Determinants of the Introduction of Prelacteal Feeds in the Maldives

Abstract

Background and Objectives: This study identified the determinants of the introduction of prelacteal feeds in the Maldives. Subjects and Methods: A cohort of 458 mothers was recruited from antenatal clinics at two major hospitals in Malé, the Maldives. The mothers were followed up after birth at 4 weeks, 3 months, and 6 months. The child's birth, the type of infant delivery, the time breastfeeding was initiated, gender of the infants, types of prelacteal feeds, and feeding method were recorded. Results: After birth, 4.1% of infants received infant formula from the hospitals, whereas 10.6% and 7.4% of them received honey and dates, respectively, as prelacteal ritual feeds. Factors associated with introduction of ritual feeds as prelacteal feeds included the infant being a boy (p=0.05; adjusted odds ratio [AOR]=1.78; 95% confidence interval [CI], 1.07–2.98), attitude toward prelacteal feeds (p=0.01; AOR=2.87; 95% CI, 1.48–5.58), and maternal employment (p=0.01; AOR=2.3; 95% CI, 1.4–3.9). Higher maternal age was inversely associated with introduction of ritual feeds as a prelacteal feed (p=0.05; AOR=0.5; 95% CI, 0.3–0.9). Introduction of infant formula as the prelacteal feed was positively associated with birth by cesarean section (p=0.01; AOR=4.6; 95% CI, 1.6–13.3) and inversely associated with maternal mother's feeding method being breastfeeding (p=0.05; AOR=0.15; 95% CI, 0.04–0.6). Prelacteal feeding was associated with cessation of breastfeeding before 6 months (p=0.01; AOR 6.0; 95% CI, 1.64–21.80). Conclusions: Health professionals need to distinguish between religious and cultural practices in order to develop appropriate health education programs to reduce the unnecessary use of early additional feeds. Understanding the barriers related to the initiation of breastfeeding after cesarean section is also important.