Mary Champeny | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: This study assessed early breastfeeding practices of mothers discharged from health facilities after delivery, and their exposure to promotions for breast-milk substitutes within the health system.

Methodology: A cross-sectional survey was conducted at randomly sampled health facilities in the most populous city of each country. Interviews were conducted among 306 Phnom Penh mothers; 304 Kathmandu Valley mothers; 288 Dakar mothers; and 295 Dar es Salaam mothers. Information was gathered on early breastfeeding practices and exposure to promotion of breast-milk substitutes within health facilities.

Results: Over two-thirds (68.1%, n=201) of Dar es Salaam, 40.8% (n=124) of Kathmandu Valley, 34.0% (n=104) of Phnom Penh, and 4.9% (n=14) of Dakar mothers reported initiation of breastfeeding within the first hour after delivery. Rates of pre-lacteal feeding varied across countries; 62.4% (n=191) of Phnom Penh, 56.6% (n=172) of Kathmandu Valley, 35.1% (n=101) of Dakar, and 4.7% (n=14) of Dar es Salaam mothers reported feeding liquids besides breast-milk to their newborn. Breast-milk substitutes (infant formula, follow-on formula, or growing-up milks) constituted the majority of pre-lacteal feeds in Phnom Penh (91.1%) and Kathmandu Valley (98.8%), and one-third (35.6%) of those in Dakar; another third (38.6%) of Dakar mothers reported providing ‘blessed water’. Among mothers that provided breast-milk substitute as a pre-lacteal feed, 74.7% of Kathmandu Valley, 58.3% of Dakar, and 17.2% of Phnom Penh, mothers reported receiving a recommendation from a health professional to use breast-milk substitutes. In Nepal and Senegal, receiving a health professional’s recommendation to use breast-milk substitutes was associated with pre-lacteal feeding among mothers (p<0.001).

Conclusions: Results indicate high rates of pre-lacteal feeding, commonly with breast-milk substitutes, in urban Cambodia, Nepal and Senegal. Given that pre-lacteal feeding increases risk of infection, can impede colostrum consumption and breast milk production, and reduces duration of exclusive breastfeeding, this finding carries great weight for neonatal health.