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Background: Prelacteal feeding has continued as a deep-rooted nutritional malpractice in developing countries. Prelacteal feeding is a barrier for implementation of optimal breastfeeding practices, and increases the risk of neonatal illness and mortality. However, its determinants are not well studied, which are essential to design intervention. This study aimed to assess the prevalence and determinants of prelacteal feeding among mothers with children aged 6-24 months in the rural population of northwest Ethiopia. Methods: A community based cross-sectional study was conducted in Dabat Health and Demographic Surveillance System site, Dabat district, northwest Ethiopia from May 01 to June 29, 2015. Eight hundred and twenty-two mother-child pairs were included in the study. A pretested and structured questionnaire was used to collect data. Multivariable logistic regression analysis was carried out to identify the determinants of prelacteal feeding. Results: In this community, about 26.8% of children were given prelacteal feeds. The odds of prelacteal feeding was higher among mothers with a poor knowledge of Infant and Young Child Feeding (IYCF) (Adjusted Odds Ratio [AOR] = 3.82; 95% Confidence Interval [CI] 2.42, 6.04), who gave birth at home (AOR = 3.74; 95% CI 2.12, 6.60), and who were in the lowest wealth status (AOR = 2.11; 95% CI 1.35, 3.31). Conclusions: Prelacteal feeding was common in the study area, and significantly associated with a poor household wealth status, poor maternal knowledge of IYCF, and giving birth at home. Thus, emphasis should be given to improve mothers IYCF knowledge and utilization of institutional delivery. Moreover, special attention should be given to mothers with poor socio-economic status to reduce the practice of prelacteal feeding.
A community-based cross-sectional study was conducted from May 01 to June 29, 2015 in Dabat Health and Demographic Surveillance System (HDSS) site which has been hosted by the University of Gondar, Gondar, Ethiopia. The site is located in the Dabat District in the northwest part of Ethiopia. The district has an estimated population size of 145,458 living in 26 rural and 4 urban kebeles (the smallest administration unit in Ethiopia). The livelihood of the residents by and large depends on subsistence farming. The district has six health centers and twenty-nine health posts. The HDSS covers thirteen randomly selected kebeles (three urban and ten rural kebeles) in different ecological zones (high land, middle land, and low land) and a total of 67,385 people were living in these kebeles. The Dabat HDSS site has been running since November 1996, and collects information on vital events like birth, death, migration, and pregnancy registrations and its outcome on quarterly bases. Initially, the study was aimed to assess the nutritional status and feeding practice of children aged 6–59 months in Dabat HDSS site. Of the total thirteen kebeles in the HDSS, eight kebeles were selected using lottery method. Accordingly, all mothers with children aged 6–59 months who lived in the selected kebeles for at least six months were included in the study. For households with more than one study subject, only one was selected using lottery. Sample size was calculated using Epi-info version 3.7 by considering the following assumptions; the prevalence of prelacteal feeding in Amhara Region as 47.8 % [27], 95 % level of confidence, 5 % margin of error, and 5 % non-response rate. Thus, a minimum sample size of 804 was obtained. However, 822 children aged 6–24 months and fulfilling the eligibility criteria were found in the original survey. Therefore, to improve the power of the study all (822) children fulfilling the eligibility criteria were included in the study. Data were collected using structured, pretested, and interviewer administered questionnaire. To maintain consistency, the questionnaire was first translated from English to Amharic, the native language of the study area, and was retranslated back to English by professional translators and Public Health experts. Fourteen data collectors and three field supervisors (working in Dabat DHSS) were recruited for the study. Two days intensive training regarding the objective of the study, confidentiality of information, and techniques to conduct interview was given to data collectors and supervisors. The tool was pre-tested on 5 % of the total sample out of the study area. During pre-test, the acceptability and applicability of the procedures and tools were evaluated. Prelacteal feeding, the outcome variable, was understood as giving anything to drink other than breast milk in the first three days following delivery of the index child [40]. Accordingly, a mother was asked a key question to ascertain prelacteal feeding practice; ‘within the first three days of delivery, did you give any drink other than breast milk to the child’. If she responded “yes” it was coded ‘1’, otherwise coded ‘0’ as she didn’t give any prelacteal feed. Mothers’ health care access was determined by asking the mother how many hours it took to reach the health care facilities. If she took less than two hours, it was considered as good health care access and was coded as “1”, otherwise “0” if she took two hours or more. Mothers’ knowledge of IYCF was assessed using nine questions. Mothers were asked about the benefit of breastfeeding, time to initiation of breastfeeding, colostrum feeding and it’s health benefit, how long an infant should exclusively breastfed, time to initiation of complementary feeding, type of food to start complementary feeding, how to feed a child, and for how long to continue on demand breastfeeding. The composite IYCF index was analyzed using Principal Component Analysis, and converted to terciles as lowest, medium, and highest. Likewise, the household wealth index was computed using a composite indicator for urban and rural residents by considering properties, like selected household assets and size of agricultural land. Principal Component Analysis was performed to categorize the household wealth index into lowest, middle, and highest. Data were entered into the EPI INFO version 3.5.3 and exported to Statistical Package for Social Sciences (SPSS) version 20 for analysis. Descriptive statistics, including frequencies and proportions were used to summarize the variables. A binary logistic regression was used to investigate factors associated with prelacteal feeding. Variables with p-values of < 0.2 in the bivariable analysis were entered in to the multivariable analysis. The Adjusted Odds Ratio with a 95 % confidence interval was estimated to show the strength of association, and a p-value of < 0.05 was used to declare the statistical significance in the multivariable analysis.
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