5
4.	Infant may have difficulties learning to eat complementary foods when they are introduced late	247	61.75
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.	304	76
6.	Complementary foods should be introduced with spoon and bowl.	200	50
7.	The texture of foods can progress from pureed to ground to fork-mashed and eventually to diced.	228	57
8.	Infants should only be given foods that are appropriate for their developmental age.	304	76
9.	Infants should not be non-vegeatarin food.	276	69
10.	Junk food should not be given to infants.	314	78.5
11.	Iron-fortified infant rice cereal is a good choice as an infant’s first complementary food	185	46.25
12.	The quality of children’s diets is more important before age 2 than at any other time in life	200	50
13.	Appropriate complementary foods and feeding practices contribute to child survival, growth and development	309	77.25
14.	Appropriate complementary Foods prevent micronutrient deficiencies, morbidity and obesity later in life	204	51
15.	An adequate diet during the complementary feeding period should be nutrient rich, without excess energy, saturated and trans fats, free sugars or salt.	185	46.25
16.	Young children need to consume a variety of foods to meet their nutrient needs and expose them to various tastes and textures	214	53.5
17.	Children should continue frequent, on-demand breastfeeding until 2 years of age or longer	181	45.25
18.	Three meals a day of solid, semi-solid or soft foods for breastfed children aged 9–23 months is Age-appropriate meal frequency	185	46.25
19.	¾ cup to 1 cup per meal to children aged 12–23 months is Age-appropriate amounts	181	45.25
20.	Young children move from eating mashed foods, to finger foods, to family foods by the time they reach their first year	266	66.5

Table 3: Knowledge towards complementary feeding among Study participants

Category (Marks)	Frequency (n=400)	Percent
V. Good (16-20)	31	7.75
Good (12-15)	286	71.5
Fair(8-11)	68	17
Poor(<8)	15	3.75

Maximum =20 Minimum=6

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 Himachal Pradesh showed that there was only 18 % Breastfeeding children age 6-23 months receiving an adequate diet. Also, in total only 19% children age 6-23 months receiving an adequate diet [8](Table-4)

Table-4: NFHS-5 data on complementary Feeding in Himachal Pradesh

Sr.no	Indicator	NFHS-5 2019-20	NFHS-4 2015-16
1		Total	Total
2	Children age 6-8 month receiving solid or semi- solid food and breastmilk (%)	68.3	52.9
3	Breastfeeding children age 6-23 months receiving an adequate diet (%)	18	11.2
4	Non- breastfeeding children age 6-23 months receiving an adequate diet(%)	21.6	10
	Total children age 6-23 months receiving an adequate diet (%)	19	10.9

Literature has shown that sociodemographic 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 factors that affect early children's diets collectively influence whether or not kids can eat healthy, inexpensive, sustainable diets that protect, promote, and encourage survival, growth, and development.[6,9]

An important global health objective continues to be the reduction of child malnutrition through adequate supplemental feeding. To lower child morbidity and death, complementary feeding education that focuses on behavioural change, especially among mothers in developing nations, is crucial.^.[4]

CONCLUSION

The current study comes to the conclusion that study subjects have good understanding about complementery feeding. Even yet, there was a sizable knowledge gap in complementary feeding since it did not meet WHO criteria at the recommended level.

It's crucial to provide supplemental feeding education that focuses on behavioral modification to lower child morbidity, mortality, and under nutrition. To increase mothers' complementary feeding knowledge and feeding practices, appropriate complementary feeding education that emphasizes prompt commencement and meal diversity is required.

Conflict of Interest:

The authors declare that they have no conflict of interest

Funding:

No funding sources

Ethical approval:

The study was approved by the Institutional Ethics Committee of MO Pediatrics Regional Hospital Kullu.

REFERENCES

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 Sep 2022)
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 Sep 2022)
Chiang, Katelyn V., et al. "Timing of introduction of complementary foods—United States, 2016–2018." Morbidity and Mortality Weekly Report 69.47 (2020): 1787. https://doi.org/10.15585/mmwr.mm6947a2.
Olatona, Foluke Adenike, et al. "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 6.1 (2017): 46. https://doi.org/10.21106/ijma.117
Center for Disease Prevention & Control. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6947a4.htm (Accessed on 17 Sep 2022)
World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding (Accessed on 13 Sep 2022)
World Health Organization. Available at: https://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf (Accessed on 15 Sep 2022)
NFHS-5. Available at: https://www.im4change.org/docs/Himachal% 20Pradesh%20NFHS-5%20Factsheet.pdf (Accessed on 19 Sep 2022)
Gewa, Constance A., and Timothy F. Leslie. "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 34.1 (2015): 1-14. https://doi.org/10.3329/jhpn.v34i1.22819

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