Advances in Public Health
Volume 2020 (2020), Article ID 4926890, 7 pages
https://doi.org/10.1155/2020/4926890

Research Article

Magnitude of Prelacteal Feeding and Its Associated Factors among Mothers Having Children Less than One Year of Age: A Community-Based Cross-Sectional Study in Rural Eastern Zone, Tigray, Ethiopia

Senait Gebreslasie Gebremeskel,¹ Tesfay Tsegay Gebru,² Selam Shushay Kassahun,¹ and Berhanu Gebresilassie Gebrehiwot¹

¹Department of Midwifery, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
²Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia

Correspondence should be addressed to Senait Gebreslasie Gebremeskel; senaitgs42@gmail.com

Received 30 October 2019; Revised 3 March 2020; Accepted 16 May 2020; Published 17 June 2020

Academic Editor: Guang-Hui Dong

Copyright © 2020 Senait Gebreslasie Gebremeskel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Background. Prelacteal feeding is an obstacle to optimal breastfeeding practices in developing countries. It directly or indirectly affects the health of the infants. Despite its importance, this issue has received little attention in Ethiopia. As a result, this study aimed to assess prelacteal feeding and associated factors among mothers of children aged less than 12 months in the rural eastern zone, Tigray, Ethiopia. Methods. Community-based cross-sectional study design was employed. The final sample size was 828, and the multistage sampling technique was used. Pretested and structured interviewer-administered tool was used for data collection. Data were entered, coded, and cleaned by Epi-Info version 7 and analyzed by using SPSS 22.0. Multivariable logistic regression was used to control the effect of confounding. Results. Eight hundred three mothers participated in this study. During the first three days after birth, 198 (24.7%) mothers practiced prelacteal feeding. Parity (AOR: 1.52, 95% CI: 1.04–2.23), late initiation of breastfeeding (AOR: 1.83, 95% CI: 1.30–2.59), and colostrum discard (AOR: 1.57, 95% CI: 1.06–2.33) were strongly associated with prelacteal feeding practice. Conclusion and Recommendation. One-fourth of participants practiced prelacteal feeding. Late initiation of breastfeeding, colostrum discard, and parity were significant determinants of prelacteal feeding. Awareness creation and health education concerning the advantages of early initiation of breastfeeding and the importance of colostrum during their health visits is necessary.

1. Introduction

Prelacteal feeding is administration of any foods or liquids other than breast milk to the infant during the first three days after birth [1]. In contrary, worldwide, nearly 2 from 5 breastfed newborns receive fluid/foods in their earliest days of life [2]. Prelacteal feeding has negative impact on breastfeeding of the baby. It results in lactation failure, diarrhea, convulsion and shortening of the duration of breastfeeding, insufficient weight gain, and becoming more susceptible to infection [3].

Globally, 60% of the 10.9 million deaths annually occurred among children aged under five years. Over two-thirds of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life [4]. Despite this fact, in many regions of the globe including Ethiopia, a significant proportion of mothers offer prelacteal feeding to their newborns [5–7], and in that, the record is highest in Southeast and Central Asia [1, 8–10], modest in Latin America accounting 22.9–40% [11], and average in sub-Saharan Africa that showed 32.2% [5]; Ethiopia’s ranges from 6.7 to 56% [12, 13].

Prelacteal feeding practice in Ethiopia accounts for 34% and 38.8% in Arba Minch Zuria and Raya Kobo account, respectively [13, 14]. Nineteen of twenty women breastfed their infants, and twelve (63%) reported ritual prelacteal feeding. A majority (fifteen of nineteen, 79%) reported discarding colostrum and breastfeeding within 24 hours of birth [15].

To solve different life-threatening conditions, evidence indicated that avoiding prelacteal feeding would help to save the lives of around 823,000 children, annually [16]. Since 2004, Ethiopia has been implementing the Infant and Young Child Feeding (IYCF) strategy as a key component of child survival approach [3]. However, prelacteal feeding is still below the standard recommendation in Ethiopia [17].

Different global works of the literature indicated that the factors associated with prelacteal feeding were sociodemographic and health-related and had individual factors like place of delivery, gestational age at delivery, mode of delivery, type of birth attendant, prenatal counseling on breastfeeding, postpartum counseling, and initiation of breastfeeding [12, 13, 18, 19].

