Colostrum Avoidance and Associated Factors among Postnatal Mothers in Health Facilities in Addis Ababa, Ethiopia: A Mixed Method Study

doi:10.21203/rs.3.rs-5080176/v1

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Colostrum Avoidance and Associated Factors among Postnatal Mothers in Health Facilities in Addis Ababa, Ethiopia: A Mixed Method Study

https://doi.org/10.21203/rs.3.rs-5080176/v1

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Background: Colostrum is the first form of milk produced immediately following the delivery of a newborn. It is highly nutritious and contains antibodies to protect the newborn against disease and crucial for the newborn's health Despite its benefits, some mothers avoid giving colostrum to their newborns.

Objective:This study aims to assess the prevalence and factors associated with colostrum avoidance among postnatal mothers in Addis Ababa, Ethiopia.

Methods: A health facility-based mixed-methods of study design was conducted. Both quantitative and qualitative data were collected using pretested questionnaires and key informant interview question guides, respectively.Quantitative data were collected through structured interviews and analyzed using descriptive statistics such as frequencies, means, and standard deviations were performed. Binary logistic regression analysis was employed to assess the associated factors of colostrum avoidance among postnatal mothers at health facilities in study area.Qualitative data were gathered via in-depth interviews and analyzed thematically.

Results: The prevalence of colostrum avoidance was 8.94% (95% CI: 5.9-10.9). Multivariable analysis revealed significant predictors of colostrum avoidance: lack of counseling about colostrum benefits (AOR = 5.802, 95% CI: 2.467-13.647), cesarean delivery (AOR = 3.420, 95% CI: 1.411-8.288), poor maternal knowledge about colostrum (AOR = 13.111, 95% CI: 5.462-31.468), and late initiation of breastfeeding (AOR = 3.330, 95% CI: 1.242-8.926). Qualitative findings echoed these results, with cultural beliefs and misconceptions about colostrum contributing to its avoidance.

Conclusion: The study highlights a significant prevalence of colostrum avoidance among postnatal mothers in Addis Ababa. Key predictors include inadequate counseling, cesarean delivery, poor knowledge about colostrum, and delayed breastfeeding initiation. Interventions aimed at improving maternal education and breastfeeding practices are essential to reduce colostrum avoidance.

Nutrition & Dietetics

Colostrum avoidance

prevalence

associated factors

Colostrum, often referred to as "liquid gold," is the first milk produced by mammals immediately after giving birth[1]–[3]. It is rich in essential nutrients, antibodies, and immune factors crucial for the newborn's health and development [3]–[5]. However, despite its nutritional and immunological benefits, colostrum avoidance remains a significant concern among postnatal mothers, particularly in low- and middle-income countries like Ethiopia [6].

Globally, over 4,000 infants and young children die each day due to not receiving colostrum within the first hour of birth. Many newborns are instead given liquids other than breast milk during the initial days of life. Breastfeeding rates differ significantly across communities, ranging from nearly 70% to as low as 13%, largely influenced by cultural practices [7].

In developing countries, many women refrain from giving colostrum due to cultural beliefs, which often suggest that it lacks nutritional value or may harm the infant’s health. Some women, however, avoid colostrum simply due to tradition, without providing a specific reason. Infants aged 0–5 months who are predominantly, partially, or not breastfed face a significantly higher risk of mortality from all causes and infections compared to those who are exclusively breastfed in low- and middle-income countries (LMICs)[8].

Despite recommendations from the WHO, as well as global and national Infant and Young Child Feeding (IYCF) guidelines, which advocate for initiating breastfeeding within the first hour after birth and emphasize the importance of colostrum feeding, colostrum continues to be discarded in various regions, especially in Ethiopia. Moreover, there is limited evidence on the extent of colostrum avoidance at the community level within the country[1][2][3][9].

Despite the WHO and both global and national Infant and Young Child Feeding (IYCF) guidelines recommending that newborns begin breastfeeding within the first hour after birth and promoting colostrum feeding, the practice of discarding colostrum remains common in many parts of the world, particularly in Ethiopia. Additionally, there is a lack of comprehensive data on the prevalence of colostrum avoidance at the community level in the country[9].

