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Background: Prelacteal feeding is one of the major harmful newborn feeding practices and is top on the list of global public health concerns. The practice deprives newborns of valuable nutrients and protection of colostrum and exposes them to preventable morbidity and mortality. Studying the prevalence and factors influencing the prelacteal feeding practice of mothers will help program managers and implementers to properly address broad major public health problems. Therefore, this study aims to investigate the prevalence of prelacteal feeding practices and its associated factors among mother-infant dyads in the Debre Berhan district of North Shoa administrative zone, central Ethiopia. Methods: A community-based cross-sectional study design was conducted from January through to April 2014 among 634 mother-infant dyads. The data were entered into EPI Info version 3.5.1. (CDC, Atlanta, Georgia). All statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) research IBM version 20.0. The prevalence of prelacteal feeding was determined using the ‘recall since birth’ method. Multi-variable logistic regression analysis was employed to control confounders in determining the association between prelacteal feeding practices and selected independent variables. Adjusted Odds Ratio (AOR), with 95% Confidence Interval (CI) and P < 0.05 was used to claim statistical significance. Results: The prevalence of prelacteal feeding practice was 14.2% (95% CI: 11.00-17.00%). Slightly greater than half, 48 (53.3%) of prelacteal fed newborns were given butter. Home delivery was a major risk factor for practicing prelacteal feeding. Mothers who delivered their indexed infant at home practiced prelacteal feeding over four folds more than mothers who delivered in a health institution (Adjusted Odds Ratio (AOR) 4.70; 95% CI: 2.56-8.60, p-value = 0.001). Mothers who did not initiate breastfeeding within an hour were six times more likely to practice prelacteal feeding (AOR 5.58; 3.21-9.46, p-value = 0.001). Similarly, with regards to the occupation of mothers, farmers practiced prelacteal feedings (AOR 4.33; 95% CI: 1.73-10.81, p-value = 0.002) up to four folds more than their counterpart housewives. Mothers who can read and write are 54% less likely to practice prelacteal feeding than their counterpart, illiterate mothers, with (AOR 0.46; 95% CI: 0.22-0.98, p-value = 0.044). Conclusions: In the Debre Berhan town of North Shoa administrative zone, central Ethiopia, almost one-sixth of mothers practiced prelacteal feeding. Therefore, improving access to information about appropriate newborn feeding practices, encouraging mothers to deliver their babies in health institutions and inspiring them to initiate breastfeeding within an hour of birth is recommended.
This community-based cross-sectional study was conducted among mother-infant dyads from March to April 2014, in the Debre Berhan district of North Shoa administrative zone within the Amhara region. The study area is located 120 km away from Addis Ababa, the capital city of Ethiopia. The study area has an estimated total population of 84,920 people [20]. The study was conducted in four of nine kebeles the smallest administrative units where 5000 people live per kebele. The data were part of the study conducted to determine factors associated with exclusive breastfeeding practices in Debre Berhan district, central Ethiopia [21]. Data were collected from 634 mother-infant dyads. The sample size was determined using Cochran’s formula [22] with its presented assumptions: Where ni is the sample size, Z is standard normal variable at 95% confidence level (1.96), P is (0.50) the proportion of mothers who practiced prelacteal feeding in the study area was not known, d is the marginal error (0.05), design effect (1.5) and contingency for non-response (0.10). Therefore, ni = 576, considering 10% for refusal and incomplete data (n = 576+ 58 = 634). Based on the assumption of homogeneity of the population, four (2 urban and 2 rural) out of nine kebeles were selected using lottery methods. Following that, a population census was conducted in these kebeles which was used to identify 1177 mother-infant dyads [20]. After developing the sampling frame, study subjects were selected using every other household with systematic random sampling techniques. During data collection, 53 mothers and their index infants were replaced due to incomplete responses and absence of basic information. Mother-infant dyads who lived for more than 6 months in the study area were chosen for the study. Structured and semi-structured questionnaires were adopted from the Ethiopian Demographic and Health Survey (EDHS) [12] and WHO recommended national assessment tools for infant and young child feeding surveys [23] were applied for this study. The questionnaire was first prepared in English, translated into Amharic, and then back into English to check its consistency using fluent speakers of both languages. The final Amharic version of the questionnaire was used to collect the data. Data on socio-demographic characteristics, maternal health service uptake and infant feeding practices were collected using the ‘recall since birth’ method. The most significant study question asked was, “Before initiation of breastfeeding, was given anything to drink and/or eat other than breast milk?”