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\ 1 ,c .rt I I?*. ;;cs- Indian Journal of Community Medicine Vol. XXV, No.2. Apr.-Jun., 2000


(Mrs.)Rama Ram, M.N. Ghosh, J.B Saha*, S.K. Bhattacharyya,
_- ._. Anima Halder (Biswas), Chitra Chatterjee
Department of Community Medicine, Calcutta National Medical College, Calcutta.
*Department of Community Medicine, North Bengal Medical College, Calcutta.
Research question: What is the pattern and influence ofsocio-cultural factors on breast feeding practices in the rural mothers of Darjeehng
Objectives: To find out the pattern of breast feeding practices in the rural mothers of Darjeeling district and influence of socio-cultural
factors with special reference to occurrence of diarrhoea. .
Study destgn: Cross-secttonal study.
Settmg. lmmumzation clinic, department of Community Medicine, North Bengal Medical College. -. --_ - - - - - -
Sample size: I200 mothers attendmg the clinic for tmmumzatton having babies 6 weeks to 24 months.
Study variables: feeding practice, time of initiation, duration of breast feeding, literacy, socio-economic status, source of knowledge,
eptsode of tliarrhoea, etc.
Method: Interview techmque. *%tilb,rr
Statistical analysis: Percentages, Z-test.
Results, X5 5% of the mothers Initiated breast feeding within 7-18 hours after delivery, 55% of mothers got information about breast
feeding tram theu lamely members. Education and socto-economtc status had a srgmftcant association with duratton of breast fecdtnp.
Bahc\ 01 both the bottle feeding and comphmentary feeding groups had significantly htgher average number of eptsodes of diarrhoea
than that of exclustvely breast fed children.
Key words: Exclusive breast feeding, diarrhoea.

Introduction: /I hi< Bengal Medical College, among the mothers having

children 6 weeks - 24 months of age, attending the clinic
The nutritional and health status of the infants mainly
with their babies for vaccination.
depends on the feeding practices of the community. It is
seen that the child rcartng practices differ in different states,
By interviewing these mothers, information about
socio-cultural factors, practices of feeding etc. were
districts and in the people living in different regions in the
collected on a pre-tested and pre-designed proforma.
same state. Supertority of breast feeding over bottle feeding
Mothers were divided into two sub-groups:
has been established almost as an axiomatic feature. During
9 those having children aged 6 weeks to 4 months and
the last decade, this has received a renewed thrust and
emphasis for being used as an effective tool in improving ii) those having children aged 12 months to 24 months.
the survival, morbidity and the health status of children. The former group was specially interviewed for any
episode of diarrhoea during previous 2 weeks period and the
This study was conducted with an objective to find
later group was enquired whether they were continuing
out the pattern of breast feeding practices in the rural
breast feeding and if not, then the time and reasons of
m o t h e r s o f Darjecling district and influence of
discontinuation. Data was statistically analysed.
socioeconomic and cultural factors with special reference
The study period was from January 1992 to December
to associatton with occurrence of diarrhoea.
Materials and Methods: Results and Discussion:
The study was undertaken in the Immunization clinic There were 1200 mothers in the study group, out of
run by the department of Community Medicine of North which 600 had their babies aged upto 12 months and the
Indian Journal of Community Medicine Vol. XXV, No.2. Apr.Jun., iOO0

number of mothers having their children aged 6 weeks to 4 Table III: Period of continuation of breast feeding
months was about 180. according to literacy status of mothers (having
Table I: Distribution of all mothers according to time children aged 12-24 months) (n=600).
of initiation of breast feeding (n=1200).
Literacy status Before 6 6-12 After 12 Total
Time of hours Number Percentage months months months
No.( %) No.(%) No.(%)
O-6 47 3.9
7-12 416 34.7 Illiterate 109(27.2) 242(60.3) 50( 12.5) 401
13-18 610 50.8 Primary/Middle 43(32.6) 74(56.0) l5( I I .4) I32
19-24 127 10.6 High school 2q41.7) 25(52.0) 3(6.3) 48

