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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 502-508

Impact of breastfeeding on respiratory and gastrointestinal infections in infants of Muslim mothers of Kolkata, India


1 Department of Bio-Science, Seacom Skills University, Birbhum, India
2 Department of Community Medicine, Malda Medical College and Hospital, Malda, India
3 Department of Sociology, Seacom Skills University, Birbhum, West Bengal, India

Date of Submission13-Oct-2022
Date of Acceptance31-Oct-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Mohammed Hossain
Department of Bio-Science, Seacom Skills University, Birbhum 731236, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_195_22

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  Abstract 

Background: Breast milk contains some proteins whose functions are not nutritive but anti-infective, which prevents infants from infections. Objective: The objective of the present study was to evaluate an association between the occurrence of diarrhea and respiratory tract infection (RTI) and breastfeeding among infants of Muslim mothers in Kolkata. Materials and Methods: An observational cross-sectional community-based study was conducted among mother–infant pairs of a total of 540 numbers in Muslim-dominated urban slums of Kolkata. The study period was from November 1, 2017, to October 31, 2018. Results: The findings indicated that 82.22% of breastfed infants had no diarrhea, and the absence of RTI was observed in 69.81%. It was also noted that both episodes of diarrhea and RTI in infants become less when the duration of breastfeeding increases. The study also significantly (P < 0.001 and P = 0.03) revealed that the occurrence of diarrhea and RTI was found to have lower incidence in colostrum-fed babies. Out of 391 colostrum-fed babies, about 85.42% had no diarrhea, and the absence of RTI was noticed in 72.12%. In conclusion, breast milk gives protection to babies against diarrheal diseases and RTI. It is the most appropriate food for infants. Conclusions: It is concluded that the prevention of RTI and diarrhea in infants, exclusive breastfeeding (EBF), early initiation of breastfeeding, and avoidance of bottle feeding should be the best practice to be recommended. To explore appropriate intervention strategies for reinforcing early initiation and continuation of EBF from birth to 6 months of life.

Keywords: Brest-fed babies, colostrum feeding, exclusive breastfeeding, infants health, Muslim mothers, prevention of diarrhea, prevention of respiratory tract infection


How to cite this article:
Hossain M, Talapatra SN, Mondal N, Mukherjee SS. Impact of breastfeeding on respiratory and gastrointestinal infections in infants of Muslim mothers of Kolkata, India. MGM J Med Sci 2022;9:502-8

How to cite this URL:
Hossain M, Talapatra SN, Mondal N, Mukherjee SS. Impact of breastfeeding on respiratory and gastrointestinal infections in infants of Muslim mothers of Kolkata, India. MGM J Med Sci [serial online] 2022 [cited 2023 Feb 7];9:502-8. Available from: http://www.mgmjms.com/text.asp?2022/9/4/502/365988




  Introduction Top


Breast milk is the most appropriate and ideal food for the infant. The baby does not require any food other than breast milk until 6 months of age. The data suggest that infant mortality rates in the developing countries are 5–10 times higher among children who have not been breastfed or who have been breastfed for less than 6 months.[1] It contains antimicrobial factors such as macrophages, lymphocytes, secretory IgA, antistreptococcal factor, lysozyme, and lactoferrin, which provide considerable protection not only against diarrheal diseases and necrotizing enterocolitis but also against respiratory infections in the first month of life.[2]

In other words, breast milk contains other proteins whose functions are not nutritive but anti-infective, e.g., IgG, lysozyme, and living cells. In the intestine, lactose helps the “right” kind of bacteria (i.e., Lactobacillus bifidus) to grow. Lactobacillus and lactose help keep the intestinal content acidic, which inhibits the growth of harmful bacteria.[3] Colostrum is the few (around 60 mL) of milk immediately delivered. It is rich in proteins, vitamins A and K, and immunoglobulins (IgA). IgA acts as an intestinal antiseptic paint. It is anti-infective. It protects the child against respiratory and alimentary diseases and also against allergic bronchitis, asthma, etc. It is the first natural vaccine the child receives from the mother.[4]

