KNOWLEDGE, ATTITUDE AND FEEDING PRACTICES AMONG THE MOTHERS HAVING UNDER-5 CHILDREN IN A RURAL COMMUNITY OF BANGLADESH

To the Editor

Maternal education is significantly related to early childhood morbidity and mortality. In Bangladesh, most mothers do not have a correct knowledge on exclusive breastfeeding and the appropriate time for introduction of weaning foods; and only 3% of them know how to prepare proper weaning foods1. Another study conducted in the rural population reported that according to Gomez classification, 96% of children had varying degrees of protein energy malnutrition (PEM) (28.4% mild, 58.2% moderate and 9.2% severe)2. Timely weaning, education and promotion of essential vaccination may reduce childhood malnutrition, especially severe PEM. It has also been reported that the prevalence of breastfeeding in Bangladesh is one of the highest in the world where diarrheal diseases are hyper-endemic and issues of breastfeeding in several diarrheal diseases have been well documented3. We undertook this study to determine knowledge, attitude and feeding behavior of the mothers in a rural community.

This cross sectional study was conducted in Sreepur Thana. Four villages were purposively selected. All women having children below 5 years were interviewed face to face. Structured questionnaire was used. Each participant was informed about the objectives of the interviewing. After taking her consent the interview session was started. The interviewing included socio-demographic information like housing, sanitation, education, water-supply and family-income. As regards feeding practices, each mother was interviewed for information related to nutrition during pregnancy and lactation. The questionnaire also included information about breast feeding like colostrum, exclusive breastfeeding, weaning and feeding during diarrhea and fever. The collected information were entered into computer using SPSS 11.5 version. The prevalence rates of feeding and weaning practices were expressed in percentages. Chi-sq was used to determine association of feeding practices with education and social class.

A total of 500 families were visited in four villages. Of these families, 409 (81.1%) women were selected. Of the 91 non-participants, 85 women had no children below 5 years and only 6 women refused to participate. The mean age of the participants was 25 years (16-45y). The average family size was 4 (4-11) and the average monthly expenditure was 3751 (500- 15000) taka. About 25% were illiterate and 95% were housewives. Most of the families had access to tube well water for drinking and domestic purposes. Of them, 94% had living rooms with corrugated tin sheet.

The study revealed that 68% of mothers took extra food during pregnancy, 80% took extra food during lactation, 54% mothers gave exclusive breast feeding for 6 months. More than one third (36%) mothers started weaning at 6th month and only 62% mothers chose khichuri made of rice and pulse as supplementary food. About two-thirds used to provide balanced diet to their children; 70% used to serve normal diet during fever, 71% during diarrhea and 88% during recovery from illness. The prevalence of taking extra food during lactation by literate mothers were significantly higher than that of illiterate mothers (84 vs 72%, p<.05). The prevalence of taking balanced (added with vegetables and fruits) diet during lactation was also significantly higher among the literate than illiterate mothers (74 vs 37%, p<.001). Taking fruits regularly with diet was more frequent among the mothers of literate and richer class than their illiterate and poorer counterparts.

It may be concluded that about one-fourth of the rural mothers were illiterate though the feeding practices for their children during fever and diarrhea were satisfactory (70 – 88%). As regards weaning practices, about 38% were found not giving their babies supplementary food and almost one-third did not know the beneficial effects of fruits and vegetables for their babies. The low income and high illiteracy among rural mothers were found to affect the rearing practices and also nutrition during pregnancy and lactation. More studies are needed to confirm our findings and it is important to initiate programs for educating mothers with special emphasis on energy dense food during pregnancy and lactation and to emphasize the requirements of fruits and vegetables.

References

1.Das DK, Ahmed S. Knowledge and attitude of the Bangladeshi rural mothers regarding breastfeeding and weaning. Indian J Pediatr 1995; 62(2): 213-7.

2.Iqbal Hossain M, Yasmin R, Kabir I. Nutritional and immunisation status, weaning practices and socio-economic conditions of under five children in three villages of Bangladesh. Indian J Public Health 1999; 43(1): 37-41.

3.Mitra AK, Rabbani F. The importance of breastfeeding in minimizing mortality and morbidity from diarrhoeal diseases: the Bangladesh perspective. J Diarrhoeal Dis Res 1995; 13(1): 1-2.