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

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.