INTRODUCTION

Title: Pattern of IYCF Practice among Rural Mothers and the

Nutritional Status of their Babies

Introduction: Infancy and early childhood are the most critical phases of human life.
The nutrition and appropriate care received in this period contribute to the optimum
functioning in later life. Hence, this period is called the “critical window”. Food
security, caring practice and disease control- these are the main three determinants of
good health, nutrition and child survival. (Salim, M., et al., 2012). The IYCF practice
comprises of breast-feeding and complementary feeding which contributes in
determining the nutritional status among children. If feeding practices during these
period are poor, it results in malnutrition among the children leading to impaired
cognitive and social development, reducing productivity in adult life. (Saizuddin, M.,
et al., 2016).

World Health Organization and UNICEF are working in collaboration to endorse

breastfeeding to save children and enrich their lives everywhere. They jointly
formulated “The Global Strategy for Infant & Young Child Feeding” in 2002 and
recommended that children must be breastfed exclusively for the first six months
followed by appropriate complementary feeding alongside breastfeeding up to 2 years
of life. (Salim, M., et al., 2012).

The United Nations General Assembly, on 1st April, 2016, adopted a resolution
proclaiming a United Nations Decade of Action on Nutrition from 2016 to 2025 which
aimed to trigger intensified action to end hunger and eradicate all forms of malnutrition
worldwide, and ensure universal access to healthier and more sustainable diets for all-
whoever they are and wherever they live. Nutrition and associated epidemiological
and demographic transitions were accepted as near-linear, gradual processes
previously, but in this modern era countries are now experiencing an evolving and much
complex nutrition paradigm. (WHO, 2016)

In reducing child death considerable global progress has been made since 1990. The
total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to
5.6 million in 2016. Since 1990, the global under-5 mortality rate has dropped 56%,
from 93 deaths per 1 000 live births in 1990 to 41 in 2016 worldwide. Even though the

1
world as a whole has been accelerating progress in reducing the under-5 mortality rate,
disparities exist in under-5 mortality across regions and countries. Sub-Saharan Africa
remains the region with the highest under-5 mortality rate in the world, with 1 child in
13 dying before his or her fifth birthday. Inequity also persists within countries
geographically or by social-economic status. The under-5 mortality among children
born in the poorest households is on average twice that of children born in the wealthiest
households. Eliminating this gap between mortality in the poorest and wealthiest
households would have saved 2 million lives in 2016. Malnourished children,
particularly those with severe acute malnutrition, have a higher risk of death from
common childhood illness such as diarrhoea, pneumonia, and malaria. Nutrition-related
factors contribute to about 45% of deaths in children under 5 years of age. (WHO, 2017)

Breastfeeding aspects, the dietary diversity and diet frequency aspects all together
reduce the morbidity and mortality of young children from malnutrition. Bangladesh,
with about 340,000 childhood deaths per year, ranks number 7 in the world along with
other countries: India, Nigeria, China, Pakistan, DR Congo, Ethiopia, Afghanistan,
Tanzania, and Indonesia are in the list of 10 countries with the most number of
childhood deaths. In Bangladesh, infant mortality has continued a remarkable decline
which brought her prestigious award for achieving MDG-4. But it is still high compared
to the developed countries. Reducing infant mortality is both an ethical obligation and
a pre-requisite to achieve the Sustainable development goal (SDG-3) within 2030.
(Saizuddin, M., Hasan, MS., 2016)

Healthy feeding behaviors by infants and toddlers are needed for healthy growth as well
as social, emotional, and cognitive development. For this reason, dietary guidance for
infants and toddlers should focus on advising caregivers what young children should
eat, as well as the right environment for their children to learn to eat healthfully. This
is a crucial time period, because food preferences, dietary patterns, and the risk of
obesity are rapidly developing between birth and 2 years of age. (Healthy Eating
Research, 2017)

Rationale: Proper feeding is important in improving nutrition and child survival.

