Caregivers' practices, knowledge and beliefs of antibiotics in paediatric upper respiratory tract infections in Trinidad and Tobago: a cross-sectional study

BACKGROUND: Antibiotic overuse and misuse for upper respiratory tract infections in children is widespread and fuelled by public attitudes and expectations. This study assessed knowledge, beliefs, and practices regarding antibiotic use for these paediatric infections among children's caregivers' in Trinidad and Tobago in the English speaking Caribbean. METHODS: In a cross-sectional observational study, by random survey children's adult caregivers gave a telephone interview from November 1998 to January 1999. On a pilot-tested evaluation instrument, respondents provided information about their knowledge and beliefs of antibiotics, and their use of these agents to treat recent episodes (< previous 30 days) of upper respiratory tract infections in children under their care. Caregivers were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. RESULTS: Of the 417 caregivers, 70% were female and between 18-40 years, 77% were educated to high school and beyond and 43% lived in urban areas. Two hundred and forty nine (60%) respondents scored high (>or12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). CONCLUSIONS: In Trinidad and Tobago, caregivers scoring low on antibiotic knowledge have erroneous beliefs and use antibiotics inappropriately. Children in their care receive antibiotics for upper respiratory tract infections without visiting a health clinic or a physician. Educational interventions in the community on the consequences of inappropriate antibiotic use in children are recommended. Our findings emphasise the need to address information, training, legislation and education at all levels of the drug delivery system towards discouraging self-medication with antibiotics in children.

Domestic and School Violence Among High School Students in Jamaica

This study determined the prevalence of domestic and school violence among high school students in Jamaica. A self-report questionnaire was administered to 3,124 students (1,468 boys and 1,657 girls) from 34 randomly selected high schools in 13 of the 14 parishes in Jamaica. There were 1,590 tenth graders (mean age 16 years) and 1,534 eleventh graders (mean age 17 years). One thousand six hundred and seventeen students were from rural and 1,507 from urban communities and 1,642 and 1,482 were children of professionals and nonprofessionals, respectively. The results revealed that 78.5 percent of the students had witnessed violence in their communities, 60.8 percent in their schools, and 44.7 percent in their homes. Twenty-nine percent of the students had caused injury to persons. Several weapons and techniques were used by the students during violent acts and these included the use of hands or feet 59.8 percent, nasty words 59.1 percent, kicks and punches 54.5 percent, blunt objects 26.5 percent, knives 18.4 percent, ice picks 9.3 percent, machetes 8.9 percent, scissors 8.5 percent, forks 7.5 percent, guns 6.9 percent, other weapons (e.g. bottles, dividers) 6.7 percent, acids 5.5 percent, and alkalis 4.9 percent. Significantly higher numbers of boys, 10th graders, and urban students indicated that they used more of the 14 weapons than girls, 11th graders and rural students, respectively. Effective programmes are urgently need to address the high rate of violence recorded in this study among high school youths in Jamaica.(Au)

Geographical variations in AIDS knowledge and attitude among adolescent girls of Jamaica

This article examines geographical differences in AIDS knowledge and attitudes. Data from a survey of 900 adolescent girls in the Caribbean nation of Jamaica indicate significant differences across geography in AIDS knowledge and attitude. Adolescent girls in more central areas have access to different and more sources of information than those in more remote areas. They are also more likely to know persons with AIDS, be more knowledgeable about the clinical manifestations of AIDS, and be more realistic in assessing their susceptibility of HIV. The implications of geographical differences for AIDS education efforts are discussed.(Au)

