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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 4  |  Page : 321-324

Assessment of proper technique of artificial feeding among infants in Al-Hilla City


1 Department of Family and Community Medicine, College of Medicine, University of Babylon, Hillah, Babylon, Iraq
2 Department of Pediatrics, College of Medicine, University of Babylon, Hillah, Babylon, Iraq

Date of Submission01-Oct-2019
Date of Acceptance15-Oct-2019
Date of Web Publication23-Dec-2019

Correspondence Address:
Dr. Dalya Muayad Al Maroof
Department of Family and Community Medicine, College of Medicine, University of Babylon, Hillah, Babylon
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_63_19

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  Abstract 


Background: Infant formula is considered an effective alternative to breast milk. Safe preparation of infant formula is a crucial goal by the World Health Organization for infants receiving some or all of their feeding using infant formula. Objectives: The objective is to find out the errors in the method of bottle-feeding which leads to feeding problems in infants in Al-Hilla city. Methods: This cross-sectional study was conducted on a convenient sample of 384 infants (who attended the general wards in Babylon Maternity and Pediatric Hospital, AL-Noor Hospital and some primary health-care centers). Results: The percentage of mothers who had followed all the recommended steps for feeding and sterilization of infant bottle was (16.90%). Conclusions: Very low percentage of mothers were found to follow all the proper steps of bottle-feeding.

Keywords: Bottle-feeding, breast milk, infant formula


How to cite this article:
Al Maroof DM, Noor MH. Assessment of proper technique of artificial feeding among infants in Al-Hilla City. Med J Babylon 2019;16:321-4

How to cite this URL:
Al Maroof DM, Noor MH. Assessment of proper technique of artificial feeding among infants in Al-Hilla City. Med J Babylon [serial online] 2019 [cited 2020 Jan 28];16:321-4. Available from: http://www.medjbabylon.org/text.asp?2019/16/4/321/273781




  Introduction Top


Breast milk is the ideal form of infant feeding for almost all infants. It has multiple advantages to the mother and infant. It permits proper growth and development of little infants.[1],[2],[3]

The choice for breastfeeding is very personal and is influenced by several conditions. Infant formula is found to be an effective alternate to breastfeeding, and it is prepared to simulate the nutritional contents of human milk. Various causes to select formula feeding include mother's sickness, some of the breast diseases, and conception of deficiency of breast milk.[4],[5],[6]

The forms of the infant formulas can be liquids or reconstituted powders fed to infants. These infant formulas can be used as an alternate to breast milk. In some children, infant formulas have a significant role in diet because they can be the only source of food for them.[7]

Bottle-fed infants do not have the same level of immunological protection as breast-fed infants; hence, rigid hygiene procedures are essential in the preparation of feed. Good infant feeding practices are the foundation of a healthy life, so safe utilization of formula is a crucial goal recognized by the World Health Organization (WHO) for infants who get some or all of their feeding using infant formula.[8],[9],[10]

A lack of solid data and studies regarding bottle-feeding practices in Iraq was the main reason for conducting the current study. No studies examined how mothers made decisions about the frequency or quantity of bottle-feeds. In addition to a deficit of studies in the world that's related to the current study.

One study done in Pakistan had addressed the cleaning practices and contamination status of feeding bottles among caregivers.[11]

In 2009, a systemic review done in the United Kingdom which assessed the mothers' experiences of bottle-feeding showed apparent mistakes in the preparation of bottle-feeds among mothers.[2]

In 2005, a Survey of Infant Feeding showed that almost half of the mothers who prepared powdered infant formula did not follow key recommendations, which are intended to reduce the risk of infection and overconcentration.[12]

A qualitative study conducted in India related to bottle-feeding practices among mothers had shown that a majority of them practiced hygienic bottle-feeding measures.[13]


  Materials and Methods Top


Study design, setting, and time

This cross-sectional study was carried out in Babylon Maternity and Pediatric Hospital, AL-Noor Hospital, and some primary health-care centers. Data collection was done from February 1 to May 1, 2019.

Sampling method

A convenient sample of 384 infants was approached (who attended the general wards at the above-mentioned hospitals and primary health-care centers).

Inclusion criteria

The inclusion criteria included bottle-fed infants aged from 1 month to 1 year whose mothers agree to participate.

Questionnaire form

A specially designed questionnaire was prepared which was partially adapted from the Food and Agriculture Organization/WHO and UNICEF guidelines for the preparation of bottle-feeding,[14],[15],[16] The questionnaire consisted of the following two parts:

  • The first part contains two sections:First, the sociodemographic data related to the mother
  • The second section of this part was related to the demographic data of the infant
  • The second part of the questionnaire included methods of feeding and sterilization of infant bottle, which were modified from the WHO and UNICEF steps for safe preparation of powdered infant formula as follows.


