Status of Breastfeeding among Infants in Nepal

Submitted by: Group-A Bidip Danekhu (11) Bishnu K.C. (13) Sabi Singh (27) Samjhana Shrestha (29) Shrawan Pokharel (31)

Table of Contents
 Introduction  Statement of Problem  Purpose of the Study  Methodology  Findings  Discussion  Conclusion  References

INTRODUCTION
 Breastfeeding is universal, easily initiated and carried out without efforts by all mothers. Breast milk is the natural food of each and every species of mammals.  It is the feeding of an infant or young child who is in the early stage of life (i.e. the period of rapid growth) with breast milk directly from human breasts rather than from a baby bottle or other container i.e. via lactation.  Breast milk has been found to provide the ideal balance of nutrients for optimal growth and development, and it is easily digestible by the baby.

2006, March of Dimes

CONTD.
 Many common childhood illnesses like diarrhea, ear infections, and respiratory tract infections can also be prevented by nursing as breast milk contains antibodies that pass from the mother to the baby for protection which is called natural immunity.  Exclusive breastfeeding means the child receives no liquids or solids other than breast milk, except vitamins, mineral supplements, or medicines for the first six months.

CONTD.
 The World Health Organization and the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life and then supplemented breastfeeding for at least one year and up to two years or more.  Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections.  It has the potential to prevent 12 to 15 per cent deaths among under five children in the developing world and breastfeeding within the first hour after delivery can reduce neo-natal mortality by around 20 percent.

ADVANTAGES OF BREASTFEEDING

Constituents of Breast milk Colostrums Infants first vaccine Property: Antibody-rich Many white cells Purgative Growth factors Vitamin-A rich

Importance

protects against infection and allergy protects against infection clears meconium; helps prevent jaundice helps intestine mature; prevents allergy, intolerance reduces severity of some infection (such as measles and diarrhoea); prevents vitamin A-related eye diseases

CONTD
 Breastfeeding with 3 E's (Early- within one hour of delivery, Exclusive- only providing breast-milk to the child up to six month and Extended -up to 24 months of age) keeps the child healthy and well nourished.  Although breastfeeding is universal in Nepali culture, exclusive breastfeeding practice is not satisfactory. Only 53 % of children are exclusively breastfed.  According to UNICEF, more than 50,000 children die of malnutrition every year in Nepal which could be reduced by effective breastfeeding by about 16 percent

STATEMENT OF PROBLEM
 Breastfeeding is recommended as the best source of infant nutrition. New mothers residing in many far flung areas of Nepal may not be aware of its benefits which may deprive both the infants and mother from ensuring optimum health.  In Nepal, there are areas where many mothers governed by social customs, beliefs and taboos on top of ignorance and lack of awareness throw away the nutrient rich colostrums capable of ensuring infants growth, development and survival.  There are also some areas where well aware, literate and body size conscious mothers hesitate to feed their infants in fear of losing their well toned body after breastfeeding and also because of the complications like mild nipple tenderness, breast infections, and pain during breastfeeding which can be relieved by treatment easily.  In such a situation the essence of breastfeeding infants is lost somewhere thus preventing the achievement of optimum health, nutritional, immunologic and developmental benefits to newborns.

 2006, March of Dimes

PURPOSE OF THE STUDY

General objective  To find out the situation of breastfeeding status among infants in Nepal. Specific objective  To study the status of initial breastfeeding among infants of the five development regions.  To study the status of initial breastfeeding among infants with respect to Residence.  To study breastfeeding status of infants by age.  To study the determinants of breast-feeding according to the characteristics of the mother. 

METHODOLOGY
 Study population: The infants under twelve months of age of various developments regions of Nepal were considered to be the population of the study.  Study Area: The area of the study was Nepal focusing on various development regions.  Study duration: The duration of the study was two months from the end of October to the beginning of December  Study design: It is a descriptive analysis. It was prepared on the basis of secondary data.

CONTD
 Data collection method: Data collection was through systematic review of related web sites and Journals.  Data Processing and Analysis: The data were managed and analyzed in MS-EXCEL and MS-Word.  Limitation of our study: Our study was totally based on secondary data obtained from various books and related websites.

