Prevalence and associated factors of prelacteal feeding among neonates admitted to neonatal intensive care units, North central Ethiopia, 2019

Bayih et al. BMC Public Health (2020) 20:1457 https://doi.org/10.1186/s12889-020-09578-5 RESEARCH ARTICLE Open Access Prevalence and associated factors of prelacteal feeding among neonates admitted to neonatal intensive care units, North central Ethiopia, 2019 Wubet Alebachew Bayih* , Demewoz Kefale Mekonen and Solomon Demis Kebede Abstract Background: Prelacteal feeding compromises the benefits of exclusive breastfeeding, thereby increasing neonatal malnutrition, infection and mortality. About 26% of the Ethiopian neonates are given prelacteal feeds and nearly 48% of whom are attributed to Amhara region. Besides, prior Ethiopian studies have shown significance of the problem at different community settings in the country. However, the prevalence and associated factors of prelacteal feeding among neonatal admissions has been overlooked in the country in general and in the study area in particular. Therefore, this study was aimed to assess the prevalence and associated factors of prelacteal feeding among neonatal admissions in the study setting. Methods: A cross-sectional study was conducted among 321 mother-neonate pairs admitted to Neonatal Intensive Care Unit (NICU) of Debre Tabor General Hospital between September 2018 and February 2019. Every fourth mother neonate pair was included to the study. Multivariable logistic regressions were fitted to find out adjusted odds ratios (AORs) of factors associated with pre-lacteal feeding. Results: The prevalence of prelacteal feeding was 20.2% [95% CI: 15.31–26.75%]. Plain water was the most common prelacteal food (32.3%). Factors associated with prelacteal feeding include rural residence (AOR = 4.07, 95% CI: 1.30, 12.81), primiparity (AOR = 4.50, 95% CI: 1.30–12.81), less than four ANC visits (AOR = 4.71, 95% CI: 1.23–17.84), spousal accompany to ANC (AOR = 0.20, 95% CI: 0.05–0.75), home delivery (AOR = 5.94, 95% CI: 1.80–19.67), having twin newborns (AOR = 6.69, 95% CI: 1.25, 35.91) and maternal belief on the purported advantages of prelacteal feeding (AOR = 2.74, 95% CI: 2.09–25.39). Conclusion and recommendation: One out of five sick neonates was given prelacteal feeds. Twin neonates, home delivered neonates, rural neonates, neonates born to primiparous mothers, neonates delivered from mothers who had less than four ANC visits, neonates born to mothers who weren’t accompanied by their spouse during ANC and those born to mothers who believe on the purported advantages of prelacteal feeding had higher odds of receiving prelacteal feeds. Therefore, mothers of these vulnerable neonates should be provided with more emphasis about counseling of infant and young child feeding practice during their stay at NICU. Keywords: Prevalence, Factors, Prelacteal, Neonates, Ethiopia * Correspondence: Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, P.O.BOX 272 Debre Tabor, Ethiopia © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Bayih et al. BMC Public Health (2020) 20:1457 Background The World Health Organization and United Nations Children’s Fund recommend an exclusive and early initiation of breastfeeding following birth [1, 2]. This recommendation of optimal breastfeeding is however contravened by prelacteal feeding, which is a nutritional malpractice of providing newborns with any food before breast feeding during the first 3 days of birth. If a newborn is prelacteal fed, it isn’t exclusively breastfed and hence the nonexclusive breastfeeding in the first 3 days of neonatal life is often followed by giving further prelacteal foods resulting in suboptimal breastfeeding (i.e forming a vicious cycle of prelacteal feeding and suboptimal breastfeeding) [2–5]. As of the 2013 Ethiopian Health and Nutrition Research Institute appraisal of the achievements and identified gaps about status of infant and young child feeding (IYCF) practice policy and programs, the implementation of Baby friendly Hospital Initiatives (BFHI) was zero (0%). Therefore, since then, different programs like health extension programs and working in collaboration with non-governmental organizations have been extensively implemented [6]. Moreover, though there is no Ethiopian hospital currently certified as “Baby Friendly Hospital”, many hospitals in the country including our study hospital have been following the ‘Baby-Friendly Hospital Initiatives’. For example, the ten steps of successful breastfeeding have been given emphasis. However, there are still several myths towards exclusive breast feeding in Ethiopia thereby challenging the implementation of the ‘Baby-Friendly Hospital Initiatives’ in several areas of the country (including our study setting) [7]. More specifically, participants of this study were only sick neonates (both home and health facility delivered neonates) whose mothers might have given them prelacteal foods at home or on the way to NICU before admission. Thus, influence of the hospital setting was thought to be lower than it would be if the study had been among mother-neonate pairs in the postnatal ward. Prelacteal feeding is a major bottleneck to optimize neonatal survival because a prelacteal food is nutritionally inferior and deprives the neonate of the most valuable perfect combination of proteins, fats, carbohydrates, minerals and fluids in breast milk [1, 2]. Furthermore, if breastfeeding is replaced by prelacteal foods, the physiologic pattern of breast milk production becomes suppressed thereby compromising both the quality and quantity of anti-infective proteins that in turn increase neonatal susceptibility to different infections. Contamination of the foods and utensils used for introducing prelacteal foods can also increase neonatal vulnerability to infections especially due to permeability of their immature gut lining [3–6]. Therefore, prelacteal feeding increases the risk of early neonatal morbidity and Page 2 of 11 mortality by limiting the health an (...truncated)