Calculation of proper technique of bottle-feeding

The study participants were divided into two groups according to the proper technique: proper group and improper one.

  • Proper group: Those who follow all the recommended steps of safe preparation of infant formula that were modified from the WHO, Centers for Disease Control and Prevention, and UNICEF guidelines
  • Improper group: Those who did not follow all the recommended steps (had a defect in some or more points).


Statistical analysis

Statistical Package for Social Sciences version 24 (SPSS, IBM Company, Chicago, USA) was used for data input and analysis.

Categorical variables were presented as frequencies and percentages. Chi-square test and P value were used to determine the differences between the two sample groups (proper and improper techniques).

Findings with P < 0.05 were considered statistically significant.

Ethical consideration

  1. The study protocol was approved by the Ethical Committee of Babylon University/College of Medicine
  2. Written agreement was obtained from the Babylon Health Directorate
  3. Verbal consents were obtained from the mothers prior to interviewing, after explaining the objectives of the study.



  Results Top


A total of 384 mothers were enrolled in this study. The most prevalent age group (38.3%) was between 21 and 30 years old, 51.3% of them had institute/college or higher level of education, a high percentage (57.6%) of them were homemakers, 69.5% of them were from urban area, and 68% of them have ≤3 children. Regarding socioeconomic status, 83.9% of them had enough income. Results also found that 29.9% of infants were aged 7.8–9.5 months, 51.3% of them were males, the average weight was between 7.8 and 9.5 kg. The more percentage (37%(of infants for sequences of child in family, was between ages 4 and 5.

Assessment of technique of bottle-feeding

In our study, a low percent (16.90%) of mothers had followed all the recommended steps for feeding and sterilization of infant bottle, who were considered proper group, whereas 83.1% had not followed all the recommended steps for feeding and sterilization of infant bottle, who were considered improper group [Figure 1].
Figure 1: Assessment of technique of bottle-feeding

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There was a positive significant association between proper technique with enough economic state of family and high educational level of mother. The employed mothers followed the proper technique more commonly than homemakers. In addition, urban background of mother was associated with proper technique than those from rural background [Table 1].
Table 1: Methods of feeding and sterilization of infant bottle

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  Discussion Top


The safe use of infant formula is challenging in developing world.[17] Supporting proper infant formula preparation may lead to positive short-term and long-term health outcomes for formula-fed infants.[18]

Despite a large proportion receiving formula, relatively little research has focused on understanding behaviors regarding the proper preparation and feeding of infant formula in the populations of healthy infants.[2],[19],[20],[21]

To our knowledge, this is the first study in Iraq that assesses the proper technique of artificial feeding among infants.

It was found that a low percent (16.9%) of mothers follow all the proper steps of bottle-feeding. This point should not be neglected and efforts are needed to elevate this level of technique. This result may be due to a defect in knowledge about appropriate steps of infant bottle preparation and feeding and most efforts concentrate on the steps of successful breast-feeding with a neglecting of that part of “infants that had difficulties in breast-feeding must be on bottle-feeding”.

Each step in the formula preparation process is an opportunity for bacterial contamination.[22]

There was a positive significant association between proper technique and enough economic status of family and high educational level of mother. This is not unexpected as high-income families may have appropriate conditions to get proper steps of bottle-feeding than low-income families. In addition, a high educational level of mothers plays an important role in many aspects of health promotion of children.

Although employed mothers do not have enough time to take care of their infant, in the current study, it was found that employed mothers followed proper technique more commonly than homemakers. This may be related to their good educational level or long maternity leave for taking care of their infants.

In addition, urban background of mother was associated with proper technique than rural background. This could be related to a high educational level of urban people than rural ones. There was no association between the level of technique and age of mothers, marital status, number of children, pregnancy status, or infants' gender.


  Conclusions Top


Very low percentage (16.9%) of mothers were found to follow all the proper steps of bottle-feeding, whereas a high percentage followed improper technique of bottle-feeding.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lessen R, Kavanagh K. Position of the academy of nutrition and dietetics: Promoting and supporting breastfeeding. J Acad Nutr Diet 2015;115:444-9.  Back to cited text no. 1
    
2.
Lakshman R, Ogilvie D, Ong KK. Mothers' experiences of bottle-feeding: A systematic review of qualitative and quantitative studies. Arch Dis Child 2009;94:596-601.  Back to cited text no. 2
    
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Happe RP, Gambelli L. Infant formula. In: Specialty oils and fats in food and nutrition. Ed Talbot G. Woodhead Publishing, Cambridge, UK, 2015; Chapter 12:285-315.  Back to cited text no. 3
    
