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Impact of socio-economic level on infant feeding patterns in Iraq

Olfat A. Darwish and Ezzat K.
Amine High Institute of Public Health, University of Alexandria, Alexandria, Egypt

Sabiha M. Abdulla
University of Basrah, Basrah, Iraq

INTRODUCTION

It is well recognized that both prevalence and duration of breast-feeding in most parts of the world is undergoing an overall decline. Reports by Mönckeberg (1), Bender et al. (2), and Ridley (3) indicate that the trend away from breast-feeding began as early as the 1940s in developed countries, and a few decades later in developing countries. Evidence was provided by Gopalan and Naidu (4), Brown (5), Jelliffe (6), Barvazion (7), Hendershot and Hirschman (8), and Deitch (9) that socioeconomic development, particularly the level of education of the mother, was the major factor affecting breast-feeding patterns. According to Buchanan (10) and Van Ginneken (11), breast-feeding lasts for an average of tvvo to six months in developed countries and in urban areas of developing countries. In rural areas of developing countries, breast-feeding lasts for 18 to 24 months and the infant is fed on demand. The most common limitations to the length of lactation in developing communities were the onset of a second pregnancy and isufficiency of breast-milk.

Age at start of supplementation of breast-feeding, type of diet, and age of weaning vary-widely in different communities. in Iraq, Gounelle and Demarchi (12), Demarchi et al. (13), and Zaki (14) reported that supplementation occurs at seven to 12 months with cereals, vegetables, milk, and eggs.

In rural Africa. Jelliffe (15) reported that supplementation with bone marrow and pre-chewed meat is given as early as the third month after birth, while Careal (16) reported that infants at the age of five to six months were supplemented with porridge made of cassava paste and sugar, and at the age of 10 to 12 months the infant changed to an adult diet. In Egypt, Darwish et al. (17) and Kamal et al. (18) showed that weaning may start before the sixth or at about 18 months, with an average age of weaning of 15 months.

OBJECTIVE AND METHODS

The aim of this study was to investigate the infant feeding patterns in Iraq. A sample of 218 mothers attending MCH centres at Basrah Governate were included. The mothers were interviewed during their visits to the centres, according to a pre-planned questionnaire. The data obtained during the interview included breast-feeding and weaning practices, socio-economic variables (including monthly income, education of fathers and mothers, occupation of both mother and father, type of family, and housing conditions). Using these variables, the investigators classified the mother into three social levels (Table 1).

RESULTS

Socio-economic characteristics of a community affect infant feeding practices in terms of the length of time an infant is fully breast-fed, age at which replacement of milk by other dietary sources takes place, and the types of diet used to supplement or replace mother's milk. The data obtained in this study show the impact of social class on infant feeding practices in southern Iraqi communities, as shown in Table 2. The duration of full lactation was inversely related to social class. Mothers in higher socioeconomic levels started bottle and supplementary feeding earlier than mothers in the other two levels. The mean lenght of full breast-feeding for infants in the higher social class was 3.8 months, while the same period for the low social class was 4.7 months. Infants in the middle class were bottle-fed later than lower social class infants at 4.9 months. The difference between high and low social class was significant (P <0.05).

TABLE 1. Distribution of Levels and Scores of Social Class Index

Group A: Professional
Group B: Clerical, businessman, skilled worker
Group C: Farmers' labourers, unskilled worker
Total score for high social class equals 80+, for middle class equals 50, and less than 50 for low social class.

The distribution of mothers according to social class and age of infant at weaning is shown in Table 3. Mothers of high social class started weaning their infants before the age of three months, the low social class delayed weaning to 18 months, while mothers from the middle social class started weaning at an age in between. An appreciable proportion of high social class mothers weaned their infants at six months of age. About two-thirds of middle class mothers weaned their infants before the end of the first year of life, while most of the infants of low-income mothers were weaned at the age of 12 to 18 months. The difference in distribution was statistically significant: x²₁₂ = 37.08, p <0 05.

Table 4 presents the distribution of the mothers according to social class and reason for weaning. The main reason in the high social class was that mothers were working. In the middle and low social classes, the reasons were "insufficient milk" and the child's being "old enough". The differencebygroupswassignificant: x²₆ =38.9,p<0.05.

TABLE 2. Mean Duration of Full Lactation and Age in Months at Start of Supplementary Feeding. by Social Class

Table 5 shows distribution of mothers according to social class and types of supplementary foods given. Well-to-do mothers gave protein-rich foods fresh fruits, and readymade infant food. The majority of low social class mothers fed infants rice and bread, while middle class mothers gave fruit juice, rice, bread, lentil soup, egg, and yoghurt. Significant differences were observed among groups when X²₁₄ = 78.77, p <0.05.

DISCUSSION

Infant feeding practices of the mothers involved in this study were affected by their social status, which is a common characteristic in most developing countries, as reported by Shakir et al. (19) in Iraq, Zaghloul (20) in Egypt, Awadh (21) in Bahrain, and Huffman et al. (22) in Bangladesh.

TABLE 3. Distribution of Mothers According to Social Class and Age of Infants at Weaning

TABLE 4. Distribution of Mothers According to Social Class and Stated Reason for Weaning

TABLE 5. Distribution of Mothers According to Social Class and Types of Food Given as Supplementary Feeding

The most important considerations in supplementary feeding of any group of infants and children seem to be age at which it is begun, what types of food are given, and how economic position may affect the kind of food a child receives.

The kind of weaning foods given to a child is affected by social class. Rice, bread, and the family diet are the main supplementary foods given to babies who belong to the lower social class. These foods are bulky, low in energy density, and poor in protein quality compared to the proteinrich foods and fruit juice given to babies in the higher class.

For Islamic populations, the Koran prescribes that mothers should nurse their children for two whole years. Compliance with this law was investigated by asking the mothers involved in this study about their past experience regarding weaning practices. It was found that this rule in most instances was overlooked, and infants were completely weaned before the end of the first year.

Early weaning is common practice in developed countries, and, where socio-economic standards are high, decrease in breast-feeding does not provoke under-nutrition, but in less developed countries it surely does. This is because of the unfavourable environment in developing communities where many factors interact to the disadvantage of the weaned infant. Adoption of early weaning practices in developing countries following the pattern in developed countries is still the major cause of the serious nutritional and health problems in infancy.

REFERENCES

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12. H. Gounelle and M. Demarchi, "Nutritional Status of Infants and Very Young Children in Baghdad, Iraq." J. Fac. Mad. Baghdad 17: 42 (1953) -

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19. A. Shakir, M. Demarchi, and N. El-Milli, "Pattern of Protein-Calorie Malnutrition in Young Children Attending an Outpatient Clinic in Baghdad." Lancet ii: 143 11972).

20. N. E. S. Zaghloul, Food Habits, Ph. D. Thesis, H.l.P.H., Alexandria University, Alexandria, Egypt (1976).

21. A. R. D. Awadh, A Study of Food Habits in Urban and Rural Areas in Bahrain, M. P. H. Thesis, H.I.P.H. Alexandria University, Alexandria, Egypt (1977).

22. S. L. Huffman, A. K. M. Chowdhury, J. Chekraborty and N. K. Simpson, "Brent Feeding Patterns in Rural Bangladesh." Am. J. Clin. Nutr. 33: 144 (1980).

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