(50.5%), cerelac (26.5%), and pap mixed with other foods (11.0%). Eighty two percent of mothers fed gruel to their infant with a feeding bottle. Sixty five also fed.
Dr. Ram Hari Chapagain, MBBS
KNOWLEDGE AND PRACTICES OF MOTHERS OF INFANT AND YOUNG CHILD ON COMPLEMENTARY FEEDING
KNOWLEDGE AND PRACTICES OF MOTHERS OF INFANT AND YOUNG CHILD ON COMPLEMENTARY FEEDING
(Based on the study done at Kanti Children’s Hospital, Kathmandu, Nepal. From June 2010 to October 2011)
Thesis submitted to
National Academy of Medical Sciences Mahaboudha, Kathmandu, Nepal
In partial fulfillment of the requirement for the degree of
Doctor of Medicine (MD) in Pediatrics
By
Dr. Ram Hari Chapagain, MBBS February, 2012 AD
Dedicated To my parents and teachers for their blessings. To my wife, kiran, for her understanding.
iv
DECLARATION
I, Dr. Ram Hari Chapagain, hereby declare that this thesis work “knowledge and Practices of mothers of infant and young child on complementary feeding” has not been submitted in candidature for any other degrees elsewhere. I personally will have no objection if my thesis, in part or whole, is photocopied or used for other research purposes.
----------------------------Dr. Ram Hari Chapagain
v
CERTIFICATE
This is to certify that the present study “knowledge and Practices of mothers of infant and young child on complementary feeding” has been undertaken by Dr. Ram Hari Chapagain under our direct supervision and guidance. His work is original and was carried out in Kanti Children’s Hospital as a part of partial fulfillment for the degree of Doctor of Medicine in Pediatrics of National Academy of Medical Sciences, Mahabaudha, Kathmandu, Nepal.
----------------------------
----------------------------------
Guide
Co-guide
Dr. Ganesh Kumar Rai
Dr. Kailash Prasad Sah
Associate Professor
Assistant Professor
Department of Pediatrics
Department of Pediatrics
NAMS
NAMS
vi
ACKNOWLEDGEMENTS
First and foremost, I would like to express my heartfelt gratitude to my guide, Associate Professor Dr. Ganesh Kumar Rai, Department of Pediatrics, NAMS, for his constant encouragement, support and proper guidance for the completion of this thesis work. I would also like to extend my sincere gratefulness to my co – guide Dr Kailash Prasad Sah, Assistant Professor, Department of Pediatrics, NAMS, without whose guidance, comments and immense help this thesis would not have been possible and would not have taken shape. I would also like to express my sincere gratefulness to all other faculty members of the Department of Pediatrics, NAMS for their guidance and constant encouragement. I would also like to thank all my senior and junior colleagues and also the staff members of Kanti Children’s Hospital who directly or indirectly helped me during the study period. I would also like to extend my sincere thanks to Ms Kimat Adhikari, public health expert and Mr Susan Man shrestha, biostatician, who helped me with statistical analysis. Last, but not least, I would like to extend my gratefulness to all the mothers who were involved with this study.
