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DOI: https://dx.doi.org/10.18535/jmscr/v6i8.53

Exclusive Breastfeeding the most cost-effective intervention- An evidence

from rural community of Haryana
Authors
Dr Sunidhi Karol , Dr Pardeep Khanna2, Dr Mohit Karol3
1
1
Junior Resident, Department of Community Medicine, PGIMS, Rohtak
2
Senior Professor & Head, Department of Community Medicine, PGIMS, Rohtak
3
Senior Resident, Department of Pediatrics, IGMC, Shimla

Abstract
Background: Exclusive breastfeeding during the first six months is the most cost-effective intervention for the
survival of a child.
Material & Methods: A community based cross-sectional study was conducted in Community Development
Block, Beri, district Jhajjar, Haryana over the period of one year.In the present study 400 mothers of children
aged 6-23 months were selected with multistage random sampling method and interviewed using structured
questionnaire for Infant and Young Child Feeding (IYCF) practices. Data were analyzed with using SPSS-
20.0, Chi-square, bivariate and multivariate logistic regression tests.
Results: Exclusive breastfeeding for six months was observed to be 59.2%, Colostrum given almost
universally to all infants (95%). 33% infants were given pre-lacteal feeds in the form of sweetened water,
ghutti, honey, water etc. around 86% infants were breastfed adequately and on demand. Bottle feeding was
observed in 26% of which more than half among 6-23months age group. Only 6% were given artificial
pacifiers in form of teats.
Conclusion: compliance to IYCF practices has shown slight improvement since the last NFHS survey in 2015-
2016 but still well below the WHO recommended guidelines for Infant and Young Child Feeding.
Keywords: exclusive breastfeeding, pre-lacteal feeding, colostrum, bottle feeding, IYCF.

Introduction appreciated. In 21st century, breast-feeding

Exclusive breastfeeding during the first six increased over the last years, beginning in the
months is the most cost-effective intervention for 1970s. Especially, in later years paediatric clinics
the survival of a child. Breastfeeding in early informed mothers about the advantages of breast-
infancy is a common practice in all societies as it feeding. It is widely accepted now, that
is the most natural process, and is considered ideal breastfeeding decreases the risk of many serious
for achieving optimal health and nutrition of diseases as acute otitis media, non-specific
infants.1 During the course of human history, gastroenteritis, severe lower respiratory tract
infants should be fed with human milk in order to infections, atopic dermatitis, asthma, obesity,
assure survival. From the ancient past until today, type1 and 2 diabetes, childhood leukaemia,
the importance of breast-feeding has been well sudden infant death syndrome (SIDS) and

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necrotizing enterocolitis. The great impact of nuclear family. The family size of the study
breastfeeding is obvious for the world health and subjects ranged from 1to 8 children with mean of
the economy, as the rates of hospitalization and 1.77 ± 0.84 children. 93.3% of study participants
morbidity have decreased. Finally, children who were married and living together with their
are fed with breast milk during infancy are spouses while 6.5% were married but not living
reported to present with a higher IQ. Exclusive together and only 0.3% of study subjects were
breastfeeding prevents 13% of estimated under- divorced. 9% were married under 18 years of age.
five mortality, hence present study was planned Regarding mothers’ occupation, 94.5% mothers
with objective to assess exclusive breastfeeding were homemakers followed by 5% working in an
practice and factors affecting it in a rural organized sector and 0.5 % mothers were
community.2 completing their education. On the basis of
education status, 13.3% mothers were illiterate.
Material & Methods The majority of children were in the age group of
A community based cross-sectional study was 13-23 months (58.5%), out of which, 29.75%
conducted in Community Development Block, were males and 28.75% were females. In 6-12
Beri, district Jhajjar, Haryana over the period of months slab there were 41.5% infants in which
year from April 2016 to March 2017 by house to 21.75% were males and 19.75% were females.
house visit. Mothers having children aged 6-23 The majority of infants (93.8%) were born at term
months were included in the study. Mothers who gestational age (≥ 37 weeks), 68(17%) of them
did not consented, mentally unsound, migrants were of low birth weight weighing less than 2.5
residing for less than one year in study area during kg, in which 37(9.25%) males and 31(7.75%)
the data collection period were excluded from the females.
study. Sample size was calculated, considering MCH services availed by Study Subjects
prevalence of exclusive breastfeeding to be 50%, The mean age for registration of pregnancy was
using formula 4PQ/L2 taking precision to be 5% 2.74 ± 1.04 months among study participants,
and level of confidence to be 95%. Thus, total 400 means most of study subjects (86.3%) got
mothers were studied using random sampling themselves registered with in first trimester. The
technique. A predesigned, pretested semi- majority of study subjects (75.5%) availed more
structured schedule mainly based on the standard than four antenatal check-ups during antenatal
IYCF indicators given by WHO was used for data visits. The majority of the study subjects (96.4%)
collection. The pre-test was done in similar had institutional delivery of which 71.3%
settings but not included in the main study of 5% delivered in government institution while 25.5%
of the sample size. Data was analyzed by using delivered in private hospitals and only 3.5%
Statistical Package for Social Sciences (SPSS) delivered at home. 85.5% of the study participants
version 20.0 delivered by normal vaginal delivery while 14.5%
delivered by caesarean section. In 71.8% of the
Results study subjects’ delivery was attended by doctors
Socio-demographic characteristics followed by 25.3% nurses and 3% by traditional
The age of mothers ranged from 18 years to 40 birth attendants. More than half (61.6%) of the
years with mean age of 24.97 ± 3.41 years. 98.6% study subjects had 48 hours hospital stay in case
study subjects were Hindus by religion. Other of normal delivery and 7 days stay in case of
Backward Classes and Scheduled Castes/Tribes caesarean section delivery.
together constituted 45.2%. Joint Family was the More than two-third of the study participants
dominant family type, with 66 % respondents (67.8%) received information about optimal
living in joint family and only 34% were living in breast-feeding in new-borns during antenatal

