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Infant feeding counseling and knowledge are the key determinants of prelacteal feeding among HIV exposed infants attending public hospitals in Ethiopia

Archives of Public HealthThe official journal of the Belgian Public Health Association201775:23

https://doi.org/10.1186/s13690-017-0191-y

Received: 25 October 2016

Accepted: 27 March 2017

Published: 22 May 2017

Abstract

Background

Despite the fact that breastfeeding promotes optimal health and growth for infants and young children, inappropriate feeding practice, such as prelacteal feeding increases the risk of neonatal death and illness and remains a public health problem in Ethiopia. Therefore, this study assessed the prevalence of prelacteal feeding and associated factors among HIV positive mothers with children aged 7–20 months attending government hospitals in North Gondar zone, northwest Ethiopia.

Methods

An institution based cross-sectional study was conducted from February to March, 2016, at public hospitals of North Gondar Zone. Three hundred sixty-seven HIV positive mothers attending PMTCT clinics in government hospitals during the study period were included in the study. A multivariate logistic regression analysis was used to investigate factors associated with prelacteal feeding. The Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was used to show the strength of association, and variables with a P-value of <0.05 were considered statistically significant.

Results

In this study, the overall prevalence of prelacteal feeding was 19.1% (95% CI: 15–23). According to the multivariate analysis, prelacteal feeding was associated with fathers with no formal education (AOR = 5.85; 95% CI: 2.02, 16.92), lack of infant feeding counseling (AOR = 3.36; 95% CI: 1.27, 8.85), discarding the colostrum (AOR = 5.16; 95% CI: 2.32, 11.45), inadequacy of antenatal care visit (AOR = 0.07; 95% CI: 0.03, 0.15), and high IYCF knowledge (AOR = 0.10; 95% CI: 0.03, 0.30).

Conclusion

In this study, the prevalence of prelacteal feeding was high. Furthermore, father’s education, colostrum feeding, infant feeding counseling, ANC visit, and IYCF knowledge were significantly associated with prelacteal feeding. As a result, strengthening maternal health care utilization, breastfeeding counseling, and IYCF knowledge are essential to address the high burden of prelacteal feeding.

Keywords

Prelacteal feedingFactorsHIV positive mothersNorthwest Ethiopia

Background

Appropriate and optimal feeding practices for infants and young children are essential for healthy growth and cognitive development [15]. Breastfeeding initiation in the first hours of birth increases the chance of getting the colostrum and its benefits [6, 7], mother-infant bond [8], as well as successful establishment of breastfeeding [9]. In addition, breastfeeding reduces risks of contracting infectious [1012] and non-infectious diseases [1316], which in turn save millions of children from death. Furthermore, it helps postnatal weight management and delayed menstruation, suggesting extra contraceptive importance [17]. Due to these facts, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend that breastfeeding should start within an hour of delivery and that exclusive breastfeeding be maintained for the first six months of the infant’s life. Furthermore, safe, adequate, and appropriate complementary feeding should be initiated at the age of six [3, 4, 18].

In the era of HIV/AIDS pandemicity, the dilemma of vertical transmission of the HIV virus through breastfeeding has been controversial, and it was previously pointed out that early cessation of breastfeeding reduces HIV transmission. However, recent reports from low and middle income countries, especially in Sub-Saharan Africa countries, indicate that childhood mortality and morbidity due to malnutrition and diarrheal diseases exceeds HIV infection [19, 20]. Therefore, WHO recommends focusing on childhood survival than on the transmission of HIV. Considering these facts, the current WHO guideline recommends that all HIV exposed infants from known HIV positive mothers get breastfeeding only for the first six months and that the children be given solid or semi-solid complementary food in addition to continued breastfeeding from the age of 6 months until 12 months [4, 18, 21].

Even though early initiation of breastfeeding promotes health and increases the duration of breastfeeding [1, 3, 4, 7, 22, 23], inappropriate breastfeeding practice after delivery, such as providing food or liquids before the establishment of breast milk is commonly practiced. Since the lining of neonatal gut is immature, any food or drink offered before the establishment of breast milk (also known as prelacteal feeding) can easily introduce infections and subsequently leads to death [24]. Prelacteal feeding is defined as offering any food or drinks before the establishment of breast milk in the first three days of delivery [3].

Global reports on childhood feeding practice indicated that the highest rate of prelacteal feeding was reported in Asia [24, 25], Latin America [26], and Africa [27, 28]. In Asia, prelacteal feeding practice ranged from 54.0–93.9% [24, 25, 29]. In Africa, where HIV/AIDS disproportionally hit, the prevalence of prelacteal feeding ranged from 5.4–75.2% [27, 28, 30]. Various reports indicated that prelacteal feeding was affected by various factors, but was mainly associated with maternal and health service related characteristics. Lack of education [24], poor household wealth status [24], maternal age, lack of counseling on breastfeeding [29, 31, 32], poor infant breastfeeding knowledge [33, 34], inadequate antenatal care visit [24, 35], and discarding colostrum [2] were some of the factors significantly associated with prelacteal feeding.

