Prevalence of Diarrhoea in Infants and its Relation to Feeding and Weaning Practices

BACKGROUND: Diarrhoea is one of the major causes of morbidity and mortality in infants in developing countries, because of diverse factors associated with it. OBJECTIVE: To study the relationship of diarrhoea with feeding and weaning practices. METHODS: In this Cross-sectional epidemiological study, 704 infants and their mothers were studied for feeding and weaning practices using semi-structured closed ended questionnaire. RESULTS: Prevalence of diarrhea was observed lowest among exclusive breast fed (3.9%) and highest among mixed fed including supplementary feeding (15.2%). Artificial feeding was prevalent in 9.2%. Consumption of leftover food was accompanied by double the prevalence (21.89%) as compared to those who did not consume such food (10.1%). CONCLUSIONS: Education and awareness of mothers regarding breast feeding, can help decrease the prevalence of diarroea in infants and associated morbidity and mortality. JMS 2011;14(1):19-21

environment; while the same factors were either missing or less practised in infants of 6-12 months of age.In addition, wrong weaning practices and higher exposure to external hazardous environment could be the factors leading to higher prevalence rate in second half of infancy.Infants feeding practices of mothers have strong bearing on diarrhea.Correct practices on one hand have beneficial effect by preventing malnutrition, while wrong behaviors especially faulty weaning practices expose them to harmful environmental hazards.Therefore most effective measures to prevent malnutrition and diarrhoea in infants is exclusive breast feeding for first 6 months and correct weaning practices thereafter.
In the current study it was seen that exclusive breast fed, exclusive bottle fed, mixed and mixed plus supplementary feeding were accompanied by diarrhoeal prevalence of 3.9%, 9.2%, 10.6% and 15.2% respectively among the infants (Table 2).
Moreover there was no significant association of weaning the infant at the age of 4-5 months or late on diarrhoeal prevalence (Table 3), but giving left over feed was associated with recorded in proforma and data analysed using standard statistical techniques and statistical package for social sciences (SPSS).Definition of diarrhoea for the purpose of study: a) Three or more loose watery motions or a single large watery motion in a day.Mother is the best judge for the purpose.b) If the episodes lasted for less than 14 days, it was termed as acute diarrhoea.c) If for more than 14 days it was considered as persistent diarrhoea.d) If blood and mucus was present then it was labelled as dysentery.e) If vomiting was also present along with diarrhoea it was termed as "Gastro-enteritis.All the cases falling under the heading (a) to (c) and (d) were considered as "diarrhoea cases".

Results and Discussion
A total of seven hundred and four infants were surveyed, eighty four were detected having diarrhoea with a prevalence rate of 11.60%.This population formed 7.45% of total population surveyed for detecting prevalence of diarrhoea in children under six years of age.Lower suffering rate in first half of infancy could be due to protective effect of maternal derived immunity, exclusive breast feeding had less chances of exposure to deleterious external higher prevalence (21.89%) as compared to other comparative group with prevalence 10.08% (Table 4).9 Kumar V et al in their study found that breast fed had half the diarrhoeal prevalence as compared to bottle fed and mixed fed infants.
Jaiswal has also shown beneficial effects of breast feeding on diarrhoeal orbidity.But, artificial feeding and mixed feeding had similar diarrhoeal morbidity in their study group of preschool children.It was observed that beneficial effect of exclusive breast-feeding were offset by introduction of supplementary feeding, presumably because of associated poor hygienic behavior.7 Popkin et al studied the effect of breast feeding on diarrhoeal morbidity at 2 months, 4 months and 6 months in urban area of Cibu.The prevalence of diarrhoea in exclusive breast fed children was 4.6%, 13% and 13.2% respectively.In non-breast fed 74.4%, 15.9% and 23.7% respectively and in mixed fed infants 5.6%, 11.6% and 19.9% respectively.
Other researchers in periurban community of Guinea Bissau revealed higher rate of diarrhoeal attacks among bottle-fed as compared to breast-fed infants.Breast feeding and correct weaning practices helped in reducing morbidity and mortality among infants to a great extent.Nutritional status and diarrhoea operate in a synergistic manner; a bi-directional causal relationship exists, leading to a vicious circle of diarrhoea-malnutritiondiarrhea.

Conclusions
Feeding practices showed lowest prevalence of diarrhoea among exclusive breast fed (3.9%) and highest among mixed fed including supplementary feeding (15.2%).Artificial feeding showed prevalence of 9.2%.Consumption of left over food was accompanied by double the prevalence (21.89%) as compared to those who did not consume such food (10.1%).Education and awareness of mothers regarding breast feeding, can help decrease the prevalence of diarroea in infants and associated morbidity and mortality.

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Jinadu et al observed highest prevalence in 0-11 months of age group.Ministry of Health and Family Welfare government of India (CDD programme plan operation 1982-83) showed higher prevalence of diarrhoea in 3-36 months of age with peak at 7 6-7 months of age.Popkin et al in a study in urban areas of Cibu found prevalence of diarrhoea to be ranging from 7.2% to 12.7 % 8 in 0-4 months of age and 20.4% at 6 months of age.Waheed et al revealed highest prevalence in 6-14 months of age.