INFANT FEEDING PRACTICES IN URBAN SLUMS

Madhu-Agarwal Objective: To study the knowledge, beliefs and practices of mothers, in relation to initiation, duration and type of breastfeeding, introduction and type of complementary food and other infant feeding practices. Also, to assess the impact of Nutrition & Health Education on the infant feeding practices and suggested relevant need-based messages, which could be used for imparting nutrition & health education to the mothers of the ICDS and the non-ICDS areas. Subject and Methods: A sample consisting of 400 households was covered ,from the Aliganj ICDS project (urban) and the non-ICDS slum areas in the neighbourhood of the ICDS project of Lucknow district of Uttar Pradesh, having the youngest child within the age group of a year. Data obtained was statistically analysed by adopting percentage analysis and by applying Chi-square tests to compare the infant feeding practices in the ICDS and the non-ICDS areas. Observations: The Chi-square analysis (X2=15.94, p=0.003) on the practice of initiation of breastfeeding shows a highly significant association, i.e., initiation of breastfeeding differs in the ICDS and the non-ICDS areas. It was analysed that, more mothers in the ICDS area (63.5 percent) had fed colostrum to their infants than those in the non-ICDS area (48.2 percent). The Chi-square analysis (X2=8.77, p=0.012) also corroborates the above analysis. The' practice of giving the new-borns some pre-lacteal feeds, after birth and before commencement of breastfeeding, was prevalent in both. the areas as the Chi-square analysis shows that it was not significant (X2=7.28, p=0.0!?4). About 51 percent mothers in the nonICDS area and 35 percent in the ICDS area initiated breastfeeding from the third day onwards. Majority of the mothers of the ICDS and the non-ICDS areas fed their infants on demand (ICDS-87.6 percent, non-ICDS-89.9 percent). Forty one percent of the infants in the ICDS area and 42.5 percent of the infants of the non-ICDS area were receiving top milk by six months of age. It was found that the percentage of the infants receiving commercial milk was very less, in both the areas (ICDS-10.5 percent, non-ICDS-5.5 percent). Further, around 80 percent of the mothers in the ICDS and 83.8 percent in the non-ICDS areas were diluting milk before boiling. A majority 'of the mothers (ICDS-44 percent, non-ICDS-61.8 percent) used 50 percent dilution ratio. Around 47 percent mothers in the ICDS and 41.7 percent mothers in the non-ICDS area had introduced solids even before six months of age. On the other hand, the percentage of infants receiving semi-solid foods during 6-9 months of age was almost identical in the ICDS and the non-ICDS areas (ICDS-48 percent, non-ICDS-45.8 percent). The Chi-square analysis ( X2=16.0, p=0.005) reveals that the two populations differ with regard to the introduction of semi-solid foods. It was found that nearly 87 percent of the ICDS mothers gave homemade foods to their children, as compared to around 81 percent in the non-ICDS area. In contrast, commercial foods were given to a smaller percentage of children, in both the areas (ICDS-13.2 percent, non-ICDS-19.1 percent). There was a difference between the mean-weight of the infants of both the areas. It was found that mean-weight of the ICDS infants (6.0 kg) was higher than the infants of the non-ICDS area (5.3 kg). The mean-weight was highest in case of the ICDS male infants (6.3 Kg), as compared to the non-ICDS (5.8 Kg) male infants. The most revealing difference was found between the mean weight of the female infant of the ICDS (5.9 Kg) and the nonICDS (5.4 Kg) area. The female infants were behind their male peers in both the 1

areas. In the ICDS area, the percentage of normal children in Grade I and Grade II were 52.6, 24.6 and 15.4, respectively. The corresponding percentage in the non-I CDS area were 42.1, 30.0 and 13.7, respectively. The non-ICDS area also recorded 6.3 percent more children in Grade III category and a minor difference was noticed in the Grade IV category of the children, in both the areas (ICDS-2.3 percent, nonICDS-2.7 percent). A significant proportion of the mothers gave water to their child (ICDS-71 percent, non-ICDS-76.2 percent), 40 percent ICDS mothers added ghee or oil to their child's diet, whereas, this percentage in the non-ICDS area was a minuscule 28.4 percent. Conclusion: Infant