Nutritional Status of Breast Fed and Formula Fed Infants with Diarrhoea

-A Retrospective Study
Deepa.T.P* and Dr.Chandra Venkatasubramanian**
ABSTRACT

Infancy is the period from birth to the end of the first year. A good nutritional base is
essential for the infants to grow. Diarrhoea is one of the most common disorders that affect
infants. Repeated diarrhoea makes the child malnourished. The methods of feeding, type of
feed used, sterilization of feeding utensils are some of the factors that affect the occurrence of
diarrhoea. Breastfeeding is the best way to feed a new born. Breast milk contains appropriate
amount of all nutrients and immuno components. A retrospective case study was carried out
among 100 infants below six months of age to compare the nutritional status of breast fed and
formula fed infants with diarrhoea. The study was from the secondary data collected over a
period of six months. The results revealed that bottle fed infants are more prone to diarrhoea
than exclusively breast fed infants.

Key Words: Diarrhoea, Nutritional Status, Breast feeding, Formula feeding

INTRODUCTION
Diarrhoea is an intestinal disorder characterized by abnormal fluidity and increased
frequency of fecal evacuations. The result of increased motility in the colon is an important
symptom of many underlying disorders. Diarrhoea can be either short-term (acute) or long-
term (chronic) in duration. Diarrhoea is the most common disorder that affects infants and
young children.
Diarrhoea is the major contributor to malnutrition, poor health and inadequate
performance in infants. In many countries, it is the main cause of death among infants. The
main causes of diarrhoea in infants are poor hygiene, lack of clean drinking water,
overcrowding, careless preparation of feeds, and the trend towards bottle-feeding rather than
breastfeeding. Improper sterilization, lack of sterilization or contamination after sterilization
of the feeding items contributes to diarrhoea.
Breast milk contains hundreds of health-enhancing cells, proteins, fats, hormones,
enzymes and immuno components. The main carbohydrate in human milk is lactose, which
facilitates the absorption of calcium, zinc, iron and manganese (Ziegler, 1983). Breast milk is
the only source of the galactose, which is essential for the formation of the myelin sheath
surrounding many nerves.
**Supervisor and Guide, Associate Professor and Head, Post Graduate department of Home
Science, Queen Mary’s College, Chennai-600004, India
*M.Sc. (DFSM) Student, Indira Gandhi National Open University, New Delhi.
 New born babies absorb about 95 to 98 percent of the fat from human milk but only
about 80 percent of fat from a milk-based formula (Kabara, 1980). In addition, the proteins
and fats in whole cow's milk are more difficult for an infant to digest and absorb than the
ones in breast milk. Human colostrum and milk have unique biochemical properties. Human
milk contains substances that bind iron, zinc and other elements, allowing them to be easily
absorbed, while protecting them from use by bacteria. Breastfeeding stimulates an infant’s
immune system and responds to vaccinations and will be continously changing to meet the
babies needs.
Formula fed infants, have IQs ten points lower than their breastfed counterparts. This
is related to special fatty acids and other components in breast milk that are known to
promote brain cell growth, development of vision and the nervous system. These components
are absent in formulas. There are numerous cases where the artificial infant formulas are
mistaken for their composition, and/or contaminated with toxins and bacteria. Some of these
mistakes have lead to injuries, including brain damage in babies fed with formulas which can
be totally avoided in breast feeding (Newman and Pitman, 2000; Anderson et al, 1999;
Solveig et al, 2000).
If every baby is immediately put skin-to-skin at the breast, hypothermia would be
prevented, saving about 20,000 lives annually. If every baby were exclusively breastfed for
six months, an estimated 1.3 million additional lives would be saved every year. Research
suggests that longer periods of breastfeeding for atleast 6 months are critical for reducing the
risk of potentially fatal gastroenteritis (Williams, 2010).
Diarrhoea can be prevented by pursuing multisectoral efforts like exclusive breast-
feeding, improving access to clean water and safe sanitation, promoting hygiene, education,
use of latrines, sanitary disposal of stools, improved weaning practices, immunizing all
infants; especially against measles, keeping food and water clean, washing hands with soap
(the baby's as well) before touching foods.
This study was taken up to assess the Nutritional Status of Breast fed and formula fed
infants with Diarrhoea. It also determines the various factors that affect the nutritional status
of breast fed and formula fed infants like - type of feed, consistency of feed and frequency of
sterilization.

METHODOLOGY
This study is a retrospective descriptive case study using secondary data. This study is
a survey undertaken using purposive sampling technique which is a type of non- probability
sampling where the samples selected are only those below six months of age and suffering
from diarrhoea.
The tools adopted are questionnaire and content analysis. A structured closed ended
questionnaire with multiple choices was used and the records available at the hospital were
analyzed.
The study was conducted for a period of six months in a corporate hospital at
Chennai. A pilot study was conducted using the questionnaire. From the pre-test it was found
that questions on consistency of feed, time period of sterilization needed to be included along
with questions on dietary advice on discharge as the condition of the infant depended on these
aspects. Thus these questions were included and the questionnaire was corrected.
The data obtained was analyzed statistically after coding. Percentage, Chi-square test,
Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance by ranks were the
tests used for data analysis

RESULTS AND DISCUSSIONS

All the results obtained have been presented in different tables.
Table 1
Association between nutritional status of the child and feeding method

Feeding Methods
Exclusive Combination of Combination of Kruskal
Nutritional Total
Breast Bottle, Breast Breast and Wallis
Status (%)
Feed and Spoon feed Spoon feed Value
(%) (%) (%)
Normal 44.4 46.0 63.2 49.0
Malnourished 16.7 30.2 5.3 23.0 0.958
Over NS
38.9 23.8 31.6 28.0
nourished
NS denotes Not Significance

