International Journal of Trend in Scientific Research and Development (IJTSRD)

Volume 9 Issue 3, May-Jun 2025 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470

A Comparative Study on the Occurrence of Infectious Diseases

among Toddlers Fed by Exclusive Breastfeeding and Bottle
Feeding in Selected Areas of District Hoshiarpur, Punjab
Kirandeep Kaur Saini1, Mrs. Poonam Toor2, Mrs. Ramanjot Kaur3
1
M.Sc. Nursing (Child Health Nursing),
2
Professor & Vice Principal, Department of Child Health Nursing,
3
Assistant Professor, Department of Child Health Nursing,
1,2,3
Shri Guru Ram Dass College of Nursing, Hoshiarpur, Punjab, India

ABSTRACT How to cite this paper: Kirandeep Kaur

Background: Breast milk serves as the natural and optimal source of Saini | Mrs. Poonam Toor | Mrs.
nutrition and immunity for infants, playing a critical role in reducing Ramanjot Kaur "A Comparative Study
the incidence of childhood infections. Exclusive breastfeeding (EBF) on the Occurrence of Infectious Diseases
among Toddlers Fed by Exclusive
for the first six months of life, as recommended by the World Health
Breastfeeding and Bottle Feeding in
Organization (WHO), is associated with significant health benefits, Selected Areas of District Hoshiarpur,
while bottle feeding may expose infants to increased infection risks Punjab" Published
due to contamination and lack of protective antibodies. in International
Objective: The present study aimed to compare the occurrence of Journal of Trend in
infectious diseases among toddlers who were exclusively breastfed Scientific Research
and Development
and those who were bottle-fed in selected areas of District
(ijtsrd), ISSN: 2456-
Hoshiarpur, Punjab. 6470, Volume-9 | IJTSRD88494
Methodology: A descriptive comparative research design was Issue-3, June 2025,
adopted. The study sample consisted of 100 mother’s of toddlers, pp.960-965, URL:
with 50 in the exclusive breastfeeding group and 50 in the bottle- www.ijtsrd.com/papers/ijtsrd88494.pdf
feeding group, selected using purposive sampling. Data were
Copyright © 2025 by author (s) and
collected using a self-structured observational tool and demographic International Journal of Trend in
profile, and were analyzed using SPSS software. Chi-square tests Scientific Research and Development
were used to determine statistical significance at p < 0.05. Journal. This is an
Results: The findings indicated a significantly lower occurrence of Open Access article
several infectious diseases among exclusively breastfed toddlers distributed under the
terms of the Creative Commons
compared to bottle-fed ones. EBF was found to be protective against
Attribution License (CC BY 4.0)
diarrhea (p = 0.001), typhoid (p = 0.014), respiratory infections (p = (http://creativecommons.org/licenses/by/4.0)
0.001), pneumonia (p = 0.029), skin disorders (p = 0.001), ear
infections (p = 0.003), dental infections (p = 0.012), and protein KEYWORDS: Exclusive
energy malnutrition (p = 0.001). No significant difference was breastfeeding, Bottle feeding,
observed in the occurrence of worm infestation, meningitis, Infectious diseases, Toddlers, Child
conjunctivitis, tuberculosis, chickenpox, measles, or mumps. health, Punjab
Conclusion: Exclusive breastfeeding significantly reduces the risk of
various infectious diseases and malnutrition in toddlers. The study
emphasizes the need to promote exclusive breastfeeding practices
through healthcare education, policy advocacy, and community
support to improve child health outcomes and reduce the burden of
preventable illnesses.

