Determinants of pre-lacteal feeding practices among mothers having children aged less than 36 months in Ethiopia: Evidence from 2016 Ethiopian demographic and health survey

SAGE Open Medicine, Volume 9, Year 2021

Interpretation

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).

AI Digest

Study Justification:

The study aimed to assess the determinants of pre-lacteal feeding practices among mothers in Ethiopia. Pre-lacteal feeding is associated with infant morbidity and mortality, particularly during the neonatal period. Inappropriate feeding practices in the first 6 months of life contribute to about 96% of infant deaths in developing countries. Understanding the factors influencing pre-lacteal feeding practices is crucial for developing effective interventions to improve infant and young child feeding practices.

Highlights:

– The study used data from the 2016 Ethiopian Demographic and Health Survey, which is a nationally representative survey.
– A weighted sample of 5,303 mothers with children aged 0-36 months was included in the analysis.
– The study found that 8% of mothers had given pre-lacteal foods to their newborn babies.
– Factors significantly associated with pre-lacteal feeding practice included being from an agrarian region, poorest wealth status, home delivery, late initiation of breastfeeding, lack of counseling on breastfeeding, and cesarean delivery.
– The study highlights the need to improve mothers’ infant and young child feeding practices through counseling and utilization of institutional delivery.
– Special attention should be given to mothers from pastoralist regions and those with poor socio-economic status to reduce pre-lacteal feeding practices.

Recommendations:

– Emphasize counseling on breastfeeding and the importance of timely initiation of breastfeeding.
– Promote institutional delivery to ensure access to proper support and guidance on infant feeding practices.
– Develop targeted interventions for mothers from pastoralist regions and those with poor socio-economic status to address specific challenges related to pre-lacteal feeding practices.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing policies and programs related to maternal and child health, including infant feeding practices.
– Health professionals: Provide counseling and support to mothers on breastfeeding and infant feeding practices.
– Community health workers: Play a crucial role in educating and supporting mothers in their communities.
– Non-governmental organizations (NGOs): Implement programs and interventions to promote proper infant feeding practices.
– Media outlets: Contribute to raising awareness and disseminating information on the importance of breastfeeding and appropriate infant feeding practices.

Cost Items for Planning Recommendations:

– Training and capacity building for health professionals and community health workers on counseling and support for breastfeeding.
– Development and dissemination of educational materials and resources for mothers.
– Implementation of community-based interventions and awareness campaigns.
– Monitoring and evaluation of programs and interventions.
– Research and data collection to assess the impact of interventions and inform future strategies.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is rated 8 because it is based on a nationally representative survey with a large sample size. The study used multivariable logistic regression analysis to identify significant factors associated with pre-lacteal feeding practices. The results are presented with adjusted odds ratios and 95% confidence intervals. However, to improve the evidence, the abstract could provide more details on the sampling techniques used in the survey and the response rate. Additionally, it would be helpful to include information on the limitations of the study and suggestions for future research.

Abstract

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).

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and guidance on maternal health, including breastfeeding practices, nutrition, and postnatal care. These apps can be easily accessible to mothers in both urban and rural areas, providing them with accurate and timely information.

2. Telemedicine: Establish telemedicine services that allow pregnant women and new mothers to consult with healthcare professionals remotely. This can help address the issue of limited access to healthcare facilities, especially in rural areas, by providing virtual consultations and advice on maternal health concerns.

3. Community Health Workers: Train and deploy community health workers who can provide education and support to pregnant women and new mothers in their own communities. These workers can offer guidance on breastfeeding practices, nutrition, and postnatal care, as well as identify and refer women who may need additional medical attention.

4. Maternal Health Clinics: Set up dedicated maternal health clinics in underserved areas, providing comprehensive care for pregnant women and new mothers. These clinics can offer antenatal and postnatal check-ups, breastfeeding support, and counseling services to ensure the well-being of both mothers and infants.

5. Public Awareness Campaigns: Launch public awareness campaigns to promote the importance of breastfeeding and discourage pre-lacteal feeding practices. These campaigns can utilize various media channels, including radio, television, and social media, to reach a wide audience and educate them on the benefits of exclusive breastfeeding.

6. Strengthening Health Systems: Invest in strengthening the overall health system, including improving infrastructure, training healthcare professionals, and ensuring the availability of essential maternal health services and supplies. This can help address the underlying factors that contribute to poor maternal health outcomes, including limited access to quality healthcare.

It is important to note that these recommendations are based on the information provided and may need to be further tailored and adapted to the specific context and needs of Ethiopia.