Breastfeeding is a “lifeline” for newborn babies and should be started immediately after birth. Although breastfeeding is a nearly universal practice in India, very few children are put on breastfeeding immediately after delivery.[5] National Family Health Survey (NFHS-4) (2015–2016) data provide cardinal information on breastfeeding practices in India. About 41.6% of children <3 years breastfed <1 h, 54.9% of newborn <6 months had exclusive breastfeeding (EBF), and 42.7% of children 6–8 months received a solid/semisolid diet. NFHS-4 West Bengal (urban) data show the initiation of breastfeeding <1 h—48.2%, EBF—61.6%, and children received a solid/semisolid diet between 6 and 8 months—46.3%.[6]

About 36% of women squeezed out the first milk from the breast (discarded colostrum) and then started breastfeeding. Thus, the beginning of breastfeeding is delayed and the newborn is unduly deprived of the most nutritious nourishment and energy.[7] The introduction of supplementary foods before 6 months of age may put infants at risk of malnutrition because other liquids and solids are nutritiously inferior to breast milk. The consumption of liquids and solid smashed foods at an early age also increases children’s exposure to pathogens and consequently puts them at a greater risk of diarrhea.[8] As 61% of children were exclusively breastfed at 6 months of age and thus over 39% of children were exposed to the risk of infection-prominent diarrheal diseases. Because only 48.2% of newborn babies were put on breastfeeding within 1 h of birth, it shows that the initiation of breastfeeding is delayed.

The goal of the 10th plan (2002–2007) was to initiate early commencement of breastfeeding (colostrum) from the status of 15.8%–50% and to promote absolute and EBF rate for children till the age of 6 months from the current rate of 55% to 80% and the enhancement of complementary feeding rate at 6 months from the current level of 33.5% to 75%.[9]

A study in Ethiopia revealed that infants who were exclusively and predominantly breastfed had a lower prevalence of diarrhea. Early initiation of breastfeeding (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.72–0.92) and EBF (OR: 0.65; 95% CI: 0.51–0.83) were associated with a lower risk of Acute Respiratory Infection (ARI). Early initiation of breastfeeding and EBF were associated with lower odds of diarrhea (OR: 0.88; 95% CI: 0.79–0.94 for early initiation of breastfeeding and OR: 0.51; 95% CI: 0.39–0.65 for EBF). Infants who were predominantly breastfed were likely to experience less probability of diarrhea (OR: 0.69; 95% CI: 0.53–0.89).[10]

Another study carried out by Penugonda et al. showed that 185 (69 EBF + 116 non-EBF) of 450 infants reported a total of 242 illnesses, most commonly respiratory (86.6%) followed by gastrointestinal (11.6%). The number of illnesses per infant was 0.45 and 0.6 in EBF and non-EBF, respectively (P = 0.015). Illness incidences in EBF infants were significantly lower during all successive time intervals after 10 weeks of age. Logistic regression analysis confirmed significantly lower illness incidence in EBF infants at 10–14 weeks (OR: 0.27 [CI: 0.12–0.64]).[11]

Because many studies have been conducted on the impact of breastfeeding on respiratory and gastrointestinal infections of babies at different locations and various groups in India, this article aims to examine the early initiation of breastfeeding, EBF, etc., among babies of Muslim women in Kolkata.


  Materials and methods Top


Study design

The present study was conducted as a descriptive, observational, community-based approach and data were collected with the help of open- and closed-structured questionnaires as well as discharge certificate of the mothers to find out the type of facilities and mode of delivery during the house-to-house survey.

Study setting

A cross-sectional study was carried out across six Muslim-dominated localities of Kolkata, namely Motijheel, Bibi Bagan, Tangra and Ripon Street, Chatu Babu Lane, and Raja Bazar. The majority of the population is comprised of the Muslim community. These areas were selected based on high priority related to low socioeconomic conditions and low awareness of the health of children and their breastfeeding practices.

Sample size

The sample size calculation was based on two groups of mothers: one group having a child <6 months, which was found to be 300 numbers, and the other group aged 6–12 months having children of 240 numbers. Thus, a total of 540 mother–infant pairs were selected for the study in six clusters.