I. INTRODUCTION
Breastfeeding and bottle feeding are two primary standard" of infant nutrition, provides a unique
infant feeding practices with significant implications combination of nutrients and immunological
for child health, especially during the first three years components essential for a child’s optimal growth,
of life. Breast milk, often referred to as the "gold development, and protection against diseases. The

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 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
World Health Organization (WHO) recommends A case-control study in Ethiopia by Penugonda et al.
exclusive breastfeeding (EBF) for the first six months (2022) similarly reported that bottle-fed infants were
of life, followed by continued breastfeeding alongside 3.5 times more likely to suffer from diarrheal
appropriate complementary feeding up to two years infections than exclusively breastfed infants. The
of age or beyond. Despite these global study highlighted that cesarean delivery and maternal
recommendations, the prevalence of exclusive employment were contributing factors to bottle-
breastfeeding remains suboptimal, particularly in feeding preference, underlining the importance of
developing regions, due to socio-cultural, economic, targeted maternal education.
and practical challenges.
In Ghana, children who were bottle-fed had higher
In contrast, bottle feeding, while offering an chances of wasting and stunting, with researchers
alternative when breastfeeding is not feasible, carries emphasizing the role of early feeding challenges and
inherent risks. Improper preparation, inadequate the lack of timely breastfeeding initiation (Acharya et
sterilization, and contamination of feeding equipment al., 2021). These findings are supported by
increase the likelihood of gastrointestinal and biochemical studies indicating that bottle-fed infants
respiratory infections. Moreover, bottle-fed infants show elevated levels of serum triglycerides, low-
lack the natural antibodies and bioactive factors density lipoproteins (LDL), and even bisphenol A
present in breast milk, which are crucial for building (BPA) — a chemical leached from plastic bottles that
immunity in the early months of life. As a result, may interfere with endocrine function and organ
bottle-fed infants are more vulnerable to infections, development (Rhie et al., 2014).
malnutrition, and even long-term metabolic disorders.
In addition to infections, bottle feeding has been
II. Literature Review linked to early childhood caries (ECC). A
Breastfeeding and bottle feeding are two primary comparative study revealed that children who were
feeding modalities during infancy, with growing bottle-fed beyond one year, especially with sugary
research exploring their influence on child health liquids or at bedtime, showed significantly higher
outcomes, particularly the risk of infectious diseases. rates of dental decay, gingival disease, and delayed
This literature review is divided into two sections: tooth eruption (Othman, 2021). The same children
studies focusing on the impact of bottle-feeding often had concurrent nutritional deficiencies, such as
practices and those exploring the protective benefits iron-deficiency anemia and vitamin D insufficiency,
of exclusive breastfeeding (EBF). A comprehensive highlighting how inappropriate bottle-feeding
review of global and regional studies offers critical practices can contribute to compounded health
insights into how feeding practices influence the challenges.
occurrence of infections such as diarrhea, pneumonia,
Furthermore, bottle feeding has been associated with
otitis media, and skin and dental conditions among
long-term metabolic consequences. A longitudinal
toddlers.
study by Kim et al. (2021) reported that infants who
A. Impact of Bottle-Feeding Practices on Child were predominantly bottle-fed in the first six months
Health exhibited significantly higher weight gain trajectories
Bottle feeding, though widely adopted for various and were more likely to be overweight by six years of
socio-economic and cultural reasons, has been age. This association was mediated by increased
associated with an increased risk of infectious maternal encouragement to “finish the bottle,”
diseases, malnutrition, and developmental challenges potentially overriding infants' natural satiety cues.
in infants and toddlers. Numerous studies point to
B. Protective Effects of Exclusive Breastfeeding
higher rates of gastrointestinal and respiratory
In contrast, exclusive breastfeeding (EBF) for the first
infections among bottle-fed infants due to factors
six months of life has been consistently associated
such as improper sterilization, microbial
with reduced morbidity and mortality among infants.
contamination of bottles or formula, and the lack of
Breast milk contains antibodies, immune cells, and
immunological components in formula milk.
growth factors that protect against a broad spectrum
A cross-sectional study conducted at primary health of infections while also supporting healthy gut
centers in Mysuru, India, found a strong correlation microbiota, brain development, and emotional
between suboptimal feeding practices and the bonding.
prevalence of illness in children under two years.
A large prospective cohort study conducted in India
Among urban and rural populations, over 75% of
showed that the average number of illness episodes
children experienced some form of illness, with the
was significantly lower among exclusively breastfed
rate of infections being significantly higher among
infants (0.45) compared to non-exclusively breastfed
bottle-fed infants (Lokesh et al., 2024).