Ethnic differences in gastro-oesophageal reflux disease

OBJECTIVES: To see whether the anecdotal statement that gastro-oesophageal reflux disease is less common in blacks than in white Caucasians is true. DESIGN: Study of the racial origin of adult patients who, at endoscopy, have oesophageal damage due to gastro-oesophageal reflux. SETTING: Gastroenterology unit of a teaching hospital in inner city in Birmingham, UK. MAIN OUTCOME MEASURE: Ethnicity and endoscopic grade of oesophageal damage (reflux oesophagitis) were recorded in every patient in whom oesophageal damage due to gastro-oesophageal reflux was diagnosed. RESULTS: Over the eight-year period 1989-1996, 1101 patients with endoscopically diagnosed grades I-V reflux oesophagitis have been seen, of whom 893 (81.9 percent) were white, 156 (14 percent) were Indian and 52 (5 percent) were Afro-Caribbeans. There were fewer patients with reflux oesophagitis from the two non-white ethnic groups than would be expected from their prevalence in the catchment population, and severe reflux oesophagitis was less common than expected in the two non-white groups. In all groups, patients with grades III, IV and V reflux oesophagitis were older than patients with grades I and II disease. Whites tended to be older than Afro-Caribbeans or Indians. CONCLUSION: There were fewer non-whites with reflux oesophagitis than would be expected but the reasons for this are unclear. This study has been useful as a pilot but further studies are needed in ethnically mixed non-migrant populations both in hospital, primary care and the community to clarify racial differences in reflux oesophagitis.(Au)

Seroprevalence of HTLV-I and HTLV-II among a cohort of HIV-infected women and women at risk for HIV infection. Women's Interagency HIV Study

OBJECTIVES: To determine the seroprevalence of, and risk factors for, HTLV-I and HTLV-II infection among HIV-infected women and women at high risk for HIV infection. DESIGN: Cross-sectional analysis of baseline data for women enrolled in the prospective Women's Interagency HIV Study (WIHS). METHODS: From October 1994 through November 1995, 2657 women from five metropolitan areas in the United States (Chicago, Los Angeles, New York City [two sites], Northern California, and Washington DC) were enrolled in WIHS. An interview-based survey collected data on demographics, behavior, and medical history. HTLV-I and HTLV-II determinations were made using a combined HTLV-I/HTLV-II indirect immunofluorescent antibody (IFA) screening test, an IFA titration specificity test, and individual HTLV-I and HTLV-II confirmatory Western blots. Fisher's exact tests and logistic regression were used to determine univariate and multi variate independent predictors for HTLV-II infection. RESULTS: Of 2625 women enrolled in WIHS with confirmed HIV results, 2487 (95 percent) were tested for HTLV-I and HTLV-II. Of these, 241 (10 percent) HTLV-II-seropositive and 13 (0.5 percent) were HTLV-I-seropositive. On multivariate analysis, independent predictors of HTLV-II infection included injection drug use (OR = 5.2; p < .001), black race (OR = 3.6; p < 0.001), age > 35 years (OR = 3.3; p < .001) and a history of sex with a male injecting drug user (OR = 1.9; p < .001). Among women injected with HIV, the seroprevalence of HTLV-II was 11 percent compared infected with HIV, the seroprevalence of HTLV-II was 11 percent compared with 6 percent for women at risk for HIV but not infected (p < .001). However, HIV was not an independent predictor of HTLV-II infection in multivariate analysis. CONCLUSIONS: This cross sectional analysis confirms that HTLV-II is found commonly in HIV-infected women at risk for HIV in major urban areas throughout the United States and that HTLV-II is far more common than HTLV-I in these populations. Although injecting drug use is most strongly associated with HTLV-II infection, sexual transmission likely contributes to the high HTLV-II seroprevalence in this cohort.(AU)

Social environment and substance misuse: a study of ethnic variations among inner London adolescents

OBJECTIVES: To explore ethnic variations in drug, tobacco and alcohol use and their correlation with other factors which operate through peer, familial and religious influences. DESIGN: Semi-structured interviews with 132 12-13-year-old young people from four ethnic groups attending secondary schools in two inner London boroughs and a follow-up interview completed approximately 17 months later. RESULTS: The data was analysed using chi-square and McNemar tests. Familial, religious and peer influence closely correlated with ethnicity. Bangladeshi young people showed lower levels of peer and higher levels of religious and familial involvement and lower levels of substance use. White young people reported higher levels of peer, lower levels of religious and familial involvement, and a higher level of substance use. Black African and Black Caribbean young people lay between the two extremes. CONCLUSION: The findings suggest that young people with lower levels of familial and religious influence, or higher levels of peer influence, have higher levels of substance consumption than other young people. Health education initiatives need to promote personal decision-making skills within the context of the young people's individual culture. Cultural diversity should be recognised within local health education needs assessment.(Au)

