DOI:10.14260/jemds/2014/3302

ORIGINAL ARTICLE

DIARRHOEA AND ITS ASSOCIATION WITH THE TIME OF WEANING AND DIETARY HABITS OF CHILDREN

Surendra Prasad Singh1,Setu Sinha2, Sanjay Kumar Choudhary3, Gautam Sarker4, Pankaj Kumar5, Kashif Shahnawaz6

HOW TO CITE THIS ARTICLE:

Surendra Prasad Singh, SetuSinha, Sanjay Kumar Choudhary, GautamSarker, Pankaj Kumar, KashifShahnawaz.“Diarrhoea and its Association with the Time of Weaning and Dietary Habits of Children”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 40, September 01; Page: 10047-10052,

DOI: 10.14260/jemds/2014/3302

ABSTRACT: INTRODUCTION: In developing countries, diarrhoea still accounts for approximately 11% of all mortality in children under five years of age. Exclusive breast feeding should be given to all babies for upto 4 months, and then weaning should be started. Chances of diarrhoea is more in babies fed on milk other than breast milk. OBJECTIVE: This study was conducted to find out the association of diarrhoea with the time of weaning and dietary habits of children. MATERIALS AND METHODS: sample size of approximately 3742 children, upto the age of 5 years were selected for the study. The survey consisted of 30 clusters and each cluster consists of 125 children. The association of diarrhoea and the time of weaning and dietary habits of children were studied. OBSERVATION: It was observed on our study that the incidence of diarrhoea was found to be much higher in children who were weaned before the age of 4 months, i.e 34.4%, in comparison to those who were weaned after 4 months, i.e., 17.2%. Regarding dietary habits of the children, it was found that the incidence of diarrhoea in children were 16%, 18.6% and 20.1% in babies fed on breast-milk only; commercial & animal milk; breast milk, animal and commercial milk respectively. CONCLUSION: The incidence of diarrhoea was found to be lower in children who were weaned after the age of 4 months and were fed on breast milk only.

KEYWORDS: Diarrhoea, Weaning, Dietary habits, Children.

INTRODUCTION:Diarrheal diseases are amongst the top three killers of children in the world today1. Despite the substantially declining mortality rate from diarrhoea in developing countries, diarrhoea still accounts for approximately 11% of all mortality in children under 5 years of age.2 In developing countries, children under three years old experience an average three episodes of diarrhoea every year. Each episode deprives the child of the nutrition necessary for the growth and development. Diarrhoea is defined as defecation frequency of three or more loose/ liquid stools in a day (or more frequent passage than is normal for the individual).3

Diarrhoea incidence remains a tremendous burden on children in low and middle income countries due to multiple determinants, such as child malnutrition, low socio-economic status and education of mothers, lack of safe drinking water, inadequate sanitation and poor hygiene, crowding and low maternal age. These determinants of diarrhoeal diseases are strongly linked to poverty and social inequities. Mothers and children in low socio-economic areas with limited hygiene and sanitation facilities tend to have poor hygiene practices such as using dirty cooking or eating utensils for their children.4

While poor hygiene practices, especially in the preparation of weaning foods and feeding practices may increase the risk of having diarrhoea, upto 70% of diarrhoea episodes are actually caused by water and food contaminated with pathogens.5

When the infant reaches four to six months of age, breast milk needs to be supplemented. With the introduction of weaning foods, which in many countries are prepared under unhygienic conditions, infants who until then have only consumed breast milk may be exposed to infective doses of foodborne pathogens. Many studies show that the incidence of diarrhoeal diseases is especially high after weaning is initiated.

Dietary habits of the children is also very important for the prevention of diarrhoeal episodes in children. Exclusive breast feeding should be continued for at least 4 months of life. In urban slums, there is a tendency of decrease in the prevalence of breast feeding and introduction of milk formula, which is often inappropriately diluted (due to higher cost of powder milk) and lack of awareness about the diet of young infants.

So, mothers should be encouraged and properly educated about the benefits of breast milk. “Growth-factor” present in the breast milk is relatively more immune towards diarrhoea. It is beneficial to the breast fed babies and so the incidence of diarrhoea among them is relatively less in comparison to artificially fed babies.

