H.B. Mallikarjuna, C.R.
Banapurmath, Shobha Banapurmath and Nirmala Kesaree
From the Department of
Pediatrics, J.J.M. Medical College, Davangere-577 004 and Bapuji Child
Health Institute and Research Center, Davangere, Karnataka, India.
Correspondence to: Dr.
H.B. Mallikarjuna, C/o. Dr. C.R. Banapurmath, 390, 8th Main, P.J.
Extension, Davangere - 577 002, India.
Manuscript received:
April 25, 2001, Initial review completed: May 29, 2001;
Revision accepted: March
27, 2002.
The present study was
conducted to document the breastfeeding problems encountered in a
rural community and to know the reasons for starting top feeds in
infants less than 6 months of life. Using the stratified sampling
method, 420 mother infant pairs were enrolled from 224 villages of
Central Karnataka. Out of these 338 (80.5%) were practicing exclusive
breastfeeding, 82 (19.5%) had started on top feeds. Seven (1.7 %)
mothers had completely stopped breastfeeding. Bottle feeding was
practiced by 39% of mothers. Maximal onset of breastfeeding problem
was noted in the first two weeks of neonatal period. Breastfeeding
problems are not uncommon even in a predominantly breastfeeding rural
community.
Keywords: Breastfeeding,
India.
Every mother who has to
breastfeed her baby is likely to come across various difficulties and
problems. Since exclusive breastfeeding is the most natural and
scientific way of feeding infants in the first 6 months of life, it will
be important to know why mothers resort to give feeds other than their
own milk. With large strata of the population in our country belonging
to rural areas, information on breastfeeding problems will give better
insight for policy makers to form appropriate breastfeeding promotional
strategies at community level.
Subjects and Methods
This study was conducted
at 224 villages of Chitradurga district having a population of 2,17,757.
Using the stratified sampling method, 70 mother and infant pairs were
enrolled for each month frequency that is 0-1, 1-2, 2-3, 3-4, 4-5 and
5-6 months.
The study was conducted
with the assistance of 7 trained supervisors who were native of the same
taluk. All these were graduates and specially trained for the study. A 4
week training programme was conducted to get the supervisors accustomed
to medical terms like exclusive breastfeeding, initiation of
breastfeeding, breastfeeding problems due to causes related to mother
and the baby etc. The supervisors were provided the study proforma in
local language (Kannada) and simple terms were used for easy
understanding during data collection. Any mother who had initiated feeds
other than her milk was considered to constitute as having a breast
feeding problem and considered for detailed analysis.
Monthly meetings were held during which
all the supervisors presented their collected material and proforma.
Field visits were carried out weekly to verify the cases. Conditions
like sore nipples, mastitis, breast
engorgement, breast abscess, maternal illness, inability to suck, breast
refusal and not enough milk leading to top feeding were noted.
Results
Out of 420 mothers, 338
(80.5%) were practicing only breastfeeding. Seventy five mothers (17.8%)
were partially breastfeeding and 7 mothers (1.7%) had completely stopped
breastfeeding. The onset of breastfeeding problem occurred in 31.7% (n
= 26) of cases in first month of life. Further analysis showed that
76.9% occurred in the first week of life, 7.7% in 2nd week and 15.4% in
3rd week. Breastfeeding problem was initiated in 1 (1.2%), 11 (13.4%),
8(9.8%) 15 (18.3%), and 21 (25.6%) cases during 1-2, 2-3, 3-4, 4-5, and
5-6 months respectively. Not enough milk, was responsible for starting
top feeds in 44 (53.6%) cases. Nineteen (23.1%) mothers had other
problems like sore nipples, mastitis, breast engorgement, breast abscess
and other illness.
Out of 82 mothers who
gave "top feeds", cow’s milk was the most preferred in 44
(53.6%) babies. The next common feed given was goat’s milk in 20
(24.4%) babies. The rest 18 (22%) were giving various combinations of
formula feeds, ragi ganjee etc. The decision to start top feeds was
taken on their own by 30.5% mothers; 68.3% were advised by family
members and in 1.2% it was traditional practice.
