This cross sectional study was carried in Leda camp, Teknaf upazilla, Cox’s Bazar district to assess the nutritional status, breast feeding practice and illness pattern among 185 children aged 6 to 24 months. Among the studied population, 41.61% children were boy and 58.4% children were girl and all the respondents were Muslim.
It was found that 88.6 % of the mothers in study population were illiterate, 10.3 % had completed primary level and only 1.1 % had completed Secondary. On the other hand, majority (77.3 %) of father in the study population were illiterate. Among the mothers of study population 2.7% were not stayed with their husband due to died or divorce or other reason. 53 % households of selected area had a monthly income less or equal Tk. 2000, 40 % had a monthly income between Tk. 2100 and Tk. 4200, 4.9 % had a monthly income of Tk. 4200 to Tk. 6300, 2.2 % had a monthly income above Tk. 6300.
On the basis of breast feeding practice 90.8% children were breast-fed and 9.2% children were never breast-fed among the studied children. Percentage of mothers who had started breast feeding immediately after birth had been found 17.3%. On the other hand, majority (69.2%) of the children were got breast milk within 1 to 23 hours. 13.5% children were got breast milk after 24 hours. Among the study population 87% children were continued breast-feeding and 13% were not continued breast feeding. It was found that only 2.7% children were received formula feeding and the majority children (97.3%) were not got any formula feeding. From the morbidity pattern, it was found that 80% studied children was suffered from fever and cough. Prevalence of diarrhea and Upper respiratory tract infection were about 65% and prevalence of other diseases was about 12% among the children. 22.7% of the children took much less food during illness.
Among the studied children, 35.7% children were consumed Green leafy vegetable (GLV), 2.2% papaya and 35.7% other fruits and vegetables.
The mean age in month of the children was 13 and mean weight of the children was 7.1916 kg. 39.5% of all children were normal by Weight for Age Z-score (Z score ≥-2 SD). The prevalence of moderate underweight among selected children was about 35.8% and severe underweight was about 25%.
Adequate and appropriate nutrition during the first years of a child’s life is critical to growth and development. Undernutrition contributes to at least 35% of deaths in children less than five years of age globally (World Health Organization, 2010). In addition to the increased mortality risk, poor nutrition in the first years of life can impair physical growth and cognitive development and increase the child’s susceptibility to infectious diseases, such as malaria, meningitis, and pneumonia. Suboptimal breastfeeding and complementary feeding practices, in particular, hinder the nutritional status of infants and young children. A lack of knowledge about feeding practices and limited access to appropriate weaning foods can result in poor diet and nutrition among infants and young children. For the first six months of life, breast milk provides all the nutrient and energy requirements for infants. As children are weaned from breast milk, they need foods that are nutrient and energy dense. Animal-source foods are energy dense and an excellent source of protein; minerals, such as iron, zinc, and calcium; and vitamins, such as vitamin A, and riboflavin. Some nutrients, such as vitamin B-12, can only be found in animal-source foods.
In low-income settings, available income, preferences, and household decision-making are just a few of the barriers to the consumption of animal-source foods. Given the association of animal-source food consumption with the prevalence of multiple micronutrient deficiencies in low-income settings, it seems natural to design programs that address barriers to consumption. Livestock interventions are one such solution that aim to increase household production and consumption of animal-source foods. Even so, the evidence for the nutritional benefits of livestock interventions is mixed (Berti, Krasevec, & FitzGerald, 2004; Leroy & Frongillo, 2007; Randolph et al., 2007; Sadler K, Kerven C, Calo M, Manske M, & Catley A, 2009). Although livestock interventions are often designed to reduce food security, improve nutrition, and generate household income, changes in food security and nutritional status are rarely measured. There are some key gaps in the literature on whether or not dairy intensification interventions, in particular, translate into positive nutritional benefits for all 1members of the household, in particular for young children.1 Even if households increase their income from dairy, it is not clear if the increased purchasing power results in an improvement in the household diet, or more specifically, the diets of young children. In addition, the draw of income from dairy may result in household decision-making that favors sales to consumption, leaving less for young children. Few, if any, studies have explored how increased dairy production may influence weaning patterns. If cow’s milk is readily available in the household, some mothers may introduce cow’s milk earlier than is appropriate, replacing breast milk in the infant’s diet, and contributing to poorer growth and development