feeding practices in ICDS areas were found to be better than those in the non-ICDS areas which contributed towards poorer nutritional status of infants in non-ICDS areas as compared to infants of ICDS area. This signifies that nutrition and health education imparted in the ICDS programme has helped to some extent in enhancing the level of awareness among mothers and brought some changes in their behaviour. Still there is need for launching an educational campaign on need based messages, to inform care-givers about appropriate infant feeding practices. Key words: Colostrum feeding, pre-lacteal feeds, breastfeeding, top feeding, complementary feeding, nutritional status, Nutrition and Health Education. Introduction It is a well-known fact that appropriate feeding practices during infancy play an important role in the child's nutrition and also in laying a strong foundation for his/her health and development in the later years of life. Nevertheless, experience shows that better feeding practices can make an important contribution in reducing infant mortality. Large number of studies conducted on infant feeding show that inappropriate feeding practices such as, early inadequate supplementation or cessation of breastfeeding and inappropriate complementary feeding were the major factors for the onset of malnutrition among children from the lower socio-economic communities of urban areas in India, which were due to lack of knowledge, ignorance, confidence and misconceptions of mothers regarding feeding practices (1,2,3,4,5). In India, government and non-government agencies have initiated several programmes for improving the knowledge of the mothers. Today, ICDS is one of the world's largest and the most unique outreach programme for early childhood care. Nutrition and Health Education (NHEd) is one of the most important component in the ICDS scheme. It has been established that nutrition and health education to community is a long-term measure to improve knowledge, attitude and behaviour of mothers for taking care of their children. The scheme is now poised for a wider expansion. Considering the magnitude of foreseen expansion, it has become imperative to assess and compare the knowledge of mothers in the ICDS Projects vis-a-vis, mothers in the non-ICDS Projects on the issues of feeding practices such as, initiation and type of breastfeeding, introduction of complementary food, etc. to the infants. This would go a long way in identifying relevant need-based messages which could be used for educating the community. Appropriate strategy could accordingly, be suggested for imparting nutrition and health education to slumdwellers.

Keeping this in view, this study was undertaken to compare the knowledge, beliefs and practices of mothers, in relation to feeding of infants of the ICDS and the non-ICDS areas. It also assessed the impact of NHEd in reducing misconceptions if any, prevalent among mothers of both the areas and suggested relevant need-based messages, which could be used for imparting NHEd to the mothers of the ICDS and the non-ICDS areas. Subjects and Methods Earlier research studies conducted in Uttar Pradesh (6.7) showed that the prevalence of malnutrition among women and children was higher in the belt comprising of Gangetic plains and Terai, as compared to the other regions. Keeping this in view, Lucknow district which is located in the central region of Uttar Pradesh was selected for data collection. From the Lucknow district, Aliganj ICDS Project (urban) that was sanctioned during the year 1979 was selected as it is one of the oldest urban block in the district. Since, there was no pre-project information available in the ICDS area, so it became imperative to select a non-ICDS area for comparison purpose. A non-ICDS area where ICDS was not in operation was selected, in the neighbourhood of the ICDS Project, to compare the ICDS and the non-ICDS areas for studying its impact. A two-stage sampling design was adopted. Selection of slums in the first stage and households in these selected slums in the second stage. Ten slums having Anganwadi centres, from the Aliganj ICDS Project were selected. From each sector, two-three centres were taken randomly in the ICDS area. Purposive sampling was done to select the households as the study required only such families which had at least one child aged less than 12 months of age. From each slum, 20 mothers