Factors associated with prelacteal feeding practices in Debre Berhan district, North Shoa, Central Ethiopia: A cross-sectional, community-based study

BMC Nutrition, Volume 5, No. 1, Year 2019

Interpretação

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. < 25, 25–35 and > 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.

AI Digest

Study Justification:

– Prelacteal feeding is a harmful newborn feeding practice and a global public health concern.
– Studying the prevalence and factors influencing prelacteal feeding will help address major public health problems.
– This study aims to investigate the prevalence of prelacteal feeding practices and its associated factors in the Debre Berhan district of Ethiopia.

Study Highlights:

– The study was conducted from January to April 2014 among 634 mother-infant dyads.
– The prevalence of prelacteal feeding practice was found to be 14.2%.
– Home delivery, delayed initiation of breastfeeding, occupation of mothers, and maternal literacy were identified as factors associated with prelacteal feeding.
– Mothers who delivered at home were four times more likely to practice prelacteal feeding.
– Mothers who did not initiate breastfeeding within an hour were six times more likely to practice prelacteal feeding.
– Farmers were four times more likely to practice prelacteal feeding compared to housewives.
– Mothers who could read and write were 54% less likely to practice prelacteal feeding compared to illiterate mothers.

Recommendations for Lay Readers and Policy Makers:

– Improve access to information about appropriate newborn feeding practices.
– Encourage mothers to deliver their babies in health institutions.
– Inspire mothers to initiate breastfeeding within an hour of birth.

Key Role Players Needed to Address Recommendations:

– Health Extension Workers (HEWs): Community level health workers trained to deliver maternal and child health services.
– Health Development Army: A network of families led by an innovator or front liner in practicing health behavior, supported by HEWs.

Cost Items to Include in Planning the Recommendations:

– Training and capacity building for Health Extension Workers.
– Awareness campaigns and educational materials for mothers and communities.
– Support for health institutions to provide quality maternal and child health services.
Please note that the provided information is based on the given description and publication.

Força da prova

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, as it provides a clear description of the study design, data collection methods, and statistical analysis. The prevalence of prelacteal feeding practice is reported with a confidence interval. The study also identifies risk factors associated with prelacteal feeding. However, to improve the evidence, it would be helpful to include more details about the sampling method and the demographic characteristics of the study population.

Resumo

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.

Materiais

N/A

Inovações

The study titled “Factors associated with prelacteal feeding practices in Debre Berhan district, North Shoa, Central Ethiopia: A cross-sectional, community-based study” provides valuable insights into the prevalence and factors influencing prelacteal feeding practices among mother-infant dyads in the Debre Berhan district.

Based on the findings of the study, the following recommendations can be made to improve access to maternal health and reduce prelacteal feeding practices:

1. Improve access to information: Provide accurate and comprehensive information about appropriate newborn feeding practices to mothers and their families through community-based health education programs, antenatal and postnatal care services, and the involvement of health extension workers and health development armies.

2. Encourage institutional deliveries: Promote and encourage mothers to deliver their babies in health institutions to reduce the risk of prelacteal feeding. Ensure that health facilities are equipped to provide safe and supportive environments for childbirth, with skilled health professionals available to assist with breastfeeding initiation.

3. Promote early initiation of breastfeeding: Emphasize the importance of initiating breastfeeding within the first hour of birth during antenatal care visits. Provide support and guidance to mothers immediately after delivery to ensure early breastfeeding initiation.

4. Address socio-economic factors: Address socio-economic disparities by providing opportunities for education and income generation, particularly for vulnerable populations such as farmers and illiterate mothers.

To implement these recommendations, innovative strategies can be employed, such as:

1. Mobile health (mHealth) interventions: Utilize mobile phones and text messaging to deliver accurate and timely information about newborn feeding practices to mothers and their families. This can help overcome barriers of access to information and reach a larger population.

2. Community health workers: Train and deploy community health workers to provide education and support to mothers and families in their homes. These workers can play a crucial role in promoting appropriate newborn feeding practices and addressing misconceptions.

