Correlation of Mother’s Knowledge on Child Nutrition, Feeding Practices and Nutritional Status of Children in Karnataka, India: A Cross-sectional Study
Correspondence Address :
Dr. Priya Reshma Aranha,
Associate Professor, Department of Child Health Nursing, Yenepoya Nursing College, Yenepoya Deemed to be University, Mangaluru, Karnataka, India.
Introduction: Malnutrition is a critical health problem in many countries, including India. The main reason for this is incorrect dietary habits that lead to illness and infections in early childhood. Inadequate food intake can hinder the growth and development of children. Childhood malnutrition can impair psychological and intellectual development, which can subsequently result in low school performance and behavioural disturbances. Therefore, child nutrition is of utmost importance. The knowledge and feeding practices of mothers can significantly influence child nutrition. Hence, it is essential to study the knowledge, feeding practices, and nutritional status of children as influenced by their mothers.
Aim: To was to determine the correlation between the knowledge of mothers regarding child nutrition, their feeding practices, and the nutritional status of children.
Materials and Methods: A cross-sectional correlational study was conducted in a 1050-bed multispecialty tertiary care hospital in Mangaluru, Karnataka, India, from December 30, 2021, to August 30, 2022. A total of 150 children under the age of five, visiting the hospital accompanied by their mothers, were selected as study participants using a non probability convenience sampling technique. Data was collected using a demographic proforma, a structured knowledge questionnaire on child nutrition, a structured checklist on feeding practices, and anthropometric measurements of children, which were taken using a digital weighing scale and stadiometer. Descriptive statistics including mean, frequency, percentage, Karl Pearson’s correlation coefficient, and World Health Organisation (WHO) Anthro software were used for statistical analysis.
Results: The majority of the study participants, 96 (64%), had average knowledge regarding child nutrition, while all of them had good child feeding practices. Regarding the nutritional status of the children, the majority fell under the normal category based on weight for height (123, 82%), weight for age (118, 78.67%), and height for age (104, 69.33%). The study also revealed a significant correlation between the knowledge of mothers, feeding practices, and nutritional status of children (p-value <0.05).
Conclusion: The study concluded that although majority of the study participants had a normal nutritional status and their mothers had average knowledge, regular awareness programs could be conducted, and the nutritional status of children needs to be regularly monitored.
Behavioural disturbance, Health problem, Infection, Malnutrition
It is essential to have good feeding practices of infant and toddler to maintain the health, growth, and development of children (1). Developing healthy eating habits early in life prevents diet-related diseases later on and in adulthood. The development of food preferences in children is complex. Familial and environmental factors affect food preferences, but they may not always promote a healthy and varied dietary practice. Parents employ a variety of strategies to influence the eating habits of children, some of which may be effective, while others may not be (2).
Malnutrition is a major health issue in developing countries. It can manifest in the form of both overnutrition and undernutrition. Across the world, undernutrition is the most common form of malnutrition, resulting from insufficient food intake and recurrent infections (3). In India, nearly half of all under-five child mortality is attributed to undernutrition (4). Malnutrition accounts for 45% of mortality among under-five children globally, as it increases the risk of death by exacerbating the frequency and severity of infections and slowing recovery (5). According to the Global Nutrition Report 2018, in India, 8.23 million children under the age of five are both stunted and wasted, and 46.6 million children are stunted, accounting for 33% of the world’s total (6). Child malnutrition is a concern in many countries as it is one of the causes of under-five mortality (7),(8),(9). The Fourth National Family Health Survey in 2015-2016 reported that 32.1% of under-five children were underweight, 35.5% were stunted, and 19.3% were wasted, which was lower compared to the survey conducted in 2005-2006 (10). This indicates that malnutrition is decreasing in under-five children but still persists.
Much research has been conducted in the area of child malnutrition, and guidelines for evidence-based practice. A randomised controlled trial has shown that home-based therapeutic food is more effective in terms of better acceptability, palatability, affordability, increased frequency of feeding, and ease of preparation (p-value<0.05) (10). On the other hand, a study in India has shown that only 39 (38.8%) of infants were breastfeed within one hour of birth, even after institutional delivery. Exclusive breastfeeding for six months was reported in only 26 (30.6%) infants. The study concluded that Infant and Young Child Feeding practices (IYCF) in India are extremely poor, which may be due to lower literacy rates, lack of IYCF education among mothers, and a lack of counseling and support (11).