Ethiopia has been implementing infant and young child feeding strategy and other nutrition programs to improve optimal child feeding practices, thereby reducing morbidity and mortality [30]. Moreover, breastfeeding is nearly universal but it continues as sub-optimal. According to the 2011 Ethiopian Demographic and Health Survey (EDHS) report, only half (51.5 & 52%, respectively) of the mothers initiated breastfeeding within an hour of delivery and exclusively breastfed [36]. However, inappropriate feeding practices, including prelacteal feeding are responsible for 24% of infant deaths [37]. About 27.1% of the mothers offered prelacteal feeds in Ethiopia. Though there are regional variations in prelacteal feeding practices which ranged from 10.4–72.5% [2, 36, 3841], the highest rates were reported in Somali (72.5%) and Amhara (47.8%), regions [36]. Despite the fact that prelacteal feeding has a negative effect on child health, little is known about its magnitude among HIV positive mothers. Therefore, this study aimed to assess prelacteal feeding and associated factors among HIV positive mothers with children aged 7–20 months attending government hospitals in North Gondar Zone, northwest Ethiopia.

Methods

Study setting and design

An institution based cross-sectional study was conducted from February to March, 2016, at North Gondar Zone government hospitals, northwest Ethiopia. The zone has 126 health centers and 6 hospitals providing services to the community. Out of the six hospitals in the study area, only three, Mettema, Dabark, and Gondar University were providing anti-retroviral treatment (ART) and prevention of mother-to-child HIV transmission (PMTCT) services at the moment. A total of 392 HIV infected mothers with children aged 7–20 were registered for HIV care and support at the PMTCT clinics of the selected hospitals.

Sample size and sampling procedure

All HIV positive mothers who had children aged 7–20 months and were attending the PMTCT clinics participated in the study. Mother-child pairs were recruited from the three government hospitals of North Gondar Zone. Sample size was calculated using the single proportion formula with the following assumptions: 38.8% expected prevalence of prelacteal feeding in Raya Kobo, Amhara Region [36], 95% level of confidence, 5% margin of error, and 5% non-response rate. Finally, the minimum sample size of 383 was obtained. Hence, only 392 HIV positive mothers with children aged 7–20 months were registered in the PMTCT clinics. All eligible mother-child pairs who attended the PMTCT clinics in the selected hospitals during the study period were included consecutively.

Data collection tools and procedure

A structured interviewer-administered questionnaire was used to collect data from HIV positive mothers with children aged 7–20 months registered in the PMTCT clinics of the selected government hospitals. To maintain consistency, the questionnaire was first translated from English to Amharic (the native language of the study area) and was retranslated to English by professional translators and public health experts. Six clinical nurses and two health officers were assigned as data collectors and supervisors, respectively. Two days’ intensive training was given to data collectors and supervisors on the objective of the study, the confidentiality of information, and techniques for conducting the interview. To address the ethical issues, the data collectors were recruited out of the full-time employees of the respective hospitals. However, such data collectors might be prone to social desirability bias in relation to respondents. So, efforts were made to equip the data collectors with techniques to minimize the bias. Awareness was created among all study participants regarding the objective of the study and on the fact that their response wouldn’t affect the possible treatment they needed. They were also informed that the study was not intended to evaluate their adherence to counseling and treatment given earlier. Moreover, data collectors created a conducive environment by keeping mothers in separate rooms and by making them comfortable during data collection. The tool was pretested on 5% of the total sample out of the study area, at Felegehiwot Referral Hospital to evaluate the acceptability and applicability of the procedures.

Operational definitions

The dependent variable, prelacteal feeding practice, was measured by asking the mothers whether they gave any food or/and drink to the index child before the establishment of breast milk in the first three days of delivery [3, 24, 36]. Accordingly, if the mother gave any drink or/and food other than breast milk to the child within the first three days of delivery, she was considered to be practicing prelacteal feeding. Mothers’ comprehensive knowledge of infant and young child feeding was assessed using the key components of appropriate feeding practices such as knowledge on the benefits of breastfeeding, time of breastfeeding initiation, colostrum feeding, negative health outcomes of prelacteal feeding, and for how long for an infant should be exclusively breastfeeding, complementary feeding, type of food, time to start complementary feeding, and how to feed a child. Principal component analysis (PCA) was done to compute the composite infant and young child feeding (IYCF) index and converted to the lowest, medium, and a highest terciles. Similarly, household wealth status of the respondents was measured using a composite indicator for urban and rural residents by considering their household assets and properties, and categorizing them into lowest, middle, and highest terciles [42].