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Martin CR, Ling PR, Blackburn GL. Review of infant feeding: Key features of breast milk and infant formula. Nutrients 2016;8. pii: E279.  Back to cited text no. 4
    
5.
Zhang K, Tang L, Wang H, Qiu L, Binns CW, Lee AH, et al. Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff. Int J Environ Res Public Health 2015;12:4520-32.  Back to cited text no. 5
    
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Kozhimannil KB, Jou J, Attanasio LB, Joarnt LK, McGovern P. Medically complex pregnancies and early breastfeeding behaviors: A retrospective analysis. PLoS One 2014;9:e104820.  Back to cited text no. 6
    
7.
Institute of Medicine FaNB, Committee on the Evaluation of the Addition of Ingredients New to Infant Formula. Infant Formula: Evaluating the Safety of New Ingredients. Washington (DC): National Academies Press (US); Available from: https://www.mightyape.com.au/product/infant-formula/3894735. [Last accessed on 2019 Mar 20].  Back to cited text no. 7
    
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Hileti-Telfer D. Infant foods milk formulas. In: Caballero B, editor. Encyclopedia of Food Sciences and Nutrition. 2nd ed. Oxford: Academic Press; 2003. p. 3270-6.  Back to cited text no. 8
    
9.
Abrams SA, Daniels SR. Protecting vulnerable infants by ensuring safe infant formula use. J Pediatr 2019;211:201-6.  Back to cited text no. 9
    
10.
Wijesundara B. Infant Formula Promotion and Infant Feeding Practices; International Conference on Business & Information (ICBI 2011) at University of Kelaniya; 2011.  Back to cited text no. 10
    
11.
Ayaz F, Ayaz SB, Furrukh M, Matee S. Cleaning practices and contamination status of infant feeding bottle contents and teats in Rawalpindi, Pakistan. Pak J Pathol 2017;28:13-20.  Back to cited text no. 11
    
12.
Bolling K, Grant C, Hamlyn B, Thornton A. Infant Feeding Survey 2005: A Commentary on Infant Feeding Practices in the UK. United Kingdom; 2007.  Back to cited text no. 12
    
13.
Lokare L, Hippargi A. Qualitative exploration of bottle feeding practices among mothers of Dharwad district, Karnataka: A focus group discussion study. Int J Community Med Public Health 2017;3:90-3.  Back to cited text no. 13
    
14.
United Nations Children's Fund. Guide to Bottle Feeding. United Nations Children's Fund; 2015. Available from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf. [Last accessed on 2019 Apr 20].  Back to cited text no. 14
    
15.
Food and Agricultural Organization, World Health Organization. How to Prepare Formula for Bottle-Feeding at Home. Food and Agricultural Organization, World Health Organization; 2007. Available from: https://www.who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf. [Last accessed on 2018 Dec 10].  Back to cited text no. 15
    
16.
Food and Agricultural Organization, World Health Organization. Safe Preparation, Storage and Handling of Powdered Infant Formula Guidelines. and Agricultural Organization, World Health Organization; 2007. Available from: http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf. [Last accessed on 2019 Jun 12].  Back to cited text no. 16
    
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Gardy ZM, Othman NR, Majaed AO. Efficacy of cleaning and disinfecting infant bottle feeding by mothers in Raparin Teaching Hospital at Erbil city/Kurdistan Region Kufa. J Nur Sci 2016;6:91-101.  Back to cited text no. 17
    
18.
Ellison RG, Greer BP, Burney JL, Goodell LS, Bower KB, Nicklas JC, et al. Observations and conversations: Home preparation of infant formula among a sample of Low-income mothers in the southeastern US. J Nutr Educ Behav 2017;49:579-870.  Back to cited text no. 18
    
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Fein SB, Falci CD. Infant formula preparation, handling, and related practices in the United States. J Am Diet Assoc 1999;99:1234-40.  Back to cited text no. 19
    
20.
Renfrew MJ, Ansell P, Macleod KL. Formula feed preparation: Helping reduce the risks; a systematic review. Arch Dis Child 2003;88:855-8.  Back to cited text no. 20
    
21.
Siega-Riz AM, Deming DM, Reidy KC, Fox MK, Condon E, Briefel RR, et al. Food consumption patterns of infants and toddlers: Where are we now? J Am Diet Assoc 2010;110:S38-51.  Back to cited text no. 21
    
22.
Green Corkins K, Shurley T. What's in the bottle? A review of infant formulas. Nutr Clin Pract 2016;31:723-9.  Back to cited text no. 22
    


    Figures

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    Tables

  [Table 1]



 

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