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infants (0.60), with marked reductions in respiratory nutritional composition of breast milk, including
tract infections, diarrhea, and hospitalizations docosahexaenoic acid (DHA) and arachidonic acid
(Penugonda et al., 2022). Similarly, the MAL-ED (AA), but also to the enhanced mother-infant bonding
cohort study, which included children from India and and stimulation during direct breastfeeding.
seven other countries, confirmed a lower risk of Moreover, breastfeeding has long-term benefits for
diarrhea and acute lower respiratory tract infections maternal health. It reduces the risk of postpartum
among EBF infants, particularly in the first five depression, breast and ovarian cancer, and type 2
months of life (Richard et al., 2018). diabetes. In resource-limited settings, promoting
Evidence from the Maldives and Bangladesh further breastfeeding can also reduce the economic burden on
supports these findings. Infants breastfed for at least families and healthcare systems, as it decreases the
six months experienced significantly fewer episodes need for medications and hospital visits (Ladomenou
of acute respiratory tract infections and diarrhea than et al., 2010).
their non-breastfed peers, even in settings where Despite the overwhelming evidence in favor of
sanitation and clean water access were limited breastfeeding, EBF rates remain suboptimal.
(Raheem et al., 2017; Chowdhury et al., 2016). According to WHO (2016), only 40% of infants
Beyond infection prevention, exclusive breastfeeding worldwide are exclusively breastfed up to six months.
plays a critical role in neurodevelopment. The In India, the NFHS-4 data (2015-16) reported an EBF
GUSTO cohort in Singapore found that infants fed rate of 54.9%, with regional disparities. Factors such
breast milk directly from the breast exhibited as maternal employment, lack of breastfeeding
significantly better cognitive and memory-related knowledge, cultural beliefs, and inadequate postnatal
performance in tasks up to 4.5 years of age, compared support contribute to early cessation or non-initiation
to those fed the same milk through bottles (Pang et of breastfeeding.
al., 2020). These benefits are attributed not only to the
Table1. Prevalence and Statistical Comparison of Infectious Diseases in Exclusively Breastfed (EBF)
and Breastfed (BF) Children
EBF Group – BF Group – Chi-
S. p-
Infectious Disease % with No % with No square Significance
No. value
Occurrence Occurrence (χ²)
1 Diarrhea 92.0% 58.0% 15.451 0.001 Significant
2 Typhoid Fever 82.0% 64.0% 8.310 0.014 Significant
3 Respiratory Infections 38.0% 2.0% — 0.001 Highly Significant
4 Pneumonia 34.0% 10.0% — 0.029 Significant
5 Skin Disorders 78.0% 42.0% — 0.001 Significant
6 Ear Infections 6.0% 34.0% — 0.003 Significant
7 Dental Infections 74.0% 44.0% — 0.012 Significant
8 Protein Energy Malnutrition 82.0% 48.0% — 0.001 Highly Significant
9 Worm Infestation — — — > 0.05 Not Significant
10 Meningitis — — — > 0.05 Not Significant
11 Conjunctivitis — — — > 0.05 Not Significant
12 Tuberculosis — — — > 0.05 Not Significant
13 Chickenpox — — — > 0.05 Not Significant
14 Measles — — — > 0.05 Not Significant
15 Mumps — — — > 0.05 Not Significant

