Background: Exclusive breast feeding for the first five years of life and appropriate introduction of complementary feeds is a key determinant of the nutrition status of children.

Objective: To assess the feeding practices among children under five years of age and its relationship with their nutritional status at Lagos State hospital.

Methodology: We conducted a case control study at the LSH pediatric emergency outpatient clinic between February and April 2021. Nutritional assessment was done using anthropometry weight for-height and height-for age; and examined the children for visible severe wasting as well as the presence of edema. Malnourished children who fulfilled the selection criteria and those who their parent accepted to participate in the study were consecutively enrolled into the study. And each case was matched with well-nourished controls of similar age.

Results: A total of 220 children with their mothers were enrolled in the study in which 110 were cases and 110 were control. A significantly larger proportion of malnourished children (9.4%) than well nourished children (1.8%) were given pre-lacteal feeds (p=0.036; χ2-test. There was a trend toward statistical significance in time breastfeeding was initiated between cases and controls (p=0.07; χ2-test). Slightly higher proportional (80%) of control than cases (75%) were initiated on breastfeeding in the first one hour. A significantly higher proportion (90%) of mothers of children with normal nutritional status than (78%) mothers of malnourished children exclusively breastfed their children for longer periods (p=0.001; χ2-test).Malnourished children were introduced to complimentary feeds at a significantly lower mean age (3.6±0.8 months) compared with children with normal nutrition status (3.9±.4 months) (p=0.003; t-test).

Conclusions/recommendations: An inappropriate feeding practice of infant and young children was associated with worse nutritional status. To reduce childhood malnutrition due emphasis should be given in improving the practice of parents on appropriate infant and young child feeding.

• Background of study
Globally malnutrition has been responsible, directly or indirectly, for 60.0% of the 10.9 million deaths annually among children under five. Well over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life. No more than 35.0% of infants worldwide are exclusively breastfed during the first four months of life; complementary feeding frequently begins too early or too late, and foods are often nutritionally inadequate and unsafe. (2) . Feeding practices that are reviewed in this study are breastfeeding practices and complimentary practices.

Breastfeeding Breast milk alone is ideal start to an infant’s life. Inappropriate breastfeeding, especially lack of exclusive breastfeeding during the first half-year of life are important risk factors for infant and childhood morbidity and mortality (2). Breastfeeding is nearly universal throughout the first year of life for both urban and rural children in Nigeria. In the second and third years of life, breastfeeding rates decline, and they decline more rapidly in urban areas. However, breastfeeding rates remain quite high overall through the second year in most communities. The use of baby feeding bottles is considered an unhealthy and inappropriate practice as far as child feeding is concerned. However, it is documented that the use of baby feeding bottle is still practiced in many countries; in Ghana, about 12.0% of young children are fed using baby feeding bottles (6). This practice has health and nutrition implications for young children and the community at large.

Breast milk is the best way to satisfy the nutritional and psychological need of the baby. The human milk has inherent anti-infective properties which no any other milk has this proactive of function of human milk is extremely important in developing countries where the exposure to infection is very high. Some of the advantages of breast milk according to WHO (1) are:

• Breast milk is the best natural food for the baby
• Breast milk is always clean
• Breast milk protect the baby from diseases
• Breast milk makes the baby more intelligent
• Breast milk available for twenty four hour a day and needs no special preparation
• Breast milk is nature” gift to the infant and does not need to be purchased
• Breast milk make a special relationship between the infant and the mother
• Breast milk help he parents to space their children
• Breast milk help the mother to shed the extra weight gained during pregnancy.
• Breast milk is easy to digest

Early initiation of breastfeeding
Early initiation of breastfeeding is extremely important for successful establishment of lactation as well as proving colostrums (mother’s first milk) to the baby. Ideally the baby should receive the first breast feed as soon as possible preferable within the first one hour after birth. The newborn is very active during the first half an hour, and if the baby is kept with the mother while efforts are made to breastfeed, infants learn suck very fast. This early suckling by the infant initiates the process of milk formation in the mother and help in the secretion of breast milk. In case of caesarean section, with the support for the mother, breastfeeding can be initiated within four to six hours after birth (2).

