BACKGROUND: Breast milk is the most appropriate and ideal food for the infant. The baby does not require any food other than breast milk until 6 months of age. The data suggest that infant mortality rates in the developing countries are 5–10 times higher among children who have not been breastfed or who have been breastfed for less than 6 months. Breastmilk contains antimicrobial factors such as macrophages, lymphocytes, secretory IgA, antistreptococcal factor, lysozyme, and lactoferrin, which provide considerable protection not only against diarrheal diseases and necrotizing enterocolitis but also against respiratory infections in the first month of life. In other words, breast milk contains other proteins whose functions are not nutritive but anti-infective e.g., IgG, lysozyme, and living cells. In the intestine, lactose helps the “right†kind of bacteria (i.e., Lactobacillus bifidus) to grow. Lactobacillus and lactose helps to keep the intestinal content acidic, which inhibits the growth of harmful bacteria. Colostrum is the milk immediately delivered after birth. It is rich in proteins, vitamins A and K, and immunoglobulins (IgA). IgA acts as an intestinal antiseptic and anti-infective. It protects the child against respiratory and alimentary diseases and also against allergic bronchitis, asthma, etc. It is the first natural vaccine the child receives from the mother. Breastfeeding is a “lifeline†for newborn babies and should be started immediately after birth. Although breastfeeding is a nearly universal practice in India, very few children are put on breastfeeding immediately after delivery. National Family Health Survey (NFHS-5) (2019–2021) data provide cardinal information on breastfeeding practices in Tamil Nadu. About 60.2% of children <3 years breastfed <1 h, 55.1% of newborn <6 months had exclusive breastfeeding (EBF), and 66.5% of children 6–8 months received a solid/semisolid diet and breast milk. The Introduction of supplementary foods before 6 months of age may put infants at risk of malnutrition because other liquids and solids are nutritiously inferior to breast milk. The consumption of liquids and solid smashed foods at an early age also increases children’s exposure to pathogens and consequently puts them at a greater risk of diarrhoea.. A systematic review and meta-analysis that summarized evidence from developed countries found that maternal employment, insufficient or lack of breast milk, associated maternal/infant morbidities, lactational difficulties, cultural norms, and maternal body image issues were the barriers associated with low practice of EBF up to 6 months of life. Lack of support from family or the absence of social support systems was also identified as one of the barriers for continuing EBF for 6 months. Further, cultural beliefs such as giving water along with feeds (believed to aid in digestion), influence the sub-optimal practice of EBF for 6 months . A study carried out by Penugonda et al. showed that 185 (69 EBF + 116 non-EBF) of 450 infants reported a total of 242 illnesses, most commonly respiratory (86.6%) followed by gastrointestinal (11.6%). The number of illnesses per infant was 0.45 and 0.6 in EBF and non-EBF, respectively (P = 0.015). Illness incidences in EBF infants were significantly lower during all successive time intervals after 10 weeks of age. Logistic regression analysis confirmed significantly lower illness incidence in EBF infants at 10–14 weeks (OR: 0.27 [CI: 0.12–0.64]). A study conducted in Kolkata showed that 82.22% of breastfed infants had no diarrhea, and the absence of RTI was observed in 69.81%. It was also noted that both episodes of diarrhea and RTI in infants become less when the duration of breastfeeding increases. The study also significantly (P < 0.001 and P = 0.03) revealed that the occurrence of diarrhea and RTI was found to have lower incidence in colostrum-fed babies. Out of 391 colostrum-fed babies, about 85.42% had no diarrhea, and the absence of RTI was noticed in 72.12%. A study on the Global trends in exclusive breastfeeding by United Nations Fund for Population Activities (UNFPA) reveals that although considerable improvements have been made in some regions of the world, the prevalence of exclusive breastfeeding remains far too low in many areas of the developing world. Though the Exclusive breastfeeding rate in Tiruvallur district is 65.5% (urban area-76% and in rural area-55%) ,this is far below the widely accepted “universal coverage†target of 90% coverage and so there is a need to rule out the factors affecting EBF in Tiruvallur district.
OBJECTIVE Primary Objective: To rule out various factors affecting exclusive breastfeeding practices. Secondary objective: To assess the effect of exclusive breastfeeding on respiratory and gastrointestinal infections in children under 3 years of age and to assess the pattern of practices over respiratory and gastrointestinal infections in children. STUDY DESIGN: This is an observational study with a duration of 6 months which includes 350 mothers of children under 3 years of age in Tiruvallur district who will be included in the study by using simple random sampling method to whom a questionnaire regarding breastfeeding will be given and collected after explaining about the study and obtaining proper consent from the mothers. Mothers with children aged between 6 months to 3 years will be included and mothers with children who have congenital heart disease, any syndrome, dysmorphic features and mothers who had contraindication for breastfeeding will be excluded from this study. OUTCOME: The various factors affecting exclusive breastfeeding will be ruled out and the effect of breastfeeding on respiratory and gastrointestinal infections will be studied and analysed. Also various patterns of practices followed in Tiruvallur district during respiratory and gastrointestinal infections in children will be studied. Understanding the intricate web of factors associated with EBF practice in the Tiruvallur district will help to plan various approaches to overcome lactation problems using principles of Siddha system of medicine in future. RESULTS AND DISCUSSION: The results will be statistically analysed and reported. KEYWORDS: Exclusive breastfeeding, Tiruvallur district, respiratory infections, gastrointestinal infections
|