Association of Socio- demographic factors with dietary practices of mothers in
under five children with diarrhea
Abstract Background :
Nutritional status has a strong impact on children’s survival as malnutrition and diseases are linked together synergistically2. There is evidence that shows that protein-calorie malnutrition contributes to increased susceptibility to infections in
children and diarrheal infections can predispose them to malnutrition3, 4. Many risk factors have been identified for malnutrition in such
age groups, such as inadequate diet, restriction of certain of food during illness (i.e. complementary feeding like potato, banana etc.),
high illiteracy rate and the poor feeding practices of mothers3, 4.
332 mothers having children under five years of age were interviewed from clinics of a tertiary care Hospital during June to
December (2013), through non-probability convenient sampling using a structured questionnaire. Univariate and multivariate analyses
was performed on SPSS 19.
A total of 332 mothers were included in the study showed that mothers between the ages 26 and 30 years had correct feeding
practices comprising of almost 44.9%, while mothers less than 25 years of age had incorrect feeding practices. Higher the mother’s
education status (p-value 0.000) was associated with the correct feeding practices almost 50%. Mothers working status was also found
to be affecting the feeding practices (p-value 0.002) as mothers who were house wives had correct feeding practices 39.3% than those
mothers who were employed.
Study indicates that there is a need of right dietary awareness amongst mothers so their dietary practices during diarrheal
infections can combat malnutrition in children.
Diarrheal infections, mother’s dietary practices.
Adequate nutrition is important during childhood for a healthy
growth and proper nourishment of all essential systems of the
body1. Nutritional status has a strong impact on children’s
survival and healthy growth as malnutrition and diseases are
linked together synergistically2. There is evidence that shows
protein-calorie malnutrition contributes to increased susceptibility
to infections and diarrhea being a common infection predisposes
children under five years of age to malnutrition3, 4. Numerous risk
factors have been identified for malnutrition of children, such as
inadequate diet, restriction of certain of food during illness (i.e.
complementary feeding like potato, banana etc.), unhygienic living
environment, high illiteracy rate and the poor feeding practices of
mothers3 ,4. Therefore Malnutrition resulting from insufficient
diet may be aggravated by diarrheal infections5. According to the
United Nations Children’s Fund (UNICEF), diarrhea is one of the
leading cause of death in children under five years of age1. The
World Health Organization (WHO) states that diarrhea accounts
for 15% of all deaths in under five years of age5.
Diarrheal infection is amongst the most common causes of death
in children under five years of age6 and studies have shown that
malnutrition in this age group of children is frequently associated
with these deaths4. Globally, amongst the major determinants of
malnutrition amongst children under five years of age due to the
diarrheal diseases are hygienic conditions and improper sanitation,
mothers educational status along with the number of children
under five years of age in a single household, mother’s dietary
knowledge and their feeding patterns i.e. the type of food given or
restricted that is in turn followed by either their learned behaviors
or cultural practices7.
Approximately 10% of children in Pakistan do not survive to their
sixth year of life and the major contributing factor to the high
childhood morality in Pakistan is the prevalence of malnutrition,
secondary to the diarrheal diseases. These high figures are the
synergistic effect of inadequate dietary intake and diarrheal
infections in children under five years of age1. Studies have shown
a direct relationship between different causes i.e. unhygienic living
conditions, inadequate diet given, withdrawal of certain foods
during diarrheal illness etc. that relate towards development of
malnutrition due to diarrheal diseases in children under five years
As mothers play the most key feature in child’s nutritional status
and his growth, their feeding practices have a direct impact on the
child’s nutritional outcomes especially during diarrheal episode10.
In our society mothers play a vital role in child’s nutrition6 but
inappropriate feeding practices and irrational use of different
herbal remedies during diarrheal episodes by the mothers, may
contribute to worsen diarrheal morbidity and mortality11, 12.
In Pakistani culture, people believe that several food should be
restricted during children’s illness; like, during diarrhea a child
should not be given breast milk, during diarrhea a child should
not be given milk and rice, etc. Studies have shown that foods
containing essential nutrients are withheld during illness that
contributes to worsening of child’s nutrition thus ends up in
Diarrhea is a curable and treatable disease but the incorrect
practices of mother’s regarding nutrition and diet during diarrheal
diseases will ultimately lead to malnutrition in children under five
years of age13.
The study was conducted in the Family medicine clinics of a
tertiary care hospital where there was high influx of mothers with
their children along with the diversity of different communities.
An ERC approved pilot tested coded questionnaire was formulated
through literature search (8, 10, 11, 14, 15 and WHO manual for
Mothers were approached in the waiting area outside the clinics.
Measures were taken to maintain the confidentiality of participants.
Verbal and written consent was taken from the mothers who
participated in the study. Mothers who full filled the inclusion
criteria were enrolled and this study excluded mothers of children
having chronic diseases. Information was taken from the past
three months to reduce chances of recall bias. Questionnaire was
filled in 10-15 minutes by the Principal Investigator by asking the
mothers a set of questions that were coded to assess their feeding
practices during diarrheal episodes. A dietary knowledge material
on the diet during Diarrheal infections was provided to the mothers
after filling the questionnaires.