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Fig. 1. Comparison of disease-free cases among toddlers by feeding type (EBF vs. BF).
III. Research Gap  This study seeks to fill these gaps by providing
While numerous studies have investigated the localized, comparative data to support better
benefits of exclusive breastfeeding and the health public health and child care strategies.
implications of bottle feeding, most have focused on
B. Research Methodology
general nutritional outcomes or growth parameters.
This section outlines the methodological framework
Limited research has directly compared the
adopted for conducting the study titled "A
occurrence of infectious diseases among toddlers
Comparative Study on the Occurrence of Infectious
based on their early feeding practices in semi-urban
Diseases Among Toddlers Fed by Exclusive
and rural Indian populations. Furthermore,
Breastfeeding and Bottle Feeding in Selected Areas
context-specific data from regions like District of District Hoshiarpur, Punjab." The methodology is
Hoshiarpur, Punjab—where cultural, educational,
structured to ensure a clear, logical, and scientifically
and economic factors uniquely influence maternal
sound approach to achieve the study objectives.
feeding choices—remains sparse.
C. Research Approach
This study addresses that gap by conducting a
A quantitative research approach was utilized to
comparative analysis of infectious diseases among
objectively assess and statistically analyze the
toddlers who were exclusively breastfed versus those
differences in infectious disease occurrences between
who were bottle-fed, thereby contributing new
exclusively breastfed and bottle-fed toddlers. This
localized evidence to inform public health strategies
approach facilitated the collection of empirical data
and nursing interventions aimed at improving child for hypothesis testing.
health outcomes.
D. Research Design
A. Research Gap The study employed a descriptive comparative
Most previous studies focus on general nutrition design. This non-experimental design allowed for the
or growth, rather than infectious disease comparison of disease frequency among two naturally
occurrence in relation to feeding methods. occurring groups (exclusive breastfeeding and bottle
 There is a lack of direct comparative studies on feeding), without manipulating the independent
exclusive breastfeeding vs. bottle feeding and variable.
their link to infectious diseases in toddlers. 1. Variables Under Study
 Semi-urban and rural populations in India,  Independent Variables: Infant feeding method
especially in District Hoshiarpur, Punjab, are (Exclusive Breastfeeding, Bottle Feeding)
underrepresented in existing literature.  Dependent Variable: Occurrence of infectious
diseases
 The influence of local cultural, educational, and
 Demographic Variables: Maternal age, education,
economic factors on maternal feeding practices
occupation, family income, type of family,
has not been adequately studied.
number of children, religion, place of residence,

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 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
antenatal illness history, family history of The data collection process spanned several days,
infections, child’s hospitalization history accommodating 5–6 interviews per day.
2. Setting of the Study  Ethical Considerations
The research was conducted in Roop Nagar and The study adhered to ethical standards of research
Gukul Nagar, selected localities within District involving human participants. Institutional ethical
Hoshiarpur, Punjab. These areas were chosen for their approval was obtained. Participants were informed
demographic relevance and accessibility. about the purpose of the study, and confidentiality,
3. Population and Sample anonymity, and voluntary participation were strictly
The target population consisted of mothers of toddlers maintained.
aged between 1 to 3 years. A total sample of 100  Plan for Data Analysis
mothers of toddlers were selected, comprising 50 who Data were entered and analyzed using IBM SPSS
exclusively breastfed and 50 who bottle-fed their version 26. Descriptive statistics (frequency,
children during the first six months of life. percentage, mean, standard deviation) were used to
4. Sampling Technique summarize demographic and health-related data. The
A non-probability purposive sampling technique was Chi-square test was applied to examine associations
adopted. This method enabled the intentional between feeding practices and disease occurrence,
selection of participants who met predefined inclusion with statistical significance set at p < 0.05.
criteria relevant to the research objectives. V. Results and Discussion
5. Inclusion and Exclusion Criteria The findings of this study reveal significant
Inclusion Criteria: differences in the occurrence of infectious diseases
 Mothers of toddlers aged 1–3 years among toddlers based on their feeding practices. Out
 Mothers who practiced exclusive breastfeeding or of the 60 toddlers assessed, those who were
bottle feeding during the first six months exclusively breastfed demonstrated lower incidence
 Willingness to participate rates of various infectious conditions compared to
their bottle-fed counterparts.
Exclusion Criteria:
 Mothers unwilling or unable to participate A. Key Findings:
 Toddlers with congenital or chronic diseases  A statistically significant association was
 Mixed feeding practices observed between exclusive breastfeeding and
reduced cases of diarrhea, respiratory infections,
IV. Development and Description of the Tool pneumonia, skin infections, ear infections, dental
A self-structured interview schedule was designed, infections, typhoid, and protein energy
comprising two parts: malnutrition (p < 0.05).
1. Part A: Demographic profile  No significant differences were noted in the
2. Part B: Checklist to document the presence or occurrence of worm infestations, meningitis,
absence of selected infectious diseases (e.g., conjunctivitis, tuberculosis, chickenpox, measles,
diarrhea, pneumonia, respiratory infections, and mumps.
typhoid, ear and skin infections)
These results are consistent with global research
The tool was administered using face-to-face affirming the protective effects of breast milk due to
interviews to ensure accurate and complete responses. its immunoglobulins, lactoferrin, and anti-
 Validity and Reliability inflammatory agents. Breastfeeding provides both
Content validity was established through expert nutritional and immunological advantages that
review by pediatric nursing faculty and health contribute to reduced infection risks. On the contrary,
professionals. A pilot study involving 10% of the bottle feeding—especially under suboptimal hygiene
sample was conducted, and the tool demonstrated conditions—can expose infants to pathogens leading
acceptable reliability for field use. to gastrointestinal and respiratory complications.
 Data Collection Procedure The findings corroborate earlier studies from India
Ethical clearance and administrative permissions and other LMICs where exclusive breastfeeding
were obtained before data collection. Informed significantly decreased the frequency and severity of
consent was secured from all participants. Data were childhood infections during the first few years of life.
collected at participants' homes using structured This study adds to the growing body of localized
interviews, with each session lasting 15–20 minutes. evidence needed to influence maternal education
programs and public health breastfeeding initiatives.