However, the studies conducted in Ethiopia concerning prelacteal feeding were limited. Nonetheless, the study area has limited evidence on this regard. Most of the studies conducted in Ethiopia were using a small sample size, assessed only a small area of interest, and were conducted in urban areas.

Findings of this research help to provide insights into governmental and nongovernmental organizations, health sector officials, regional and local health authorities, program managers, stakeholders, and researchers in order to plan and design appropriate interventions. Therefore, this study intends to assess prelacteal feeding and the factors associated with it among mothers of children aged less than 12 months.

2. Methods and Materials

2.1. Study Setting

Community-based cross-sectional study design was employed from April to May, 2018, among 828 mothers of children aged less than 12 months in rural areas of eastern Tigray.

2.2. Sampling Strategy

The sample size was determined using a single population proportion formula by taking the prevalence of a study done in Ethiopia (42.9%) [20]. This study uses assumptions of 95% confidence interval (CI), 5% margin of error multiplied by 2 for design effect, and added 10% nonresponse rate.

Of the seven rural districts of the eastern zone of Tigray, Seasi Soda Emba and Ganta Afeshum words were selected by using simple random sampling using a lottery method. Multistage sampling was used. Out of these districts, 4 tabias from each rural district were selected. The sample size was allocated to each tabia proportionally. The list of households of the mothers having children aged less than twelve months was identified by health extension workers working in each tabia, and sampling frame was made from that. Simple random sampling using the lottery method was used to select the study participants.

2.3. Data Collection

A structured, interviewer-administered questionnaire was used for data collection. Seven nurses working outside the study area and 6 BSc health professionals were recruited for data collection and supervision, respectively. The questionnaire was pretested on 10% of the same source population other than the sampled population. Based on the pretest, questions were revised and edited for the clarity and understandability of the participants to the local context. Finally, the Tigrigna version questionnaire was used for data collection. Prelacteal feeding is the practice of giving fluid or semisolid food other than breast milk to a child during the first three days before giving mother’s milk [1, 12, 13].

2.4. Data Analysis

Data were coded, entered, and cleaned using SPSS version 22.0 software. Variables with a value < 0.2 in bivariate analysis were entered into multivariable logistic regression. The model of fitness was checked by Hosmer and Lemeshow test, and its value was 0.371. Multicollinearity linearity was checked using variance inflation factor (VIF), and those with VIF greater than 10 were excluded from the model. Finally, adjusted odds ratio (AOR) with a 95% confidence interval and value < 0.05 were declared as significant with prelacteal feeding.

2.5. Ethical Statement

Ethical approval was obtained from a research and the ethical approval committee of the college of health Sciences of Adigrat University with a registration number of AGU/CMHS/036/10. Informed written consent was obtained from mothers of study participants.

3. Results

3.1. Sociodemographic Characteristics of Respondents

Totally, 803 mother-child pairs were involved in this study with a response rate of 96.98%. Two hundred and twenty-four (27.9%) mothers were found in the age group of >35. Regarding marital status, 727 (90.5%) of the mothers were currently married. Three hundred and thirty-three (45.2%) fathers had the educational status of primary education (Table 1).

Table 1: Sociodemographic characteristics among mothers of children aged less than 12 months in rural eastern zone, Tigray, Ethiopia, 2018 (n = 803).

Variable
Alternatives
Frequency (n)
Percentage (%)