Study participants

A total sample of 540 mothers age ranged between 18 and 45 years were interviewed by a house-to-house survey by random cluster sampling in the above-specified Muslim-dominated areas.

Period of study

The study was conducted for 1 year from November 1, 2017, to October 31, 2018.

Data collection

Information related to appropriate infant feeding practices in the initial first 6 months, e.g., rate of early initiation of breastfeeding and impact of various demographic and socioeconomic factors of mothers such as age groups, educational level, place of delivery, family income, prelacteal, and colostrum feed on the same, were collected. Also, incidences of babies who presented common illnesses predominantly, e.g., respiratory tract infection (RTI) and diarrhea, were considered. The study was done after receiving data received from government and private hospitals in Kolkata, India. The protocol for infant feeding method and practices were followed as per National Guidelines on Infants and Young Child Feeding.[12]

Inclusion criteria

The inclusion criteria were mainly mothers who delivered their babies and those with children <12 months of age.

Exclusion criteria

The exclusion criteria were selected for which pregnant women or mothers having a child with any kind of malformation.

Statistical analysis

Data entry was done by Epi Info, statistical software for epidemiology developed by Centres for Disease Control and Prevention in Atlanta, Georgia (USA), and validated by double entry. The data were further analyzed statistically to come out with observations and a realistic conclusion. P < 0.05 was considered significant.

Ethical approval

Ethical approval was given by Kolkata Municipal Corporation, Kolkata, West Bengal, India, to survey its six Muslim-dominated wards. The ethical committee has given written permission with memo no. H/00/113/17–18 dated July 19, 2017, for conducting the present research work.


  Results Top


In our study [Table 1], out of 540 children, 256 (47%) were females and 284 (53%) were males. Most of the mothers were in the age group of 20–29 years, 209 (38.70%) within 20–24 years, and 217 (40.19%) within 25–29 years. As regards, the educational category, the majority, 220 (40.74%) mothers were educated up to the primary level; by profession, 534 (98.89%) were housewives; by type of families, 390 (72.22%) belonged to joint families; by parity, 315 (58.33%) were multigravida; and by socioeconomic condition, 322 (59.63%) had family income between Rs. 5000 and 10000 per month. Our study revealed that out of 540 mothers who had ever breastfed their child, 444 (82.22%) mothers did not experience episodes of diarrhea in their babies, whereas 96 (17.78%) mothers did have diarrhea in their children. So, the majority of breastfed mothers had no diarrhea in their children.
Table 1: Prevalence of diarrhea in breastfed babies (N = 540)

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Out of 540 mothers who had ever breastfed their child, 377 (69.81%) mothers did not experience episodes of RTI in their babies, whereas 163 (30.19%) mothers did have RTI in their children. So, the majority of breastfed mothers had no RTI in their children [Table 2].
Table 2: Prevalence of respiratory tract infection in breastfed babies (N = 540)

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Out of 540 mothers, 387 mothers were asked about the occurrence of diarrhea in their babies. The remaining 153 mothers could not be asked because their babies did not complete 6 months of age. Out of 387 mothers, nine mothers breastfeed their babies for <1 month, among which eight (88.89%) mothers did not notice diarrhea in their babies in comparison to one (11.11%) mother who had noticed diarrhea in their babies. Out of 43 mothers who continued breastfeeding for >6 months, 33 (76.74%) had no diarrhea in their babies in comparison to 10 (23.26%) mothers who had diarrhea in their children. Out of 167 mothers who continued breastfeeding for up to 1 month, 132 (79.04%) had no diarrhea in their babies in comparison to 35 (20.26%) mothers who had diarrhea in their children. Out of 26 mothers who continued breastfeeding for up to 2 months, 20 (76.92%) had no diarrhea in their babies in comparison to six (23.08%) mothers who had diarrhea in their children. Out of 23 mothers who continued breastfeeding for up to 3 months, 16 (69.57%) had no diarrhea in their babies in comparison to seven (30.43%) mothers who had diarrhea in their children. Out of 22 mothers who continued breastfeeding for up to 4 months, 13 (59.09%) had no diarrhea in their babies in comparison to nine (40.91%) mothers who had diarrhea in their children. Out of 21 mothers who continued breastfeeding for up to 5 months, 16 (76.19%) had no diarrhea in their babies in comparison to five (23.81%) mothers who had diarrhea in their children. Out of 76 mothers who continued breastfeeding for up to 6 months, 65 (85.53%) had no diarrhea in their babies in comparison to 11 (14.47%) mothers who had diarrhea in their children. Increased episodes of diarrhea were seen in infants breastfed till the second, third, and fourth months. Episodes of diarrhea started decreasing from the fifth month onward. As the duration of breastfeeding became longer, episodes of diarrhea started decreasing [Table 3].
Table 3: Prevalence of episodes of diarrhea in babies concerning the duration of breast feeding (N = 540)