Dr. Ram Hari Chapagain Feb 2012 vii
ABBERIVIATIONS
AA
Arachidonic acid
AAP
American Academy of Pediatrics
AGE
Acute gastroenteritis
BF
Breastfeeding
BFHI
Baby friendly hospital initiative
CI
Confidence interval
CF
Complementary feeding
DHA
Docosahexaenoic acid
DoHS
Department of health services
EBF
Exclusive breastfeeding
EGF
Epidermal growth factor
G-CSF
Granulocyte colony-stimulating factor
GH
Growth hormone
GI
Gastrointestinal
HIV
Human immunodeficiency virus
IBFAN
International breastfeeding action network
IEC
Information, education and communication
IF
Infant formula
IgA
Immunoglobulin A
IGFs
Insulin like growth factors
INGO
International nongovernmental organization
IRB
Institutional review board
viii
IYCF
Infant and young child feeding
LCP
Long-chain polyunsaturated
LSCS
Lower segment caesarian section
MoHS
Ministry of health and population
NAMS
National academy of medical science
NGF
Nerve growth factor
NGO
Nongovernmental organization
NHDS
Nepal health and demographic survey
NPAN
National plan of action on nutrition
NRP
Nepalese rupees
PHC
Primary health centre
PL
Placental lactogen
PRL
Prolactin
PTH
Parathyroid hormone
sIgA
Secretory immunoglobulin A
TGF
Transforming growth factor
UNICEF
United nations children emergency funds
WBTi
World breastfeeding trend initiative
WHO
World health organization
SPSS
Statistical package for social sciences
ix
TABEL OF CONTENTS
S.No Description
Page
1
Executive summary
1
2
Introduction
4
3
Literature review
10
4
Objective
41
5
Methodology
43
6
Observations and results
53
7
Discussion
74
8
Conclusion
89
9
Recommendations
92
10
Limitations of Study
94
10
References
96
11
Annex and master chart
110
x
LIST OF TABLES S.No Description
Page
1
Socio-demographic characteristics of the family
55
2
Education related characteristics of participants
58
3
Socioeconomic characteristics
59
4
Mother’s knowledge related characteristics of infant and young
60
child feeding 5
Practice related characteristics of infant and young child feeding
62
6
Frequency, consistency and amount of practiced complementary
66
feeding 7
Mother related characteristics and proper and improper feeding
68
8
Father related characteristics and proper and improper feeding
69
9
Appropriate and inappropriate feeding
70
according to family
residence and religion 10
Association of characteristics with inappropriate feeding practices
xi
73
LIST OF FIGURES S.No Description
Page
1
Sampling frame and technique
45
2
Conceptual frame work of variables
48
3
Use of marketed complementary foods
63
4
Time of starting complementary foods
64
5
Varieties of food used for complementary feeding
65
6
Feeding practices of mothers
67
xii
LIST OF ANNEXES
Annex no.
Description
Page
1
Performa
110
2
Written consent from in English
112
3
Written consent from in Nepali
113
4
Caste system of Nepal
114
xiii
EXECUTIVE SUMMERY
1
Introduction: Exclusive breastfeeding for the first six months followed by complementary feeding along with breastfeeding is crucial for proper growth and development of a child. Lack of knowledge and proper feeding practices contribute to higher childhood morbidity and mortality. Assessment of mother’s knowledge about breast feeding and complementary feeding and their practices and study of factors affecting them is of outmost important for health planners and policy makers.
Objectives: To study the knowledge and practices of mothers about complementary feeding in infant and young child and factors influencing it.
Methodology: A hospital based cross-sectional study was conducted between June, 2010 to October, 2011, at Kanti Children's Hospital, Nepal, involving mothers of children from 6 to 24 months of age who attended outpatient department of this hospital, applying systematic sampling technique excluding mothers of child less than 6 months and more than 24 months and using semi-structured questionnaire. During the study period, 1100 mothers were interviewed. Mothers of children with known anomalies, mothers whose children were very sick needing emergency care and those who failed to provide consent for any reason were also excluded from the study.
