International Journal of Health & Allied Sciences

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 6  |  Issue : 1  |  Page : 30--34

Pre-lacteal feeding practices and associated factors in Himachal Pradesh


Anupam Parashar1, Deepak Sharma2, Anmol Gupta1, Dineshawar Singh Dhadwal1,  
1 Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Community Medicine, Government Medical College, Chandigarh, India

Correspondence Address:
Anupam Parashar
Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh
India

Abstract

BACKGROUND: Prelacteal feeds are dangerous for newborn health and thus should not be given. Studying the enabling factors of this harmful practice can help determine ways of how to get rid of it. AIMS AND OBJECTIVES: This study aims to assess the pattern of prelacteal feeding in a district of Himachal Pradesh and to study its predictive factors. SETTINGS AND DESIGN: A cross-sectional study was conducted among 200 mothers attending Anganwadi centers in Shimla district of Himachal Pradesh. MATERIALS AND METHODS: Data were obtained by trained field investigator using a pretested interview schedule. In-depth interviews were held to find out the reasons for providing prelacteal feeds. STATISTICAL ANALYSIS: Data were analyzed using Epi Info software for windows (Centre for Disease Control and Prevention, Atlanta). Logistic regressions were used to find out the adjusted odds ratios (AORs) for factors associated with the practice of giving prelacteal feed. RESULTS: The prevalence of prelacteal feeding was 49.5% (confidence interval [CI] = 42.5%–56.4%). In logistic regression analysis, living in joint family (AOR = 2.5, CI = 1.3–4.9) and higher socioeconomic status (AOR = 3.8, CI = 1.1–13.1) were positively associated with prelacteal feeding practice. Mothers who delivered by cesarean section were more likely to give prelacteal feeds to their baby (AOR = 3.4, CI = 1.3–8.8) as compared to those who delivered by normal vaginal delivery. CONCLUSIONS: It is concluded that prelacteal feeding is commonly practiced in both urban and rural areas of Shimla hills of Himachal Pradesh. Child health programs in the study area should use behavior change communication to decrease the harmful practice of giving prelacteal feeds to newborns.



How to cite this article:
Parashar A, Sharma D, Gupta A, Dhadwal DS. Pre-lacteal feeding practices and associated factors in Himachal Pradesh.Int J Health Allied Sci 2017;6:30-34


How to cite this URL:
Parashar A, Sharma D, Gupta A, Dhadwal DS. Pre-lacteal feeding practices and associated factors in Himachal Pradesh. Int J Health Allied Sci [serial online] 2017 [cited 2022 Aug 20 ];6:30-34
Available from: https://www.ijhas.in/text.asp?2017/6/1/30/200205


Full Text

Proper nutrition during the initial years of life is vital for the healthy growth and development of children. The Rapid Survey on Children (2013–2014) conducted by Ministry of Women and Child Development Government of India showed that 38.7% of children under five were stunted (<–2 Z-score) and 17.3% were severely stunted (<–3 Z-score).[1] The high rates of undernutrition can be attributed to suboptimal breastfeeding practices. Prelacteal feeds are a major contributor to suboptimal breastfeeding practices. Common prelacteal feeds practiced in India are honey, ghutti, animal milk, etc. The harmful effects of prelacteal feeding include a delay in initiation of breastfeeding and prevention of the initial bonding between the mother and the baby. Infants who receive prelacteal feeding are more likely to be malnourished. Furthermore, prelacteal feeds may introduce pathogens and thus causes diarrhea and other diseases in newborns. Unlike colostrum, prelacteal feeds have lesser nutrient value.[2],[3]

Worldwide countries are scaling up efforts to increase rates of optimal breastfeeding practices thus decrease child mortality. Breastfeeding is linked to many objectives of the 2030 agenda for Sustainable Development Goals. World Breastfeeding Week is celebrated every year for raising awareness regarding the fact that breastfeeding is a key to sustainable development. India has made great strides in improving child nutrition over the past decade. The government of India has promoted child health programs and is advocating healthy infant child feeding practices. One such program is the implementation of the “National Infant and Young Child Feeding” (IYCF) Guideline which discourages prelacteal feeding practices and encourages optimal breastfeeding practices. Health workers working in peripheral health facilities play an active role in getting breastfeeding off to a good start among children.[4],[5],[6],[7]

To the best of the author's knowledge, no studies were carried out in Shimla hills of Himachal Pradesh to describe the prelacteal feed given to the newborn. With this background, the present study was conducted to assess the pattern of prelacteal feeding in Shimla district of Himachal Pradesh and to analyze its contributing factors.

