Author: Alasfoor, D.; Rawas, S.; Al-Farsi, Y.; Alshishtawi, M.
Several studies had shown that Protein Energy Malnutrition (PEM) is a widespread problem among Omani children at the age below five years. This problem is thought to be associated with gastro-intestinal diseases and ARI in this population. The causal factors associated with child malnutrition in this area are not yet known.
Purpose / Objective
To assess the prevalence and duration of exclusive and predominant breast-feeding in Oman.
To assess complementary feeding, hygiene, and psycho-social behaviors towards children feeding in a national sample of Omani mothers.
To estimate the association between complementary feeding patterns, hygienic and psycho-social attitudes towards infants and the nutritional status of Omani children at the age of 0-2 years.
1,429 infants and their mothers were surveyed, with information collected on weight and feeding practices. A representative national sample was used including subjects from all the ten regions.
Key Findings and Conclusions
The prevalence of underweight was 17.6%, and was higher among males: 19.0% compared to 15.7% for females. These are much lower than the figures reported in the Oman Family Health Survey.
We found in the study that 87.1% of the mothers started breastfeeding within one hour, and an additional 7% started within two hours after birth. In 1995, the Oman family health survey showed that 83% of mothers initiated breastfeeding immediately after birth, compared to 89% in the Child Health Survey (1992). The increase in early initiation of breastfeeding reflects the success of the baby friendly hospital initiative. When asked about breastfeeding, 82.0% of the mothers said that they breastfed on demand.
The results in this study indicate that only 16.2% of the mothers prepare the breast prior to the delivery. This is a sign of a lack of awareness among mothers, which reflects a gap between antenatal and paediatric health education messages. We have not seen in any of the previous studies a comparable question, therefore it is not possible to interpret a trend in this factor.
It was observed that 20% of the mothers had problems that are related to breastfeeding, out of whom 94.8% continued to breastfeed and 4.8% started using a bottle while having the problem. This reflects the commitment of Omani mothers to breastfeeding.
In this study, we found that 30.8% of Omani mothers had been, or are currently, exclusively breastfeeding for their infant during the age of 0-4 months. In addition, 40.5% of infants were/are predominantly breastfed, whereas 27.8% were/are partially breastfed. Complementary foods were introduced earlier than 4 months to 17.6% of all children in this study, whereas 14.6% of the mothers introduced complementary foods after six months.
Among children older than 4 months, we found than 32.1% of males and 31.4% of females were fed by hand as opposed to a spoon, which warrants the attention of health educators to the personal hygiene of the mother before and during child feeding.
The contribution of some behavioural care factors to underweight was assessed through appropriate statistical analysis. We could not elucidate a significant association. This is probably because these factors are subjective and situational, and cannot be measured precisely, leading to high variability. However, it was obvious that being underweight increased with the child's age. This may be explained by poor feeding habits and lack of responsive feeding. In the age group below 5 months, in which children are mostly breastfed, 10.6% of them were underweight, compared to 20.0% among children over 12 months of age.
- Although the rates of breastfeeding on demand are encouraging, this aspect should be emphasised, together with bed sharing, to maintain the frequency of breastfeeding at night.
- Education for breastfeeding should start during pregnancy. Several mothers in this study were not informed about possible problems, or what to expect. This is especially true for first time mothers.
- Policies, guidelines, and step-by-step instructions on how to re-enforce breastfeeding and overcome problems that are associated with it through proper training of personnel.
- Community support group members should be encouraged to take these messages, as it was found that women got their advice mostly from relatives.
- Proper weaning policy that explains the frequency, energy density, and active feeding should be reviewed and promoted.
- Stress should be made on encouraging the autonomy and self reliance of the child through access to food, providing a separate plate for infants and children, etc. together with breastfeeding into the second year.
In this study, we attempted to assess the hygienic practices of mothers, and some of their attitudes towards the psycho-social development of their children. However, we found that this was very difficult and needed anthropological expertise to observe and document patterns in social behaviours. Therefore, we recommend that a detailed study that addresses the behavioural patterns of mothers and the psycho-social development of their offsprings be conducted.
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ECD - Health