Understanding the factors contributing to colostrum avoidance is essential for designing effective interventions to promote optimal breastfeeding practices and improve infant health outcomes.

Ethiopia, with its diverse cultural practices and healthcare landscape, faces significant challenges in promoting optimal breastfeeding practices, including colostrum feeding. Studies have indicated that a considerable proportion of mothers in Ethiopia refrain from feeding colostrum to their newborns due to various socio-cultural beliefs, misinformation, and inadequate support from healthcare providers. Understanding the factors influencing colostrum avoidance among postnatal mothers in health facilities is crucial for designing targeted interventions aimed at promoting optimal breastfeeding practices and improving infant health outcomes[10], [11]

Addis Ababa, the capital city of Ethiopia, serves as a microcosm of the country's diverse population and healthcare dynamics. In urban settings like Addis Ababa, where access to healthcare facilities is relatively better compared to rural areas, addressing colostrum avoidance practices among postnatal mothers becomes imperative to ensure the health and well-being of newborns. However, despite the availability of healthcare services, the prevalence of colostrum avoidance among postnatal mothers in Addis Ababa's health facilities remains a matter of concern and also studies have indicated that colostrum avoidance persists among postnatal mothers attending health facilities in different region of Ethiopia, highlighting the need for further investigation into the underlying factors influencing this practice [3], [6], [9], [12], [13]

This study aims to investigate the prevalence of colostrum avoidance among postnatal mothers attending health facilities in Addis Ababa, Ethiopia, and to explore the associated factors contributing to this phenomenon. By identifying the socio-cultural, economic, and healthcare-related factors influencing colostrum avoidance, this research seeks to inform targeted interventions and policies aimed at promoting optimal breastfeeding practices in urban Ethiopian settings. Ultimately, addressing colostrum avoidance among postnatal mothers has the potential to significantly improve infant health outcomes and contribute to the overall well-being of children in Ethiopia.

While previous research has explored various determinants of colostrum avoidance, many studies have relied solely on quantitative methodologies, providing limited insights into the complex socio-cultural and contextual factors at play [9], [12]–[18] A mixed-method approach combining quantitative surveys with qualitative inquiry can offer a more comprehensive understanding of colostrum avoidance among postnatal mothers in health facilities [14].

This mixed-method study aims to investigate the prevalence of colostrum avoidance among postnatal mothers attending health facilities in Addis Ababa, Ethiopia, and to explore the associated factors using both quantitative and qualitative methodologies. By integrating quantitative surveys to assess the prevalence and determinants of colostrum avoidance with qualitative interviews to elucidate the underlying socio-cultural beliefs, perceptions, and experiences, this study seeks to provide a holistic understanding of colostrum avoidance in the context of urban Ethiopia.

Through a mixed-method approach, this study seeks to address several key research questions: What is the prevalence of colostrum avoidance among postnatal mothers in health facilities in Addis Ababa? What are the socio-demographic, cultural, and healthcare-related factors associated with colostrum avoidance? How do socio-cultural beliefs, perceptions, and experiences influence colostrum feeding practices among postnatal mothers?

By shedding light on the multifaceted determinants of colostrum avoidance, this study aims to inform evidence-based interventions and policies aimed at promoting optimal breastfeeding practices and improving infant health outcomes in urban Ethiopian settings. Ultimately, bridging the gap between research and practice is crucial for addressing colostrum avoidance and ensuring the health and well-being of newborns in Ethiopia.