outcomes. In order to explore the influence that increased dairy production has on young child nutrition, a study was conducted in Rift Valley Province, Kenya, where most of Kenya’s dairy production is concentrated. About 53% of Kenya’s dairy cattle are found in Rift Valley and from there the milk is distributed to milk deficient areas or Nairobi and other urban centers (TechnoServe Kenya, 2008). Dairy has an important role in Kenya. In fact, the top food and agricultural commodity in Kenya in 2005 was cow’s milk (whole and fresh) (Food and Agricultural Organization, 2010a). The nation has one of the largest dairy industries in East Africa and relies heavily on the smallholder sector which contributes between 75-80% of the national production and marketing of milk (Ngigi, 2005). Dairying is particularly important in the economies of the rural poor. It is estimated that the number of smallholder dairy farms is between 1 and 1.8 million households, or 35% of rural households and 26% of total households (TechnoServe Kenya, 2008). Rift Valley Province is the largest in terms of size and population (Food and Agricultural Organization, 2010b). The study area of Buret and Kipkelion Districts contains relatively small (less than 10 hectares), smallholder family farms. The main system of agriculture is subsistence farming and mixed crop/livestock. English and Kiswahili are the national languages and Kalenjin is the predominant local language. The predominant ethnic group in this population is the Kalenjin. Today 1 Dairy intensification is a term used to describe a particular strategy to increase smallholder dairy production. Typically, dairy intensification combines multiple technologies including but not limited to, investment in higher-yielding cows and improved cattle management, feeding systems, and feed production. 2the Kalenjin in this area are a mixed farming community, focusing mainly on dairy and crops such as tea, maize, sorghum, and millet. Cattle remains highly valued, often as the household’s most valuable resource, and as such, are symbols of wealth and status (Huss-Ashmore, 1996). Dairy cattle are common and dairy products are an integral part of the diet for children and adults (Kipng’eno, 2010). The main purpose of this thesis was to explore within the context of rural dairy farming in three communities in Rift Valley Province, Kenya, the relationship between level of household dairy production and selected infant and young child feeding practices using a mixed methods approach. By comparing households not currently producing dairy to two other groups of households of increasing levels of dairy production, the author wishes to investigate how a household’s level of dairy production may influence certain infant and young child feeding practices. The comparison may provide qualitative answers to questions about the influence intervening effects of dairy interventions may have on young child nutrition. The primary quantitative question of this research was to examine whether the household’s level of dairy production was independently associated with five infant and young child feeding practices within the context of rural dairy farming communities in Kenya, namely (1) currently breastfeeding; (2) exclusive breastfeeding to six months; (3) introduction of water before six months; (4) introduction of cow’s milk before six months; and (5) age-appropriate dietary diversity. A secondary question was to examine the association between demographic and household characteristics and any of the five infant and young child feeding practices. The key qualitative question of this research was to explore the attitudes and beliefs of women involved in dairy farming toward infant and young child feeding practices, including their perceptions about age-appropriate diets, breastfeeding practices, weaning, and introduction of complementary foods.
Rationale of the Study
Malnutrition is a serious public health socio-economic problem of Bangladesh, where the most affected population are under 5 years` children, adolescent girls ,pregnant and lactating mothers. The infant mortality rate (IMR) is 27 per 1000 in the country. However, 35.8 percent studied children are underweight and 25 percent of them are severely underweight. In our country 48% of the children are underweight, with 13% severely underweight.
Rate of child malnutrition rise very rapidly from 6 months of age and reach their peak during weaning age among nutritionally vulnerable children aged 6 to 24 months.
There are many factors which accelerate malnutrition. Non-exclusive breast feeding, delay of early initiation of breast milk, delayed and faulty weaning practices, prolong breast feeding are the most crucial factors among those. Maternal malnutrition is another significant cause of child malnutrition. A malnourished mother gives birth of Low Birth Weight (LBW) babies. However, if those children are not taken care with proper feeding practices, it expedites malnutrition.
The study was taken to evaluate the nutritional status of children aged 6 to 24 months to identify the current nutrition situation. This study will help decision making to maximize utilization of limited resources particularly important for developing countries like us burdened with numerous health, nutrition and economic problems to address.
