ORIGINAL

Niger J Paed 2013; 40 (2): 139 –144

Ibadin OM

Ofili NA

Monday P

Nwajei CJ

Prelacteal feeding practices among

lactating mothers in Benin City,

Nigeria

DOI:http://dx.doi.org/10.4314/njp.v40i2,6

Accepted: 21st August 2012

Abstract Background: Exclusive included perceived delayed lacta-

breastfeeding is the cornerstone of tion and the need to keep the body

Ibadin OM

(

Department of Paediatrics,

)

adequate early infant nutrition. De- warm and mouth moist.

The

spite the acknowledged gains of younger the respondents, the more

Baby Friendly Hospital Initiative likely she w₂ould practice pre-lacteal

Ofili NA

(

BFHI) and other interventional feeding (X = 11.4; p = 0.022).

Department of Community Health,

measures in ensuring optimal infant Also significantly associated with

nutrition, it is still a common prac- pre-lacteal feeding is the route of

tice for newborn babies to be given delivery. Pre-lacteal feeding was

Monday P, Nwajei CJ

Medical Intern, University of Benin

Teaching Hospital, Benin City,

Nigeria.

substances other than breast milk commoner with surgical deliveries

2

within the first day of life.

(X = 7.0; p = 0.05). Pre-lacteal

Methods: To re-examine why this is feeding was however un-associated

so, a prospective, cross-sectional with respondents’ tribe, educational

study involving mothers with recent status, religion and place of deliv-

history of lactation was carried. It ery. Pre-lacteal feeding remains a

involved 403 mothers attending the challenge to adequate infant nutri-

well Baby Clinic of the University tion.

of Benin Teaching Hospital in Conclusion/Recommendations:

2

009. A semi structured question- There is need for further enlighten-

naire was used in obtaining relevant ment on the dangers inherent in the

information on pre-lacteal feeding. practice. Education of the populace

Results: The prevalence of pre- would need to be improved upon if

lacteal feeding was 11.7%. Water the initial gains accruing from

only constituted the most common BFHI are not to be reversed.

(

44.3%) pre-lacteal feed. Other

feeds administered included glucose Key words: Pre-lacteal feeding

drink, (37.2%), and honey (4.6%). Infant, Nutrition, Benin City.

The reasons for pre-lacteal feeding

Introduction

only, b) water based (herbal concoction, rice water₄,

juice), c) milk-based (i.e. milks other than breast milk).

Breast-feeding is the most nat₁ural way of meeting the

infant’s nutritional demands. Nursing mothers are

therefore encouraged to exclusively breastfeed their ba-

bies for a period of at least 6 months. Human milk has

since been found to be superior to othe₁r forms of supple-

mentary feeds that the infant receives.

Despite the existence of the UNICEF/WHO BFHI cam-

paign to popularize exclusive breastfeeding and its

global acceptability, it is still a common practice in

some cultures to give babies other substances to drink

within the first day of₂_-l₄ife before the actual commence-

ment of breastfeeding.

Even among heal₂th workers pre-lacteal feeding is a

common practice. Reasons for giving PLFs fall into

three main groups as shown₂ by Akuse in a study con-

ducted in 2002 in Kaduna. These are:- a) perceived

breast milk insufficiency, b) medical reasons (including

prevention of dehydration, hypoglycaemia), c) non-

medical reasons (these include cleansing and preparing

the baby’s gastrointestinal tract for digestion, to quench

thirst; flush the bladder and afford the mother some

rest). Caesarean delivery, vaginal delivery in hospital

(versus at home), late initiation of breastfeeding, pre-

lacteal water feeds, and delayed milk arrival were posi-₅

tively associated with the use of milk-based PLFs.

Other factors associated with the use of milk-based

PLFs include primiparity, male infant, higher level of

maternal education, and maternal employment outside of

Such feeds or fluids when administered before lactation

is established are known as pre-lacteal feeds (PLFs).

Pre-lacteal feeds can be categorized as follows: a) Water

1

40

5

the household.

The data collected were entered into a computer for

analysis using the Statistical Package for Social Sci-

ences (SPSS) version 13.0 software. Chi-square test

was used to test for association between independent

variables. Winpepi programs version 2.16 was also used

for the calculation of Chi Square test.