Study Design and Setting

This health-facility-based mixed methods research design was conducted from July to August 2022 to assess the prevalence of colostrum avoidance and its associated factors among postnatal mothers in Addis Ababa, Ethiopia. Addis Ababa is the capital city of Ethiopia.As to the national population and housing census report of 2007 of Ethiopia with a total population of 3,384,569 [19].As of 2024, the city's population is approximately 5.7 million, up from 5.5 million in 2023, reflecting an annual growth rate of about 4.45%. This makes Addis Ababa one of the fastest-growing cities in Africa. Administratively, the city is divided in to 11 sub cities and above120 woredas. The city has health service access in less than 2 kilometers for all people. There are 5 hospitals under Ministry of health, 6 Hospitals under Addis Ababa Health Bureau, 1 Hospitals under Ministry of Defense, 1 Hospital under Police Force and around 40 Private Hospitals. The city also has more than 100 functional governmental health centers and more than 760 private clinics in11 sub cities.

Study Participants and Sampling

Addis Ababa has eleven sub-cities and in this all-sub-city there are more than 100 health centers which are giving postnatal and EPI services.

The study was conducted in four sub-cities (30% of all sub-cities) to represent all the inhabitants of the city by using simple random sampling technique. Out of all health centers in each four sub-cities, 30% of health centers were selected from each sub-city again by simple lottery method. The total sample size was proportionally be allocated for the 10health centers based on average monthly postnatal visit of each health center. A Sampling frame was prepared. Proportional allocation and systematic random sampling techniques were used to select 481 study participants.

For qualitative data collection, participants were intentionally selected using criterion-based purposive sampling from mothers with children younger than six weeks. At each selected health center, ten mothers were chosen based on their knowledge and experience regarding colostrum avoidance.

Data Collection and Quality Control

Primary data were collected from postnatal mothers from selected health institution using both quantitative and qualitative data collection methods. A structured interviewer administered questionnaire was adapted and modified from different literature[6], [7], [12], [13], [20] to assess colostrum avoidance and associated factors among postnatal mothers.

Both data collection tools (questionnaire and in-depth interview tool) were prepared in English and translated into local languages, Amharic. All data collection tools were pre-tested to assess their completeness in capturing all the variables required as per the specific objectives of the study. Quality assurance audits were carried out during the data collection process by field supervisors. All the data collected, documents were subject to regulatory audits and scrutiny without hindering confidentiality. Two days of training were given to both data collectors and supervisors by the researchers. The training included a discussion on the objectives of the study, contents of the data collection tools, data collection techniques, and maintaining the confidentiality of the responses. Moreover, the completeness of the filled questionnaires and checklists was checked by supervisors on a daily basis

Data Management and Analysis

The collected quantitative data were first entered and cleaned using Epi Info version 7.2 statistical software and then exported to SPSS software version 26.0 for analyses. Various statistical methods like descriptive statistics such as frequencies mean and standard deviations (SDs) and also binary logistic regression tests were employed to identify associated factors of colostrum avoidance among postnatal mothers.

The qualitative data obtained from in-depth interview were auto-taped, transcribed and translated, and coded by the principal investigator. The responses were transcribed into Amharic language and translated into English. The collected data were organized and prepared for analysis. The data was read, again and again, then the data was coded by step-by-step coding analysis, and the main responses were categorized into the main theme. The main response from the respondents was reported using narratives. Inductive analysis was used to process of analysis and systematically code segment by segment based on the request question. Finally, the narrative qualitative information was organized and integrated according to the emerging themes and concepts, and then the results were triangulated with quantitative findings.

Results of the Quantitative Data Analysis from the Survey

In this study, a total of 481 (97.8%) postnatal mothers who were less than six weeks postpartum were interviewed. The age distribution of the participants revealed that 47.6% of mothers were between 25 and 29 years old.Regarding educational status, 423 (88.0%) of the mothers had attended formal education, and 439 (90.8%) of their husbands had also attended formal education. Among the mothers who attended formal education, 128 (26.6%) had completed primary education, while 109 (22.7%) held a degree or higher. Similarly, 177 (38.4%) of their husbands had attained a degree or above.In terms of employment, more than half of the mothers, 250 (52%), were housewives. The marital status data indicated that 461 (95.8%) of the mothers were married.

Regarding economic status, 186 (38.7%) of the mothers reported an average monthly family income of greater than 9000 Ethiopian Birr (ETB).

