1International Center For Equity In Health, Universidade Federal De Pelotas, Pelotas, Brasil.
Background and objective. Prelacteal feeds (PLF) negatively affect the duration and exclusivity of breastfeeding, yet little is known about their inequalities in most countries. We investigated between- and within-country inequalities in PLF in 76 low- and middle-income countries (LMICs).
Methods. Using data from 76 nationally representative surveys in LMICs since 2010, we studied the prevalence of any milk-based (formula/animal milk), and water-based (water/honey/tea, etc.) PLF among ever breastfed children who were under two years of age at the time of the survey. Inequalities were examined according to wealth quintiles and institutional delivery (yes/no), and according to country income groups and UNICEF regions of the world. We also explored the relationship between PLF and national Gross Domestic Product per capita (GDP), as well as the country-level correlation between PLF with the prevalence of early breastfeeding initiation.
Results. Prevalence of any PLF ranged from 2.3% (Turkmenistan) to 86.7% (Chad), with a median of 26.9% (interquartile range 14.7-42.9%). Whereas frequency of milk-based PLF increased with GDP, prevalence of waterbased PLF declined. Within-country analyses showed that milk-based PLF were positively associated with family wealth, particularly in Latin America & Caribbean; inequalities for water-based PLF were less marked, but most countries showed higher consumption in children from poor families. Milk-based PLF were more common among children born in institutions in upper-middle income countries, while water-based PLF were more common in noninstitutional births. Between-country analysis showed that early breastfeeding was inversely correlated with any (r=-0.59, P<0.0001), milk-based (r= -0.41, P=0.0002), and water-based PLF (r= -0.34, P=0.0022).
Conclusion. All types of PLF were inversely correlated with early initiation of breastfeeding in LMICs. Any and milk-based PLF were associated with family wealth and institutional delivery, while water-based PLF was more frequent in births outside a health facility. Interventions aimed at promoting breastfeeding practices should consider the high prevalence of PLF in health facilities and wealthier families.
Keywords: prelacteal-feeding, breastfeeding, infant feeding, health equity.