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Year : 2013 | Volume : 1 | Issue : 2 | Page : 61 - 63  


Short Communications
Knowledge, Attitude and Practices (KAP) of Mothers regarding Weaning in Rural Areas of Karimnagar, Andhra Pradesh, India

Mohd. Shafee1, Rana Firdous2

1Professor and Head, Dept. of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur-621113, TN. 2Tutor, Dept. of Community Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Bommakal, Karimnagar-505001, Andhra Pradesh, India.

 

SUMMARY

In Indian context, Breast Feeding is widely accepted, but early initiation of Breast Feeding is what we have to strive for. Exclusive Breast Feeding is the infant’s consumption of Human milk only, in the first 6 months of life, with no supplementation of any type of food. Weaning is a process in which infants are given energy rich complementary foods, from the age of 6 months along with continuation of Breast Feeding. This study was conducted with the objectives of to assess KAP of mothers regarding weaning and to Eliminate Harmful Breast Feeding Practices, by Intensive Health Education to mothers. A cross sectional community based study was conducted during August to December 2011 in Gunturpally Village of Karimnagar. 500 Females with at least one infant were selected by Systematic Random Sampling & their KAP regarding weaning were assessed. Statistical analyses were done using percentage, Chi-Square test, Odds Ratio(OR), 95% Confidence Interval(CI) and inferences were drawn. It was observed that majority of the subjects (62%) knew that weaning should be initiated by 4-6 months of age but only 35% mother initiated it by age of 6 months. Only 18% knew about the harmful effects of delayed weaning. 81% mothers preferred liquid foods for weaning and a statistically significant difference was found among illiterates & literates (x2 = 4.747, P <0.05). Many (85%) agreed that baby should take solid food by 1 year of age. It was concluded that all mothers should be educated about Basic principles of BF & weaning during antenatal period. Literacy rate should be increased among rural females. As television influences the layman, it should be used for promotion of BF.

Keywords: weaning, rural area, KAP.

Corresponding Author: Dr. Mohd. Shafee,MD, Professor and Head, Dept. of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur-621113, TN., AP.                        E-mail- Mohdshafee2008@gmail.com

 

Introduction

Breast Feeding is the biologic norm for Homosapiens and dates back some 40,000 years. It is crucial for lifelong health & well being of the infant. It provides unique nutritional, immunological, psychological and child spacing benefits.

All national health surveys (Surveys done by National Nutrition Monitoring Bureau[1], National Family Health Surveys[2] and District leven Household Surveys[3]) have shown that in India, steps taken for the protection and promotion of BF from 1970s have been effective; breast feeding is almost universal and the mean duration is over two years. However, the message that EBF up to six months and gradual introduction of semisolids from six months has not been effectively communicated. The optimal BF practices that need to be promoted are early initiation of BF (within an hour after birth), EBF for six months and initiating supplementary feeding, continued BF for two years or beyond.[4]

            Most of the mothers either initiate early or delay weaning which has a harmful effect on growth and development of child. Therefore, an attempt was made through this study to find out knowledge, attitude and practices regarding weaning among mothers from rural area.

Method and Materials:

The permission from the head of the institution and clearance from Institutional Ethics Committee was taken to perform this study.

            Karimnagar district located in Andhra Pradesh, has a population of 13.2 lakhs. It has 10 mandals (Taluka) of which one was selected by simple random sampling. One village (Gunturpally) with a population of 5324 was selected from the mandal by simple random sampling. This village is located three kilometers from the institute. Total 500 females having at least one infant were selected by systematic random sampling from 2276 females in the village. A community based cross-sectional study is undertaken to account the demographic characteristics of mothers along with their knowledge, attitude and practices regarding weaning in rural areas of Karimnagar. The survey was performed for six months from July to December 2011. A questionnaire was prepared which contained details like age, educational status, occupations of mother. It also contains questions regarding knowledge, attitude and practices of subjects regarding weaning. The data was collected based on the predesigned pretested structured proforma by taking personal interviews. The aim and purpose of the study was explained and an informed consent was obtained from the study subjects before taking the interview.

            Statistical analysis was done using mean, percentage, chi- square Test, Odds Ratio, 95% Confidence Interval of Odds Ratio and inference were drawn.

Findings

Total 500 mothers were included in the study. Out of these mothers, 230(46%) were illiterate and 270(54%) were literate. Majority of mothers 235(47%) were found in the age group of 23-26 years, 135(27%) in the age group of 18-22 years & 130(26%) in 27-30yrs.