Neonate Characteristics

Concerning the characteristics of the neonates, more than half, 245 (50.9%), were male.For a detailed breakdown of the socio-demographic characteristics, refer to Table 1.

2. Obstetrics and Maternal Medical Characteristics

From the total participants, over one-fourth of the mothers, 132 (27.4%), were primipara. The majority of the mothers, 96.9%, received antenatal care (ANC). Among them, 355 (76.2%) attended ANC follow-up at local health centers, and 361 (77.5%) had four or more ANC visits during their pregnancy.

More than three-fourths of the mothers, 391 (83.9%), were counseled about the advantages of colostrum feeding. Regarding the place of delivery, the vast majority of mothers, 98.1%, delivered in health institutions. Concerning the mode of delivery, 353 (73.4%) of the mothers gave birth by spontaneous vaginal delivery, and 449 (93.3%) of the mothers delivered at term.

Most of the respondents, 448 (93.1%), were healthy and not admitted to the hospital during pregnancy, refer to Table 2.

3. Knowledge and Sources of Information on Colostrum Feeding

Among all respondents, 452 (94.0%) mothers had knowledge about colostrum, indicating they had heard about it. Regarding sources of information, 397 (65.1%) postnatal mothers received information from health professionals, 139 (22.8%) from media, 62 (10.2%) from their relatives and friends, and 2% from voluntary health workers, refer to Table 3.

4. Cultural and Traditional Beliefs About Colostrum Feeding

The majority of participants, 456 (94.8%), disagreed or strongly disagreed with the belief that colostrum breast milk should be discarded. Similarly, 455 (94.6%) postnatal mothers disagreed or strongly disagreed with the notion that colostrum is not important for a baby's growth and development. Most postnatal mothers, 438 (91.1%), disagreed with the belief that colostrum is the dirty part of milk and looks like pus. Regarding the belief that colostrum causes diarrhea, 38 (7.9%) of the respondents were neutral. Additionally, 36 (7.5%) mothers indicated that colostrum is forbidden in their culture.

For more detailed information, refer to Table 4.

5. Colostrum Avoidance Practice and Colostrum Feeding Related Characteristics

From the total respondents, 43 mothers (8.94%, CI: 5.900–10.900) avoided colostrum for their babies for various reasons, while 428 mothers (91.06%) fed colostrum to their neonates (Fig. 1). Most respondents, 414 (86.1%), initiated breastfeeding immediately after birth, within one hour.

The reasons for colostrum avoidance included cultural prohibitions, maternal illness, neonatal illness, the perception that colostrum is dirty and resembles pus, and the belief that colostrum causes neonatal diseases, with the latter being the most common reason, accounting for 46.5%, refer to Table 5.

6. Factors Associated with Colostrum Feeding Practice

From the total participants of this study, 43 mothers (8.94%, CI: 5.900–10.900) practiced colostrum avoidance. Each variable was assessed independently to identify factors associated with colostrum feeding practice. Initially, variables were tested using bivariable analysis. The factors statistically associated with colostrum avoidance in bivariable analysis (p < 0.2) included the mother's educational status, husbands’ educational status, husbands’ occupation, parity, ANC follow-up, counseling about colostrum during ANC, mode of delivery, term delivery, awareness of colostrum feeding, initiation of breastfeeding, and mothers' knowledge.

The odds of practicing colostrum avoidance were 0.285 times lower among mothers who had formal education compared to those with a diploma or above (AOR = 0.285, 95% CI: 0.116–0.698). Conversely, mothers whose husbands had no formal education were 2.503 times more likely to practice colostrum avoidance compared to their counterparts. Mothers whose husbands were private workers were 2.125 times more likely to practice colostrum avoidance compared to those whose husbands were government employees (AOR = 2.125, 95% CI: 0.950–4.752).