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while (69%) during hospital stay. However, 32% status, mode of delivery and breastfeeding
did not get any information regarding optimal knowledge during antenatal period. With increase
breastfeeding from any of the health worker in mothers education rate of exclusive
before and after delivery. Nearly two-third breastfeeding increases. Mothers who gave birth
(65.8%) mothers received breastfeeding by normal vaginal delivery are more likely to feed
knowledge from Anganwadi workers. their babies exclusively than caesarean
Exclusive breastfeeding and related practices counterparts. Pre-lacteal feeding found to be
Exclusive breastfeeding for six months was significantly interfering with exclusive
observed to be 59.2% of which 31.75% among breastfeeding. Also, mothers having breastfeeding
males and 27.5% among females. Colostrum knowledge during antenatal period fed their
given almost universally to all infants (95%). 33% babies exclusively for 6 months. However, no
infants were given pre-lacteal feeds in the form of significant association was observed for other
sweetened water, ghutti, honey, water etc. around variables like age, age at marriage, type of family,
86% infants were breastfed adequately and on parity, socio-economic status, gestational age and
demand. Bottle feeding was observed in 26% of birth-weight. On applying multivariate logistic
which more than half among 6-23months age regression on significant variable pre-lacteal
group. Only 6% were given artificial pacifiers in feeding and knowledge during ANC was found
form of teats.(Table 1) significant with adjusted odds of 1.5 & 1.8
Exclusive breastfeeding & associated factors respectively p value less than 0.05.(Table 2)
Exclusive breastfeeding was found to be
statistically significant with maternal education

Table: 1 Exclusive breastfeeding and related practices

IYCF Practices Frequency Percentage
Colostrum Feeding
Yes 379 94.8
No 21 5.2
Pre-lacteal Feeds given
Yes 133 33.3
No 267 66.7
No. of times baby breastfed (8-10 times per day)
Adequate 343 85.8
Inadequate 57 14.2
Demand Feeding
Yes 332 83
No 68 17
Bottle Feeding
Yes 104 26
0-6 months 49 47
6-23 months 55 53
No 296 74
Artificial Pacifiers/Teats
Yes 24 6
No 376 94
Exclusive Breastfeeding
Yes 237 59.2
No 163 40.8

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Table 2 Exclusive breastfeeding & associated factors
Characteristics Exclusive breastfeeding n (%) p value
Age group(yrs) Yes No
15-19 05(83.3) 01(16.7)
20-24 101(53.7) 87(46.3) 0.05
25-29 106(65) 57(35)
30-34 23(63.9) 13(36.1)
≥ 35 02(28.6) 05(71.4)
Type of family
Nuclear 158 (59.8) 106(40.2)
Joint 79(58.1) 57(41.9) 0.11
Education
Illiterate 31 (53.4) 27 (46.6)
Primary school 30 (56.6) 23 (43.4) 0.04
Middle school 60 (69.7) 26 (30.3)
Secondary school 62 (63.9) 35 (36.1)
Graduate & above 54 (50.9) 52 (49.1)
Socio economic status
Upper 38 (55.9) 30 (44.1)
Upper middle 56(60.9) 36(39.1) 0.05
Middle 54(51.9) 50(48.1)
Lower middle 65(73) 24(27)
Lower 24(51.1) 23(48.9)
Age at marriage
< 18 years 22(61.1) 14(38.9)
0.81
>18 years 215(59.1) 149(40.9)
Parity
P=1 93(39.2) 78(47.9) 0.08
P≥ 2 144(60.8) 85(52.1)
Mode of delivery
Normal 211 (61.6) 131(38.4) 0.01
Caesarean 26 (44.8) 32(55.2)
Gender
Male 127(53.6) 79(48.4) 0.36
Female 110( 46.4) 84( 51.6)
Gestational age
Term 221(93.2) 154 (94.5) 0.67
Preterm 16 (6.8) 09 (5.5)
Birth weight
<2.5 kg 37 (15.6) 28( 17.2) 0.68
>2.5kg 200( 84.4) 135 (82.8)
Pre-lacteal feeds
Yes 11(4.6) 122( 74.8) 0.00
No 226( 95.4) 41(25.2)
Breastfeeding knowledge during antenatal visits
Yes `173(73) 98(60.1) 0.00
No 64(27) 65(39.9)