Studies have shown that most of the reasons why PLFs

are given or prescribed have no scientific basis, instead

they c₄o_,₆_,u₇ld have negative and adverse effects on the in-

fants.

PLFs result in the baby receiving insufficient

breast milk, lactation failure, d₂iarrhoea and shortening of

the duration of breastfeeding. The use of breast milk

substitutes could jeopardize subsequent breastfeeding

6

success. Because pre-lacteal feeding practices are deter-

mined by a number of variables including cultural prac-

tices, extent of success of exclusive breastfeeding advo-

cacy campaigns and time of study, it is important that

from time to time, PLF practice is reviewed. Results of

such endeavors would set the stage for interventional

measures meant to discourage pre-lacteal feeding and

enhance optimal early child nutrition.

Result

Social Characteristics of study subjects

Four hundred and three mothers of child bearing age

(respondents) were recruited into the study. The modal

age bracket of these respondents was 26-30 years.

One hundred and forty three (35.5%) were Binis while

6

2(15.4%) were Ibos. Disposition of other ethnic

This study therefore seeks to determine the current prac-

tices of pre-lacteal feeding among lactating mothers in

Benin City. The study shall also address some of the

determinants of pre-lacteal feeding among lactating

mothers.

groups is as shown in table 1. Also shown in table I is

the occupational distribution of the respondents.

Table 1: Bio data and social characteristics of study subjects

Age bracket (years)

Number (%)

1

2

3

6 – 20

1 – 25

6 – 30

1 – 35

6 – 40

10(2.5)

107(26.6)

153(38.0)

102(25.3)

27(6.7)

Subjects and methods

Study Area

This study was carried out in the Well Baby Clinic

41 – 45

Tribe/Ethnicity

Bini

Ibo

Ishan

Yoruba

Urhobo

Itsekiri

4(1.00)

(

WBC) of the University of Benin Teaching Hospital

UBTH) located in the General Practice Clinic (GPC) of

143(35.5)

62(15.4)

61(15.1)

47(11.7)

33(8.2)

the Hospital. The WBC holds on every working day of

the week. About 50 lactating mothers with babies (aged

one year and below) are seen daily.

UBTH is a UNICEF/WHO designated Baby Friendly

Hospital implying that clients should be aware of the

benefits of exclusive breast-feeding (EBF) and the other

packages contained in the Baby Friendly Hospital initia-

tive (BFHI). Collection of data was carried out in the

mornings when respondents with their babies were ex-

pected to be in the clinic.

13(3.2)

44(10.9)

*Others

Occupation

Business woman

House wife

Hair dressing

Civil servant

Schooling

164(40.7)

54(13.4)

46(4.4)

31(7.7)

24(6.0)

12(3.0)

46(4.4)

*

*Professional

Others

Others as shown in the table (under Ethnicity), comprise

Respondents were those in the reproductive age bracket

of 16-45 years, who were lactating and had babies aged

one year and below. However, those who had contra-

indications to breastfeeding were excluded. Also ex-

cluded were those who declined participation in the

study and those who were not biological mothers of the

index babies. (e.g. grandmothers, step-mothers, surro-

gate mothers, etc). Ethical clearance for the study was

obtained from the Ethics Committee of UBTH. Respon-

dents were informed about the nature and benefits of the

study and their consents obtained before administration

of the questionnaires made up of both open ended and

closed questions meant to achieve the objectives of the

study. A total of 403 lactating mothers were recruited

into the study. Every mother that met the criteria for

inclusion at the WBC was recruited into the study that

took place between April and September, 2008. Each

subject had an equal chance of being selected as con-

secutive sampling method was used until the desired

sample size was achieved.

Isoko, Etsako, Ika, Igbanke and tribes such as Hausas.

** Professionals include doctors, lawyers, engineers, etc.

Table 2 reveals the distribution of respondents according

to educational status and religion. Two hundred and

thirty two (57.6%) respondent had secondary education

while only four (1.0)%) had no formal education. Chris-

tianity was the dominant (96.3%) religion among the

respondents. Religious disposition of the remaining 15

(3.7%) is as shown in Table 2. Of the 403 respondents,

401(99.5%) were married. One (0.2%) each was single

or separated.

1

41

Table 5: Relationships between Respondents’ Social Characteristics and Administration of Pre-lacteal Feeds.

