Determinants of Prelacteal Feeding Among Mothers in the Remote Communities of Chitral, Pakistan

Background: Prelacteal feeding (PLF) is influenced by sociocultural factors and may disrupt exclusive breastfeeding while increasing the risk of neonatal infections. This study aimed to elucidate PLF practices among geographically isolated and culturally distinct communities in the Hindukush ranges of Chitral, northwestern Pakistan. Methods: A community-based cross-sectional study was conducted among 345 mothers with infants aged less than 24 months in Chitral. Data were collected using a structured, interviewer-administered questionnaire. PLF practices were assessed through descriptive statistics, and associated factors were examined using logistic regression. Results: Overall, 26% ( n = 91) of mothers reported practicing PLF. PLF was significantly more common among Kho mothers (31%, n = 91) than Kalash mothers (0%) ( p < 0.0001). The most commonly used prelacteal substances were infant formula (41%, n = 37), Zamzam water (30%, n = 27), butter (18%, n = 16), and honey (12%, n = 11). The primary reasons cited for PLF were perceived health benefits for the infant, insufficient breast milk production, and cultural or religious beliefs. Conclusion: Approximately one-quarter of mothers practiced PLF, with a marked disparity between Kho and Kalash communities. Ethnicity emerged as the principal determinant of PLF, highlighting the influence of cultural practices. Targeted breastfeeding counseling, maternal education, and community-based awareness interventions are urgently needed to promote exclusive breastfeeding and reduce PLF practices in this population.