|ORIGINAL RESEARCH REPORT
|Year : 2022 | Volume
| Issue : 3 | Page : 86-91
Feeding practices and nutrition in children of working and stay-At-Home mothers: A comparative study
Sananda Kumar1, Barathy Chandrasegaran2, Devi Kittu3, RL Jayavani4, Shanthi Ananthakrishnan5
1 Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pediatrics, Indira Gandhi Medical College and Research Institute, Puducherry, India
3 Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India
4 Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India
5 Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
|Date of Submission||31-Mar-2022|
|Date of Acceptance||18-Jul-2022|
|Date of Web Publication||25-Aug-2022|
Dr. R L Jayavani
Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Kathirkamam, Pondicherry - 605 009
Source of Support: None, Conflict of Interest: None
Introduction: Exclusive breastfeeding (EBF) for the first 6 months of life and timely introduction of complementary feeds (CFs) with continuation of breastfeeding up to 2 years or beyond are optimum infant and toddler nutrition practices. Mother's employment status influences the feeding practice which in turn can have a negative impact on the growth and development of the infant. The objectives of the study were to determine and compare breastfeeding and CF practices in working and stay-at-home mothers attending our health facility and its effect on the growth of their children. Methods: This observational comparative study was done on 200 mothers, 100 working mothers and 100 stay-at-home mothers of children aged 1–24 months after obtaining written consent. Data were recorded in a pretested semi-structured questionnaire using interview method. Details were elicited regarding feeding practices and illnesses in the child. Each infant's growth and development were assessed using the World Health Organization growth chart and Trivandrum development chart. Statistical tests used were descriptive statistics for frequencies, means and standard deviation, Chi-square for proportions, and Student's t-test for means. A P < 0.05 was considered statistically significant. Results: EBF for 6 months was given by 37% (37/100) of stay-at-home and 45% (45/100) of working mothers (P = 0.251). Breastfeeding beyond 6 months was given by 94.7% (n = 71/75) of stay-at-home and 93.8% of working mothers (n = 90/96, P = 0.800), and beyond 12 months by 61.1% n = 33/54) and 54.8%, respectively, (n = 40/73, P = 0.477). CF was initiated by 180 days by 44% of stay-at-home (44/100) and 55% of working mothers (55/100, P = 0.120). Underweight, wasting, and stunting were seen in 12%, 10%, and 13% (12/100, 10/100, 13/100), respectively, of stay-at-home and 14%, 15%, and 13% (14/100, 15/100, 13/100), respectively, of working mothers and there was no statistical difference between the two groups. A higher frequency of diarrheal episodes was observed in babies of working mothers (6/100, 6% vs. 18/100, 18%, P = 0.009). Conclusion: There was no statistical difference between stay-at-home and working mothers in time of initiation of first feed, giving colostrum, EBF rate, continued breastfeeding beyond 12 months, and age of initiation of CF. Thus, the nutrition and health status of children in both groups were comparable except acute diarrheal illness which was more in babies of working mothers.
Keywords: Breastfeeding, complementary feed, infant nutrition, infant, mothers' employment, toddler
|How to cite this article:|
Kumar S, Chandrasegaran B, Kittu D, Jayavani R L, Ananthakrishnan S. Feeding practices and nutrition in children of working and stay-At-Home mothers: A comparative study. J Clin Sci 2022;19:86-91
|How to cite this URL:|
Kumar S, Chandrasegaran B, Kittu D, Jayavani R L, Ananthakrishnan S. Feeding practices and nutrition in children of working and stay-At-Home mothers: A comparative study. J Clin Sci [serial online] 2022 [cited 2022 Sep 26];19:86-91. Available from: https://www.jcsjournal.org/text.asp?2022/19/3/86/354672
| Introduction|| |
Infant and toddler feeding practices are vital for their optimum growth and development. The first feed for a newborn should be initiated within 1 h of birth. Prelacteal feeds (PLF) should be avoided as they increase the chance of infection and interfere with successful breastfeeding. Exclusive breastfeeding (EBF) for the first 6 months of life is recommended by the World Health Organization (WHO). Breastfeeding should be done at least for a minimum of eight feeds per 24 h.
