The Context of Prelacteal Feeding and its Association with Neonatal Infectious Disease Morbidity in Rural Bangladesh
Prelacteal feeding (PF) describes the practice of introducing food other than breastmilk to a neonate prior to initiation of breastfeeding. Although this practice is common as part of indigenous cultural practices in many areas of the world, its effect on delayed breastfeeding initiation, exclusive breastfeeding, or neonatal infection has not been assessed in detail. Despite this lack of information, there is a widespread assumption that the potential harm of PF is negligible, given the small quantities these represent, over a short period of time in early life Often, PF are not considered when evaluating exclusive breastfeeding (EBF) in a population. However, in a context where low birth weight is extremely common (>50%) and prematurity rates are high (>20%), these exposures (especially to high-risk, potentially infective substances) may be less benign than assumed. For this reason, we propose to study the practice of PF in rural Bangladesh, where the practice is common (>80% of mothers). Using new and existing data from a large ongoing cohort of over 120,000 pregnancies to date, we will characterize PF by type, frequency, timing, maternal factors such as socioeconomic status (SES), and neonatal factors such as gender, gestational age at birth, and birth weight. We will assess the association of PF and delayed breastfeeding initiation, adherence to EBF, and risk of early infant morbidity possibly associated with PF exposure. Comprehensive research of PF is needed, and this preliminary data will help to mount focused epidemiologic studies to inform and, if necessary, modify recommendations regarding PF and EBF.