were contacted who had male/female child upto 12 months of age for eliciting the information. A sample consisting of 200 households, was covered from the Aliganj ICDS Project having the youngest child within the age group of a year. The procedure was similar in the non-ICDS area. In this area also, 200 households from 10 slums scattered in the different areas of Lucknow city, where ICDS or any other nutrition education intervention was not in operation, were contacted for data collection. In all, 400 mothers belonging to 20 slums from the ICDS Project and the non-ICDS area were studied from different localities of Lucknow city. The data was obtained by interviewing the mothers of the children and also the heads of the households using a questionnaire. Two types of questionnaires were canvassed- Interview and Observation. The questionnaires were pretested in the slum areas of Lucknow city, covering 25 families each, in both the areas. From the pretesting of the questionnaires, it was ascertained that the responses elicited through the questionnaire were more or less in keeping with the objectives of the study. The questionnaires were modified on the basis of responses obtained in the field. Data Analysis

Data obtained was tabulated and statistically analysed by adopting percentage analysis and by applying Chi-square test, to compare the infant feeding practices in the ICDS and the non-ICDS areas. Suitable graphs were also used to derive inter-relationships. Results and Discussion Breastfeeding Several studies have confirmed that colostrum is the best food for neonates from the nutritional, psychological and immunological points of view. But in the present study, it was found that some mothers rejected this precious material. The Chi-square analysis (X2=15.94, p=0.003) on the practice of initiation of breastfeeding shows a highly significant association, i.e., initiation of breastfeeding differs in the ICDS and the non-ICDS areas. It was analysed that, more mothers in the ICDS area (63.5 percent) had fed colostrum to their infants than those in the non-ICDS area (48.2 percent). The Chi-square analysis (X2=8.77, p=0.012) also shows that, colostrum feeding differs in the two target populations (Fig. 1). This finding is similar to the findings of several studies (8,9,10) which reported that the colostrum feeding practices in the ICDS areas are better than those in the non-ICDS areas. The reasons cited by most of the mothers for rejecting colostrum were almost identical in both the areas. They were, inadequate quantity of milk as considered by the mothers and advice of the relatives not to feed colostrum, or to feed only after the ritual bath (see Table A). This finding is in conformity with the results obtained by the previous studies (1,2,3,4,5,8,11). The practice of giving the new-borns some pre-lacteal feeds, after birth and before commencement of breastfeeding, was prevalent in both the areas as the Chisquare analysis shows that it was not significant (X2=7.28, p=0.064). The common prelacteal feeds offered were sweetened water (ICDS-37.04 percent, non-ICDS29.13 percent), diluted animal milk (ICDS-30.09 percent, non-ICDS-31.49 percent) and honey (ICDS-28.9 percent and non-ICDS-19.69 percent) (Fig. 2). This finding is also in accordance with the earlier reports (1,2,3,4,5,8,10). Some mothers reported that, pre-lacteal feed was given with a belief that, it helps to loosen meconium before establishment of lactation and acts as a tonic and a source of nutrition until milk is secreted. These feeds were given by a cotton swab (ICDS-33 percent and nonICDS-55.3 percent) or with a spoon (ICDS-31.8 percent and non-ICDS-38.2 percent). The use of bottle for giving pre-lacteal feeds was also common in both the areas (ICDS-27.8 percent and non-ICDS-6.5 percent) (Fig. 3). It was observed that these feeds were administered under unhygienic conditions, which may cause diarrhoea to slum-dwelling children. About 51 percent mothers in the non-ICDS area and 35 percent in the ICDS area initiated breastfeeding from the third day onwards. The present study shows that, delayed breastfeeding was more common in the non-ICDS area as compared to the ICDS area. The number of 'never breastfed' infants was very small (ICDS-1.5 percent, non-ICDS-1 percent) in both the areas. It is gratifying to note that, the incidence of lactation failure was very rare in the surveyed areas.