AI Innovations Description

The study titled “Determinants of pre-lacteal feeding practices among mothers having children aged less than 36 months in Ethiopia: Evidence from 2016 Ethiopian demographic and health survey” provides valuable insights into the factors influencing pre-lacteal feeding practices in Ethiopia. Pre-lacteal feeding refers to the practice of giving newborn babies foods or drinks other than breast milk within the first three days after delivery.

The study found several determinants of pre-lacteal feeding practices in Ethiopia. These include:

1. Region: Mothers from agrarian regions were less likely to practice pre-lacteal feeding compared to mothers from other regions.

2. Wealth status: Mothers from the poorest wealth index were more likely to practice pre-lacteal feeding.

3. Delivery location: Home delivery was associated with a higher likelihood of pre-lacteal feeding.

4. Timing of breastfeeding initiation: Late initiation of breastfeeding (after 1 hour of delivery) was strongly associated with pre-lacteal feeding.

5. Counseling on breastfeeding: Mothers who did not receive counseling on breastfeeding were more likely to practice pre-lacteal feeding.

6. Mode of delivery: Cesarean delivery was associated with a higher likelihood of pre-lacteal feeding.

Based on these findings, the study recommends several strategies to improve access to maternal health and reduce pre-lacteal feeding practices in Ethiopia:

1. Emphasize counseling on breastfeeding: Providing comprehensive counseling on the benefits and importance of exclusive breastfeeding within the first hour of delivery can help reduce pre-lacteal feeding practices.

2. Improve institutional delivery: Encouraging more mothers to deliver in healthcare facilities can ensure access to skilled birth attendants who can provide appropriate guidance on breastfeeding practices.

3. Target vulnerable populations: Special attention should be given to mothers from pastoralist regions and those with poor socio-economic status, as they are more likely to practice pre-lacteal feeding. Tailored interventions and support should be provided to these populations.

4. Strengthen antenatal care: Increasing the number of antenatal clinic visits and incorporating breastfeeding education into routine antenatal care can help prepare mothers for optimal breastfeeding practices.

By implementing these recommendations, Ethiopia can work towards improving access to maternal health and promoting exclusive breastfeeding practices, ultimately reducing infant morbidity and mortality associated with inappropriate feeding practices during the first six months of life.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive education programs to raise awareness about the importance of maternal health and the risks associated with pre-lacteal feeding. This can include community-based workshops, health campaigns, and targeted messaging through various media channels.

2. Strengthen antenatal care services: Improve access to and quality of antenatal care services, including regular check-ups, counseling on breastfeeding, and nutrition education. This can be achieved by training healthcare providers, increasing the number of healthcare facilities, and ensuring availability of necessary resources.

3. Promote institutional delivery: Encourage more women to give birth in healthcare facilities by addressing barriers such as cost, transportation, and cultural beliefs. This can be done through financial incentives, transportation support, and community engagement programs.

4. Enhance breastfeeding support: Provide comprehensive support for breastfeeding, including lactation counseling, peer support groups, and workplace policies that support breastfeeding mothers. This can help mothers initiate breastfeeding early and continue exclusive breastfeeding for the recommended duration.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define indicators: Identify key indicators to measure the impact, such as the percentage of women receiving antenatal care, the percentage of institutional deliveries, and the prevalence of pre-lacteal feeding.

2. Collect baseline data: Gather data on the current status of maternal health indicators in the target population. This can be done through surveys, interviews, or existing data sources.

3. Introduce interventions: Implement the recommended interventions in a targeted manner, considering factors such as geographical location, socio-economic status, and cultural context.

4. Monitor and evaluate: Continuously monitor the implementation of interventions and collect data on the selected indicators. This can be done through routine data collection systems, surveys, or qualitative assessments.

5. Analyze and compare data: Analyze the collected data and compare it with the baseline data to assess the impact of the interventions. This can involve statistical analysis, trend analysis, or qualitative analysis of individual experiences.

6. Adjust and refine interventions: Based on the findings, make adjustments to the interventions as needed to further improve access to maternal health. This can include scaling up successful interventions, addressing implementation challenges, and adapting strategies to specific contexts.

7. Repeat the process: Continuously repeat the cycle of monitoring, evaluating, and refining interventions to ensure sustained improvement in access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommended interventions on improving access to maternal health and identify effective strategies for addressing the issue of pre-lacteal feeding.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1177/20503121211019235

Research Areas:

Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Male & Female