Administration of prelacteal feeds

2

Variable

Total (%)

Yes (%)

No (%)

Likelihood ratio X

p-value

0.022

0.832

0.628

Mother’s age [in brackets (years)]

1

2

3

6-20

1-25

6-30

1-35

10(100.0)

107(100.0)

153(100.0)

102(100.0)

31(100.0)

04(40.0)

14(13.1)

20(13.1)

07(6.9)

06(60.0)

93(86.9)

133(86.9)

95(93.1)

29(93.5)

11.40

0.87

>

36

02(6.5)

Tribe

Bini

Ishan

Ibo

Others

Educational Status

None

Primary

Secondary

Tertiary

143(100.0)

61(100.0)

62(100.0)

137(100.0)

15(10.5)

08(13.1)

09(14.5)

15(10.5)

128(89.5)

53(86.9)

53(85.5)

122(89.1)

04(100.0)

52(100.0)

232(100.0)

115(100.0)

0(0.0)

04(100.0)

47(90.4)

202(87.1)

103(89.6)

05(9.6)

30(12.9)

12(10.4)

1.74*

*

Likelihood-ratio Chi Square, 0.0000001 added to zero to permit computation.

Religion: Forty six (11.9%) of the 388 Christians and

one (12.5%) of the eight Moslems practiced pre-lacteal

feeding. None of remaining seven who practiced other

forms of religion did so. However there was no signifi-

cant association between mothers’ religion and practice

of pre-lacteal feeding.

The study further revealed that the major reason why

these mothers administer pre-lacteal feeds was delayed

lactation (53.3%). The findings from this study were in

keeping with those noted in a previous community-

6

based study in Chittagong district of rural Bangladesh.

However, in the Bangladeshi study, social customs ac-

counted for the major reason why pre-lacteal feeds were

administered. The findings contained in our study are

consistent with those noted in another study conducted

in rural Bilbeis, Egypt in 1992 where lack of milk in the

mother’s breasts and maternal exhaustion were the two

Route of delivery: Regarding the route of delivery re-

sponses were available for only 392 respondents.

Twelve (23.1%) of the 52 respondents who had their

babies through caesarian section practiced pre-lacteal

feeding while only 35(10.3%) who had spontaneous

vertex delivery did so. A significant association existed

between route of delivery of index child and practice of

8

.

most commonly stated reasons for pre-lacteal feeding

Our findings were also consistent in part with the find-

ings of a UNICEF sponsored study among healthcare

workers in Kaduna, where insufficient breast milk was

the major reason nurses administered PLFs – a fallout of

which is the fact that such health workers could actually

reinforce the practice of pre-lacteal feeding. Other rea-

sons advanced were non-medical reasons such as gas₂tro-

2

pre-lacteal feeding. (X = 7.0, df=1, p=0.05). Mothers

who had surgical deliveries were more likely to practice

pre-lacteal feeding.

intestinal tract preparation and quenching of thirst.

A

Discussion

possible explanation for the similarity in reasons for

PLFs administration as seen in this study and previous

studies could be due to limited mother’s knowledge of

breastfeeding practices and perception of infant feeding.

The prevalence of pre-lacteal feeding amongst the re-

spondents was 11.7%. This value is low relative to fig-

ures obtained from previous studies conducted in rural

6

8

Bangladesh and India where prevalence values of 77%

and 45% were obtained respectively. Although these

studies were carried out after the commencement of the

UNICEF/WHO BFHI in 1992, a possible explanation

for the large disparity between the_,₈prevalence rate in this

Pre-lacteal feeding was not carried out by the respon-

dents alone, other individuals also did. A number of

mothers were influenced to administer pre-lacteal feeds.

Healthcare providers also influence mothers to adminis-

ter PLF₉_-s₁₁and also do administer PLFs to infants them-

This situation majorly arose in cases of de-

6

study and these previous studies, could be attributed to

selves.

differences in the cultural values and practices of these

different communities. However, it could also be as-

sumed that the BFHI has become a more generally ac-

cepted and established practice at the time and place of

this study compa₆_,r₈ed to the periods and places of these

previous studies.

layed lactation, maternal illnesses and infants’ ailments

e.g. neonatal jaundice. It is therefore necessary that

healthcare workers undergo training and subsequent

retraining programs in lactation management, with em-

phasis on the dangers of giving PLFs and₂discounte-

nancing the misconceptions surrounding EBF.

