Journal of Clinical and Diagnostic Research. 2020 Feb, Vol-14(2): LC17-LC21 17 17 DOI: 10.7860/JCDR/2020/42391.13531 Original Article Infant and Young Child Feeding Practices- An Interventional Behaviour Change Communication Approach Community Medicine Section INTRODUCTION Poor infant and young child nutrition practices are an important contributor to poor nutrition which in turn leads to poor survival outcomes and poor long term outcomes such as school performance and wages in adulthood [1-3]. Undernourished children suffer from ill-health which is associated with over 50% of deaths in the under- five age group [4]. The period between conception and two years is the critical period in a child’s life when interventions to improve nutrition must be delivered [5]. Though Kerala is a state with high female literacy, declining rates of early initiation of breastfeeding and shifting partially or completely to formula feed before the completion of six months of age have been observed according to National Family Health Survey (NFHS) 2007-2008 and District Level Household Survey (DLHS 3) [6,7]. In Ernakulam district where the study was carried out, only 51.8% of newborns were breastfed within one hour of birth and children exclusively breastfed up to six months was only 16.9% in comparison to the state of Kerala statistics of 65.3% and 22.3%, respectively [7]. This is in sharp contrast to the 100% institutional delivery in Ernakulam district and female literacy rate of 90.7% [7]. There is a complex relationship between intrinsic characteristics of the child, competence of the mother in providing child care and social support in determining growth and nutritional outcomes of children [8]. Socio-cultural norms, embedded networks of support influence infant and young child feeding practices [9]. In order for women to be successful in breastfeeding they should have correct information and support for early initiation and maintenance of exclusive breastfeeding [10]. Breastfeeding in India is almost universal but the rate of early initiation of breastfeeding, exclusive breastfeeding up to 6 months and timely complementary feeding are very poor [11]. Breastfeeding is an evidence based intervention that has been found to significantly reduce neonatal and thereby child deaths and provides short-term and long-term economic and environmental advantages to society [9,12]. Breastfeeding protection, promotion and support must be available in the community, and forms an important part of a comprehensive support approach [13]. Hence, addressing these issues through behaviour change communication is important and so is targeting not only mothers of under-three children but also key influencers in the family who are responsible for decisions relating to infant and young child feeding. Studies using Peer counselling methods and behaviour change communication approaches have been successful in improving various aspects of infant and young child feeding [9,14]. However, behaviour change communication approaches through the Integrated Child Development Services (ICDS) unit, Anganwadi has not been considered for the delivery of the intervention to improve breastfeeding, infant and young child feeding practices. The other novelty of the study includes taking the opinion of key influencers in S ASWATHY 1 , KN PANICKER 2 , G RAJANI 3 , P NIMITHA 4 , RITHIMA ANVAR 5 Keywords: Bottle feeding, Breastfeeding initiation, Exclusive breastfeeding, Hygienic practices, Prelacteal feeds ABSTRACT Introduction: Infant and young child feeding have the single greatest potential impact on child nutrition and survival. The period between conception and two years is critical in a child’s life and this is when interventions to improve nutrition must be delivered. Aim: To determine the impact of a tailored intervention on Infant and Young Child Feeding (IYCF) practices among mothers of children under three years of age and antenatal women. Materials and Methods: An interventional study was carried out among Antenatal women, mothers of children under three years of age and influencers in a self-administration area. The calculated sample size for the primary objectives varied between 30-50. In order to give representation to at least 80% of the panchayat, all underthree mothers and antenatal women numbering numbering 351 and 87 for each category from the randomly selected 12 of the 16 wards were enrolled in the study. Knowledge and practice of diet during pregnancy, antenatal check-up, breastfeeding initiation, exclusive breastfeeding, expressed breast milk, complementary food items, consistency and frequency of feeding, hygiene, feeding during illness, dangers of bottle feeding were assessed before intervention. After the intervention, an endline survey was conducted to assess the change in the knowledge and practice of the infant and young child feeding practices. Statistical analysis was carried out by comparison of mean, proportions before and after the study. Mc Nemar’s chi-square was done on variables with significant improvement followed by multivariate logistic regression. Results: The mean age of the mothers was 27.42±4.53 years. There was a significant increase in knowledge with regard to initiation, exclusive breastfeeding (p≤0.01, p<0.01) and bottle feeding (p<0.01) among respondents and influencers. About half (47.9%) of the mothers had initiated breastfeeding within 1 hour of birth registering, a marginal increase from 45.2%. Reasons cited for non-initiation (n=187) were caesarean section (84.5%), child in intensive care unit (10.7%), delay in getting baby (2.1%) and no breast milk (1.07%). A significant decline in prelacteal feeds from 28.9% at baseline to 23.4% after the intervention was observed. Regression analysis for the IYCF practices with significant change demonstrated that belonging to a nuclear family was a predictor of improvement in diet of antenatal women; decrease in bottle feeding was a predictor of prelacteal feeds (OR=10.9 95%CI 3.9-29.9, p<0.001) and vice versa. Conclusion: Complex behaviour in relation to IYCF can be successfully addressed through a multisectoral approach; though follow-up is necessary to sustain it.