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Background : Studies have identified numerous factors affecting breastfeeding initiation and duration , including maternal education , mode of delivery , birth weight , socioeconomic status , and support of the infant ’s father . Objective : The objective was to investigate the effects of an antenatal education session and postnatal support targeted to fathers . Methods : The Fathers Infant Feeding Initiative ( FIFI Study ) is a r and omized controlled trial to increase the initiation and duration of breastfeeding that was conducted in 8 public maternity hospitals in Perth , Western Australia . A total of 699 couples were r and omized within hospitals to either intervention or control groups . The intervention consisted of a 2-hour antenatal education session and postnatal support provided to fathers . Results : The any breastfeeding rate for the intervention group was significantly greater at 6 weeks : 81.6 % in the intervention group compared to 75.2 % in the control group , odds ratio 1.46 ( 95 % CI , 1.01 - 2.13 ) . After adjustment for age and hospital , the odds ratio for any breastfeeding in the intervention group was 1.58 ( 1.06 - 2.35 ) and for socioeconomic status ( SES ) , 1.56 ( 1.06 - 2.30 ) . The infants of older fathers were more likely to be breastfed at 6 weeks compared to infants of younger fathers ( P < .01 ) , and infants of fathers with high SES more likely than infants of fathers with low SES ( P = .013 ) . Conclusion : Even a small increase in breastfeeding rates brings public health benefits . In this study , a minimal intervention was found to significantly increase any breastfeeding at 6 weeks : 81.6 % in the intervention group compared to 75.2 % in the control group Objective : To determine the impact of breast crawl on breast feeding and its feasibility and acceptability in a busy labor room . Study Design : A prospect i ve , single blinded , r and omized controlled clinical trial . Impact of breast crawl was studied in one group and the outcome was compared with the other group where breast crawl was not performed . Feasibility and acceptability was determined by analysis of question naire given to obstetricians and nurses . Descriptive statistics and χ2- analysis was applied to evaluate the question naire and to compare the outcome in the two groups . Result : Breast crawl had a significant positive impact on the onset of lactation ( P=0.0005 ) as well as extent of neonatal weight loss on day 3 ( 0.032 ) . Conclusion : Our study adds to the body of evidence that breast crawl results in positive short-term breast feeding outcome but acceptability of breast crawl as a routine in a busy labor room remains a major issue OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed Objective To assess whether exclusive and prolonged breast feeding reduces the risk of childhood asthma and allergy by age 6.5 years . Design Cluster r and omised trial . Setting 31 Belarussian maternity hospitals and their affiliated polyclinics . Participants A total of 17 046 mother-infant pairs were enrolled , of whom 13 889 ( 81.5 % ) were followed up at age 6.5 years . Intervention Breastfeeding promotion intervention modelled on the WHO/UNICEF baby friendly hospital initiative . Main outcome measures International study of asthma and allergies in childhood ( ISAAC ) question naire and skin prick tests of five inhalant antigens . Results The experimental intervention led to a large increase in exclusive breast feeding at 3 months ( 44.3 % v 6.4 % ; P<0.001 ) and a significantly higher prevalence of any breast feeding at all ages up to and including 12 months . The experimental group had no reduction in risks of allergic symptoms and diagnoses or positive skin prick tests . In fact , after exclusion of six sites ( three experimental and three control ) with suspiciously high rates of positive skin prick tests , risks were significantly increased in the experimental group for four of the five antigens . Conclusions These results do not support a protective effect of prolonged and exclusive breast feeding on asthma or allergy . Trial registration Current Controlled Trials IS RCT N37687716 CONTEXT The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother 's behavior or her interaction with the infant . OBJECTIVE To assess whether prolonged and exclusive breastfeeding improves children 's cognitive ability at age 6.5 years . DESIGN Cluster-r and omized trial , with enrollment from June 17 , 1996 , to December 31 , 1997 , and follow-up from December 21 , 2002 , to April 27 , 2005 . SETTING Thirty-one Belarussian maternity hospitals and their affiliated polyclinics . PARTICIPANTS A total of 17,046 healthy breastfeeding infants were enrolled , of whom 13,889 ( 81.5 % ) were followed up at age 6.5 years . INTERVENTION Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF . MAIN OUTCOME MEASURES Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence , and teacher evaluations of academic performance in reading , writing , mathematics , and other subjects . RESULTS The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months ( 43.3 % for the experimental group vs 6.4 % for the control group ; P < .001 ) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months . The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures , with cluster-adjusted mean differences ( 95 % confidence intervals ) of + 7.5 ( + 0.8 to + 14.3 ) for verbal IQ , + 2.9 ( -3.3 to + 9.1 ) for performance IQ , and + 5.9 ( -1.0 to + 12.8 ) for full-scale IQ . Teachers ' academic ratings were significantly higher in the experimental group for both reading and writing . CONCLUSION These results , based on the largest r and omized trial ever conducted in the area of human lactation , provide strong evidence that prolonged and exclusive breastfeeding improves children 's cognitive development . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N37687716 Background In Sub-Saharan Africa over one million newborns die annually . We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practice s and survival . Here we report the effect on newborn care practice s one year after full implementation . Methods All 132 wards in the 6-district study area were r and omised to intervention or comparison groups . Starting in 2010 , in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practice s including hygiene , breastfeeding and identification and extra care for low birth weight babies . In 2011 , in a representative sample of 5,240 households , we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practice s. Results Four of 14 newborn care practice s were more commonly reported in intervention than comparison areas : delaying the baby ’s first bath by at least six hours ( 81 % versus 68 % , OR 2.0 ( 95 % CI 1.2 - 3.4 ) ) , exclusive breastfeeding in the three days after birth ( 83 % versus 71 % , OR 1.9 ( 95 % CI 1.3 - 2.9 ) ) , putting nothing on the cord ( 87 % versus 70 % , OR 2.8 ( 95 % CI 1.7 - 4.6 ) ) , and , for home births , tying the cord with a clean thread ( 69 % versus 39 % , OR 3.4 ( 95 % CI 1.5 - 7.5 ) ) . For other behaviours there was little evidence of differences in reported practice s between intervention and comparison areas including childbirth in a health facility or with a skilled attendant , thermal care practice s , breastfeeding within an hour of birth and , for home births , the birth attendant having clean h and s , cutting the cord with a clean blade and birth preparedness activities . Conclusions A home-based counselling strategy using volunteers and design ed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania . Further research is needed to evaluate if , and at what cost , these gains will lead to improved newborn survival . Trial registration Trial Registration Number NCT01022788 ( http://www . clinical trials.gov , 2009 AIMS To evaluate the effects of a breastfeeding intervention on primiparous mothers '  breastfeeding self-efficacy , breastfeeding duration and exclusivity at 4 and 8 weeks postpartum . BACKGROUND Few studies have examined the effects of breastfeeding self-efficacy on improved breastfeeding outcomes among primiparous mothers in China . DESIGN An experimental pre-test and posttest , two-group design was used in the study . METHODS A total of 74 participants were recruited to the study from a tertiary hospital in central China , from June-October 2012 . An individualized , st and ardized nursing intervention based on the Self-Efficacy Theory was delivered to enhance mothers ' breastfeeding self-efficacy , breastfeeding duration and exclusivity at 4 and 8 weeks postpartum . Participants were r and omly assigned to an intervention or referent group . Participants in the intervention group received three individualized , self-efficacy-enhancing sessions . Participants in the referent group received st and ard care . RESULTS Participants in the intervention group showed significantly greater increases in breastfeeding self-efficacy , exclusivity and duration than participants in the control group at 4 and 8 weeks postpartum ( except for duration at 4 weeks ) . High baseline breastfeeding self-efficacy predicted higher breastfeeding self-efficacy later and more exclusive breast-feeding . CONCLUSION The findings in this study suggest that intervention aim ed at increasing self-efficacy has a significant impact on maternal breastfeeding self-efficacy and short-term breastfeeding outcomes We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7 - 10 days among African-American WIC participants . Of the 242 women with complete data , 48 % initiated breastfeeding , but only 31 % were still breastfeeding at 7 - 10 days . Initiation was associated with cesarean delivery , infant feeding instruction , no artificial milk discharge pack , attending the peer counselor only-intervention site , and intention to breastfeed . Continuation was influenced by infant feeding instruction , no artificial milk discharge pack , and intention to breastfeed . Overall , trends toward a positive impact of the breastfeeding promotion activities were evident but weak , and largely gone by 7 - 10 days postpartum Background Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO . We report its impact on early infant feeding practice s from the PROMISE-EBF trial . Methods PROMISE-EBF was a cluster r and omised behaviour change intervention trial of exclusive breastfeeding ( EBF ) promotion by peer counsellors in Burkina Faso , Ug and a and South Africa implemented during 2006 - 2008 among 2579 mother-infant pairs .  