Why healthcare workers give prelacteal feeds.

OBJECTIVE: Because prelacteal feeds can adversely affect breastfeeding, UNICEF/WHO discourage their use unless medically indicated. The study was carried out to determine the proportion of healthcare workers who routinely give prelacteal feeds, and their reasons for doing so; further, to determine whether any differences exist between medically and non-medically trained healthcare workers in their administration of prelacteal feeds. DESIGN: Survey. SETTING: Primary, secondary and tertiary health facilities in Kaduna township Nigeria. SUBJECTS: Of 1100 healthcare workers sampled, 747 (68%) responded. Of these 80% had received medical training, 20% had not. METHODS: Use of a pretested validated questionnaire. RESULTS: Large proportions of both medical and non-medically trained healthcare workers stated they routinely give prelacteal feeds (doctors, 68.2%; nurses, 70.2%; and non-medical, 73.6%). However their reasons for doing so differed significantly (P=0.00001). Nurses gave mainly for perceived breast milk insufficiency, doctors for prevention of dehydration, hypoglycaemia and neonatal jaundice and non-medical staff to prepare the gastrointestinal tract for digestion and to quench thirst. CONCLUSIONS: Most healthcare workers (medical and non-medical) routinely and unnecessarily give prelacteal feeds. Therefore training and retraining programmes in lactation management are necessary and must include non-medical staff. These programmes, while emphasizing the danger of giving prelacteal feeds, must deal with the misconceptions of each group. Deliberate efforts have to be made to incorporate clinical training in breastfeeding in curricula of Schools of Medicine and Nursing.

Perceptions of Neonatal Tetanus and Immunization During Pregnancy: A report of Focus Group Discussions in Kaduna, Nigeria.

Focus group discussions were held with mothers in Kaduna, Nigeria, to investigate health practices during pregnancy and childbirth and perceptions of neonatal tetanus (NNT) and tetanus toxoid (TT) immunization. Mothers' responses indicated that while home births and traditional practices still predominate, health clinics are regarded as useful sources of health services and information during pregnancy or ill health. However, there is little recognition of the symptoms and causation of NNT; immunizations during pregnancy are reportedly associated with family planning and are therefore avoided. Group discussions conducted with traditional birth attendants and health clinic staff confirmed these findings. Recommendations are made for improving acceptance of tetanus toxoid immunizations.