A CROSS-SECTIONAL STUDY ON THE PREVALENCE OF EXCLUSIVE BREASTFEEDING PRACTICES AMONG THE IRULAR MOTHERS IN THIRUVALLUR DISTRICT, TAMILNADU 2011 Dissertation submitted to THE TAMILNADU DR. MGR MEDICAL UNIVERSITY In partial fulfillment of the requirements for the degree of M.D. BRANCH XV COMMUNITY MEDICINE THE TAMIL NADU Dr. MGR MEDICAL UNIVERSITY, CHENNAI, TAMILNADU. APRIL - 2012 CERTIFICATE This is to certify that the dissertation titled ‘A CROSS-SECTIONAL STUDY ON THE PREVALENCE OF EXCLUSIVE BREASTFEEDING PRACTICES AMONG THE IRULAR MOTHERS IN THIRUVALLUR DISTRICT, TAMILNADU, 2011’ is a bonafide work carried out by Dr. P. SARAVANAKUMAR, Post Graduate student in the Institute of Community Medicine, Madras Medical College, under my supervision and guidance towards partial fulfillment of the requirements for the degree of M.D. Branch XV Community Medicine and is being submitted to The Tamilnadu Dr.M.G.R. Medical University, Chennai. Dr.V.Kanagasabai, M.D., Dr.A.K.Rajendran, M.D., D.P.H., Dean, Director, Madras Medical College, Institute of Community Medicine, Chennai- 600 003. Chennai- 600 003. ACKNOWLEDGEMENT I gratefully acknowledge and sincerely thank Dr.V.Kanagasabai, M.D., the Dean, Madras Medical College, Chennai for granting me permission to carry out this community based study. I would like to express my sincere and profound gratitude to Dr.A.K.Rajendran, M.D., D.P.H., Director, Institute of Community Medicine, Madras Medical College, who has been a constant encouragement and perseverance which has helped me in the successful completion of this study. I am deeply indebted to Dr.V.V.Anantharaman, B.Sc., M.D., DPH., D.D, Assistant Professor, Institute of Community Medicine, Madras Medical College who has been the guiding force behind my study and helped me by extending his knowledge and experience during the course of this study. I extend my sincere gratitude to Dr. A. Chitra, M.D., Assistant Professor, Dr.S.Soundammal, D.P.H, Tutor , Institute of Community Medicine, Madras Medical College for their expert suggestions and encouragement. I would like to express my sincere thanks to Dr.E.Nedunchezian, M.D. Assistant Professor of Pediatrics, Institute of Child health and Hospital for Children, Chennai for the timely help and guidance rendered by him for this study. My sincere thanks to all the faculty members, staff and my colleagues in the Institute of Community Medicine, Madras Medical College for their moral support and continuous encouragement during the study period. I wish to thank Dr.K.Gunasekaran, DD Trbal Welfare, Directorate of Tribal Welfare, Tamil Nadu for his guidance and support to conduct this study among the Irualr tribes in Tamil Nadu. I wish to express my heartfelt thanks to all the Irular tribal mothers in this study, who willingly and enthusiastically participated and without whom this work would not have been possible. I would also like to thank my wife and son for their immense love and moral support throughout the study period. Above all, I thank God for His grace and blessings which he had showered on me to complete this task successfully. ABBREVIATIONS ANM - Auxiliary Nurse Midwifery BPNI - Breastfeeding Promoting Network of India DLHS - District Level Household Survey Df - Degree of freedom HSC - Health Sub Centre IIPS - Indian Institute of Population Sciences MDG - Millennium Development Goals NGO - Non-Government Organizations NFHS - National Family Health Survey NS - Not significant statistically PHC - Primary Health Centre RCH - Reproductive Child Health ST - Scheduled Tribes SPSS - Statistical Package for Social Sciences S - Significant statistically UNICEF - United Nations International Children’s Fund VHN - Village Health Nurse WHO - World Health Organization TABLE OF CONTENTS CHAPTER NO. TITLE PAGE NO. 1 INTRODUCTION 1 2 OBJECTIVES 4 3 JUSTIFICATION OF THE STUDY 5 4 REVIEW OF LITERATURE 6 5 MATERIALS AND METHODS 27 6 RESULTS 32 7 DISCUSSION 62 8 SUMMARY 69 9 LIMITATIONS 71 10 RECOMMENDATIONS 72 BIBLIOGRAPHY ANNEXURES I INFORMED CONSENT IN ENGLISH AND TAMIL II QUESTIONNAIRE – ENGLISH AND TAMIL III SOCIO ECONOMIC CLASSIFICATION - MODIFIED BG PRASAD SCALE-2011 IV TAMIL NADU MAP WITH THIRUVALLUR DISTRICT AND TALUKS V DETAILS OF IRULAR POPULATION IN THE SIX TALUKS OF THIRUVALLUR DISTRICT, TAMIL NADU VI LIST OF VILLAGES WITH IRULAR SETTLEMENT IN STUDY AREA VII KEY TO MASTER CHART. VIII MASTER CHART – DATA ENTRY IX ETHICAL COMMITTEE CLEARANCE CERTIFICATE LIST OF TABLES Page Number Contents of the tables number 1 Occupation of the Irular mother 34 2 Age of the mother at marriage and first conception 35 3 Place and mode of delivery of the present child( 6-24months) 37 4 Personnel who conducted the delivery 38 5 Personnel who initiated the breastfeeding 40 6 Reasons for delayed initiation of breastfeeding (after I hour of 41 life) 7 Reasons for non-exclusive breastfeeding till 6 months of age 44 8 Person approached for help in infant feeding 45 9 Role of Health personnel in timely introduction of 47 complementary