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          National Health And Morbidity Survey 2016 : Maternal And Child Health (MCH)  Volume II : Findings

                 99.10)] while the lowest was from Pahang [81.1% (95% CI: 75.06-85.91)]. Other Bumiputera
                 has the highest prevalence of children practising breastfeeding or bottle feeding just before
                 sleep or during sleep [97.8% (95% CI: 94.71-99.10)] compared to other ethnicities.


                 Giving plain water after breastfeeding or bottle feeding
                 The prevalence of children who did not drink plain water after breastfeeding or bottle feeding
                 was 54.1% (95% CI: 51.33-56.78). By state, Wilayah Persekutuan Putrajaya had the highest
                 prevalence of children who did not drink plain water after breastfeeding or bottle feeding
                 [68.7% (95% CI: 61.45-75.21)] while Johor had the highest prevalence of children who
                 practiced drinking plain water after breastfeeding or bottle feeding [64.4% (95% CI: 55.91-
                 72.06)]. By ethnicity, those from the ‘other’ group [63.4% (95% CI: 54.99-71.05)] were
                 significantly higher than Malay [42.7% (95% CI: 39.48-46.02)] to skip giving plain water after
                 nursing. In addition, children from the lowest household income group of less than RM1000
                 [50.7% (95% CI: 42.61-58.68)] had higher prevalence of drinking plain water after
                 breastfeeding or bottle feeding as compared to other household income groups.


                 Children who sleep with a milk bottle in their mouth
                 The majority of children did not sleep with a milk bottle in their mouth [87.2% (95% CI: 85.43-
                 88.72)]. By state, Negeri Sembilan had the highest prevalence of children who did not sleep
                 with a milk bottle in their mouth [96.8% (95% CI: 92.38-98.72)] while the lowest was in Perak
                 [71.2% (95% CI: 63.86-77.64)]. However, there was no significant difference between sex,
                 age of mother, ethnicity, citizenship, marital status, education, occupation and household
                 income.


                 Sugar added to milk
                 Overall, almost all mothers did not feed their children aged 0-23 months with sugar added to
                 milk [98.9% (95% CI: 98.43-99.18)]. However, there was no significant difference by state,
                 sex, educational status, marital status and household income (Table 5.3.2.11).

          Conclusion

          This study indicates that early initiation of breastfeeding was more common among Other
          Bumiputeras, mothers who were married, mothers who had a vaginal delivery, and mothers with
          lower education levels. Apart from that, exclusive breastfeeding practices for babies below six months
          of age was more common among Malay mothers, housewives and mothers with lower education
          levels. We observed that mothers from rural areas tend to breastfeed longer than mothers from urban
          areas. In addition, almost all children were fed appropriately according to their age. Overall acceptable
          diet was relatively low especially in the state of Kelantan.

          Recommendations


          i. To establish a more supportive breastfeeding environment especially at the workplace and public
            places such as the availability of facilities to breastfeed or express breast milk and to store
            expressed breast milk for working mothers.

          ii. To strengthen the breastfeeding education and support to mothers who delivered via caesarean
            section and also address specific problems of breastfeeding among this group of mothers.

          iii. To create awareness among parents or caregivers about the importance of dietary diversity for
            children under two years and to provide specific infant feeding training to health care providers.

          iv. To educate parents or caregivers on how to fulfil dietary diversity requirement for children under
            two years old in order to improve nutritional status of children especially stunting among children
            within this age group.
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