Age of mothers (in years)
<20
14
1.7

20–24
208
25.9

25–29
180
22.5

30–34
177
22

≥35
224
27.9

Religion
Orthodox
798
99.1

Others
8
0.9

Ethnicity
Tigray
791
98.5

Amhara
12
1.5

Marital status
Currently married
727
90.5

Currently unmarried
76
9.5

Educational status of mothers
No formal education
318
39.6

Primary education
285
35.5

Secondary education and above
200
24.9

Mothers occupation
Housewife
735
91.5

Daily laborer
20
2.5

Farmer
26
3.2

Others
22
2.8

Fathers education
No formal education
231
31.4

Primary education
333
45.2

Secondary education and above
172
23.4

Occupation of fathers
Farmer
490
61

Daily laborer
150
18.7

Merchant
47
5.9

Private organization
26
3.2

Others
34
11.2

Child age (in months)
<1 month
57
7.1

1–6 months
476
59.3

>6 months
270
33.6

Sex of child
Male
455
56.7

Female
348
43.3

Family size
≤3
417
51.9

≥4
386
48.1

Childbirth order
1
189
23.5

2-3
234
29.2

4–6
289
36

>6
91
11.3

Childbirth interval
No previous child
189
23.5

<24 months
89
11.1

≥24 months
525
65.4

3.2. Health Service Utilization of Study Participants

About three-fourths of the respondents were multiparous (75.2%), and 753 (93.8%) mothers did not have a complication during the current pregnancy. Totally, 703 (87.5%) mothers did not have PNC follow-up, and 98% of the mothers were ever breastfed their current children (Table 2).

Table 2: Feeding practices and health service utilization among mothers of children aged less than 12 months children in Eastern zone, Tigray, Northern Ethiopia, 2018 (n = 803).

Variable
Alternatives
Frequency (n)
Percentage (%)

Parity (n = 803)
Primi
199
24.8

Multipara
604
75.2

Gestational age (n = 803)
Preterm
12
1.5

Term
777
96.8

Postterm
14
1.7

Pregnancy (n = 803)
Intended
648
80.7

Unintended
39
4.9

Mistimed
116
14.4

Complication during pregnancy (n = 803)
Presence
50
6.2

Absence
753
93.8

Place of delivery (n = 803)
Home
42
5.2

Health institution
761
94.8

Mode of delivery (n = 803)
C/S
28
3.5

Vaginal delivery
775
96.5

Duration of labor (n = 803)
<12 hours
673
83.8

≥12 hours
130
16.2

ANC follow-up (n = 803)
Yes
796
99.1

No
7
0.9

Number of ANC visit (n = 796)
1
6
0.8

2-3
173
21.7

≥ 4
617
77.5

Healthcare provider’s counseling during ANC (n = 796)
Yes
409
51.4

No
387
48.6

PNC follow-up
Yes
100
12.5

No
703
87.5

Healthcare provider’s counseling during PNC (n = 100)
Yes
83
83

No
17
17

Decision maker
Mother
775
96.5

Healthcare providers
22
2.7

Others
6
0.8

Breastfeeding for the child (n = 803)
Yes
787
98

No
16
2

EIBF (n = 787)
Yes
487
61.9

No
300
38.1

Colostrum feeding (n = 787)
Yes
669
85

No
118
15

Among the total study participants, 198 (24.7%) practiced prelacteal feeding (Figure 1).

Figure 1: Magnitude of prelacteal feeding among mothers of children aged less than 12 months in the rural eastern zone, Tigray, Ethiopia, 2018.

Out of 198 mothers who practiced prelacteal feeding, the most common reason was not having enough breast milk secretion (84 (42.4%)) (Figure 2).

Figure 2: Reasons for practicing prelacteal feeding among mothers of children aged less than 12 months in the rural eastern zone, Tigray, Ethiopia, 2018.

Out of the 198 mothers who practice prelacteal feeding, the type of prelacteal mentioned by 35.4% and 34.8% participants was plain water and sugar/glucose water, respectively (Figure 3).

Figure 3: Type of prelacteal feeding given to infants by mothers in the rural eastern zone, Tigray, Ethiopia, 2018.

3.3. Factors Associated with Prelacteal Feeding

Variables with a value ≤ 0.2 in bivariate analysis were entered into the multivariable logistic regression model. In multivariable logistic regression, parity, late initiation of breastfeeding, and colostrum discard were statistically associated with prelacteal feeding practice at a value < 0.05.

Primigravida mothers were 1.52 times more likely to practice prelacteal feeding than those multiparous women [AOR: 1.52, 95% CI: 1.04–2.23) ()]. Women who initiated breastfeeding after one hour after birth were [AOR: 1.83, 95% CI: 1.30–2.59) ()] more likely to practice prelacteal feeding compared to mothers who initiated breastfeeding early. Mothers who discard their colostrum were 1.57 times more likely to practice prelacteal feeding as compared with mothers who gave colostrum [AOR: 1.57, 95% CI: 1.06–2.33) ()] (Table 3).

Table 3: Factors associated with the prelacteal feeding practice among mothers with children aged less than 12 months in the rural eastern Tigray, Ethiopia, 2018.