Total I200 100.0 College/University g(47.4) 7(36.8) 3( 15.8) 19

Table I shows that 85.5% of the mothers initiated Total 181(30.2) 348(58.0) 71(11.8) 6 0 0
breast feeding between 7- I8 hours after delivery and it was
started by 100% mothers within 24 hours. Kar et al’ and df = 6, x*=57.4, p<.OOl
Dutta Banik’ have reported that 5 I .3% and 42.9% of infants Table IV: Period of continuation of breast feeding
were put to breast within a span of 24 hours after delivery. according to socio-economic status of mothers (n=600).
Table II: Distribution of all mothers according to
source of knowledge of breast feeding (n=1200). Socio-economic Before 6 6-12 After 12 Total
status months months months
Source Number Percentage
No.(%) No.(%) No.(%)
Family members 660 55.0

Doctors 195 16.3 I & II 81(39. I ) 94(45.4) 32( 1 5 . 5 ) 2 0 7

Paramedical staff 211 17.5 III 83(33.7) 146(59.3) I7(7.0) 2 4 6

TBAIAWWNHG 125 10.4 Iv 17(11.6) 108(73.5) 22(14.9) 147

Others 9 0.8
Total 181(30.2) 348(58.0) 71(11.8) 6 0 0
Total I200 100.0
df = 4, x’ = 43.18, p<.OOl
Table II shows that 55% of the mothers got
information about breast feeding from their family Table III and IV show that socio-economic and
members, 17.5% from paramedical staff and 16.3% from educational status of the mothers have a significant
doctors. So far as source of advice regarding breast feeding association with duration of breast feeding. Shorter duration
is concerned, Dutta Banik’ also observed that in Indian was noted among mothers with higher education and
society the grandmothers of infants play a dominant role in socio-economic status, prolonged duration among poor and
advising the daughters or daughter-in-laws regarding breast illiterate mothers. Similar findings were observed by Kar et
feeding (42.9%). al’.

Breast feeding practices in rural Darjeeling Mrs. Ram R et al

.c. b , .., 1 . t -.,,;* ‘0 ‘$ i+,,.J
i., Indian Journal of Community Medicine Vol. XXV, No.2, Apr.Jun., 2000
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Table V: Reasons of discontinuation of breast feeding Table V shows that out of mothers who discontinued
in relation to duration (n=600). before 6 months, 61.9% had insufficient milk and 33.1%
Reasons Duration of breast feeding had developed breast infections. After 6 months,
Before 6 6-12 Total discontinuation was mostly a part of the weaning process
months months No.(%) (79.9%), pregnancy (15.80/o), and babies’ illnesses (4.3%).
No.(%) No.(%)
Karl and Kumar3 also commented insufficient milk to
InsuffIcIent milk I 12(61.9) - 112(21.2)
Breast infection 60(33.1) - 60(1 1.3) be the commonest reason of discontinuation.
Weaning 278(79.9) 278(52.6)
The help of WHO criteria4 of indicators of breast
Pregnancy ’ ‘: - 55( 15.8) 55( 10.4)
Illness of baby 9(5.0) l5(4.3) 24(4.5) feeding practices was taken for categorising the feeding
practices and accordingly the children aged 6 weeks to 4
Total IX I ( 100.0) 348( 100.0) 529( 100.0)’
months have been divided into three groups, (i) exclusive
‘Mothers of 71 children continued breast feeding after 12 breast feeding, (ii) complimentary feeding and (iii) bottle
months. feeding.

Table VI: Association between prevalence of diarrhoea and breast feeding practices in children aged 6 weeks to 4
months (n=lgO).

Feeding practices t No. of children Total no. of Mean SD Z value

experiencing diarrhoea episodes

Exclusive breast feeding 133 0 0 0 0

Complimentary feeding 15 10 0.66 0.14 18.7 (pc.001)

Bottle feeding 32 40 1.25 0.4 17.8 (p<.OOl)

Total I80 50 0.27

Table VI shows that the mean number of episodes of women should be particularly focussed in avoiding
diarrhoea among cxcluslvely breast fed children was nil and non-human milk with or without bottle upto the age of 4
that of bottle fed was 1.25. the difference between them months and also on timely weaning practices.
being highly significant (Z = 17.8, p-&01). Similarly, the
mean numhcr ofcpisodes m case of complimentary feeding
group was 0.66. which was also significantly different from 1. Kar M, De R: Breast feeding practices-impression
that of exclusively breast fed children (Z=l8.3, p<.ClOl). from an Urban Community. Indian Journal of Public
Similar observations were also made by Kaur’. Health I99 I ; 35(4): 93-5.

