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 [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 growth [2].

Many studies recommends introducing complementary foods at approximately age 6 months. Introduction before age 4 months is too early because infants are not developmentally ready for complementary foods. Early introduction prevents infants from reaching the recommended 6 months of exclusive breastfeeding [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].

Increasing awareness of and adherence to feeding recommendations could help reduce early introduction. Health care providers and others who might influence infant feeding practices should educate families on recommended timing of introduction of complementary foods[5].

A number of studies have assessed knowledge of complementary feeding in different parts of the India; such studies are limited among postnatal mothers in rural areas of District Sirmaur. Thus the present study was developed to examine the knowledge towards complementary feeding among postnatal mothers’ of rural areas of District Sirmaur.

Objectives of the Study

To evaluate the knowledge regarding complementary feeding among postnatal mothers’ of rural areas of District Sirmaur.

• Research Approach -Descriptive

• Research Design-Hospital based cross-sectional survey design

• Setting of the study- Pediatric OPD in civil hospital Dadahu

• Study duration- between March 2021- August 2021 

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

• Sample size- 400 Post Natal Mothers assuming 50% mothers have adequate knowledge regarding Breast 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 Pediatric 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/assent 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 Check up 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 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

Table 1: Socio Demographic Characteristics of the Participants

• 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.

Present study was developed to evaluate the knowledge towards complementary feeding among postnatal mothers’ of rural areas of District Sirmaur. A total of 400 Post Natal Mothers came to Pediatric OPD and having children aged less than 2 year were selected after explaining the purpose of the study. Among the total mothers, maximum 201(50.25%) were having age between 26-30 years, educated up to Matric & Senior Secondary 162(40.5%) Hindu 326(81.5%), Housewife 351(87.75%), Multigravida 280(70%) and delivered in government hospitals 278(69.5%).

In the present study 8.25%(33) postnatal mothers’ had very good knowledge (16-20 marks) towards complementary feeding , 72.0%(288) having good knowledge (12-15 marks), 15.25%(61) having fair knowledge (8-11 marks) and 4.5%(18) having poor knowledge (<8 marks).

According to WHO, complementary feeding is the period wherein there is a transition from exclusive breastfeeding to family foods although breastfeeding is still continued. The World Health Organization recommends that children be fed at least 2 times daily between 6-8 months and at least 3 times for children between 9-12 months and >12months of age [6,7].

Table 2: Responses of the Participants to Various Statements

Table 3: Knowledge towards Complementary Feeding among Postnatal Mothers’

Maximum =20 Minimum=6

Table-4: NFHS-5 Data on Complementary Feeding in District Sirmaur

NFHS 5 data on complementary feeding in District Sirmaur showed that there was only 11.5% Breastfeeding children age 6-23 months receiving an adequate diet. Also, in total only 9.9% children age 6-23 months receiving an adequate diet [8] (Table-4).

The influence of socio-demographic factors on infant feeding knowledge has been documented in literature. The determinants of young children’s diets during the complementary feeding period include adequate complementary foods, adequate complementary feeding practices, and adequate nutrition services. These determinants are shaped by socio-demographic factors – referred to as drivers. Together, the determinants and drivers of young children’s diets determine children’s ability to enjoy nutritious, safe, affordable and sustainable diets that protect, promote and support survival, growth and development [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 mortality [4].

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.

The present study concludes that the mothers have a good knowledge toward complementary feeding. Still there was significant gap in the complementary feeding knowledge as it was not at the optimal level when compared with the recommendations of the WHO.

Complementary feeding education targeting behavioral change is important to reduce child malnutrition, morbidity and mortality. Appropriate complementary feeding education emphasizing timely initiation and meal diversity is necessary to improve complementary feeding knowledge and feeding practices of mothers.

1. Nutrition Week. “Complementary Feeding.” Nutrition Week South Africa, https://www.nutritionweek.co.za/20compfeeding.html#:~:text=Complementary%20feeding%20is%20needed%20to,have%20a%20role%20to%20play. Accessed September 2021.

2. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. World Health Organization, 2009. Session 1, “The Importance of Infant and Young Child Feeding and Recommended Practices.” NCBI Bookshelf, https://www.ncbi.nlm.nih.gov/books/NBK148967/. Accessed September 2021.

3. Chiang, K.V., H.C. Hamner, R. Li, and C.G. Perrine. “Timing of Introduction of Complementary Foods—United States, 2016–2018.” Morbidity and Mortality Weekly Report, vol. 69, no. 47, November 2020, pp. 1787–1791. https://doi.org/10.15585/mmwr.mm6947a4.

4. Olatona, F.A., J.O. Adenihun, S.A. Aderibigbe, and O.F. Adeniyi. “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, vol. 6, no. 1, 2017, pp. 46–59. https://doi.org/10.21106/ijma.181.

5. Centers for Disease Control and Prevention. “Timing of Introduction of Complementary Foods—United States, 2016–2018.” Morbidity and Mortality Weekly Report, vol. 69, no. 47, November 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6947a4.htm. Accessed September 2021.

6. World Health Organization. “Infant and Young Child Feeding.” World Health Organization, https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. Accessed September 2021.

7. World Health Organization. Guiding Principles for Complementary Feeding of the Breastfed Child. World Health Organization, 2003. https://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf. Accessed September 2021.

8. National Family Health Survey (NFHS-5). “Sirmaur, Himachal Pradesh: Fact Sheet.” International Institute for Population Sciences, http://rchiips.org/nfhs/NFHS-5_FCTS/HP/Sirmaur.pdf. Accessed September 2021.

9. Gewa, C.A., and T.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, vol. 34, 2015, p. 6. https://doi.org/10.1186/s41043-015-0008-y.