This review has several objectives. Given that the goal of dairy interventions is to increase the amount of milk produced by households with implicit expectations that the household, perhaps young children will consume more milk, the first objective is to describe the nutritional importance of dairy in human nutrition and assess the influence animal-source foods have in the diets of undernourished children in low-income settings. Second, because cow’s milk is one of the first foods introduced to young children, the appropriateness of this as a complementary food in the infant diet is described alongside current recommendations for breastfeeding and complementary feeding practices. Finally, a summary of studies focused on the nutritional impacts of dairy cow production and/or ownership will be summarized and evaluated. This review is intended to demonstrate the potential nutritional impact dairy intensification interventions can have on young children in low-income settings like Kenya. At the same time, the review identifies the existing gaps in the literature of studies that have explored the nutritional impact of dairy intensification interventions on infant and young child feeding practices. Studies published in the last 20 years were collected for review through searches in Medline, Web of Science, AGRICOLA, WHOLIS, JSTOR, CABDirect, Google Scholar, organization specific web-sites, and recommendations from subject matter experts. For the dairy intensification portion of the review, all studies which looked at livestock ownership or production in relation to human nutrition were considered for inclusion, and special attention was given to studies which took place in low-income settings and studies that were specific to dairy cows.
The role of dairy in the diets of infants and young children and its impact on nutrition has been well studied. Although whole cow’s milk is mostly liquid (87% water), it contains more than 100 different components and provides a high concentration of nutrients relative to the amount of energy it contains (Miller, Jarvis, & McBean, 2007). Cow’s milk is also a good source of high-quality 4protein. Unfortified cow’s milk is a good source of micronutrients such as vitamin A, vitamin B-12, riboflavin, and folate. Without consuming dairy, it can be difficult to meet recommended intakes for calcium. Despite being a rich source of key micro- and macronutrients, milk is a poor source of bioavailable iron and zinc.
Even though cow’s milk is considered to be an energy-dense, high-quality protein, the nutritional benefits do not necessarily apply to children less than 12 months of age. Breast milk alone provides all the nutrient needs for infants up to six months (Dewey, 2003).Physiologically, an infant’s gastrointestinal, renal, and neurophysiological systems are not mature enough to process any foods or liquids other than breast milk before six months. Cow’s milk contains excessive levels of protein, sodium, potassium, phosphorus, and calcium for infants compared to breast milk. Furthermore, the levels of iron, vitamin C, and linoleic acid are insufficient to meet infant needs. Therefore, in order to maximize the nutritional benefit of cow’s milk and minimize any undue harm, some recommend that the introduction of cow’s milk to the diet should be delayed until the infant reaches 12 months of age (Wijndaele, Lakshman, Landsbaugh, Ong, & Ogilvie, 2009). Alternatively, among populations whose traditional complementary foods are not nutrient-dense, like uji, the maize-based porridge common in Kenya, cow’s milk is recommended as an additive to increase the nutrient quality and fill in the energy and nutrient gaps unmet by breast milk for children under 12 months (World Health Organization, 2000).