Discussion and Haryana (52.4%) and lower when compared

The recommendation to exclusively breastfeed to District Level Household Survey (DLHS-4)5for
babies for the first six months of life was district Jhajjar (76.1%). Similar findings for
formulated after a meta-analysis and review of the exclusive breastfeeding rates have been reported
evidence by a WHO Expert Committee. Exclusive from studies done by Garget al6 in Karnataka and
breastfeeding was observed to be higher in our Khan et al7 in New Delhi. However, higher rates
study area when compared with National Family have been reported in studies conducted by
Health Survey (NFHS-4)3,4 data for India (54.9%) Prashar et al (94.9%)8 and Chandwani et al (95%)9
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in Gujarat. Another study done by Padmanabhan Thereafter, to meet their nutritional requirements,
& Mukherjee10 in Tamil Nadu showed this figure infants should receive adequate and safe
to be as low as 33.6%. The reason for higher complementary foods while breastfeeding
exclusive breastfeeding could be because of the continues up to two years of age and beyond. It is
fact that information regarding optimal further recommended that a feeding bottle with a
breastfeeding practices was given to mothers nipple should not be used at any age.19
during antenatal (68%) and postnatal periods
(69%) through frontline workers like ASHAs, Conclusion
MPHWs (F) and AWWs with 1.8 times higher The study concluded that compliance to IYCF
odds. And also, every year Global Breastfeeding practices has shown slight improvement in
Week (1-7 August) is observed in collaboration feeding practices since the last NFHS survey in
with Women and Child Development Department 2015-2016 but still well below the WHO
to spread awareness regarding optimal IYCF recommended guidelines for Infant and Young
practices among mothers. Infants who were given Child Feeding. Mother’s educational status, mode
pre-lacteal feeds at birth had 1.6% lesser odds to of delivery, pre-lacteal feeding and breastfeeding
be exclusively breastfed for 6 months. This knowledge during ANC are significant factors
finding is consistent with studied done by interfering exclusive breastfeeding. There is large
Tewabe11 and Reddy et al12. Thus, the practice of need to improve mothers’ education status and
pre-lacteal feeding is a risk factor for early empower mothers with adequate knowledge of
cessation of breastfeeding. Policies to promote breastfeeding regarding benefits and harms of pre-
exclusive breastfeeding are necessary to enable lacteal feeding through community based
infants to attain optimal health and for attainment activities like village health nutrition days
of Sustainable Development Goals. The gender of (VHND). Thus exclusive breast feeding is the
the child was not among the significant factors most cost effective intervention to decrease infant
affecting exclusive breastfeeding in the present mortality.
study. The association between baby’s gender and
exclusive breastfeeding was not consistent in the References
literature. (Bulk-Bunschoten et al., Lande et al., 1. Krishnaswamy K. Nutrition research
Duong et al., Batal et al.)13-16Bottlefeeding current scenario and future trends.
observed among 26% of children of which Hyderabad: Oxford & IBH publishing
12.25% in the first 6 months of life and the Co. Pvt. Ltd;2000. Chapter 8, Infant
remaining 13.75% after 6 months. A study from Feeding and Weaning Dilemma in
Madhya Pradesh done by Jain et al 17 in 2014 had Developing Countries; p.81-4.
shown this to be around 14% whereas 28.1% 2. Papastavrou M, Genitsaridi SM,
mothers used bottles for feeding as observed in a Komodikie, Paliatsou S, RMidw,
study conducted by Dasgupta et al18 in West Kontogeorgou A et al.Breastfeeding in
Bengal. The feeding bottle is a vital factor in the the Course of History. Journal of
viciousmal nutrition-infection cycle, often Paediatrics and Neonatal Care. 2015
reported to be a major cause of infant and child Sept8;2(6):11-9.
mortality. Main reason for this practice was 3. India Fact Sheet. National Family Health
observed to be the milk insufficiency. Survey-4: Mumbai: IIPS; 2015-16.
To achieve optimal growth, development and 8p.Available from:
health, the World Health Organization http://rchiips.org/NFHS/factsheet_NFHS
recommends that infants should be exclusively -4.shtml[Accessed 2017 October 10]
breastfed for the first six months of life.