Chlamydia pneumoniae infection and ethnic origin

OBJECTIVES: To test the association of Chlamydia pneumoniae infection with ethnic origin. DESIGN: A prospective study by micro-immunofluorescence of antibodies to C. pnuemoniae in patients admitted to one hospital with a variety of non-pulmonary, non-cardiovascular disorders. SETTING: A large district general hospital serving a multi-ethnic inner-city population in Birmingham, UK. SUBJECTS: There were 1518 patients, 1061 of whom were Caucasian, 290 Asian and 167 Afro-Caribbean. Each of 169 Asian and 141 Afro-Caribbeans was matched with two Caucasians for age, sex, smoking habit, steriod medication and date of admission, and logistic regression methods were used to compared the effects on C. pneumoniae antibody levels of ethnic origin, these confounding variables, diabetes mellitus and social deprivation. OUTCOME MEASURES: Serological evidence of acute C. pnuemoniae infection or reinfection (defined by titres of IgM > or = 8, a four-fold rise in IgG or IgG > or = 512) and previous infection (IgG 64-256 or IgA > or = 8). RESULTS: Results showed 4.8 percent of Caucasians, 6.6 percent of Asians and 10.2 percent of Afro-Caribbeans had antibody titres suggesting acute (re) infection; and 11.2 percent of Caucasians, 13.4 percent Asians and 21.0 percent of Afro-Caribbeans had titres suggesting previous infection. On chi 2 analysis, the distributions of the three possible serological outcomes (acute, previous and no infection) differed significantly (p < 0.05) between the Afro-Caribbean and Caucasian groups, but not between Asians and Caucasians or between Afro-Caribbeans and Asians. After adjusting for possible confounding variables, odds ratios for Afro-Caribbean versus Caucasian origin were 5.5 (95 percent confidence intervals 2.0-15.0) for acute (re) infection and 1.9 (1.0-3.7) for previous infection. CONCLUSION: Our results suggest that C. pneumoniae infection may be more prevalent among Afro-Caribbean than among Caucasian people, and that Asians may lie somewhere them in this respect. The behaviour of this pathogen in different ethnic groups deserve further investigation. Future studies of this organism should give due attention to the ethnic origins of patients.(AU)

Factors affecting the time at which pregnant women first attend antenatal clinic in an urban and a rural community in Jamaica

Maternal and child health services have been priority in Jamaica for at least seven decades. Studies have shown that early access to antenatal care by pregnant women will impact positively on the outcome of the pregnancy. This survey was carried out to identify factors affecting the time pregnant women first attend antenatal clinics, and the relationship that these factors have with variables such as aged, union status and level of education. The sample of 145 was selected from pregnant women attending one rural and one urban health centre. The results revealed 54 percent of women surveyed attended antenatal clinic with the first 15 weeks of pregnancy. Age and level of education were not important determinants of time of first clinic attendance. The realization of the value of antenatal care per se, that is the minimizing of risk to the pregnant mother and foetus seemed the most important factor which influenced early antenatal clinic attendance. Facilitating factors for early attendance is included shorter waiting hours, location of the health centre, the cost of the services and convenient clinic hours based on the individual's work schedule.(AU)

Seroprevalence of hepatitis B virus among school-age children in the Stann Creek District of Belize, Central America

Adults in the Stann Creek district of Belize have a high prevalence of hepatitis B virus (HBV) infection, but the age of onset of these infections is unclear. We conducted a seroprevalence study of hepatitis B markers among Stann Creek school-age children to provide information for planning a hepatitis B vaccine program. The overall prevalence in 587 students was high for antibody to hepatitis B core antigen (anti-HBc) (43.3percent) and hepatitis B surface antigen (HBsAg) (7.7 percent). There was marked variation of anti-HBc by school and by the predominant ethnic groups attending those schools. Maya had the highest prevalence (76 percent), followed by Mestizo (50 percent), Garifuna (37 percent), and Creole (25 percent). Children less than nine years of age attending the rural primary schools (mostly Garifuna and Creole) (p< 0.05). Anti-HBc was found in 42 percent and 36 percent of students at the two high schools. Of the five schools tested, only at the urban primary school did anti-HBc positivity increase with age. Based on an analysis of the cost of serologic screening before immunization compared with mass vaccination, preimmunization serologic screening resulted in vaccine program cost savings in four of the five schools. Because most children in the rural areas contract hepatitis B before entering school, immunization against HBV should be integrated into the routine infant immunization program (AU)