FINDINGS

Figure 1: Bar diagram showing the status of initial breastfeeding among infants of the five development regions

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 2: Bar diagram showing the status of initial breastfeeding among infants with respect to Residence

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 3: Bar diagram showing the status of initial breastfeeding among infants without any education of mother

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 4: Bar diagram showing the status of initial breastfeeding by the mothers having primary level education

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 5: Bar diagram showing the status of initial breastfeeding by the mothers having secondary level education

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 6: Bar diagram showing the status of initial breastfeeding by the mothers having the education of SLC and above

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 7: Bar diagram showing the status of initial breastfeeding with respect to delivery at any health facility

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 8: Bar diagram showing the status of initial breastfeeding with respect to delivery at home

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 9: Bar diagram showing the status of exclusive breastfeeding with respect to age of the infants

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 10: Bar diagram showing the status of feeding only plain water except breast milk with respect to age of the infants

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 11: Bar diagram showing the status of feeding only non milk liquids/juice except breast milk with respect to age of the infants

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 12: Bar diagram showing the status of feeding other milk products except breast milk with respect to age of the infants

Source: Nepal Demographic and Health Survey (NDHS), 2006

Figure 13: Bar diagram showing the status of feeding complementary food products except breast milk with respect to age of the infants

Source: Nepal Demographic and Health Survey (NDHS), 2006

DISCUSSION
 By analyzing our findings, it is realized that the highest percentage of infants who started breastfeeding within 1 hr & 1 day of birth was in FWDR i.e. 44.7% & 98.1% respectively and lowest in MWDR & CDR i.e. 32.5% & 74.9% respectively.  Also, highest percentage who received prelacteal feed was in CDR i.e. 49.7% and lowest in FWDR i.e. 10.3%.  In urban area 39.4% infants started breastfeeding within 1 hr, 82.5% within 1 day of birth and 35.4% infants received prelacteal feeding  Similarly, in rural area 34.8% started breastfeeding within 1 hr, 85.4% within 1 day of birth and 36.6% infants received prelacteal feeding in rural areas.  Our study also revealed that 31.7% mothers who were not educated started breast feeding within 1 hr of birth, 81.2% started breastfeeding within 1 day of birth while 38.6% started prelacteal feeding.

CONTD
 Also, 37.4% mothers with primary education started breastfeeding within 1 hr of birth, 88.8% within 1 day & 30.5% started prelacteal feeding.  And, 47.2% mothers with education of SLC & above started breastfeeding within 1 hr of birth and 93.2% within 1 day of birth  It was realized that 39.9% mothers delivering baby at any health facilities started breastfeeding within 1 hr of birth, 87.9% started breastfeeding within 1 day of birth and 35.2% started prelacteal feeding.  Similarly 34.3% mothers delivering at home started breastfeeding within 1 hr of birth, 84.3% within 1 day and 36.9% started prelacteal feeding.  While comparing our data to the study conducted by Nepal Med Association on Breastfeeding in Nepal: patterns and determinants ", we found out that they related the increasing level of education with early termination of breastfeeding while our study related mothers level of education positively with initiation of breastfeeding.

CONCLUSION
 Breastfeeding is more than a lifestyle choice - it is the Natural Choice for feeding and an important health choice.  Infants from the FWDR are most likely to be breastfed immediately after birth, and nearly all children in this region are breastfed within one day of birth. Similarly the infants from CDR are least likely to be breastfed immediately after birth and nearly all children in this region are breastfed within one day of birth.  More proportion infant received prelacteal feed in rural residence in comparison to urban residence.  Women who have completed their primary, secondary, SLC or a higher level of education are more likely to be exclusively breastfed in comparison to women without education.

CONTD.
 Other characteristics of mother, such as place of delivery have important influences on early breastfeeding practices  Surprisingly good proportions of infants are exclusively breastfed till six months but it does not seem satisfactory.  There are significant proportions of infants who are fed only plain water except breast milk which must be reduced to promote better infant health.  Still some infants are depended on breast milk substitutesnon milk liquids, juices, other milk etc. Complementary foods are introduced to infants only after six months which seems satisfactory.  It must be remembered that benefits of breastfeeding are reduced if it is not exclusive breastfeeding among infants less than six months. Breastfeeding is priceless: there is no substitute for Human Milk.

RECOMMENDATIONS
Strengthening of health education, especially to young mothers of rural areas, primary school girls and professional mothers which should include information especially like:  Educating mothers about the importance and duration of exclusively breast feeding for first six months of lives of their babies.  Make a clean distinction between water being a harmful additive to their exclusive breastfeeding for the first 4-6 months and the various ways it can harm the baby.  Mothers should be made aware that prelacteal feeds like water, sugar solution, solution of Jaggery, Vitamins, tonics should not be given. These give no advantage to healthy child and there is no loss if they are not given.

References
   

NDHS 2006 UNICEF. The State of the Worlds Children, 2004 Centers for Disease Control: www.cdc.gov/breastfeeding Ministry of Health/UNICEF/WHO/MI/New Era Ltd. Nepal Micro Nutrient Status Survey, 1998.  A Hrnell, C Aarts, E Kylberg, Y Hofvander,M GebreMedhin Breastfeeding patterns in exclusively breastfed infants: a longitudinal prospective study in Uppsala, Sweden. Actaaediatrica 1999; 88 (2): 203-211