It is observed from table 1 that among the normal infants, 44.4 percent of them are
exclusively breast fed, 46 percent of them are given bottle feed in combination with breast
feed and spoon, whereas 63.2 percent of them are given breast feed along with spoon feed. In
the over nourished category, 38.9 percent of them are breast fed, 23.8 percent of them are
bottle fed (in combination with the breast and spoon feeding), and 31.6 per cent of them are
given breast feed in combination with the spoon feed. Among the malnourished infants,
majority of them are given bottle feed (combined with breast and spoon). About 16.7 percent
of the exclusively breast fed infants are malnourished and 5.3 percent of the infants who are
given breast milk and spoon feed are malnourished. The Kruskal Wallis Value denotes that
there is no significant association between nutritional status of the child and feeding methods.
The reason why this could not be significantly brought about in this study is due to the fact
that only secondary data was used which may not have been authentic and the study was
carried out for only a short duration. Figure 1 shows the relationship between nutritional
status of the child and feeding method.

Figure 1
 Table 2
Association between consistency of the Complementary feed and
literacy level of the mother

Literacy level of
mother
Consistency of Complementary Total Chi Square
Feed (%) Value
Literate Illiterate
(%) (%)
Liquid 68.5 96.4 78.0
Thin 22.2 3.6 15.9 8.479**
Thick 9.3 0 6.1
** Denotes 1% significant

Table 2 elucidates that, in majority of infants of illiterate mothers (96.4 percent); the
consistency of Complementary feed is liquid. Only some of them (3.6 percent) give thin form
of Complementary feed. Among the literate mothers 68.5 percent of them give liquid form of
Complementary feed, 22.2 percent of them give Complementary feed of thin consistency and
9.3 percent of them give thick form of feed. This shows that majority of illiterate mother’s
feed thin or diluted form of feed. The chi square value denotes significance at 1per cent level
showing association between Consistency of the Complementary feed and literacy level of
the mother.

Table 3
Association between method of feeding and number of infants suffering from diarrhea

Number of infants Total Chi-square

Method of feeding
(%) (%) value
Exclusive Breast feed 18.0 18.0
Combination of Bottle,
63.0 63.0
Breast and Spoon feed 39.620**
Combination of Breast
19.0 19.0
and Spoon feed
** Denotes 1% significance

It is observed from table 3 that only 18 percent of exclusively breast fed infants are
prone to diarrhoea whereas 63 percent of infants who are bottle fed in combination with
breast and spoon are prone to diarrhoea, only 19 percent of infants who are breast fed along
with spoon feeding are prone to diarrhoea. This clearly elucidates that there is a direct
association between type of feed and prevalence rate of diarrhoea. The chi square value
denotes significance at 1per cent level showing that there exists an association between
method of feeding and number of infants suffering from diarrhea

Table 4
Association between choice of complementary feed and
number of infants suffering from diarrhoea

Choice of Number of infants Total

Chi-square value
Complementary feed (%) (%)
Home Made 8.5 8.5
Commercial 81.7 81.7 86.366**
Both 9.8 9.8
** Denotes 1% significance

It could be inferred from table 4 that, majority of the infants (81.7 percent) of them
are given only commercial feed. Only 8.5 percent of them are given home made feed and 9.8
percent of them are given both. This clearly shows the positive association between the use of
commercial feed and increased prevalence of diarrhoea. The reason could be due to use of
contaminated feeding bottles and teats or due to lack of knowledge about the preparation of
formulas.
The chi square value denotes significance at 1% level showing that there is an
association between choice of Complementary feed and number of infants suffering from
diarrhoea. Figure 2 elucidates the relationship between choice of complementary feed and
number of children suffering from diarrhoea.
 Figure 2

Table 5
Association between time period of sterilization of bottles and
number of infants suffering from diarrhoea

Time period of Total Chi-square

Number of infants (%)
sterilization (%) value
Less than 10 min 27.0 27.0
10-20 min 55.6 55.6 14.857**
More than 20 min 17.5 17.5
** Denotes 1% significance

It is observed from table 5 that, the time period of sterilization is between 10 to 20

minutes in most of the bottle fed infants (55.6 percent). Only in 17.5 percent of bottle fed
infants the time period of sterilization is more than 20 minutes, which is the required time of
sterilization. In 27 percent of infants who are bottle fed the sterilization time is less than 10
minutes. This shows that the number of incidence of diarrhoea increases due to lack of proper
sterilization of feeding bottles. The chi square value denotes significance at 1per cent level
showing that there is an association between time period of sterilization of bottles and
number of infants suffering from diarrhoea

SUMMARY AND CONCLUSION

From the study it is confirmed that bottle fed infants are more prone to diarrhoea than
exclusively breast fed infants. It is seen that 50 percent of the infants are given
complimentary feed along with breast milk and 32 percent are given only complimentary
feed; whereas only 18 percent are given exclusive breast milk. . Thus it is observed that early
initiation of complimentary feed leads to diarrhoea.

Majority of the mothers (81.7 percent) choose commercial formula for complimentary
feeding, whereas only 8.5 percent are given home made blend and 9.8 percent were given
both. Hence it is clear that infants who are given commercial formulae are more prone to
diarrhoea The results revealed that there was a significant association between choice of
complimentary feed and monthly income. The results showed that there was a significant
association between frequency of feed and feeding method and there was a association
between time period of sterilization of bottles and number of infants suffering from diarrhoea.
This shows that the use of contaminated feeding bottles and teats are the major cause of
diarrhoea in bottle fed infants.

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