Exploration of Breastfeeding Practices in India: A Systematic Review

Introduction: Breastfeeding is essential and a unique way of providing food to infants for development and healthy growth. Various breastfeeding practices are followed in different regions of India. Objective: This study aims to collect the information for practices related to prelacteal feed, early initiation of breastfeeding, exclusive breastfeeding, and weaning in India. Materials and Methods: A systematic search was conducted in PubMed, MEDLINE, Embase, Google Scholar, Clinical key, the Cochrane Library, and Science Direct databases to identify studies on practices related to the initiation of early breastfeeding, prelacteal feed, Exclusive Breastfeeding (EBF) practices, and weaning as outcomes. Quality assessment of each study was done by the Newcastle-Ottawa scale. Results: Twenty-four studies were included in this systematic review. Seven studies reported an early initiation of breastfeeding within 1-6 hours of birth. Six studies reported various prelacteal foods given to infants, such as tea, boiled water, honey, sugar, jaggery, or glucose with plain water and diluted animal milk. Four studies stated that exclusive breastfeeding was a suboptimal practice, often continued for less than six months for reasons like working mothers (not enough time for breastfeeding), traditional beliefs, and inadequate milk output. Four studies explored the causes of early onset of weaning, and the most common reasons were initiation of supplementary feeding before six months, insufficient breastmilk, and lack of knowledge. Conclusion: Overall, the results of the individual studies indicate that unhealthy breastfeeding practices such as prelacteal feeding, suboptimal exclusive breastfeeding, and early initiation of weaning practices were prevalent and almost the same across India.

Determinants of prelacteal feeding practice in Uganda; a population based cross-sectional study using Uganda demographic and health survey data

BackgroundBreastfeeding has well-established short-term and long-term health benefits for both the mother and infant. Initiating breastfeeding immediately after birth stimulates breast milk production. Prelacteal feeding (PLF) may result in late initiation of breastfeeding, and thus insufficient production of breast milk. This study aimed to identify the determinants of PLF among children under five years in Uganda. MethodsThis cross-sectional study was conducted using the data from the database of Uganda Demographic and Health Survey 2011. The data of 4,774 children/mothers were evaluated in this study.ResultsThe prevalence of PLF was 40.3%. The rate of PLF practice was found to be 2.15 times higher in women with moderate economic status and 2.02 times higher in women with high economic status compared to those who have low economic status. The rate of PLF practice was found to be 1.73 times higher in newborns delivered by an unskilled birth attendant and 4.35 times higher in newborns delivered with no birth attendant compared to those infants delivered by a skilled birth attendant. The ratio of PLF practice was found to be 2.49 times higher in multiple births. Mothers who initiated breastfeeding in the first 24 hours after birth had higher odds of PLF. No relationship was found between PLF practice with somesociodemographic characteristics of mother’s (age, marital status, educational status, religion, residential location), maternal factors (number of children, antenatal and postnatal care attendance, place of delivery), and characteristics of the newborn infants (sex, type of delivery, birth order number) in the multivariate logistic regression analysis.ConclusionsAll mothers should be informed about the importance of initiation of breastfeeding immediately after delivery, the risks associated with PLF, the optimal practices for breastfeeding, and the presence of a skilled birth attendant at delivery.

Prevalence and determinants of early initiation of breastfeeding (EIBF) and prelacteal feeding in Northern Ghana: A cross-sectional survey

