Association of infant and young child feeding practices with diarrheal morbidity and hospitalization outcomes among under-five children in eastern India: A cross-sectional analytical study.

Dr.Shrestha  Shee; Sarbani  Misra; Dr. Gauranga  Biswas; Sushama  Sahoo

doi:10.51168/sjhrafrica.v6i12.2218

Authors

Dr. Shrestha Shee Post Graduate Trainee, Department of Paediatrics, Malda Medical College, Malda, West Bengal,India.
Dr. Sarbani Misra Associate Professor, Department of Paediatrics, Malda Medical College, Malda, West Bengal,India.
Dr. Gauranga Biswas Associate Professor, Department of Paediatrics, Malda Medical College, Malda, West Bengal,India.
Dr. Sushama Sahoo Professor and Head, Department of Paediatrics, Malda Medical College, Malda, West Bengal, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2218

Keywords:

Child Feeding, Diarrheal Morbidity, Nutrition, Immunization

Abstract

Background
Diarrheal illnesses remain a major cause of morbidity and hospitalization among children under five years of age in India. Infant and young child feeding (IYCF) practices strongly influence illness severity and recovery. However, adherence to optimal feeding practices remains low in several regions.

Objective
To assess the association between IYCF practices and diarrheal morbidity and hospitalization outcomes among under-five children admitted with acute diarrhoea in Eastern India.

Methods
A cross-sectional analytical study was conducted among 228 children aged 1 month to 5 years presenting with acute diarrhoea to a tertiary care hospital in West Bengal during 2023–24. Information regarding feeding habits, nutritional status, immunization profile, and clinical course was obtained from caregiver interviews and medical records. Data were analysed using Chi-square, Mann-Whitney U, and Kruskal-Wallis tests, with significance set at p<0.05.

Results
Early initiation of breastfeeding (52.2%) and exclusive breastfeeding for the first 6 months (33.3%) were associated with milder diarrheal episodes (p=0.005 and p=0.004). Children who were top-fed (52.2%) or received mixed feeding (40.6%) had higher rates of dysentery and persistent diarrhoea (p=0.001). Under-feeding was linked with prolonged hospitalization and a greater likelihood of complications (p<0.01). Inadequate immunization status also showed significant association with complicated diarrhoea (p=0.001).

Conclusion
Suboptimal IYCF practices substantially contribute to increased diarrheal severity and longer hospital stays among under-five children in Eastern India. Strengthening breastfeeding support and improving complementary feeding guidance can help reduce disease burden.

Recommendations
Community-level counselling, antenatal and postnatal breastfeeding support, growth monitoring during immunization visits, and targeted awareness programs are essential to improve feeding behaviours and prevent recurrent diarrheal episodes.

Author Biographies

Dr. Shrestha Shee, Post Graduate Trainee, Department of Paediatrics, Malda Medical College, Malda, West Bengal,India.

is currently pursuing postgraduate training in Paediatrics at Malda Medical College, West Bengal. Her clinical interest revolves around childhood infectious diseases and nutritional disorders. She has been actively involved in bedside clinical teaching and departmental academic activities.
ORCID: https://orcid.org/0009-0003-3591-6027

Dr. Sarbani Misra, Associate Professor, Department of Paediatrics, Malda Medical College, Malda, West Bengal,India.

serves as an Associate Professor in the Department of Paediatrics at Malda Medical College. She has several years of clinical and teaching experience, with a focus on paediatric respiratory conditions and growth-development assessment. She regularly contributes to postgraduate training and clinical audit programs.
ORCID: https://orcid.org/0000-0002-4772-356X

Dr. Gauranga Biswas, Associate Professor, Department of Paediatrics, Malda Medical College, Malda, West Bengal,India.

is an Associate Professor in the Department of Paediatrics, Malda Medical College. He has a strong academic background and a special interest in paediatric emergency care and adolescent health. He is actively involved in clinical services, research activities, and institutional teaching programs.
ORCID: https://orcid.org/0009-0008-7449-1160