Culturally appropriate and home-based complementary feeds (CFs) are recommended from 6 months onward, along with a continuation of breastfeeding till 2 years of age or even beyond. Minimum two meals are recommended per day between 6 and 8 months of age, three meals for those 9–23 months if breastfed and four meals for those 6–23 months not breastfed from various food groups. Minimum meal diversity is receiving food from at least 4 food groups out of eight. Recently, it has been revised to five food groups, the fifth being breast milk. Various socio-demographic factors influence these feeding practices, such as mothers' employment, workplace support, family support, and socioeconomic status.,, Early return to work, nonsupportive work environment, lack of infant care facilities in or near the workplace, lack of facilities to pump and store milk are some factors that affect feeding practices which in turn can impact the nutritional and health status of children.,
Lack of workplace support, for example, contributes to anxiety and guilt over being unable to fulfill both mother and employee roles, and thus toward the decision to stop feeding breast milk. Family-friendly policies, on the other hand, such as paid maternity and paternity leave, breastfeeding breaks at or near workplace helps to support and promote breastfeeding in working mothers.
One study at Bengaluru showed that 55% of the children of stay-at-home were underweight compared to 45% of those of working mothers. This was attributed to caretakers providing child care in the case of nursing mothers. Yet another study reported children of stay-at-home mothers weighed significantly higher and were taller than those of employed mothers. Therefore, this study was done to assess and compare breastfeeding and CF practices in working and stay-at-home mothers in the local population and its impact on their infant and toddler growth, development, and health.
| Methods|| |
This study was an observational comparative study conducted in our institute after obtaining the institute ethical clearance. A period of the study was from January 2018 to February 2019. All mothers with children between the ages of 1 month and 2 years attending the well-baby clinic and immunization clinic of the outpatient department of pediatrics were included. They were grouped as working and stay-at-home mothers. A working mother was defined as one employed at least during the previous 3 months at the time of the study. A stay-at-home mother was defined as one taking care of her children and household and not holding an employment outside or even work from home. As minimum meal diversity is a strong predictor for nutritional status, taking the prevalence of minimum meal diversity as 10% from the previous study, the sample size was calculated as n = Z (1−α)2 × p × q/(d)2 where, Zα = 1.96, P = 15%, q = (1 − p) = 85%, and d = 5% and n was calculated as 196 approximated to a total of 200 with 100 in each group. Data were collected from the mothers using a validated, pretested semi-structured questionnaire by interview method after obtaining informed written consent from them. The questionnaire included demographic data such as age of the mother, her education, employment status, monthly income, family type, and family support. For working mothers, questions included work hours per day, maternity/child care leave arrangements, work resumption, breastfeeding breaks, infant care facilities in or near workplace, and workplace support. Breastfeeding practice was assessed using questions on prelacteal feed, colostrum, time of initiation of the first feed, feed frequency per day, and average duration of each feed in the previous 24 h, EBF for the first 6 months, total duration of breastfeeding, any artificial/top feeds and any bottle-feeding or nipple use. CF practice was assessed by questions on age of initiation, type of CF, frequency per day, and problems faced with CF for the previous 24 h. The growth and development of children included in the study were assessed using WHO growth charts and Trivandrum development assessment chart. The child's present illness, past illnesses, and previous hospitalization were recorded. The mothers were categorized as working and stay-at-home mothers. The income groups were classified into five groups based on BG Prasad classification as outlined in [Table 1].
Data were entered into MS Excel worksheet and analyzed with SPSS software SPSS version 21 (Statistical Product and Service Solutions, Copyright IBM Corporation 1989, 2012. USA). Statistical tests, namely means and standard deviation (SD), were used for continuous variables. Categorical data between the two groups were compared by Chi-square test for proportions and Student's t-test for means. A P < 0.05 was considered statistically significant.
| Results|| |
A total of 200 mothers, including 100 working mothers and 100 stay-at-home mothers, were enrolled in the study. Their mean age was 27.8 ± 4.6 years (mean with SD). The mean ± SD age of all the children was 14.3 ± 6.8 months and 11.67 ± 6.4 months for children of stay-at-home mothers and 16.91 ± 6.1 months for children of working mothers, respectively (P = 0.869). There were 109 female (54.5%) and 91 male children (45.5%). One hundred and one children (50.5%) were from nuclear families, while 66 (33%) were from extended nuclear families which are three-generation family consisting of grandparents, parents, and children, and 33 (16.5%) were from joint families consisting of grandparents, parents, children, uncles, aunts, and cousins. Family support was available in 72 stay-at-home mothers (72%) and 98 working mothers (98%). The most common caretakers apart from the mother were grandparents in 136 families (68%). The mean ± SD work hours per day were 7.1 ± 1.5 h. Workplace support in the form of employer and co-worker support encouraging the mother in breastfeeding was reported by 77 (77%) and 86 (86%) of the working mothers, respectively. Maternity and child care leave was availed by 51% and 50% (n = 51 and n = 50) of the working mothers, respectively. The mean duration of maternity leave and child care leave was 5.2 ± 1.4 and 3.5 ± 2.2 months, respectively. The daycare facility in/near the workplace was reported by 58 (58%) working mothers. Breastfeeding breaks and facilities for storing breast milk in the workplace was available for 36% and 9% (n = 36, n = 9) of the working mothers. The comparison of breastfeeding and CF practice between stay-at-home and working mothers is shown in [Table 2] and [Table 3].