When knowledge about weaning (supplementary feeding) was assessed it was observed that 310(62%) subjects knew that weaning should be initiated within four to six months of age. Out of these, majority 195(39) were literate. Total 165(33%) subjects knew that it was necessary to initiate weaning by six months, 105(21%) were literate. Totally 440(88%) mothers preferred the use of liquid foods for weaning with 250(50%) of them being literate. Total 90(18%) subjects were aware that delay in weaning was harmful to the baby & only 50(10%) knew the exact reason of initiating weaning at six months i.e. from the age of six months breast milk will only not be sufficient for the growth of the baby.(Tab. No.1)

Regarding attitude of mothers toward weaning, 145(29%) subjects had positive attitude towards initiation of weaning at six months, with majority 90(18%) of them being literate. Total 405(81%) subjects told that weaning should be initiated with liquids, majority 240(48%) being literate and 425(85%) mothers had the attitude that the baby should start taking solid food by one year of age, majority 235(47%) of them being literate. (Tab. No.1)

Total 175(35%) mothers initiated weaning at six months of which 105(21%) were literate and remaining 95(19%) initiated weaning before six months with 60(12%) being literate. Total 230(46%) initiated weaning after six months with 125(25%) of them being illiterate. (Tab. No.1)

Total 34% mothers gave mashed rice & pulses to their babies & another 17 % gave mashed rice & ghee. Uggu [20%] was found to be another popular weaning food. Cerelac [15%] , porridge [11%] 7 banana [3%] were the other weaning foods used. (Tab. No.2)

Other finding includes common reasons for early initiation of weaning were not enough breast milk, working mothers & lack of proper knowledge whereas for delayed weaning, customary belief, baby being unresponsive to food & sufficient breast milk were found to be the common causes.

Discussion

Out of 500 mothers, 230(46%) were illiterate & 270(54%) were literate. Only 28% mothers initiated BF within one hour. of which 32.14% subjects were illiterate & remaining 76.86% were educated.

It was observed that 62% subjects were aware that weaning should be initiated between 4-6 months of age. With 39% among them being educated & 23% being illiterate. A statistically significant difference was found among illiterates and educated subjects (x2=5.206, p<0.05). But it was observed that only 35% mothers practiced, initiation of weaning at 6 months with 21% of them being educated & 33% being illiterates. A statistically significant difference was found among them (x2=4.747, p<0.05). Total 85% mothers had the attitude that baby should take solid food by 1 year of age, majority of them being educated. Galhotra A[5] found that knowledge about complementary feeding among subjects was seen to improve post BFAC from 80% to 95%. Aggrawal A[6] found that only 8% had knowledge of proper timing, adequate quantity & proper consistency of complementary foods. Tiwari S[7] found that only 11.67% infants were weaned between 4-6 months of age & 71% were not weaned even by 1 year of age. It was also noticed that 18% infants were given liquid food for weaning, 9.33%-semisolid & 1.67% solid. Chauhan M[8] found that 21.9% mothers initiated weaning at the right age & this was significantly associated with literacy status (p<0.05). he also assessed that weaning foods given were mostly (88.6%) of semisolid consistency. Rai M[9] found that 62% of rural mothers were aware of beneficial effects of weaning on childs health & 65% of rural mothers started weaning between 6-9 months of age. Sangole SS[10] assessed that 70.49% infants received weaning between 6-9 months of age.

In this study, it was assessed that mashed rice & dal (34%) were the major weaning foods used & others being UGGU, porridge, cerelac, banana. According to Dilip Kumar[11] only 3% subjects knew how to prepare proper weaning foods. Banerjee B[12]found that infants more than 6 months of age were more susceptible to malnutrition due to improper weaning & faulty nutritional supplementation.

Conclusion and Recommendations:

  • Television & other media should be used for promotion of breast feeding.
  • Very few mothers initiated weaning at 6 months; they should be promoted to do so by explaining them the harmful effects of delayed weaning. Integrated Child Development Scheme services should be provided for better growth & development of the child.
  • Mothers should take guidance from health care professionals regarding proper timing of weaning and adequate quantity and consistency of weaning foods.
  • An attempt should be made to increase the literacy rate among rural mothers so that they can understand the basic principles of breast feeding and weaning.