When the infant reaches 4-6 months of age, breast milk needs to be supplemented with the introduction of weaning foods, which is many countries are prepared under unhygienic conditions, infants who until than have only consumed breast milk may be exposed to infective doses of food borne pathogens. Many studies show that the incidence of diarrhoeal diseases is especially high after meaning is initiated.

MATERIALS & METHODS:Present study was conducted in Kishanganj district of Bihar, from April 2014 to June 2014 (Three months). A pre-designed, pre-tested study schedule was used for collecting data. A structured questionnaire, used for conducting interviews and observations, consisted of four sections: a) general information b) diarrhoea prevalence c) complete list of food hygiene practices and d) nutritional status. The questionnaire was developed, based on a similar survey, the guidelines set by WHO, information from staff members of the community health centers and voluntary mothers. In addition, the interview was conducted by the field worker to the mother or caretakers of the child.

Both open and close ended questions were kept in the schedule. Privacy and confidentiality of the children and their parents were maintained. This work has been undertaken to find out the association of diarrhoea and the age of the child at which weaning started. The children selected for the study belonged to the age group of newborn to 5 years, who are mostly permanent residents of this area or who are residing in this zone for more than 6 months. Children who are visitors from outside of this area are not considered in this study.

The survey has been conducted as cluster sampling method as described in WHO/ CDD household survey manual (CDD/ SER/86.2, REV. 1989). The survey consisting of 30 clusters by and large from rural and few from sub and semi urban population. To ensure reasonable limit of precision target sample size of approximately 3742 children upto 5 years of age was selected. Thus each cluster consisted of about 125 children.

At this point a very pertinent question arouse as to what is the meaning of diarrhoea in the mind of the caretaker of the child. At this point the definition of diarrhoea, i.e., 3 or more loose or watery stool/ day with or without blood for one or more day was properly defined and made to understand in the mind of the caretaker of the child.

The diagnosis was confirmed after detailed and thorough interrogation of the patients and their parents or guardians, clinical examination of the patients and by required pathological examination like routine examination of stool of the sufferer child. Finally, the relation of diarrhoea in children, in relation to time of weaning and feeding habits of children were established.

OBSERVATION:In this study weaning status of children were divided into 3 groups. In the first group, of children, weaning had started before the age of 4 months, in the second group it started after 4 months and in the third group, weaning time was not mentioned.

Age group in month / Weaning Time
Weaning < 4 months / Weaning > 4 months / Weaning time not mentioned
Normal / Diarrhoea / Total / Normal / Diarrhoea / Total / Normal / Diarrhoea / Total
0-4 / 2 / 5 / 7 / 30 / 2 / 32 / 77 / 3 / 80
5 / 0 / 0 / 0 / 28 / 2 / 30 / 0 / 0 / 0
6-11 / 0 / 4 / 4 / 97 / 73 / 170 / 1 / 0 / 1
12-35 / 15 / 15 / 30 / 435 / 217 / 652 / 1 / 1 / 2
36th & above / 44 / 8 / 52 / 2353 / 318 / 2671 / 11 / 0 / 11
Total / 61 / 32 / 93 / 2943 / 612 / 3555 / 90 / 4 / 94
Percentage / 65.6 / 34.4 / 100.0 / 82.8 / 17.2 / 100.0 / 95.8 / 4.2 / 100.0
TABLE1

Prevalence of Diarrhoea among children of each group according to weaning status.

In the study group 93 children (2.6%) were weaned before the age of 4 or less months, as compared to 3555 (95%) children, who were weaned after 4 months. In the 94 (2.4%) children, the weaning date could not reliably ascertained. The incidence of diarrhoea was found to be much higher in children who were weaned before 4 months, i.e. 34.4%, in comparison to those who were weaned after 4 months, i.e 17.2%. In 4.2% children, diarrhoea cases were found where weaning time was not mentioned.

Age group
in month / Breast
milk only / Animal &
commercial Milk / Breast + animal +
commercial Milk
Normal / Diarrhoea / Total / Normal / Diarrhoea / Total / Normal / Diarrhoea / Total
0-5 / 117 / 22 / 139 / 0 / 0 / 0 / 4 / 1 / 5
6-11 / 105 / 22 / 127 / 18 / 7 / 25 / 46 / 11 / 57
12-35 / 18 / 2 / 20 / 71 / 16 / 87 / 326 / 82 / 408
36th & above / 0 / 0 / 0 / 186 / 40 / 226 / 8 / 3 / 11
Total / 240 / 46 / 286 / 275 / 63 / 338 / 384 / 97 / 481
Percentage / 84 / 16 / 100 / 81.4 / 18.6 / 100.0 / 79.9 / 20.1 / 100.0
TABLE 2

Prevalence of Diarrhoea among children of each group according to feeding habits.In this study, dietary habits of the children and its association with diarrhoea were studied.

