title: Promotion and prelacteal feeding of breastmilk substitutes among mothers in Kathmandu Valley, Nepal.
abstract: In 1992, Nepal passed the Mother's Milk Substitutes (Control of Sale and Distribution) Act in order to regulate the sale, distribution and promotion of substitutes for breastmilk within Nepal, in an effort to protect and promote breastfeeding. Helen Keller International, in collaboration with Nepal's Ministry of Health and Population's Child Health Division, implemented a study to assess mothers' exposure to promotions for and utilization of breastmilk substitutes in Kathmandu Valley, Nepal. A health facility-based, cross-sectional survey was conducted among 304 mothers being discharged after delivery. Prelacteal feeding of breastmilk substitutes is prevalent (55.9% of mothers, n = 170). Reported recommendations during antenatal checks and after delivery from health professionals to use breastmilk substitutes were prevalent, occurring among 47.4% (n = 144) of mothers; rates of these recommendations were significantly higher for mothers that delivered in private health facilities, as compared with public (67.7% vs. 38.0%, P < 0.001). Mothers that received a recommendation to use a breastmilk substitute from a health worker were 16.7 times more likely to provide a prelacteal feed of a breastmilk substitute, as compared with mothers that did not receive a recommendation (P < 0.001). Few mothers reported observation of commercial advertisements for breastmilk substitutes inside a health facility (reported by 3.6% of mothers). No mothers reported receiving a sample of a breastmilk substitute, bottle or teat from a health professional. More information is needed to determine why there is such a high rate of health worker recommendations for breastmilk substitute use in the first few days after delivery.
  
  
  CONCLUSIONS
  While utilization of breastmilk substitutes is low among mothers of young children in Nepal, prelacteal feeding of breastmilk substitutes is highly prevalent in Kathmandu Valley. Reported recommendations from health professionals to use breastmilk substitutes are common (over 40%) and are associated with prelacteal feeding among Nepal mothers included in this study. Provision of lactation management training to health workers and monitoring their practices regularly could strengthen breastfeeding counselling, aid in reducing high rates of prelacteal feeding and contribute to improved infant feeding practices.
authors.affiliation: Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia.
authors.forename: Alissa M
authors.initials: AM
authors.lastname: Pries
authors.affiliation: Consultant to Helen Keller International.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Huffman
authors.affiliation: Helen Keller International, Kathmandu, Nepal.
authors.forename: Indu
authors.initials: I
authors.lastname: Adhikary
authors.affiliation: Ministry of Health and Population, Kathmandu, Nepal.
authors.forename: Senendra Raj
authors.initials: SR
authors.lastname: Upreti
authors.affiliation: Helen Keller International, Kathmandu, Nepal.
authors.forename: Shrid
authors.initials: S
authors.lastname: Dhungel
authors.affiliation: Helen Keller International, Washington, DC, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Champeny
authors.affiliation: Helen Keller International, Washington, DC, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Zehner
mesh_terms: D001291:Attitude of Health Personnel / Q000208:ethnology; D001942:Breast Feeding / Q000208:ethnology; D002657:Child Development; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004032:Diet / Q000009:adverse effects* / Q000191:economics / Q000208:ethnology; D005260:Female; D005515:Food Labeling / Q000331:legislation & jurisprudence; D006801:Humans; D041943:Infant Formula / Q000191:economics; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000193:education; D009390:Nepal; D018673:Nutrition Policy; D009749:Nutrition Surveys; D010349:Patient Compliance / Q000208:ethnology; D010353:Patient Education as Topic
keywords: Nepal; breastfeeding; breastmilk substitutes; prelacteal feeding