Pratibha Vinay Kale¹, Satish Tiwari², Pankaj Barabde^3*, Pravina Kale⁴

 

¹Associate Professor, ²Professor, ³Assistant Professor, ⁴Final MBBS Student, Department of Pediatrics, Dr. P.D.M.M.C. and R.C., Amravati, Maharashtra, INDIA.

Email: drpvbarabde@gmail.com

Variable	Year (n=300)	YES (%)	NO (%)
Prelacteal Feeds	First (76)	27 (36)	49 (64)
	Second (104)	26 (25)	78 (75)
	Third (120)	15 (12)	105 (88)
Colostrumis Insufficient	First (76)	17 (22)	59 (78)
	Second (104)	23 (22)	81 (78)
	Third (120)	18 (15)	102 (85)
Excessive Crying means Inadequate Breast-milk	First (76)	19 (25)	57 (75)
	Second (104)	19 (18)	85 (82)
	Third (120)	7 (6)	113 (94)
Habit of Bottle for Giving Top Milk	First (76)	35 (46)	41 (54)
	Second (104)	36 (35)	68 (65)
	Third (120)	16 (13)	104 (87)
Restriction in Lactating Mother's Diet	First (76)	58 (76)	18 (24)
	Second (104)	69 (66)	35 (34)
	Third (120)	32 (27)	88 (73)
Awareness Program for B.F.	First (76)	73 (96)	3 (4)
	Second (104)	96 (92)	8 (8)
	Third (120)	113 (94)	7 (6%)
Information of I.M.S. Act 1992	First (76)	6 (8)	70 (92)
	Second (104)	30 (29)	74 (71)
	Third (120)	21 (18)	99 (83)

64% from 1^st year and 88% from 3^rd year students said no to prelacteal feed, improvement in knowledge from 1^st to 3^rd year and it is significant. (p<0.005). 54% from 1^st year and 87% from 3^rd year students said no to bottle, improvement in knowledge and it is significant (P<0.005)

Figure 1: Initiation of first Breast-feeding in Normal Delivery

 

22% from 1st year and 75% from 3rd year are of opinion that start B.F. <1 hour and it is statasticlly significant (p<0.005)

Table 2: When Water Should be Offered to Baby

 

Table 3: C.F. Should be Started at What Age

 

Figure 2: Type of Food for C.F.

7% from 1^st year and 55% third year are ready for home available food and it is significant (p<0.005)

 

Table 4: Total duration of B.F.

54%from 1^st year and 69% from 3^rd year students are in favour of 12 to 24 months and it is significant (p<0.005)

 

Table 4: Total duration of B.F.

54%from 1^st year and 69% from 3^rd year students are in favour of 12 to 24 months and it is significant (p<0.005)

 

Table 5: Whether Balkadu / Gripe Water / Dental Tonics Are

 

Table 6: In H.I.V. +ve Mother and H.I.V. -ve Baby Should get

10% students from 1^st year and 15%fom 3^rd year in favour of giving exclusive B.F,

 