1

42

Table 2: Respondents’ status by education and religion

Table 4: Reasons for Pre-lacteal feeds administration

Educational Status

Number (%)

n = 403

Reasons

Frequency

Delayed Lactation

Keep body warm

Keep mouth moist

Insufficient milk

Cultural practice

Clear intestines

Others

24(51.1)

5(10.6)

4(8.5)

3(6.4)

1(2.1)

5(10.6)

2(4.3)

None

Primary

4(1.0)

52(12.9)

232(57.6)

115(28.5)

Secondary

Tertiary

Religion

Christianity

Islam

388(96.3)

8(2.0)

2(0.5)

African Tradition

Others

No response

5(1.2)

Some respondents gave multiple responses

Prevalence of Pre-lacteal feeding.

Knowledge of Disadvantages or Demerits of Pre-lacteal

Feeding

Forty seven (11.7%) of the 403 respondents practiced

pre-lacteal feeding while the remainder, 356(88.3%) did

not. The prevalence of pre-lacteal feeding was therefore

Majority, 241/403 or 59.8% of the respondents asserted

there were no disadvantages associated with pre-lacteal

feeding, while 22(5.5%) claimed they do not know if

there were any dangers associate with this practice.

However, 140 or 34.7% of the respondents were of the

opinion that there were possible dangers inherent in the

practice.

1

1.7%. Of the 47 respondents who practiced pre-lacteal

feeding 21(44.7%) did so on their own volition while in

6(55.3%) pre-lacteal feeding was carried out by rela-

2

tions and friends.

Types of Pre-lacteal Feeds.

Water only constituted the most common (19/47 or

Demerits of Pre-lacteal feeding as Volunteered by Re-

spondents

4

4.2%) pre-lacteal feeds administered.

This was

closely followed by glucose drinks, 16/47 or (37.2%);

while the least administered pre-lacteal feed was honey

accounting for 4.6% of cases. (Table 3).

Demerits or disadvantages of PLF as volunteered by the

respondents included infection, 73(39.5%); diarrhea, 63

(

34%); poor growth, 35(18.9%) and vomiting, 14(7.6%).

Table 3: Types of Pre-lacteal feeds utilized

Place of Delivery of Index Child

Types of Feeds

Number (%)

n = 43

The highest proportion of respondents, 318 or 79.0%

gave birth to their index children in hospitals (79.0%).

However 58(14.4%), 16(4.0%) and 11(2.6%) delivered

in churches/spiritual homes and at traditional birth atten-

dants’ places respectively.

Water only

Glucose drink

Nonhuman milk

Honey

19(44.2)

16(37.2)

06(13.6)

02(4.6)

Total

43(100.0)

Relationship between Respondents’ Social Charac-

teristics and Administration of Pre-lacteal feeds.

Forty seven respondents practiced pre-lacteal feeding but four

of the respondents gave no responses

Age: The age group with the highest proportion of re-

spondents that practiced pre-lacteal feeding was 16-20

years (40%), while the age bracket with the least propor-

tion of respondents who practiced pre-lacteal feeding in

the index children was > 36 years (02 or 6.5%). (Table

Pre-lacteal Feeds Administration

Pre-lacteal feeds were administered by both the respon-

dents themselves and also by someone else. Of the 47

children who received pre-lacteal feeds, only 21(44.7%)

had it administered by the respondents themselves.

5

). There was an association between the age of respon-

dents and the practice of pre-lacteal feeding in the index

child (p= 0.022). The younger the respondents were, the

higher the tendency to practice pre-lacteal feeding.

Reasons for Administration of Pre-lacteal Feeds

Tribe: Pre-lacteal feeding was commoner among the

Ibos (14.5%) and Esan people (13.1%) however there

was no significant association between tribe/ethnicity

and practice of pre-lacteal feeding. (Table 5).

The main reason for the administration of pre-lacteal

feeds was delayed lactation observed in 24(53%) of the

4

7 respondents that did so. Reasons proffered by the

remaining 23 concerned respondents are as shown in

Table 4.

Mothers’ educational status: There was no significant

association between mothers’ educational status and

practice of pre-lacteal feeding (Table 5).

