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Background: Pre-lacteal feeding is associated with infant morbidity and mortality especially during the neonatal period. About 96% infant deaths in developing countries are attributable to inappropriate feeding practice during the first 6 months of life. This study assessed determinants of pre-lacteal feeding practices in Ethiopia using the data from nationally representative survey. Methods: Data were extracted from the 2016 Ethiopian Demographic and Health Survey to assess determinants of pre-lacteal feeding practices in Ethiopia. The analysis included a weighted sample of 5303 mothers having children aged 0–36 months. A multivariable logistic regression analysis was conducted and the results were presented with adjusted odds ratio at 95% confidence interval, declaring statistical significance at a p-value < 0.05 in all analyses. Results: From a total of 5303 mothers having children aged 0–36 months, 423 (8%, 95% confidence interval, 7.06%, 8.99%) had given pre-lacteal foods to their newborn baby. Being from agrarian region (adjusted odds ratio = 0.15, 95% confidence interval, 0.11, 0.20), poorest wealth status (adjusted odds ratio = 1.50, 95% confidence interval, 1.02, 2.22), home delivery (adjusted odds ratio = 1.35, 95% confidence interval, 1.01, 1.79), late initiation of breast feeding (adjusted odds ratio = 4.52, 95% confidence interval, 3.62, 5.64), having no counseling on breast feeding (adjusted odds ratio = 1.33, 95% confidence interval, 1.01, 1.75), and cesarean delivery (adjusted odds ratio = 2.47, 95% confidence interval, 1.45, 4.20) were factors significantly associated with pre-lacteal feeding practice. Conclusion: A significant proportion of Ethiopian mothers had given pre-lacteal foods to their newborn babies. Poorest wealth index, region, late initiation of breast feeding, not counseled on breast feeding, home delivery, and cesarean delivery were identified as determinants of pre-lacteal feeding. Thus, emphasis should be given to improve mothers’ Infant and Young Child Feeding practice through counseling and utilization of institutional delivery. Moreover, special attention should be given to mothers from pastoralist regions and poor socio-economic status to reduce pre-lacteal feeding practice.
The data were extracted from the 2016 Ethiopian Demographic and Health Survey (EDHS), a nationally representative survey that collected data on basic health, demographic, and socio-economic indicators. The Central Statistical Agency (CSA) together with the Ministry of Health (MoH) and the Ethiopian Public Health Institute conducted the survey from 18 January 2016 to 27 June 2016 and The United States Agency for International Development (USAID) funded the survey.28 Among 16,583 eligible women, the interview was completed for 15,683 women (15–49 years) across the nine administrative regions and two city administrations.28 We extracted data for all mothers who had child birth in the last 3 years prior to the survey, and a weighted sample of 5303 mothers with a children of 0–36 months age were included in the study for the purpose of this analysis. Details about the DHS sampling techniques and sample size are available at http://www.dhsprogram.com/. The EDHS research protocol complies with the National Health Research Ethics Committee and Institutional Review Board guidelines. The outcome variable was pre-lacteal feeds. The mothers were asked two questions to assess if the child was provided with any pre-lacteal feeds: In the first 3 days after delivery, was the child given anything to drink other than breast milk? What was the child given to drink? (Options were milk (other than breast milk); plain water; sugar or glucose water, gripe water, sugar salt water solution; fruit juice; baby formula; tea infusion; coffee, honey; and others). The main outcome variable (provided pre-lacteal feeds = 1 and did not provide pre-lacteal feeds = 0) was derived from the response to the first question. The types of pre-lacteal feeds were reported as a frequency. This study included place of residence (urban and rural), religion, maternal education (no education, primary education, secondary, and higher education), age of the mother (15–24, 25–34, 35–49 years), sex of the child (male, female), and access to media was recorded as frequency of reading newspaper, listening to radio and watching TV (categorized as Yes or No). The number of antenatal clinic (ANC) visits was also categorized into no ANC visits, one to three ANC visits, and four or more ANC visits. Counseling on breast feeding (Yes or No), timing of breastfeeding initiation categorized as timely if initiated within 1 h of delivery and late if initiated after 1 h after delivery. Mode of delivery (vaginal or cesarean), and places of delivery (categorized as institutional or home). Number of children was also categorized into one child, two children, and three or more children. The 11 regions of Ethiopia are delineated for administrative purposes, and in this study, they were categorized into three contextual regions: pastoralist, agrarian, and city (which were defined on the basis of the cultural and socio-economic backgrounds of their populations).29 Household wealth is represented by wealth index (in five categories: poorest, poorer, middle, richer, and richest). Wealth index was constructed using data on a households’ ownership of selected assets, such as television and bicycles, materials used for housing construction, and types of water access and sanitation facilities. The index placed individual households on a continuous scale relative to their wealth status.28 Extracted data were weighted so that the sample was representative of 15- to 49-year-old respondents in 2016 EDHS. Analyses were performed using STATA version 14. To assess the association between socio-demographic characteristics and other explanatory variables, and pre-lacteal feeding practices of mothers with children aged 0–36 months, a logistic regression model was employed. First, each variable was entered into a binary logistic regression model. Second, variables which were significant at a p-value of less than or equal to 0.25 were fitted into a multivariable logistic regression model to identify independent factors of pre-lacteal feeding practices among mothers with children aged 0–36 months in Ethiopia. Statistical significance was declared at a p-value < 0.05 in all analyses. The results from the logistic regression analyses are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).
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