Pre-Lacteal Feeding Practices Of Doctors And Nurses In A State And Teaching Hospital In Western Nigeria: A Cause For Concern
O Adetunji, A Joseph, E Olusola, V Joel-Medewase, F Fadero, G Oyedeji
O Adetunji, A Joseph, E Olusola, V Joel-Medewase, F Fadero, G Oyedeji. Pre-Lacteal Feeding Practices Of Doctors And Nurses In A State And Teaching Hospital In Western Nigeria: A Cause For Concern. The Internet Journal of Nutrition and Wellness. 2006 Volume 3 Number 1.
The UNICEF/WHO baby friendly hospital initiative program is based on the recognition that breast feeding activities in the hospital are important to the success of later breastfeeding.1 In spite of the official acceptance of the Baby Friendly Hospital Initiative (BFHI) policy and practices by the Nigerian ministry of health, many hospitals in the land are yet to adopt and implement the 10 steps to successful breastfeeding. Such hospitals may encourage the prelacteal use of breast milk substitutes, such as infant formula, glucose drinks and water.
The zeal and the enthusiasm demonstrated by the UNICEF/WHO and many stakeholders at the inception of the BFHI led to the expectations that the principles and the practice of the initiative would spread from the designated to non-designated hospitals and health units. 2 This study was conducted to determine to which extent the BFHI practices had influenced the early feeding of newborn in the 2 non-designated major hospitals in the Osun state capital. The State Specialist Hospital and the Ladoke Akintola University Teaching Hospital in which this study was conducted are both situated in Osogbo, the capital of a Western Nigeria state. Both hospitals are specialist and referral hospitals. None of the two hospitals has so far being designated baby friendly by the UNICEF and WHO.
Subjects And Methods
The subjects were the 62 doctors and nurses in the newborn and postnatal wards of the State Specialist Hospital, and the Ladoke Akintola University Teaching hospital, Osogbo, who responded to the questionnaire. All the subjects were interviewed to obtain information regarding their practices on prelacteal feeding of the newborn between the 1st and 31st of August 2006. Information elicited with the questionnaire included the designation and assigned wards of duty of the respondents, the details of the types of feeds, the times of feeding and the reasons for prescribing the feeds. The doctors and nurses in the newborn unit were classified as paediatric and those in the post natal unit were classified as obstetric. The data obtained was analyzed and presented as simple descriptive statistics.
Population of doctors and nurses studied.
Thirty (75%) of the total 40 doctors working at the neonatal and post-natal wards of the State Specialist Hospital and the Ladoke Akintola University Teaching hospital were studied. The 30 doctors consisted of 15(50%) doctors each from the obstetric and paediatric departments. The fifteen doctors from the obstetric department were 6(40%) consultant and 9(60%) resident cadres. Also, 6(40%) consultants and 9(60%) residents were studied at the paediatric unit. Of the total 52 nurses working in both establishment 32 (61.5%) responded. The 32 nurses were ranked, 10 (31.3%) chief nursing officers, 10 (31.3%) senior nursing sisters and 12(.37.4%) nursing officers and they consisted of 15(46.9%) paediatric and 17(53.1%) obstetric nurses. Thus, the total number of health workers studied was 62.
Breast feeding practices
Breast milk was declared to be the best food for the newborn by all respondents. In addition exclusive breast feeding practice was accepted to be the best feeding practice for all the newborn when practicable by all the health workers studied. However, prelacteal feeding practices were adopted, when the mothers' lactation was considered to be delayed.
Practice and indications for prelacteal feeding
Sixty (96.8%) respondents of the total 62 respondents gave prelacteal feeds because of delayed maternal lactation. This 60 consisted of 29 doctors and 31 nurses. Thus one each of paediatric doctors and nurses did not prescribe prelacteal feeds. Prevention of hypoglycemia was the stated background purpose for giving prelacteal feeds. An additional reason offered by one (6.7%) of the 15 obstetric doctors for giving prelacteal glucose drinks was for the prevention of neonatal jaundice. Also, another 1(6.7%) of the obstetric doctors prescribes plain water prior to lactation in order to prevent dehydration. Of the 17 nurses attached to the obstetric unit 16(94.1%) practiced the administration of prelacteal feeds for delayed lactation and prevention of hypoglycemia. One (6.25%) of the nurses also prescribed prelacteal glucose fluids in order to prevent and treat neonatal jaundice.