1

43

Water-only (44.2%) was the main pre-lacteal feeds ad-

ministered. This finding was however at variance with

those contained in a previous study carried out in Ka-

duna, Nigeria in 2002, in which infant formula was the

main type of PLF administered and plain water (i.e. wa-

ter-only) was the least administered PLF by healthcare

workers. This difference could possibly be due to varia-

tions in the social characteristics of the subjects in the

two studies.

was positively associated with the administration of pre-

lacteal feeds.

One had expected that majority of the respondents

would have ample knowledge of the possible dangers

associated with pre-lacteal feeding irrespective of their

educational status, and also, that awareness of these dan-

gers would influence their practice of pre-lacteal feed-

ing. This assumption is predicated on the fact the study

locale is a tertiary health facility that was designated a

UNICEF/WHO baby friendly hospital, and as such, the

mothers who patronized her services are expected to

have had adequate health education with regards to pre-

lacteal feeding. Unfortunately, a sizeable number of

respondents (59.8%) claimed that there were no demer-

its associated with the practice of pre-lacteal feeding.

However, infections (39.5%), diarrheal diseases

(34.0%), poor growth (18.9%) and vomiting (7.6%)

were the dangers associated with pre-lacteal feeding as

volunteered by the respondents. These findings were

however in agreement with those obtained in a previous

2

A high proportion of the respondents were in the second

and third decades of life. This implied that such persons

would probably be in their active reproductive periods in

life. There was an association between the age of re-

spondents and the practice of pre-lacteal feeding. The

highest proportion of respondents who practiced pre-

lacteal feeding fell within the age group of 16-20 years

(

40.0%). It was very obvious that the tendency to prac-

tice pre-lacteal feeding declined as maternal age in-

creased. Our findings are con₅sistent with those from a

study conducted in Honduras. A possible explanation

for this trend could be that as maternal age rises, nursing

mothers perfect the skills of infant care and acquire the

much needed patience to nurse their young in the proper

way. It could also be asserted that this group of rela-

tively older mothers tended to adhere better to instruc-

tions and teachings received from health education talks.

2

UNICEF sponsored study in Kaduna. Apart from the

already outlined risks, pre-lacteal feeding also carries

the danger of jeopardizing subsequent breastfeeding

5

success ; leads to lactation failure, results in the infant

receiving insufficient bre₂ast milk. It also shortens the

duration of breastfeeding.

Less than one percent of the respondents had no formal

education. This finding is perhaps a reflection of the

result of the increased advocacy for the girl child educa-

tion in the study locale. Also, the study was conducted

in an urban centre where there are lots of educational

centres where education even up to the tertiary level

could be acquired. However, there was no association

between the educational status of the respondents and

practice pre-lacteal feeding. This finding is at variance

with that in a previous study conducted in India in which

the effects of maternal literacy was found to be signifi-

cant₈ly associated with the practice of pre-lacteal feed-

ing.

Against expectations the knowledge of dangers associ-

ated with pre-lacteal feeding was independent of the

educational status of respondents. Why this should be

so is not readily apparent.

Conclusion

Pre-lacteal feeding is common, reasons responsible for

the perpetuation of the practice are non medical and

untenable. Substances utilized are not superior to breast

milk and the major determinants could be targeted in

interventional measures meant to reduce the practice to

the barest minimum. The BFHI as agent for entrenching

optimal early infant feeding would need to be reinvigo-

rated and health education in schools strengthened.

The religious inclination of the respondents is in keeping

with what is obtainable in the population of the study

locale where Christianity predominates. However, there

was also significant association between the religious

inclinations of respondents and the practice of pre-

lacteal feeding.

Conflict of interest :None

Funding: None

Virtually every respondent was married (99.5%). This

may be traceable to the cultural practices in the study

location that abhors child birth outside marriage. Also,

a high proportion of the respondents had their antenatal

care and delivery at a registered health facility (93.8%

and 79.0%) respectively). Again, majority of the re-

spondents had their delivery via the vaginal route. Find-

ings in this study showed that surgical deliveries were

associated with increased incidence of pre-lacteal feed-

ing. A substantial proportion of respondents who had

caesarean section administered pre-lacteal feeds. This

finding is consistent with those contained in other stud-

Acknowledgement

We wish to thank the respondents for agreeing to partici-

pate in the study. The cooperation of the workers at the

Well Baby Clinic is immensely appreciated.

5

ies which identified caesarean delivery as a factor that

1

44

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