Background There is suboptimal early initiation of breastfeeding (EIBF) with widespread prelacteal feeding in Ghana. However, studies exploring the determinants of EIBF and prelacteal feeding are limited in Ghana. The study was conducted to assess the prevalence and determinants of EIBF and prelacteal feeding in Northern Ghana. Methods This cross-sectional study was conducted among 508 mothers with infants aged 0–24 months in the Sagnarigu Municipality of Northern Ghana. The quantitative data were collected using a structured questionnaire adapted from Ghana’s demographic and health survey. Multivariate logistic regression was used to identify the independent determinants of EIBF and prelacteal feeding. Results The prevalence of EIBF and prelacteal feeding was 72% and 21%, respectively. The independent positive determinants of EIBF were partner support to breastfeed [adjusted Odds ratio (AOR): 1.86, 95% Confidence interval (CI): 1.09–3.17] and exposure to breastfeeding information during pregnancy (AOR = 1.63 (95% CI: 1.01–2.64). Lower odds of EIBF were observed among mothers from extended family (AOR = 0.62, 95% CI: 0.41–0.95). Regarding prelacteal feeding, negative determinants were having a normal weight baby (AOR: 0.50, 95% CI: 0.27–0.90), exposure to breastfeeding information during pregnancy (AOR: 0.54, 95% CI: 0.31–0.92), while experiencing delayed onset of lactation was a risk factor for prelacteal feeding practice (AOR: 2.35, 95% CI: 1.41–3.94). Conclusion In this study, EIBF was slightly higher than the 2030 global target on EIBF with widespread prelacteal feeding practice. Health programs aimed at improving EIBF should focus on the women partners, nutrition counselling, and support to mothers from the extended family. In the same vein, programs aimed at discouraging prelacteal feeding practice should also target women at risk, such as those with low birthweight babies and women experiencing delayed lactation onset.

Prelacteal feeding among infants within the first week of birth in eastern Uganda: evidence from a health facility-based cross-sectional study

Background Prelacteal feeding hinders early initiation of breastfeeding and exclusive breastfeeding but is understudied in Uganda. We examined the prevalence and factors associated with prelacteal feeding among postpartum mothers in Kamuli district in rural eastern Uganda. Methods We conducted a cross-sectional study between December 2020 and January 2021 at four large healthcare facilities and randomly sampled mother-baby pairs attending postnatal care and immunization clinics. Prelacteal feeding was defined as giving anything to eat or drink to a newborn other than breast milk within the first 0–3 days of life. Data were collected using a researcher-administered questionnaire and summarized using frequencies and percentages. The Chi-squared, Fisher’s exact, and Student’s t-tests were used for comparison while the factors independently associated with prelacteal feeding were determined using modified Poisson regression analysis, reported as an adjusted prevalence risk ratio (aPRR) with corresponding 95% confidence intervals (CI). Results Of 875 participants enrolled, 319 (36.5%) practiced prelacteal feeding. The likelihood of prelacteal feeding was lower among participants who were unemployed (aPRR 0.70; 95% CI 0.5, 0.91), married (aPRR 0.71; 95% CI 0.58, 0.87), had received health education on infant feeding practices (aPRR 0.72; 95% CI 0.60, 0.86), had a spontaneous vaginal delivery (aPRR 0.76; 95% CI 0.61, 0.95), had delivered in a health facility (aPRR 0.73; 95% CI 0.60, 0.89), and who knew that prelacteal feeding could lead to difficulties in breathing (aPRR 0.70; 95% CI 0.57, 0.86). Conversely, prelacteal feeding was more likely among participants who had attended antenatal care at a public health facility during the most recent pregnancy (aPRR 2.41; 95% CI 1.71, 3.39) and those who had travelled more than 5 km to a health facility for postnatal care services (aPRR 1.46; 95% CI 1.23, 1.72). Conclusions The prevalence of prelacteal feeding among postpartum mothers in rural eastern Uganda is slightly higher than the national average. Accordingly, there is a need to continuously educate mothers and staff on infant feeding practices to tackle the factors influencing prelacteal feeding and promote appropriate infant and young child feeding practices as emphasized in the baby-friendly health facility initiative policy.

