Background: Breast milk provides the newborn with all of the nutrients they require in the appropriate amounts and contributes to their overall health, whereas complementary feeding is required to deliver the energy and crucial nutrients for sustained growth and development. Present study was carried out to evaluate the knowledge towards breast feeding as well as complementary feeding among postnatal mothers of Himachal Pradesh. Methodology: This cross-sectional survey was conducted among the postnatal mothers residing in the state of Himachal Pradesh, using Google forms. The questionnaire was circulated among all over the state for responses using online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn till the 400 responses were collected. Data was analyzed using Epi info V7 Software. Results: Among the total 400 Post Natal Mothers, maximum 238(59.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 185(46.25%) , Hindu 382(95.5%), Housewife 298(74.5%), Multigravida 281(70.25%) and delivered in government hospitals 290(72.5%).In the present study 66(16.5%) postnatal mothers’ had very good knowledge (16-20 marks) towards breast feeding , 259(64.75%) having good knowledge (12-15 marks), 70(17.5%) having fair knowledge (8-11 marks) and 5(1.25%) having poor knowledge (<8 marks) towards breast feeding. Similarly, 39(9.75%) postnatal mothers’ had very good knowledge (16-20 marks) towards complementary feeding , 288(72%) having good knowledge (12-15 marks), 54(13.5%) having fair knowledge (8-11 marks) and 19 (4.75%) having poor knowledge (<8 marks) towards complementary feeding. Conclusion: During the antenatal period, every Postnatal Mother should receive proper breastfeeding assistance and education in addition to complementary feeding information, and all of their myths should be appropriately debunked.
For mothers and babies, breastfeeding has unrivalled health advantages. Breast milk is specifically crafted to satisfy the health needs of a developing baby, making it the clinical gold standard for infant feeding and nutrition. Because breast milk includes all the necessary nutrients, including vitamins and minerals, it is the greatest diet for infants throughout their first six months of life. Infants should only be breastfed during the first six months of life, according to the World Health Organization, to guarantee the best possible growth, development, and health [1-4].
Complementary feeding is vital to provide the nutrients and energy needed for sustained growth and development. The name derives from the fact that the advised extra foods' nutrients balance out those in breast milk. They work nicely together and each has a certain purpose. Infants who are introduced too soon cannot only rely on breast milk for the recommended six months. Numerous studies have found that more than 50% of newborns receive supplemental food too early, often with little nutritional value, and infrequently enough to meet the requirements of dietary diversity and feeding frequency. Consequently, very few children receive supplemental food that is both safe and nutritionally adequate [5-8].
In spite of convincing evidence of the benefits, of breastfeeding as well as complementary feeding rates are less than satisfactory in Himachal Pradesh, which need to be identified and addressed. While, a number of studies have assessed knowledge of breastfeeding and complementary feeding in different parts of the India; such studies are limited among postnatal mothers in the hilly state of Himachal Pradesh has a diverse population with distinct customs, traditions, and cultural practices that strongly influence maternal and child-rearing behaviors. The present study was undertaken to assess the level of knowledge regarding breastfeeding and complementary feeding among caregivers, in order to identify existing gaps and misconceptions. Such information is essential for designing a more culturally sensitive, locally relevant, and effective health education plan that can be implemented as a targeted health promotion intervention to improve infant and young child feeding practices.
Objectives of the Study
To evaluate the knowledge towards breast feeding as well as complementary feeding among postnatal mothers of Himachal Pradesh.
Research Approach
Descriptive
Research Design
Cross-sectional survey design
Study Area
Hilly state of Himachal Pradesh
Study Duration
Between October 2021 to December 2021
Study Population
Post Natal Mothers and having children aged less than two years
Sample Size
400 Post Natal Mothers assuming 50% have adequate knowledge regarding breast feeding & complementary feeding, 5% absolute error, 95% confidence level, and 5% non-response rate
Sampling Technique
Convenience and snowball Sampling technique
Study Tool
A Google Form questionnaire consisting of questions related to socio-demographic characteristics, breastfeeding, and complementary feeding practices was developed. The questionnaire was initially pre-tested on a small number of postnatal mothers to identify any difficulties in comprehension, clarity of language, or interpretation of the questions by the respondents, and necessary modifications were made accordingly.
