Assessment of Knowledge, Attitude, and Practice of Colostrum Feeding Among Lactating Women in Northeast Ethiopia

Abstract

Remedy Publications LLC., | http://clinicalcasereportsint.com/ 2022 | Volume 6 | Article 1402 2 birth) is important for both the mother and the child and confirms that the infant receives the protective milk, the colostrum [4]. Early initiation of breastfeeding protects the newborn from diseases, encourages bonding between the mother and her newborn, facilitates the production of regular breast milk, and helps the uterus contract, reducing the postpartum hemorrhage [5]. In addition, colostrum has a laxative effect that encourages passage of the baby's first stool (meconium) which intern helps to clear excess bilirubin produced in large quantities at birth and helps prevent jaundice [2]. For most children breastfeeding makes the difference between life and death and is the infants' "passport to life". Colostrum is also considered the first vaccine for newborns. Even if it is secreted in small amounts (30 ml to 100 ml per day), the mothers need to be explained that this small amount of colostrum is adequate for the infant and must not be discouraged [5]. A secondary analysis of the WHO Global Survey on Maternal and Perinatal Health indicated that the prevalence of Early Initiation of Breastfeeding (EIBF) ranges from 17.7% to 98.4% (average 57.6%) [6]. According to data from 35 Sub-Saharan Africa (SSA) Demographic and Health Surveys (DHS), the timely initiation of breastfeeding in SSA is 58%, ranging from 24% in Chad to 86% in Burundi [7]. In Ethiopia, 73% of children begin breastfeeding within 1 h after birth, 92% of infants breastfed within 1 day of birth, and 8% of children receive prelacteal feeding. Amhara region is the third-lowest region in the level of early initiation of breastfeeding (66%) [5]. Malnutrition has been a cause directly or indirectly for millions of deaths annually among under-five children. Globally in 2020, over 149 million children under 5 were estimated to be stunted, 45 million were wasted, and 38.9 million were overweight or obese. Under nutrition accounts for about 45% of deaths among under 5 years of age. They are the most vulnerable groups to ill health. These mostly occur in low-and middle-income countries particularly in Southern Asia, Asia, and Africa. However, the number of children with stunting has declined in all regions except Africa [8]. One of the main reasons for under nutrition is delayed breastfeeding along with colostrum avoidance [9]. Additionally, newborns who initiated breastfeeding 2 h to 23 h after birth had a 33% greater risk of neonatal mortality, and those who initiated after 24 h of birth had an 85% greater risk of neonatal mortality than those initiated within 1-h of birth [10]. Universal optimal breastfeeding could save more than 800,000 child death per year [11], and an estimated 20,000 annual deaths from breast cancer [12]. In a study of Wolaita Zone, 66% of mothers were knowledgeable and 70% had a positive attitude towards colostrum feeding [3]. Though 90% of mothers in the Tigray region knew about colostrum feeding; only 48% of them started colostrum feeding within 1-h of birth [1]. According to a study done in Bench Maji Zone, 66.6%, 69.4%, and 72.4% of mothers had good knowledge, positive attitude, and practice colostrum feeding, respectively [2]. In Debre Tabor, 74% of mothers gave colostrum to their index children [13]. In Harar town, 8% of mothers discourage colostrum feeding because of increased abdominal cramping (45%), difficulty to digest (18%), and belief it is polished (36%) [14]. Similarly in Debre Tabor, 12% of mothers thought that colostrum doesn't contain sufficient milk secretions [13]. Further, in NorthEastern Ethiopia, 13.5% of mothers discard colostrum. The reasons for colostrum avoidance were a belief that colostrum is not good (26%), traditional (23.5%), and thought colostrum milk is dirty (22.4%) [15]. The 2016 Ethiopian Demographic Health Survey (EDHS) results showed that the neonatal, infant and under 5 mortality rates were 29, 48, and 67 deaths per 1,000 live births, respectively [5]. Besides, in Ethiopia, colostrum feeding is still unsatisfactory. These major child deaths can be reduced by immediate initiation of breastfeeding and colostrum after birth [11]. Thus, this study aimed to assess the knowledge, attitude, and practice of colostrum feeding among lactating women in North Shewa Zone, Ethiopia, 2021. Methods Study setting, design, and population An institution-based cross-sectional study was done in Debre Berhan town from May to June 2021. Debre Birhan is the capital city of the North Shewa Zone of Amhara Region and is located 130 km Northeast of Addis Ababa on the Ethiopian highway. It is the highest town in Africa with an elevation of 2,840 m. Debre Berhan has fourteen kebeles with a total population of 1,10,500; of whom 14,966 are children under five years. The town has 2 hospitals, 3 Health centers, 14 clinics, and around 20 pharmacies. All lactating women presented for an Expanded Program of Immunization (EPI) in the North Shewa Zone health facilities were the source population. All lactating women who fulfilled the inclusion criteria and were available at the time of the data collection were the study population. Randomly selected mothers with infants less than 6 months of age presented for EPI were included. Lactating mothers with known chronic illnesses (Hepatitis B/C and HIV/AIDS), had active herpes simplex virus infection with lesions present on the breast, who delivered premature baby, and birth defects (cleft lip/ palate) were excluded from the study. Sample size, sampling technique, and procedure The sample size was determined using Open Epi Version 3.03. The following assumptions were considered: 95% confidence level, 5% margin of error, and proportion, 74.4% of practice of colostrum feeding [13]. Adding a 5% non-response rate, the final sample size equals 308. The number of mothers with infants less than 6 months of age visiting the health facilities was obtained from the respective health institutions 'EPI registration book. Then systematic random sampling was applied to proportionally select mothers from all health institutions included in the study. Data collection tool, quality control, and statistical analysis A structured and pre-tested interviewer-administered questionnaire was used to collect data. The questionnaire was adapted from different works of literature and modified according to the local context. The questionnaire was first prepared in English and then translated to the local language, Amharic, and then back to English to maintain consistency. The questionnaire was pre-tested on 5% of the samples in Deneba health center which was not selected in the study. The questionnaire was modified based on the result obtained from the pre-test. In addition, one-day training was given to the data collectors and supervisors about the objective and methods of data collection. The supervisor and principal investigators daily checked and reviewed the data for completeness, clarity, and consistency. The data was cleaned, coded, and entered into Epi-Info software version 7.2.1 and exported to SPSS version 24.0 statistical software for analysis. Univariable analysis was computed and the finding