The WHO recommends that after first 6th months of life, infants should receive nutritionally adequate & safe complementary foods, while continuing to breastfeed for up to 2 years or more to achieve optimal growth health and development of child. As requirements of the infant for energy & nutrients start to exceed what is provided by breast milk at the age of 6 months, complementary foods are necessary to meet those needs at that time [1].

In many developing countries, the incidence of under-nutrition usually increases during the period of complementary feeding from the age of 6 to 18 months. The occurrence of early nutritional deficits is linked with long-term impairments in child health and growth [2].

According to many studies, more than 50% of infants are given complementary food too early and usually of poor nutritional value which don’t meet the criteria of dietary diversity and feeding frequency. Therefore, only few children receive nutritionally adequate and safe complementary food [3].

Complementary foods which are often of inadequate nutritional quality or that are given too early or too late, in too small amounts, or not frequently enough or given inappropriately, may falter the growth of the infant. Also, inappropriate complementary feeding practice may result in malnutrition and cause various diseases. Malnutrition has been the underlying factor leading to childhood killer diseases such as malaria, pneumonia, diarrhea. Under-nutrition causes stunting, underweight and wasting. Malnutrition can also lead to obesity in adulthood which is a risk factor for many diet related non-communicable diseases such as hypertension, heart diseases, diabetes and some types of cancer. Child malnutrition hurts cognitive function and contributes to poverty by impeding a child’s ability to lead productive lives, hence slows down national development [1,2,4].

Adequate and timely complementary feeding practices do not only regulate growth and functional development of a young child, but also appear to play a pivotal role in lifelong programming effects that regulate health, disease, mortality risks, neural function and behavior and quality of life in adulthood [1,3].

In most of studies, indicators used to measure infant and young child feeding practices in population based surveys have focused mostly on breastfeeding practices. Considerations were not given to quantity and quality of complementary foods including dietary diversity like breast feeding. Meanwhile, inadequate knowledge about appropriate complementary feeding practices is often greater determinants of malnutrition. Having good complementary feeding knowledge and practices among postnatal mothers will prevent the consequences of under-nutrition thereby enabling children to receive appropriate nutrition and consequently achieve their full human potential [1,3,5].

A number of studies have assessed knowledge of complementary feeding in different parts of the India; such studies are limited among postnatal mothers in Northeastern parts of India. Thus the present study was developed to examine the knowledge towards complementary feeding among postnatal mothers’ of Agartala City.

Objectives of the Study

To evaluate the knowledge regarding complementary feeding among postnatal mothers’ of Agartala City.

• Research Approach: Descriptive

• Research Design: Descriptive cross-sectional survey design

• Setting of the Study: Municipal Council of Agartala city

• Study Duration: Between June-July 2019

• Study Population: Post Natal Mothers having children aged less than 2 year

• Sample Size: 400 Post Natal Mothers assuming 50% mothers have adequate knowledge regarding complementary feeding, 5% absolute error, 95% confidence level and 5% non-response rate

• Sampling Technique: Purposive Sampling Technique

• Sampling Criteria: 20 Postnatal mothers from 20 wards of Agartala were selected randomly after explaining the purpose of the study. Informed consent was taken from all selected mothers and confidentiality of the selected mothers was also maintained 

• Inclusive Criteria: Post natal mothers available during the period of data collection in study setting and who were willing to participate in the study.

• Exclusion Criteria: Post natal mothers who were not willing to participate in the study and who were not present during data collection

Description of Tool 

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income, delivery pattern, ANC Checkup and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions 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

• Data collection by under the guidance of supervisors and Post-natal mothers were given 30 minutes’ time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage

Present study was developed to evaluate the knowledge towards complementary feeding among postnatal mothers’ of Agartala City. A total of 400 Post Natal Mothers from 20 wards of Agartala were selected randomly after explaining the purpose of the study. Among the total mothers, maximum 211 (52.75%) were having age between 26-30 years, educated up to Matric and Senior Secondary 172 (43%), Hindu 336 (84%), housewife 361 (90.25%), Multigravida 270 (67.5%) and delivered in government hospitals 268 (67%) (Table 1,2).

Table 1: Socio Demographic Characteristics of the Participants

Table 2: Responses of the Participants to Various Statements

Table 3: Knowledge Towards Breast Feeding Among Postnatal Mothers’ of Agartala City

Maximum = 20, Minimum = 6

In the present study 10.75% (43) postnatal mothers’ had very good knowledge (16-20 marks) towards breast feeding, 69.5% (278) having good knowledge (12-15 marks), 17.75% (71) having fair knowledge (8-11 marks) and 2% (8) having poor knowledge (<8 marks) (Table 3).

According to WHO, complementary feeding is the period wherein there is a transition from exclusive breastfeeding to family foods although breastfeeding is still continued. The World Health Organization recommends that children be fed at least 2 times daily between 6-8 months and at least 3 times for children between 9-12 months and >12months of age [1,6].