3. Peer support groups: Establish peer support groups where mothers can share their experiences and receive guidance from other mothers who have successfully practiced appropriate newborn feeding. These groups can provide emotional support and practical tips for breastfeeding initiation.

4. Income-generating programs: Implement income-generating programs targeted at vulnerable populations, such as farmers and illiterate mothers, to improve their socio-economic status. This can include vocational training, microfinance initiatives, and support for small-scale businesses.

By implementing these recommendations and innovative strategies, it is possible to improve access to maternal health and reduce the prevalence of prelacteal feeding practices, ultimately contributing to better health outcomes for both mothers and infants.

AI Innovations Description

Based on the findings of the study, the following recommendations can be made to improve access to maternal health and reduce prelacteal feeding practices:

1. Improve access to information: It is crucial to provide accurate and comprehensive information about appropriate newborn feeding practices to mothers and their families. This can be done through community-based health education programs, antenatal and postnatal care services, and the involvement of health extension workers and health development armies.

2. Encourage institutional deliveries: Promoting and encouraging mothers to deliver their babies in health institutions can significantly reduce the risk of prelacteal feeding. Health facilities should be equipped to provide safe and supportive environments for childbirth, ensuring that skilled health professionals are available to assist with breastfeeding initiation.

3. Promote early initiation of breastfeeding: Initiating breastfeeding within the first hour of birth is essential for newborns’ health and well-being. Health workers should emphasize the importance of early breastfeeding initiation during antenatal care visits and provide support and guidance to mothers immediately after delivery.

4. Address socio-economic factors: The study found that occupation and educational status of mothers were associated with prelacteal feeding practices. Efforts should be made to address socio-economic disparities by providing opportunities for education and income generation, particularly for vulnerable populations such as farmers and illiterate mothers.

By implementing these recommendations, it is possible to improve access to maternal health and reduce the prevalence of prelacteal feeding practices, ultimately contributing to better health outcomes for both mothers and infants.

AI Innovations Methodology

The methodology used in the study titled “Factors associated with prelacteal feeding practices in Debre Berhan district, North Shoa, Central Ethiopia: A cross-sectional, community-based study” involved the following steps:

1. Study Design: The study utilized a community-based cross-sectional design, which involved collecting data from a representative sample of mother-infant dyads in the Debre Berhan district.

2. Sample Size Determination: The sample size was determined using Cochran’s formula, taking into account the estimated prevalence of prelacteal feeding practices, confidence level, and margin of error. The final sample size was 634 mother-infant dyads.

3. Sampling Technique: Four out of nine kebeles (administrative units) in the study area were selected using a lottery method. Systematic random sampling was then used to select study participants from each kebele.

4. Data Collection: Structured and semi-structured questionnaires were used to collect data on socio-demographic characteristics, maternal health service uptake, and infant feeding practices. The ‘recall since birth’ method was employed to gather information on prelacteal feeding practices.

5. Data Analysis: The collected data were entered into EPI Info version 3.5.1 and analyzed using the Statistical Package for Social Sciences (SPSS) software. Descriptive statistics, bivariate logistic regression, and multivariable logistic regression analysis were performed to determine the prevalence of prelacteal feeding and identify factors associated with this practice.

6. Ethical Considerations: Ethical clearance was obtained from the Institute Review Board of Debre Berhan University. Informed consent was obtained from all participating mothers, and their confidentiality and anonymity were ensured.

The study’s findings revealed that the prevalence of prelacteal feeding in the Debre Berhan district was 14.2%. Factors such as home delivery, delayed initiation of breastfeeding, occupation (farmers), and educational status (illiteracy) of mothers were associated with a higher likelihood of practicing prelacteal feeding.

Based on these findings, the study recommended several interventions to improve access to maternal health and reduce prelacteal feeding practices, including improving access to information, encouraging institutional deliveries, promoting early initiation of breastfeeding, and addressing socio-economic factors.

Overall, the study provides valuable insights into the prevalence and factors influencing prelacteal feeding practices in the Debre Berhan district, which can inform the development of targeted interventions to improve maternal and infant health outcomes in the region.

Autor

Dima Health

Statistics:

Citations: 10

Identifiers:

DOI: 10.1186/s40795-019-0277-8

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

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