Data processing and analysis

Data were entered into Epi-info version 3.5.3 and exported to the Statistical Package for Social Sciences (SPSS) version 20 for analysis. Descriptive statistics, including frequencies and proportions, were computed using the binary logistic regression model in order to summarize the variables. Variables with a p-value of less than 0.2 in the bi-variable analysis were entered into the multivariable analysis. Both Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with 95% confidence intervals were estimated to show the strength of associations. Finally, a p-value of less than 0.05 at the multivariable logistic regression analysis was used to identify variables significantly associated with prelacteal feeding practices.

Results

Socio-demographic and economic characteristics

Out of the total 392 study participants, 367 HIV positive mothers attending public hospitals were included in the study. The mean (standard deviation) age of the mothers was 31 (±4.4) years. The majority (80.7 and 82.3%, respectively) of the respondents were Orthodox Christians and 20–35 years old. Nearly one-third (30%) of the mothers had no formal education. About 74.9% were married at the moment, and 86.9% of the fathers had primary and above educational status. Almost half (52.6 and 50.4%, respectively) of the children were male, aged 7–12 months (Table 1).
Table 1

Socio-demographic and economic characteristics of HIV positive mothers with children aged 7–20 months in government hospitals of North Gondar zone, Northwest Ethiopia, 2016

Variables

Frequency (n)

Percentage (%)

Sex of the child (n = 367)

 Female

174

47.4

 Male

193

52.6

Age of the child (n = 367)

 7-12 months

185

50.4

 13-20 months

182

49.5

Mother’s age (n = 367)

 20-35 years

302

82.3

  > 35 years

65

17.7

Religion (n = 367)

 Orthodox

296

80.7

 Protestant

52

14.2

 Muslim

19

5.1

Mother’s ethnicity (n = 367)

 Amhara

286

77.9

 Kemant

62

16.9

 Tigre

12

3.3

 Oromo

7

1.9

Mother’s education (n = 367)

 No formal education

110

30

 Primary

115

31.3

 Secondary

64

17.4

 Certificate

18

4.9

 College and above

60

16.3

Father’s education (n = 367)

 No formal education

48

13.1

 Primary

115

31.3

 Secondary

87

23.7

 Certificate

15

4.1

 College and above

102

27.8

Mother’s occupation (n = 367)

 Housewife

166

45.2

 Government employed

43

11.7

 Private employed

53

14.4

 Farmer

12

3.3

 Merchant

51

13.9

 Daily laborer

42

11.4

Father’s occupation (n = 367)

 Governmental

116

31.6

 Private

33

9.0

 Farmer

63

17.2

 Merchant

107

29.2

 Daily laborer

48

13.1

Mother’s marital status (n = 367)

 Married

275

74.9

 Currently unmarried

92

25.1

Wealth status (n = 367)

 Poor

122

33.2

 Medium

130

35.4

 Rich

115

31.3

Maternal and child health service utilization

About 82.6% of the mothers made at least one antenatal care (ANC) visit; 85.6% delivered at health institutions. Out of total 47.4% mothers who reported obstetric problems, the majority encountered prolonged labor. The majority (89.5%) of the respondents received counseling on breastfeeding, and nearly one-third (30.8%) had optimal comprehensive knowledge on infant feeding (Table 2).
Table 2

Maternal and child service utilization among HIV positive mothers with children aged 7–20 months in government hospitals of North Gondar zone, Northwest Ethiopia, 2016

Variables

Frequency (n)

Percentage (%)

Antenatal care (ANC) (n = 367)

 Yes

303

82.6

 No

64

17.4

Number of ANC visit (n = 303)

 1

41

13.5

 2-3

62

20.5

  > 4

200

66.0

Place of delivery (n = 367)

 Home

53

14.4

 Health institution

314

85.6

Counseling on breastfeeding (n = 354)

 Yes

317

89.5

 No

37

10.5

Mode of delivery (n = 367)

 Spontaneous vaginal delivery

174

47.4

 Episotomy

101

27.5

 Instrumental delivery

13

3.5

 Cesarean section (CS)

79

21.5

Parity (n = 367)

 1-3 children

325

88.6

 4-6 children

42

11.4

Comprehensive knowledge on IYCFa (n = 367)

 Poor

143

39

 Medium

113

30.8

 Good

111

30.2

Obstetric problem (n = 367)

 Yes

174

47.4

 No

193

52.6

Type of obstetric problem (n = 174)

 Prolonged labor

138

79.3

 APH

14

8.0

 PPH

20

11.6

 Others

2

1.1

Birth weight (n = 333)

  

 Low birth weight (<2.5kgb)