Documentation of knowledge of caregiver on infant and child feeding is relatively less
in our country. Hence, the aim of our study will be to describe feeding practices and
nutritional status among infants and young children (IYC) in rural community of

2
Dhamrai Upazilla. Statistics indicate about 35% of child death and 11% of total global
burden of disease are due to poor nutrition. Appropriate feeding practices are
fundamental to survival, growth, development, health and nutrition of infants and
children and to the well-being of the mothers. There is sufficient evidence of cause
effect for certain preventive interventions such as exclusive breastfeeding in the first
six months in the prevention of diarrhea, pneumonia and neonatal sepsis,
complementary feeding in preventing diarrhea, pneumonia, measles and malaria and
vitamin A in prevention of diarrhea. (Bwalya, MK., et al., 2015)

A lot of wrong perceptions, knowledge and practices prevail among different socio-
demographic groups in our country. Pre-lacteal feeding/ heating food feeds are a
common practice just after born of a new baby. About 98% new born are traditionally
fed these foods such as honey, sweetened water or mustard oil with believe that they
will give strength to the babies and make their voice sweet. (Saizuddin, M., Hasan, MS.,
2016). This type of feeds greatly hampers newborn’s immunity and as a result different
infections proceed. So to have an overview of the prevailing scenario of the feeding
practices of under 2 children and the nutritional link with their feeding practices the
study need to be undertaken.

WHO offers three recommendations for IYCF practices for children aged 6-23 months
which are continued breastfeeding or feeding with appropriate calcium-richen foods if
not breastfed, feeding solid or semi-solid food for a minimum number of times per day
according to age and breastfeeding status and including foods from a minimum number
of food groups per day according to breastfeeding status. The present study was
therefore undertaken to determine and to identify the patterns of feeding practices in
children aged 3-23 months old in Bangladesh. . (Saizuddin, M., Hasan, MS., 2016).

3
Research question:

• What is the pattern of IYCF practice among the mothers of rural community
having child 3 to 23 months of age?
• What is the nutritional status of the mothers and their babies of rural
community?

General objective:

• To assess the pattern of IYCF practice among the mothers of rural community
having child 3 to 23 months of age.
• To identify the nutritional status of the mothers and their babies of rural
community

Specific objective:

• To determine the pattern of breast feeding among the mothers of rural

community
• To determine the pattern of complementary feeding among the mothers of rural
community
• To determine the association between feeding practice and sociodemographic
condition of the respondents
• To determine the association between pattern of feeding practice and nutritional
status of the mothers.

4
 Methodology:
Study Design

A cross sectional study will be conducted in the community among the mothers who
have children under 5 years of age.

Study period

The study will be conducted from over a period of 5 days starting from 25 March 2018
to 29 march 2018.

Study place

The study will be conducted among the mothers who have children aged under 5 years
at the Dhamrai upazilla in Dhaka district.

Study population

In the study the target population of the study will be the mothers those who have
children aging from 3 to 23 months of age and those who satisfied our inclusion and
exclusion criteria.

Selection criteria

Inclusion criteria

• All mothers having children aging 3 to 23 months will be the respondents in

this study
• Mothers having more than one under five years children will also be included
in this study
• Healthy mothers and healthy baby
Exclusion criteria

• Seriously sick mothers will be excluded from this study

• Mothers having seriously ill babies (CHD, any chronic illness)
• Mothers having autistic babies will be excluded
• Mothers having adopted child will be excluded
• Psychologically instable mother who will not response to the interview.

5
 • mothers who have no willingness to participate.

Sampling unit

Each mother having children aging 3 to 23 months will be considered as a sampling

unit.

