Nutritional Status of Breast Fed and Formula Fed Infants with Diarrhoea -A Retrospective Study Deepa.T.P* and Dr.

Chandra Venkatasubramanian** ABSTRACT Infancy is the period from birth to the end of the first year. A good nutritional base is essential for the infants to grow. Diarrhoea is one of the most common disorders that affect infants. Repeated diarrhoea makes the child malnourished. The methods of feeding, type of feed used, sterilization of feeding utensils are some of the factors that affect the occurrence of diarrhoea. Breastfeeding is the best way to feed a new born. Breast milk contains appropriate amount of all nutrients and immuno components. A retrospective case study was carried out among 100 infants below six months of age to compare the nutritional status of breast fed and formula fed infants with diarrhoea. The study was from the secondary data collected over a period of six months. The results revealed that bottle fed infants are more prone to diarrhoea than exclusively breast fed infants. Key Words: Diarrhoea, Nutritional Status, Breast feeding, Formula feeding INTRODUCTION Diarrhoea is an intestinal disorder characterized by abnormal fluidity and increased frequency of fecal evacuations. The result of increased motility in the colon is an important symptom of many underlying disorders. Diarrhoea can be either short-term (acute) or longterm (chronic) in duration. Diarrhoea is the most common disorder that affects infants and young children. Diarrhoea is the major contributor to malnutrition, poor health and inadequate performance in infants. In many countries, it is the main cause of death among infants. The main causes of diarrhoea in infants are poor hygiene, lack of clean drinking water, overcrowding, careless preparation of feeds, and the trend towards bottle-feeding rather than breastfeeding. Improper sterilization, lack of sterilization or contamination after sterilization of the feeding items contributes to diarrhoea. Breast milk contains hundreds of health-enhancing cells, proteins, fats, hormones, enzymes and immuno components. The main carbohydrate in human milk is lactose, which facilitates the absorption of calcium, zinc, iron and manganese (Ziegler, 1983). Breast milk is the only source of the galactose, which is essential for the formation of the myelin sheath surrounding many nerves. **Supervisor and Guide, Associate Professor and Head, Post Graduate department of Home Science, Queen Marys College, Chennai-600004, India *M.Sc. (DFSM) Student, Indira Gandhi National Open University, New Delhi.

New born babies absorb about 95 to 98 percent of the fat from human milk but only about 80 percent of fat from a milk-based formula (Kabara, 1980). In addition, the proteins and fats in whole cow's milk are more difficult for an infant to digest and absorb than the ones in breast milk. Human colostrum and milk have unique biochemical properties. Human milk contains substances that bind iron, zinc and other elements, allowing them to be easily absorbed, while protecting them from use by bacteria. Breastfeeding stimulates an infants immune system and responds to vaccinations and will be continously changing to meet the babies needs. Formula fed infants, have IQs ten points lower than their breastfed counterparts. This is related to special fatty acids and other components in breast milk that are known to promote brain cell growth, development of vision and the nervous system. These components are absent in formulas. There are numerous cases where the artificial infant formulas are mistaken for their composition, and/or contaminated with toxins and bacteria. Some of these mistakes have lead to injuries, including brain damage in babies fed with formulas which can be totally avoided in breast feeding (Newman and Pitman, 2000; Anderson et al, 1999; Solveig et al, 2000). If every baby is immediately put skin-to-skin at the breast, hypothermia would be prevented, saving about 20,000 lives annually. If every baby were exclusively breastfed for six months, an estimated 1.3 million additional lives would be saved every year. Research suggests that longer periods of breastfeeding for atleast 6 months are critical for reducing the risk of potentially fatal gastroenteritis (Williams, 2010). Diarrhoea can be prevented by pursuing multisectoral efforts like exclusive breastfeeding, improving access to clean water and safe sanitation, promoting hygiene, education, use of latrines, sanitary disposal of stools, improved weaning practices, immunizing all infants; especially against measles, keeping food and water clean, washing hands with soap (the baby's as well) before touching foods. This study was taken up to assess the Nutritional Status of Breast fed and formula fed infants with Diarrhoea. It also determines the various factors that affect the nutritional status of breast fed and formula fed infants like - type of feed, consistency of feed and frequency of sterilization. METHODOLOGY This study is a retrospective descriptive case study using secondary data . This study is a survey undertaken using purposive sampling technique which is a type of non- probability