21

6.3

 Normal

312

93.7

aInfant and Young Child Feeding, bkilogram

Prevalence of prelacteal feeding

In this study, about 19.1% (95% CI: 0.15, 0.23) of the mothers offered prelacteal feeds to their newborn. The most common prelacteal food given to children was sugar solution (35.7%), plain water (27.1%) and abesh (15.7%). Culture and mothers’ breast problems were the most reported reasons for practicing prelacteal feeding. The majority (79.6%) of the children had the first milk (colostrum) within an hour of delivery (Table 3).
Table 3

Feeding practice of children aged 7–20 months born from HIV positive mothers in government hospitals of North Gondar Zone, Northwest Ethiopia, 2016

Variables

Frequency (n)

Percentage (%)

Pre-lacteal feeding practice for index child

 Yes

70

19.1

 No

297

80.9

Pre-lacteal foods (n = 70)

 Butter

8

11.4

 plain water

19

27.1

 Abesha

11

15.7

 Sugar solution

25

35.7

 Traditional medicine

7

1.1

Reasons for pre-lacteal feeding (n = 70)

 Culture

42

60.0

 Breast problem

16

22.8

 Others

12

17.2

Colostrum feeding

 Yes

292

79.6

 No

75

20.4

Reasons for not feeding colostrum (n = 75)

 Not clean

21

28.0

 Not comfortable for the baby

11

14.7

 Not important

17

22.6

 Have breast problem

26

34.7

Have breast illness during breastfeeding (n = 363)

 Yes

45

12.4

 No

318

87.6

amade from roasted and powdered fenugreek diluted with water

Factors associated with prelacteal feeding

In the bivariable logistic regression analysis, residence, father’s education, wealth status, antenatal care visit, counseling about infant feeding, place of birth, mother’s comprehensive knowledge of infant and young child feeding (IYCF), obstetric problem, and colostrum feeding were factors associated with prelacteal feeding at a p-value of less than 0.2. Consequently, these variables were entered into the multivariate logistic regression analysis, and it was noted that fathers’ education, mothers’ antenatal care visits, their counseling on infant feeding and comprehensive knowledge of IYCF, and giving the colostrum were significantly and independently associated with a prelacteal feeding practice.

The odds of prelacteal feeding were higher among illiterate fathers compared with the literate ones (AOR: 5.85; 95% CI: 2.02, 16.92). Mothers who had just one antenatal care visit also had high odds of prelacteal feeding (AOR: 0.07; 95% CI: 0.03, 0.15). Similarly, the odds of prelacteal feeding were high among mothers who did not get counseling about infant feeding (AOR: 3.36; 95% CI: 1. 27, 8.85). Mothers who had medium comprehensive knowledge on IYCF were 62% less likely to practice prelacteal feeding compared with mothers who had poor comprehensive knowledge on IYCF (AOR:0.38; 95% CI: 0.16, 0.88). Mothers who had optimal (good) comprehensive knowledge were consistently 90% less likely to practice prelacteal feeding compared with mothers who had poor comprehensive knowledge (AOR:0.10; 95% CI: 0.03, 0.30). Furthermore, the odds of prelacteal feeding were higher among mothers who discarded the colostrum (AOR: 5.16; 95% CI: 2.32, 11.45) (Table 4).
Table 4

Factors associated with prelacteal feeding practice among HIV positive mothers with children aged 7–20 months in government hospitals of North Gondar zone, Northwest Ethiopia, 2016

Variables

Prelacteal feeding

Crude odds ratio

Adjusted odds ratio

 

Yes

n (%)

No

n (%)

(95% CI)

(95% CI)

Place of residence

 Urban

46 (16.1)

239 (83.9)

0.47 (0.26,0.82)

0.82 (0.23,2.88)

 Rural

24 (29.3)

58 (70.7)

1

1

Father’s education

 No formal education

17 (35.4)

31 (64.6)

2.75 (1.42,5.33)

5.85 (2.02,16.92)*

 Primary and above

53 (16.6)

266 (83.4)

1

1

Wealth status

 Poor

31 (25.4)

91 (74.6)

1

1

 Medium

16 (12.3)

114 (87.7)

0.41 (0.21,0.80)

0.57 (0.20,1.62)

 Rich

23 (20.0)

92 (80.0)

0.73 (0.39,1.35)

1.16 (0.44,3.07)

ANC

 Yes

31 (10.2)

272 (89.8)

0.073 (0.039,0.136)

0.07 (0.03,0.15)*

 No

39 (60.9)

25 (39.1)

1

1

Counseling about infant feeding

 Yes

49 (15.5)

268 (84.5)

1

1

 No

14 (37.8)

23 (62.2)

3.32 (1.60,6.91)

3.36 (1.27,8.85)*

Place of birth

 Home

21 (39.6)

32 (60.4)

3.55 (1.89,6.65)

2.00 (0.79,5.04)

 Health institution

49 (15.6)

265 (84.4)

1

1

Comprehensive knowledge on IYCFa

 Poor

36 (25.2)

107 (74.8)

1

1

 Medium

26 (23.0)