Between the ages of 6 and 23 months – the complementary feeding period–breastfeeding and access to a diverse range of nutritious foods provide children with the essential nutrients, vitamins and minerals they need to develop to their full physical and cognitive potential, with benefits that endure well into adulthood [1,2]. The complementary feeding period is also a critical opportunity to prevent all forms of childhood malnutrition, including stunting, wasting, micronutrient deficiencies, overweight, obesity and diet-related non-communicable diseases. In addition, lifelong food preferences, tastes and habits are often established in childhood [1,6,7].

The quality of children’s diets is more important before age 2 than at any other time in life [4,6]. Appropriate complementary foods and feeding practices contribute to child survival, growth and development; they can also prevent micronutrient deficiencies, morbidity and obesity later in life. During the complementary feeding period, the quality of children’s diets is determined by the foods that children eat and the feeding behaviours of their caregivers [1,2,6].

NFHS 5 data on complementary feeding in Tripura showed that there was only 13.3% Breastfeeding children age 6-23 months receiving an adequate diet while only 16.3% Non- breastfeeding children age 6-23 months receiving an adequate diet. So, in total 13.5% children age 6-23 months receiving an adequate diet [8] (Table 4).

Yet in nearly every part of the world, families face economic, political, market, social or cultural barriers to providing nutritious, safe, affordable and sustainable diets to young children. These challenges are exacerbated in humanitarian situations, where access to nutritious food, clean drinking water and good quality health services are limited and the resources and capacities of caregivers already stretched. Young children and their caregivers are increasingly exposed to foods of low nutritive value, including commercial complementary foods and processed foods high in added sugar, salt and saturated and trans fats that are inexpensive, ubiquitous and easy to feed to young children. Accelerating progress to improve the quality of complementary foods and feeding practices for young children is therefore critical [1,2,9].

The influence of socio-demographic factors on infant feeding knowledge has been documented in literature. The determinants of young children’s diets during the complementary feeding period include adequate complementary foods, adequate complementary feeding practices and adequate nutrition services. These determinants are shaped by socio-demographic factors – referred to as drivers. Together, the determinants and drivers of young children’s diets determine children’s ability to enjoy nutritious, safe, affordable and sustainable diets that protect, promote and support survival, growth and development [1,2,10].

Table 4: NFHS Data on Complementary Feeding in Tripura

Limitations of the Study

The present study has certain limitations such as cross sectional in nature, all the participants were at postpartum having children aged less than 2 years and small sample size that made difficult to generalize the findings. Future research should be focused on larger sample and qualitative studies such as focus group interviews to identify barriers to promote appropriate complementary feeding knowledge and practices among postnatal mothers.

However, despite of these limitations, the present study findings may be helpful to the health professionals and policy makers in designing the interventions to promote age appropriate complementary feeding practices.

The present study concludes that the mothers have a good knowledge toward complementary feeding but still there was room for improvement. Still there is a significant gap in the complementary feeding knowledge as it was not at the optimal level when compared with the recommendations of the WHO.

Complementary feeding education targeting behavioral change is important to reduce child malnutrition, morbidity and mortality. Appropriate complementary feeding education emphasizing timely initiation and meal diversity is necessary to improve complementary feeding knowledge and feeding practices of mothers.

1. World Health Organization. “Infant and young child feeding.” World Health Organization, https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. Accessed June 2021.

2. World Health Organization. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. World Health Organization, 2009. “Session 1: The importance of infant and young child feeding and recommended practices.” https://www.ncbi.nlm.nih.gov/books/NBK148967/. Accessed June 2021.

3. 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 Maternal and Child Health and AIDS, vol. 6, no. 1, 2017, pp. 46–59. https://doi.org/10.21106/ijma.203.

4. Government of India. Infant and Young Child Feeding (IYCF) Guidelines. Ministry of women and child development, https://wcd.nic.in/sites/default/files/nationalguidelines_1.pdf. Accessed June 2021.

5. World Health Organization. Indicators for Assessing Infant and Young Child Feeding Practices. World Health Organization, https://apps.who.int/iris/bitstream/handle/10665/43895/9789241596664_eng.pdf. Accessed June 2021.

6. World Health Organization. Guiding Principles for Complementary Feeding of the Breastfed Child. World Health Organization, https://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf. Accessed June 2021.

7. UNICEF. Complementary Feeding Guidance. UNICEF, 2020, https://www.unicef.org/media/93981/file/Complementary-Feeding-Guidance-2020.pdf. Accessed June 2021.

8. International Institute for Population Sciences. National Family Health Survey (NFHS-5): Fact Sheet. IIPS, http://rchiips.org/nfhs/NFHS-5_FCTS/FactSheet_TR.pdf. Accessed June 2021.

9. UNICEF. UNICEF Nutrition Strategy 2020–2030. UNICEF, https://www.unicef.org/media/92031/file/UNICEF%20Nutrition%20Strategy%202020-2030.pdf. Accessed June 2021.

10. Gewa, C.A. and T.F. Leslie. “Distribution and determinants of young child feeding practices in the east African region: demographic health survey data analysis from 2008–2011.” Journal of Health, Population and Nutrition, vol. 34, 2015, pp. 6.