Neonatal and Pediatric Medicine
Open Access

Dire Dawa; Practice; Milk; Colostrum

Introduction

Colostrum is the first milk or a viscous, yellow fluid that mammals’ mammary glands create in the final stages of pregnancy, right before giving birth, and throughout the early stages of breastfeeding. Although colostrum has less lipids and potassium than regular milk, it is much richer in proteins, carbs, vitamin A, and salt chloride. Because colostrum contains nutrients and antibodies that are essential in the protection of infections and nutritional issues, it is regarded as a baby’s first immunization and has a good impact on the prevention of childhood sickness and malnutrition. Additionally, it promotes the first bowel movement, which aids in clearing excess bilirubin, which is produced in huge amounts during birth, and prevents jaundice [1].

The World Health Organization (WHO) and United Nations Children’s Emergency Fund (UNICEF) advised mothers to exclusively breastfeed their infants for the first six months of their lives. They also advised against using bottles, teats, or pacifiers, and to continue breastfeeding until 24 months or later [2].

Despite the recommendations of the WHO, UNICEF, and Ethiopian Infant and Young Child Feeding (EIYCF) guidelines, many mothers in the country continue to discard colostrum because they view it as heavy, dirty milk, harmful to children’s health, lacking in nutrition, or as bad karma for the family and the infant given other pre-lacteal foods other than mother’s milk in the first few days after birth [3].

Negligent colostrum feeding practices can raise a newborn’s risk of infection, stunting, wasting, underweight, and death [4]. Therefore, the purpose of this study was to evaluate the colostrum feeding practice (CFP) and its associated factors in the government health facility of Dire Dawa Administrative City (DDAC), Eastern Ethiopia [5].

Methods and Materials

Study area and period

The study was conducted from February 1–30, 2022, in governmental health facilities in Dire Dawa City. Dire Dawa city is located about 515 km from Addis Ababa, the capital city of Ethiopia. The city has ten public health institutions, of which two are hospitals and eight are health centers [6].

Study design

An institutional-based cross-sectional study design was used [7].

Source population and study population

All moms who visited the child immunization clinics at the governmental health facilities in DDAC during the study period served as the study’s source population. All moms who attended child immunization clinics in particular governmental health institutions during the study period made up the study population [8].

Inclusion and exclusion criteria

All mothers who had baby less than or equal to twelve months and attended child immunization clinic at selected governmental health facilities, of DDAC were included [9].

Sample size determination

Based on research done in North West Ethiopia, where the prevalence of colostrum feeding practice was estimated to be 91.2% (38), the sample size was computed using a single population proportion formula while taking the following assumptions into account. Z value at alpha=0.05, or 1.96, is the crucial value for a normal distribution at a 95% confidence level. P = Expected Level of Practice of Colostrum Feeding, d = Margin of Error, 0.05. Therefore,

by considering 10% non-response rate and design effect 2 = 123 *10/100 = 123+13 = 136*2=272 [10].

Sampling technique

The study population was chosen using a multi-stage sampling procedure. The administrative city’s public health facilities are divided into hospitals and health centers based on the ten public health facilities that DDAC possesses (two hospitals and eight health centers). Then one hospital and three health centers were chosen using a straightforward random sampling procedure. Based on each health facility’s quarterly extended program of immunization (EPI) unit flow, the total sample size was proportionally distributed for each of the administrative city’s health facilities [11].

Based on EPI registration books at all chosen health institutions, the average number of mothers who visited an EPI unit quarterly was 1405. In the Dilchora referral hospital (DCRH), Genda kore health center (GKHC), Gende Gerada health center (GGHC), and Goro health center (GHC), respectively, there were 570, 310, 251, and 274 mothers who visited the EPI unit on a quarterly basis [12].

After proportionate allocation, the overall sample size for DCRH, GKHC, GGHC, and GHC was 119, 64, 52, and 57 mothers, respectively. Each facility’s eligible mothers were chosen using a methodical random sampling process. By dividing the number of mothers who visited an EPI unit on a monthly basis by the sample size, the sampling interval or Kth units (1405/292 = 5) was calculated. The first Kth units in each healthcare facility were drawn at random to determine the starting unit (Figure 1).

Figure 1: Schematic presentation of sampling procedure.

Operational definition

Colostrum: is the yellowish breast milk during the three days following delivery (18).

Practice: The behavior, habit or custom of mothers of infants on CF to their current infants (19).

Good practice: Participant who responds for ≥ 60% of practice related questions(19).

Poor practice: Those participant who answer <60% of practice related questions (19).

Knowledge: In this study, knowledge refers to mothers’ understanding of colostrum breast milk and was assessed by mothers’ responses to knowledge-related questions. (19).

Good knowledge: Those mothers who answer ≥ 60% knowledge related questions (32).

Poor knowledge: Those mothers who answer < 60% knowledge related questions (19).

Study variables

Dependent variable: Colostrum feeding practice Independent factors: Age, place of residence, marital status, religion, level of education, line of work, partner’s level of education, and who she was living with are sociodemographic characteristics. Obstetric and reproductive factors: Parity, ANC visits, TIBF, CF, and BF counseling during ANC visits, delivery site, birth attendant, mode of delivery, and BF counseling following delivery. Factors relating to knowledge and practice: the information’s source.