Non-probability convenience sampling was used. The Sample
size was calculated with WHO software (52) for sample size
determination. Data was double entered and analyzed in SPSS
version 19. Baseline information on demographics was analyzed
using descriptive statistics. For continuous variables such as age
mean and standard deviation was reported. The outcome variable
i.e. Practices of mothers regarding diet in children under five years
of age during diarrheal infections was calculated to fulfill the
objectives. All the correct answers were calculated as percentages.
A total score of 60% or above was marked as correct practice and
below 60% as incorrect practice.
Logistic regression analysis was performed taking practices (Yes &
No) as binary outcome variable. Univarate analysis was performed
and the explanatory variables at the univariate level (p value <
0.25) was selected for inclusion in the multivariable model, and
results were reported as unadjusted odds ratio with their 95%
A multivariable logistic regression analysis was performed to
assess the independent effect of all demographic variables (age,
working status, education, no. of children etc.) on the practices
during diarrheal infections in the form of adjusted odds ratio and
their 95% confidence interval. All of the analyses was two tailed,
and p values of 0.05 or less were considered statistically significant.
A total of 332 mothers participated in the study (Demographic
characteristics in table 1). Majority of the mothers were between
ages of 26 to 30 years and majority them were housewives and had
achieved higher education as shown in table 2. The study showed
that 74% of the mothers had incorrect dietary practices during their
child’s diarrheal episode as shown in figure 1.
Univariate analysis showed that a higher educational status of
mother and her being at home had a strong association with her
dietary practices during her child’s diarrheal episodes as mentioned
in table 3. Multivariate analysis as shown in table 4 showed that
mother’s higher educational status had a strong association with
her correct diarrheal dietary practices.
The study showed association between different socio-demographic
factors and mothers dietary practices during diarrheal diseases
in children under five years of age. Mothers play the most key
feature in child’s nutritional status and his growth, their feeding
practices has a direct impact on the child’s nutritional outcomes
especially during diarrheal episode10. As it’s already evident from
literature that one of the main cause of death in under five children
are diarrheal illnesses3.
Our study showed that out of 332 mothers, 89 (26.80%) mothers
had correct practice whereas almost 243 of then mothers had
incorrect diarrheal dietary practices (73.2%) as mentioned in a
study done on the beliefs of mother’s in diet to be given during
diarrheal episodes in India showed that only 5% had reported about
increasing diet during the illness15. A similar Iranian study showed
that only 2.3% of the mothers had correct feeding practices during
diarrheal episodes16. In our culture people believe that several food
should be restricted during children’s illness; like, during diarrhea
a child should not be given breast milk, or complementary feeds
like potato, banana, etc. Literature shows that foods containing
essential nutrients are withheld during illness, which ends up with
child having malnutrition and poor growth parameters8, 18. The
reasons for this gap could be the different cultural norms related
to hot and cold foods in our society as cold food (i.e. rice, juices,
banana etc.) is perceived to worsen symptoms. Family influence
of elders could also affect family’s own traditional beliefs which
restrict mothers from following correct practices and in turn they
restrict diet that are healthy and nutritional for their children
especially in the times of diarrheal episodes.
Regarding the factors affecting the dietary practices of mothers
during diarrheal diseases mothers’ age seemed to play a vital role
(p-value 0.05). Results showed that mothers between the ages 26
and 30 years had correct feeding practices comprising of almost
44.9%. These results are similar to a study done in the Primary
care centers of Saudi Arabia that majority of the women practicing
correct diet, included young mothers17. This could be due to
the awareness through easy media access and reachable health
Amongst the other determinants mothers education also affected
mothers feeding practices (p-value 0.000) as higher the mother’s
education status was associated with the correct feeding practices
almost 50% which was similar to the results from a study
conducted in Ghana and Ethiopia showing mothers of higher
educational background demonstrated more correct dietary
practices in childcare as compared to mothers of low educational
Mothers working status was also found to be affecting the feeding
practices (p-value 0.002) as mothers who were house wives had
more correct feeding practices 39.3% than those mothers who
were employed. The results are consistent with the results of a
study conducted in Riyadh that showed working mothers not
being able to cope up with correct feeding practices in children
during diarrheal episode18. A reason for this difference in feeding practices of mothers could be because working mothers may find it
difficult to manage their time for preparation of healthy nutritious
and prefer pre-formed meals.
Mother dietary practices in children’s diarrheal episodes need
more awareness. By having more informed mother we can reduce
the disease burden in children under five years.
The limitation of the study included limited sample size, and
sample was drawn from only one location of Karachi, limiting
external validity. This study can be a useful resource for primary
care centers for educating the mothers and helping them realize
that cultural beliefs and practices should not hinder a child’s
right to proper nutrition. Future population based studies are
recommended in order to validate the findings of this study.
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