Description of Tool
Demographic Data Survey Instrument
The demographic form elicited information on
Participants’ Background
Age, marital status, religion, employment, education and many more
Questionnaire
The questionnaire contains 40 structured questions (20 related to breast feeding & 20 related to complementary feeding) having three options (yes, no, don’t know). The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good,60-79% (12-15) = Good,41-59% (8-11) = Fair, <40% (< 8) = poor
Validity of Tool
By the experts in this field
Inclusive Criteria
Who were willing to participate in the study
Exclusion Criteria
Who were not willing to participate in the study
Data Collection
Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn in both rural and urban area of Himachal Pradesh till the 400 responses were collected. Responses were then recorded in a Google Excel spreadsheet
Data Analysis
Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage.
Ethical Considerations
Participants confidentiality and anonymity were maintained
Present study was developed to evaluate the knowledge towards breast feeding as well as complementary feeding among postnatal mothers of Himachal Pradesh.
Among the total400 Post Natal Mothers, maximum 238(59.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 185(46.25%), Hindu 382(95.5%), Housewife 298(74.5%), Multigravida 281(70.25%) and delivered in government hospitals 290(72.5%) (Table 1).
In the present study 66(16.5%) postnatal mothers had very good knowledge (16-20 marks) towards breast feeding, 259(64.75%) having good knowledge (12-15 marks), 70(17.5%) having fair knowledge (8-11 marks) and 5(1.25%) having poor knowledge (<8 marks) towards breast feeding. Similarly, 39(9.75%) postnatal mothers had very good knowledge (16-20 marks) towards complementary feeding, 288(72%) having good knowledge (12-15 marks), 54(13.5%) having fair knowledge (8-11 marks) and 19 (4.75%) having poor knowledge (<8 marks) towards complementary feeding (Table 2,3).
Table 1: Socio Demographic Characteristics of the Study Participants
Maternal Age | Frequency | Percent |
<20 | 9 | 2.25 |
21-25 | 105 | 26.25 |
26-30 | 238 | 59.5 |
31-35 | 42 | 10.5 |
>35 | 6 | 1.5 |
| Maternal education | ||
Primary (1–8 yrs) | 54 | 13.5 |
Matric & Senior Secondary | 185 | 46.25 |
Graduate | 133 | 33.25 |
Post graduates | 28 | 7 |
Religion | ||
Hindu | 382 | 95.5 |
Muslim/others | 18 | 4.5 |
Employed | ||
No (Housewife) | 298 | 74.5 |
Yes | 102 | 25.5 |
Gravida |
|
|
Primigravida | 119 | 29.75 |
Multigravida | 281 | 70.25 |
Delivery place | ||
Home | 8 | 2 |
Sub-center/PHC/District Hospitals (Government) | 290 | 72.5 |
Maternity/Private Nursing Home | 102 | 25.5 |
Delivery type | ||
Vaginal | 308 | 77 |
Caesarian | 92 | 23 |
Table 2: Responses of the participants to various statements regarding Breast Feeding
S. No. | Statements | Response | Percent |
1. | Colostrum (the first breast milk) helps in developing the newborn’s immature digestive tract. | 94 | 23.5 |
2. | Colostrum is important for the baby to maintain immunity | 309 | 77.25 |
3. | Breast feeding should be started as soon possible after delivery. | 270 | 67.5 |
4. | Only breast milk should be given to baby without the addition of any other liquids or solids in first 6 months | 152 | 38 |
5. | Exclusive breastfeeding should be continued along with complementary feeds for at least 2 years | 241 | 60.25 |
6. | Burping should be done after each feed | 318 | 79.5 |
7. | Awakening the baby while breastfeeding is very important | 269 | 67.25 |
8. | Breast feeding helps in mother and child bonding | 372 | 93 |
9. | Breast feeding significantly reduces mortality in neonatal sepsis, pneumonia, and diarrhea | 386 | 96.5 |
10. | The mother should sit comfortably at the time of breast feeding | 174 | 43.5 |
11. | Breast milk protects against allergies, sickness, ear infections and obesity, diabetes and cancer. | 222 | 55.5 |
12. | While breastfeeding, an eye-to-eye contact with the baby should be maintained | 127 | 31.75 |