Following exclusive breastfeeding for six months, it is important that children receive a variety of complementary foods, including animal-source foods. Several studies have examined the link between animal-source foods and child health. Some of the most well-known are the Nutrition Collaborative Research Support Program’s (NCRSP) longitudinal observational studies conducted in Egypt, Kenya, and Mexico (Allen, 1993). Even after controlling for multiple factors including SES, parental education, and social factors, the NCRSP found positive associations between children’s 5intake of animal-source foods and physical growth, cognitive development, social interactions, and school performance(Allen, 1993). Another well-known feeding intervention, the Kenya Child Nutrition Project, was conducted among rural schoolchildren in Kenya (Neumann et al., 2003). The study compared children randomized to three groups receiving three different snacks during the school year: ground beef added to githeri, a traditional meal of maize, beans, and greens; a glass of whole milk with githeri, and githeri with extra vegetable oil. The study found improved outcomes in the areas of weight gain, cognitive performance, and only one micronutrient, vitamin B-12, among the children consuming the meat or milk snack (Grillenberger et al., 2003; Siekmann et al., 2003; Whaley et al., 2003). Although the benefits of dairy on child growth and nutrition have been demonstrated in observational studies and randomized controlled trials, it is difficult to replicate the results in dairy interventions. The link between dairy farming and child nutrition is sensitive to a collection of dynamic factors. Households participating in interventions may choose to sell more milk and keep less in the home for consumption in order to increase household income. Decision-making patterns in households may or may not result in allocation of the increased milk for young children. Land and labor devoted to intensifying dairy can take resources away from other food production or child care and feeding. Furthermore, particularly among smallholder farmers, the availability of milk in the household may depend on the season (the cows are producing more milk because they are well-fed) and the reproductive cycle of the small herd. The primary objective of most livestock interventions has been to generate income through increased milk production and it is less common to find a project whose primary objective is to improve child nutrition. Even though there is evidence for how dairy intensification interventions can reduce poverty by increasing dairy production, it is less clear if increased household consumption results in any nutritional benefit, particularly for young children, or what effect increasing dairy production has on infant and young child feeding practices. Other authors have noted that of the few studies of livestock interventions that examine nutritional outcomes, it is challenging to find robust 6studies that directly measure the nutritional impact of livestock interventions (Leroy & Frongillo, 2007).
Objectives of the Study
To assess the pattern of health, illness and socio-economic condition of the children aged 6-24 months
1. To assess the socio-economic status of the studied population
2. To evaluate the nutritional status of children (6 to 24 months) by anthropometric measurement
3. To rectify their conscious about colostrums and providing pattern
4. To see the exclusive and total breast feeding pattern
5. To understand the morbidity pattern of the studied childrenMaterials and Methods
This thesis was a cross–sectional study. The study was conducted among the children aged 6 to 24 months in Cox’s Bazar areas. The aim of the study was to investigate the pattern of health and nutritional, socio-economic and morbidity among selected children.
Time Frame: The study was carried out from June to November 2011 which includes study design, data collection, data analysis and write up.
The study was conducted at Leda Camp, Teknaf, Cox`s Bazar. The places were chosen in a purpose to reach the target population during the limited time of data collection.
The study was conducted among 185 children by simple random sampling. The study subjects included children aged 6 to 24 months. Ages of the children were confirmed mostly by using the child’s birth certificate or immunization card. The purpose of the study was explained to the authority of those centers and all the respondents. To conduct the study, consent was taken from the mothers of the children.
Questionnaire Design and Field Trial
A standard close ended questionnaire was developed to obtain relevant information based on the objectives of the study. In order to standardize the data collection procedure, pretesting of the questionnaire was conducted in people of camp areas who were not included in the study. Based on the observations and pre-test findings necessary corrections were made in the questionnaire. The questionnaire was then finalized.
Overview of Data Collection Method
The mothers were interviewed to collect information. In the selected areas target children were reached by door to door visit. To avoid information missing or faulty information, the collected information from the locations were checked, coded everyday and cross-checked at the field sites in order to avoid any misreporting. Any confusion arising in this matter was settled on the following day during subsequent spot visit. The following information was taken:
Socio-economic & Demographic Data Collection:
Information regarding socio- economic and demographic condition was collected as an essential part of the study by a personal interview with mothers. Socio-economic information such as educational attainment, occupation, number of family members, income, monthly expenditure, age, religion, sector wise expenditures, utility facilities and water sources for different household usages were carefully investigated and recorded in the specified portion of the questionnaire.
Breast-feeding related Data Collection:
Child feeding practices: colostrum feeding, pre-lacteal feeding, exclusive breast
feeding, supplementary feeding, complementary feeding practices.
Morbidity Data Collection:
Morbidity of the 6-24 months aged children
Anthropometric Data Collection:
Nutritional status of the target children were assessed with the help of anthropometric measurements.
Weight: Body weight of children were weighed by using weighing scale, which was calibrated with known weight and balanced at zero before each series of measurements. For the children who were unable to stand alone, at first mother was made to stand at the center of the platform with hands on his side, barefoot and in light clothing and her weight was recorded to the nearest 0.1 kilogram. Then the mother was made to stand with the baby in her lap and then their combined weight was taken. Then by subtracting the two values the weight of the child was estimated.
Age: The children’s age were recorded by examining their birth registration card. When there had no birth registration card, mothers were requested to remember duration of their conjugal life, or birth gap between two children and then the children’s age were recorded.