87 (77.0)

0.89 (0.49,1.58)

0.38 (0.16,0.88)*

 Good

8 (7.2)

103 (92.8)

0.23 (0.10,0.52)

0.10 (0.03,0.30)*

Have obstetric problem

 Yes

43 (24.7)

131 (75.3)

2.01 (1.18,3.43)

1.72 (0.85,3.47)

 No

27 (14.0)

166 (86.0)

1

1

Give colostrum

 Yes

37 (12.7)

254 (87.3)

1

1

 No

33 (43.4)

43 (56.6)

5.27 (2.98,9.31)

5.16 (2.32,11.45)*

*Variables with P-value of < 0.05, aInfant and Young Child Feeding

Discussion

Infant and young child optimal breastfeeding is essential for survival, growth, and cognitive development; however, inappropriate feeding practices, including prelacteal feeding, remain a problem [4, 43].

This study showed that the prevalence of prelacteal feeding was 19.1% (95% CI: 15%, 23%). The finding was in line with those of studies conducted in different regions of Ethiopia, for instance, in Southern (16.8%) [38], Oromiya (21.9%), and Benshangul-Gumuz regions (23.4%) [36]. However, the prevalence was higher than the reports of other developing countries, such as Malawi (5.4%) [44], Zambia (8.9%) [28]. This might be related to the socio-cultural differences of the study settings. Studies also claimed that mothers’ perceived insufficient and delayed milk production is a common reason for offering prelacteal feeds [45, 46].

However, the finding of this study was lower than the national report of 27%, and that of the Amhara (47.4%) and Somali regions (72.5%) [36]. Like the reports of other studies [47, 48], better care provided to HIV positive mothers might reduce prelacteal feeding and increase appropriate feeding practices. Moreover, the difference of scope between the EDHS report and this study might have contributed to the differences in prelacteal feeding practices. Similarly, the reported low rate of prelacteal feeding in this study compared to the study conducted in Raya Kobo district, north-east Ethiopia, may be due to differences in the participants of the study. For instance, the respondents of the Raya Kobo study were rural dwellers who had poor access to maternal and child health services [33]. The prevalence of prelacteal feeding was high in countries that have better economic status and more educated mothers, like Vietnam (73.3%) [34], Egypt (58%) [49], Thailand (34.6%) [50], Kuwait (81.8%) [51], Bangladesh (92%) [52], and the Philippines (55%) [53]. This might be due to the fact that better wealth status enables mothers to purchase expensive formulae feeds for their newborn before the establishment of breastfeeding [24, 49]. In addition, educated mothers’ unfavorable attitude toward prelacteal feeding, like perceived risks of hypoglycemia and dehydration plus social norms that favor the practice might be the other causes [45, 46].

Out of the variables which showed a significant association with prelacteal feeding at p-value of less than 0.05, higher odds of prelacteal feeding were noted among fathers who had no formal education, who didn’t get counseling about infant feeding, and who discarded the colostrum. In contrast, the odds of prelacteal feeding were lower among mothers who attended antenatal care centers and among mothers who had medium and good comprehensive knowledge on IYCF.

In this report, high odds of prelacteal feeding were noted among mothers who discarded the colostrum. This finding is supported by other findings reported in northeast Ethiopia [2], and Bangladesh [54]. This might be due to maternal misperception of the benefits of breastfeeding, especially mothers’ negative attitude on the benefits of the colostrum [41]; breast problems after delivery might also lead to prelacteal feeding. Other reports stated that mothers’ misconception that the colostrum is not important for the child and that it rather makes the newborn sick might be the reasons for discarding the substance [23, 34]. Besides, the introduction of other foods to the newborn before breast milk establishment decreases infant suckling activity and the secretion of milk, subsequently leading to further prelacteal feeds [8, 41].

The odds of prelacteal feeding practices among HIV positive mothers who had medium and good comprehensive knowledge of IYCF were lower compared to their counterparts’. This might be due to the fact that mother’s knowledge of IYCF is an important component of optimal and appropriate child feeding practice. This finding is similar with that of studies conducted elsewhere [34, 39, 55].

Like studies conducted elsewhere [56, 57], high odds of prelacteal feeding practices were noted among illiterate fathers compared to fathers with some level of education. This can be due to the role of education as an important social determinant of health for children. As fathers are educated, their involvement in child feeding practices increases and might have its own impact in practicing appropriate child breastfeeding. Besides, in countries like Ethiopia, where husbands are more influential, any father support in breastfeeding practice enables the mother to avoid prelacteal feeds.