Prevalence of and Factors Associated With Lactational Mastitis in Eastern and Southern Africa: An Exploratory Analysis of Community-Based Household Surveys

BackgroundLactational mastitis is an extremely painful and distressing inflammation of the breast, which can seriously disrupt breastfeeding. Most of the evidence on the frequency of this condition and its risk factors is from high-income countries. Thus, there is a crucial need for more information on lactational mastitis and its associated factors in Sub-Saharan Africa (SSA).MethodsWe used data from representative, community-based cross-sectional household surveys conducted with 3,315 women from four countries (Ethiopia, Kenya, Malawi, and Tanzania) who reported ever-breastfeeding their last child born in the two years before the survey. We first estimated country-specific and pooled prevalence of self-reported lactational mastitis and examined mastitis-related breastfeeding discontinuation. Additionally, we examined factors associated with reporting mastitis in the pooled sample using bivariate and multivariable logistic regression accounting for clustering at the country level and post-stratification weights.ResultsThe prevalence of self-reported lactational mastitis ranged from 3.1% in Ethiopia to 12.0% in Kenya. Close to 17.0% of women who experienced mastitis stopped breastfeeding because of mastitis. The adjusted odds of self-reported lactational mastitis were approximately two-fold higher among women who completed at least some primary school compared to women who had no formal education. Study participants who delivered by caesarean section had 1.46 times higher odds of reporting lactational mastitis than women with a vaginal birth. Despite wide confidence intervals, our models also indicate that young women (15 – 24 years) and women who practiced prelacteal feeding had higher odds of experiencing lactational mastitis than older women (25+ years) and women who did not give prelacteal feed to their newborn. ConclusionThe prevalence of lactational mastitis in four countries of SSA might be somewhat lower than estimates reported from other settings. We found that lactational mastitis may result in breastfeeding discontinuation in approximately 1 in 5 woman-infant dyads affected by the condition. Factors such as younger age, higher education, caesarean section, and prelacteal feeding may be associated with experiencing mastitis. Further studies should explore the risk and protective factors for lactational mastitis in African contexts and address the negative consequences on breastfeeding.

Prelacteal feeding practice and its associated factors among mothers having children less than 2 years of age in East Africa: a multilevel analysis of the recent demographic and health surveys

Background Prelacteal feeding is a major public health problem that increases the risk of morbidity and mortality in children. It also result delayed breastfeeding initiation and interferes with exclusive breastfeeding. Although numerous studies have been done on prelacteal feeding in individual East African countries, most of them did not consider community-level factors that could affect the likelihood of prelacteal feeding. This study, thus, aimed to assess the pooled prevalence and associated factors of prelacteal feeding practice in East Africa. Methods We used pooled data from the 12 east Africa countries Demographic and Health Surveys (DHS). A total weighted sample of 33,423 women was included in the final analysis. We employed multilevel logistic regression analysis to assess factors associated with prelacteal feeding practice. Finally, the Adjusted odds ratio (AOR) with 95% Confidence (CI) interval was reported and variables with p value< 0.05, in the multivariable analysis, were declared to be significant predictors of prelacteal feeding practice. Result In this study, the pooled prevalence of prelacteal feeding practice was 11.85% (95%CI: 11.50, 12.20) with great variation between countries, ranging from 3.08% (95%CI: 2.35, 3.81) in Malawi to 39.21% (95%CI: 36.36, 42.06) in Comoros. Both individual and community-level factors were associated with prelacteal feeding practice. Of the individual-level factors, home delivery, multiple birth, cesarean delivery, non-exposure to media, delayed initiation of breastfeeding, and being a small-sized baby were associated with higher odds of prelacteal feeding practice. Among the community-level factors, rural residence and higher community-level of media exposure were associated with lower odds of prelacteal feeding practice. Conclusion In this study, the pooled prevalence of prelacteal feeding is high. Both individual and community level variables were associated with prelacteal feeding practice. Therefore, individual and community-level interventions that encourage mothers to deliver in the health facility and promoting timely initiation of breastfeeding are needed to reduce prelacteal feeding practices in east Africa. Moreover, media campaigns regarding this harmful traditional practice could be strengthened.