These children were divided into different groups of the basis of diet, i.e. Non-specific; breast milk only; commercial milk and animal milk; breast milk, animal milk and commercial milk. The number of children in each category was as 2637 (70.5%), 286 (7.6%), 338 (9%) and 481 (12.9%), respectively. The non-specific group was left out of the study. The incidence of diarrhoea in these groups were 16%, 18.6% and 20.1% respectively.

DISCUSSION:In the present study, association of diarrhoea and time of weaning was studied. The incidence of diarrhoea was found to be higher in children who were weaned before the age of 4 months, i.e. 34.4%, in comparison to those who were weaned after 4 months, i.e. 17.2%.

It is true that breast feeding keeps the infant away from contamination, but after 3-4 months of age, breast milk alone is not sufficient to satisfy the nutritional requirement. Other food items must be introduced even though, breast feeding should be continued at least upto second year of life. To improve the nutritional value and hygiene standard of traditional weaning food, it is desirable to have an understanding of diarrhoeal diseases including their etiololgy and common routes of transmission.

The risk of having diarrhoea in children whose mother had poor food hygiene practices in our study was similarly observed in a peri urban district of Guinea-Bissau6. This finding may be explained by the fact that weaning foods for young children prepared under unhygienic conditions are frequently contaminated with pathogens and are an important risk factor of diarrhoea transmission.

The higher incidence of diarrhoea in children who were weaned earlier is probably attributed to the fact that digestive power of infants is not matured to handle the solid load.

This problem is compounded further by the faulty selection, handling and storage of weaning food.Saran et al (1981)7 and Agarwal et al (1981)8, similarly found a higher incidence of diarrhoea in children who were weaned much earlier than normal i.e. 4 months. Black et. al. found in their study that the prevalence of diarrhoea was highest during the second 6 months of life and declined with increasing age thereafter.(9,10) The declining incidence of foodborne illnesses with increasing age of weaning is explained by the probable acquisition of immunity from repeated exposure to the pathogens.

In this study, the association ofdietary habits of children and diarrhoea were also studied. Children were divided into 4 groups on the basis of diet, i.e. non-specific; breast milk only; commercial and animal milk; breast, commercial and animal milk. The incidence of diarrhoea were 16%, 18.6% and 20.1% in children who were fed on breast milk only; commercial and animal milk; and breast, commercial and animal milk, respectively.

The non-specific group was left out of the study.The highest incidence of diarrhoea seen in children taking a mixture of breast, animal and commercial milk (20.1%) may be due to improper handling and contamination of the milk. Moreover, it may be due to improper cleaning of the feeding bottle through which milk is given to the child.

Results of our study were consistent with the studies of Manchanda et al (1958),11who concluded from their study that breast fed infants were relatively resistant to gastroenteritis due to infection by E.coli, because of the presence of Lactobacillus in the gut of the breast fed children. Shrivastava et al (1968)12 from their work held the view that the low incidence of diarrhea in breast fed infants are due to the absence of contamination, presence of easily digestible fats and antibodies in the breast milk.

CONCLUSION:The present study has been carried out to find out the association between the time of weaning and dietary habits of children and diarrhoea. Followings were the summary of this study:

  1. The incidence of diarrhoea was much higher in children who were weaned earlier (34.5%) as compared to an incidence of 17.2% in children who weaned after 4 months.
  2. The incidence of diarrhoea was maximum in children fed on mixture of breast milk, animal milk and commercial milk (20%) as compared to children who were on diet of animal and commercial milk where the incidence was 18.7%. The incidence was minimum (16.3%) where the children were on breast milk only.

RECOMMENDATION:Mothers should be educated more effectively during health education programme regarding correct type of feeding practices. Food safety education should be especially targeted to this group, focusing on good food hygiene practices. Mothers and pregnant women should be educated about the benefits of exclusive breast feeding and correct methods of weaning.

REFERENCES:

  1. W.H.O. World Health Report 2000. Geneva: World Health Organization, 2000: 164.
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