|Ahead of print publication
Prevalence and Determinants of Exclusive Breastfeeding Among Children Less Than Two Years of Age in a Rural Area of Delhi, India
Pallavi Singh1, Rajesh Kumar2, Gajendra S Meena2, Panna Lal2
1 Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
2 Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
|Date of Submission||30-Dec-2021|
|Date of Decision||20-Jan-2022|
|Date of Acceptance||04-Apr-2022|
|Date of Web Publication||21-Jun-2022|
Department of Community and Family Medicine, Room No. 85705, SR/JR Hostel, Building No. 85, AIIMS Rishikesh, Uttarakhand – 249203
Source of Support: None, Conflict of Interest: None
Context: Exclusive breastfeeding for the first 6 months of life is highly beneficial to the child. Unfortunately, it is frequently not practiced among women due to a lack of knowledge. Aims: The study aims to to find the prevalence of exclusive breastfeeding among children aged less than 2 years of age and to study the factors influencing the practice of exclusive breastfeeding among the mothers of the study participants. Methods and Material: The design was a community-based cross-sectional study. Between January 2019 and January 2020, we enrolled 190 children aged less than 2 years of age and their mothers residing in a rural area of Delhi, India. We collected baseline sociodemographic data and details of feeding practices followed using a pretested semi-structured questionnaire. To measure association, the chi-square test or Fischer exact test was used. Statistical analysis used: Collected data was entered into MS-Excel and analyzed using IBM Statistical Package for the Social Sciences – 25 for descriptive and inferential statistics. Results: Of the 190 participants with complete information, 74 were under 6 months of age and it was found that 57 (77.0%) of those were exclusively breastfed till their present age. The remaining 116 children were aged between 6 and 23 months and the prevalence of exclusive breastfeeding in these children was found to be 55.2% (64). The mean duration of exclusive breastfeeding was 5.75 ± 1.79 months. The age of the child was found to be statistically significant with the practice of exclusive breastfeeding (P = 0.01). Conclusions: The exclusive breastfeeding up to 6 months of age was practiced only by approximately half of the mothers.
Keywords: Breastfeeding practices, exclusive breastfeeding, infant feeding
|How to cite this URL:|
Singh P, Kumar R, Meena GS, Lal P. Prevalence and Determinants of Exclusive Breastfeeding Among Children Less Than Two Years of Age in a Rural Area of Delhi, India. MAMC J Med Sci [Epub ahead of print] [cited 2023 Jan 28]. Available from: https://www.mamcjms.in/preprintarticle.asp?id=347904
Key Messages: The study highlighted the decline in exclusive breastfeeding prevalence till the required age of 6 months. Positive reinforcement of the caregivers till the child attains the age of 6 months is necessary.
| Introduction|| |
According to the ‘Convention on the Rights of the Child,’ every infant and child has the right to good nutrition. Human milk is the most ideal food for a child and its role in the proper growth and development of the child is incomparable to any other form of food. Human milk provides all the vitamins, minerals, enzymes, and antibodies necessary for the appropriate growth of the child in the first 6 months of life and then continues to be a crucial dietary component up to the age of 2 years or beyond.
Exclusive breastfeeding means that the infant receives only human milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution or drops/syrups of vitamins, minerals, or medicines.
The global recommendations for appropriate feeding are early initiation of breastfeeding preferably within 1 hour of birth, exclusive breastfeeding for 6 months, and appropriate complementary feeding to be initiated from the age of 6 months that should be timely, adequate, safe, and properly fed.
Breastfeeding confers short-term and long-term benefits for both child and mother, including helping to protect children against a variety of acute and chronic disorders. Exclusively breastfed children are less susceptible to diseases such as diarrhea and pneumonia and are 14 times more likely to survive than nonbreastfed children. Breastfeeding is also beneficial for mothers as it helps prevent postpartum hemorrhage, reduces the risk of breast and ovarian cancers, and allows women to better space their pregnancies.
In India, undernutrition attributes to nearly 35% of mortality in children. The more recent National Family Health Survey (NFHS) 2019–2021 data reveals that 63.7% of children under 6 months of age were exclusively breastfed as compared to 54.9% in NFHS IV data.,
National Capital Territory (NCT) of Delhi is among the poor performing states of India when it comes to child feeding practices. In NCT Delhi, 49.6% children under the age of 6 months are exclusively breastfed as per NFHS IV and this has shown an improvement in NFHS V where this prevalence is 64.3%.,
Many sociodemographic factors can also affect the exclusive feeding practices, such as the education status of the parents and socioeconomic status and beliefs. Knowledge of these factors can help in planning interventions to improve infant and young child feeding practices.
