Risk factors for prelacteal feeding in sub-Saharan Africa: a multilevel analysis of population data from twenty-two countries.

OBJECTIVE: To examine the risk factors of prelacteal feeding (PLF) among mothers in sub-Saharan Africa (SSA).
DESIGN: We pooled data from Demographic and Health Surveys in twenty-two SSA countries. The key outcome variable was PLF. A multilevel logistic regression model was used to explore factors associated with PLF.
SETTING: Demographic and Health Surveys in twenty-two SSA countries.
SUBJECTS: Mother-baby pairs (n 95348).
RESULTS: Prevalence of PLF in SSA was 32·2 %. Plain water (22·1 %), milk other than breast milk (5·0 %) and sugar or glucose water (4·1 %) were the predominant prelacteal feeds. In the multivariable analysis, mothers who had caesarean section delivery had 2·25 times the odds of giving prelacteal feeds compared with mothers who had spontaneous vaginal delivery (adjusted OR=2·25; 95 % CI 2·06, 2·46). Other factors that were significantly associated with increased likelihood of PLF were mother's lower educational status, first birth rank, fourth or above birth rank with preceding birth interval less than or equal to 24 months, lower number of antenatal care visits, home delivery, multiple birth, male infant, as well as having an average or small sized baby at birth. Mothers aged 20-34 years were less likely to give prelacteal feeds compared with mothers aged ≤19 years. Belonging to the second, middle or fourth wealth quintile was associated with lower likelihood of PLF compared with the highest quintile.
CONCLUSIONS: To achieve optimal breast-feeding, there is a need to discourage breast-feeding practices such as PLF. Breast-feeding promotion programmes should target the at-risk sub-population groups discovered in our study.