|Table 3: Complementary feeding practice between stay-at-home and working mothers|
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The breastfeeding practices among stay-at-home and working mothers are shown in [Table 2]. EBF for 6 months was given by 37% (37/100) of stay-at-home and 45% (45/100) of working mothers (P = 0.251). Breastfeeding beyond 6 months was given by 94.7% (n = 71/75) of stay-at-home and 93.8% of working mothers (n = 90/96, P = 0.800). The mean ± SD time of initiation of BF (TIFF) of children without nursery care was 1.3 ± 1.1 h. While 67.6% (n = 98/145) of mothers having vaginal deliveries initiated feeding within the 1st h, only 36.4% of those having cesarean section (20/55) initiated within the 1st h. This difference was statistically significant (P = 0.000). Mean ± SD TIFF was 1.0 ± 0.9 h for mothers with vaginal delivery and 2.0 ± 1.4 h for those with cesarean section. It was not affected by maternal age (P = 0.249), education status (P = 0.166), birth order of the child P = 0.140), socioeconomic status (P = 0.363), and maternal employment status (0.887).
The mean ± SD duration of exclusive breastfeed was 5.1 ± 1.8 months overall being 5.18 ± 1.69 months for stay-at-home mothers and 5.23 ± 1.72 months for working mothers, there being no statistical difference between them (P = 0.837). Reasons for not exclusively breastfeeding till 6 months were perceived as insufficient milk (n = 29, 29%) among stay-at-home mothers and working status (n = 28, 28%) for working mothers. Bottle feeding/pacifier use was reported by a total of 47 mothers (23.5%), 21 stay-at-home (21%), and 26 working mothers (26%). Although the proportion of mothers continuing breastfeeding beyond 1 year of age was similar in both the groups [Table 2], the mean ± SD breastfeeding duration was significantly longer statistically in working mothers (12.5 ± 5.0 months) than in stay-at-at-home mothers (10.1 ± 5.5 months, P = 0.002).
Complementary feeding practice
Details of CF are shown in [Table 3]. The mean ± SD age of introduction of CF was 6.1 ± 1.3 months overall. The mean ± SD age (4.9 ± 1.5 months) for the stay-at-home mothers was earlier than that for the working mothers (6.2 ± 1.3 months), (P = 0.000). Mean feed frequency per day was 5.6 ± 1.5 times and was significantly higher in working (6.02 ± 1.7 times) than in stay-at-home mothers (3.93 ± 2.7, P = 0.000). Minimum meal diversity (receiving foods from 4 or more food groups) was met by 146 mothers (83.9%) in total, 88 working mothers (60.3%), and 58 stay-at-home mothers (39.7%, P = 0.00). Minimum meal frequency was met by 168 mothers (96.5%), 95 working mothers (56.5%) and 73 stay-at-home mothers (43.5%, P = 0.00). A comparison between working and stay-at-home mothers with regard to child's nutrition and health is shown in [Table 4]. Longer duration of breastfeeding was correlated with higher weight, height, and head circumference (pr 0.475, P = 0.000, pr = 0.587, P = 0.000, and pr = 0.570, P = 0.000). There was no difference in the nutritional status of children in both groups. However, children of working mothers were observed to have a significantly higher incidence of diarrheal illnesses.
|Table 4: Nutrition and health of children of stay-at-home and working mothers|
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| Discussion|| |
The prevalence of PLF varies from 12.7% to as high as 64.7%, as reported by various authors.,, This could be because of differences in cultural practices and coverage of population by health education. We observed a low prevalence of 2.5% in the present study, and it was comparable between stay-at-home and working mothers, similar to the observation made by Polineni et al. in Mysore, India (29%). This may be due to awareness of the dangers and disadvantages of prelacteal feeding.