 Materials and Methods



A community-based, cross-sectional study was conducted in selected Anganwadis of Shimla district of Himachal Pradesh during the months of June and July 2011. For calculating sample size, we used the “exclusively breastfed” IYCF indicator of Himachal Pradesh (27.1%). Considering the 95% confidence level, 10% absolute precision and 20% nonresponse rate, the sample size calculated was 92. Based on this, it was decided to interview 100 mothers in urban and 100 in rural areas. The list of Anganwadi centers in urban and rural areas of Shimla was obtained from the Child Development Project Officer (CDPO). Out of this list, ten Anganwadi centers were selected in an urban area (Boileauganj) and ten in a rural area (Mashobra Block) by the simple random sampling method. In each Anganwadi center, mothers of infants and children younger than 24 months presenting at the center and who agreed to participate in the study, were recruited. If >1 child <24 months of age was accompanying a mother, the information was collected for all of them.

A trained field investigator interviewed the mothers using a predesigned and structured questionnaire. Before each interview, written informed consent was obtained. The main outcome variable was practice of prelacteal feeding which was defined as “any food other than breast milk given to the newborn after birth before initiating breastfeeding.” Among different independent variables, education of mother, education of father, occupation of mother, occupation of father, per capita monthly income of family, family type (joint or nuclear), type of delivery (normal vaginal delivery or cesarean section), place of delivery (hospital, home), and initiation of breastfeeding within the recommended 1 h of birth were included in this study.

Nuclear family was taken as one which consisted of a married couple and their dependent children. Joint family was taken as one in which number of married couples and their children live together in the same household. For categorizing economic status of families, we used the state of Himachal Pradesh poverty line (urban Rs. 1064/month, rural 913/month).[8] Maternal breastfeeding knowledge was assessed based on mothers' answers to eight questions related to breastfeeding. Each question was given a score of 1 or 0 depending on a correct or incorrect response, respectively.[9] Subsequently, a combined score was generated adding up correct answers which ranged from 0 to 8. Score <5 were regarded as “inadequate knowledge” and >5 were considered as “adequate knowledge.” In-depth interviews were held with eight mothers to know the reasons for giving prelacteal feeds. Themes which emerged from these interviews were grouped according to the responses.

Data entry and analysis were done using Epi Info software for windows (Centre for Disease Control and Prevention, Atlanta). Frequency and percentage for categorical variables were calculated. Chi-square and Fisher's exact tests (where required) were used to compare different variables between those receiving prelacteal feeds and those who did not. P < 0.05 was considered statistically significant. Logistic regressions were used to find out the adjusted odds ratios (AORs) and 95% confidence interval (CI) for factors associated with practice of giving prelacteal feed. The result of Hosmer–Lemeshow goodness-of-fit test was not significant (P = 0.53). Overall, correct classification result indicated that 71.5% of the independent variables rightly predict about behavior regarding prelacteal feeding. Permission from the Institutional Ethical Committee and CDPO was obtained before the study.

 Results



A total of 200 mother-child pairs were included in the study out of which nearly half mothers fed prelacteal feeds to newborns (49.8%, CI = 42.5%–56.4%). In urban areas, the prelacteal feed was given by 44% of the mothers (CI = 34.27%–53.73%), while in rural area prelacteal feed was practiced by 55% (CI = 45.25%–64.75%). The common prelacteal feed was honey (67.6%) followed by ghutti (herbal formulation) (11.8%). Prelacteal feeds were comparatively more reported in rural area (55%) as compared to an urban area (45%) [Table 1].{Table 1}

Comparatively more mothers from rural background (55%) and families above poverty line practiced prelacteal feeding (50%). Mothers living in joint families (56%) practiced prelacteal feeding more than those living in nuclear families (42%, P < 0.05). Literacy level of mother and father were not related to giving prelacteal feeds; neither was the occupation of mother and occupation of father. Prelacteal feeds were more encountered among women with delivery at home (60.7%). Mothers delivered by cesarean section practiced more prelacteal feeding (67.6%). Among the mothers who practiced prelacteal feeding, more than half (55%) initiated breastfeeding later than the recommended guidelines. Among those mothers who gave prelacteal feeds more than two-third had less than adequate knowledge of optimal breastfeeding pracxtices (65%) [Table 2]. In the detailed knowledge assessment, mothers who practiced prelacteal feeding were less aware of the fact that colostrum or first milk serves as the first immunization for the baby. Similarly, more of them had the myth that infant formula contains antibodies that protect against diseases, especially against diarrhea, respiratory, and ear infections [Table 3].{Table 2}{Table 3}

In-depth interviews revealed that the major reason stated for providing prelacteal feeding was the societal norm and belief in which mother believed that the person who makes newborn baby taste “honey” with finger, the child when grows up will become like him and imbibe his/her good qualities. The other reasons were advice by elder family members or relatives and baby excessive cry immediately after birth, inability of the baby to suck breast milk and mother illness.

