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Early child health in Lahore, Pakistan: V. Feeding patterns
R N Ashraf1, F Jalil, S R Khan
1Department of Social and Preventive Pediatrics, King Edward Medical College, Lahore, Pakistan.
Insights
Breastfeeding is common in Pakistan, but delayed initiation and prelacteal feeds are prevalent. Exclusive breastfeeding is rare, with early introduction of supplements and bottles impacting infant nutrition.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Infant feeding practices are critical for child survival and development.
- Understanding feeding patterns in diverse socioeconomic settings is essential for targeted interventions.
- Longitudinal data on infant nutrition in Pakistan is limited.
Purpose of the Study:
- To describe infant feeding practices from birth to 24 months in Lahore, Pakistan.
- To analyze feeding patterns across different socioeconomic and urbanization levels.
- To identify key challenges in optimal infant nutrition.
Main Methods:
- Longitudinal study of 1476 children aged 0-24 months.
- Inclusion of four distinct socioeconomic groups: village, periurban slum, urban slum, and upper middle class.
- Data collection on breastfeeding initiation, exclusivity, supplementation, and complementary feeding.
Main Results:
- Delayed breastfeeding initiation and prelacteal feeding were common across all groups.
- High prevalence of breastfeeding at one month (87-98%), but exclusive breastfeeding was rare (9% at one month).
- Early introduction of water, animal milk, and formula was observed, with bottle use widespread (82-100%).
- Significant delays in introducing semi-solids in lower socioeconomic groups compared to the upper middle class.
Conclusions:
- While breastfeeding is prevalent, suboptimal practices like delayed initiation and prelacteal feeding undermine optimal infant nutrition in Pakistan.
- Widespread use of feeding bottles and early introduction of supplements necessitate targeted health education.
- Interventions should focus on promoting timely breastfeeding initiation, exclusive breastfeeding, and appropriate complementary feeding practices.
Abstract:
The feeding practices of children (n = 1476) from birth to 24 months, as determined in a longitudinal study, in Lahore, Pakistan, are presented. Four socioeconomic groups at various levels of urbanization were included; a village, periurban slum, urban slum and an upper middle class. Initiation of breastfeeding was delayed in all the neonates. Sixty-five percent of the periurban slum mothers and 45% of the village mothers had not started breastfeeding at 48 hours after the birth of the infant. Prelacteal feedings, especially of herb water and honey, were the norm. Breastfeeding was highly prevalent. Eighty-seven to 98% of the infants in all the areas were breastfed at one month of age. Exclusive breastfeeding was rare, with 9% at one month, declining rapidly with age and being highly influenced by season. Partial breastfeeding was the most common mode of feeding. Water in addition to human milk was given by 45-73% of the mothers living in the urban slum, village and periurban slum at one month of age. Fresh animal milk and/or commercial formula was already being given at 1 month by 22-64% of the mothers in all areas. Commercial formula was the preferred food in the upper middle class, while in the other three areas it was rare and fresh animal milk was mainly used. More than 50% of the mothers in the village and in the periurban slum gave diluted animal milk even beyond the age of 10-15 months. In the upper middle class 50% of the infants were fed semisolids at the age of four months, while in the village, the periurban and the urban slum at 6 months of age only 10%, 12% and 47% of the infants received semisolids. The results of this study indicate that breastfeeding was highly prevalent in the three poorest areas. However, in all the areas initiation of breastfeeding was delayed and prelacteal feeding was the norm. Exclusive breastfeeding was rare, feeding bottles were used by 82-100% of the mothers to feed supplements and human milk substitutes, in the four areas.