Data collection tools

Data was gathered using a structured interviewer-administered questionnaire that was adjusted to the local context and derived from pertinent literatures. An expert in this language initially developed the questionnaires in English, after which they were translated into Amharic and then back into English to ensure uniformity. The questionnaire asked about socio demographic traits, obstetric and reproductive traits, as well as questions about knowledge and practice. Correct answers received a score of +1, while incorrect ones received a score of –1. Each mother’s score was added up and put into categories.

Data collection method

Data collection involved using a standardized intervieweradministered questionnaire that had been pre-tested. Four BSc midwives, a nurse, and a public health officer collected the data under the direction of a public health officer.

Data quality control

The instrument was pretested before the actual data collection, and the data were gathered by skilled data collectors. Prior to the actual data collection period, the questionnaire was pre-tested on 5% (15) of the moms who attended the child immunization clinic at Sabian General Hospital but were not included in the study. The investigator gave two days of training to the supervisors and data collectors. Additional adjustments were made based on the findings of the pre-test after the necessary modifications and corrections were made to standardize, ensure, and guarantee its reliability and validity. During data collection, data collectors verified that the data were comprehensive, and supervisors examined the data on a daily basis to ensure it was.

Data processing and analysis

The data were entered into Epi data 4.2, edited and cleaned for inconsistencies, missing values and outliers, then exported to SPSS version 25.0 for analysis. During analysis all explanatory variables which have significant association in bivariate analysis with P value <0.20 was entered into a multivariate logistic regression model to get adjusted odds ratio (AOR) and those variables with 95% of confidence intervals (CI) and a P value of < 0.05 was considered as statistically significance with CFP. Multi collinearity test was done using variance inflation factor and no collinearity exists between the independent variables. The model goodness of the test was checked by Hosmer- Lemeshow goodness of the fit and the p-value of the model fitness of the test was 0.780. Frequency tables, and descriptive summaries were used to describe the study variables.

Result

Socio demographic characteristics of child immunization clinic attendees

A total of 292 mothers participated in the study with a response rate of 100%. The mean age of the child immunization clinic attended mothers was 24.72 years with (±SD=4.55) ranging from 15-40 years. Of these, 134 (45.9%) of them found in the age group of 20-25 years. Majority of the mothers (80.5%) lived in urban and 278 (95.2%) of them were married. Of the child immunization clinic attendees 151 (51.7%) of them were Muslim religion followers. From the total child immunization attended mothers115 (39.4%) of them had primary educational level and 165 (56.5%) of them were house wife. Regarding to their partner educational level 87 (31.3%) of them had secondary educational level.

Reproductive and obstetric characteristics of the child immunization clinic attendees

In this study, 218 (74.7%) of the mothers were multigravida and 238 (81.5%) of them had history of ANC visit in their most recent pregnancy. Among mothers who had history of ANC visit, 195 (81.9%) of them were counselled on timely initiation of breast feeding (TIBF) during your ANC visits. One hundred seventy-six (73.9%) of them were counselled on CF and 189 (79.4%) counselled on exclusive breast feeding (EBF) for the first six months after delivery during their ANC visit. From the total child immunization clinic attended mothers 248 (84.9%) of them gave child birth at health institution and 253 (86.6%) of the birth were attended by health professional. Two hundred thirtytwo (79.5%) of the mothers were counseled about BF immediately after delivery and 255 (87.3%) of them were gave child birth vaginally.

Knowledge of the study participants on colostrum feeding

According to the above predetermined criteria, from total study participants 187 (64.0%) mothers had good knowledge about CF., and most of the mothers obtaining their information on colostrum from health professional (n=149, 51.1%).

Practice of study participants towards colostrum feeding

In our study, 259 (88.7%) of the mothers gave colostrum to their baby within three days after birth, while 33 (11.3%) did not provide colostrum and it may cause abdominal discomfort and diarrhea for the baby 13 (39.4%) was their mean reason not feeding colostrum. Of the participants 43 (14.7%) them were gave PLF to their baby and majority of them 24 (55.8%) gave infant formula milk. Two hundred ten (71.9%) of the mothers were put the baby to the breast immediately within an hour and 203 (69.5%) of them were start colostrum with breast milk feeding within an hour, while 287 (98.3) of the mothers were continued to give colostrum with breast milk within the first three days of delivery. Overall, in our study, according to the predetermined criteria, 201 (68.8%) mothers had good practice of CF.

Factors associated with colostrum feeding practice

In bivariate analysis variables which have significant association with a P value of <0.20 were age, residency, educational level of the mothers, parity, history of ANC visit, counselling on; TIBF, CF and EBF as well as place of deliver, giving child birth with the assistant of health care provider, counselling on BF after delivery, source of information and good knowledge of CF. In a multivariate logistic regression analysis; Living in an urban area [AOR=2.52, 95% CI=1.08- 5.88], having at least a secondary education [AOR=2.79, 95% CI=1.12- 6.98], having visited an antenatal clinic in the past [AOR=3.12, 95% CI=1.12-9.21], receiving counseling on when to start breastfeeding [AOR=2.59, 95% CI=1.02-6.59], receiving colostrum feeding counseling [AOR=2.65, 95% CI=1.12-6.30], having a professional attend the birth [AOR=3.20, 95% CI=1.23-8.31], getting information from a professional [AOR=3.89, 95% CI=1.54-9.82], and having good knowledge of colostrum feeding [AOR=3.53, 95% CI=1.56-7.96] were found to be associated with practice of colostrum feeding .

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