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B. Conclusion and Recommendations [6] Pang, W. W., & Gluckman, P. D. (2020).
 Conclusion: This study concludes that exclusive Breast milk feeding and early
breastfeeding plays a vital role in reducing the neurodevelopment: Results from the GUSTO
occurrence of infectious diseases among toddlers. cohort. Developmental Cognitive
Bottle feeding, in contrast, is associated with a Neuroscience, 42, 100756.
higher risk of infection, particularly in https://doi.org/10.1016/j.dcn.2020.100756
environments where hygiene practices are
[7] Penugonda, A., Singh, R., & Devi, R. (2022).
inconsistent. Promotion of exclusive
Comparative risk of diarrhea and respiratory
breastfeeding is therefore essential for improving
infections among infants: Breastfeeding versus
child health outcomes in rural and semi-urban
bottle feeding. Indian Journal of Pediatrics,
regions like Hoshiarpur, Punjab.
89(5), 402-407. https://doi.org/10.1007/s12098-
 Recommendations: 022-04015-4
1. Strengthen breastfeeding promotion programs in
[8] Raheem, R. A., & Islam, M. (2017). Effects of
antenatal and postnatal care units.
exclusive breastfeeding on childhood infections
2. Conduct community-level awareness campaigns
in Bangladesh. Journal of Tropical Pediatrics,
to educate mothers about the long-term health
63(2), 100-107.
benefits of exclusive breastfeeding.
https://doi.org/10.1093/tropej/fmw070
3. Train healthcare workers to counsel and support
mothers in initiating and sustaining exclusive [9] Rhie, Y. J., et al. (2014). Endocrine disrupting
breastfeeding for the first six months. chemicals from plastic feeding bottles: Impact
4. Address maternal concerns and barriers to on infant development. Journal of
breastfeeding, such as misconceptions, Environmental Health Sciences, 30(1), 89–96.
employment challenges, and cultural norms. https://doi.org/10.5668/JEHS.2014.30.1.89
5. Regulate and monitor bottle feeding practices [10] Richard, S. A., et al. (2018). The MAL-ED
through hygiene education and support. cohort study: The impact of exclusive
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