Majority of the mothers of the ICDS and the non-ICDS areas fed their infants on demand (ICDS-87.6 percent, non-ICDS-89.9 percent). There was an insignificant difference in the values (X2=3.91, p=0.271) which shows that there was no difference between breastfeeding schedules of both the areas (Fig. 4). The data suggests that feeding on demand is by far the most popular practice among the urban poor mothers. Maximum number of mothers felt that they breast-fed the child as long as the child demanded, in both the areas (ICDS-48.5 percent, non-ICDS 66 percent). Thus, in both the areas, mothers believed in prolonged breastfeeding. Mothers who discontinued breastfeeding reported some reasons which were, 'insufficient milk' - as perceived by the mother, mother's next pregnancy, mother's ill health, etc. 'Insufficiency of milk' was the most common pretext for discontinuing breast milk. It is suggested that attempts must be made to improve the lactation of the mother through nutritional supplementation and counselling. Majority of the mothers of both the areas, ICDS as well as the non-ICDS expressed their opinion about the value of breastfeeding. They considered breast milk to be nutritious and good for the child. However, 14.5 percent in the ICDS and 27 percent mothers in the non-ICDS area did not express their opinion. Thus, the mother's perception about the breastfeeding practices was better in the ICDS project in comparison to the nonICDS area. Complementary Feeding Top-feeding The age at which top milk was introduced was almost identical in both the areas. Forty one percent of the infants in the ICDS area and 42.5 percent of the infants of the non-ICDS area were receiving top milk by six months of age. However, the insignificance of the Chi-square analysis (X2=2.31, p=0.510) shows no difference between the ICDS and the non-ICDS areas with regard to the initiation of top milk (Fig. 5). The more disturbing finding is that, among those infants who received top milk, around 60 percent of the infants in both the areas had received top milk before one month of age. The present study indicates that initiation of the first top milk feed was much earlier in both the areas. Mothers opted for bottle-feeding mainly due to the reasons of employment or insufficient milk supply as perceived by the mothers. Most of the mothers in the studied population were predominantly using buffalo's milk, but it was used more in the non-ICDS area as compared to the ICDS area (non-ICDS-65.4 percent, ICDS-52.8 percent). Cow's milk (ICDS-29.2 percent, nonICDS-14.9 percent) and Parag milk packet (ICDS-16.7 percent, non-ICDS-11.1 percent) was used more by the ICDS mothers, as compared to the non-ICDS mothers (Fig. 6). The mothers reported that as buffalo's milk was easily available, so they were using it. Thus, the choice for the type of top milk was largely influenced by its availability. It was found that the percentage of the infants receiving commercial milk was very less, in both the areas (ICDS-10.5 percent, non-ICDS-5.5 percent) (Fig. 7). However, the percentage of the mothers using commercial infant milk was higher in the ICDS area than in the non-I CDS area. Amongst the brands of commercial milk used, the use of Amul Spray was more popular among the mothers, in both the

areas. Thus, majority of the mothers gave animal milk to the infants and commercial milk was not popular in the slums. The study reveals that top milk was most popular amongst the mothers in both the areas. Keeping in view the family constraints, top milk would impose a massive strain on the family's budget. Further, around 80 percent of the mothers in the ICDS and 83.8 percent in the nonICDS areas were diluting milk before boiling. The dilution ratio varied from family to family. A majority of the mothers (ICDS-44 percent, non-ICDS-61.8 percent) used 50 percent dilution ratio (1 part of milk with 1 part of water) (Fig. 8). More mothers of the non-I CDS area diluted the milk by 50 percent, as compared to the mothers of the ICDS area. Thus, in both the areas complementary milk feeds were given in far too dilute composition. The mothers reported that dilution of milk was done to facilitate digestion and to increase the quantity of milk. Thus, ignorance and poverty seem to be the underlying reasons. It was found that 55.8 percent mothers in the ICDS and 80.2 