A data entry form was first prepared and data from the finally checked questionnaires were entered in that form using Statistical Package for Social Scientists (SPSS) Windows version 16 software and this was followed by an extensive period of logical checking to identify any data entry errors. Those identified errors were corrected by consulting the original questionnaires.
Descriptive analysis was undertaken to explore the household socioeconomic, demographic, monthly income, sector wise monthly expenditure, parity, number of abortion, delivery place, birth weight, colostrums feeding, exclusive breast feeding, supplementary feeding, complementary feeding, morbidity, anthropometric status, dietary intake among the children aged 6 to 24 months of the selected area.
Limitations of the Study
During the time of the study some difficulties and challenges were faced which were addressed and mitigated properly to ensure most accuracy. Those are:
- The study was conducted in a camp area of Cox`s Bazar where the level of education and standard of living were different which was sometimes difficult to communicate.
- Most of the respondents were unwilling to express their original monthly income. Several of them tried to lessen their income.
- Some of the households in studied areas were not cooperative for allowing me in data collection, so it needed more persuasion to convince them.
- Managing time for interview of mothers was one of the difficult tasks which was overcome by repeated motivations.
- While collecting age of the mothers in selected population, some difficulties were faced as few of them had no birth cards or immunization cards and even they could not remember the exact year. Various referral questions related to remarked incidents were asked to make her recall for calculating the approximate age. So, there was a chance of recall bias.
Result and Discussion
Table-1: Percent distribution of sex of studied children
No. of family
The above table shows the percent distribution of sex. 41.61% children were boys and 58.4% children were girls.
Table-2: Percent distribution of literacy rate of mother of the studied children
|Literacy rate of mother|
Table shows the percent distribution of mother literacy rate. According to the table 10.8% responded mother attended school and majority (89.2%) percent responded mother had not ever attended school.
Table-3: Percent distribution of education level of mother of the studied children
|Education level of mother|
No. of family
Table 3 shows the education level of the mothers. 88.6 % of the mothers from selected area were illiterate, 10.3 % had completed primary level and 1.1 % had completed Secondary.
Table-4: Percent distribution of marital status of women of the studied children
|Marital status of women|
No. of mothers
The above table shows the percent distribution of marital status of women. According to the table 97.3% women were married and they still stay with their husband but 2.7% women were not with their husband due to died or divorce or other reason among the study population.
Table-5: Percent distribution of literacy rate of fathers of the studied children
|Literacy rate of fathers||No. of family||Percent (%)|
Table-5 shows the literacy rate of husband. According to the table 24.3% husband attended school and majority (75.7%) percent husband had not ever attended school.
Table-6: Percent distribution of education level of fathers of the studied children
|Education level of fathers|
No. of family
Table-6 shows the education level of the husband and main income earners of selected areas. However, 77.3 % of the husbands from selected area were illiterate, 21.6 % had completed primary level and only 1.1 % had completed Secondary. No graduation was found among the selected area.
Table-7: Percent distribution of religion of the studied children
No. of family
Table-7 shows the composition of respondents by their religion. 100% of the respondents were Muslim and there were no Hindu or others religion among the study group.
Table-8: Percent distribution of employment status of mothers of the studied children
|Employment status of mothers|
No. of family
The above table-8 shows the percent distribution of employment status of women. According to the table only 9.2% women employed informally and 90.8% women were not employed.
Table-9: Percent distribution of monthly income of family of the studied children
|Monthly income of family|
No. of family
|>2100 to ≤4200|
|>4200 to ≤6300|
The above table demonstrates that 53 % households of selected area had a monthly income less or equal Tk. 2000, 40 % had a monthly income between Tk. 2100 and Tk. 4200, 4.9 % had a monthly income above Tk. 4200 to Tk. 6300, 2.2 % had a monthly income above Tk. 6300.