It is essential that the baby gets the first milk (colostrums) which is thicker and yellowish than the later milk. Colostrums is limited in amount and it lasts only for first few days (1).

Early initiation of breastfeeding is encouraged for a number of reasons. Mothers benefit from early suckling because it stimulates breast milk production. The first breast milk Contains colostrums, which is highly nutritious and has antibodies that protect the newborn from diseases like diarrhea that predispose the child to early malnutrition. Early initiation of breastfeeding also fosters bonding between mother and child.

Globally, over one million newborn infants could be saved each year by initiating breastfeeding within the first hour of life. In developing countries alone, early initiation of breastfeeding could save as many as 1.45 million lives each year by reducing deaths mainly due to diarrheal disorders and lower respiratory tract infections in children (4). WHO recommends early initiation of breastfeeding (i.e. within one hour of giving birth). A recent trial has shown that early initiation of breastfeeding could reduce neonatal mortality by 22%. This would go a long way in the achievement of the Millennium Development Goals (5).

Overall in Nigeria, 58 percent of children are breastfed within one hour of birth and 86 percent within one day after delivery. Forty-two percent of children are given something before breastfeeding (prelacteal feed). The proportion of children who receive a prelacteal feed is negatively correlated with the level of education of the mother; children whose mothers have no education are the most likely to receive a prelacteal feed (54%), while those whose mothers have attended primary school are the most likely to receive a prelacteal feed (54%), while those whose mothers have attended secondary school are the least likely to be fed before starting breastfeeding (36 percent). Children born at home are more likely to receive a prelacteal feed (51%) than those born in a health facility (31%). The proportion of children who receive a prelacteal feed is negatively correlated with the household wealth (9).

• Problem Statement
Under nutrition is a human disaster on a vast scale especially among children under two years of life living in developing countries communities. Chronic under nutrition affects one in three children in developing countries. Malnutrition accounts for the death of more than 3 million children and more than 100,000 mothers every year. Under nutrition cripples the immune system, making children much more susceptible to disease. It increases the risk of anemia and women dying during pregnancy and childbirth. It prevents proper brain development, which means children are less able to start school when they should, and less able to learn and perform. Adults who were undernourished in childhood earn significantly less and contribute less to economic growth. Under nutrition also reduces Gross Domestic Product in every country across the globe. The immediate causes include inadequate dietary intake and disease. Underlying these are causes operating at household and community levels: household food insecurity, inadequate care for women and children, and unhealthy household environments and lack of health services, with income poverty underpinning all three.

• Study justification
Good nutrition in early ages is translated into high productivity and economic development at the national level. There is increasing recognition that optimal complementary feeding depends not only on what is fed, but also on how, when, where, and by whom the child is fed (38) Poor feeding practices lead to malnutrition. This study looked at the association of feeding practices and malnutrition in our set up.

The results will also serve as baseline data for the Lagos State. It shall also provide information on the feeding practices associated with children with malnutrition in the area. Understanding the practices and the possible reason for the feeding practices is important as it will guide us in coming up with better interventions informed by local findings. The results of this study will guide interventions specific to the target population.

• General Objective
To compare infant feeding practices among children aged under 5 with PEM, with that of healthy controls at Lagos State hospital.

• Specific Objectives
• To compare breastfeeding practices (timing of initiation and duration of exclusive breastfeeding among children aged under 5 with PEM, with that of healthy controls at Lagos State hospital.

• To compare complementary feeding practices among children aged under 5 with PEM, with that of healthy controls at Lagos State hospital.

• To compare the social economics characteristics among children aged under 5 with PEM, with that of healthy controls at Lagos State hospital.

• Research questions
• Is there an association between exclusive breast-feeding practice of children when they are under 5 and their nutritional status at Lagos State hospital?

• Is there an association between feeding practice of children aged under 5 and their nutritional status at Lagos State hospital?

• Delimitations
This study was carried out in an urban public health centre and the findings can only be generalized to mothers of mothers of under five children.

• Limitations
The sample was recruited from a health centre and not from the households and therefore not be representative of the entire Lagos state population since not all mothers in urban areas attend public health centers for child welfare clinics especially those from middle and higher socio-economic classes.

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