Colostrum avoidance and associated factors in Ethiopia: A systematic review and meta-analysis
Abstract Background: Colostrum is the first milk produced by the mammary glands during the second half of pregnancy for a few days (3-4) after birth. However, colostrum is a normative standard for infants’ complete form of nutrition, most mothers' giving prelacteal food such as honey, butter, sugar water, and plain water instead of colostrum to their newborn. In Ethiopia, colostrum was seen as abnormal milk causing abdominal problems, and to mitigate this problem most mothers were discarding the portion of the colostrum. Although studies have been conducted on colostrum avoidance and associated factors in Ethiopia, their report was inconsistent regarding the prevalence and associated factors. The main aim of this systematic review and meta-analysis was to estimate the pooled prevalence of colostrum avoidance and associated factors in Ethiopia.Methods: In this systematic review and meta-analysis databases such as Google, Google Scholar, PubMed/Medline, Science Direct, and Hinari were searched. We found a total of 327 records, of which 292 records were excluded due to duplication and unrelated to our objective. Finally, 35 studies were included in this systematic review and meta-analysis. The data were extracted in Microsoft Excel format and exported to STATA Version 14.0 statistical software for analysis. Heterogeneity was checked by the I2 test. A random-effect meta-analysis model was used to estimate the pooled prevalence of colostrum avoidance and associated factors. Egger’s weighted regression and Begg’s rank correlation test were used to assess publication bias. Result: This review revealed that the pooled prevalence of colostrum avoidance in Ethiopia was 20.5% (95% CI; 16.46, 24.45). Ante-natal care (ANC) visits [OR= 0.274 (95% CI; 0.175, 0.428)], place of delivery [OR= 3.8 (95% CI; 2.9, 4.9)], breastfed counselling [OR= 0.261(95% CI; 0.147 - 0.462), timely initiation of breast feeding [OR = 3.8 (95% CI; 1.9, 7.4)] and prelacteal feeding [OR= 5.77 (95% CI; 4.03- 8.22)] were significant factors for colostrum avoidance. Conclusion: This meta-analysis showed that one of five mothers discarded colostrum in Ethiopia. Colostrum avoidance was higher in rural mothers than in urban mothers. Strengthening ANC visits, institutional delivery, breastfed counseling, early initiation of breastfeeding, and avoidance of prelacteal feeding are recommended interventions to reduce colostrum avoidance in Ethiopia. Furthermore, promoting the health benefit of colostrum and its nutritional value also emphasizes to improving colostrum feeding in the community.