A cross-sectional study in Karnataka revealed that 136 (39%) mothers initiated breastfeeding within half an hour of childbirth. A total of 31 (9%) of them reported giving prelactea feeds. Only 91 (26%) of the mothers were found to be providing the WHO recommended minimum adequate diet to their children. The study highlighted the prevalence of inappropriate IYCF practices in the community (12).
Recent research has demonstrated that the period before a child reaches 18 months of age is essential for preventing and treating iron-deficiency anaemia. This suggests that the effects of poor feeding practices during this stage of a child’s life may have long-term impacts on their development and health status (13).
It is evident from the above discussion that the burden of malnutrition among children under the age of five is relatively high. Despite various government projects carried out in Karnataka and throughout the country, the prevalence of undernutrition has not reduced significantly. There are many factors that influence the nutritional status of children, such as cooking and child-rearing practices, likes or dislikes of food, beliefs or taboos, and the quality and quantity of the food served (13). The literature shows that malnutrition still exists as a major health problem in India, with faulty feeding practices being the main cause among children under the age of five (13). Many research studies have explored mothers’ knowledge regarding nutrition and the nutritional status of children. A mother’s knowledge of child nutrition is also important for the nutritional status of children. Therefore, the present study was conducted to find the correlation between mothers’ knowledge of child nutrition, feeding practices, and the nutritional status of children.
A cross-sectional correlational study was conducted at a 1050-bed multispecialty tertiary care hospital in Mangaluru, Karnataka, India, from December 30, 2021, to August 30, 2022. Ethical clearance was obtained from Institutional Ethics Committee (IEC), and permission was obtained from the concerned hospital authority (Approval protocol number: YEC2/835). Informed consent was obtained from the study participants.
Inclusion criteria: Under-five children, both males and females, visiting the Outpatient Department (OPD) or admitted to the paediatric ward, along with their mothers, were included in the study.
Exclusion criteria: Critically ill children and mothers who were physically or mentally disturbed were excluded from the study.
Sample size calculation: The sample size was estimated based on the prevalence of mothers’ knowledge regarding feeding practices for infants (p=0.25%), considering a significance level of 5% and a study precision of 7% around the specified prevalence (14). The recommended sample size for the present study was 150.
Data collection: Data were collected using a demographic proforma, a structured knowledge questionnaire on child nutrition, a structured checklist on feeding practices, and anthropometric measurements of children taken using a digital weighing scale and stadiometer. The demographic proforma consisted of eleven items related to demographic data for children and their mothers, including the child’s age, gender, birth order, religion, type of family, family income, mother’s education, socio-economic condition, and information regarding child nutrition. The structured knowledge questionnaire consisted of 40 questions classified under four domains: a) nutrients and requirements, balanced diet; b) importance of child nutrition; c) nutritional deficiency, malnutrition; and d) factors affecting child nutrition. The questionnaire was validated by subject experts and was found to be reliable (r=0.83). The investigators arbitrarily graded the knowledge as good (27-40), average (14-26), or poor (<14) based on the scores obtained. The structured checklist on feeding practices consisted of 39 statements categorised under five domains: a) breastfeeding; b) weaning; c) hand hygiene/food hygiene; d) follow-up of nutritional status; and e) method of cooking. The checklist was validated by subject experts and was 6found to be reliable (r=0.99). Practices were arbitrarily graded as good (scores ≥20) or poor (scores <20).
For the anthropometric assessment of children, a calibrated digital weighing scale was used to measure weight, and a stadiometer was used to measure height. The nutritional status of the children was then assessed based on WHO growth standards (15) using WHO Anthro software Version 1.0.4. and described as follows: Underweight (weight for age <-2SD, indicating changes in the magnitude of malnutrition over time), Stunting (height for age <-2SD, indicating growth retardation), and Wasting (weight for height <-2SD, indicating inadequate nutrition).
Formal permission was obtained from the concerned hospital authority to conduct the study, and informed consent was obtained from the participants. The questionnaire was administered to the participants, and it took approximately 45-50 minutes for them to complete it [Annexure I]. The investigator ensured that the tool was completely filled out by the participants. At the same time, the investigator measured the height and weight of the children and recorded the data. Finally, the investigator thanked the study participants for their participation.
The data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Descriptive statistics of knowledge and practice regarding child nutrition were analysed in terms of frequency and percentage. The nutritional status of the children was analysed using WHO Anthro software. Karl Pearson’s correlation coefficient was used to identify correlations between the mother’s knowledge on child nutrition, feeding practices, and the nutritional status of the children.
(Table/Fig 1) describes the demographic characteristics of the study participants. In addition to this data, all the participants had a ration card, and 89 (59.3%) belonged to below the poverty line. The mean age of the children in completed months was 33.23±13.87, and the mean age of the mothers in completed years was 28.51±16.3.