percent in the nonICDS areas prepared milk feed once, for the whole day. In contrast, 39 percent of the mothers of the ICDS and only 17.3 percent mothers of the non-I CDS area prepared fresh milk each time. The Chi-square value (11.4) was highly significant (p=0.022) showing that, the practice of reconstitution of milk differs in both the areas. The majority of the infants were receiving 2-3 top milk feeds per day in both the areas. The statistical analysis (X 2=6.37, p=0.364) also shows no difference in the ICDS and the non-ICDS areas (Table 9). Although there was no difference between the ICDS and the non-ICDS areas with regard to the number of feeds, the two populations differed significantly on the mode of the feeding (X 2=17.25, p=0.028). Larger number of the mothers of the ICDS area (63.7 percent) offered top milk in the commercially available feeding bottles, as compared to the mothers of the non-ICDS area (40.7 percent). The practice of feeding with the traditional utensil was very uncommon amongst the mothers of both the areas. Since the risk of infection is the highest with bottle-feeding, due to improper cleaning, so the data was collected to know how the bottles were being actually cleaned. The majority of the mothers (ICDS-70 percent, non-ICDS-63 percent) cleaned the bottle with water like any cooking utensil, using mud or soap powder in both the areas. Only 15.6 percent mothers in the ICDS and 6 percent mothers of the non-ICDS area reported that they sterilised the bottles before use. It was observed that bottle and nipple were handled with dirty hands, which were a source of infection for the baby. It should thus be made clear that the conditions under which bottlefeeding is practised favour infections, especially in communities where environmental sanitation is poor and safe drinking water is not accessible. Thus if the mothers have to use top milk for feeding, the preparation of milk under hygienic conditions must be stressed. Regarding the storage of the animal milk, only one fifth of the mothers of both the areas reported that they boiled the milk and stored it in clean covered utensils. Majority of the mothers initiated top feeding before the infant reaches six months of age. Infact some mothers initiated this practice when the infant was even below one 6

month of age. This should be discouraged in slum areas. In addition, instead of bottle, use of cup and spoon should be encouraged, as bottles are difficult to clean and can cause infection to the infant. Further, preparation of milk under hygienic conditions and correct formulations should be stressed. Mothers must be made aware that nursing the infant for around six months will provide the nutrient needs of the child. Mothers must be persuaded to eat nutritious meals, in order to ensure good quality and quantity of her milk flow and to keep herself healthy. Semi-solid Foods Introduction of the first semi-solid foods to the infant was reported over an age range of 3 months to one year. Around 47 percent mothers in the ICDS and 41.7 percent mothers in the non-ICDS area had introduced solids even before six months of age. On the other hand, the percentage of infants receiving semi-solid foods during 6-9 months of age was almost identical in the ICDS and the non-ICDS areas (ICDS-48 percent, non-ICDS-45.8 percent). The Chi-square analysis (X2=16.0, p=0.005) reveals that the two populations differ with regard to the introduction of semi-solid foods (Fig. 10). Thus, both early and delayed introduction of first semisolid foods, were prevalent in the surveyed areas. The introduction of supplementary foods at an early age, may put infants at the risk of malnutrition because other liquids and solid foods are nutritionally inferior to breast milk. It also increases children's exposure to pathogens and consequently puts them at a greater risk of getting infected with diarrhoea. Regarding the number of feeds per day, majority of the mothers occasionally gave semi-solid foods to their infants i.e., 2-3 times a day (ICDS-55 percent and nonICDS-61.7 percent). The X2 value (X2=13.30, p=0.021) is highly significant. This shows that ICDS and non-ICDS areas also differ with regard to the number of feeds given to the infants. The mothers who delayed introduction of the first semi-solid foods, reported some misconceptions like - the child