13. | Brest feed Babies have healthier weights as they grow | 359 | 89.75 |
14. | Breastfed babies score higher on IQ tests. | 275 | 68.75 |
15. | Breast feeding can prevent diseases affecting the breast and breast cancer | 126 | 31.5 |
16. | Mothers who breastfeed generally have less blood loss after delivery and faster involution of the uterus | 109 | 27.25 |
17. | Breastfeed affect the beauty of feeding mothers | 163 | 40.75 |
18. | Mother should not feed the child when she has fever | 150 | 37.5 |
19. | Mother should not feed the child when she has diarrhea | 131 | 32.75 |
20. | Pacifier or bottle should not be given to breast feed babies | 344 | 86 |
Table 3: Responses of the Participants to Various Statements Regarding Complementary Feeding
Table 3: Responses of the Participants to Various Statements Regarding Complementary Feeding | |||
|---|---|---|---|
S. No. | Statements | Frequency | Response |
1. | Complementary feeding should be start at 6 months of age. | 347 | 86.75 |
2. | Complementary foods introduced too early are of little benefit to the infant and may even be harmful due to the possibility of choking, developing food allergies | 317 | 79.25 |
3. | Introducing complementary foods too late may cause an infant to develop nutritional deficiencies and/or miss that period of developmental readiness | 355 | 88.75 |
4. | Infant may have difficulties learning to eat complementary foods when they are introduced late | 293 | 73.25 |
5. | When complementary foods are introduced appropriate to the developmental stage of the infant, nutritional requirements can be met and eating and self-feeding skills can develop properly. | 367 | 91.75 |
6. | Complementary foods should be introduced with spoon and bowl. | 257 | 64.25 |
7. | The texture of foods can progress from pureed to ground to fork-mashed and eventually to diced. | 255 | 63.75 |
8. | Infants should only be given foods that are appropriate for their developmental age. | 344 | 86 |
9. | Infants should not be non-vegetarian food. | 282 | 70.5 |
10. | Junk food should not be given to infants. | 365 | 91.25 |
11. | Iron-fortified infant rice cereal is a good choice as an infant’s first complementary food | 219 | 54.75 |
12. | The quality of children’s diets is more important before age 2 than at any other time in life | 233 | 58.25 |
13. | Appropriate complementary foods and feeding practices contribute to child survival, growth and development | 347 | 86.75 |
14. | Appropriate complementary Foods prevent micronutrient deficiencies, morbidity and obesity later in life | 241 | 60.25 |
15. | An adequate diet during the complementary feeding period should be nutrient rich, without excess energy, saturated and trans fats, free sugars or salt. | 208 | 52 |
16. | Young children need to consume a variety of foods to meet their nutrient needs and expose them to various tastes and textures | 282 | 70.5 |
17. | Children should continue frequent, on-demand breastfeeding until 2 years of age or longer | 208 | 52 |
18. | Three meals a day of solid, semi-solid or soft foods for breastfed children aged 9–23 months is Age-appropriate meal frequency | 212 | 53 |
19. | ¾ cup to 1 cup per meal to children aged 12–23 months is Age-appropriate amounts | 217 | 54.25 |
20. | Young children move from eating mashed foods, to finger foods, to family foods by the time they reach their first year | 306 | 76.5 |
Table 4: Knowledge towards breast feeding and Complementary feeding among postnatal mothers’
| Category (Marks) | Breast feeding Knowledge (n = 400) | Percent | Complementary feeding knowledge (n = 400) | Percent |
V. Good (16-20) | 66 | 16.5 | 39 | 9.75 |
Good (12-15) | 259 | 64.75 | 288 | 72 |
Fair (8-11) | 70 | 17.5 | 54 | 13.5 |
Poor (<8) | 5 | 1.25 | 19 | 4.75 |
Maximum = 20 Minimum = 7
Table 5: NFHS-5 Data on Breast Feeding and Complementary Feeding in Himachal Pradesh
| S. No. | Indicator | NFHS-5 (2019-20) | NFHS-4 (2015-16) |
1 | Children under age 3 year breastfed with in one hour of birth (%) | 45.1 | 41.1 |
2 | Children under age 6 months exclusively breastfed (%) | 69.9 | 67.2 |
