Introduction

This investigation was requested by the Ministry of Food. Its purpose was to discover the extent to which mothers of children under 5 made use of the fruit juice and cod liver oil supplied by the Ministry of Food, and the factors which encourage or hinder the use of these supplements.

The investigation was based on interviews with 829 mothers concerning their children under 5, or themselves if nursing. In the following tables, with the exception of one analysis which shows the number of mothers who take the food supplements themselves, the mothers are not separated but the mother and the child she is nursing are counted as one individual, as both benefit from the one allocation of vitamin supplements and could, therefore, be included in the sample.

The sample was selected at random from food cards in towns and villages (see Appendix I for details of sample). The interviews were conducted by trained investigators who also gathered relevant information about the family size, income etc. and recorded each mother’s replies on a schedule (Appendix II). They reported that the mothers easily recognised the purpose of the inquiry, were generally accurate, interested, and co-operative.

Summary

Among 829 mothers interviewed with children under 5, 73% gave their children, or took themselves if feeding, vitamin C supplements in the form of fruit juices. The majority, 69%, gives the supplements provided by the Ministry of Food, only 4% buys them privately from the chemist.

62% gave their children, or took for themselves, vitamin A and D mainly as cod liver oil. A third of these or 21%, bought it from the chemist and two-thirds used M.O.F. supplements.

Four-fifths of the children who take M.O.F. fruit juice and M.O.F. cod liver oil, take it regularly every day.

The greatest number of the children who get both fruit juice and cod liver oil are in the age group 6 months - 1 year. The consumption of cod liver oil, particularly, declines after the age of 2 years.

Practically all children who take fruit juice like it, but one third of the children who take cod liver oil dislike it. This fact might account for the decline in the number of children who take it when they grow out of babyhood and are better able to express more forcefully their likes and dislikes.

More than a third of the mothers admitted that they do not reserve the fruit juice for the child which is entitled to it, but share it among other members of their family. This number might even be greater in reality. A quarter of the mothers who take cod liver oil share it also.

More than two-thirds of the mothers who do not take M.O.F. fruit juice and half of those who do not give cod liver oil, tried the supplements but discontinued them. The most frequent reason given for discontinuing fruit juice is that it is too difficult to obtain; for cod liver oil that the child disliked it and that it did not agree with the child.

Only half of the mothers interviewed have the right ideas about the health value of the fruit juice. More than one-third think its main function is to open the bowels, and one-fifth has never thought in health terms about this supplement.

The health value of cod liver oil is better known. 80% of the mothers have the right notion.

Factors which influence the uptake of the supplements are:

In summing up it can probably be said that the two main factors hindering the consumption of fruit juice are the inconvenience of distribution centres and the lack of understanding of the health value of this supplement by the mother.

The same two factors operate in keeping the consumption of cod liver oil at a rather low level, but here a third, and more important, factor is added - the actual, or sometimes imagined by the mother, dislike of the taste of cod liver oil, especially by elder children.

Kinds of Food Supplements taken

Table 1 shows the percentage of children in the sample who were given any food supplement during the previous four weeks. (Note: distribution of oranges at this period may have influenced adversely the numbers taking the supplements).

SAMPLE: No. of entitled children about whom information obtained 1212

More than two-thirds of the children take fruit juices, not quite two-thirds of the children take cod liver oil preparations and nearly one-quarter of the children do not take any vitamin supplements at home. From this last section 4% those receiving supplements at nursery schools, must be deducted.

The great majority of children taking fruit juices are given M.O.F. orange juice and two-thirds of those taking cod liver oil preparations are given M.O.F. cod liver oil.

More than half the children in the sample are given both fruit juices and cod liver oil. One-quarter have fruit juices only, but a very small percentage of children have only cod liver oil.

Analyses show that neither family size nor income has any significant bearing on the taking of vitamin supplements, although some interviewers reported that a few mothers told them their milk bills were as much as their money would cover and they could not afford these extras - in parenthesis implying their doubt of the value of these ‘extras’.

Analysis by age of child concerned shows that the highest percentage given fruit juices or cod liver oil is in the 6 months to 1 year age group.

The cases where the mother took the vitamin supplements are not counted here.

There is no appreciable difference between urban and rural households in the taking of M.O.F. vitamin supplements during the preceding month, but whether or not the mother goes out to work affects the demand to a small extent. In view of the considerable numbers of mothers not giving their children these supplements it was thought important to consider the effect of the location of the Distribution Centre.

Distance of the nearest distribution Centre from home of mother

Mothers were asked whether they thought that the Distribution Centre was conveniently placed or not.

Sample: No. of families who gave information on distance and time - 780

In interpreting this table it must be remembered that distance in miles or time from home is not the only measure of convenience; proximity to the shopping centre or possibly to the husband’s work or elder children’s school may make a more distant centre convenient. Again many mothers interviewed emphasised that the centre’s hours of opening was a big factor in difficulty or ease of obtaining supplies of these vitamin supplements.

A further analysis confirms that inconvenience to mother, which includes such factors as distance and opening hours of M.O.F. distribution centres, as well as the mother’s time available, militates against the taking of M.O.F. vitamin supplements.

Frequency with which M.O.F. supplements are taken

Mothers were asked whether they gave their children food supplements during the week preceding the interview; if so, how often.

Four-fifths of the mothers who give their children M.O.F. orange juice give it to them daily.