The present study was undertaken to find the prevalence of exclusive breastfeeding and to study the various factors influencing the practice of exclusive breastfeeding among the mothers of the study subjects in a rural area of Delhi.
| Material And Methods|| |
This was an observational cross-sectional study conducted to study the breastfeeding practices followed by mothers of children aged less than 2 years of age in a rural area. This study design enabled us to collect information regarding the practice of exclusive breastfeeding among the study participants. The study was approved by the Institutional Ethics Committee and prospectively registered with the Clinical Trial Registry of India as an observational trial. Written and informed consent was taken from all the participants.
The NCT of Delhi is the largest metropolis by area and the second largest metropolis by population in India. It is the eighth largest metropolis in terms of population with 16,753,235 inhabitants as per the census of India, 2011. The study was conducted at Barwala village, which is situated in the North-West district of Delhi.
Inclusion criteria to be included as part of the study were children under 2 years of age at the time of enrolment and their mothers/caregivers who were residents of Barwala for the past 6 months. Children whose mothers had severe debilitating conditions, which made them unable to communicate, were excluded from the study.
The final sample size was considered to be 190, which was based on the prevalence of exclusive breastfeeding under 6 months of age as given by the NFHS IV 2015-2016 fact sheet of NCT Delhi. At a 95% confidence interval, with the prevalence of exclusive breastfeeding in infants under 6 months of age (49.8%), and an allowable relative error of 15%, the sample size came out to be 172. Considering a nonresponse rate of 10%, the final sample size was 190.
A pretested, semi-structured interview schedule was used to collect the information from the mothers. The interview schedule included questions to gather data on the identification, sociodemographic profile of the study participants including the education and occupation of mothers/caregivers, religion, obstetric history of the mother, and breastfeeding practices followed.
The data are described as relative and absolute frequencies or mean and standard deviation. To measure the association between various sociodemographic factors and exclusive breastfeeding, the chi-square test or Fischer exact test was used. A significance level of 0.05 was considered in all the tests. The confidence intervals were 95%. The data were entered in Microsoft Excel 2019 and were analyzed using Statistical Package for the Social Sciences (SPSS for Windows, Version 25.0, IBM Corporation, Armonk, New York, United States).
| Results|| |
[Table 1] shows the age and gender-wise distribution of the study participants. Among 190 study participants, 105 (55.3%) were females and 85 (44.7%) were males. The majority of the children, 74 (38.9%), belonged to the age group of 0 to 6 months. The mean age of males was 9.92 ± 7.10 months and that of females was 9.73 ± 6.87 months. The overall mean age was 9.82 ± 6.96 months.
[Table 2] shows the prevalence of exclusive breastfeeding in children under 6 months of age. Out of 190 children, 74 were under 6 months of age and it was found that 57 (77.0%) of those were being exclusively breastfed till their present age. Out of 74, 17 (23.0%) were not exclusively breastfed. [Table 3] shows the prevalence of exclusive breastfeeding in children 6 to 23 months of age. Out of 190 study subjects, 116 children were aged between 6 to 23 months and the prevalence of exclusive breastfeeding up to 6 months was found to be 55.2%. The remaining 52 (44.8%) children were not exclusively breastfed for up to 6 months. The mean duration of exclusive breastfeeding was 5.75 ± 1.79 months.
|Table 2 Prevalence of exclusive breastfeeding among study participants aged less than 6 months|
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|Table 3. Prevalence of exclusive breastfeeding among study participants aged 6 to 23 months|
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[Table 4] shows the association between sociodemographic factors and the practice of exclusive breastfeeding for up to 6 months. Age of the child was found to be statistically significant with the practice of exclusive breastfeeding as it was observed that 57 (77.0%) children who were under 6 months of age at the time of the study were being exclusively breastfed but this prevalence decreased with increasing age of the child (P = 0.01). The practice of exclusive breastfeeding was not found to be associated with gender of the child, religion, type of family, and total number of family members (P > 0.05). Though it was observed that the majority, 37 (69.8%), of children who belonged to the upper class according to the Modified B.G. Prasad Scale were exclusively breastfed as compared to other classes, the association was not found to be statistically significant (P > 0.05).
|Table 4. Association of sociodemographic factors with practice of exclusive breastfeeding among study participants|
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Age of the mother, native residence of the mother, educational and occupational status of the mother, and parity were found to have no statistical significance with the practice of exclusive breastfeeding (P > 0.05).
