Article 4_homescience

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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 long-

term (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. Themain causes of diarrhoea in infants are poor hygiene, lack of clean drinking water,

overcrowding, careless preparation of feeds, and the trendtowards bottle-feeding rather thanbreastfeeding.Improper sterilization, lack of sterilization or contamination after sterilizationof 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.


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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 breast-

feeding, 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

Thisstudy 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


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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

Nutritional

Status

Feeding Methods

Total

(%)

Kruskal

Wallis

Value

Exclusive

Breast

Feed

(%)

Combination of

Bottle, Breast

and Spoon feed

(%)

Combination of

Breast and

Spoon feed

(%)

Normal 44.4 46.0 63.2 49.0

0.958

NS

Malnourished 16.7 30.2 5.3 23.0

Overnourished

38.9 23.8 31.6 28.0

NS denotes Not Significance

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


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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.

0

10

20

30

40

50

60

70

NutritionalStatus

Exclusive Breast

Feed

Combination of

Bottle, Breast andSpoon feed

Combination of

Breast and Spoonfeed

Feeding Methods

Association between nutritional status and feeding method in percentage

Normal

Malnourished

Over nourished

Figure 1


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Table 2

Association between consistency of the Complementary feed and

literacy level of the mother

Consistency of Complementary

Feed

Literacy level of

motherTotal

(%)Chi Square

ValueLiterate

(%)

Illiterate

(%)

Liquid 68.5 96.4 78.0

8.479**Thin 22.2 3.6 15.9

Thick 9.3 0 6.1

** Denotes 1% significant

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 feedingNumber of infants

(%)

Total

(%)

Chi-square

value

Exclusive Breast feed 18.0 18.0

39.620**

Combination of Bottle,

Breast and Spoon feed63.0 63.0

Combination of Breast

and Spoon feed19.0 19.0

** 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


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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

Number of infants

(%)

Total

(%)Chi-square value

Home Made 8.5 8.5

86.366**Commercial 81.7 81.7Both 9.8 9.8


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.


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0

10

20

30

40

50

60

70

80

90

Numberofinfants

Choice of Complementary feed

Association between choice of complimentary feed and number of

infants suffering from diarrhoea in percentage

Home Made

Commercial

Both

Figure 2

Table 5

Association between time period of sterilization of bottles and


Time period of

sterilizationNumber of infants (%)

Total

(%)

Chi-square

value

Less than 10 min 27.0 27.0

14.857**10-20 min 55.6 55.6

More than 20 min 17.5 17.5


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


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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


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 to535.

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.


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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

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