Odent, P.L.G.; (2011) Early infant feeding and neonatal survival in Nepal: breastfeeding, colostrum and discarding of the first milk. Doctoral thesis , UCL (University College London).

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Abstract

Of four million annual neonatal deaths, 80% occur in Asia and sub-Saharan Africa. To improve survival, cheap, equitable strategies are needed that are effective within community settings. The overall aim of the thesis was to explore early infant feeding practices and neonatal mortality across two trial surveillance systems in rural sites in Nepal, with particular interest in the discarding of first breastmilk as a new dimension in early infant feeding. The primary objectives were to examine the associations between maternally reported discarding of first breastmilk and neonatal mortality in (i) Makwanpur and (ii) Dhanusha districts, Nepal, and (iii) to describe qualitatively the practices and reasons behind discarding of first breastmilk in Makwanpur. Secondary objectives were to describe associations of first milk discarding with suspected acute respiratory infection and infection-specific mortality, replicate previous analyses of established breastfeeding patterns, breastfeeding initiation time and neonatal mortality, clarify any relationship between prelacteal feeding and neonatal mortality, and to determine characteristics predicting discarding. A qualitative secondary objective was to explore the behaviours represented by mothers categorised as having discarded or not discarded their first milk. Data on a range of variables were collected from mothers aged 15-49 who had given birth at least one month previously. Discarding of first milk was significantly associated with neonatal mortality in Makwanpur (n=15 919, aOR 2.21 [1.47 - 3.32], p<0.0001) and Dhanusha (n=14 991, aOR 1.28 [1.00 - 1.62], p<0.043) after adjustment for several covariates including other infant feeding dimensions, and exclusion of deaths within two days of birth. There was dichotomy in perceptions of first milk. Practices of discarding included squeezing out small volumes of breastmilk before initial feeding. The findings suggest that discarding of first milk represents an important dimension of early infant feeding in addition to breastfeeding initiation time, with implications for policy and research.

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