Primiparous mothers were 1.836 times more likely to practice colostrum avoidance compared to multiparous mothers (AOR = 1.836, 95% CI: 0.961–3.508). The odds of practicing colostrum avoidance were 10.451 times higher among mothers who did not receive ANC services compared to those who did (AOR = 10.451, 95% CI: 3.585–30.466). Mothers who delivered via caesarean section were 2.676 times more likely to practice colostrum avoidance compared to those who delivered by spontaneous vaginal delivery (AOR = 2.676, 95% CI: 1.408–5.084).

Multivariable Analysis

In a multivariable analysis, counseling about colostrum during ANC, mode of delivery, time of initiation of breastfeeding, and knowledge of postnatal mothers remained statistically significant (p < 0.05). However, the mother’s educational status, husbands’ educational status, husbands’ occupation, parity, getting ANC follow-up, hearing about colostrum feeding, and term delivery lost their significance.

Mothers who did not receive counseling about the advantages of colostrum feeding were significantly more likely to avoid colostrum compared to those who received counseling (AOR = 5.802, 95% CI: 2.467–13.647). The odds of practicing colostrum avoidance were 3.330 times higher among mothers who initiated breastfeeding after one hour compared to those who initiated breastfeeding within one hour (AOR = 3.330, 95% CI: 1.242–8.926).

Additionally, postnatal mothers who delivered via caesarean section were 3.420 times more likely to practice colostrum avoidance compared to those who delivered through spontaneous vaginal delivery (AOR = 3.420, 95% CI: 1.411–8.288). The odds of colostrum avoidance were 13.111 times higher among mothers with poor knowledge of optimal breastfeeding practices compared to their counterparts (AOR = 13.111, 95% CI: 5.462–31.468).

Additionally, the odds of practicing colostrum avoidance were 3.389 times higher among mothers with preterm babies compared to those with term babies (AOR = 3.389, 95% CI: 1.282–8.961).

Qualitative Study Results

In the qualitative part of this study, fourteen in-depth interviews were conducted in two selected health facilities. The respondents included 9 postnatal mothers, 2 grandmothers, 2 fathers, and 1 health professional. Most participants clearly defined the meaning of colostrum and colostrum avoidance. The main findings are summarized under four identified themes:

1. Mechanisms of Colostrum Avoidance

2. Factors for Colostrum Avoidance

3. Consequences of Colostrum Avoidance

4. Importance of Colostrum Feeding

1. Mechanisms of Colostrum Avoidance

"A mother described her process of colostrum avoidance: 'Even if the professionals counselled me to feed colostrum, I didn’t give it to the baby because it was mixed with blood for a week, and I feared transmitting an illness to the infant through that blood. I discarded colostrum by massaging my breast, milking, and spilling the milk, and gave my baby formula milk for one week.'" (In-depth interview – postnatal mother).

"Supporting this, a grandmother shared: 'Years ago, we didn’t know about the advantages of colostrum, and we removed it to keep our child from getting sick. Even though professionals told us that colostrum is beneficial during my daughter’s antenatal follow-up, I told my daughter to avoid colostrum because I thought it was dirty, yellowish, wrinkled, or inflamed, and caused abdominal cramping.'" (In-depth interview – grandmother).

2. Factors for Colostrum Avoidance

"A midwife providing postnatal care commented: 'The community, family, especially older mothers, neighbors, and mothers who gave birth at home before, push postnatal mothers to avoid colostrum. They think it is dirty and useless because they didn’t receive professional advice or lack knowledge.'" (In-depth interview – health professional).

3. Consequences of Colostrum Avoidance

"A father explained: 'Primiparous mothers and those who gave birth through cesarean section practice colostrum avoidance because they first think it is dirty and do not know its benefits. Those who underwent surgery are mostly in pain. Avoidance of colostrum results in physical and mental damage because the baby doesn’t receive the beneficial substances in it.'" (In-depth interview – husband).

4. Importance of Colostrum Feeding

"Regarding the importance of colostrum, a mother stated: 'Health professionals told me about the importance of colostrum feeding during antenatal follow-up. They said it acts as the first vaccine for the child. If it is removed, I think it leaves a significant gap in the infant's health.'" (In-depth interview – postnatal mother).