2
Results: Eighty-seven percent of mothers had knowledge about the duration of exclusive breast feeding but only 33.0% practiced it and only 21.0% breast fed their children up to 3 months. Eighty-seven percent of mothers knew when to start complementary feeding and 53.27% of mothers used the marketed weaning food. lito alone was offered by 28.27% as complementary food. Though 36.6% had proper knowledge of frequency of complementary feeding, only 33.27% were actually practicing it and 9.9% were offering more frequent than recommendation. About half of the mothers fed their child with the food of appropriate consistency and 66.0% fed with the appropriate amount. But only 15.82% mothers fed their children with ideal frequency, sufficient amount and ideal quality. Inappropriate feeding practices were associated with type of family (OR1.726, CI 95%,1.199-2.485), knowledge to start complementary feeding (OR14.979, CI 95%9.637-23.281), knowledge of frequency complementary feeding (OR14.979,CI 95%,9.637-23.281), profession of father (OR1.714CI 95%0.895-3.270), education of mother (OR1.962 CI 95%,1.341-2.871), not receiving feeding advice in immunization (OR 1.715 CI 1.239-2.375 , P 6 months. The arguments for both of these options are comprehensively reviewed in the recent literature, including a discussion about the time of introduction of complementary foods those in terms of benefit-risk ratio, morbidity, growth, and nutritional status of children.51 A study conducted by Butte N F, Mardia G. Lopez A and Cutberto G for a WHO expert consultation, evaluated the nutrient adequacy of exclusive breastfeeding for term infants during the first 6 months of life in the USA. In this study human-milk intake of infants was measured from 4 to 9 months through the transitional feeding period. Complementary feeding was started at the discretion of the mother in consultation with the child’s pediatrician. According to this study, forty-two per cent (19/45) of the infants were exclusively breastfed until 5 months of age, 40% (18/45) until 6 months, and 18% (8/45) until 7 months. 55 However, some authors have raised the question about the duration of exclusive breast feeding and they suggest the duration should be shorter than 6 months as mother milk is not sufficient for 6 months for a child.56 The timely introduction of complementary foods (all solid foods and liquid foods other than breast milk or formula, also called weaning foods or beikost) during infancy is necessary to enable transition from milk feedings to other foods and is important for nutritional and developmental reasons. The dilemmas of the weaning
17
period are different in different societies. The ability of exclusive breast-feeding to meet macronutrient and micronutrient requirements becomes limiting with increasing age of the infant. Current WHO recommendations on the age at which complementary food should be introduced are based on the optimal duration of exclusive breastfeeding. A WHO-commissioned systematic review of the optimal duration of exclusive breast-feeding compared outcomes with exclusive breast-feeding for 6 vs 34 mo. The review concluded that there were no differences in growth between the 2 durations of exclusive breast-feeding. Another systematic review concluded that there was no compelling evidence to change the recommendations for starting complementary foods at 4-6 mo. The AAP Pediatric Nutrition Handbook also states that there is no significant harm associated with introduction of complementary foods at 4 mo of age and no significant benefit from exclusive breast-feeding for 6 mo in terms of growth, zinc and iron nutriture, allergy, or infections. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition considers that exclusive breast-feeding for ~6 mo is desirable, but that the introduction of complementary foods should not occur before 17 weeks (~4 mo) and should not be delayed beyond 26 weeks (~6 mo).57 Guiding principles for complementary feeding After 6 months of age, it becomes increasingly difficult for breastfeed infants to meet their nutrient needs from human milk alone. Furthermore, most infants are developmentally ready for other foods at about 6 months. In settings where environmental sanitation is very poor, delayed introduction of complementary foods might reduce exposure to food-borne diseases. However, because infants are beginning to actively explore their environment at this age, they will be exposed to 18