. The data was then collected through face to face interviews conducted at the study participants’ home. Respondents who were unavailable or absent were revisited. The questionnaires noted the socio-demographic information of the mother-infant dyads and prelacteal feeding practices of mothers for the index infant. In this study, the dependent variable was prelacteal feeding practices. In the regression analysis, prelacteal feeding practice was coded ‘1’ while ‘0’ was coded for non-prelacteal feeding practices. The independent variables considered were: age, educational status, residence, marital status of mothers, household income, occupation, family size, sex of infant, place of delivery and ante-natal and post-natal service utilization. The age of mothers was categorized into three groups i.e. 35 years. The younger age group was taken as a reference population in the regression analysis. The religion of mothers was coded as ‘0’ for Christian and ‘1’ for Muslim. Urban and rural residences of mothers were coded as ‘0’ and ‘1’ respectively. Regarding the educational status of parents, those who could not read and write were coded as ‘0’ while the rest were coded as ‘1’. Mothers who were housewives were coded ‘0’ while farmers and employed mothers were coded ‘1’. The lowest household income was coded ‘0’ while the other two levels were coded ‘1’. Mothers who received infant feeding counseling and delivered in a health institution were coded as ‘0’, while those who did not receive those services were coded as ‘1’ [21]. Prelacteal feeding: is defined as giving liquids or foods other than breast milk prior to the establishment of regular breastfeeding [6]. Early initiation of breastfeeding: are the proportion of children born in the last 24 months who were made to breastfeed within 1 h of birth [3]. Exclusive breastfeeding: are the proportion of infants less than 6 months of age, who are exclusively breastfed with breast milk and no other liquids or solids, with the exception of oral rehydration solution, supplements or medicines [3]. Health Extension Workers (HEWs): are community level health workers trained for 1 year at undergraduate level to deliver preventive, promotive and curative health services, such as maternal and child health services [24]. Health Development Army: are a network of up to 5 families each of which one of the families, who is an innovator or front liner in practicing health behavior, leads the network and gradually influences the rest of the households to acquire skills and changes in attitudes towards healthy behavior. The network is technically supported by the HEWs, who facilitate and follow up through regular conversations held within the community [24]. Kebele: is the smallest administrative unit with a population of 5000 people [25]. A two-day long training and pretesting were arranged for data collectors and supervisors. Moreover, to maintain the quality of collected data, the questionnaires were pre-tested using 10% of the sample size at the Basona Worana district within North Shoa administrative zone. The data collection tools were amended based on the findings of the pilot test. Supervision was conducted during the actual data collection by the investigators. Every questionnaire was checked for completeness and supervisors were providing feedback on the quality of collected data on a daily basis. In addition, filled in questionnaires were cleaned and coded to double enter into computers by the data encoder. Data were entered using the EPI Info statistical software V.3.5.1(CDC, Atlanta, Georgia, USA) [26] and exported to Statistical Package for Social Science (SPSS) research (SPSS-IBM- version 20) [27] for analysis. Cleaning was conducted using frequencies and univariate analysis. Percentages, frequency distributions and measures of central tendency and measures of dispersion were used for describing the data. The investigators used the ‘recall since birth’ method to determine the magnitude of prelacteal feeding practices among mother-infant dyads in the targeted community. Bivariate logistic regression was computed to identify the association of independent and dependent variables. Finally, based on the recommendations of Bendel and Afiff (1977), independent variables found to have P-value <=0.2 [28] were entered into multivariate logistic regressions to control the effect of confounding. The Hosmer-Lemeshow goodness-of-fit was used to test for model fitness. Results were reported as Crude Odds Ratio (COR) or Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CIs). The statistical significance test was accepted at p < 0.05. Ethical clearance was obtained from the Institute Review Board (IRB) of Debre Berhan University. Permission was granted form both Debre Berhan District Health Office and kebele administrations. Informed consents were obtained from all mothers participating in the study. Participation of all respondents in the survey was strictly voluntary. All information obtained from the respondents was anonymous and confidential.
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