Dr. Sushama Sahoo , Professor and Head, Department of Paediatrics, Malda Medical College, Malda, West Bengal, India.

is Associate Professor and Head of the Department of Paediatrics at Malda Medical College. With extensive experience in clinical paediatrics and departmental leadership, she has guided multiple research projects and postgraduate training initiatives. Her academic interests include neonatal care, childhood morbidity prevention, and health system strengthening.
ORCID: https://orcid.org/0000-0002-6216-8189

References

Lakshminarayanan S, Jayalakshmy R. Diarrheal diseases among children in India: Current scenario and future perspectives. J Nat Sci Biol Med. 2015;6(1):24–8.

Saha J, Mondal S, Chouhan P, Hussain M, Yang J, Bibi A. Occurrence of Diarrheal Disease among Under-Five Children and Associated Sociodemographic and Household Environmental Factors: An Investigation Based on National Family Health Survey-4 in Rural India. Children (Basel). 2022 May 3;9(5):658.

Sharma M, Gaidhane A, Choudhari SG. A Review of Infant and Young Child Feeding Practices and Their Challenges in India. Cureus. 16(8):e66499.

Jain M, Vandana, Jain M, Vandana. Compliance to Infant and Young Child Feeding (IYCF) Indicators amongst Infants of Rural Saharanpur, India. In: Infant Nutrition and Feeding [Internet]. IntechOpen; 2023 [cited 2025 Oct 30]. Available from: https://www.intechopen.com/chapters/87344

Malhotra N. Inadequate feeding of infant and young children in India: lack of nutritional information or food affordability? Public Health Nutr. 2013 Oct;16(10):1723–31.

Gleason A, Kumar CK, Klein E, Laxminarayan R, Nandi A. Effect of rotavirus vaccination on the burden of rotavirus disease and associated antibiotic use in India: A dynamic agent-based simulation analysis. Vaccine. 2024 Sept 17;42(22):126211.

Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475–90.

Lamberti LM, Fischer Walker CL, Noiman A, Victora C, Black RE. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health. 2011 Apr 13;11 Suppl 3(Suppl 3):S15.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008 Feb 2;371(9610):417–40.

Briend A, Khara T, Dolan C. Wasting and stunting--similarities and differences: policy and programmatic implications. Food Nutr Bull. 2015 Mar;36(1 Suppl):S15-23.

Immunization Data [Internet]. [cited 2025 Oct 30]. WHO Immunization Data portal - Detail Page. Available from: https://immunizationdata.who.int/global/wiise-detail-page

Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001 Oct;108(4):E67.

Dhalaria P, Kapur S, Singh AK, Verma A, Priyadarshini P, Taneja G. Potential impact of rotavirus vaccination on reduction of childhood diarrheal disease in India: An analysis of National Family Health Survey-5. Vaccine X. 2023 May 23;14:100319.

Press Releases | Ministry of Health and Family Welfare | GOI [Internet]. [cited 2025 Oct 30]. Available from: https://www.mohfw.gov.in/?q=en%2Fpress-info%2F8920

Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008 Jan 19;371(9608):243–60.

Clark A, Sanderson C. Timing of children’s vaccinations in 45 low-income and middle-income countries: an analysis of survey data. Lancet. 2009 May 2;373(9674):1543–9.

Dhalaria P, Kapur S, Singh AK, Verma A, Priyadarshini P, Taneja G. Potential impact of rotavirus vaccination on reduction of childhood diarrheal disease in India: An analysis of National Family Health Survey-5. Vaccine X. 2023 May 23;14:100319.

Bhat N, Vodicka E, Clifford A, Ananth KB, Bavdekar A, Roy AD, et al. The evidence base for rotavirus vaccination in India: Current status, future needs. Vaccine. 2025 Jan 12;44:126551.