Sample size

Following formula was followed to calculate the sample size

𝑧 2 𝑝𝑞
n= 𝑑2

Where,

n= Desired sample size

Z= Standard normal deviate (it is set at 1.96 when confidence interval is 95%)

p= Anticipated population proportion, proportion of IYCF practice among the rural

mothers of Bangladesh

Here p= .23(BBS)

q= (1-p) = (1-.23) = 0.77

d=Allowable error, degree of accuracy required, here set at 0.05%

Therefore, in this study, sample size is calculated as 272.13 or 273 (Two hundred and
seventy-three)

Sampling technique

Sample will be taken purposively from the mothers children aging 3 to 23 months age
from the community.

Research instrument

A planned questionnaire will be developed containing both the closed and open-ended
query to collect data through face to face interview with respondents.

Data collection tools

• Weight machine
• MUAC tape
• Z score card
• Measuring tape

6
Data collection technique

• Data will be collected by face to face interview of the mothers in the

community using semi structured questionnaire
• Breast feeding and Complementary practice of mothers by check lists
• Anthropometry for children and mothers

Anthropometric measurement

It is important to measure the weight, height and mid upper arm circumference of the
child to assess the nutritional status for the study.

Weight and height will also be taken.

Before the measurement we will demonstrate the procedure to the mother and take
permission from each of them.

Capture the result

After the child is correctly positioned and the readout on the measurement device
become stable, weight will be recorded in kg up to 0.1kg

Standing height measurement

The height of the children will be measured using measuring tape and a hard
background (wall of the house)

Data analysis plan and interpretation

• Collected data was checked-rechecked, edited, coded and recoded for quality
management.
• To assess or measure the objectives, for descriptive statistics-frequency,
percentage, mean median, mode, range and standard deviation [SD] was done
• Uni-variate and multi-variate analysis was done.
• Chi-Square test, t test, ANOVA, correlation were done. To see the relationship
and statistical significance between dependent variable Low back pain and
functional disability with other factors.
Ethical implication

• Formal approval of the study will be obtained from Ethical Implication Board
of NIPSOM
• Each respondent will be informed about the research, assured and informed
written consent will be taken
• All participants will be assured that all information will be kept confidential
and will not be used any other purpose except research
7
• Participants will not be subject to harm in any ways
• Respect for the dignity of the participants will be prioritized
• Participants will have rights to withdraw from the study at any stage if they
wish to do so
• The protection of the privacy of research participants will be ensured

8
 Reference:

Bwalya, MK., et al. (2015) Infants and young children feeding practices and nutritional
status in two districts of Zambia. International Breastfeeding Journal.

Healthy Eating Research. (2017) Feeding Guidelines for Infants and Young Toddlers:
A Responsive Parenting Approach, Building evidence to prevent childhood obesity.
[Internet] Available from:
http://healthyeatingresearch.org/wp/2017/02/her_feeding_guidelines_report_021416-
1.pdf. Accesed on: 15.03.2018

Salim, M., et al. (2012) Infant and Young Child Feeding Practices upto Two Years of
Age and Their Nutritional Status. Bangladesh Medical Journal. Vol. 41 No. 1.

Saizuddin, M., Hasan, MS. (2016) Infant and Young Child Feeding (IYCF) Practices
by Rural Mothers of Bangladesh. Journal of National Institute of Neurosciences
Bangladesh. Vol. 2, No. 1.

Saizuddin, M., et al. (2016) Infant and Young Child Feeding (IYCF) Practices by Rural
Mothers of Bangladesh. Medicine today. Vol. 28, No. 1.

World Health Organization. (2017) Children: reducing mortality. [Internet] Available

from: http://www.who.int/mediacentre/factsheets/fs178/en/ Accesed on: 14.03.2018

World Health Organization. (2016) The double burden of malnutrition: Policy Brief.
United Nations Decade Of Action On Nutrition 2016-2025. [Internet] Available from:

http://apps.who.int/iris/bitstream/10665/255413/1/WHO-NMH-NHD-17.3-
eng.pdf?ua=1 Accesed on: 15.03.2018