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Out of 540 mothers, 387 mothers were asked about the occurrence of RTI in their babies. The remaining 153 mothers could not be asked because their babies did not complete 6 months of age. Out of 387 mothers, nine mothers breastfeed their babies for <1 month, among which nine (100%) mothers did not notice RTI in their babies. Out of 43 mothers who continued breastfeeding for >6 months, 32 (74.42%) had no RTI in their babies in comparison to 11 (25.58%) mothers who had RTI in their children. Out of 167 mothers who continued breastfeeding for up to 1 month, 105 (62.87%) had no RTI in their babies in comparison to 62 (37.13%) mothers who had RTI in their children. Out of 26 mothers who continued breastfeeding for up to 2 months, 17 (65.38%) had no RTI in their babies in comparison to nine (34.62%) mothers who had RTI in their children. Out of 23 mothers who continued breastfeeding for up to 3 months, 11 (47.83%) had no RTI in their babies in comparison to 12 (52.17%) mothers who had RTI in their children. Out of 22 mothers who continued breastfeeding for up to 4 months, 14 (63.64%) had no RTI in their babies in comparison to eight (36.36%) mothers who had RTI in their children. Out of 21 mothers who continued breastfeeding for up to 5 months, 15 (71.43%) had no RTI in their babies in comparison to six (28.57%) mothers who had RTI in their children. Out of 76 mothers who continued breastfeeding for up to 6 months, 53 (69.74%) had no RTI in their babies in comparison to 23 (30.26%) mothers who had RTI in their children. Increased episodes of RTI were seen in infants breastfed till the first and third months. Episodes of RTI decreased in infants breastfed till the second, fourth, and fifth months. There was a slight rise of RTI in infants breastfed till 6 months. On average, as the duration of breastfeeding became longer, episodes of RTI started decreasing [Table 4].
Table 4: Prevalence of episodes of respiratory tract infection concerning the duration of breastfeeding (N = 540)

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Out of 540 mothers, 391 gave their babies colostrum feed. Out of 391 mothers who fed their babies colostrum, 334 (85.42%) mothers did not notice diarrhea in their babies in comparison to 57 (14.58%) mothers who found diarrhea in their babies. So, diarrhea happened less in colostrum-fed babies. Again, out of 149 mothers who did not feed their babies colostrum, 110 (73.83%) mothers did not find diarrhea in their child in comparison to 39 (26.17%) mothers who found diarrhea in their babies. So, here also diarrhea happened less in non-colostrum-fed babies. But in comparison to the incidence of diarrhea among colostrum-fed and non-colostrum-fed babies, we find that the incidence of diarrhea is increased in non-colostrum-fed babies. Similarly, in comparison to the nonoccurrence of diarrhea among colostrum-fed and not fed babies, we find that nonoccurrence of diarrhea is reduced in not fed babies. The result is statistically significant [Table 5].
Table 5: Relation of diarrheal incidence with colostrum feeding (N = 540)