The study shows that there needs a lot to be done to 2. Dutta Banik ND: Breast feeding and weaning
improve the feeding practices in all sections of the society, practices of Indian pre-school children. Indian
particularly the mothers having higher education and Journal of Community Medicine, 1987; 12(3):
socio-economic status. The health education to the pregnant 109-16.

Breast feeding practices in rural Dajeeling 81 Mrs. Ram R et al


lhdlan Journal of Communtty Medtclne Vol XXV, No 2, Apr -Jun ,200O

3 Kumar S, Slngh S, N&h LM et al Changmg trend; in 4 Kaur P, Kaur N Breast feeding practices in Varanasi
breast teedlng attltudc and practices m India - need for District (U P ) Indian Journal ot Public Health, 1996,
appropi late intervention Indian J o u r n a l o f 40(4) 52-3.
Commumty Medicme, 1987, 12(3) 124-36

Letter to the Editor:

Respected Sir, 1048 underfives. 71(6 8%) reported episode 01 dlarrhoea

Experiences of MICS In Dakshm Kannada (Karnataka) wlthln last 24 hours and only 58 6% of mothers were aware
Multi-mdlcator cluster surveys (MICS) data provided of ORS and avallablhty of ORS was ensured only In half of
useful lnformatron at the dlstnct level for Dakshln Kannada the clusters surveyed Another dlsturbmg ob<ervatmn ot
During the year 1995-96 ‘1 total population of 8551 was concern was that only 38% of households had access to safe
coveled by standald Lluster sampling techmque within a water supply and 34% of households had sanitary latrine
pellod o f o n e weeh b y tramed s t a f f with a d e q u a t e IodlLed salt was available only m 55% of the clu\ters and
Fupportlve \upelvl\lon Ot 305 children between 12-23 35% of the households stated use of lodr7ed salts whllc none .
months, 88 5% were lully Immunized and over 74% of of the salt sample tested posmve for Iodine content at
childlen lecelved vlt,m~ln-A p r o p h y l a x i s a l o n g with household level School enrollment ratio for male and
measles Immunlzdtlon Of I7 I dntenatals, 94 2% received female children was quite high dt the level of 95% and drop
two or mole than two ‘mtcnatal check-ups and almost same out rates were neghglble at 0 7%
proportIon of women lecclved two doses of tetanus toxoid
The whole exercise of MICS was a rich experience It
and uon dnd fohc dLld tablets Over 77% of antenatdls
consumed Iron and follc acid tablets One of the dlstut blng demonstrated rapid methods of collectlon of mdlcators of

obsclvatlon was that neally 40% of pregnancies were teen maternal and child health and proved to be lcarnmg
age pregndncles, ovel 59% 01 deliveries were InstItutIonal experience for fdCUlty of community medlclne and the
and the lest wete home deliveries, two fifth ot home health teams The fmdmgs were shared with the local health
dehvel ies were conduLtcd by untrained personnels Nearly authorltles and the vlllagc community Data of MICS was
25% of new born were glvcn breast fecdlng wlthm an hour also used In teaching and training of undergraduate
ot delivery and veiy high plop01 tlon (68%) of children were studrnts These raplds surveys should be undcl t&n quite
exLlu\lvely b r e a s t ted upto t o u r m o n t h s o f hfe frequently by the health care delivery system to get a feed
Complementary ‘oodb were started at right age by 42% Of back of the system

N Udaya Koran, M S Kotlan,B S SaJJan, Mural1 Madhav, Rdhul Bansal,

Anand Saldahna, M V Sagar. RaJeev, S Latha, Roy AbhiJit,
Thomas Mathcw, Padma Mohnan, Asha Kamath, A L Lobo
Deptt of Community Medicine, Kasturba Medical College Mangalore

Breast feeding practices In rural Daqeellng 82 Mrs Ram R et al