Acknowledgement: To all mothers throughout world who start breast feeding within one hour.

Limitations: The study is performed among rural mothers where most of illiterate mothers reside. A comparison group from urban area should be selected.

References

  1. National Nutrition Monitoring Bureau. NNMB Reports. National Institute of Nutrition, Hyderabad.1979-2006.
  2. National Family Health Survey (NFHS-3) Factsheets:2005-06. Available from URL: http://mohfw.nic.in/nfhsfactsheet.htm
  3. District level Household Survey. Available from URL: http://www.iipsindia.org/nws.htm
  4. World Health Organization. Exclusive Breast Feeding. Available from URL: http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
  1. Kishore MS, Kumar P, Aggarwal AK. Breastfeeding knowledge and practices amongst mothers in rural population of north India: a community based study. J Trop Pediatr. 2009 Jun;55(3):183-8.
  2. Medhi GK, Mahanta J. Breast feeding, weaning practices & nutritional status of infants of tea garden workers of Assam. Indian Pediatrics Dec 17-2004;41:1277-9.
  3. Kulkarni RN, Anjenaya S, Gujar R. Breast feeding practices in an urban community of Kalamboli, Navi Mumbai. Indian J Community Med Oct-Dec 2004;29(4):
  4. Banapurmath CR, Nagaraj MC, Banapurmath S, Kesaree N. Breastfeeding practices in villages of Central Karnataka. Indian Pediatr. 1996 Jun;33(6):477-9.
  5. Ogbeide DO, Siddiqui S, Al Khalifa IM, et al. Breast feeding in a Saudi Arabian community. Profile of parents and influencing factors. Saudi Med J. 2004 May;25(5):580-4.
  6. Sangole SS, Durge PM. Breast feeding practices of mothers in urban slum, Nagpur. Indian Journal of Preventive & Social Medicine Jan – June 2002;28(1&2):26-8.
  7. Dilip Kumar Das & Shameem Ahmed, Knowledge & attitude of Bangladeshi rural mothers regarding breast feeding & weaning. Indian Journal of Pediatrics;1995;62;213-217
  8. Banerjee B, Mandal DN. An intervention study in malnutrition among infants is a tribal community of West Bengal. Indian journal of Community Medicine; March 2005; 30(1):

 

 TABLE NO.1 ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICES OF WEANING ACCORDING TO EDUCATIONAL STATUS OF STUDY SUBJECTS

Sr. no

Question

Educational status

Odds Ratio

95% CI

P Value

Illiterate[%]

Literate

Knowledge

1

Initiation between 4 to 6 months

115 (23)

195 (39)

0.3846

0.2653-0.5575

<0.0001

2

Necessary to start at 6 months

60 (12)

105 (21)

0.5546

0.3782-0.8133

0.0033

3

Using liquid foods

190 (38)

250 (50)

0.38

0.2151-0.7613

0.001

4

Any harm in delayed

30 (06)

60 (12)

0.525

0.3251-0.8478

0.0109

5

Importance of starting at 6 months*

20 (02)

30 (06)

0.7617

0.42-1.382

0.4546

Attitude

1

Should it start at 6 months

55 (11)

90 (18)

0.6286

0.4235-0.9325

0.0268

2

Initiation with liquids

165 (33)

240 (48)

0.3173

0.1971-0.5107

<0.001

3

Benefits to baby

230 (46)

270 (54)

-

-

-

4

Taking solid food by 1 yr

190 (38)

235 (47)

0.7074

0.4324-1.158

0.2089

Practices

1

Initiating at 6 months

70 (14)

105 (21)

0.6875

0.4737-0.9979

0.0599

2

Initiating before 6 months

35 (07)

60 (12)

0.6282

0.3965-0.9954

0.0607

3

Initiating after 6 months

125 (25)

105 (21)

1.3871

1.309-2.673

0.0008

 

 TABLE NO 2 DISTRIBUTION OF STUDY SUBJECTS ACCORDING TO WEANING FOODS

Sr. No.

Type of weaning food

% of study subjects

1

Mashed rice & dal

170       (34)

2

Mashed rice & ghee

85         (17)

3

Porridge

55         (11)

4

Uggu*

100       (20)

5

Cerelac

75         (15)

6

Banana

15         (03)

 

Total

500       (100)

  • All types of pulses & rice are grounded & this mixture is cooked in water

 

 

 

 





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