The findings of this study provide valuable insights into the prevalence of colostrum avoidance among postnatal mothers attending health facilities in Addis Ababa, Ethiopia, as well as the factors associated with this practice. Our analysis of data collected from 481 postnatal mothers revealed a prevalence of colostrum avoidance at 8.94% (95% CI: 5.9–10.9). These findings underscore the importance of understanding the determinants of colostrum avoidance to inform targeted interventions aimed at promoting optimal breastfeeding practices.

The above findings regarding the prevalence of colostrum avoidance among postnatal mothers were supported by the reports from previous studies conducted in urban North west Ethiopia which is 8.8%[6] and with a study done in Jinka which is 9.8%[3] The similarity may be due to studies were conducted in urban setting. However, it is lower than studies conducted in Bure Ethiopia(14.5%)[13], Kombolcha town (11.4%)[21], Raya kobo district which was 13.5%[20] and study done in Bangladesh (37%)[22]. The possible explanation for the difference might be due to socio-cultural variations of the infant breastfeeding practice, maternal health service access, and geographical distribution of study participants. And also,the difference possibly be due to a higher proportion of mothers who had a history of institutional delivery and who got counseling about colostrum advantage during ANC.

One significant factor identified in our study was the provision of counseling regarding the advantages of colostrum feeding. Postnatal mothers who received counseling about the benefits of colostrum feeding were nearly six times more likely to practice colostrum feeding compared to those who did not receive such counseling (AOR = 5.802, 95% CI: 2.467–13.647).

This highlights the crucial role of healthcare providers in educating mothers about the importance of colostrum and dispelling any misconceptions or cultural beliefs that may contribute to colostrum avoidance.

Additionally, our findings indicate that the mode of delivery is associated with colostrum avoidance, with mothers who gave birth through cesarean section being over three times more likely to avoid colostrum feeding compared to those who had vaginal deliveries (AOR = 3.420, 95% CI: 1.411–8.288). which is consistent with the study conducted in Bure Ethiopia[23]. This suggests a need for targeted support and education for mothers who undergo cesarean sections to ensure that they are adequately informed about the benefits of colostrum and encouraged to initiate breastfeeding early.

Furthermore, poor maternal knowledge about colostrum emerged as a significant predictor of colostrum avoidance in our study. Mothers with insufficient knowledge about colostrum were over thirteen times more likely to avoid colostrum feeding compared to those with adequate knowledge (AOR = 13.111, 95% CI: 5.462–31.468).This finding was supported by studies in Bure and Jinka Ethiopia[13][24]. This highlights the importance of comprehensive breastfeeding education programs aimed at improving maternal knowledge and awareness of the nutritional and immunological benefits of colostrum [25][26][27].

A postnatal mothers from LidetaHC said the following, grandmothers, older people and neighbors were the ones that discourage colostrum feeding. Likewise the in-depth interview revealed that grandmothers discourage their daughters to feed colostrum because they thought that it looks dirty and causes child sickness. Similarly grandmothers of the child have strong influence on their daughters to avoid colostrum in Bure district[13].

In an in-depth interview, a 50 years old woman from Kebena HC said that ‘before years, we didn’t know about advantage of colostrum and we were removed it because of the intention of keeping our child from getting sick. Even if professionals told colostrum is beneficial at my daughter’s antenatal follow up, I told my daughter to avoid colostrum because I think it is dirty, yellowish, wrinkled or inflamed and causes abdominal cramping’. This explains that mothers who have no information about the importance of colostrum practicing to avoid it.

Additionally, qualitative finding in this study also revealed that some mothers and grandmothers thought colostrum as yellowish, rubbish-like milk that causes diseases for infants. A study conducted in Raya Kobo district also revealed that mothers thought colostrum as yellowish-dirty milk that is not good for infants[28]. There were also similar findings from Tigray region Ethiopia[29].