3 | Breastfeeding children age 6-23 months receiving an adequate diet (%) | 18.0 | 11.2 |
4 | Total children age 6-23 months receiving an adequate diet (%) | 19.0 | 10.9 |
Breastfeeding and complementary feeding are processes in which mothers' positive attitudes and good understanding are crucial. Although breastfeeding has many advantages for both mother and child, some postpartum women still lack the confidence and enthusiasm to do so. Lack of understanding about breastfeeding information sources may be the cause of this issue. The factors that determine young children's diets during the complementary feeding phase are adequate complementary meals, proper complementary feeding procedures, and adequate nutrition services. To lower child morbidity and mortality, complementary feeding education that focuses on behavioral change—especially among mothers in poor nations—is crucial [9-14].
Even while more than 80% of newborns in almost every country receive breast milk, only half start nursing during the first hour of life, and rates of exclusive breastfeeding are far below 50% in the majority of the nations. According to NFHS 5 data on breastfeeding in Himachal Pradesh, the percentage of babies who were breastfed within an hour of birth increased from 41.1 to 45.1 percent. Additionally, the percentage of women who exclusively breastfeed increased from 67.2 to 69.9 percent. Only 18.0% of breastfeeding children aged 6-23 months received a sufficient diet, according to NFHS 5 statistics on complementary feeding in Himachal Pradesh. Additionally, just 19.0 percent of kids aged 6-23 months receive a sufficient diet nationwide [15-18]. An important global health objective continues to be the reduction of child malnutrition through optimal breastfeeding and supplemental feeding. In addition to being crucial for achieving many of the recently announced Sustainable Development Goals by 2030, optimal feeding practices have the potential to be among the most effective interventions for lowering under-five mortality. They can help to improve maternal and child health, nutrition, the economy, intelligence, and human capital while also reducing inequalities. Lower IQ and economic losses of around $302 billion annually, or 0.49 percent of global gross national product, are linked to suboptimal feeding practices [19-22] (Table 4,5). According to the results of this study, postpartum mothers need to be educated on the benefits of breastfeeding and complementary feeding methods.
Limitations
The cross-sectional design of the current study, the postpartum status of the participants, the presence of children under the age of two, and the small sample size made it difficult to generalize the findings. To identify the barriers to encouraging good breastfeeding and complementary feeding behaviors among postnatal mothers, future studies should concentrate on qualitative investigations with a larger sample size, such as focus groups. However, despite these limitations, the findings of this study may be helpful to policymakers and health professionals in creating programmes to enhance breastfeeding and age-appropriate complementary feeding practices.
The current study shown that women understood breastfeeding and complementary feeding well, still there is potential for improvement due to a significant knowledge gap. Healthcare providers should increase public health information, education, and communication (IEC) programmes to better educate all women on breastfeeding and complementary feeding during antenatal follow-up visits, especially those with low educational attainment and no prior breastfeeding experience. Finding solutions to these problems is crucial, particularly for working women.
Centers for Disease Prevention and Control. Why It Matters. CDC, https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html. Accessed 21 June 2022.
Martin, C.R. et al. “Review of infant feeding: Key features of breast milk and infant formula.” Nutrients, vol. 8, no. 5, 2016, pp. 279.