The incidence of
bottle-feeding was high. Thirty two infants (38%) with breastfeeding
problem were bottle fed, of which 14 (43.8%) were in the age group of
0-1 month, 10 (31.3%) in the age group of 5-6 month, and 4 (12.5%) each
in 3-4 and 4-5 months category. A variety of bottles were used for
feeding including brandy bottle, tonic bottles etc. The reasons stated
for starting bottle-feeding by majority of mothers was ease of
administration (22%), baby takes feed well by bottle (16%) and spillage
with cup and spoon (10%). However most mothers (52%) could not give any
particular reason.
Breastfeeding was
initiated within 24 hours for 322 infants (76.7%). Among them 53 infants
(16.5%) had breastfeeding problems. In contrast, among the remaining 98
infants in whom breastfeeding was initiated after 24 hours, 29 infants
(29.6%) had breastfeeding problems. The difference between these two
groups was statistically significant (x2 = 8.2, P < 0.01), showing
that delayed initiation is associated with higher incidence of
breastfeeding problems.
Cessation of breastfeeding was observed
in 7 mothers of which 4 could not initiate breastfeeding since birth.
The reasons mentioned in these 4 cases were (i) family fear of
ill health to the baby, because the previous baby had abdominal colic
and discomfort, (ii) breast refusal by the baby inspite of
multiple attempts and mother giving-up, (iii) mother found no
milk by manual expression and hence she started top feeds and never
tried breastfeeding, and (iv) "inability to suck" due
to extreme prematurity. In the other 3 cases, baby and mother were
separated hence breastfeeding was stopped on D3, D4 and D7 of life, due
to maternal illness, bilateral breast abscess and sore nipples
respectively.
Discussion
Breastfeeding has been
the traditional way of feeding newborns in our country, more so in
villages. It is a common belief that breastfeeding is a natural
phenomenon and proceeds smoothly and uneventfully in villages. However
the result of the present study are contrary to this belief. The onset
of breastfeeding problems in this study were alarmingly high in the
neonatal period, of which majority (76.9%) occurred in the 1st week of
life itself. This is in concurrence with various other studies(1-4).
Breastfeeding problems in
relation to initiation of breastfeeding revealed that, earlier the
initiation lesser the incidence of breastfeeding problems. Early
initiation is a good predictor of exclusive breastfeeding and prolonged
breastfeeding(5).
Cessation of
breastfeeding among 7 mothers indicates that there are some mothers who
have difficulties in initiating breastfeeds. Three mothers were
prevented from breastfeeding by family elders, because of suspicion of
ill effects to baby. This demonstrates that socio-cultural perceptions
influence breastfeeding practices(5). Cessation of breast-feeding during
an attack of mastitis and breast abscess does not help mothers to
recover faster and there is no risk to the baby by continuing
breastfeeds(6). In one study(1) unsatisfactory growth (42.1%) was the
most frequent reason for starting supplements by one month of age.
However in the present study this was not a major reason during first
month of life.
In this study, 25.6% of
mothers had resorted to top feeds for ‘better growth of the child’
during 5-6 months of age since around this time baby has to be taken to
in-laws place. Risk factors like regular use of breast milk substitutes
were responsible for early termination of breastfeeding in developing(7)
and developed countries(5).
First week after delivery
is crucial for success or failure of breastfeeding. This is the period
when mothers are more likely to fail to initiate breastfeeding. They may
develop engorgement of breasts, or soreness of nipples due to ‘poor
positioning’ of the baby. During this time, many mothers also start
getting doubts about breast milk adequacy.
In conclusion, this study
has shown that, first week to 1 month of life is the ‘crucial period’
for ‘success or failure’ of breastfeeding. Breastfeeding problems
are not uncommon even in a predominantly breastfeeding rural community,
which are easily preventable by education and practical help to
breastfeeding mothers(8). Hence peripheral ‘health workers’ like ANM’s
and anganwadi workers need to be trained to deal with common
breastfeeding problems.
Acknowledgements
We wish to express our
sincere thanks to mothers and their babies, supervisors and locales
whose co-operation made this study possible.
Contributors:
HBM designed the study; collected, analyzed and interpreted the data;
and drafted the manuscript. CRB and NK provided the concept and
critically reviewed the manuscript. SB contributed to analysis and
interpretation of data.. HBM shall act as guarantor for the paper.
Funding:
None.
Competing interests:
None stated.
|
Key
Messages |
• First week to
one month after delivery is the crucial period for success or
failure of breastfeeding.
• Breastfeeding problems can
occur even among predominantly breastfeeding rural communities.
|