sampling where the samples selected are only those below six months of age and suffering from diarrhoea. The tools adopted are questionnaire and content analysis. A structured closed ended questionnaire with multiple choices was used and the records available at the hospital were analyzed. The study was conducted for a period of six months in a corporate hospital at Chennai. A pilot study was conducted using the questionnaire. From the pre-test it was found that questions on consistency of feed, time period of sterilization needed to be included along with questions on dietary advice on discharge as the condition of the infant depended on these aspects. Thus these questions were included and the questionnaire was corrected. The data obtained was analyzed statistically after coding. Percentage, Chi-square test, Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance by ranks were the tests used for data analysis RESULTS AND DISCUSSIONS All the results obtained have been presented in different tables. Table 1

Association between nutritional status of the child and feeding method

Feeding Methods Nutritional Status Exclusive Breast Feed (%) Combination of Bottle, Breast and Spoon feed (%) 46.0 30.2 23.8 Combination of Breast and Spoon feed (%) 63.2 5.3 31.6 Total (%) Kruskal Wallis Value

Normal 44.4 Malnourished 16.7 Over 38.9 nourished NS denotes Not Significance

49.0 23.0 28.0

0.958 NS

It is observed from table 1 that among the normal infants, 44.4 percent of them are exclusively breast fed, 46 percent of them are given bottle feed in combination with breast feed and spoon, whereas 63.2 percent of them are given breast feed along with spoon feed. In the over nourished category, 38.9 percent of them are breast fed, 23.8 percent of them are bottle fed (in combination with the breast and spoon feeding), and 31.6 per cent of them are

given breast feed in combination with the spoon feed. Among the malnourished infants, majority of them are given bottle feed (combined with breast and spoon). About 16.7 percent of the exclusively breast fed infants are malnourished and 5.3 percent of the infants who are given breast milk and spoon feed are malnourished. The Kruskal Wallis Value denotes that there is no significant association between nutritional status of the child and feeding methods. The reason why this could not be significantly brought about in this study is due to the fact that only secondary data was used which may not have been authentic and the study was carried out for only a short duration. Figure 1 shows the relationship between nutritional status of the child and feeding method.

Association between nutritional status and feeding method in percentage 70 60 50

Nutritional Status

Normal Malnourished Over nourished

40 30 20 10 0
Exclusive Breast Combination of Combination of Feed Bottle, Breast and Breast and Spoon Spoon feed feed

Feeding Methods

Figure 1

Table 2 Association between consistency of the Complementary feed and literacy level of the mother Literacy level of mother Literate (%) 68.5 22.2 9.3 Illiterate (%) 96.4 3.6 0

Consistency of Complementary Feed Liquid Thin Thick ** Denotes 1% significant

Total (%) 78.0 15.9 6.1

Chi Square Value

8.479**

Table 2 elucidates that, in majority of infants of illiterate mothers (96.4 percent); the consistency of Complementary feed is liquid. Only some of them (3.6 percent) give thin form of Complementary feed. Among the literate mothers 68.5 percent of them give liquid form of Complementary feed, 22.2 percent of them give Complementary feed of thin consistency and 9.3 percent of them give thick form of feed. This shows that majority of illiterate mothers feed thin or diluted form of feed. The chi square value denotes significance at 1per cent level showing association between Consistency of the Complementary feed and literacy level of the mother.

Table 3 Association between method of feeding and number of infants suffering from diarrhea Method of feeding Exclusive Breast feed Combination of Bottle, Breast and Spoon feed Combination of Breast and Spoon feed ** Denotes 1% significance It is observed from table 3 that only 18 percent of exclusively breast fed infants are prone to diarrhoea whereas 63 percent of infants who are bottle fed in combination with breast and spoon are prone to diarrhoea, only 19 percent of infants who are breast fed along Number of infants (%) 18.0 63.0 19.0 Total (%) 18.0 63.0 19.0 Chi-square value

