Correlates of early neonatal feeding practice in Dabat HDSS site, northwest Ethiopia

Breastfeeding is one of the most effective ways of ensuring child health and survival [1]. The World Health Organization (WHO) recommends early initiation of breastfeeding and colostrum is produced with its well-known benefits [1, 2]. Breastfeeding within one hour of birth has important benefits both infants and the mothers. It enhances the child’s cognitive development and reduces its risk of developing many infectious. Early breastfeeding also benefits the biological and emotional health of the newborn, helps prevent maternal death by reducing maternal blood loss, and creates a strong and healthy relationship between mother and child [2–6].

Globally, about four million babies die annually in the neonatal period (first four weeks of life), in which almost all (99%) of these deaths are reported to occur in low and middle income countries [7, 8]. In Ethiopia, neonatal and infant mortality rate was 31 and 59 deaths per 1,000 live births, respectively [9]. Suboptimal breastfeeding practices alone, including delay of initiation of breastfeeding and prelacteal feeding cause up to 10% of the global disease burden, and over a million deaths each year in children [10–12]. Thus, endorsement of early initiation of breastfeeding (EIB) is a cost effective intervention and may alone reduce 1.45 million or 22% of all neonatal deaths in developing countries [11, 13]. Furthermore, infants who initiate breastfeeding within one hour of life are more likely to avoid prelacteal feeds and have less chance of being exposed to pathogenic microorganisms [14]. However, in most regions of the world, less than a half of all newborns are put to the breast within one hour in South Asia (42%), West and Central Africa (35%), and sub-Sahara Africa (45%) [15].

Although the Ethiopian Government has developed infant and young child feeding guidelines and a National Nutrition Programme to improve nutrition through realizing and promoting the importance of breastfeeding [16, 17], a sizeable (48% and 27%, respectively) proportion of children were not put to the breast within the first hour of life and were given prelacteal feeds [9].

Sociodemographic and health service related factors, as well as traditional beliefs are the major reasons for poor breastfeeding practices in Ethiopia [9, 18, 19]. Various studies elicited the predictors of the early initiation of breastfeeding, according to which, rural residence [20], being a housewife [21], possession of radio receiver/TV set [21], two or above parity [20], being male infants and mothers in the upper wealth quintiles [22, 23] are associated with increased odds of the early initiation of breastfeeding. On the other hand, illiteracy [24, 25] and lack of antenatal care [26] are correlated with delayed initiation of breastfeeding. Not giving prelacteal feeding has been shown to be associated with the early initiation of breastfeeding [20, 27]. Also, a misconception about the importance of the first breast milk and that giving colostrum caused abdominal cramp, was dirty and the milk was not produce immediately, are the other influencing factor [28].

So far little attention has been given to early neonatal feeding practice by healthcare practitioners and policy-makers [29]. Studies showing the practice and determinants of early neonatal feeding will be of vital importance to address barriers to appropriate early neonatal feeding. Providing evidence on early neonatal breastfeeding practice and its determinant will have a crucial role in improving early neonatal feeding practices. Studies conducted in Ethiopia concerning early neonatal feeding are limited to rural areas and no study has been conducted to address the early neonatal feeding practice in the current study area. Therefore, this study aimed to assess early neonatal feeding and its determinants among mothers in the predominantly rural population of northwest Ethiopia.

In this study, the early initiation of breastfeeding was 43.9%; urban residence, antenatal care, and avoiding prelacteal feeding were identified as independent predictors of the early initiation of breastfeeding.

The prevalence of breastfeeding initiation within one hour of birth was fair when compared to the World Health Organization (WHO) recommendations [31]. This was consistent with studies reported from Northern Ethiopia (41.6%) [32], Western Nepal (42.2%) [33] and Nigeria (45%) [34]. However, the current finding was lower than the national studies conducted in Ethiopia (52%) [9], Tanzania (49%) [35] and Kenya (58%) [36]. The difference might be explained by the depth of the studies and the latter reports were, for example, national studies including large cross-cultural differences in breastfeeding practices across communities. However, the current study was done in predominantly rural areas of northwest Ethiopia. The low educational status, poor nutritional awareness, local beliefs and traditions all contribute to suboptimal breastfeeding practices, and that the delayed initiation of breastfeeding is more common in the predominantly rural areas [9, 28, 37]. Compared to the urban settlements, breastfeeding of children is affected by limited healthcare facilities in rural areas [37].

The current study revealed that more than half (56%) of the neonates were given prelacteal feeding, which was similar with the finding reported from Egypt (57.8%) [38]. This finding was more prevalent than that of the 2011 Ethiopian Demographic and Health Survey (EDHS) report (27%) [9]. This could be related to the low maternal healthcare utilization and poor maternal educational status in the study area and suggests that the healthcare services and education are fertile grounds to prevent suboptimal breastfeeding, such as prelacteal feeding. On the other hand, the result was lower than the report from Vietnam (73.3%) [39] and could be explained due to sociocultural differences.

The result of the multivariable analysis showed that the likelihoods of early initiation of breastfeeding were higher among mothers living in urban areas. This was in agreement with a previous national finding in Vietnam, where breastfeeding initiation within one hour of birth was more common in urban areas than in rural areas [37]. An explanation might be the fact that mothers living in rural areas are more likely to be affected by community beliefs towards in delays in the initiation of breastfeeding practices, and their low access to nutrition education and counseling about infant and young child feeding (IYCF). However, a finding from Saudi Arabia showed that rural mothers were more likely to initiate breastfeeding earlier than urban mothers [40]. This might be explained by the fact that in Saudi Arabia the participants had better education and adequate maternity care provided to both urban and rural areas through a network of primary healthcare centers. This suggests that better education and maternal healthcare accessibility create a perfect opportunity for encouraging appropriate breastfeeding practices.

This finding also confirmed that mothers who had antenatal care were 1.41 times more likely to initiate breastfeeding within one hour of birth, and is similar to another study from Nigeria [26]. It may be attributed to the mother’s opportunity to obtain information about the importance of timely initiation of breastfeeding from antenatal counseling sessions. This suggests the significance of the role of information to empower mothers to resist external interferences and pressures from traditional faiths and misunderstandings that encourage the delay in the initiation of breastfeeding. Currently, the focused antenatal care guideline in Ethiopia recommends intensive heath education about breastfeeding at the time of antenatal care visits for mothers.

Furthermore, increased odds of early initiation of breastfeeding were observed among mothers who didn’t give prelacteal feeding. The finding was supported by evidences from the rural parts of Western Ethiopia [21] and Saudi Arabia [20]. As this is a cross-sectional analysis, it is not clear whether prelacteal feeding is a cause or consequence of timely initiation of breastfeeding but this might be due to prelacteal feeding, which might result in weakening the suckling stimulus of the baby [14]. Since the information was obtained from mothers with children aged to 59 months, recall bias could not be ruled out. Also, hence, this study employed the WHO criteria [30] to estimate early initiation of breastfeeding, in which mothers attempt to initiate breastfeeding, was not adequately captured [40]. Consequently, the prevalence of EIB might be overestimated.

Delay of initiation of breastfeeding and the practice of prelacteal feeding remains public health concerns in this community. Therefore, promotion of improved infant and young child feeding (IYCF) practices and utilization of antenatal care should be intensified.