(Table/Fig 2) depicts the knowledge of mothers regarding child nutrition. The study revealed that the mean percentage of the subjects’ knowledge was 57.7%. The domain-wise mean percentage of knowledge on nutrients and requirements, balanced diet was 65.22%, the importance of child nutrition was 56.87%, nutritional deficiency and malnutrition was 52.22%, and factors affecting child nutrition was 48%.
It was also observed that all the study participants had good feeding practices as they responded positively to the practice checklist. The mean percentage of the mothers’ practice was 83.64%. The domain-wise mean percentage of practice on breastfeeding was 95.54%, weaning was 69%, food hygiene was 97%, follow-up of nutritional status was 88.51%, and methods of cooking was 85.20%.
When comparing the nutritional status of the children with the WHO growth standards, it was found that 118 (78.66%) children had a normal weight for age (Table/Fig 3), 104 (69.33%) had a normal height for age (Table/Fig 4), and 123 (82%) had a normal height for weight (Table/Fig 5). However, 32 (21%) were found to be wasted, 17 (11%) were underweight, and 33 (22%) were stunted.
Karl Pearson’s correlation coefficient was used to assess the correlation between the mother’s knowledge on child nutrition, feeding practices, and the nutritional status of the children. The study results showed a positive correlation between the mother’s knowledge and feeding practices (r-value=0.72, p-value<0.05), the mother’s knowledge and nutritional status (r-value=0.11, p-value<0.05), and feeding practices and nutritional status (r-value=0.37, p-value<0.05).
In the present study, 78 (52%) of the children were male, and 57 (38%) belonged to the first and second order of birth. Additionally, 50 (33.3%) of the mothers had primary education, 121 (80.7%) were housewives, 103 (68.7%) belonged to nuclear families, and 89 (59.3%) were below the poverty line. These findings are consistent with previous studies, where 229 (57.3%) of the subjects were male (16), 140 (34.9%) of the mothers were housewives (15), 11 (57%) belonged to nuclear families, and 383 (76.6%) had a poor socio-economic condition (17),(18).
The present study showed that the majority, 96 (64%), of the mothers had average knowledge regarding child nutrition. A similar study showed that mothers had good knowledge on IYCF recommendations (19), while another study contradicted this finding, showing that the majority, 321 (64.2%), of the mothers had inadequate knowledge about Complementary Feeding (CF) (17). The main reason for this discrepancy could be that the population in the latter study was from an urban slum where personal and environmental sanitation was very poor, and people were ignorant about child nutrition and health (18).
In the present study, it was observed that all the mothers had good feeding practices regarding child nutrition. The mean percentage of the practice score was 109 (72.7%). However, a similar study conducted showed contradictory findings, with mothers exhibiting poor feeding practices regarding child nutrition (20). The mothers and their children in that study consumed a lot of fast food and lacked nutritional education, which could lead to poor feeding practices (20).
Regarding the nutritional status of the children, the present study revealed that the majority of the children were well-nourished. However, 32 (21%) were found to be wasted, 17 (11%) were underweight, and 33 (22%) were stunted. A similar study found that 204 (26%) of the study participants were undernourished, 102 (13%) were stunted, 94 (12%) were wasted, and 78 (1%) were both stunted and wasted (21). The investigators also compared the present study findings with the literature, where contrasting study findings were found (Table/Fig 6) (19),(20),(21),(22). The main reason for this difference may be the low socio-economic status of the mothers.
The feeding practice was assessed through verbal responses by the mother, but the actual practice was not observed by the researcher. The study was limited to a single setting in a single geographical area; therefore, the generalisation of study findings was not possible.
This study finding suggests that mothers had average knowledge and good child feeding practices, and the majority of the children were well nourished. There was a positive correlation between knowledge, feeding practices, and nutritional status. The current study will provide important information for future research in the area of child nutrition and malnutrition among children, as well as the knowledge and practices of mothers. The outcomes of this study can be used by researchers to perform interventional research, exploring and testing various interventions to maintain the nutritional status of under-five children and enhance their mothers’ knowledge and practices regarding child nutrition.
The authorities of Yenepoya Medical College Hospital are to be commended for providing all the necessary technical and other assistance for the completion of this research project. The authors also wish to thank all the validators for their help in construction the tool, as well as all the study participants for their wholehearted support.
Date of Submission: Apr 25, 2023
Date of Peer Review: Jul 13, 2023
Date of Acceptance: Sep 05, 2023
Date of Publishing: Nov 01, 2023
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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