Another important finding is the association between late initiation of breastfeeding and colostrum avoidance. Postnatal mothers who initiated breastfeeding late were over three times more likely to avoid colostrum feeding compared to those who initiated breastfeeding early (AOR = 3.330, 95% CI: 1.242–8.926). This underscores the significance of promoting early initiation of breastfeeding as a critical component of optimal breastfeeding practices,[15][16] which includes timely initiation of colostrum feeding.The finding is in line with previous studies in Northwest Ethiopia[14]and in Bure Ethiopia[13].

Furthermore, lack of counseling about colostrum breastfeeding during ANC was significantly associated with colostrum avoidance. Postpartum mothers who received no counseling about colostrum breastfeeding during ANC had odds of discarding colostrum 5.802 times higher than those who were counseled about breastfeeding during ANC [AOR = 5.802, 95%Cl = 2.467–13.647] which is congruent with the study done in North West Ethiopia[14]The fact that in our study, colostrum is avoided primarily because postnatal mothers believe that it causes neonatal diseases ( diarrhea and abdominal cramping ) and consider it as a dirty part of breast milk which is consistent with studies conducted in Bure[13] and Kombolcha town[6].

In conclusion, our study highlights the prevalence of colostrum avoidance among postnatal mothers in Addis Ababa, Ethiopia, and identifies counseling about colostrum feeding, mode of delivery, maternal knowledge about colostrum, and timing of breastfeeding initiation as important predictors of this practice. Addressing these factors through targeted interventions, including comprehensive breastfeeding education programs and support for mothers during delivery and postnatal care, is essential for promoting optimal breastfeeding practices and improving infant health outcomes in urban Ethiopian settings.

Comparisons with Existing Literature

Our findings align with existing literature indicating that educational status and ANC attendance significantly influence maternal health behaviors. However, the persistence of colostrum avoidance practices, despite high levels of knowledge and counseling, highlights the complexity of changing culturally ingrained practices. This discrepancy has been noted in other studies, emphasizing the need for culturally sensitive interventions.

Limitations

The study's cross-sectional design limits the ability to establish causal relationships. Additionally, self-reported data may be subject to recall bias. The sample, while large, may not be representative of all regions, potentially limiting the generalizability of the findings.

Future Directions

Future research should focus on longitudinal studies to assess the long-term impact of educational interventions on colostrum feeding practices. Additionally, exploring the role of community-based approaches in addressing cultural barriers could provide more nuanced strategies for promoting colostrum feeding. Interventions should also target family members, particularly older generations, to mitigate their influence on maternal health practices.

This study underscores the critical role of education and ANC in promoting positive health behaviors among postnatal mothers. While knowledge about colostrum is high, the persistence of avoidance practices highlights the need for targeted, culturally sensitive interventions. By addressing both educational and cultural factors, healthcare providers can more effectively promote colostrum feeding, thereby improving neonatal health outcomes.

Recommendations

Enhance Maternal Education: Implement educational programs to improve mothers' knowledge about the benefits of colostrum.

Promote Early Breastfeeding Initiation: Encourage and support immediate breastfeeding initiation post-delivery.

Provide Targeted Counseling: Offer specific counseling for mothers undergoing cesarean sections regarding the importance of colostrum.

Address Cultural Beliefs: Develop community-based interventions to challenge and change harmful cultural beliefs and misconceptions about colostrum.

Further Research: Conduct additional studies to explore other potential factors influencing colostrum avoidance and to evaluate the effectiveness of implemented interventions.

ANC,Antenatal Care ;EDHS,Ethiopia Mini Demographic and Health Survey; EPI, Extended ProgramonImmunization;HC,Health Center; HIV, HumanImmune DeficiencyVirus;IYCF,Infant and Young Child Feeding;PLF,Pre lacteal Feeding;SPSS, Statistical Packagefor Social Science;TB, Tuberculosis;UNICEF,United Nation International Child;WHO,World Health Organization.