microbial contaminants through soil and objects even if they are not given complementary foods. Thus, 6 months is the recommended appropriate age to introduce complementary foods.58 During the period of complementary feeding, children are at high risk of undernutrition.59 Amount of complementary foods should be started at six months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding. The energy needs from complementary foods for infants with “average” breast milk intake in developing countries are approximately 200kcal per day at 6−8 months of age, 300 kcal per day at 9−11 months of age, and 550 kcal per day at 12−23 months of age. In industrialized countries these estimates differ somewhat (130, 310 and 580 kcal/d at 6−8, 9−11 and 12−23 months, respectively) because of differences in average breast milk intake and increase in the number of times that the child is fed complementary foods as he/she gets older. The appropriate number of feedings depends on the energy density of the local foods and the usual amounts consumed at each feeding. For the average healthy breastfed infant, meals of complementary foods should be provided 2−3 times per day at 6−8 months of age and 3−4 times per day at 9−11 and 12−24 months of age. Additional nutritious snacks (such as a piece of fruit or bread or chapatti with nut paste) may be offered 1-2 times per day, as desired. Snacks are defined as foods eaten between meals, usually self-fed, convenient and easy to prepare. If energy density or amount of food per meal is low, or the child is no longer breastfed, more frequent meals may be required.51 Complementary foods are often of inadequate nutritional quality, or they are given too early or too late, in too small amounts, or not frequently enough. Premature cessation or low frequency of breastfeeding also contributes to insufficient nutrient and energy 19
intake in infants beyond 6 months of age. The Guiding principles for complementary feeding of the breastfed child set standards for developing locally appropriate feeding recommendations.51 They provide guidance on desired feeding behaviors as well as on the amount, consistency, frequency, energy density and nutrient content of foods. Guiding principles for complementary feeding of the breastfed child based on WHO is as follows.60 • Practise exclusive breastfeeding from birth to 6 months of age, and introduce complementary foods at 6 months of age (180 days) while continuing to breastfeed. • Continue frequent, on-demand breastfeeding until 2 years of age or beyond. • Practise responsive feeding, applying the principles of psychosocial care. • Practise good hygiene and proper food handling. • Start at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding. • Gradually increase food consistency and variety as the infant grows older, adapting to the infant’s requirements and abilities. • Increase the number of times that the child is fed complementary foods as the child gets older. • Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met. • Use fortified complementary foods or vitamin-mineral supplements for the infant, as needed. • Increase fluid intake during illness, including more frequent breastfeeding, and encourage the child to eat soft, favorite foods. After illness, give food more often than usual and encourage the child to eat more. 20
Importance of infant and young child feeding. Adequate nutrition during infancy and early childhood is essential to ensure the growth, health and development of children to their full potential. Poor nutrition increases the risk of illness, and is responsible, directly or indirectly, for one third of the estimated 9.5 million deaths that occurred in 2006 in children less than 5 years of age.61,62 Inappropriate nutrition can also lead to childhood obesity which is an increasing public health problem in many countries. Early nutritional deficits are also linked to long term impairment in growth and health. Malnutrition during the first 2 years of life causes stunting, leading to the adult being several centimeters shorter
21
than his or her potential height.63 Although considerable flexibility in the diet of each infant should be permitted to allow for personal idiosyncrasies and family habits, the caregiver should be given an outline of the basic daily dietary needs. Importantly, the caregiver should also be aware of what to expect in terms of eating behavior as the child matures.53 There is evidence that adults who were malnourished in early childhood have impaired intellectual performance.64 They may also have reduced capacity for physical work.65,
66
If women are malnourished in childhood, their reproductive
capacity is affected, their infants may have lower birth weight, and they have more complicated deliveries.67When many children in a population are malnourished, it has implications for national development. The overall functional consequences of malnutrition are thus immense. The first two years of life provide a critical window of opportunity for ensuring children’s appropriate growth and development through optimal feeding.68Based on evidence of the effectiveness of interventions, achievement of universal coverage of optimal breastfeeding could prevent 13.0% of deaths occurring in children less than 5 years of age globally, while appropriate complementary feeding practices would result in an additional 6.0% reduction in under five mortality.69 It is essential to have a variety of foods to ensure that nutrient needs are met. Meat, poultry, fish or eggs should be eaten daily, or as often as possible. Vegetarian diets cannot meet nutrient needs at this age unless nutrient supplements or fortified products are used. Vitamin A-rich fruits and vegetables should also be given daily. It is also