Development of food frequency questionnaires in three population samples of African origin from Cameroon, Jamaica and Caribbean migrants to the UK

OBJECTIVES: To develop the methods for assessment of food and nutrient intake using standardized food frequency questionnaires (FFQ) in three African origin populations from Cameroon, Jamaica and Caribbean migrants to the United Kingdom. DESIGN: Cross-sectional assessment of diet from a representative sample in each site, using either a 2-day food dairy or a 24-h recall method to determine food for inclusion on the food frequency questionnaire. SETTING: A rural and urban site in Cameroon, Evodoula and Cite Verte in Yaounde, respectively; a district in Kingston, Jamaica; Afro-Caribbeans living in central Manchester, UK. SUBJECTS: Aged 25-79 years, 61 from the Cameroonian urban site, 62 from village site; 102 subjects from Jamaica (additional analysis on a subsample of 20): 29 subjects from Manchester, UK. MAIN OUTCOME MEASURES: Food contributing to nutrients in each site to allow the development of a FFQ. RESULTS: A high response rate was obtained in each site. Comparison of macronutrient intakes between the sites showed that carbohydrate was the most important contributor to energy intake in Jamaica (55 percent) and the least in the rural Cameroon. In rural Cameroon, fat (mainly palm oil) was the most important contributor to energy intake (44 percent). Manchester had the highest contribution of protein energy (17 percent). Food contributing to toal energy, protein, fat and carbohydrate were determined. In rural Cameroon, the top 10 food items contributed 66 percent of the total energy intake compared to 37 percent for the top 10 foods in Manchester. Food contributing to energy were similar in Jamaica and Manchester. Cassava contributed 40 percent of the carbohydrate intake in rural Cameroon and only 6 percent in urban Cameroon. One FFQ has been developed for use in both sites in Cameroon containing 76 food items. The FFQ for Jamaica contains 69 foods and for Manchester 108 food items. CONCLUSION: Considerable variations exist within sites (Cameroon) and between sites in foods which are important contributors to nutrient intakes. With careful exploration of eating habits it has been possible to develop standardized, but locally appropriate FFQs for use in African populations in different countries.(AU)

Many voices: sociocultural results of the ethnocultural communities facing AIDS study in Canada

This paper presents the results of Phase 11 of the Ethnocultural Communities facing AIDS Study, the sociocultural investigation of factors contributing to risk behaviour associated wih HIV/AIDS in six ethnocultural communities in Canada in three urban sites. In Vancouver, the South Asian and Chinese communities were studied, the Horn of Africa and English-speaking Caribbean communities in Toronto and the Latin American and Arab-speaking communities in Montreal. Results demonstrated that there are common elements across these ethnocultural communities that increase the risk for HIV transmission. HIV/AIDS awareness and prevention in ethnocultural communities must address sociocultural differences, particularly sex role differences between men and women in terms of power within relationships to negotiate for safer sexual practices (AU).

Abnormal eating attitudes and behaviours in two ethnic groups from a female British urban population

African-Caribbean (N=136) and White British (N=192) female family planning clinic attenders were administered the Bulimic Investigatory Test, Edinburgh (BITE) and the General Health Questionnaire (GHQ-28). A proportion of the participants were subsequently interviewed. The African-Caribbeans were found to have both significantly more disordered eating attitudes and a significantly higher level of abnormal eating behaviour than the White British. Although the African-Caribbean group had a significantly higher mean Body Mass Index this did not mediate the difference in levels of eating attitudes. When compared with the White British group more African-Caribbean women reported feelings of failure, guilt, abnormality and self consciousness concerning their eating habits. The results indicate that eating problems may be highly prevalent in this ethnic minority population and suggest that there may be differences in the nature of eating disorder psychopathology between ethnic groups. (AU)

