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Hunger, health and society

Weaning practices in urban and rural Egypt
Community-level nutrition interventions in Sri Lanka: a case study
The prevention and control of diarrhoeal diseases
Questions and answers about weaning
Inventory of International and Regional Training Courses in Human Nutrition

Weaning practices in urban and rural Egypt

Olfat A. Darwish, Ezzat K. Amine, and Ahmed F. El-Sherbiny
High Institute of Public Health, Alexandria University, Alexandria, Egypt
Hekmat E. Aly and Maisa H. Salama
Nutrition Institute, Cairo, Egypt

INTRODUCTION

Weaning is defined as that period from complete breastfeeding until the infant is entirely on an adult diet. It is a vulnerable period in an infant's life, during which the child is still growing extremely rapidly and has just about run out of maternal protective antibodies.

The value of breast milk in infant feeding has been stressed by Falkner et al. (1), Harfouche (2), and Jelliffe and Jelliffe (3). Breast milk provides the infant with a diet containing unique nutritional and immunological properties. Anderson (4) and Fomon (5) showed that approximately 6 to 16 per cent of the calories in breast milk are from high-quality proteins, 30 to 50 per cent from easily absorbed fat, and 38 per cent from lactose. A proper weaning diet should be based on this pattern of caloric distribution in order to provide the infant with adequate amounts of protein for growth. Evans et al. (6) showed that adequate supplementary feeding during the first two years of life prevents malnutrition and retardation in growth and mental development in the most formative years.

The present study investigates some of the factors related to weaning practices and the effect of current weaning practices on the growth of infants in some rural and urban areas of Egypt.

METHODOLOGY

A systematic random sample of mothers of nursing infants aged one month to two years was selected from representative rural and urban areas in Egypt. - The rural sample included 253 mostly lower-income mothers living in upper and lower rural Egypt (Edfo, Sanhoure, and El-Shobak el-Gharby). - The urban sample included 277 mothers from two contrasting residential areas in Cairo, attending Maternal and Child Health Centres at Masr el-Kadema and Heliopolis, and at the Heliopolis Day-Care Centre. The mothers in the rural areas were interviewed at home;
those in the urban areas were interviewed privately at the health centres or the day-care centre.

Information was collected on the following topics:

- Income. The mothers were classified into four groups according to income per capita: very low (less than 5 Egyptian pounds [LE] per month), low (LE 5 to less than LE 10), moderately high (LE 10 to LE 15), and higher (over LE 15).
- Mother's age. The mothers were grouped in four age ranges: less than 20 years, 20-29 years, 30-39 years, 40 years and over.
- Weaning. Data recorded included whether the weaning was abrupt or gradual, the infant's age at the start and at the completion of weaning, techniques used, reasons for weaning, and the preparation of special weaning foods.
- Infant nutritional status. Data included the infants' weights and haemoglobin levels, weights in relation to standard weight for age according to Jelliffe (7), and infant mortality from gastroenteritis within each family. These data were subjected to statistical analysis to show the
relationships between infant weaning patterns and surrounding environment and the effect on infant growth.

RESULTS

Table 1 shows the weaning practices and ages at the beginning of weaning in different urban and rural areas. Mothers who practiced abrupt weaning usually began at some time from around the first year up to the age of two years. These mothers constituted 9 per cent of the total sample-15 per cent of the rural and 2.2 per cent of the urban mothers. Gradual weaning was most often begun at anywhere from about 6 months up to 18 months. Weaning was begun by about 6 months of age for 26.4 per cent of the infants in urban areas and 0.8 per cent of those in rural areas. It was begun in the second half of the first year for 66.1 per cent in urban and 53.4 per cent in rural areas, and between the ages of 12 and 18 months for 30.8 and 5.3 per cent of rural and urban infants respectively.

TABLE 1. Pattern and Age of Weaning in Different Localities Start of Gradual Weaning, by Age

TABLE 2. Age at Completion of Gradual Weaning, by Locality Completion of Gradual Weaning, by Age

X²_y total rural and total urban = 78.8,P<0.01.

Table 2 shows the age at which gradual weaning was completed. The second year of the child's life was the most common age for completing gradual weaning in both localities-58.6 per cent in rural and 81.5 per cent in urban areas.

Completing gradual weaning after the second year of the infant's life was more common in rural than in urban groups, being 21.4 per cent and 1.8 per cent respectively. The onset of a second pregnancy was the reason for weaning in 5.3 per cent of the total sample and was more common in rural than in urban groups.

Effect of Weaning on Infant Weights and Haemoglobin Levels start of weaning ranged between 90 and 100 per cent of the standard weight for age, and haemoglobin levels were between 10.4 and 10.5 g/dl. With the start of weaning, both weight and haemoglobin dropped, reaching their lowest levels by the age of 12 months. At that age, 95 per cent of urban infants and 85 per cent of rural infants had started weaning. During the second year of life both infant weights and haemoglobin levels improved at varying rates.

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