recommended to have diets with adequate fat content and to avoid giving drinks with
22
low nutrient value, such as tea, coffee and sugary drinks such as soda. It is advised to limit the amount of juice offered so as to avoid displacing more nutrient-rich foods.59
Current status of infants and young children feeding Poor breastfeeding and complementary feeding practices are widespread. Worldwide, it is estimated that only 34.8% of infants are exclusively breastfed for the first 6 months of life, the majority receiving some other food or fluid in the early months. 70 A comparative study of infant and young child feeding practices in South Asian Countries found that lowest rates of timely initiation of breast feeding were found in India (23.5%) and Bangladesh (27.5%) as compared to Nepal (35.4%) and Sri Lanka (56.3%). Similarly, exclusive breastfeeding rates were almost equal in Bangladesh (42.5%) and India (46.4%) but higher in Nepal (53.1%). Complementary foods are often introduced too early or too late and are often nutritionally inadequate and unsafe. Data from 64 countries covering 69.0% of births in the developing world suggest that there have been improvements in this situation. Between 1996 and 2006 the rate of exclusive breastfeeding for the first 6 months of life increased from 33.0% to 37.0%.However, this increase in improvement of exclusive breast feeding in South Asia is not significant (from44.0% to 45.0%). Significant increases were made in subSaharan Africa, where rates increased from 22.0% to 30.0%; and Europe, with rates increasing from 10.0% to 19.0%. In Latin America and the Caribbean, excluding Brazil and Mexico, the percentage of infants exclusively breastfed increased from 30.0% in1996 to 45.0% in 2006.71
23
A hospital based study conducted in Manipal Teaching Hospital, time of 6 months. Nepal from April 2011 to May 2011 on infant feeding practice in Kaski district revealed that almost 86.6% mother were practicing breastmilk as its first food.47% initiated breastfeeding within half an hour of child’s birth. Eighty six percent gave jaulo as the first complementary food to their children. About 26% of the mother practiced complementary feeding to their children before the recommended.72
Socio-demographic factors influencing IYCF A study based on the analysis of secondary data of NDHS 2006 found that complementary feeding of children age 6-9 months were associated with mother's better education and age above 35 years. Women who have completed school leaving certificate (SLC) or a higher education are found to be slightly more likely to initiate breastfeeding within one hour and one day of birth than women with lower levels of education.73. Study based on urban area of Nepal found that demographic factors like mother’s age, education level, and sex of the child and birth order had no any significant relation with initiation of breastfeeding but family type and family size were found to be associated significantly (p-value 0.02 in each case respectively).74 However, maternal age and education were found to be associated factors of timely complementary feeding practices in Nepal while it was not observed in other countries like India, Bangladesh and Srilanka in comparative study done in South Asia.75 Breastfeeding duration is found to be shorter than WHO recommendation even in developed countries like Czech Replubic as observed by Kudlova E et al. It is found to be influenced by maternal education and marital status. Compliance with complementary feeding recommendations is relatively good.76 A study conducted in
24
Tibet by Dang S et.al found mothers' age, education, child's residence, and introduction of egg, fresh milk and milk powder were strongly associated with the duration of breastfeeding and introduction of complementary feeding. Cross–sectional study conducted in India in 2004 found that delay in initiation of breast feeding was significantly associated with maternal age, literacy, socioeconomic status and place of delivery. Delayed initiation of breast feeding was found more common among illiterate mothers delivering at home irrespective of their socio demographic characteristics like religion, parity, birth spacing, and gender preferences etc.46