Consistent with previous studies [2, 29, 31, 32], the odds of prelacteal feeding among mothers who had antenatal care visits and counseling on breastfeeding were lower compared with their counterparts. This might be due to the fact that behavioral change communication strategies, such as individual and group counseling, increase appropriate and optimal breastfeeding practices. In addition, breastfeeding counseling during critical periods of pregnancy, including antenatal care visits discourages prelacteal feeding and promotes appropriate and optimal child feeding practices. That is because mothers who have prenatal care visits or maternal and child health services get better access and exposure to health information from health care providers and educational materials that might lead to avoiding prelacteal feeding practices.

The study attempted to show what prelacteal feeding looks like in rural areas, particularly among HIV positive mothers. However, it was not free from limitations, such as inadequate sample size, and inability to include qualitative study methods. In addition, recall and social desirability bias are also possible limitations of the study.

Conclusion

In this study, the prevalence of prelacteal feeding was high and fathers’ education, colostrum feeding, infant feeding counseling, ANC visits, and IYCF knowledge were significantly associated with it. As a result, strengthening maternal health care utilization, breastfeeding counseling, and IYCF are essential to address the burden.

Abbreviations

AOR: 

Adjusted Odds ratio

AIDS: 

Acquired immune deficiency syndrome

ANC: 

Antenatal care

ART: 

Antiretroviral treatment

CI: 

Confidence interval

EDHS: 

Ethiopia demographic and health survey

HIV: 

Human Immune deficiency Virus

IYCF: 

Infant young child feeding

PCA: 

Principal component analysis

PMTCT: 

Prevention of mother to child transmission

SPSS: 

Statistical package for social sciences

UNICEF: 

United Nations Children’s Fund

WHO: 

World Health Organization

Declarations

Acknowledgments

We are indebted to the study participants, data collectors and supervisors for their commitment to take part in the study.

Funding

No funding was obtained for this study.

Availability of data and materials

Data will be available upon request from the corresponding authors.

Authors’ contributions

MKY, HG, AT conceived of the study, coordinated data collection, performed statistical analysis, and drafted the manuscript. MKY, HG, AT participated in the design and tool development, performed statistical analysis, and drafted the manuscript. All authors read and approved the final manuscript.

Competing interest

Authors declare that they have no any conflict of interest.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical clearance was obtained from the Ethical Review Board of the University of Gondar. A letter of permission was collected from the chief executive officers of the hospitals under study. After the objective of the study was explained, verbal and written consent was secured from the mothers. The right of participants to withdraw from the study at any time without any precondition was disclosed. Moreover, the confidentiality of information obtained was guaranteed by using code numbers rather than personal identifiers and by keeping the questionnaire locked.

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Authors’ Affiliations

(1)
Department of Epidemiology and Biostatistics, University of Gondar
(2)
Gondar University Hospital
(3)
Department of Human Nutrition, University of Gondar