cannot chew the food or the child cannot digest it, the child does not accept or not allowed by the elders, etc. Wrong perceptions and ignorance about the introduction of semi-solid foods appear to have strong influence on the mothers, in both the areas. Thus, knowledge and access to information should be strengthened for improving feeding practices. The type of semi-solid foods offered as supplementary food was almost identical in both the areas. It was found that nearly 87 percent of the ICDS mothers gave homemade foods to their children, as compared to around 81 percent in the nonICDS area. In contrast, commercial foods were given to a smaller percentage of children, in both the areas (ICDS-13.2 percent, non-ICDS-19.1 percent). Larger proportion of the mothers from both the areas gave biscuits (ICDS-33.8 percent, non-ICDS-39.6 percent) to satisfy hunger of their child. Other foods offered were cereal-pulse preparations (ICDS-24.7 percent, non-ICDS-25 percent) and cooked dal (ICDS-29.8 percent, non-ICDS-29.2 percent) to their child. Fruits, cooked vegetables and commercial infant food were introduced to a very few infants although in small amounts, in both the areas (Fig. 11). It was observed that semi-solid foods offered to the children were inadequate in quality and quantity. In majority of the cases, the

infants ate and shared with other siblings or parents, without considering quantity and frequency of feeding. Regarding the preparation of homemade foods for their child, it was found that around 55 percent mothers in the ICDS area gave regular adult family food to their children, as compared to nearly 66 percent in the non-ICDS area. In addition, no special foods were prepared by mothers in the non-ICDS area, where as around 14 percent mothers in the ICDS area prepared special foods for their children. About 52 percent of the mothers in the ICDS area and 70 percent of the mothers in the non-ICDS area enlisted various constraints in introducing adequate amount of semi-solid foods such as, cost of semi-solid foods, employment of women, ignorance of the ways of preparing baby foods, etc. Thus, more mothers in the non-I CDS area than the ICDS area expressed constraints in introducing semi-solid foods. The issues such as, the right time of the introduction of the complementary foods, good quality and adequate quantity, the frequency of feeding, the technique with which they are provided must be stressed while imparting nutrition and health education to the community. Mothers must be convinced through education that supplementary foods be given in conjunction with nursing and be prepared in a form that is easily acceptable to the child and should be rich in both, calories and proteins. It should be suitable as per their age with slight modifications in the normal existing adult diet. The suitable recipes without adding any extra expenditure should be developed and disseminated among the community. Nutritional Status There was a difference between the mean-weight of the infants of both the areas and it was found that mean-weight of the ICDS infants (6.0 kg) was higher than the infants of the non-ICDS area (5.3 kg). The mean-weight was highest in case of the ICDS male infants (6.3 Kg), as compared to the non-ICDS (5.8 Kg) male infants. The most revealing difference was found between the mean weight of the female infant of the ICDS (5.9 Kg) and the non-ICDS (5.4 Kg) area. The female infants were behind their male peers in both the areas. Differences of mean-weight were tested through t-test. It shows that all the tvalues are highly significant (P-value smaller than 0.01). It is therefore evident that there is a significant difference between the mean-weight of the male and female infants of the ICDS as well as of the non-I CDS areas (see Table B). More attention and better impetus is required to be given to improve the nutritional status of the girl child in both the areas. In the ICDS area, the percentage of normal children in Grade I and Grade II were 52.6, 24.6 and 15.4, respectively. The corresponding percentage in the nonICDS area were 42.1, 30.0 and 13.7, respectively. The non-ICDS area also recorded 6.3 percent more children in Grade III category and a minor difference was noticed in the Grade IV category of the children, in both the areas (ICDS-2.3 percent, non-ICDS-2.7 percent) (Fig. 12).