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Out of 540 mothers, 391 gave their babies colostrum feed. Out of 391 mothers who fed their babies colostrum, 282 (72.12%) mothers did not notice RTI in their babies in comparison to 109 (27.88%) mothers who found RTI in their babies. So, RTI happened less in colostrum-fed babies. Again, out of 149 mothers who did not feed their babies colostrum, 95 (63.76%) mothers did not find RTI in their child in comparison to 54 (36.24%) mothers who found RTI in their babies. So, here also, RTI happened less in non-colostrum-fed babies. But in comparison to the incidence of RTI among colostrum-fed and non-colostrum-fed babies, we find that the incidence of RTI is increased in non-colostrum-fed babies. Similarly, in comparison to the nonoccurrence of RTI among colostrum-fed and not fed babies, we find that nonoccurrence of RTI is reduced in not fed babies. The result is statistically significant [Table 6].
Table 6: Relation of respiratory tract infection incidence with colostrum feeding (N = 540)

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  Discussion Top


It is a well-known fact that breast milk prevents infectious diseases among babies. In the present study, the findings were based on the prevalence of diarrhea and RTI after breastfed babies. As regards the prevalence of diarrhea among breastfed infants, we found in our study that 82.22% of infants had no diarrhea. This means that breastfed infants are less likely to develop diarrhea. Though statistically not significant (P = 1), the result is quite impressive and encouraging. Wright et al.[13] conducted a study on diarrheal episodes in breastfed and non-breastfed infants, and their study revealed that at 2 months of age, breastfed infants had diarrhea (5%) when compared with non-breastfed infants, who had observed diarrhea (15%). The result also showed that at 6 months, breastfed infants had diarrhea (21.55%) in comparison with non-breastfed infants (24.97%). A similar observation was exhibited in our study that the prevalence of diarrhea is less in breastfed infants. Thus, it is quite evident that breastfeeding boosts intestinal immunity, which further prevents babies from diarrhea.[10],[11]

Concerning the prevalence of RTI in breastfed and non-breastfed infants, our study indicated that RTI (30.19%) occurred in breastfed infants and nonoccurrence of RTI (69.81%) in breastfed babies. So, we find that breastfed babies suffer less from RTI. According to Oddy et al., it was known that breastfeeding had good impact to prevent RTI, which RTI was common with 60% of breastfed infants with at least one episode, 28% having one to three, and 12% having four and more episodes.[14] So, in our study, the occurrence of RTI among breastfed infants had a lower impact compared with the occurrence of the same in Oddy’s study. Another study conducted by Pandolfi et al. showed that RTI occurred in 44.5% of breastfed babies.[15] Here also, we noticed that the occurrence of RTI in breastfed infants was more in comparison to the same in our study.

In the present study, we analyzed the relationship between the duration of breastfeeding and the occurrence of diarrhea. We noted that babies breastfed <1 month, till 1 month, up to 2 months, up to 3 months, up to 4 months, up to 5 months, and up to 6 months had no diarrhea of about 88.89%, 79.09%, 76.92%, 69.57%, 59.09%, 76.19%, and 85.53%, respectively. The above data showed that quite a good percentage of <1-month breastfed babies had no prevalence of diarrhea. This is due to retaining enough immunoglobulins received from their mother’s blood before birth and may continue to age <1 month. But, after 1 month of childbirth, the immunoglobulins in the babies start declining if proper breastfeeding is not occurring. So, it is quite evident from our findings that as the duration of breastfeeding from 1 month and 1 month onward, the prevalence of no diarrhea among infants starts declining, i.e., the prevalence of diarrhea starts increasing. This means that breastfeeding done for a shorter duration will increase the occurrence of diarrhea among babies. We have further noticed that the occurrence of no diarrhea among babies completed breastfeeding up to 5 months and >5 months started increasing, i.e., the prevalence of diarrhea started declining. Though not statistically significant, from our study, we are concerned that episodes of diarrhea in infants become less and less when the duration of breastfeeding increases. Babies breastfed for a longer duration may give rise to a lesser number of diarrheal episodes. Felix et al. in their study on the association of infant and young child feeding practices and diarrhea in Tanzania concluded that infants 0–5 months who had EBF were less likely to experience diarrhea in comparison with those who were not EBF.[16] Our study is supported by Felix.