References

  1. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding. Protecting Infants through Human Milk: US: Springer; 2004. p. 63–77.Google Scholar
  2. Bililign N, Kumsa H, Mulugeta M, Sisay Y. Factors associated with prelacteal feeding in North Eastern Ethiopia: A community based cross-sectional study. Int Breastfeed J. 2016;11(1):1.View ArticleGoogle Scholar
  3. WHO. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. 2009.Google Scholar
  4. WHO, UNICEF. Global strategy for infant and young child feeding. Geneva: World Health Organization; 2003.Google Scholar
  5. Jedrychowski W, Perera F, Jankowski J, Butscher M, Mroz E, Flak E, et al. Effect of exclusive breastfeeding on the development of children’s cognitive function in the Krakow prospective birth cohort study. Eur J Pediatr. 2012;171(1):151–8.View ArticlePubMedGoogle Scholar
  6. Brownlee A. Breastfeeding, weaning & nutrition: the behavioral issues: US Agency for International Development Washington, DC; 1990Google Scholar
  7. Labbok MH, Clark D, Goldman AS. Breastfeeding: maintaining an irreplaceable immunological resource. Nat Rev Immunol. 2004;4(7):565–72.View ArticlePubMedGoogle Scholar
  8. Himani BK, Kumar P. Effect of initiation of breastfeeding within one hour of the delivery on" maternal-infant bonding. Nursing and Midwifery Research Journal. 2011;7(3):99–109.Google Scholar
  9. Begum K, Dewey KG. Impact of early initiation of exclusive breastfeeding on newborn deaths. 2010Google Scholar
  10. Duijts L, Jaddoe VW, Hofman A, Moll HA. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. 2010;126(1):e18–25.View ArticlePubMedGoogle Scholar
  11. Stuebe A. The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol. 2009;2(4):222–31.PubMedPubMed CentralGoogle Scholar
  12. Diarrhoea O. Short-term effects of breastfeeding. 2013Google Scholar
  13. Verret-Chalifour J, Giguère Y, Forest J-C, Croteau J, Zhang P, Marc I. Breastfeeding initiation: impact of obesity in a large Canadian perinatal cohort study. PLoS One. 2015;10(2):e0117512.View ArticlePubMedPubMed CentralGoogle Scholar
  14. Von Kries R, Koletzko B, Sauerwald T, Von Mutius E, Barnert D, Grunert V, et al. Breast feeding and Obesity: cross sectional study. BMJ. 1999;319(7203):147–50.View ArticleGoogle Scholar
  15. Jones ME, Swerdlow AJ, Gill LE, Goldacre MJ. Pre-natal and early life risk factors for childhood onset diabetes mellitus: a record linkage study. Int J Epidemiol. 1998;27(3):444–9.View ArticlePubMedGoogle Scholar
  16. Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH. Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet. 1997;350(9072):166–8.View ArticlePubMedGoogle Scholar
  17. WHO. Exclusive breastfeeding for six months best for babies everywhere. Geneva: World Health Organization; 2011.Google Scholar
  18. Doherty T, Chopra M, Jackson D, Goga A, Colvin M, Persson L-A. Effectiveness of the WHO/UNICEF guidelines on infant feeding for HIV-positive women: results from a prospective cohort study in South Africa. Aids. 2007;21(13):1791–7.View ArticlePubMedGoogle Scholar
  19. Amadi B, Kelly P, Mwiya M, Mulwazi E, Sianongo S, Changwe F, et al. Intestinal and systemic infection, HIV, and mortality in Zambian children with persistent diarrhea and malnutrition. J Pediatr Gastroenterol Nutr. 2001;32(5):550–4.View ArticlePubMedGoogle Scholar
  20. Shearer WT. Breastfeeding and HIV infection. Pediatrics. 2008;121(5):1046–7.View ArticlePubMedGoogle Scholar
  21. UNICEF, Organization WH. HIV and infant feeding. 1998.Google Scholar
  22. Pérez-Escamilla R, Segura-Millán S, Canahuati J, Allen H. Prelacteal feeds are negatively associated with breast-feeding outcomes in Honduras. J Nutr. 1996;126(11):2765–73.PubMedGoogle Scholar
  23. Lakati A, Makokha O, Binns C, Kombe Y. The effect of pre-lacteal feeding on full breastfeeding in Nairobi, Kenya. East Afr J Public Health. 2010;7(3):258–262.PubMedGoogle Scholar
  24. Khanal V, Adhikari M, Sauer K, Zhao Y. Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal demographic and health survey 2011. Int Breastfeed J. 2013;8(1):1.View ArticleGoogle Scholar
  25. FU A, Rahmani M, Alam M. Prelacteal feeding: influencing factors and relation to establishment of lactation. Bangladesh Med Res Counc Bull. 1996;22(2):60–4Google Scholar
  26. Ludvigsson JF. Breastfeeding intentions, patterns, and determinants in infants visiting hospitals in La Paz, Bolivia. BMC Pediatr. 2003;3(1):1.View ArticleGoogle Scholar
  27. Ogah A, Ajayi A, Akib S, Okolo S. A cross-sectional study of Pre-lacteal feeding practice among Women Attending Kampala International University Teaching Hospital Maternal And Child Health Clinic, Bushenyi, Western Uganda. Asian J Med Sci. 2012;4(3):79–85.Google Scholar
  28. Katepa-Bwalya M, Mukonka V, Kankasa C, Masaninga F, Babaniyi O, Siziya S. Infants and young children feeding practices and nutritional status in two districts of Zambia. Int Breastfeed J. 2015;10(1):1.View ArticleGoogle Scholar
  29. Dawal S, Inamdar I, Saleem T, Priyanka S, Doibale M. Study of pre lacteal feeding practices and its determinants in a rural area of Maharashtra, India. Sch J Appl Med Sci. 2014;2(4D):1422–7.Google Scholar
  30. Federal Ministry of Health Ethiopia (FMOH). National strategy for Infant and Young Child Feeding (IYCF). 2004.Google Scholar