There was no statistically significant association found between the birth history of the child and the practice of exclusive breastfeeding up to 6 months as maturity at birth, place of delivery, mode of delivery, and birth order were found to have no statistically significant association with the practice of exclusive breastfeeding up to 6 months (P > 0.05).
| Discussion|| |
According to UNICEF, 42% of infants are exclusively breastfed. NFHS-IV shows that prevalence of exclusive breastfeeding up to 6 months of age at the national level is 54.9% and in Delhi, it is 49.6%., In our study, the prevalence of exclusive breastfeeding up to 6 months is 55.2%, which is more or less close to the national and the state average. A similar study conducted in the slums of Delhi by Bhushan and Shahrawat found the prevalence of exclusive breastfeeding in children aged 1 to 6 months to be 66.4%. This difference may be attributed to the study settings and differences in socioeconomic status. A study conducted in Nepal by Bhandari et al. found that 50.8% of children were exclusively breastfed for 6 months. Campbell et al. found the prevalence of exclusive breastfeeding up to 6 months to be 52% in a study conducted in Bhutan. The similarity in the prevalence shows that the South-East Asian region of WHO has similar feeding practices.
In our study, the prevalence of exclusive breastfeeding was 77.0% in children who were less than 6 months of age at the time of the interview and 55.2% in children 6 to 23 months of age. A similar study conducted by Jain et al. in central India found that in children who were presently under 6 months of age, the prevalence of exclusive breastfeeding was 85%. It was also observed in the same study that among children aged 6 to 23 months, only 36.5% had been exclusively breastfed for 6 months. Maciel et al. conducted a study in Brazil and found that while 65% of the children received exclusive breastfeeding for the first month, only 5% received it till the sixth month. Though the prevalence varies, these studies show that there is a decreasing trend in exclusive breastfeeding practices as the age of the child increases.
In our study, it was found that 69.8% of children who belonged to the upper class and 67.2% of children who belonged to the upper middle class were exclusively breastfed. Bhanderi et al. conducted a study in Gujarat, India, and reported similar results where 40.6% children who belonged to the upper class and 39.4% who belonged to the upper middle class were exclusively breastfed.
Factors such as religion, gender of the child, type of family, and maternal characteristics such as age, educational status, occupational status, and native residence were not found to be significant in the practice of exclusive breastfeeding in our study. Mahmood et al. conducted a study in Uttar Pradesh, India, and found that factors such as religion, type of family, gender of child mother’s age, educational status, occupational status, and parity were not significantly associated with the feeding practices of mothers. This difference may be attributed to the difference in the study setting, study population, cultural beliefs, and geographical variation.
In our study, factors regarding the birth history of the child such as maturity at birth, place of delivery, and birth order were found to have no statistical significance in the practice of exclusive breastfeeding. Mahmood et al. conducted a study in Uttar Pradesh and found that all the above-mentioned factors had no statistical significance on the feeding practices of mothers. Hossain et al. conducted a study in Bangladesh and found out that a higher prevalence of exclusive breastfeeding was seen in women who home delivered, had a normal vaginal delivery, and was multiparous. This may be due to differences in socioeconomic status and sociodemographic and sociocultural differences.
There were several strengths of our study. Reducing the infant and under-five mortality rate through appropriate feeding practices is one of the important goals of SDGs and as per national policies, and hence it was a very pertinent issue to study in the Indian context. The study instrument was developed meticulously, pretested, and tested for validity and reliability and a relatively less studied concept of knowledge and sociodemographic factors affecting the feeding practices were studied.
There were certain limitations to this study as well. As the study was done in a rural area of Delhi, India, results may not be extrapolated to all rural areas in other parts of the country because of differences in the urbanization process and sociocultural practices. The presence of recall bias for those mothers whose children were more than 6 months of age at the time of the interview as they were giving past history regarding exclusive breastfeeding was another limitation.
| Conclusion|| |
Our findings reflect similar findings as in the existing literature, with the differential that they relate specifically to a large population of children under 2 years of age. We found a low prevalence of exclusive breastfeeding for 6 months, and there exists room for improvement. The study reflects that counseling regarding breastfeeding practicing should be initiated right from the time the woman conceives and should be continued till the child attains the age of 2 years.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]