Socio economic factors influencing ideal IYCF WHO global forum for health research, a foundation for improving child health, stated that there are various factors influencing ideal IYCF practices. Complementary feeding is also influenced by cultural practices, beliefs and knowledge of parents regarding appropriate practices.77 A hospital based study in India by Agarwal A et al found that knowledge of proper timing was present in 46.0% of mothers, adequate quantity in 46.5% and thick consistency in 25.5%. Only 8.0% mothers had proper knowledge of all three aspects of CF. Knowledge regarding appropriate timing and consistency varied significantly with maternal education and paternal education. Graduate mothers were 3.56 times more likely to know the correct timing and consistency of food to be given to their children.30 Community based cross sectional household survey conducted in western Uganda in 2002 to find out socioeconomic correlates of IYFC concluded that among the socioeconomic factors, only mother’s education and household assets index was found to be positively correlated.76 Other studies have also described maternal
25
education to be the most influential factor for the timely introduction and quality continuation of the complementary feeding.78,79 Cross–sectional study conducted in India in 2004 found that delay in initiation of breast
feeding was significantly
associated with maternal age, literacy, socioeconomic status and place of delivery. Delay in initiation of breast feeding was found more common among iliterate mothers delivering at home, irrespective of their socio demographic characteristics like religion, parity, birth spacing, and gender preferences etc.75 Another study conducted in Mutals, a rural sub- district of Limpopo Province in South Africa by Musaphi et al found that the majority (97%) of mothers were still breastfeeding till age of 2 years at the time of interview. Only 7.6% practiced exclusively breast-feeding, while 43.2% had introduced solid foods at 3 months and 15% before 2 months. The weaning food given by most of the mothers was soft porridge and had been introduced before four month of age.80
Knowledge and practice of mothers on IYCF A Community based study conducted in Pokhara Municipility of Nepal on infant feeding practices revealed that almost 60.0% of mothers were practicing exclusive breast-feeding at 5 months, almost 40.0% started complementary feeding before the recommended age of 6 months and about 22.0% delayed introduction of complementary feeding.74 It has been shown in a study by Bhavana Singh regarding the breast-feeding that all mothers regarded breast-feeding as being nutritious, 99.0% being promoting bonding between mother and child, 97.0% being healthier for children, 81.0% being cheaper
26
than buying supplements and 80.0% protecting their children from disease. However, 38.0% of mothers disagreed to the contraceptives benefits of breastfeeding.81 A hospital based study in India in 2006 found that only 54.0% of mothers had correct knowledge about the recommended time for starting complementary feeds and only 35.0% had practiced it properly.30 Similarly, a study done in Uganda found that initiation of breastfeeding was nearly universal. However, 43.0% of mothers reported the use of prelacteals in which plain water, glucose water and sugar were in the order. Exclusively breast feeding rate was 57.0%.82 Promotion of breast feeding intervention trial model developed by WHO/UNICEF baby friendly initiative when applied in hospital based observational cohort study conducted in Republic of Belarus observed a lower risk of gastrointestinal problems and no demonstrable adverse health effects in first year of life in the interventional group.83 It seems that there are several factors influencing the CF. For instance, Igbedioh S et.al showed that the most important factors influencing the type of supplementary food were suitability for infant (35.5%), high quality (21.5%) and price (19.5%). The leading types of weaning foods observed by them were pap (50.5%), cerelac (26.5%), and pap mixed with other foods (11.0%). Eighty two percent of mothers fed gruel to their infant with a feeding bottle. Sixty five also fed legumes, vegetables, and/or fruits to their infants. The decisions to feed these foods to their infants were based on hospital advice (36.0%), availability in the family menu (24.0%) and easy availability (18.5%).84
27
Another study done by Gittelsohn J, et.al in Nepal had shown that mothers of control children tended to have a higher level of education (p 6 months 9%
< 1 month 6%
1 month 5% 2 months 6% 3 months 14%
6 months 33% 5 months 18%
Figure 4: Time of Starting the complementary feeding
64
4 months 9%
started
The following bar diagram shows the varieties of food used for complementary feeding. Lito is the commonest one followed by lito dal bhat, lito cerelacs, cerelacs and dal bhat alone.