Prelacteal Feeding and Associated Factors among Mothers of Infants Aged 6 to 12 Months in Chitwan District, Nepal: A Community Based Cross-sectional Study

ABSTRACTBackgroundA Prelacteal feed is any food except mothers’ milk provided to a newborn before breastfeeding is established. Prelacteal feeding is a major barrier to exclusive breastfeeding and is associated with newborn infection. It is a prevalent practice in Nepal. This study aimed to investigate prelacteal feeding practice and associated factors among mothers of infants aged 6 to 12 months in Chitwan district, Nepal.MethodsA community-based cross-sectional study was conducted. 297 mothers of infants aged 6 to 12 months were selected using a systematic random sampling technique. Descriptive statistics, univariate and binomial logistic regression analysis were done to identify the factors associated with prelacteal feeding practice. Variable with a p-value <0.05 were identified as statistically significant factors.ResultThe prevalence of prelacteal feeding was 40.1% (95% CI: 34.5%-45.7%). Formula milk (n=109), animal milk (n=13), Plain water (n=6) were some of the types of prelacteal feed reported. Respondents in the 25-29 years age group were about 58.2% less likely to practice prelacteal feeding (adjusted odds ratio (AOR)=0.415, 95% confidence interval (CI):0.209-0.837) as compared to the respondents belonging to 35 years or more age group. Economic status was another factor associated with prelacteal feeding practice. Those mothers with poorer economic status were about 57.9 % (AOR= 0.421, CI: 0.179-0.992) less likely to practice prelacteal feeding than the mothers belonging to the richest. Similarly, mothers having poor knowledge on prelacteal feeding were found about three (AOR= 2.661, CI: 1.514-4.674) times more likely to have prelacteal feeding than those mothers who had good knowledge about prelacteal feeding. Home delivery and caesarean section in case of institutional delivery were two major reasons stated for providing prelacteal feeding.ConclusionPrelacteal feeding was commonly practiced in the Chitwan district, Nepal. Mother’s age, economic status, mothers’ knowledge of prelacteal feeding practices, and mode of delivery were factors associated with prelacteal feeding practices. Therefore, awareness and knowledge on the risk associated with prelacteal feeding, promotion of institutional delivery, timely initiation of breastfeeding, and avoidance of prelacteal feeding are important measures for preventing prelacteal feeding practices in Chitwan district, Nepal.

Perception and practice of early initiation of breastfeeding and associated factors among postnatal mothers in East Sikkim

Background: Breastfeeding is the most desirable method for achieving a normal growth and development of the child. Breastfeeding practice is multifactorial, and number of variables influence mothers’ decisions and ability to breastfeed. This study aimed to assess the perception and practice regarding early initiation of breastfeeding and factors associated with breastfeeding among hospitalized postnatal mothers in East Sikkim.Methods: The descriptive study was carried out among 80 postnatal mothers who delivered term healthy babies either through normal vaginal delivery (n=34) or lower segment caesarean section (n=38), selected through purposive sampling technique and were interviewed within six hours of postpartum. Data were collected over a period of one month through an interview schedule to get information on feeding practice, perception and the factors responsible for delayed breastfeeding. Data analysis was done using Statistical package for social sciences (SPSS) version 16. Chi square test was used to examine the factors associated with perception and practice of early initiation of breastfeeding (within one hour of birth).Results: The result shows that early initiation of breast feeding within one hour of birth was done by 36% of mothers after the delivery and few adopted prelacteal feeding (19%) where as 86% had positive perception towards it. The factors that mostly influenced early initiation of breastfeeding were planned pregnancy (100%) and support from family members during pregnancy and delivery (100%). There was a statistically significant association between mother’s educational status and information regarding early initiation of breastfeeding and influencing factors like breastfeeding education during antenatal period and guidance from the health professional (p<0.05).Conclusions: Early initiation of breastfeeding within one hour was found extremely low which is an alarming. The findings also suggest the need of breastfeeding promotion programs among the mothers who are less educated. Such breastfeeding promotion programmes could be implemented through network of community-based workers.