Counselling started in the last pregnancy trimester and mothers were offered at least five postnatal visits . Early infant feeding practice s : use of prelacteal feeds ( any foods or drinks other than breast milk given within the first 3 days ) , expressing and discarding colostrum , and timing of initiation of breastfeeding are presented by trial arm in each country . Prevalence ratios ( PR ) with 95 % confidence intervals ( 95%CI ) are given . Results The proportion of women who gave prelacteal feeds in the intervention and control arms were , respectively : 11 % and 36 % , PR 0.3 ( 95 % CI 0.2 , 0.6 ) in Burkina Faso , 13 % and 44 % , PR 0.3 ( 95 % CI 0.2 , 0.5 ) in Ug and a and 30 % and 33 % , PR 0.9 ( 95 % CI 0.6 , 1.3 ) in South Africa . While the majority gave colostrum , the proportion of those who expressed and discarded it in the intervention and control arms were : 8 % and 12 % , PR 0.7 ( 95 % CI 0.3 , 1.6 ) in Burkina Faso , 3 % and 10 % , PR 0.3 ( 95 % CI 0.1 , 0.6 ) in Ug and a and 17 % and 16 % , PR 1.1 ( 95 % CI 0.6 , 2.1 ) in South Africa . Only a minority in Burkina Faso ( < 4 % ) and roughly half in South Africa initiated breastfeeding within the first hour with no large or statistically significant differences between the trial arms , whilst in Ug and a the proportion of early initiation of breastfeeding in the intervention and control arms were : 55 % and 41 % , PR 0.8 ( 95 % CI 0.7 , 0.9 ) . Conclusions The PROMISE-EBF trial showed that the intervention led to less prelacteal feeding in Burkina Faso and Ug and a. More children received colostrum and started breastfeeding early in the intervention arm in Ug and a. Late breastfeeding initiation continues to be a challenge . No clear behaviour change was seen in South Africa . Trial registration NCT00397150 Background : Whereas breastfeeding initiation rates have risen in all groups throughout the country , rates of breastfeeding duration have changed more slowly . Peer counseling has had some success in sustaining breastfeeding , but with intensive programs and variable effects . Objectives : We aim ed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally . We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention . Methods : One hundred twenty prenatal women underwent stratified r and omization based on breastfeeding attitude , measured by the Iowa Infant Feeding Attitude Scale ( IIFAS ) . The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery . Study groups were compared on breastfeeding outcomes , adjusting for IIFAS strata , and on interactions with self-efficacy . Results : One hundred three women were followed to at least 1 month . Women with positive attitudes had significantly higher rates of initiation ( 93 % vs 61 % ) and breastfeeding at 1 and 6 months ( 79 % vs 25 % and 12 % vs 0 % , respectively ) than those with negative attitudes , regardless of intervention . After adjusting for self-efficacy , women who received peer counseling had significantly higher breastfeeding rates at 1 month ( odds ratio = 3.2 ; 95 % confidence interval , 1.02 - 9.8 ) . The intervention group was marginally more likely to achieve their breastfeeding goal ( 43 % vs 22 % , P = .073 ) . Conclusion : Breastfeeding rates in all women improved during the study period . Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support . Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service The aim of this study was to investigate whether mothers with newborn children , the usage of autogenic training with advice on breastfeeding effect on : the decision and the duration of breastfeeding , increase maternal confidence and support . It was assumed that the above result in a higher percentage of mothers who exclusively breastfed baby during the first six months of child 's life . The survey was conducted in the Association " For a healthy and happy childhood"-Counseling center for mother and child , in Bjelovar in 2010 . The Counseling center was attended by 100 nursing mothers with children aged up to two months . They r and omly went to the study or control group . Mothers of both groups were advised to successful breastfeeding . Study group has practice d autogenic training until the child 's age of six months . In parallel , by using psychotherapeutic interview and specific question naires we collected data on the somatic , psychological and social situation of the mother , discovered mother 's mental changes ( anxiety , depression ) that were treated . The results at the end of the study confirm the initial expected benefits from the application of autogenic training . Mothers of the study group were significantly more emotionally balanced with a higher self-esteem .  Autogenous training with the advices for successful breastfeeding conducted in this counseling center contributed in significantly higher rate of breastfeeding children up to six months of life , improved mental and physical health of mother and child and their peculiar relationship OBJECTIVE To assess the impact of a child feeding training program for primary care health professionals about breastfeeding and complementary feeding practice s. METHODS Cluster-r and omized field trial conducted in the city of Porto Alegre , ( RS ) , Brazil . Twenty primary health care centers ( HCC ) were r and omized into intervention ( n = 9 ) and control ( n = 11 ) groups . The health professionals ( n = 200 ) at the intervention group centers received training about healthy feeding practice s. Pregnant women were enrolled at the study . Up to six months of child 's age , home visits were made to obtain variables related to breastfeeding and introduction of foods . RESULTS 619 children were evaluated : 318 from the intervention group and 301 from the control group .  Exclusive breastfeeding prevalence in the first ( 72.3 versus 59.4 % ; RR = 1.21 ; 95%CI 1.08 - 1.38 ) , second ( 62.6 versus 48.2 % ; RR = 1.29 ; 95%CI 1.10 - 1.53 ) , and third months of life ( 44.0 % versus 34.6 % ; RR = 1.27 ; 95%CI 1.04 - 1.56 ) was higher in the intervention group compared to the control group . The prevalence of children who consumed meat four or five times per week was higher in the intervention group than in the control group ( 36.8 versus 22.6 % ; RR = 1.62 ; 95%CI 1.32 - 2.03 ) . The prevalence of children who had consumed soft drinks ( 34.9 versus 52.5 % ; RR = 0.66 ; 95%CI 0.54 - 0.80 ) , chocolate ( 24.5 versus 36.7 % RR = 0.66 95%CI 0.53 - 0.83 ) , petit suisse ( 68.9 versus 79.7 ; 95%CI 0.75 - 0.98 ) and coffee ( 10.4 versus 20.1 % ; RR = 0.51 ; 95%CI 0.31 - 0.85 ) in their six first months of life was lower in the intervention group . CONCLUSION The training of health professionals had a positive impact on infant feeding practice s , contributing to the promotion of child health Background The World Health Organization recommends promoting exclusive breastfeeding for six months . Women often end breastfeeding earlier than planned , however women who continue to breastfeed despite problems often experience good support and counselling from health professionals . The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses , on women ’s satisfaction with breastfeeding counselling , problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months . Methods An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden . This study was conducted in Sweden , in 2000 - 2003 . Ten municipalities were paired , and within each pair , one was r and omly assigned to the group of five intervention ( IG ) municipalities and one to the group of five control municipalities . Primiparas ( n = 540 ) were invited to participate in a longitudinal study to evaluate the care they received . A survey was distributed at 3 days , 3 months and 9 months postpartum . Data collection for control group A ( n = 162 ) started before the intervention was initiated . Data for control group B ( n = 172 ) were collected simultaneously with the intervention group ( IG ) ( n = 206 ) . Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months . Results Women in IG were more satisfied with the breastfeeding counselling ( p = 0.008 ) and felt the breastfeeding counselling was more coherent ( p = 0.002 ) compared to control groups , when exclusive breastfeeding was < 3 months . In addition fewer women in the IG , among the group exclusively breastfeeding < 3 months , had problems with insufficient breast milk compared to the control groups ( p = 0.01 ) . Conclusion A process-oriented training for health professionals in support influenced women ’s ability to solve breastfeeding problems such as the experience of insufficient breast milk production . Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in line with their planned breastfeeding duration , compared to women who had breastfeeding duration < 3 months . Trial registration OBJECTIVE to assess the effect of an antenatal training programme on knowledge , self-efficacy and problems related to breast feeding and on breast-feeding duration . DESIGN a r and omised controlled trial . SETTING the Aarhus Midwifery Clinic , a large clinic connected to a Danish university hospital in an urban area of Denmark . PARTICIPANTS a total of 1193 nulliparous women were recruited before week 21 + 6 days of gestation , 603 were r and omised to the intervention group , and 590 to the reference group . INTERVENTION we compared a structured antenatal training programme attended in mid-pregnancy with usual practice . MEASUREMENTS data were collected through self-reported question naires sent to the women 's e-mail addresses and analysed according to the intention to treat principle . The primary outcomes were duration of full and any breast feeding collected 6 weeks post partum ( any ) and 1 year post partum ( full and any ) . FINDINGS no differences were found between groups according to duration of breast feeding , self-efficacy score , or breast-feeding problems , but after participation in the course in week 36 of gestation women in the intervention group reported a higher level of confidence ( p=0.05 ) , and 6 weeks after birth they reported to have obtained sufficient knowledge about breast feeding ( p=0.02 ) . Supplemental analysis in the intervention group revealed that women with sufficient knowledge breast fed significantly longer than women without sufficient knowledge ( HR=0.74 CI : 0.58 - 0.97 ) . This association was not found in the reference group ( HR=1.12 CI : 0.89 - 1.41 ) . KEY CONCLUSIONS AND IMPLICATION S FOR PRACTICE antenatal training can increase confidence of breast feeding in pregnancy and provide women with sufficient knowledge about breast feeding after birth . Antenatal training may therefore be an important low-technology health promotion tool that can be provided at low costs in most setting s. The antenatal training programme needs to be followed by postnatal breast-feeding support as it is not sufficient in itself to increase the duration of breast feeding or reduce breast-feeding problems This paper makes use of data collected in a r and omised controlled trial that was design ed to test the efficacy of postpartum breastfeeding counselling to increase exclusive breastfeeding  among term low birth weight infants in Manila during the first six months . Mothers were r and omised to a control group or one of two home visit interventions : by trained breastfeeding counsellors or child care counsellors without breastfeeding support training .  Sixty mothers received peer breastfeeding counselling while a further 119 mothers did not . The median duration of exclusive breastfeeding among mothers who received counselling was five weeks versus two weeks among those who received no counselling ( p<0.001 ) . Exclusive breastfeeding was interrupted to offer infants water , traditional herbal extracts or artificial baby milk . Mothers who interrupted exclusive breastfeeding cl aim ed they had insufficient milk or that their infants had slow weight gain . Early and sustained breastfeeding support will enable mothers to exclusively breastfeed low birth weight infants for the first six months OBJECTIVE To study the factors involved in the maintenance of exclusive breastfeeding  in healthy infants during the first 4 months of life , with emphasis on the role of pediatricians . MATERIAL AND METHODS A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba , state of Minas Gerais , Brazil . The babies were divided at r and om into three groups : G1 , receiving advice from a multiprofessional breastfeeding team ; G2 , receiving advice from a pediatrician trained in breastfeeding ; and G3 , receiving advice from a pediatrician with no breastfeeding training . Group r and omization was confirmed by analysis of variance . The factors involved in the type of feeding at 4 months were analyzed by the chi-square test , by analysis of variance and by multiple variable analysis . RESULTS At the end of follow-up , Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding . In addition , the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 ( p = 0.002 ) . The use of a pacifier was negatively correlated with exclusive breastfeeding ( p = 0.003 ) . More maternal schooling increased the chance of exclusive breastfeeding at 4 months ( p = 0.041 ) . CONCLUSIONS In this study , a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months Objective To determine whether the use of sidecar cribs on the postnatal ward affects breastfeeding duration . Design A r and omised non-blinded parallel trial comparing sidecar cribs with st and alone cots . Setting Postnatal wards of the Royal Victoria Infirmary , Newcastle upon Tyne . Participants 1204 pregnant women intending to breastfeed were recruited at 20 weeks ' gestation and r and omised at 34 weeks to use either a sidecar crib attached to their bed ( n=601 ) or a st and alone cot adjacent to their bed ( n=603 ) . Main outcome measures Duration of any , and exclusive , breastfeeding up to 26 weeks obtained by telephone follow-up . Results 334 mothers were withdrawn or lost to follow-up from the trial ; infant feeding data were therefore obtained for 870 mothers ( 433 intervention ; 437 controls ) . Using an intention-to-treat Cox regression analysis , no significant difference was found between the two groups for duration of any breastfeeding  ( sidecar crib vs cot , hazard ratio ( HR ) 0.96 , 95 % CI 0.79 to 1.18 ) , or exclusive breastfeeding ( HR 0.99 , 95 % CI 0.85 to 1.16 ) adjusting for maternal age , education , previous breastfeeding and delivery type . Bed sharing was not significantly more common in mothers r and omised to sidecar cribs ( 67 % vs 64 % , adjusted difference 2.8 % , 95 % CI −3.5 % to 9.0 % ) . There were no adverse events . Conclusion The use of sidecar cribs for mothers and infants did not improve the duration of any or exclusive breastfeeding , or frequency of bed sharing at home . Trial Registration IS RCT BACKGROUND Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries A r and omized controlled trial is used to determine whether assigning mixed feeders to a breastfeeding clinic within 1 week postpartum will increase exclusive breastfeeding at 1 month among Hispanic immigrants . Subjects are eligible for the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) , and 85 % are monolingual Hispanic . Mothers ( n = 522 ) of infants at low risk for hyperbilirubinemia are approached at bedside 20 to 48 hours after delivery and r and omly assigned to treatment or control groups . Intent-to-treat analysis of feeding behavior at 4 weeks postpartum indicates that the intervention group is more likely to be exclusively breastfeeding ( 16.4 % vs 10 % in the control group , P = .03 ; adjusted odds ratio 1.87 ; 95 % confidence interval , 1.07 - 3.26 ) ; that the incidence of formula supplementation does not differ between groups ; and that the intervention group is less likely to supplement with water and tea  ( P < .002 ) . J Hum Lact . 25(3):287 - 296 PURPOSE To develop , implement , and examine the effect of a breastfeeding educational program on breastfeeding knowledge and practice s of Egyptian mothers of preterm infants . METHODS An experimental design was used with a convenience sample of 60 mothers and their preterm infants who were born before 37 weeks of gestation . They were r and omly assigned to intervention and control groups . Data collection instruments included breastfeeding knowledge question naire , observational checklist of mother 's breastfeeding practice s , breastfeeding diary , infant 's and mother 's profile form , and demographic information . A five-session breastfeeding educational program based on B and ura 's Social Cognitive Theory was implemented with the intervention group during the infant 's hospitalization and after discharge . Both groups were followed up to 3 months after discharge . Descriptive statistics , ANOVA , Chi-square , and regression were used to analyze the data . FINDINGS Mother 's knowledge significantly increased for the intervention group but not the control group ( p = 0.041 ) . The intervention group showed gradual improvement in breastfeeding practice s , i.e. , started breast milk expression earlier and had more breast milk expression frequency than the control group . Of the intervention group , 80 % were discharged on exclusive breastfeeding compared to 40 % among the control group , and breastfeeding problems were less among the intervention group . CONCLUSIONS The breastfeeding educational program was effective in improving breastfeeding knowledge and practice s among mothers of preterm infants OBJECTIVE To determine whether peer counselors impacted breastfeeding duration among premature infants in an urban population . DESIGN This was a r and omized controlled clinical trial . SETTING The trial was conducted in the Newborn Intensive Care Unit at Boston Medical Center , an inner-city teaching hospital with approximately 2000 births per year . PARTICIPANTS One hundred eight mother-infant pairs were enrolled between 2001 and 2004 . Pairs were eligible if the mother intended and was eligible to breastfeed per the 1997 guidelines from the American Academy of Pediatrics and if the infant was 26 to 37 weeks ' gestational age and otherwise healthy . INTERVENTION Subjects were r and omized to either a peer counselor who saw the mother weekly for 6 weeks or to st and ard of care . MAIN OUTCOME MEASURE The main outcome measure was any breast-milk feeding at 12 weeks postpartum . RESULTS Intervention and control groups were similar on all measured sociodemographic factors . The average  gestational age of infants was 32 weeks ( range , 26.3 - 37 weeks ) with a mean birth weight of 1875 g ( range , 682 - 3005 g ) . At 12 weeks postpartum , women with a peer counselor had odds of providing any amount of breast milk 181 % greater than women without a peer counselor ( odds ratio , 2.81 [ 95 % confidence interval , 1.11 - 7.14 ] ; P = .01 ) . CONCLUSIONS Peer counselors increased breastfeeding duration  among premature infants born in an inner-city hospital and admitted to the neonatal intensive care unit .  Peer counseling programs can help to increase breastfeeding in this vulnerable population Objective To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team ( proactive ) and woman-initiated ( reactive ) telephone support after discharge . Design R and omised controlled trial embedded within a before- and -after study . Participatory approach and mixed- method process evaluation . Setting A postnatal ward in Scotl and . Sample Women living in disadvantaged areas initiating breast feeding . Methods Eligible women were recruited to a before- and -after intervention study , a proportion of whom were independently r and omised after hospital discharge to intervention : daily proactive and reactive telephone calls  for ≤14 days or control : reactive telephone calls ≤ day 14 . Intention-to-treat analysis compared the r and omised groups on cases with complete outcomes at follow-up . Main outcome measures Primary outcome : any breast feeding at 6–8 weeks assessed by a telephone call from a research er blind to group allocation . Secondary outcomes : exclusive breast feeding , satisfaction with care , NHS costs and cost per additional woman breast feeding . Results There was no difference in feeding outcomes for women initiating breast feeding before the intervention ( n=413 ) and after ( n=388 ) . 