Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia

Objective: To identify specific cultural and behavioural factors that might be influenced to increase colostrum feeding in a rural village in Northern Ethiopia to improve infant health. Design: Background interviews were conducted with six community health workers and two traditional birth attendants. A semi-structured tape-recorded interview was conducted with twenty mothers, most with children under the age of 5 years. Variables were: parental age and education; mother's ethnicity; number of live births and children's age; breast-feeding from birth through to weaning; availability and use of formula; and descriptions of colostrum v. other stages of breast milk. Participant interviews were conducted in Amharic and translated into English. Setting: Kossoye, a rural Amhara village with high prevalence rates of stunting: inappropriate neonatal feeding is thought to be a factor. Subjects: Women (20-60 years of age) reporting at least one live birth (range: 1-8, mean: similar to 4). Results: Colostrum (inger) and breast milk (yetut wotet) were seen as different substances. Colostrum was said to cause abdominal problems, but discarding a portion was sufficient to mitigate this effect. Almost all (nineteen of twenty) women breast-fed and twelve (63%) reported ritual prelacteal feeding. A majority (fifteen of nineteen, 79%) reported discarding colostrum and breast-feeding within 24h of birth. Prelacteal feeding emerged as an additional factor to be targeted through educational intervention. Conclusions: To maximize neonatal health and growth, we recommend culturally tailored education delivered by community health advocates and traditional health practitioners that promotes immediate colostrum feeding and discourages prelacteal feeding.