The initiation of first feed within the 1st h was seen in 53.5% of mothers in our study, similar to that reported by Reddy et al.(59%) but higher than NFHS-4 and NFHS-5 national statistics (41.6% and 41.8%, respectively).,, The NFHS regional statistics documented a timely initiation rate of 65.3% for the year 2015–2016 and 54.1% for the year 2019–2021, respectively, for children <3 years. There was no difference between working and stay-at-home mothers in our study in this regard, unlike the observation by Polineni et al., where it was higher in the nonworking group (53.3%) compared to the working group (33.6%). This may be related to the type of delivery and time of transport from the recovery room and early or delayed rooming-in. Early initiation of breastfeeding in the newborn ensures that first milk called colostrum is given to the newborn and protects from infections, reduces neonatal mortality, and improves child survival. A study by Phukan et al. observed that not initiating breastfeeding within 1 h increases the odds of neonatal mortality threefold compared to those who did. Phukan et al. Colostrum was given by 97% of women in our study, higher than that reported by other investigators who observed rates of 89.6% and 90.3%, respectively.,
We observed that only 41% of mothers exclusively breastfed for 6 months, which is lower than NFHS-4 national statistics (55%) but similar to NFHS-4 regional statistics (45.5%)., and that observed by Bhanderi et al. who reported a rate of 49.7%. Some authors from Jordan have reported rates as low as 2.1%. Bhanderi et al. found maternal employment status and less educated parents as barriers to EBF. Nishimura observed higher EBF rates with greater maternal age and lower education. Working mothers were also able to exclusively breastfeed for 6 months perhaps because of paid maternal and child care leave, family and workplace support. Bhagwat et al. reported that 84.6% of working mothers continued breastfeeding at 12 months, higher than in our study (57.5%)., Mehta et al. reported a mean duration of breastfeeding of 12 months in their study similar to ours, whereas Bhandari et al. reported a mean duration of breastfeeding of 89.3 ± 42.8 days in theirs.,
In the present study, 49.5% of mothers initiated CF at 6 months (180 days) as recommended, higher than that reported by Bably et al.(21%). Jain et al. reported that 84% gave CF between 6 and 8 months of age. There was a significant difference between working and stay-at-home mothers in our study. Semisolid food, home-based CF and more frequent CF were given by a higher proportion of working mothers. This could be because the caretakers were mostly grandparents, and they could spend more time with the grandchildren. The MMD and MMF in our study were 83.9% and 96.5%, respectively, higher than that reported by Chhabra et al. (60.6% and 15.1%) and Jain et al. (57% and 86%) and significantly higher in working mothers.,
Chhabra et al. reported stunting wasting (43.7%), underweight (43.4%), and stunting (29.1%) higher than the present study 14%, 13%, and 11.5%, respectively. The absence of any difference in the nutritional status of children in both the groups might be due to the fact that breastfeeding practices were similar between the groups with better CF indicators working, owing perhaps to the good support system at home and work. However, a higher proportion of children of working mothers developed diarrhea compared to those of stay-at-home mothers. This could be due to the higher CF frequency and variety such as fruit juice and probably hygienic practices not being followed strictly by the caregivers.
| Conclusion|| |
Our study demonstrates that there was no difference between stay-at-home and working mothers in PLF, in time of initiation of first feed, giving colostrum, rate of EBF for 6 months, continued breastfeeding beyond 12 months, and age of initiation of CF, meeting minimum meal diversity and minimum meal frequency. Appropriate feeding practice was observed in working mothers in the form of the administration of home-based CF, semisolid consistency, and higher feed frequency. The nutritional status and prevalent illnesses in the children in both groups were comparable. However, gastrointestinal infection was significantly higher in children of working mothers than stay at home.
There is still the need to improve the food practices in both working and stay-at-home mothers. In accordance with the theme of world breastfeeding week 2019, there is also the need to empower the fathers in care of their children's nutrition. Targeting fathers and other immediate caretakers from the antenatal period will perhaps go a long way in achieving the set target goals.
This was a cross-sectional questionnaire-based convenience sampled study and therefore prone to recall bias. Further sample size is small. Mixed method studies on a larger and more inclusive sampling could have given a better understanding of the issues addressed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]