Spatial distribution and determinants of the change in pre-lacteal feeding practice over time in Ethiopia: A spatial and multivariate decomposition analysis

Background: Pre-lacteal feeding persists in low and middle-income countries as deep-rooted nutritional malpractice. It imposes significant negative consequences on neonatal health, including increased risk of illness and mortality. Different studies revealed that pre-lacteal feeding practice is decreased over time. Even though different studies are done on the prevalence and determinants of pre-lacteal feeding practice, up to our knowledge, the spatial distribution and the determinants of the change in pre-lacteal feeding practice over time are not researched. Objective: To assess the spatial distribution and determinants of the change in pre-lacteal feeding practice over time in Ethiopia. Methods: We used the Ethiopian demographic and health surveys (EDHSs) data. For this study, a total weighted sample of 14672 (5789 from EDHS 2005, 4510 from EDHS 2011, and 4373 from EDHS 2016) reproductive-age women who gave birth within two years preceding the respective surveys and whoever breastfeed were used. The logit-based multivariate decomposition analysis was used to identify factors that contributed to the decrease in pre-lacteal feeding practice over the last 10 years (from 2005 to 2016). Using the 2016 EDHS data, we also conducted a spatial analysis by using ArcGIS version 10.3 and SaTScan version 9.6 software to explore the spatial distribution and hotspot clusters of pre-lacteal feeding practice. Result: Pre-lacteal feeding practice was decreased from 29% [95% Confidence interval (CI): 27.63–29.96%] in 2005 to 8% [95% CI: 7.72–8.83%] in 2016 with annual rate of reduction of 7.2%. The overall decomposition analysis showed that about 20.31% of the overall decrease in pre-lacteal feeding practice over the last 10 years was attributable to the difference in composition of women (endowment) across the surveys, while, the remaining 79.39% of the overall decrease was explained by the difference in the effect of characteristics (coefficient) across the surveys. In the endowment component, the difference in composition of residence, perception of distance from the health facility, maternal educational level, wealth status, occupation, ANC visit, place of delivery, the timing of breastfeeding initiation, and wanted last-child/pregnancy were found to be significant contributing factors for the decrease in pre-lacteal feeding practice. After controlling for the role of compositional changes, the difference in the effect of distance from the health facility, wealth status, occupation, antenatal care (ANC) visit, and wanted last-child/pregnancy across the surveys were significantly contributed to the observed decrease in pre-lacteal feeding practice. Regarding the spatial distribution, pre-lacteal feeding practice was non-random in Ethiopia in which the primary and secondary clusters’ of pre-lacteal feeding identified in Somalia and the Afar region respectively. Conclusion: Pre-lacteal feeding practice has shown a significant decline over the 10-year period. Program interventions considering women with poor maternal health service utilization such as ANC visits, women with poor socioeconomic status, women with an unintended pregnancy, and women from remote areas especially at border areas such as Somali and Afar could decrease pre-lacteal feeding practice in Ethiopia.