Figure 5: Varieties of food used for complementary feeding
65
Table 6 shows the feeding practices in relation to quality, quantity and timing of complementary feeding. More than half (56.81%) of mothers fed their child less than prescribed frequencies per day. Where as one among 10 mothers fed more frequent than required and only one third mothers fed their children as per recommendation. Likewise half of the mothers fed their child either thin or thick food and 4 among 5 mothers feed their child appropriate amount. In computing the ideal feeding only 15.82% of mothers fed their child ideally means normal amount with appropriate consistency and appropriate frequency in a day. Table 6: Frequency, consistency and amount of practiced complementary feeding Characteristics
Frequencies n=1100
%
Frequency of complementary feeding Less than required As required More than required
625 366 109
56.81 33.27 9.90
Consistency of complementary feeding Thick 341 Thin 199 Appropriate 560
31.00 18.09 50.91
Amount of complementary feeding Inappropriate Appropriate
266 834
24.18 75.82
Ideal feeding status Not ideal Ideal
926 174
84.18 15.82
66
The figure 6 shows the feeding practices of the mothers. Only sixteen percent of mothers had ideal feeding practices.
Ideal 16%
Not ideal 84%
Fig.6: Feeding practices of mother
Factors influencing to ideal feeding practices Table 7 shows the factors influencing the inappropriate feeding (not ideal feeding) practices. Education status of mothers and fathers, profession of mothers and fathers, income, religion, residence, sufficiency of food and use of commercial food were assessed. It was found that mothers education, type of family and religion of the family were strongly associated with the appropriate feeding. Educated mother had high rate of ideal feeding than the uneducated mother (p=0.008). Mothers from joint family had high chance of feeding their child appropriately than mother from nuclear family (p=0.003). Similarly, religion (p=0.03) also had significantly affected the ideal feeding
67
Table 7: Mother related characteristics for proper and improper feeding
% 91.30%
Ideal Number 18
% 8.70%
145
87.30%
21
12.70%
some secondary
281
82.20%
61
17.80%
SLC Intermediate
226
81.00%
53
19.00%
Bachelor and above
84
80.00%
21
20.00%
Professi House wife on of mother HW with Agriculture
652
83.40%
16.6
137
89.50%
130 % 16
10.50%
Business
57
81.40%
13
18.60%
Skilled work
22
91.70%
2
8.30%
Service
50
82.00%
11
18.00%
Labour
8
80.00%
2
20.00%
Characteristics Educatio No education n of mother primary education
Not ideal Number 190
p
0.008
Sufficie 12 Months
392
84.10%
74
15.90%
926
84.20%
174
15.80%
68
Table:8 Father related characteristics for proper and improper feeding
Inappropriate Number %
Characteristics
Education of Noeducation(N=99) 87 father primary(N=147) 130
Appropri ate Number
P %
87.90% 88.40%
12 17
12.10% 11.60% 0.266
Profession of father
Some secondary(N=335) SLC and Intermediate (N=359) Bachelor and above (N=160) Unemployed(N=8)
275
82.10%
60
17.90%
304
84.70%
55
15.30%
130
81.30%
30
18.80%
8
100.00%
0
0.00%
Agriculture
88
88.90%
11
11.10%
Business
166
81.40%
18.60%
Skilled work
286
84.90%
38 % 51
Service
279
82.10%
61
17.90%
Labour
33
91.70%
3
8.30%
Foreign employee
66
86.80%
10
13.20%
0.273
69
15.10%
Table:9 Appropriate and inappropriate feeding practices by family residence and religion inappropriate Appropriate Frequen cy %
Characteristics Frequency
%
City
508
83.60%
100
16.40%
Town
217
81.90%
48
18.10%
Rular
201
88.50%
26
11.50%
926
84.20%
174
P
Residen ce
Total
0.107
15.80% Type of Joint family Nuclear
348
88.50%
45
11.50%
578
81.80%
129
18.20%
Total
926
84.20%
174
15.80%
Religion of family
Hindu
724
82.60%
153
17.40%
Buddist
160
89.90%
18
10.10%
Muslim
17
94.40%
1
5.60%
Christian
25
92.60%
2
7.40%
926
84.20%
174
15.80%
0.003
0.03
Total
70
Analysis of association This section includes the results of bivaritae analysis done between the predictor variables (socio demographic and socio-economic) and the outcome variables of interest (inappropriate feeding). Confidence interval (CI) for odds ratio was set as 95% and p value of