39.620**

with spoon feeding are prone to diarrhoea. This clearly elucidates that there is a direct association between type of feed and prevalence rate of diarrhoea. The chi square value denotes significance at 1per cent level showing that there exists an association between method of feeding and number of infants suffering from diarrhea Table 4 Association between choice of complementary feed and number of infants suffering from diarrhoea Choice of Complementary feed Home Made Commercial Both ** Denotes 1% significance Number of infants (%) 8.5 81.7 9.8 Total (%) 8.5 81.7 9.8 Chi-square value

86.366**

It could be inferred from table 4 that, majority of the infants (81.7 percent) of them are given only commercial feed. Only 8.5 percent of them are given home made feed and 9.8 percent of them are given both. This clearly shows the positive association between the use of commercial feed and increased prevalence of diarrhoea. The reason could be due to use of contaminated feeding bottles and teats or due to lack of knowledge about the preparation of formulas. The chi square value denotes significance at 1% level showing that there is an association between choice of Complementary feed and number of infants suffering from diarrhoea. Figure 2 elucidates the relationship between choice of complementary feed and number of children suffering from diarrhoea.

Association between choice of complimentary feed and number of infants suffering from diarrhoea in percentage

Home Made
90 80 70 Number of infants 60 50 40 30 20 10 0 Choice of Complementary feed
Figure 2

Commercial Both

Table 5 Association between time period of sterilization of bottles and number of infants suffering from diarrhoea Time period of sterilization Less than 10 min 10-20 min More than 20 min ** Denotes 1% significance Number of infants (%) 27.0 55.6 17.5 Total (%) 27.0 55.6 17.5 Chi-square value 14.857**

It is observed from table 5 that, the time period of sterilization is between 10 to 20 minutes in most of the bottle fed infants (55.6 percent). Only in 17.5 percent of bottle fed

infants the time period of sterilization is more than 20 minutes, which is the required time of sterilization. In 27 percent of infants who are bottle fed the sterilization time is less than 10 minutes. This shows that the number of incidence of diarrhoea increases due to lack of proper sterilization of feeding bottles. The chi square value denotes significance at 1per cent level showing that there is an association between time period of sterilization of bottles and number of infants suffering from diarrhoea SUMMARY AND CONCLUSION From the study it is confirmed that bottle fed infants are more prone to diarrhoea than exclusively breast fed infants. It is seen that 50 percent of the infants are given complimentary feed along with breast milk and 32 percent are given only complimentary feed; whereas only 18 percent are given exclusive breast milk. . Thus it is observed that early initiation of complimentary feed leads to diarrhoea. Majority of the mothers (81.7 percent) choose commercial formula for complimentary feeding, whereas only 8.5 percent are given home made blend and 9.8 percent were given both. Hence it is clear that infants who are given commercial formulae are more prone to diarrhoea The results revealed that there was a significant association between choice of complimentary feed and monthly income. The results showed that there was a significant association between frequency of feed and feeding method and there was a association between time period of sterilization of bottles and number of infants suffering from diarrhoea. This shows that the use of contaminated feeding bottles and teats are the major cause of diarrhoea in bottle fed infants. BIBLIOGRAPHY 1. Anderson J. B. Johnstone & D. Remley. (1999):"Breast-feeding and cognitive development: a meta-analysis" American Journal of Clinical Nutrition, 70 (4) 525 to 535. 2. Kabara, J.J.( 1980): Lipids as Host-Resistance Factors in Human Milk, Nutr. Rev, 38: 65-73. 3. Lippincott Williams. Wilkins. (2010): Journal of Acquired Immune Defeciency Syndromes. 4. Newman, J. and T. Pitman. (2000): Dr. Jack Newman's Guide to Breastfeeding, Harper Collins, 9-13.

5. Solveig.F, C. Mulford, S. James, & P. Schellenberg. (2000): The Milk of Human Kindness" Crossroads Books. 6. Ziegler EE, Formon SJ.( 1983): Lactaose enhances mineral absorption in infancy, J Pediatar Gastroenterol Nutr. 2: 288. 7. www.who.int 8. www.rehydrate.org 9. www.unicef.org

10. Mediline Medical Encyclodpedia, 2004 11. DD Online Diarrhoea Dialogue Online Issue 17 May 1984