Variable
Prelacteal feeding
COR (95% CI)
AOR (95% CI)
value

Yes
No

Number of ANC visit

1
1
5
0.64 (0.07–5.52)
0.62 (0.07, 5.55)
0.667

2-3
50
123
1.30 (0.89–1.89)
1.43 (0.965, 2.122)
0.075

≥4
147
470
1
1

Parity

Primi
60
139
1.46 (1.02–2.08)
1.52 (1.04, 2.23)
0.032

Multipara
138
466
1
1

Complication during pregnancy

0.235

Yes
20
30
2.15 (1.19–3.89)
0.52 (0.18, 1.53)

No
178
575
1
1

Sex of children

0.082

Male
126
329
1.47 (1.06, 2.04)
1.37 (0.96, 1.95)

Female
72
276
1
1

Early initiation of breastfeeding

Yes
93
394
1
1

No
89
211
1.787 (1.28–2.49)
1.83 (1.30, 2.59)
0.001

Colostrum discard

Yes
49
118

1.57 (1.06, 2.33)
0.026

No
133
487
1.52 (1.03, 2.23)
1

∗Statistically significant on multivariate logistic regression analysis at a P value of 0.05.

4. Discussion

The prevalence of prelacteal feeding in this study was 24.7%. Similar findings were found in Dabat (26.8%) [21], Sidama (25.5%) [22], and Ethiopia (28.9%) [15]. Slightly higher rates were reported in Ethiopia and were 45.4% in Harari, 42.9% in Afar, and 38.8% in Raya Kobo district [13, 19, 20]. Lower prevalence rates were found in Jimma (12.6%) [23], North Wollo (11.1%) [24], and Tigray (12.8%) [25]. The finding of this study was also lower than the studies from Vietnam (73.3%) [1], India (49.5%) [10], and Egypt (58%) [26], This variation could be due to the difference in sociocultural variations of the study subjects, study area, and maternal beliefs towards breastfeeding.

Primigravida mothers were 1.52 times more likely to practice prelacteal feeding than those multiparous women. Concerning this finding, the research conducted among primigravida mothers indicated that majority of the respondents were found in age group of 17–23 years, most of them were primary school graduates, about one-third of participants depended their source of information on their relatives, and having low knowledge on the breastfeeding practice [27].

Women who initiated breastfeeding after one hour of birth were about two times more likely to practice prelacteal feeding compared to mothers who initiated breastfeeding early. Similar findings were reported in different countries [14, 18, 22, 28]. This might be due to misperception of the mothers and sociocultural malpractices of early breastfeeding. Delay in time interval between delivery and breastfeeding initiation might also exacerbate prelacteal feeding.

Mothers who discard their colostrum were 1.57 times more likely to practice prelacteal feeding as compared with mothers who gave the colostrum to their infants. This finding in lines with studies conducted in North Wollo [24], Raya Kobo [13], and North West [21]. This might be due to maternal misperception that colostrum may cause newborn sickness and considering it as dirty milk are the reasons of avoiding this medicinal substance and also considering raw butter is thought in cleansing the infants stomachs [29].

5. Conclusion and Recommendation

Based on the findings, about one-fourth of the participants practiced prelacteal feeding. Late initiation of breastfeeding, colostrum discards, and parity were strongly associated with prelacteal feeding practice. Awareness creation activities should be undertaken, especially to the primigravida mothers on the risk associated with prelacteal feeding and health education on the advantages of early initiation of breastfeeding and the importance of colostrum during the health visits via the concerned healthcare providers.

Abbreviations

ANC: | Antenatal care
AOR: | Adjusted odds ratio
CI: | Confidence interval
COR: | Crude odds ratio
EIBF: | Early initiation of breast feeding
VIF: | Variance inflation factor.

Data Availability

The datasets analyzed during the current study available are from the corresponding author on reasonable request.

Conflicts of Interest

The authors declare that there are no conflicts of interest.

Authors’ Contributions

All the authors participated in the designing, data collection, analysis, and writing of the study. The authors have read and approved the final paper.

Acknowledgments

The authors of this research would like to thank Adigrat University, Tigray Regional Health Bureau, Eastern Tigray Woreda Health Bureau Administrators, study participants, data collectors, and supervisors for their necessary collaboration.

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