Selected aspects of infant complementary feeding practice in a district of Sri Lanka and outcome of an intervention aimed at improving these practices

Abstract

Nutrition is a crucial aspect of care of infants which has a lasting impact on the subsequent life events of an individual. In the context of Sri Lanka, complementary feeding practices of infants is considered a priority area since available data on deterioration of nutritional status of infants points towards the age of initiation of complementary feeding. The present study was aimed at addressing the need to develop interventions to improve complementary feeding practices of infants which is at least partly constrained by lack of data on complementary feeding practices in Sri Lanka. A cross sectional survey was carried out in four Medical Officer of Health (MOH) areas in the Regional Director of Health Services (RDHS) area Colombo in order to study the complementary feeding practices of infants and their correlates and to determine the adequacy of nutrient intake of infants on complementation. Based on the findings of the above survey and information gathered in the literature review, an intervention on complementary feeding. was devised targeting the grass root health worker network of Public Health Midwives (PHMM) after assessing their knowledge, attitudes and practices in two focus group discussions (FGDD) with them conducted in the same RDHS area. An Infant Complementary Feeding Index (lCFI) was devised to enable them to do a rapid assessment of the complementary feeding practices in the field. This was achieved with the assistance of a panel of experts using the Delphi technique. The ICFI drafted was validated against the anthropometric data gathered in the preliminary survey. A manual was also drafted for PHMM incorporating the above findings to facilitate them to counsel mothers on complementary feeding effectively. Breastfeeding is the cornerstone of infant nutrition and the preliminary survey revealed a very high current breastfeeding rate but only 48.8 percent of mothers exclusively breastfed their infants till the end of fourth month. Majority of infants in the sample are started with complementation at the recommended age of 4.0-4.9 months but 2.9percent had received the recommended complementary food of mashed rice/rice mix. The commonest first complementary food item was rice canjee water. Though large majority of infants in the sample had been introduced a variety of new items around the middle of infancy, introduction of new food items becomes less frequent in the older infants. Literature on care aspects of feeding stresses the importance of consistency of the feeding situation and in the sample of infants in the preliminary survey 85.7 percent had fixed meal times but only 60.9 percent had fixed place for eating. Disadvantages of using bottles for infant feeding has been well documented but majority of infants in the sample had feeding bottles which were mainly used for feeding of water (72.0 percent of bottle users). The ICFI drafted was proved to be a valid tool to assess complementary feeding practices as denoted by its high correlation with anthropometric indices. When the pre and post intervention complementary feeding practices and nutritional status in the intervention and control areas were compared, the intervention designed for this study proved effective in improving several important aspects of complementary feeding but not the level of malnutrition. This point towards the hypothesis that to address the level of malnutrition a broader multi sect oral approach is required