The logistic regression revealed that the significant independent predictors of prelacteal feeding living in joint family (AOR = 2.5, CI = 1.3–4.9) and high socioeconomic status (AOR = 3.8, CI = 1.1–13.1). Mothers who delivered baby by cesarean section (AOR = 3.4, 1.3–8.8) and had inadequate knowledge (AOR = 5.6, 2.8–11.1) had higher odds of giving prelacteal feeds to the baby. Delivering baby at home had higher odds of prelacteal feeding (AOR = 2.0, CI = 0.7–5.4) as compared to delivery in the hospital. Similarly, mothers who initiated breastfeeding >1 h after birth had higher odds of prelacteal feeding (AOR = 1.5, CI = 0.7–3.0) [Table 4] as compared to those who initiated breastfeeding within an hour of birth.{Table 4}

 Discussion



Prelacteal feeding is widely practiced in the Shimla hills of Himachal Pradesh. This study revealed that the prevalence of prelacteal feeding was 49.8%. A similar finding has been reported in a study conducted in Chandigarh by Kumar et al. wherein 40% mothers gave prelacteal feed to their babies.[10] Another study from Kashmir valley of India has reported 80% prelacteal feeding rate.[11] Madhu et al. conducted a study in Karnataka and reported a lower prevalence of prelacteal feeding than the current study (19%).[12] Breastfeeding Promotion Network of India carried out a nationwide study and reported that the prevalence of prelacteal feed in the state of Himachal Pradesh was 60%.[13]

In the present study, prelacteal feeding was more popular in rural areas. Similar to our finding Legesse et al. have reported more rural mothers give prelacteal feeds to baby.[14] It was observed that mothers who gave birth at home were more likely to give prelacteal feeds to baby than those delivering in government hospital. This finding is similar to what has been reported in studies by Gupta and Gautam and Ogah et al.[15],[16] Our study has reported that women who have less knowledge of breastfeeding practices were more likely to give prelacteal feeds to baby. Similar to our finding, a study done by Legesse et al. reported that mothers who were not aware of the risks associated with prelacteal feeding were more likely to practice it.[14] It was found that the reason for practicing prelacteal feeding were the myths and misconceptions, for example, thinking that “artificial feeds have disease preventing factors.” It is suggested that for bringing a favorable change in knowledge and practice, there is a need to draft and implement a region specific behavior change communication (BCC). In an interventional study done by Parashar et al. in New Delhi, the harmful practices of prelacteal feeding was reduced by BCC package.[17]

In contrast to other studies, our study finding has established that mothers belonging to high socioeconomic status practiced more prelacteal feeds.[18],[19] The reason may be that well to do families has easy access to purchasing prelacteal feeds. Further, it was observed that education of parents was not related to prelacteal feeding practice. The finding is in sharp contrast to a study finding which has reported that educated parents have fewer tendencies to give prelacteal feeds.[20] In this study, the common feeds given on the 1st day of life were honey and ghutti. This is in agreement with previous studies in India wherein similar prelacteal feeds have been reported.[21],[22] Consistent with evidence from a study in Uganda by Ogah et al., in this study mothers who started breastfeeding within an hour of birth were less likely to give prelacteal feeds.[16]

In this study, cesarean section was a risk factor for prelacteal feeding. A possible explanation is that breastfeeding is initiated only when the mother is shifted from recovery room in operation theater to indoor ward which means a delay of few hours. This time duration gives access to family members for giving prelacteal feeds to the baby. Prior et al. in a meta-analysis concluded that cesarean delivery is associated with lower rates of early breastfeeding initiation.[23] Finally in our study, mothers who were from joint family more likely to give prelcateal feeding to their child. A possible reason may be more family members of joint family may exercise collective influence on child nutrition-related practices. Similar to our finding, studies done Nguyen et al. and Akuse and Obinya have reported that joint family is a factor that promotes prelacteal feeding.[24],[25]

The study has few limitations. There is the possibility of recall bias as data was collected after few days of childbirth. In addition, the sample was restricted to newborns in Shimla district of Himachal Pradesh. It is recommended that in future nationwide study should be done to document the practices in other regions of India. The findings of this multicentric study can be used for designing specific interventions.

 Conclusions



This study has inferred that there is a high prevalence of prelacteal feeding in Shimla district of Himachal Pradesh. Inadequate knowledge, living in joint family, home delivery, and cesarean section were associated with prelacteal feeding. It is suggested that mothers should be educated about adverse effects of prelacteal feeds. BCC should be targeted for tackling the traditional beliefs and practices. Innovative approaches like establishing mother groups in the community for influencing family attitude should be considered as an option.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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