69 women were r and omised to telephone support : 35 intervention ( 32 complete cases ) and 34 control ( 26 complete cases ) . 22 intervention women compared with 12 control women were giving their baby some breast milk ( RR 1.49 , 95 % CI 0.92 to 2.40 ) and 17 intervention women compared with eight control women were exclusively breast feeding ( RR 1.73 , 95 % CI 0.88 to 3.37 ) at 6–8 weeks after birth . The incremental cost of providing proactive calls was £ 87 per additional woman breast feeding and £ 91 per additional woman exclusively breast feeding at 6–8 weeks ; costs were sensitive to service organisation . Conclusions Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes . Integrating the FEeding Support Team ( FEST ) intervention into routine postnatal care was feasible . Trial registration number IS RCT N27207603 . The study protocol and final report are available on request Study objective : To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on  maternal and child health outcomes . Design : R and omised controlled trial with economic and process evaluations and follow up at 12 and 18 months . The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor ( SHV ) , or a year of support from community groups providing drop in sessions , home visiting and /or telephone support ( CGS ) . Each was compared with a control group that received st and ard health visitor services . Setting : Two disadvantaged boroughs of London , United Kingdom . Participants : 731 women from culturally diverse background s with infants . Main results : At 12 and 18 months , there was little impact for either intervention on the main outcomes : child injury ( SHV : relative risk 0.99 ; 95 % confidence intervals 0.68 to 1.45 , CGS : 0.91 ; 0.61 to1.36 ) , maternal smoking ( SHV : 0.86 ; 0.62 to 1.19 , CGS : 0.97 ; 0.72 to 1.33 ) or maternal depression ( SHV : 0.86 ; 0.62 to1.19 , CGS : 0.93 ; 0.69 to 1.27 ) . SHV women had different patterns of health service use ( with fewer taking their children to the GP ) and had less anxious experiences of motherhood than control women . User satisfaction with the SHV intervention was high . Uptake of the CGS intervention was low : 19 % , compared with 94 % for the SHV intervention . Conclusions : There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population . The SHV intervention was associated with improvement in some of the secondary outcomes BACKGROUND Observational studies suggest that breastfeeding benefits later maternal child-feeding practice s , which in turn may contribute to positive eating attitudes . We investigated the effect of a r and omized intervention to increase duration and exclusivity of breastfeeding  on  pre-adolescent eating attitudes . METHODS Long-term follow-up of the Promotion of Breastfeeding Intervention Trial ( PROBIT ) , a cluster-r and omized trial in 31 maternity hospitals and affiliated polyclinics in Belarus . Sites were r and omly assigned an experimental intervention to promote longer duration and exclusivity of breastfeeding in mothers who initiated breastfeeding ( n = 16 sites ) , or a control intervention of continuing usual care ( n = 15 sites ) ; 17 046 healthy infants were enrolled in 1996 - 7 , of whom 13 751 ( 80.7 % ) completed the  Children 's Eating Attitude Test ( ChEAT ) at 11.5 years of age . A ChEAT score ≥ 22.5 ( 85th percentile ) was used as an indicator of problematic eating attitudes . Analysis was based on intention-to-treat , accounting for clustering within hospitals/clinics . RESULTS Compared with the control arm , the experimental intervention substantially increased breastfeeding exclusivity ( 43.3 % vs 6.4 % exclusively breastfed at 3 months of age ) and duration of any breastfeeding throughout infancy . The proportion of children with ChEAT scores ≥ 22.5 was lower in the experimental than control arm ( boys 11.4 % vs 17.2 % ; girls 18.5 % vs 23.4 % ) [ cluster-adjusted odds ratio ( OR ) , boys : 0.44 ; 95 % confidence interval ( CI ) : 0.21,0.93 ; girls : 0.51 ; 95 % CI : 0.27,0.99 ) . Results were robust to adjustment for potential confounders and using a ChEAT score ≥ 25.5 ( 91st percentile ) as the outcome ( OR : 0.53 ; 95 % CI : 0.28,1.03 ) . CONCLUSIONS An intervention to improve the duration and exclusivity of breastfeeding among term infants in Belarus was associated with a reduction in problematic eating attitudes at 11.5 years of age In northern Nigeria , interventions are urgently needed to narrow the large gap between international breastfeeding recommendations and actual breastfeeding practice s. Studies of integrated microcredit and community health interventions documented success in modifying health behaviors but typically had uncontrolled design s. We conducted a cluster-r and omized controlled trial in Bauchi State , Nigeria , with the aim of increasing early breastfeeding initiation and exclusive breastfeeding among female microcredit clients . The intervention had 3 components . Trained credit officers led monthly breastfeeding learning sessions during regularly scheduled microcredit meetings for 10 mo . Text and voice messages were sent out weekly to a cell phone provided to small groups of microcredit clients ( 5 - 7 women ) . The small groups prepared songs or dramas about the messages and presented them at the monthly microcredit meetings . The control arm continued with the regular microcredit program . R and omization occurred at the level of the monthly meeting groups . Pregnant clients were recruited at baseline and interviewed again when their infants were aged ≥6 mo . Logistic regression models accounting for clustering were used to estimate the odds of performing recommended behaviors . Among the clients who completed the final survey ( n = 390 ) , the odds of exclusive breastfeeding to 6 mo ( OR : 2.4 ; 95 % CI : 1.4 , 4.0 ) and timely breastfeeding initiation ( OR : 2.6 ; 95 % CI : 1.6 , 4.1 ) were increased in the intervention vs. control arm . Delayed introduction of water explained most of the increase in exclusive breastfeeding among clients receiving the intervention . In conclusion , a breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended breastfeeding practice s. This intervention could be scaled up in Nigeria , where local organizations provide microcredit to > 500,000 clients . Furthermore , the intervention could be adopted more widely given that > 150 million women , many of childbearing age , are involved in microfinance globally Background Child stunting ( low height-for-age ) is a marker of chronic undernutrition and predicts children ’s subsequent physical and cognitive development . Around one third of the world ’s stunted children live in India . Our study aims to assess the impact , cost-effectiveness , and scalability of a community intervention with a government-proposed community-based worker to improve growth in children under two in rural India . Methods The study is a cluster r and omised controlled trial in two rural districts of Jharkh and and Odisha ( eastern India ) . The intervention tested involves a community-based worker carrying out two activities : ( a ) one home visit to all pregnant women  in the third trimester , followed by subsequent monthly home visits to all infants aged 0–24 months to support appropriate feeding , infection control , and care-giving ; ( b ) a monthly women ’s group meeting using participatory learning and action to catalyse individual and community action for maternal and child health and nutrition . Both intervention and control clusters also receive an intervention to strengthen Village Health Sanitation and Nutrition Committees . The unit of r and omisation is a purposively selected cluster of approximately 1000 population . A total of 120 geographical clusters covering an estimated population of 121,531 were r and omised to two trial arms : 60 clusters in the intervention arm receive home visits , group meetings , and support to Village Health Sanitation and Nutrition Committees ; 60 clusters in the control arm receive support to Committees only . The study participants are pregnant women identified in the third trimester of pregnancy and their children ( n = 2520 ) . Mothers and their children are followed up at seven time points : during pregnancy , within 72 hours of delivery , and at 3 , 6 , 9 , 12 and 18 months after birth . The trial ’s primary outcome is children ’s mean length-for-age Z scores at 18 months . Secondary outcomes include wasting and underweight at all time points , birth weight , growth velocity , feeding , infection control , and care-giving practice s. Additional qualitative and quantitative data are collected for process and economic evaluations . Discussion This trial will contribute to evidence on effective strategies to improve children 's growth in India . Trial registration IS RCT N register 51505201 ; Clinical Trials Registry of India number 2014/06/004664 Low-income , multi-ethnic women are at elevated risk for obesity and chronic diseases , yet influences at different levels may act as barriers to changing risk behaviors . Following the birth of a child , childrearing and social isolation can exacerbate these influences . The social ecological framework integrates behavior-change strategies at different levels , providing a strong theoretical base for developing interventions in this high-risk population . The primary purpose of this r and omized controlled trial is to test the efficacy of an educational model delivered by community-based paraprofessionals in improving diet , activity and weight loss  among new mothers over a 12-month postpartum period and a 6-month maintenance period . This model fosters institutional change to support behavior changes influenced at intrapersonal and interpersonal levels , through collaboration with federal programs for low-income families : the Special Supplemental Food Program for Women , Infants and Children ( WIC ) , and the Exp and ed Food and Nutrition Education Program ( EFNEP ) . Participants are r and omized to the Usual Care , e.g. WIC nutrition and breastfeeding education , or Enhanced EFNEP intervention arm , consisting of Usual WIC Care plus a sustained , multi-component intervention including home visits , group classes and monthly telephone counseling . If shown to be efficacious , this program will be readily sustainable through existing federal agencies Background Counselling human immunodeficiency virus ( HIV ) positive mothers on safer infant and young child feeding ( IYCF ) options is an important component of programmes to prevent mother to child transmission of HIV , but the quality of counselling is often inadequate . The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options . Method This was a un-blinded cluster-r and omized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were r and omized to intervention ( IYCF counselling with counselling cards )  or  non- intervention arm ( IYCF counselling without counselling cards ) . Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants . Results Totals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility . The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member ( RR = 1.46 , 95 % CI [ 1.11 , 1.92 ] ) ; used visual aids in explaining the risk of HIV transmission through breast milk ( RR = 4.65 , 95 % CI [ 2.28 , 9.46 ] ) ; and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers ( all p values < 0.05 ) . The differences also included exploration of the home situation ( p < 0.05 ) ; involving the partner in the process of choosing a feeding option ( RR = 1.38 , 95 % CI [ 1.09 , 1.75 ] ) ; and exploring how the mother will manage to feed the baby when she is at work ( RR = 2.82 , 95 % CI [ 1.70 , 4.67 ] ) . The clients in the intervention group felt that the provider was more caring and underst and ing ( RR = 1.81 , 95 % CI [ 1.19 , 2.75 ] ) . Conclusion The addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session The importance of exclusive breast-feeding in the first 6 mo of life is widely recognized , but most mothers still do not reach this goal . Several studies have shown that face-to-face lactation counseling is effective in increasing not only exclusive breast-feeding rates but also the total duration of breast-feeding . However , it is unclear whether counseling could increase breast milk intake . The purpose of this study was to evaluate the effect of lactation counseling on breast milk intake , assessed through the deuterium dilution method . This was a blind , r and omized intervention trial of lactation counseling in a sample of 188 babies born in Pelotas , selected with the same criteria used for the WHO Multicentre Growth Reference Study ( MGRS ) . The main outcomes were breast-feeding pattern and duration for all infants as well as breast milk intake for a sub sample of 68 infants at the age of 4 mo . Mothers in the control group were almost twice as likely to stop breast-feeding by 4 mo as those in the intervention group ( prevalence ratio 1.85 ; P = 0.04 ) . Cox regression confirmed that the velocity of weaning was twice as high in the control group . Breast milk and total water intakes did not differ between the groups . The deuterium dilution technique proved to be a practical means of assessing breast milk intake .  Lactation counseling reduced early weaning , but breast milk intake at 4 mo was not affected Complementary feeding practice s are often inadequate in developing countries , result ing in a significant nutritional decline between 6 and 18 mo of age . We assessed the effectiveness of an educational intervention to promote adequate complementary feeding practice s that would be feasible to sustain with existing re sources . The study was a cluster r and omized controlled trial in communities in the state of Haryana in India . We developed the intervention through formative research . Eight communities were pair matched on their baseline characteristics ; one of each pair was r and omly assigned to receive the intervention and the other to no specific feeding intervention . Health and nutrition workers in the intervention communities were trained to counsel on locally developed feeding recommendations .  Newborns were enrolled in all of the communities ( 552 in the intervention and 473 in the control ) and followed up every 3 mo to the age of 18 mo . The main outcome measures were weights and lengths at 6 , 9 , 12 , and 18 mo and complementary feeding practice s at 9 and 18 mo . All analyses were by intent to treat . In the overall analyses , there was a small but significant effect on length gain in the intervention group ( difference in means 0.32 cm , 95 % CI , 0.03 , 0.61 ) . The effect was greater in the subgroup of male infants ( difference in mean length gain 0.51 cm , 95 % CI 0.03 , 0.98 ) . Weight gain was not affected . Energy intakes from complementary foods overall were significantly higher in the intervention group children at 9 mo ( mean + /- SD : 1556 + /- 1109 vs. 1025 + /- 866 kJ ; P < 0.001 ) and 18 mo ( 3807 + /- 1527 vs. 2577 + /- 1058 kJ ; P < 0.001 ) . Improving complementary feeding practice s through existing services is feasible but the effect on physical growth is limited . Factors that limit physical growth in such setting s must be better understood to plan more effective nutrition programs Exclusive breast-feeding ( EBF ) rates remain low despite numerous health benefits associated with this behavior . We conducted a r and omized trial on the effect of lactation counseling on EBF , which controlled for the Hawthorne effect while also varying the timing of the intervention . Pregnant women attending prenatal clinics in Tema were r and omly assigned to 1 of 2 intervention groups ( IG ) or to a control group ( C ) , as follows : 1 ) EBF support given pre- , peri- , and postnatally ( IG1 ; n = 43 ) ; 2 ) EBF support given only peri- and postnatally ( IG2 ; n = 44 ) ; or 3 ) nonbreast-feeding health educational support ( C ; n = 49 ) that had an equal amount of contact with lactation counselors . Two educational sessions were provided prenatally , and 9 home follow-up visits were provided in the 6-mo postpartum period . Infant feeding data were collected monthly at the participant 's home . The 3 groups did not differ in sociodemographic characteristics . At 6 mo postpartum , 90.0 % in IG1 and 74.4 % in IG2 had exclusively breast-fed during the previous month . By contrast , only 47.7 % in C were doing so ( P = 0.008 ) . Similarly , the percentage of EBF during the 6 mo was significantly higher ( P = 0.02 ) among IG1 and IG2 ( 39.5 % ) than among C ( 19.6 % ) . The 100 % increase in EBF rates can be attributed to the lactation counseling provided . Additional prenatal EBF support may not be needed within a context of strong routine prenatal EBF education Survival analysis and logistic regression were used to identify factors associated with the onset of perceived insufficient milk among 165 healthy mothers who planned to breast-feed and gave birth by vaginal delivery , without complications , to a healthy term infant in either a nursery ( n = 58 ) or a rooming-in-hospital where formula supplementation was not allowed ( n = 107 ) . Women were interviewed in the hospital and at 1 wk , 2 mo and 4 mo postpartum . Women from both hospitals were similar in socioeconomic , demographic , anthropometric , previous infant feeding experience and prenatal care variables . Eighty percent of the women reported perceived insufficient milk at some point during the study . The cue interpreted most often as indicating insufficient milk was the crying of the infant . Multivariate analyses indicated that lack of confidence in breast-feeding , delayed onset of milk production , maternal education , multiparity , sore nipples , early introduction of formula to the previous child and mother breast-fed as a child were significantly associated ( P < 0.05 ) with perceived insufficient milk . Among women who reported perceived insufficient milk before 1 wk , breast-feeding confidence and maternal education interacted with the hospital in which they delivered BACKGROUND The World Health Organization recommends exclusive breastfeeding until age 6 mo . Studies relying on mothers ' self-reported behaviors have shown that lactation counseling increases both the rate and duration of exclusive breastfeeding . OBJECTIVE We aim ed to vali date reported infant feeding practice s in rural Bangladesh ; intakes of breast milk and nonbreast-milk water were measured by the dose-given-to-the mother deuterium dilution technique . DESIGN Subjects were drawn from the large-scale Maternal and Infant Nutrition Interventions , Matlab , study of combined interventions to improve maternal and infant health , in which women were r and omly assigned to receive either exclusive breastfeeding counseling or st and ard health care messages . Data on infant feeding practice s were collected by question naire at monthly visits . Intakes of breast milk and nonbreast-milk water were measured in a sub sample of 98 mother-infant pairs ( mean infant age : 14.3 wk ) and compared with question naire data reporting feeding practice s. RESULTS Seventy-five of the 98 subjects reported exclusive breastfeeding .  