In our study, we analyzed the relationship between the duration of breastfeeding and the occurrence of RTI. We noticed that babies breastfed <1 month, till 1 month, up to 2 months, up to 3 months, up to 4 months, up to 5 months, and up to 6 months had no RTI of about 100%, 62.87%, 65.38%, 47.83%, 63.64%, 71.43%, and 67.74%, respectively. The above data showed that quite a good percentage of <1-month breastfed babies had no RTI. This is due to immunoglobulins received from their mother’s blood by babies. We noticed from our study that there was an increase in the episodes of RTI at the end of the first and third month and a decrease in the episodes of RTI at the end of the second, fourth, and fifth months. There was a slight increase in RTI at the end of the sixth month. So, it is quite evident from our findings that as the duration of breastfeeding from 1 month and 1 month onward, the prevalence of no RTI among infants starts declining, i.e., the prevalence of RTI starts increasing. This means that breastfeeding done for a shorter duration will increase the occurrence of RTI among babies. We have further noticed that the occurrence of no RTI among babies completed breastfeeding up to 5 months and >5 months started increasing, i.e., the prevalence of RTI started declining. Though not statistically significant, from our study, we have found that episodes of RTI in infants become less and less as the duration of breastfeeding increases. Raheem et al. in their study noticed that the risk of acquiring RTI is significantly reduced when infants were predominantly breastfed for 3 months.[17] Our study supported the findings of Raheema et al.

Efforts have been made to find a relationship between colostrum feeding and diarrhea in infants. The study revealed that the occurrence of diarrhea was found to be low in colostrum-fed babies. It was observed that out of 391 colostrum-fed babies, about 85.42% had no diarrhea. Colostrum is regarded as the first milk and is the most suitable food for babies during the early period because it contains a high concentration of protein and other nutrients, which support the nutritive diet for the baby as well as it is rich in anti-infective factors, which protect the baby against RTI and diarrheal diseases.[9] So, it is quite evident from our findings that colostrum protects babies from diarrhea. Next, the study also witnessed the absence of diarrhea in 73.83% of non-colostrum-fed babies; this is because these babies were not fed colostrum but had breastfeeding, which protected the babies from diarrhea. In a comparison of the occurrence of diarrhea in colostrum-fed and colostrum-non-fed babies, our study revealed that the occurrence of diarrhea was more (26.17%) in non-colostrum-fed babies in comparison to 14.58% in colostrum-fed babies. The result was statistically significant. So, the protective mechanism of colostrum has been noticed. Ziyane concluded from her study on infant feeding practices and diarrhea that infants who received colostrum had fewer attacks of diarrhea than those who were denied colostrum.[18]

In our study, we tried to find out the relationship between the occurrence of episodes of RTI and colostrum feeding. Our study revealed that the absence of RTI was noticed in 72.12% of colostrum-fed babies. We also found that the absence of RTI was also noticed in 63.76% of non-colostrum-fed babies. This is since 63.76% of babies were not fed colostrum but they had breastfeeding, which gave protection against RTI. But on comparison of the occurrence of RTI among colostrum-fed and non-fed babies, RTI was found to be more in non-colostrum-fed babies. So, we can conclude that colostrum has a protective function against RTI also. The result was statistically significant. Deeva Kumar et al. observed in their study on the incidence of RTI in young children that children who did not receive colostrum had a higher incidence of RTI (3.30 episodes per child per year) when compared with children who had received colostrum (2.42 episodes per child per year).[19]


  Conclusions Top


So, from our study, we have noticed that breastfeeding protects infants from RTI and diarrhea. Thus, we conclude that for preventing RTI and diarrhea episodes in infants, EBF and early initiation of breastfeeding should be the best practice to be recommended. We need to explore appropriate intervention strategies for reinforcing the early initiation and continuation of EBF from birth to 6 months of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Park K Park’s Textbook on Preventive and Social Medicine. 26th ed. Jabalpur: M/S Banarsi Das Bhanot; 2021. p. 621.  Back to cited text no. 1
    