Use of food expenditure data to estimate household nutrient accessibility

The nutritional status of at-risk groups is usually monitored using health statistics. This approach has limitations as individuals are identified only after they have been afflicted by morbidity. In Jamaica, national surveys are carried out in which expenditure data on all consumption items are collected. We used these data to monitor food accessibility in at-risk groups. The identification of decreases in accessibility levels relative to requirements would enable timely intervention before there is a deterioration in nutritional status. We analysed the data from the survey of 3861 households conducted by Statistical and Planning Institutes of Jamaica in 1989. Using the food expenditure data, per capita energy and protein accessibility levels were determined. The mean energy and protein accessibility levels for the sample were 2170 Cals and 64 g, respectively. The results showed that the per capita accessibility levels of 20 percent and 9 percent of the households were less than half of requirments for energy and protein, respectively. The situation was worse in rural areas than in urban centres. However, the accessibility levels may have been underestimated as the data did not include meals bought and consumed away from the home, which may be significant to some households. We believe that the use of data from these surveys is a cost-effective way to monitor nutrient accessibility in Jamaica (AU)

Disparities in access to family planning in Jamaica

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas (AU)

Obesity in peoples of the African diaspora

People of African descent in the Caribbean and the USA originated from the Bight of Benin in West Africa. Although these populations share a common genetic heritage, they now live under different socioeconomical conditions. Assuming genetic similarity, a cross-cultural examination of these peoples in West Africa, the Caribbean and the USA may attenuate the effect of genetic factors and allow the assessment of environmental contributions to a biological outcome. We carried out an epidemiological survey to determine the prevalence of hypertension and the contribution of risk factors to the variation in blood pressure. We measured the height, weight, waist and hip circumferences, and blood pressure of adults in Nigeria, Cameroon, Jamaica, St. Lucia, Barbados and the USA. In urban populations there was a trend towards increasing weight, height, body mass index, and proportions of those overweight and obese going from West Africa to the USA, with the Caribbean being intermediate. The prevalence of hypertension lay on a similar gradient. Given a common genetic susceptibility, urbanization and western acculturation are therefore associated with increasing hypertension and obesity.(AU)

Child and adolescent psychiatric presentations of second-generation Afro-Caribbeans in Britain

BACKGROUND. A clinical sample was used to investigate whether second-generation Afro-Caribbean children differed from other British-born children in their psychiatric presentation or vulnerability to risk factors. METHOD. Second-generation Afro-Caribbean patients (n=292) were compared with a predominantly white group of patients (n=1311) who lived in the same inner-city area and attended the same child psychiatric clinic between 1973 and 1989. Data on psychiatric presentation and background factors were systematically recorded at the time of the initial clinical assessment. RESULTS. Afro-Caribbean patients were exposed to more socio-economic disadvantage but less family dysfunction. The ratio of emotional to conduct disorders was lower among Afro-Caribbean than among the comparison patients - an effect that was not evidently due to demographic factors or diagnostic bias. Most risk factors for emotional or conduct disorders had comparable effects on Afro-Caribbean and comparison patients. Psychotic and autistic disorders were disproportionately common among the Afro-Caribbean patients. CONCLUSIONS. Second-generation Afro-Caribbean children differ somewhat from other British-born children in their psychiatric presentation - a difference that has persisted over the 1970s and 1980s and that deserves more investigation than it has received to date (AU)

Low prevalence of rheumatoid arthritis in Black-Caribbeans compared with whites in inner city Manchester

OJECTIVES- to compare the prevalence of rheumatoid arthtitis (RA) in Black-Caribbeans and whites living in the same urban area. METHODS- cases of inflammatory joint disease were ascertained initially from a postal screening survey of 1851 blacks and 1829 age and sex-matched non-Blacks identified from general practices in the Moss Side and Hulme districts of Manchester. The ethnicity of the respondents was confirmed using data from a postal screening questionnaire. Those reporting joint swelling or a history of arthritis were reviewed by a rheumatologist at surgeries held in each practice. The clinical records of the questionnaire non-responders and questionnaire-positive non-attenders at surgery were reviewed. RESULTS- in an adjusted denominator population of 1046 Black-Caribbeans and 997 whites, the cumulative prevalence of RA was 2.9/1000 in Black-Caribbeans and 8/1000 in whites, representing a prevalence in Black Caribbeans of 0.36 times that found in whites (95 percent confidence interval 0.1-1.3). CONCLUSIONS- rheumatoid arthritis occurs less commonly in Black-Caribbeans than in Whites. The findings are consistent with published studies showing a low RA prevalence in rural black populations (AU)