Thus, the findings of this study reveal that nutritional status of the children of the ICDS area was better, as compared to that of the non-ICDS area. This finding is consistent with the study conducted by NIPCCD (1992) which showed that, the nutritional status of the children was better in the ICDS, as compared to the nonICDS children. The analysis suggests that the ICDS has the potential to improve the nutritional status of the children, which although is not optimal but is better than that of children of the non-ICDS area. The Chi-square test was applied to ascertain whether there is a significant association between the nutritional status (grades of malnutrition) and the age of the infants. The calculated Chi-square value at 65 of was 86.4 for the ICDS area and at 60 of was 80.59 for the non-ICDS area, which were significant (p=0.039). This shows a strong association between age (months) and grades of malnutrition among the infants of both the ICDS and the non-ICDS areas. This finding is consistent with the studies conducted by the Department of Women and Child Development (1999), National Family Health Survey-I (1992-93) and NFHS-II (1998-99), which state that the proportion of the malnourished children increases rapidly with the child's age. This could be explained as, delayed introduction of semi-solid foods, inadequate in quantity and quality. Other Feeding Practices Despite the fact that water should not be given to the child before six months of age, still a significant proportion of the mothers gave water to their child (ICDS-71 percent, non-ICDS-76.2 percent) (Fig. 13). The addition of water can introduce contaminants and reduce nutrient intake. Thus, there is a need to educate the caregivers about exclusive breast-feeding and not to give water for about the first six months. Only 40 percent mothers in the ICDS area were providing oil or ghee to their children between 6 months to one year of age. The corresponding figure in the non ICDS area was nearly 28.4 percent. Less number of mothers in the non-ICDS area were including ghee or oil in the diet of their children. There were two main reasons reported by the mothers for not providing ghee or oil to their children, firstly, they can't afford and secondly, they are unaware of the importance of giving such foods. Thus, poverty and ignorance were the main reasons for not providing ghee or oil to their children. Gender Bias in Relation to Food Allocation There was a slight discrimination of food allocation between the male and the female infants of both the areas. It was found that only 2 percent of the mothers in the ICDS and 2.5 percent of the mothers in the non-ICDS area reported that, they gave more food to the male infants as compared to the female infants. However, statistical analysis reveals a different picture (X2=1.07, p=0.585) with regard to food allocation. The insignificance of the Chi-square values indicates that there is no gender bias with regard to food allocation, among male and female infants of both the areas.

Advisors of Mothers Regarding Infant Feeding Majority of the mothers (ICDS-48 Thus, in urban areas, the prominent percent, non- ICDS63.50 percent) never areas of concern including discarding of received any advice from their relatives or the feeding of colostrum or delayed initiation field functionaries. Out of those who received of breast-feeding, non-exclusive breastadvise, maximum advisors were relatives feeding, early and over dilution of top premature or delayed (ICDS-27.5 percent, non-ICDS-18 percent) in feeding, introduction of semi-solids low in caloric both the areas. However, 5.5 percent mothers density and feeding less frequently. of the non-ICDS area than 5.0 percent of the ICDS area were benefited by the doctors also. It was gratifying to note that in the ICDS area 16.5 percent mothers received the advice from the Anganwadi Workers also. Thus, the mothers of the ICDS area were benefited relatively more as compared to their counterparts in the non-ICDS area. As maximum number of the mothers benefited from their relatives' advice, so educational messages should be imparted not only to the mothers but also to the other family members, providing counselling to the mothers. The application of correct knowledge through community education must be stressed in both the areas. Faulty feeding practices were due to lack of knowledge, confidence, ignorance and misconceptions among the care-givers. Although this is true of the mothers of both the ICDS and the non-ICDS areas, but it is more so in the case of the mothers of the non-ICDS area. This signifies that nutrition and health education imparted in ICDS programme has helped to some extent in enhancing the level of awareness, among mothers and brought some changes in their behaviour. This has also been observed by others concerned (5,8,10,13,14). Still, there is a need for launching an educational campaign on need based messages to inform care-givers about early initiation of breastfeeding practices in both the areas. Conclusion Since NHEd service is expected to support or have a positive influence on infant feeding practices, the findings show that there is a need to strengthen NHEd