Determinants of the introduction of prelacteal feeds in rural Nepal: a cross-sectional community-based study.

Conflict of interest We declare we have no conflict of interest. Determinants of the Introduction of Prelacteal Feeds in Rural Nepal: a Cross-sectional Community Based Study Dear Editor: INTRODUCTION. The health benefits of exclusive breastfeeding for infants and mothers are well known. Breastmilk provides nutrition and protection from gastroenteritis, respiratory illness, type II diabetes (1) and leukaemia (2). Further, it can enhance the neuro-cognitive development of the child (3). The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding for the first six months and the continuation of breastfeeding thereafter (4). They recommend that initiation of breastfeeding should occur within the first hour of birth to increase child survival. WHO and UNICEF guidelines state that nothing should be provided to the child before initiating breastfeeding (5). Despite this, the practice of introducing prelacteal feeds to the newborn is still prevalent in many countries across the South East Asia region (6-9). Prelacteal feeds include any food introduced to the newborn prior to the introduction of mother's milk within the first three days (6, 8). Such foods might include ghee (refined butter), honey, sugar solution, or ghutti (herbal paste) amongst others. (6). The introduction of prelacteal feeds has been shown to adversely affect the duration of breastfeeding, may contribute to the development of infections and cause indigestion in newborns (10, 11). The Nepal Demographic and Health Survey reported that 28% of the children in Nepal are provided prelacteal feeds within first three days of their life (12), however, the social determinants surrounding the introduction of prelacteal feeds in Nepal have not be identified. To better understand why prelacteal feeding is occurring, a cross-sectional study was undertaken to measure the prevalence of prelacteal feeding and to identify their underlying determinants in the Kapilvastu district of Western Nepal between November and December 2010. METHOD. The Kapilvastu district has a population of 570,612 with one hospital, 384 outreach clinics and 1054 female community health volunteers (FCHVs) (13). This study was part of a larger social mobilisation program-Community Action Process which included 10 of the 77 Village Development Committees (VDCs) in the district (13). A list of households was obtained from the local VDC office and households were selected using the WHO " lot quality assurance sampling survey guideline " (14, 15). Only those mothers whose child was between 12 and 23 months were included in the current study. Ethical approval was …