KAP study of secondary school students towards obesity in Jamaica

A series of focus groups was used to study the knowledge, attitudes and practices of students (ages 11-18 years) towards obesity in Jamaica. Specifically the study sought to: Understand whether obesity is considered a nutritional disorder or disease among secondary school students in Jamaica. Understand whether obseity is accepte, and if so what are the specific cultural influences? Describe any difficulties between urban and rural atitudes towards obesity. Provide information to assist the development of public health messages that may be most beneficial for health programmes to utilize, for secondary school students in combatting the problems of obesity. Fifteen focus groups with a total of 180 students were drawn form a total of one thousand and twenty-two (1,022) students, from two schools: one located in the urban area of Kingston, St. Andrew; and the other located in the rural area of Ewarton, in the parish of St. Catherine. Samples of students from the two schoos were divided into three categories: Young-for-Grade; Average-for-Grade and Old-for-Grade. Students were further grouped into all boys, all girls, and mixed groups of boya and girls. Group interviews were tape recorded, and all recordings were transcribed verbatim. Notes were also made during each session. Following the standard procedures outlined in grounded methods of groupd interviews, open coding of the transcriptions was done. Concepts were identified and developed in terms of their properties and dimensions. Similar questions werelabelled and grouped to form categories relating to each research question. Analysis of the sessions showed that there was no significant difference in the knowledge of causes of obesity among students in diffferent grades. The majority of male students showed a negative attitude or feeling toward being obese. Yet many preferred women who were heavier or had a lower body distribution of adipose tissue which was referred to as a "coca-cola bottle shape" (gynoid obesity), rather than women with an upper-body or abdominal distribution of adipose tissue (android obesity). The majority of female students expressed a positive attitude toward gynoid obesity, but disliked android obesity. In addition, many of the female students expressed their dislike for obese men. Studnts' knowledge about the causes of obesity and prevention measures was not very consistent with their dietary patterns. Most of the students who participated in the focus group sessions did not think of obesity as a nutritional disease, but rather regarded it as a sign of wealth, good living, or access to an abundance of food (AU)

Perceptions of gender roles: attitudes toward family life and sexual behaviour in urban Jamaica

Looks at the extent to which there is rigidity in the perception of gender roles in Jamaica. The survey was administered to 400 persons aged 12 to 15 years, 61.5 per cent were female; the median age was 16 years, most were single and unemployed and has a post primary education; and 53 per cent were raised by their mothers only and 7.1 per cent by fathers only. Responses were solicited about attitudes towards sex and relationships, ideal family size, sexuality and family life, and roles and responsibilities eg. for child-rearing and domestic duties. Concludes that while men and women are seen as having particular traditional roles, perceptions of gender roles within Caribbean society are flexible and changing. Evidence from the data indicates that people do not think rigidly about male and female roles. (AU)

Factors affecting weaning in rural and urban areas of south eastern Nigeria

A total of 512 mothers were interviewed in Anambra State, Nigeria to study factors related to weaning, using 254 (49 percent) from rural areas and an urban sample of 258 mothers (50.45). A validated pretested structured questionnaire was used to obtain background information, weaning patterns and health history. The results showed that most mothers (985) breastfed their infants but gave supplementary bottles simultaneously. Rural mothers (69.7 percent) breastfed infants longer (12-18 months) than urban mothers (37.6 percent) who breastfed for 0-6 months. The lower the income level and socio-educational background of the mothers, the longer the duration of breastfeeding. There was a positive correlation (r = 0.991) between amount budgeted for food and income level. Older mothers weaned infants earlier than younger ones; working urban mothers weaned infants earlier than non-working rural mothers. Mothers with smaller families weaned infants earlier than those with larger families. Urban mothers substituted other foods as a weaning method while rural mothers weaned by discouraging from breastfeeding. Urban mothers introduced protein rich food, fruit and vegetables earlier than rural mothers, who introduced starchy foods earlier. There was a high correlation between income level and introduction of protein foods (r = 0.846) and (r = 0.858), in urban and rural areas, respectively. High incidences of diarrhoea in most infants and inadequate water supplies in the communities were noted. (Au)