  31. Roy S, Dasgupta A, Pal B. Feeding practices of children in an urban slum of Kolkata. Indian J Community Med. 2009;34(4):362.View ArticlePubMedPubMed CentralGoogle Scholar
  32. Seid AM, Yesuf ME, Koye DN. Prevalence of Exclusive Breastfeeding Practices and associated factors among mothers in Bahir Dar city, Northwest Ethiopia: a community based cross-sectional study. Int Breastfeed J. 2013;8(1):1.View ArticleGoogle Scholar
  33. Legesse M, Demena M, Mesfin F, Haile D. Prelacteal feeding practices and associated factors among mothers of children aged less than 24 months in Raya Kobo district, North Eastern Ethiopia: a cross-sectional study. Int Breastfeed J. 2014;9(1):1.View ArticleGoogle Scholar
  34. Nguyen PH, Keithly SC, Nguyen NT, Nguyen TT, Tran LM, Hajeebhoy N. Prelacteal feeding practices in Vietnam: challenges and associated factors. BMC Public Health. 2013;13(1):1.View ArticleGoogle Scholar
  35. Tessema M, Belachew T, Ersino G. Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia. Pan African Medical Journal. 2013;14(1):1–12.Google Scholar
  36. Demographic E. Health Survey (2011) Addis Ababa. Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International. 2012.Google Scholar
  37. Initiative EPHT. Essential Nutrition Actions to Improve the Nutrition of Women and Children in Ethiopia, Including Under Situations of Emergencies and HIV/and AIDs; Training Manual, Linkages. Addis Ababa: Ethiopia Public Health Training Initiative. 2004Google Scholar
  38. Haile D. adherence to WHO breastfeeding guidelines among HiV positive mothers in southern ethiopia: implication for intervention. 2015.Google Scholar
  39. Legesse M, Demena M, Mesfin F, Haile D. Factors Associated with Colostrum Avoidance Among Mothers of Children Aged less than 24 Months in Raya Kobo district, North-eastern Ethiopia: Community-based Cross-sectional Study. Journal of Tropical Pediatrics. 2015:fmv039.Google Scholar
  40. Bekele Y, Mengistie B, Mesfine F. Prelacteal feeding practice and associated factors among mothers attending immunization clinic in Harari region public health facilities, Eastern Ethiopia. Open Journal of Preventive Medicine. 2014;2014Google Scholar
  41. Rogers NL, Abdi J, Moore D, Nd’iangui S, Smith LJ, Carlson AJ, et al. Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia. Public Health Nutr. 2011;14(11):2029–36.View ArticlePubMedGoogle Scholar
  42. Rutstein SO, Johnson K, MEASURE OM. The DHS wealth index: ORC Macro, MEASURE DHS; 2004Google Scholar
  43. Mukuria AG, Kothari MT, Abderrahim N. Infant and Young Child Feeding update. 2006Google Scholar
  44. Macro O. Malawi demographic and health survey 2004. Zomba, Malawi: National Statistical Office; 2005.Google Scholar
  45. Aborigo RA, Moyer CA, Rominski S, Adongo P, Williams J, Logonia G, et al. Infant nutrition in the first seven days of life in rural northern Ghana. BMC Pregnancy Childbirth. 2012;12(1):76.View ArticlePubMedPubMed CentralGoogle Scholar
  46. Semega-Janneh IJ, Bøhler E, Holm H, Matheson I, Holmboe-Ottesen G. Promoting breastfeeding in rural Gambia: combining traditional and modern knowledge. Health Policy Plan. 2001;16(2):199–205.View ArticlePubMedGoogle Scholar
  47. de Paoli MM, Manongi R, Klepp K-I. Counsellors’ perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in northern Tanzania. Reprod Health Matters. 2002;10(20):144–56.View ArticlePubMedGoogle Scholar
  48. Chopra M, Piwoz E, Sengwana J, Schaay N, Dunnett L, Sanders D. Effect of a mother-to-child HIV prevention programme on infant feeding and caring practices in South Africa. S Afr Med J. 2002;92(4):298–302.PubMedGoogle Scholar
  49. El-Gilany A-H, Abdel-Hady DM. Newborn first feed and prelacteal feeds in Mansoura, Egypt. BioMed Research International. 2014;2014Google Scholar
  50. Senarath U, Dibley MJ, Agho KE. Breast-feeding Performance Index: a composite index to describe overall breast-feeding performance among infants under 6 months of age. Public Health Nutr. 2007;10(10):996–1004.View ArticlePubMedGoogle Scholar
  51. Dashti M, Scott JA, Edwards CA, Al-Sughayer M. Determinants of breastfeeding initiation among mothers in Kuwait. Int Breastfeed J. 2010;5(1):1.View ArticleGoogle Scholar
  52. Taranum S, Hyder SZ. Pre-lacteal Feeding Practices in Rural Area of Bangladesh: Citeseer; 1998Google Scholar
  53. MEASURE D, Calverton M. Philippines National Demographic and Health Survey 2003: ORC Macro; 2004Google Scholar
  54. Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet. 2000;356(9242):1643–7.View ArticlePubMedGoogle Scholar
  55. Chezem J, Friesen C, Boettcher J. Breastfeeding knowledge, breastfeeding confidence, and infant feeding plans: effects on actual feeding practices. J Obstet Gynecol Neonatal Nurs. 2003;32(1):40–7.View ArticlePubMedGoogle Scholar
  56. Tan KL. Factors associated with exclusive breastfeeding among infants under six months of age in peninsular Malaysia. Int Breastfeed J. 2011;6(1):1.View ArticleGoogle Scholar
  57. Taddele M, Abebe L, Fentahun N. Exclusive breastfeeding and maternal employment in Ethiopia: A comparative cross-sectional study. Int J Nutr Food Sci. 2013;3(6):497–503.View ArticleGoogle Scholar

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