# Pre-lacteal feeding practices, determinants, and early health outcomes among children under 2 years of age in Nogob Zone, Somali Region, Ethiopia: a facility-based cross-sectional study

## TL;DR

This study finds that giving infants foods or liquids other than breast milk before breastfeeding is common in Ethiopia and linked to worse health outcomes.

## Contribution

The study identifies specific factors influencing pre-lacteal feeding in a pastoralist region of Ethiopia and its impact on neonatal health.

## Key findings

- Pre-lacteal feeding prevalence was 40.1% in the Nogob Zone of Ethiopia.
- Factors like rural residence and maternal illiteracy increase the likelihood of pre-lacteal feeding.
- Pre-lacteal feeding is associated with higher odds of neonatal complications.

## Abstract

Pre-lacteal feeding, the provision of foods or liquids other than breast milk before breastfeeding, undermines optimal infant feeding and increases neonatal morbidity. Evidence from pastoralist settings in Ethiopia is limited.

This study aimed to assess the prevalence, determinants, and early health outcomes of pre-lacteal feeding among children aged 2 years in the Nogob Zone, Somali Region, Ethiopia.

A facility-based cross-sectional study was conducted from June to December 2025 among 609 mother – infant pairs attending seven health centers and one primary hospital. Stratified and systematic sampling were applied. Data were collected via structured questionnaires and analyzed using multivariate logistic regression. Adjusted odds ratios with 95% confidence intervals identified determinants and associated neonatal outcomes.

Pre-lacteal feeding prevalence was 40.1% (95% CI: 36.2%–44.0%), with plain water, sugar water, and animal milk being the most common. Determinants included rural residence (AOR = 2.05; 95% CI: 1.30–3.22), no antenatal care (AOR = 2.10; 95% CI: 1.28–3.45), birth order ≥5 (AOR = 2.05; 95% CI: 1.25–3.35), maternal illiteracy (AOR = 2.90; 95% CI: 1.65–5.10), and cesarean delivery (AOR = 4.55; 95% CI: 1.72–12.10). Pre-lacteal feeding increased the odds of neonatal complications (AOR = 2.30; 95% CI: 1.35–3.95).

Pre-lacteal feeding is common in the Nogob zone and is linked to adverse neonatal outcomes. Maternal education, antenatal care promotion, early breastfeeding initiation, and culturally sensitive community interventions are essential to reduce pre-lacteal feeding and improve neonatal health in pastoralist settings.

Main findings: Pre-lacteal feeding practices are common in the study area and are significantly influenced by maternal, household, and healthcare factors.

Added knowledge: This study identifies key determinants of early infant feeding practices and their association with neonatal health outcomes in pastoralist and resource-limited settings.

Global health impact for policy and action: Findings highlight the need for targeted interventions and health policies to promote optimal breastfeeding practices and reduce neonatal morbidity in similar low-resource regions.