feeding 10 Age of the mother and Exclusive breastfeeding practice 48 11 Formal education of the mother and Exclusive breastfeeding: 49 12 Age of the mother at first conception and Exclusive 49 breastfeeding 13 Parity of the mother and Exclusive breastfeeding practice 50 14 Type of family and Exclusive breastfeeding practice 50 15 Place of antenatal checkup and Exclusive breastfeeding 51 16 Antenatal counseling and Exclusive breastfeeding practice 52 17 Sex of the baby and Exclusive breastfeeding practice 52 18 Place of delivery and Exclusive breastfeeding practice 53 19 Person who conducted the delivery and Exclusive breastfeeding 54 20 First feed to the baby and Exclusive breastfeeding practice 55 21 Time of initiation of breastfeeding and Exclusive breastfeeding 55 22 Person who initiated the breastfeeding and Exclusive 56 breastfeeding 23 Awareness on Exclusive breastfeeding and the Practice of 57 exclusive breastfeeding 24 Postnatal advice and practice of Exclusive breastfeeding 58 25 Motivation during the Immunization visit and Exclusive 58 breastfeeding practice 26 Breastfeeding in the previous child and Exclusive breastfeeding 59 27 Per capita income and the Exclusive breastfeeding practice 60 28 Type of Occupation of the mother and Exclusive breastfeeding 60 practice 29 Mode of delivery and Exclusive breastfeeding practice 61 LIST OF FIGURES Page Number Title number 1 Age of the respondent (Irular Mothers) 32 2 Educational status of the mother 33 3 Place of antenatal checkups attended by the mothers 36 4 Antenatal counseling on breastfeeding 36 5 First feed given to the baby after the birth 39 6 Time of initiation of breastfeeding 39 7 Maternal Awareness about the duration of exclusive 42 breastfeeding 8 Duration of practice of Exclusive breastfeeding 42 9 Prevalence of Exclusive breastfeeding 43 INTRODUCTION 1. INTRODUCTION Breastfeeding is the ideal way of providing nutrition for the healthy growth and development of infants. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health1. Early initiation of breastfeeding is extremely important for providing ‘Colostrum’ to the newborn and establishing successful lactation. Ideally, the baby should be breastfed as soon as possible and preferably within one hour of birth1. Exclusive breastfeeding means that babies are given only breast milk and nothing else – no other milk, food, drinks and not even water excluding medications during the first six months of life1.It is important to ensure exclusive breastfeeding of all the babies, as it saves them from diarrhoea, pneumonia and also helps in reducing the ear infections, risk of attacks of asthma and allergies1. Globally, only 35% of infants are exclusively breastfed during the first six months of life2. Improper Infant feeding practices not only results in malnutrition but also contribute to impaired cognitive development, poor school performance and reduced productivity in later life3. Of all the under-five deaths, under-nutrition is the underlying cause of estimated 53% of deaths2. Over 2/3 of these deaths occur during the infancy and are often associated with inappropriate feeding practices. The status of breastfeeding practices is very dismal in India4. According to NFHS-3, the prevalence of the early initiation of breastfeeding in India is only 25% and Exclusive breastfeeding is only 46.4%5. The low rate of exclusive breastfeeding is equally prevalent in both rural and urban parts of India including the urban slums5. While the rate of exclusive breastfeeding is low among the general population itself, the practice and the rate of exclusive breastfeeding among the tribal population is indeed a matter of interest and concern. 1 India is home to almost half the tribal population of the world6. Tribes are social group of people characterized by a distinctive culture, beliefs, traits and territorial affliction constituting 8.2% of total population6. Various factors like illiteracy, geographical isolation, cultural isolation and socio-economic backwardness render the tribals to remain at the lowest stratum of the society. About 91% of the tribal population still lives in rural areas and 47.3% are below the poverty line6. According to NFHS-35, the infant mortality and under-five mortality among the tribals have decreased when compared to NFHS-27 but the median months of exclusive breastfeeding is 1.9 months only5. Poor infant feeding practices predispose to malnutrition even in the early part of life. Malnutrition as expected is the most common public health problem among the tribals6. Kshatriya GK et al reported the widespread prevalence of under nutrition among the tribal children in Himalaya, coastal and Desert ecology in India8. There is paucity of data on the exclusive breastfeeding practices and the infant nutrition among the tribals, especially in Tamil Nadu. A separate Directorate has been created in Tamil Nadu for the welfare of the Tribals which has identified 36 Scheduled Tribal communities in 13 districts within the state6.