Ethics Approval and Informed Consent

Ethical approval for the study was granted by the Institutional Review Board (IRB) of St. Paul’s Hospital Millennium Medical College (SPHMMC). A formal support letter was issued to the relevant health institutions and the Addis Ababa Health Bureau. Prior to participation, written informed consent was obtained from all participants' parents or legal guardians and health professionals, including consent for the publication of anonymized responses. Participants were fully informed about the study’s purpose, procedures, potential risks, and benefits, and were given the opportunity to ask questions. Participation was entirely voluntary, with the option to withdraw at any time. For participants under 16, consent was obtained from their parents or legal guardians in accordance with ethical standards, and assent was sought from minors where applicable to ensure they understood their involvement in the study. All data were kept confidential, with personal information anonymized using pseudonyms throughout data collection and reporting. The study adhered to the ethical principles set forth in the Declaration of Helsinki.

Consent for publication

Not applicable.

Conflict of Interest

The authors declare that they have no potential conflicts of interest in this work.

Funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

Authors’ contributions

BMS contributed to the conception and design of the study, while SZE interpreted the data and drafted the initial manuscript. BMS, SZE, and FWS provided feedback on the document. All authors read and critically reviewed the article, gave their final approval for the version to be published, agreed on the journal for submission, and accepted responsibility for all aspects of the work.

Acknowledgments

First, our gratitude goes to St. Paul’s Hospital Millennium Medical College and School of Public Health to conduct this research work. Secondly, our gratitude goes to participants, data collectors, and supervisor for their cooperation to complete the data collection. Last, but not least, we are grateful for those who participated actively and positively from the inception up to the final report of the research project.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Tables 1 to 6 are available in the Supplementary Files section.

The authors declare no competing interests.

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Table 1: Socio-demographic and economic characteristics of post-natal mothers in selected health centers in Addis Ababa, Ethiopia, August 2022.
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Table 2: Obstetrics and maternal medical characteristics of post-natal mothers in selected health centers in Addis Ababa, Ethiopia, August 2022.
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Table 3: knowledge of postnatal mothers about colostrum in selected health centers in Addis Ababa, Ethiopia, August 2022.
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Table 4: Cultural and traditional believes and attitudes of mothers about colostrum feeding in selected health centers in Addis Ababa, Ethiopia in August 2022.
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Table 5: Colostrum feeding related characteristics of postnatal mothers about colostrum feeding in selected health facilities in Addis Ababa, Ethiopia in August 2022.
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Table 6: Bivariable and Multivariable analysis of factors that affect colostrum avoidance practice among post-natal mothers in selected health centers in Addis Ababa Ethiopia, August 2022.
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Table 6: Bivariable and Multivariable analysis of factors that affect colostrum avoidance practice among post-natal mothers in selected health centers in Addis Ababa Ethiopia, August 2022.

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Colostrum Avoidance and Associated Factors among Postnatal Mothers in Health Facilities in Addis Ababa, Ethiopia: A Mixed Method Study

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Abstract

Figures

Introduction

Methods and Materials

Study Design and Setting

Study Participants and Sampling

Data Collection and Quality Control

Data Management and Analysis

Results

Results of the Quantitative Data Analysis from the Survey

Neonate Characteristics

2. Obstetrics and Maternal Medical Characteristics

3. Knowledge and Sources of Information on Colostrum Feeding

4. Cultural and Traditional Beliefs About Colostrum Feeding

5. Colostrum Avoidance Practice and Colostrum Feeding Related Characteristics

6. Factors Associated with Colostrum Feeding Practice

Multivariable Analysis

Qualitative Study Results

1. Mechanisms of Colostrum Avoidance

2. Factors for Colostrum Avoidance

3. Consequences of Colostrum Avoidance

4. Importance of Colostrum Feeding

Discussions

Comparisons with Existing Literature

Limitations

Future Directions

Conclusion

Abbreviations

Declarations

Conflict of Interest

Funding

Authors’ contributions

Acknowledgments

Availability of data and materials

References

Tables

Additional Declarations

Supplementary Files

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