Breast feeding practice among the rural women in selected villages of Dumuria upazilla , Khulna

Every year millions of infant die throughout the world, mostly in developing countries. In Bangladesh, infant has continued a notable decline but it is still high in Bangladesh compared to other South Asian countries. Various factors including community factors also influence infant mortality and improvement of public health and family planning. At the community level, infant mortality might be influenced by specific cultures and customs. In Bangladesh, breastfeeding in rural areas appears to be shaped by the beliefs of a community1, which are further influenced by social, cultural, and economic factors. Initiation of breast feeding immediately after birth Abstract The study attempted to describe the pattern of breast feeding practice among the rural women of Bangladesh with last child below 5 years of age living in the villages of Dumuria Upazilla. Due to small size of study group limited analysis were possible yet important variables such as the level of maternal education, age of starting complementary food, food used during weaning period, maternal knowledge of importance of colostrum and feeding of colostrum to the infant were considered. One of the important variables of the study was the level of the education of the respondents. As per the study, the majority (41.06%) of the respondents passed secondary level. Maximum 90.0% mothers gave breast milk, 4.4% gave honey, 4.4% gave others and minimum 1.2% gave mixed food just after delivery. Majority 46% started breast feeding after 4 hours, 44.8% had within 1 hour, 6.8% after 1st hours, 2.4% after 3 hours of delivery. Maximum 89.2% of the respondent fed exclusive breast feeding up to 1-2 months, 9.6% fed up to 3-4 months, and 1.2% fed up to 5-6 months. Maximum 48.4% fed breast milk for 3-4 months. Maximum 88.8% started complementary food within 6 months, 11.2% after 6 months.

in Bangladesh preceded by so called prelacteal feeds. About 98% new born are traditionally fed "heating foods" such as honey, sugar water, or mustard oil with believe that these foods give strength and prevent colds during first few days of life and they also believed that honey makes babies' voice sweet. 2 Breast milk contains antibodies and live cells which protect infants from bacterial and viral pathogens and stimulates the infant's immune system. 3 There are two main reasons for poor breastfeeding rates in our country: (i) a lack of support for mothers to initiate and sustain breastfeeding and (ii) secondly the erosion in breastfeeding practices by the violations of the national and international codes for the marketing of breast milk substitutes by the milk companies. Human milk provides advantages with strongest defense comes from colostrums, the substance produced in the first few days after birth, which provides the baby's first immunization. This works both before and during the time of feeding, the baby acquires active immunity through breast milk. The beneficial effects of breast milk depend on breastfeeding initiation, its duration, and the age at which the breast-feed child is weaned. 4 We know from the Lancet 2003 Child survival series and from Karen Edmond's 2006 Pediatrics paper from Ghana 5 that universal optimal breastfeeding and complementary feeding are the most significant determinants of child mortality reduction in low and middle income countries. So, young child feeding practices are crucial for improving the health and nutritional status of children. Almost 96% of Bangladeshi children are breastfed for some period of time but only 9% initiate during the first hour of life and 48% within the first day of life. 6 In Bangladesh, tragically the majority of fewer than 5 deaths (80%) occur in the 1st year of life, out of them, 45% from neonatal infection, 30% from diarrheal, 18% from acute respiratory infection. The importance of exclusive breastfeeding and the immunological and nutritional values of breast milk have been demonstrated in deferent records. Breastfeeding is one of the most important determinants of birth spacing and prevention of childhood infections. 7 Early initiation of breastfeeding helps mothers and child to get extra contact which foster bonding between mother and child from first hours of baby's life. 8 Hence, the study with these relationships helps in orienting the breastfeeding promotional activities and for preventing a decline in initiation and duration of breastfeeding practices.

Materials and methods
A descriptive type of cross sectional study was carried out on breast feeding practices among rural women at the villages named Gutudia of Dumuria Upazilla from 30 January to 8th February, 2018.By purposive sampling technique a total number of 250 respondents having child less than 5 years old were included as sample. Before the collection of data, a structured questionnaire was prepared to explore the objective of the study. The contents were onset of breast-feeding, duration of breast-feeding, and weaning period. After collection, data were verified, edited for its consistency. The data were compiled, tabulated and processed in the computer according to the key variables. Data was processed and analyzed manually and by Computer. Data were presented by bar diagram and pie chart.   Figure 01 shows that majority 41.6 % of the respondents were secondary level, 28% were primary level, 10.4% were higher secondary level, 8.4% were informal education, only 7.6% were graduate and 4% were illiterate.

Discussion
The study attempted to describe the pattern of breast feeding practice among the rural women of Bangladesh with last child below 5 years of age living in the villages. This study revealed that majority of the respondents 57.6% were from 18-25 years age group. Delayed initiation of breast feeding is also common in Bangladesh. But, in this study, the majority (46.0%) started breast feeding after 4 hours, 44.8% within one hour. The recent DHS survey confirms 24% of the women initiated breast feeding within 1 hour and 83% one day after delivery. In Zeenath Rehana's study, 95 initiated within one hour, 48% within one day. 13 Holman DJ et all in their survey found that 59% initiated breast feeding within 4 hours and 88% within 12 hours of delivery. 14 A study conducted by ICDDR, B found out that 18% fed the newborn with breast milk within one hour and 23% within 2-3 hours. So the starting time of breast feeding is more or less similar.
ICDDR, B study showed that only 12% of the mothers were exclusively breast feeding their 0-5 month's old infant and 1% of 9-12 months' infants which is slightly lower than the national recent survey according to which 4% of 10-12 months' infants were exclusively breast fed. 11 One study showed that 34.5% of 0-3 month old infants were breast fed. 12 DHS 2004 showed that 38% infants aged 2-3 months were exclusively breast fed. As per this study the majority (89.2%) of the respondents exclusively breast fed up to 1-2 months.
While the distribution of respondents according to time of starting complementary food in months was recorded, as per this study it was found that 88.8% of mothers started it within 6 months, and 11.2% after 6 months of age. ICDDR, B study suggests that 11% 0f 1month infants were started weaning food and 7.6% at 6months of age. 11 The type of food which was used for comple- Our study shows that the Pattern of breast feeding Practice among the respondents of rural area of Bangladesh Correlates with the previous studies. The policy makers should provide proper health education about breast feeding. First of all, the practice of breast feeding has to be improved at the grassroot level.

Conclusion
Infants being the future generation of our society should be brought up healthy both physically and mentally for which breast feeding, weaning and rearing should be appropriate and in time. The results of this study shows that knowledge and practice regarding proper breast feeding practice among the rural women of Bangladesh is average while considering the fact that a lot other important variables were not considered and the study population was limited. Findings of the study suggest that it is important to raise awareness among the mothers, especially the rural women of Bangladesh, regarding proper breast feeding, including giving colostrums.