Table10: Percent distribution of early initiation of breast feeding of the studied children
|Initiation of breast feeding|
No. of family
|After hours of birth|
|After days of birth|
Percentage of mothers who had started breast feeding immediately after birth has been shown in figure 14, where it is seen that the rate is 17.3%. However, 69.2% children were got breast milk within 1 to 23 hours, 13.5% children were got breast milk after 24 hours
Early initiation of breastfeeding is encouraged for a number of reasons. It is also benefitial for mothers because early suckling stimulates breast milk production and facilitates the release of oxytocin, which helps the contraction of the uterus and reduces postpartum blood loss. The first breast milk is known as colostrum, which is highly nutritious and contains antibodies that protect the newborn from infection and diseases. Early initiation of breastfeeding also encourages bonding between a mother and her newborn. Breast feeding within an hour or two after delivery is associated with the establishment of exclusive breast feeding and also for longer or more successful breast feeding.
The study revealed health, socio-economic and morbidity profile of target children.
Colostrum is important for child’s nutrition, immunological protection and brain development. UNICEF and WHO recommend that children be fed colostrum (the first breast milk) immediately after birth and continue to be exclusively breastfed even if regular breast milk has not begun flowing. Table 10 illustrates that major parts of both slum and non-slum areas had fed colostrum to their newborns. The reason to reject colostrum was mostly mother’s illness. However this percentage was 56.5 in non-slum areas and 30.5 percent in slum areas.
Lack of knowledge about benefit of colostrum reflects a practical reasoning of the basic cause of rejecting colostrum. Almost all non-slum respondents (95.6 percent) reported that they knew about the benefits of colostrum, this percentage was 79.8 for slum respondents.
Exclusive breast feeding is recommended by WHO for the first six months from birth. Mother’s milk alone provides all the required nutrients for the baby at proper quantity and quality during this period. Figure 15 shows that exclusive breast feeding was not practiced in almost half of the total respondents in both slum(48.2 percent) and non-slum areas (50.5 percent).
It is recommended that no supplementary food is needed from birth till 6 months if mother is not severely ill. Almost every mother is capable of breast feeding, rare exceptions can be due to HIV positive cases and other selective communicable disease conditions. However breast size, diet, fluid intake, exercise, multiple births sometimes cause less milk production. But infant suckling can initiate and sustain this breast feeding process. Artificial feeding is expensive and carries risks of additional illness, particularly where the levels of infectious disease are high and access to safe water is poor. So, if supplementary food is given to the child it has to ensure that foods are prepared and given in a safe manner, meaning that measures are taken to minimize the risk of contamination with pathogens. And they are given in a way that is appropriate, meaning that foods are of appropriate texture and given in sufficient quantity.
Early cessation of breast feeding causes post partum depression in mothers. Again prolonged breast feeding may cause anemia and growth retardation to children. Breast feeding is promoted internationally to be continued up to two years with the addition of weaning food after 6 months.
Complementary feeding should be timely, meaning that all infants should start receiving foods in addition to breast milk from 6 months onwards. It should be adequate, meaning that the nutritional value of complementary foods should parallel at least that of breast milk.
The highest prevalence of morbidity among children was fever and cough which were about 80%. Prevalence of diarrhea and Upper respiratory tract infection were about 65% and prevalence of other diseases was about 12% among the selected children. 22.7% children took much less food during illness, 45.9% children took somewhat less food, 14.1% children took about the same food, 15.1% children took more and 2.2% children never took food during illness.
The mean age in month of the children was 13.43 and standard deviation of child age was 4.930 months. The mean weight of the children was 7.1916 kg. Mean of height of children was 70.209 cm and standard deviation was 5.6415cm. The prevalence of moderate underweight among selected children was about 35.8 percent and severe underweight was about 25 percent.
The study highlighted the existing situation of nutritional and status. Based on the study findings and comparative analysis the following recommendations are given below:
- In order to improve the nutritional status of children (aged 6 to 24 months) among selected population, extensive behavior change communication in terms of nutritional awareness and appropriate feeding practices needs to be strengthened by both government and NGO activities.
- A social safety net program should be introduced for children aged 6 to 24 months from poor households as well as pregnant women and severely malnourished mothers and children by supplementary feeding program
- Growth monitoring and promotion of low birth weight (LBW) babies, malnourished (mild to moderate) children and undernourished pregnant women should be followed up.
- Systematic surveys are needed to be undertaken in both slum and non-slum areas to update comparison among health and nutritional status of vulnerable groups.
- An emphasis on adoption of family planning services can also help in improving the child health situation in slum area