Mean ( + /-SD ) breast milk intake was 884 + /- 163 mL/d in that group and 791 + /- 180 mL/d in the group reported as nonexclusively breastfed ( P = 0.0267 ) . Intakes of nonbreast-milk water were 40 + /- 80.6 and 166 + /- 214 mL/d ( P < 0.0001 ) , respectively . Objective cross-validation using deuterium dilution data showed good accuracy in reporting of feeding practice s , although apparent misreporting was widely present in both groups . CONCLUSIONS The dose-given-to-the-mother deuterium dilution technique can be applied to vali date reported feeding behaviors . Whereas this technique shows that the reports of feeding practice s were accurate at the group level , it is not adequate to distinguish between feeding practice s in individual infants BACKGROUND Obese women often have difficulties breastfeeding . OBJECTIVE We evaluated whether telephone-based support could increase the duration of breastfeeding in obese women and , thereby , reduce offspring growth . DESIGN We recruited 226 dyads of obese mothers and their singleton , healthy , term infants . The women were r and omly assigned to 6 mo of breastfeeding support or st and ard care controls . At 6 mo , there were 207 dyads in the study ; 105 dyads received support , and 102 dyads were control subjects . One International Board Certified Lactation Consultant carried out the intervention , which was based on structured interviews and consisted of encouraging telephone calls . RESULTS The support group breastfed exclusively for a median of 120 d ( 25th-75th percentiles : 14 - 142 d ) compared with 41 d ( 3 - 133 d ) for control subjects ( P = 0.003 ) . Any breastfeeding was maintained for a median of 184 d ( 92 - 185 d ) for the support group compared with 108 d ( 16 - 185 d ) for control subjects ( P = 0.002 ) . Support increased the adjusted ORs for exclusive breastfeeding at 3 mo and the ratios for partial breastfeeding at 6 mo to 2.45 ( 95 % CI : 1.36 , 4.41 ; P = 0.003 ) and 2.25 ( 95 % CI : 1.24 , 4.08 ; P = 0.008 , respectively ) . Although the duration of exclusive breastfeeding was inversely associated with infant weight ( β = -4.39 g/d ; 95 % CI : -0.66 , -8.11 g/d ; P = 0.021 ) and infant length at 6 mo ( β = -0 . 012 cm/d ; 95 % CI : -0.004 , -0.02 cm/d ; P = 0.004 ) , the breastfeeding support did not achieve a significant effect on infant growth at 6 mo ( n = 192 ) . CONCLUSIONS Telephone-based advisory support was very effective in prolonging breastfeeding  in obese mothers who often terminate the breastfeeding of their infants prematurely . A longer duration of breastfeeding may decrease risk of noncommunicable diseases in these infants . This trial was registered at clinical trials.gov as NCT01235663 By mapping the mechanisms through which interventions are expected to achieve impact , program impact pathway ( PIP ) analysis lays out the theoretical causal links between program activities , outcomes , and impacts . This study examines the pathways through which the Alive & Thrive ( A&T ) social franchise model is intended to improve infant and young child feeding ( IYCF ) practice s in Vietnam . Mixed methods were used , including qualitative interviews with franchise management board members ( n = 12 ) , surveys with health providers ( n = 120 ) , counseling observations ( n = 160 ) , and household surveys ( n = 2045 ) . Six PIP components were assessed : 1 ) franchise management , 2 ) training and IYCF knowledge of health providers , 3 ) service delivery , 4 ) program exposure and utilization , 5 ) maternal behavioral determinants ( knowledge , beliefs , and intentions ) toward optimal IYCF practice s , and 6 ) IYCF practice s. Data were collected from  A&T-intensive areas ( A&T-I ; mass media + social franchise ) and A&T-nonintensive areas ( A&T-NI  ; mass media only ) by using a cluster-r and omized controlled trial design . Data from 2013 were compared with baseline where similar measures were available . Results indicate that mechanisms are in place for effective management of the franchise system , despite challenges to routine monitoring . A&T training was associated with increased capacity of providers , result ing in higher- quality IYCF counseling ( greater technical knowledge and communication skills during counseling ) in A&T-I areas . Franchise utilization increased from 10 % in 2012 to 45 % in 2013 but fell below the expected frequency of 9 - 15 contacts per mother-child dyad . Improvements in breastfeeding knowledge , beliefs , intentions , and practice s were greater among mothers in A&T-I areas than among those in A&T-NI areas . In conclusion , there are many positive changes along the impact pathway of the franchise services , but challenges in utilization and dem and creation should be addressed to achieve the full intended impact Background Breastfeeding is a critical component of interventions to reduce child mortality .  Exclusive breastfeeding practice is extremely low in South Africa and there has been no improvement in this over the past ten years largely due to fears of HIV transmission . Early cessation of breastfeeding has been found to have negative effects on child morbidity and survival in several studies in Africa . This paper reports on determinants of early breastfeeding cessation among women in South Africa . Methods This is a sub group analysis of a community-based cluster-r and omized trial ( PROMISE EBF ) promoting exclusive breastfeeding  in three South African sites ( Paarl in the Western Cape Province , and Umlazi and Rietvlei in KwaZulu-Natal ) between 2006 and 2008 ( Clinical Trials.gov no : NCT00397150 ) . Infant feeding recall of 22 food and fluid items was collected at 3 , 6 , 12 and 24 weeks postpartum . Women ’s experiences of breast health problems were also collected at the same time points . 999 women who ever breastfed were included in the analysis . Univariable and multivariable logistic regression analysis adjusting for site , arm and cluster , was performed to determine predictors of stopping breastfeeding by 12 weeks postpartum . Results By 12 weeks postpartum , 20 % of HIV-negative women and 40 % of HIV-positive women had stopped all breastfeeding . About a third of women introduced other fluids , most commonly formula milk , within the first 3 days after birth . Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks ( Adjusted odds ratio , AOR 5.6 , 95 % CI 3.4 – 9.5 and AOR 4.1 , 95 % CI 1.6 – 10.8 , respectively ) . Also important was self-reported breast health problems associated with a 3-fold risk of stopping breastfeeding ( AOR 3.1 , 95%CI 1.7 – 5.7 ) and the mother having her own income doubled the risk of stopping breastfeeding ( AOR 1.9 , 95 % CI 1.3 – 2.8 ) . Conclusion Early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa . There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems CONTEXT Promotion of breastfeeding in Brazilian maternity hospitals . OBJECTIVE To quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the Wellstart-SLC course  , comparing them with changes among mothers attended by institutions not exposed to this course . DESIGN R and omized Institutional Trial . SETTING The effects of training on breastfeeding duration was assessed in eight Brazilian hospitals assigned at r and om to either an exposed group ( staff attending the Wellstart-SLC course ) or a  control group .  SAMPLE For each of the eight study hospitals , two cohorts of about 50 children were visited at home at one and six months after birth . The first cohort ( n = 494 ) was composed of babies born in the month prior to exposure to the Wellstart-SLC course , and the second cohort ( n = 476 ) was composed of babies born six months subsequent to this exposure . MAIN MEASUREMENTS Kaplan-Meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves . Hazard ratio ( HR ) estimates were calculated by fitting Cox proportional hazard regression models to the data . RESULTS The increases in estimated , adjusted rates for children born in hospitals with trained personnel were 29 % ( HR = 0.71 ) and 20 % ( HR = 0.80 ) for exclusive and full breastfeeding , respectively . No changes were identified for total breastfeeding . CONCLUSION This r and omized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration The evidence that breast-feeding protects against obesity is based on observational studies , with potential for confounding and selection bias . This article summarizes a previously published study in which we assessed whether an intervention design ed to promote exclusive and prolonged breast-feeding affects children 's height , weight , adiposity , and blood pressure ( BP ) at age 6.5 y. The Promotion of Breastfeeding Intervention Trial ( PROBIT ) is a cluster-r and omized trial of a breast-feeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative . A total of 17,046 healthy breast-fed infants were enrolled from 31 Belarussian maternity hospitals and affiliated clinics , of whom 13,889 ( 81.5 % ) were followed up at 6.5 y with duplicate measurements of height , weight , waist circumference , triceps and subscapular skinfold thicknesses , systolic and diastolic BP . Analysis was based on intention to treat , with statistical adjustment for clustering within hospitals/clinics to permit inferences at the individual level . The experimental intervention led to a large increase in exclusive breast-feeding at 3 mo ( 43.3 % vs. 6.4 % , P < 0.001 ) and a significantly higher prevalence of any breast-feeding throughout infancy . No significant intervention effects were observed on height , BMI , adiposity measures , or BP . The breast-feeding promotion intervention result ed in substantial increases in the duration and exclusivity of breast-feeding yet did not reduce measures of adiposity at age 6.5 y. Previous reports of protective effects against obesity may reflect uncontrolled bias caused by confounding and selection Reported are the results of a r and omized controlled trial to assess the effectiveness of the WHO/UNICEF 40-hour course " Breastfeeding counselling : a training course " . The course was conducted in a maternity hospital which provides care to a low-income population in a metropolitan area in São Paulo , Brazil . Health workers from 60 health units were r and omly assigned to be either participants ( 20 ) or controls ( 40 ) , and their breastfeeding knowledge and skills were assessed before and immediately after the course , as well as 3 months later . Immediately after the course the participants ' knowledge of breastfeeding had increased significantly compared to controls . Both their clinical and counselling skills also improved significantly . When assessed 3 months later , the scores remained high with only a small decrease . The implementation of the course was also evaluated . The methods used were participatory observation , key interviews and focus group discussion . In the 33 sessions of the course , the average score was 8.43 out of 10 . Scores were highest for content and methodology of the theory sessions , and lowest for " use of time " , " clinical management of lactation " , and " discussion of clinical practice " .  " Breastfeeding counselling : a training course " therefore effectively increases health workers ' knowledge and their clinical and counselling skills for the support of breastfeeding . The course can be conducted adequately using the material and methodology proposed , but could be more satisfactory if the time allocated to exercises and clinical practice sessions were increased Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea , so that they could start exclusive breast-feeding during their hospital stay . Infants ( n = 250 ) up to 12 weeks of age were r and omized to intervention and control groups . Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education . During follow-up at home by the counsellors a week later , only the mothers in the intervention group were counselled . All the mothers were evaluated for infant feeding practice s at home two weeks after discharge . Among the 125 mother-infant pairs in each group , 60 % of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6 % in the control group ( P < 0.001 ) ; two weeks later , these rates rose to 75 % and 8 % in the intervention and control groups , respectively ( P < 0.001 ) . However , 49 % of mothers in the control group reverted back to bottle-feeding compared with 12 % in the intervention group ( P < 0.001 ) . Thus , individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home . Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practice OBJECTIVE To describe the costs of providing support to breastfeeding low-income women and compares costs to cost offsets of the intervention . DESIGN Secondary analysis of data from a r and omized controlled trial of an intervention to promote breastfeeding  among low-income women with full-term infants . SETTING A university hospital and a community hospital in Baltimore , Maryl and . PARTICIPANTS Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) eligible breastfeeding women ( N = 328 ) were r and omized to usual care or the community health nurse/peer counselor intervention . METHODS The research ers collected and described personnel and mileage costs over the entire duration of the intervention ( 24 weeks ) . Research ers also compared ( using t tests ) change in re sources associated with breastfeeding including the number of clinic visits , hospital nights , emergency room visits , prescriptions , and formula feedings per day up to 12 weeks . RESULTS The cost of the personnel and travel required for the intervention was $ 296 per woman . The use of medical care and number of formula feedings per day were similar for the intervention and usual care groups . When differences in use of medical care and formula feeding were statistically significant , the intervention group used fewer re sources . CONCLUSION Support for breastfeeding by community health nurses and peer counselors is partially offset by reducing medical care utilization and formula feeding costs Food preferences are established in early childhood and track later in life . Therefore , it is important to promote healthy feeding practice s as early as possible . A r and omized field trial was conducted with 500 mother-child pairs from a low-income area of São Leopoldo , State of Rio Gr and e do Sul , Brazil , to evaluate the impact of a nutritional intervention in the first year of life on the dietary quality of 3- to 4-y-old children . Mother-child pairs were r and omized either to intervention and control groups and dietary counseling was provided for mothers in the intervention group during 10 home visits in the course of the first year of life . These visits were carried out by fieldworkers who counseled the mothers about the Ten Steps for Healthy Feeding from Birth to Two Years of Age , based on the WHO guidelines . Dietary intake was assessed at 3 - 4 y of age for 345 children using two 24-h food recalls . Overall diet quality was determined by the Healthy Eating Index . The prevalence of poor diet in the intervention group was lower compared with the control group [ relative risk ( RR ) = 0.30 ; 95 % CI = 0.13 - 0.71 ) . The number of children who achieved the 75th percentile for the vegetable and fruit component score was higher in the intervention than in control group ( RR = 1.95 ; 95 % CI = 1.31 - 2.89 and RR = 1.49 ; 95 % CI = 1.07 - 2.07 , respectively ) . Such data provide evidence that dietary counseling for mothers during the first year of life improves the overall dietary quality of children in a low-income population BACKGROUND Although the WHO recommends that complementary feeding in infants should begin at 6 mo of age , it often begins before this in developed countries . OBJECTIVE Our objective was to determine whether lactation consultant ( LC ) support , with educational re sources given at 4-mo postpartum , can delay the introduction of complementary foods until around 6 mo of age . METHODS A total of 802 mother-infant pairs were recruited from the single maternity hospital serving Dunedin , New Zeal and ( 59 % response rate ) and r and omly assigned to the following : 1 ) usual care ( control group ) ; 2 ) infant sleep education intervention ( Sleep ) ; 3 ) food , activity , and breastfeeding intervention ( FAB ) ; or 4 ) combination ( both ) intervention ( Combo ) . Certified LCs delivered 3 intervention sessions ( late pregnancy and 1-wk and 4-mo postpartum ) . The 4-mo contact used educational re sources focused on developmental readiness for complementary foods . Age when complementary foods were introduced was obtained from repeated interviews ( monthly from 3- to 27-wk postpartum ) . RESULTS A total of 49.5 % and 87.2 % of infants received complementary foods before 5 and 6 mo of age , respectively . There was evidence of group differences in the number of infants introduced to complementary foods before 5 mo ( P = 0.006 ) , with those receiving support and re sources ( FAB and Combo groups combined ; 55.6 % ) more likely to wait until at least 5 mo compared with controls ( control and Sleep groups combined ; 43.3 % ) ( OR : 1.52 ; 95 % CI : 1.08 , 2.16 ) . However , there was no evidence they were more likely to wait until 6 mo of age ( P = 0.52 ) . Higher  maternal  age , higher parity , and a less positive attitude toward breastfeeding were positively associated , and drinking alcohol during pregnancy was negatively associated , with later age of introduction of complementary foods . CONCLUSIONS Providing an LC and educational re sources at 4-mo postpartum to predominantly well-educated , mainly European , women can delay the introduction of complementary foods until 5 mo of age , but not until the WHO recommendation of 6 mo . This trial was registered at clinical trials.gov as NCT00892983 OBJECTIVE Maternal obesity is associated with poor breastfeeding outcomes , yet no intervention has been developed to improve them . To ascertain whether increased breastfeeding support or provision of a breast pump is a feasible , effective intervention to improve breastfeeding , we enrolled obese women who intended to breastfeed in two r and omized trials . METHODS In Bassett Improving Breastfeeding Study ( BIBS ) 1 , 40 women received targeted breastfeeding support in the hospital  and via telephone or usual care .  Information regarding breastfeeding was collected via telephone for 7 days after delivery and at 30 and 90 days postpartum . In BIBS 2 , 34 obese mothers received a manual or electric breast pump to use for 10 - 14 days or no pump ; data collection was similar . RESULTS In both experiments , r and omization failed to distribute women of differing postpartum body mass index adequately among the treatment groups . When analyses were adjusted for this , there was no difference in BIBS 1 between targeted and usual care groups and in BIBS 2 among the treatment groups in the proportion of women still breastfeeding at the times studied . CONCLUSIONS In future studies of obese women , stratified r and omization may be necessary . Further development of interventions to help obese women achieve optimal breastfeeding outcomes is required Objective To assess the effectiveness of an antenatal service using community based breastfeeding peer support workers on initiation of breast feeding . Design Cluster r and omised controlled trial . Setting Community antenatal clinics in one primary care trust in a multiethnic , deprived population . Participants 66 antenatal clinics with 2511 pregnant women : 33 clinics including 1140 women were r and omised to receive the peer support worker service and 33 clinics including 1371 women were r and omised to receive st and ard care . Intervention An antenatal peer support worker service planned to comprise a minimum of two contacts with women to provide advice , information , and support from approximately 24 weeks ’ gestation within the antenatal clinic or at home . The trained peer support workers were of similar ethnic and sociodemographic background s to their clinic population . Main outcome measure Initiation of breast feeding obtained from computerised maternity records of the hospitals where women from the primary care trust delivered . Results The sample was multiethnic , with only 9.4 % of women being white British , and 70 % were in the lowest 10th for deprivation . Most of the contacts with peer support workers took place in the antenatal clinics . Data on initiation of breast feeding were obtained for 2398 of 2511 ( 95.5 % ) women ( 1083/1140 intervention and 1315/1371 controls ) . The groups did not differ for initiation of breast feeding : 69.0 % ( 747/1083 ) in the intervention