Al Ketbi, M.I. et al. “Knowledge, attitudes, and practices of breastfeeding among women visiting primary healthcare clinics on the island of Abu Dhabi, United Arab Emirates.” International Breastfeeding Journal, vol. 13, no. 1, 2018, pp. 1–4.
World Health Organization. Exclusive Breastfeeding. WHO, https://www.who.int/elena/titles/exclusive_breastfeeding/en/. Accessed 14 June 2022.
Nutrition Week. “Complementary Feeding.” https://www.nutritionweek.co.za/20compfeeding.html#:~:text=Complementary%20feeding%20is%20needed%20to,have%20a%20role%20to%20play. Accessed 17 June 2022.
World Health Organization. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. WHO, 2009. https://www.ncbi.nlm.nih.gov/books/NBK148967/. Accessed 13 June 2022.
Chiang, K.V. et al. “Timing of introduction of complementary foods—United States, 2016–2018.” Morbidity and Mortality Weekly Report, vol. 69, no. 47, 2020, pp. 1787–1791.
Olatona, F.A. et al. “Complementary feeding knowledge, practices, and dietary diversity among mothers of under-five children in an urban community in Lagos State, Nigeria.” International Journal of MCH and AIDS, vol. 6, no. 1, 2017, pp. 46–59.
Vijayalakshmi, P. et al. “Knowledge, attitudes, and breastfeeding practices of postnatal mothers: A cross sectional survey.” International Journal of Health Sciences, vol. 9, no. 4, 2015, pp. 364–374.
Magawa, R. “Knowledge, attitudes and practices regarding exclusive breastfeeding in Southern Africa—Part 2.” 2012, http://www.consultancyafrica.com. Accessed 12 June 2022.
Kishore, M.S. et al. “Breastfeeding knowledge and practices amongst mothers in a rural population of North India: A Community-Based Study.” Journal of Tropical Pediatrics, vol. 55, no. 3, 2009, pp. 183–188.
Centers for Disease Prevention and Control. “Timing of introduction of complementary foods.” CDC, https://www.cdc.gov/mmwr/volumes/69/wr/mm6947a4.htm. Accessed 17 June 2022.
World Health Organization. Infant and Young Child Feeding. WHO, https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. Accessed 13 June 2022.
World Health Organization. Guiding Principles for Complementary Feeding of the Breastfed Child. WHO, https://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf. Accessed 15 June 2022.
“Nursing answers: Knowledge and importance of exclusive breastfeeding.” https://nursinganswers.net/essays/knowledge-and-importance-of-exclusive-breastfeeding-health-essay.php. Accessed 13 June 2022.
Operational Guidelines of IYCF. https://ima-india.org/windata/Operational-Guidelines.pdf. Accessed 15 June 2022.
NFHS-5. Himachal Pradesh Fact Sheet. http://rchiips.org/nfhs/NFHS-5_FCTS/Himachal_Pradesh.pdf. Accessed 19 June 2022.
NFHS-5. HP Fact Sheet. http://rchiips.org/nfhs/NFHS-5_FCTS/HP.pdf. Accessed 19 June 2022.
Stuebe, A. “The risks of not breastfeeding for mothers and infants.” Reviews in Obstetrics and Gynecology, vol. 2, no. 4, 2009, pp. 222–231.
BPNI. Breastfeeding in the 21st Century: Epidemiology and Mechanisms. https://www.bpni.org/Article/Breastfeeding-in-the-21st-century-epidemiology-mechanisms.pdf. Accessed 16 June 2022.
World Health Organization. Global Target 2025: Discussion Paper Extension Targets 2030. https://www.who.int/nutrition/global-target-2025/discussion-paper-extension-targets-2030.pdf. Accessed 17 June 2022.
UNICEF. State of the World’s Children 2019. https://www.unicef.org/media/60806/file/SOWC-2019.pdf. Accessed 17 June 2022.
Download PDF
Download PDF
Download PDF
Download PDF
Download XML