Type of prelacteal feeds and mode of administration
Feeding of the new born babies by cup and spoon was the practice by all the health workers who prescribed prelacteal feeds. Infant formula was the most common prelacteal feed administered to newborn babies by the paediatric nurses and doctors. Eleven (73.3%) of the 15 paediatric doctors and 10(58.8%) of the 17 nurses gave this feed. On the other hand glucose water was the most common feed given by the obstetric doctors and nurses-9(60.0%) of the 15 doctors and 8(47.1%) of 17 nurses. The details of the kinds of prelacteal feeds given by the health workers are shown in Table 1
Time of administration of prelacteal feeds post delivery
The time for commencement of prelacteal feed varied a lot among the health workers. Most of the health workers administered prelacteal feeds within 0-2 hours of delivery especially to crying inconsolable babies. Of the total 15 paediatricians and 15 obstetricians studied 5 (33.3%) doctors from each unit gave prelacteal feeds within 2 hours of delivery. While among the 15 paediatric and 17 obstetric nurses 5(33.3%) and 7 (41.2%) respectively of the nurses in the 2 units gave prelacteal feeds within 2 hours of delivery. On the other hand for 3 (20.0%) paediatric doctors and 4 (23.5%) obstetric nurses, gave no specific time as to the time of administration of feeds. The details showing the prelacteal feeding periods of the new born babies are shown in Table 2
Paediatric specialty and infant feeding training.
None of the nurses had paediatric specialist training post basic qualification. Also majority of the nurses have not undergone a course on infant feeding since they started working on the neonatal and post-natal wards. None of the obstetric doctors had received special training on infant feeding since their basic qualifications. On the other hand, all the paediatricians had received training on infant feeding by virtue of their training/ rotation through the neonatology posting. Most of the obstetricians 14 (93.3%) and paediatricians 12(80%) were desirous to attend an update course on infant feeding so as to upgrade their knowledge. Similarly 13(86.7%) of the paediatric and 11(64.7%) of the obstetric nurses respectively responded that they felt the need to undergo a training update on neonatal feeding.
The present study has shown that the pre-lacteal feeding of healthy newborn babies is a common practice among health workers in these 2 major hospitals. The prevalence of use of pre-lacteal feeds in the present study is unacceptably high, since it is the routinely prescribed mode of feed management of babies whose mothers commence lactating from shortly after birth to as long as 48 hours post delivery. One aspect of the serious concern which this situation invites will be appreciated when we consider the leadership position of both hospitals. While one is a teaching hospital the other is the apical hospital of the whole state. They therefore train and influence other health workers, yet their example in this respect is unworthy of emulation.
Our findings suggest a need to educate the health workers in order to dissuade them from these harmful practices and to motivate them to adopt, implement and promote the UNICEF/WHO breast feeding initiative activities.1,3 The other aspect of the concern relates to the finding that doctors in the newborn unit, also, in spite of their training prescribe prelacteal feeds. This is an unexpected finding and it more likely to be due to a lack of whole hearted belief in the BFHI than to ignorance.
The issues regarding the disparities in perceived indications for prelacteal feeds and the use of breast milk substitutes such as plain water and glucose water for feeding has been documented by previous studies.3,4,5 The variance in post delivery feeding time and the different types of prelacteal feeds all point to a basic need perceived by the respondents that they need an update information on neonatal care. Babies delivered in the communities outside hospitals and with no access to paediatricians are at a greater potential risk of receiving prelacteal feeds. On the other hand babies delivered in the hospital who have feeding problems are usually referred to paediatricians.
Previous studies on pre-lacteal feeding have paid little attention to the varying time interval between onset of maternal lactation and delivery. 3,4,5 A previous study conducted in Nigeria has shown that the risk of developing hypoglycemia in babies on exclusive breastfeeding in the first 6 hours was minimal but yet, existed.6 Routine early prelacteal feeds 2-6 hours post delivery as observed in the present study may therefore seem unjustified, and could be a disadvantage by delaying lactation.
In conclusion our findings suggest that Nigerian health workers need to be educated about right infant feeding practices. Previous studies have shown that education of mid-wives and doctors in charge of nursing mothers reduced the chances of prelacteal feeding and formula supplementation. 3,7 Adoption of the baby friendly policies in all our hospitals will reduce the practice of prelacteal feeding. All non-baby friendly hospitals can ensure that all the doctors and nurses who work in their postnatal and neonatal wards receive a verbal briefing on their hospitals' neonatal feeding policy, which should be based on the BFHI steps which should also be written up and conspicuously displayed on the wards. The media houses can assist in effecting the needed change by playing the role of disseminating correct feeding information to the target population. The government on its part can provide facilities for workshops and update courses as well as issue out directives to hospital managements on the feeding practices it wishes to promote.
Dr. O.A Oyedeji. Department of Paediatrics, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. E-mail: email@example.com Telephone: +234 (0) 8056715508