Again the great majority (7/8ths) of the mothers who give their children M.O.F. cod liver oil give it to them daily.

Analysis shows that the highest percentage of children taking both orange juice and cod liver oil daily is in the 6 months - 1 year age group.

Income groupings of parents seems to have no significant relation to the amount of vitamin supplements taken weekly. However, a higher percentage of mothers attending welfare centres or clinics give these supplements daily to their children.

Mothers who gave the supplements to their children less often than four times during the week preceding the investigation were asked why they did not give them more often. The reasons were:

Among the miscellaneous are such reasons as that the child had had an illness during the preceding week, had plenty of milk recently and, therefore, the supplements weren’t necessary, Rose Hip Syrup was being tried instead for a while, that the mother cant’ afford it, and in a few cases that the mother has no definite reason but supposed she hadn’t really bothered. It should be noted that the proportions in table 10 are based on small numbers and consequently are subject to wide margins of error. However, these mothers, in all, form a very small section of those giving orange juice and cod liver oil to their children.

Sharing Food Supplements

In order to see whether the food supplements were reserved for the child who was entitled to it, mothers were asked whether they shared their supply with other members of their family or not. Mothers did not hesitate to answer this question as most feel that all foods should be shared equally among their children.

More than a third of the mothers who give fruit juices share it among the members of their family.

One-quarter of the mothers share cod liver oil among the members of their family.

As would be expected the mothers with larger families of children tend more to share out the supplements.

Mother’s attitude to M.O.F. orange juice and cod liver oil

The mothers interviewed who took these supplements for their children were asked about their own opinion of the taste of M.O.F. orange juice and cod liver oil. Of the 571 mothers in the sample who gave orange juice to their children, 83% liked it, 11% did not like it, and 4% had never tasted it. The complaint of those disliking it was that some bottles were bitter and impossible to sweeten. Of the 362 mothers who gave cod liver oil to their children, 21% liked the taste, 43% disliked it and 13% had never tasted it.

Further questions were then asked about the children’s attitude to these supplements.

Children’s attitude towards the M.O.F. orange juice and cod liver oil

Practically all children who take orange juice like it, but one-third of the children who take cod liver oil are not very keen on it, or positively dislike it.

The ways in which food supplements are given

Three-quarters of the mothers dilute the orange juice, but 13% give it undiluted. More than one-third add sugar.

One-quarter of the mothers mix the cod liver oil with other foods, such as jam, sugar, orange juice, breakfast food. The rest give it undiluted in a spoon.

An analysis was made to see if different ways of giving orange juice and cod liver oil affected the child’s taste for it. All ways of giving orange juice seem to be popular. The majority of children take cod liver oil undiluted in a spoon, and of these, 70% like it, 20% are not keen on it. But the various ways of taking it do not show that any way is more popular than another. The highest percentage of those who like it, 79%, take it in a spoon, as do the highest percentage, 60% of those who dislike it, and other ways of giving it show corresponding likes and dislikes.

A slightly higher percentage of those who dislike cod liver oil take it with jam, sugar or orange juice, presumably because it has to be coaxed down - rather unsuccessfully, as over two-thirds of the children taking it that way also dislike it in this form.

Knowledge of nutrient value of food supplements

In order to see how far mothers knew the effect of food supplements on the health of their children, all mothers were asked: “What do you think orange juice and cod liver oil do for your children?”

None of the analyses by the age of the mother, by urban or rural households, or by attendance at a clinic, showed significant differences in knowledge of the effect of these food supplements.

Questions directed to those mothers who had not taken M.O.F. orange juice or cod liver oil for their children under 5 during the month preceding the interview

A few questions were put specifically to those mothers whose children had not been given any M.O.F. supplements for the month preceding the interview and, therefore, had not been asked some of the previous questions.

First they were asked if they had ever given any M.O.F. supplements to their children.

Only 7% of the children in the sample have never had any M.O.F. orange juice and 18% have never had any M.O.F. cod liver oil.

The income of the chief wage earner of the household seems to have no bearing on this, and analysis by urban and rural households shows differences too small to be significant.

Those mothers who have given the Supplements at any time were then asked for their reasons for discontinuing M.O.F. orange juice and cod liver oil.

It should be noted that the total is the number of answers given and not the number of mothers interviewed.

Among the miscellaneous reasons were the broken habit by change of address or some such reason, or in a very few cases the mother’s dislike of the clinic or ignorance of her exact entitlement.

Those mothers who mentioned their own or their children’s dislike of these supplements were asked if they had ever tried to help their children over this dislike. Half the mothers whose children disliked their orange juice had tried to persuade them to take it, but only one-third of the mothers whose children disliked cod liver oil had tried to help them conquer their dislike.

Substitutes taken for M.O.F. orange juice and cod liver oil

These same mothers who did not now give M.O.F. orange juice and those who did not now give M.O.F. cod liver oil were asked if they gave substitutes for these supplements.

The miscellaneous included calcium tablets, Ostermalt, Haliborange, Vimaltol, Allenbury’s, Bengers Food.

The miscellaneous here included Doctor’s prescription, Parrishes’ Chemical Food, Ostermilk, Allenburys, Milk of Magnesia, Truefood, and in one case, blackcurrant puree.

Diphtheria Immunisation

Mothers were asked for each child if he had been immunised against diphtheria, and analysis by this result did not give any special indications that mothers who had had their children immunised were any more conscious than the others of the value of M.O.F. food supplements or took them more regularly.