Dr Sunidhi Karol et al JMSCR Volume 06 Issue 08 August 2018 Page 321

JMSCR Vol||06||Issue||08||Page 317-323||August 2018
4. Haryana Fact Sheet. National Family 11. Tewabe T. Timely initiation of
Health Survey-4: Mumbai: International breastfeeding and associated factors
Institute for Population Sciences; 2016. among mothers in Motta town, East
6p. Available from: Gojjam zone, Amhara regional state,
http://rchiips.org/NFHS/pdf/NFHS4/HR Ethiopia, 2015: a cross-sectional study.
_FactSheet.pdf[Accessed 2016 May 24] BMC Pregnancy Childbirth. 2016 Oct
5. District Fact Sheet. District Level 19; 16: 314-21.
Household and Facility survey -4: 12. Reddy S, Abuka T. Determinants of
Mumbai: International Institute for Exclusive Breastfeeding Practice among
Population Sciences; 2014. 8 p. Mothers of Children Under Two Years
Available from: https://nrhm- Old in Dilla Zuria District, Gedeo Zone,
mis.nic.in/DLHS4/State [Accessed 2015 Snnpr, Ethiopia, 2014. Journal of
March 15] Pregnancy and Child Health. 2016 Feb
6. Garg M, Hasan M, Kapur D. Infant and 26; 3(1): 224-30.
Young Child Feeding (IYCF) practices 13. Bulk-Bunschoten AM, Bodegon W,
in Udupidistrict, Karnataka. J Nut Res. Reerink SV, Jong JD, Groot C.J.
2015 Jan 21; 3(1): 38-44. Reluctance to continue breastfeeding in
7. Khan AM, Kayina P, Agrawal P, Gupta the Netherlands. ActaPaediatrica. 2001;
A, Kannan AT.A study in infant and 90:1047-53.
young child feeding practices among 14. Lande B, Andersen LF, Berug, AB,
mother attending urban health centre in Trygi, KU, Lund-Larsen K, Veierod
east Delhi. Indian Journal of Public M.B, Bjorneboe G.E. Infant feeding
Health. 2012 Jan 24; 56(4): 301-4. practices and associated factors in the
8. Parashar A, Sharma D, Thakur A, Mazta first six months of life: The Norwegian
SR. Infant and young child feeding infant nutrition survey. Acta Pediatrica,
practices - insights from a cross- 2003; 92:152-61.
sectional study in a hilly state of North 15. Duong D.V, Binns, C.W, Lee A.H.
India. International Journal of Breast feeding initiation and exclusive
Nutritional Pharmacology, Neurological breastfeeding in rural Vietnam. Public
Diseases. 2015 Jun 08; 5(3): 103-7. Health Nutrition. 2004;7(6):795-99.
9. Chandwani H, Prajapati A, Rana B, 16. Batal M, Boulghourjian C, Abdallah A,
Sonaliya K. Assessment of infant and Afifi R. Breast-feeding and feeding
young child feeding practices with practices of infants in a developing
special emphasis on IYCF indicators in a country: A national survey in Lebanon.
field practice area of Rural Health Public Health Nutrition. 2006; 9(3):313–
Training Centre at Dabhoda, Gujarat, 9.
India. International Journal of Medical 17. Jain S, Borle A, Agrawal SS, Mishra
Science and Public Health. 2015 Apr 24; MK, Gupta SK, Bathma V. Assessment
4(10): 1414-9. of Infant and Young Child Feeding
10. Padmanabhan PS, Mukherjee K. Infant Practices Among Mothers in Rural
and Young Child Feeding (IYCF): A Madhya Pradesh. National Journal of
Gap Analysis between Policy and Community Medicine. 2014 Dec 31;
Practice. Indian Journal of Nutrition. 5(4): 419-23.
2017 Jun 14;4(3): 165-7. 18. Das N, Chattopadhyay D, Chakraborty
S, Dasgupta A. infant and young child

Dr Sunidhi Karol et al JMSCR Volume 06 Issue 08 August 2018 Page 322

JMSCR Vol||06||Issue||08||Page 317-323||August 2018
feeding perceptions and practices among
mothers in a rural area of West Bengal.
Ann Med Health Sci Res.2013 Jul
03;3(3):370-5.
19. Infant and young child programming
guide. New York: nutrition section,
UNICEF; 2012.Available from:
https://www.unicef.org/nutrition/files.
[Accessed on 2015 Feb 25]

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