components of the ICDS scheme, for community empowerment and behaviour change. The focus should be more on knowledge, which the care-givers already have and strive to support it and build on it. In order to ensure desirable behavioural change in the community and to reinforce desirable infant feeding practices, the care provider should make more door to door visits for imparting NHEd to the mothers. She should also, frequently organise mothers' meetings or community meetings for this purpose, for influencing the social behaviour with particular reference to the feeding practices. In the non-ICDS areas, doctors, nutrition experts, social activists and health providers can encourage appropriate feeding practices. Firstly, they may educate and motivate the care-givers for adoption of healthy infant feeding practices. Secondly, they may alter hospital and health-centre policies that discourage breastfeeding. In this connection, capacity building of care-providers on appropriate

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infant feeding practices is essential for improving their knowledge and skills. In addition, services of the non-government organisations, community level workers, media and involvement of formal and non-formal education are suggested to be utilised for imparting nutrition and health education. The non-government organisations can network and liaison with the government, judiciary, medical profession and with all the groups interested in the promotion of early initiation of breastfeeding. They can discuss the benefits of breastfeeding with the family members and have good contacts with the people at the grass-root level. Thus, an effort should be made to incorporate a very strong nutrition education input, in the various developmental programmes for improving nutritional status of the children. Although the observations cannot be generalised, due to small sample size of this study, however, the results are encouraging in the ICDS area as compared to the non-ICDS area. Lastly more studies with bigger sample spread are therefore, needed to be undertaken for designing suitable policies. Acknowledgement The author thanks Dr. Surendra Singh, Professor and Head, Department of Social Work and Dean, Faculty of Arts, Lucknow University, Mr. Muttoo, Director, NIPPCD, New Delhi, Dr. Sheila Vir, Project Director, UNICEF and Dr. Shelly Awasthi, Professor, Paediatric Department, KGMC for their constant guidance and invaluable suggestions without which this endeavour would have never been completed. Contributors: Dr. A.K. Nigam, Director, Institute if Applied Statistics and Development Studies deserves to be highly appreciated for the data-analysis and Mr. A.K. Dwivedi, Director, Academy of Management Studies (AMS) for his help and support rendered for completing the task. Funding None Competing Interests: None stated

REFERENCES 1. Dutta Banik, N.D. 1977. Some observations on feeding Programmes, Nutrition and Growth of Pre-school Children in an Urban Community. Indian Journal Paediatrics. 1977 44: 139. 2. Rebello L.M., Srivastava V., Juneja S., 1997. Infant feeding and weaning practices in the Katras of Delhi. Research and Evaluation Division, Central Health Education Bureau, New Delhi.

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3. Gupta, R. 1982. Infant feeding patterns in urban families: A field study. Unpublished master's dissertation. Department of Child Development, Lady Irwin College, University of Delhi. 4. Dutta, R.1982, Infants and Mothers: Feeding Practices of Domestic Workers. Unpublished master's disseration. Department of Child Development, Lady Irwin College, University of Delhi. 5. Shekhar, M. 1983. Infant feeding practices in an urban slum. A report by National Institute of Public Cooperation and Child Development. 6. Institute of Applied Statistics and Development Studies, Lucknow, 1999. 7. Nutritional status of Children and Women in U.P. : Department of Women and Child Development, 1998. 8. Agarwal, M.; Infant feeding practices in ICDS and non-ICDS rural areas of Uttar Pradesh - A comparative study, NIPCCD, Regional Centre, Lucknow, 2000. 9. Ananthakrishna, Suseela : A comparative study of Infant feeding practices in an ICDS area. Madras (Tamil Nadu), Kilpauk Medical College, Department of Paediatrics, 1984. 10. National Evaluation of Integrated Child Development Services Scheme, NIPCCD, New Delhi, 1992. 11. Narayanan L. Prakash, K. Prabhakar, A.K. and Gujral, V.v. 1980 : A planned prospective evaluation of anti-infective property of varying quantities of expressed human milk, Acta. Pediatric, Scand., 71 441. 12. Nutritional Status of Children and Women in U.P., Department of Women and Child Development, 1998. 13. Barua, Alok and Patowary : A comparative study of nutritional status of children below six years of age in ICDS and non-ICDS blocks of Kamrup District, Guwahati (Assam) Medical College, Guwahati, Department of Social and Preventive Medicine (1987). 14. Prasad K.R. and Nath L.M.; A controlled study of socio-culturally determined child feeding habits in relation to protein-calorie malnutrition. Indian Paediatrics, 1976.

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