DISCUSSION

Table no.1 shows that almost 88% of students from 3^rd year MBBS, were of opinion that prelacteal feed should not be given. But 64% of 1^st year MBBS, students were in favour of giving prelacteal feeds. From the above table it is seen that there is difference in opinion of 1^st and 3^rd year of students and it is statistically significant (P<0.05) indicating that gradually with the medical education their knowledge regarding the proper B.F. practices is improving. A Gupta and R Gupta (1989) surveyed 100 mothers with babies below 4 months. Breast milk was the first feed in 2% infants, honey in 90%, glucose water in 5% and jaggery, sugar-salt water in 1% each. Most of the exclusively breast fed infants, had received some other feed before establishing a status of exclusively breast-feeding⁸ In fig. no.1 there is difference in opinion between 1^st year and 3^rd year students of MBBS almost 22% of 1^st year students and 75% of 3^rd year students wanted to start the B.F within 1 hour of birth. This is statistically significant (P<0.05), indicating that knowledge regarding B.F. is improving from 1^st year to 3^rd year. G. N. Prabhakar et al (1987)⁹ studied 1055 families living in slums of Bangalore. The mothers starting breast-feeding within 4 hours, 4 – 12 hours, 12 – 24 hours, 1– 4 days and more than 4 days were 19.48%, 21.2%, 41.7%, 14.1% and 3.5% respectively. But 85% of students of 3^rd year MBBS, were in favour that colostrum is sufficient. Among majority of Indian mothers, studied in various areas colostrum was considered to be harmful and was not given to the baby.¹⁰ The another study by V Vimla and C Ratnaprabha in the tribal of Andhra Pradesh observed 100% acceptance of colostrum.¹¹ In table no.1 most of the students were of the opinion that excessive crying of baby does not always mean inadequate breast milk. Here again there is a difference in views of 1^st year (75%) and 3^rd year (94%) students and this is statistically significant. According to table no.2 significant % of students i.e. 37% from 1^st year, 45%- 2^nd year and 41%-3^rd year were of opinion that water should be offered during 1 – 2 months and about 7-15% of students thought that it should be offered after 6 months. The survey conducted by H.P.S. Sachdeva¹² on 70 doctors (20 senior residents and 50 junior residents) and 34 nurses in Delhi Hospital. All were aware of the superiority of breast milk. However 97% nurses and 63% doctors (P<0.0005) believed that water supplementation was necessary during summer. Of those who advocated water supplementation 6% nurses and 23% doctors suggested that water should be given on demand. The suggested frequencies ranged from 1 – 24 times a day for nurses and 2 – 10 times a day for doctors. Regarding the age of complementary feeding the concept of most of the students was wrong. The most common view was to start between 2 – 4 months.BNS Walia et al (1974 – 84)¹³ observed that the addition of semisolid to the diet of infant aged upto 6 months increased from 16.2% to 46.3% among illiterate mothers. Our observations probably are the effect of this trend. As per fig no.2 the encouraging finding was 55 % of students from final year were of the view that home made food should be used. But still the significant % of students from 1^st year and 3^rd year MBBS, were in favour of giving baby food along with home available food. There was statistically significant difference in the opinion from 1^st year to 3^rd year students (P<0.05). As their knowledge regarding infant B. F. practices is improving from 1^st year to 3^rd year but they still need the health education regarding the use of only home available food and restricting the use of commercial food. G.P. Katiyar et al¹⁴ pointed out that delayed weaning and late introduction of solids and semisolids along with adverse beliefs regarding food items were added hazards to the health and well being of the children. The study revealed that most of the children of the urban slum and rural area were not given cereals, meat, etc. during infancy. As per table no4, 54% of students from 1^st year and 69% from 3^rd year MBBS, were in favour that the total duration of B.F should be between 12 – 24 months and is statistically significant (P<0.05). About 17%, 17%, 18% from1st, 2^nd, 3^rd year students were of opinion that total duration of B.F. should be 24 months or more. Kumar et al ⁽¹⁵⁾ found that 68.4% mothers wanted B.F. to continue till the baby wanted, 11% for more than two years and 12.7% for one – two years. Table no.1shows 54% of 1^st year and 87% of 3^rd year MBBS, students thought that bottle should not be used. The awareness in the 3^rd year students regarding the habit of bottle is better than the 1^st year and the 2^nd year students (P<0.05), and is probably because of medical education regarding B.F. and avoidance of bottle feeding. A Gupta and R Gupta studied 100 mothers with following observations. In group I, antenatal advice was given 13% only through all mothers attended ANC OPD Bottle-feeding was used at one or another time in 90% infants.⁸ In group II, of the 100 mothers interviewed, antenatal checkup was done in all but only 11% mother received advice regarding breast-feeding. However after campaign against bottle-feeding, 60% mothers got postnatal information on advantages of breast-feeding and dangers of bottle-feeding. Prevalence of artificial feeding was 56% (54% were fed with bottle and 2% with spoon). The commonest reason (70% of bottle fed group) for giving supplementary feeds was to get the child used to bottle, he may refuse it later on. Insufficient breast milk was the other reason in about half of the cases. The advice to give bottle feeds was received by mothers from doctors in 25 cases, nurses in 20 cases and grandmother in 16 cases. In 6 cases the decision was that of the mothers.⁸ GP Mathur and PK Pande studied 615 newborns in 7 nursing home 52.4% mothers (45.1% mixed feed and 7.3% bottle fed) were given infant formula.¹⁶ Table no.5 shows that 45% of 1^st year and 73% of 3^rd year MBBS students thought that balkadu gripe water and dental tonics are not necessary. There is improvement in knowledge of 1^st year to 3^rd year students and is statistically significant (P<0.05). But still 10 – 20% of 3^rd year students were in favour of giving balkadu, gripe water and dental tonics. Thus the health education regarding this aspect is essential. Table no.1 shows 24% 1^st year and 73% of 3^rd year, students were of opinion that there should be no restriction of diet for lactating mother. There is improvement in knowledge from 1^st year to 3^rd year students because of medical education. Table no.6 shows almost 70 – 80% of students from 1^st year, 2^nd year and 3^rd year MBBS, were of opinion that H.I.V.+ve mother and H.I.V –ve baby should get artificial feeding. Only 10–20% of students were in favour of exclusively B.F. the baby in H.I.V. +ve mother and H.I.V. –ve baby. Position statement on H.I.V. and infant feeding states that: The general principle¹⁷ “Irrespective of H.I.V. infection rates, breast-feeding should continue to be protected, promoted and supported” should be followed. Table no.5 shows almost 95% students thought that there is a need of health education program for breast-feeding awareness in India. Table no.1 shows 70 – 90% of students were unaware of I.M.S. act.

 

sUMMARY AND CONCLUSIONS

After the survey of 300 undergraguate medical students, there is a gradual improvement in knowledge regarding giving prelacteal feed, colostrum, giving Balkadu / Gripe Water / Dental Tonics, water should be offered after 6 months, starting complementary food, total duration of Breast feeding, habit of bottle for giving top milk, restriction in lactating mother's diet from1^st year to 3^rd year students because of medical education and it is significant. It seems that all these concepts are deep rooted, much need to be done to improve knowledge regarding Breast feeding, discouraging wrong practices and encouraging healthy practices by giving education to students in their medical curriculum. Inspite of advertisement of baby food on large scale encouraging finding is that 3^rd year students were in favour of giving home available food for complementary feeding. H.I.V. is a measure health problem, in our study almost 70 – 80% of students were in favour of giving only artificial feeding to such babies. As mothers, health workers facing with dilemma concerning the infant feeding regarding H.I.V. and B.F. practices. This finding is very important because the final year students are equivalent to medical practitioners, as they will be going as intern practicing in the field. This issue needs more emphasis regarding health education as well as making a policy, which can be followed with clear recommendation. In our study regarding need of health education program for B.F. awareness in India almost 95% students were in favour of such programs, so as to give scientific and correct information regarding B.F. In our study maximum students (70 – 90%) were unaware of the I.M.S. act 1992. Most of the students from final year usually know about MTP act, CP act, etc as this is covered in Gynecology and Forensic Medicine, but they did not know this act. Thus this act should be included in medical education to protect, promote and support breast-feeding. Though there is a general awareness in B.F. knowledge and practices is far away from satisfactory.

 

REFERENCES