2.
Helsing E, King FS Breastfeeding in Practice. New Delhi: Oxford University Press; 1984.  Back to cited text no. 2
    
3.
World Health Organization. The World Health Report 1995: Bridging the Gaps. Report of the Director-General. Geneva: WHO; 1995. Available from: https://apps.who.int/iris/handle/10665/41863. [Last accessed on Jan 2022].  Back to cited text no. 3
    
4.
Suriyakantha AH Textbook of Community Medicine. 6th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2022. p. 512.  Back to cited text no. 4
    
5.
Sunder L, Adarsh , Pankaj . Textbook of Community Medicine (Preventive and Social Medicine). 1st ed. New Delhi: CBS Publishers & Distributors. 2007. p. 152.  Back to cited text no. 5
    
6.
International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-4), 2015–16. Mumbai: IIPS; 2017. p. 637.  Back to cited text no. 6
    
7.
Kumari S, Kshatriya GK Breastfeeding practices among currently married women of selected tribes of Jharkhand, India. Int J Community Med Public Health 2018;5:2959-67.  Back to cited text no. 7
    
8.
Sunder L, Adarsh , Pankaj . Textbook of Community Medicine (Preventive and Social Medicine). 7th ed. New Delhi: CBS Publishers & Distributors. 2021. p. 144.  Back to cited text no. 8
    
9.
India Planning Commission. Tenth 5 Years Plan (2002–2007), Vol. II: Sectoral Policies and Programmes. New Delhi: Planning Commission; 2012. p. 1116 + Appendix.  Back to cited text no. 9
    
10.
Ahmed KY, Rwabilimbo AG, Abrha S, Page A, Arora A, Tadese F, et al; Global Maternal and Child Health Research Collaboration (GloMACH). Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women. PLoS One 2020;15:e0237720.  Back to cited text no. 10
    
11.
Penugonda AJ, Rajan RJ, Lionel AP, Kompithra RZ, Jeyaseelan L, Mathew LG Impact of exclusive breast feeding until six months of age on common illnesses: A prospective observational study. J Family Med Prim Care 2022;11:1482-8.  Back to cited text no. 11
    
12.
India. Ministry of Human Resource Development, Department of Women and Child Development (Food and Nutrition Board). National Guidelines of Infant and Young Child Feeding. New Delhi: Department of Women and Child Development; 2004. p. 26. Available from: https://wcd.nic.in/sites/default/files/nationalguidelines.pdf. [Last accessed on 10 Sep 2022].  Back to cited text no. 12
    
13.
Wright MJ, Mendez MA, Bentley ME, Adair LS Breastfeeding modifies the impact of diarrhoeal disease on relative weight: A longitudinal analysis of 2–12 month-old Filipino infants. Matern Child Nutr 2017;13:e12312.  Back to cited text no. 13
    
14.
Oddy WH, Sly PD, de Klerk NH, Landau LI, Kendall GE, Holt PG, et al. Breast feeding and respiratory morbidity in infancy: A birth cohort study. Arch Dis Child 2003;88:224-8.  Back to cited text no. 14
    
15.
Pandolfi E, Gesnaldo F, Rizzo C, Candoni E, Villani A, Concato C, et al. Breastfeeding and respiratory infections in the first 6 months of life: A case-control study. Front Paedtr 2009;7:152.  Back to cited text no. 15
    
16.
Ogbo FA, Ogeleka P, Awosemo AO Trends and determinants of complementary feeding practices in Tanzania, 2004-2016. Trop Med Health 2018;46:40.  Back to cited text no. 16
    
17.
Raheem RA, Binns CW, Chih HJ Protective effects of breastfeeding against acute respiratory tract infections and diarrhoea: Findings of a cohort study. J Paediatr Child Health 2017;53:271-6.  Back to cited text no. 17
    
18.
Ziyane IS The relationship between infant feeding practices and diarrhoeal infections. J Adv Nurs 1999;29:721-6.  Back to cited text no. 18
    
19.
Deeva Kumar B, Kumar R Incidence of acute respiratory tract infections in less than 2 years children. Int J Contemp Med 2017; 4:6-10.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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