group and 68.1 % ( 896/1315 ) in the control groups ; cluster adjusted odds ratio 1.11 ( 95 % confidence interval 0.87 to 1.43 ) . Ethnicity , parity , and mode of delivery independently predicted initiation of breast feeding , but r and omisation to the peer support worker service did not . Conclusion A universal service for initiation of breast feeding using peer support workers provided within antenatal clinics serving a multiethnic , deprived population was ineffective in increasing initiation rates . Trial registration Current Controlled Trials IS RCT N16126175 Objective : Approximately 40 % of women who smoke tobacco quit smoking during pregnancy , yet up to 85 % relapse after delivery . Those who resume smoking often do so by 2 to 8 weeks postpartum . Smoking mothers are more than twice as likely to quit breastfeeding by 10 weeks postpartum . The hospitalization of a newborn , while stressful , is an opportunity to emphasize the importance of a smoke-free environment for babies . Supporting maternal-infant bonding may reduce maternal stress and motivate mothers to remain smoke free and continue breastfeeding . The objective of this study was to reduce postpartum smoking relapse and prolong breastfeeding duration during the first 8 weeks postpartum in mothers who quit smoking just before or during pregnancy and have newborns admitted to the Neonatal Intensive Care Unit ( NICU ) . Study Design : This study was an Institutional Review Board-approved prospect i ve r and omized clinical trial . After informed consent , mothers of newborns admitted to the NICU were r and omized to a  control  or intervention group . Both groups received weekly encouragement to remain smoke free and routine breastfeeding support . Mothers in the intervention group were also given enhanced support for maternal-infant bonding including information about newborn behaviors , and were encouraged to frequently hold their babies skin-to-skin . Result : More mothers were smoke free ( 81 vs 46 % , P<0.001 ) and breastfeeding ( 86 vs 21 % , P<0.001 ) in the intervention than in the control group at 8 weeks postpartum . Conclusion : Interventions to support mother – infant bonding during a newborn 's hospitalization in the NICU are associated with reduced rates of smoking relapse and prolonged duration of breastfeeding during the first 8 weeks postpartum Background It has proven difficult to reach World Health Organization ( WHO ) recommendations that infants be exclusively breastfed from birth to six months of age [ 1 , 2 ] , yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration . Particularly lacking is evidence about how to maintain breastfeeding rates in countries which already have a high initiation of breastfeeding . This study aims to determine whether mid-pregnancy breastfeeding education  , with a focus on either attitudes to breastfeeding or on technical aspects of breastfeeding , has an effect on rates of breastfeeding initiation and duration . Secondary aims of the study are to : explore what factors might affect the duration of breastfeeding and evaluate the interventions from the participant and childbirth facilitator perspectives . Methods / Design A r and omised controlled trial ( RCT ) design will be used . Women having their first baby , and planning to give birth as public patients at the Royal Women 's Hospital ( RWH ) , Melbourne , will be approached at 18–20 weeks of pregnancy and invited to participate in the study . Participants will be r and omly allocated to a control group or one of two group interventions : a previously design ed and trialled tool to teach practical aspects of breastfeeding or an exploration of family attitudes to breastfeeding . The latter was developed and piloted by the investigators in conjunction with the group facilitators , prior to trial commencement . The interventions are planned to take place at 20–25 weeks . Data will be collected by question naire at recruitment , at interview in hospital after the birth and by telephone interview six months later . Medical/obstetric outcomes will be obtained from the medical record . The sample size ( 972 ) was calculated to identify an increase in breastfeeding initiation from 75 to 85 % and an increase from 40 to 50 % in breastfeeding at six months Background The protection and promotion of breastfeeding is considered a priority in Europe where only 22 % of infants less than 6 months old are exclusively breastfed . In Spain this percentage reaches 24.8 % but in our city it falls to 18.26 % . Various studies emphasise that the improvement of these results should be based upon the training of health professionals . Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age . Method / Design This study involves a community based cluster r and omized trial in primary healthcare centres in Leganés ( Madrid , Spain ) . The project aims to determine whether the use of an implementation strategy ( including training session , information distribution , opinion leader ) of a breastfeeding guideline in primary care is more effective than usual diffusion . The number of patients required will be 240 ( 120 in each arm ) . It will be included all the mothers of infants born during the study period ( 6 months ) who come to the health centre on the first visit of the child care programme and who give their consent to participate . The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age .. Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group . All statistical tests will be performed with intention to treat . Logistic regression with r and om effects will be used to adjust for prognostic factors . Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis . Discussion Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period . By applying the guide 's recommendations , clinical variability can be reduced and the care received by patients can be improved . Trial registration The trial was registered with Clinical Trials.gov , number An evaluation of a  lactation nurse  by means of a r and omised controlled trial is described . The lactation nurse was employed to assist , support , and encourage mothers during the early weeks after parturition in hospital and at home . All mothers who breast-fed at least once were entered into the trial . Altogether 649 mothers were interviewed 12 months later to establish the duration of breast-feeding and to enquire after practice s of and attitudes towards infant feeding . The lactation nurse significantly extended the duration of breast-feeding , particularly during the first four weeks and among women of lower social class . Although she did not reduce problems or change practice s significantly , all the trends were consistently in the right direction . Mothers in the experimental group were more satisfied with the help they received than were mothers in the control group . It seems likely that the lactation nurse by consistent advice , assistance , support , and encouragement enabled mothers to cope more successfully with difficulties and that this led to significantly fewer ending breast-feeding prematurely STUDY OBJECTIVES : The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies , during a period of 42 days after delivery . Another aim was to compare the mothers ' , the midwife 's , and the doctor 's findings of prevalence of health problems at the end of the puerperium period . DESIGN : A r and omised controlled trial was carried out . One group of mothers and their infants were r and omly allocated to a home visiting group ( Group A ) ; the other group ( Group B ) was only visited at day 42 . SETTING : The study was carried out at the University Teaching Hospital ( UTH ) in Lusaka , the capital city of Zambia . PARTICIPANTS : A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant , as assessed by the attending midwife , were r and omised to two groups . Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3 , 7 , 28 , and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42 . MAIN RESULTS : At day 42 an equal proportion ( 30 % ) of mothers in both groups perceived that they had health problems . The prevalence of infant health problems in Group B was significantly higher ( p < 0.01 ) as perceived by mothers . There were more mothers in Group B ( p < 0.01 ) perceiving insufficient milk production and giving supplementary feeding . At day 42 , mothers in Group A ( 56 % ) took more actions than mothers in Group B ( 41 % ) to solve infant health problems ( p < 0.03 ) . In both groups the mothers ' perceived own health problems , were significantly higher ( p < 0.01 ) than those observed by the obstetrician and those observed by the midwife . The midwife found more infant health problems in Group B ( p < 0.01 ) than in Group A and more infants with health problems in both groups compared with the paediatrician 's findings ( p < 0.01 ) . CONCLUSIONS : There was a significant difference between the mothers ' reported health problems and the health problems identified by the midwife and the doctors . The study shows that a midwife home visit and individual health education to mothers , reduce the prevalence of infant health problems , and enables the mother to more often take action when an infant health problem is identified . There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care Overweight and obesity is prevalent among women of reproductive age ( 42 % BMI > 25 kg/m2 ) and parity is associated with risk of weight gain . Weight gain greater than that recommended by the Institute of Medicine ( IOM ) is also associated with lower rates of breastfeeding initiation and duration in women . The aim of this pilot r and omised controlled trial is to examine the feasibility of recruiting and maintaining a cohort of pregnant women with the view of reducing postpartum weight retention and improving breastfeeding outcomes .  Women ( BMI of 25–35 kg/m2 ( n = 36 ) ) were recruited from the John Hunter Hospital antenatal clinic in New South Wales , Australia . Participants were stratified by BMI and r and omised to one of three groups with follow-up to six months postpartum . Women received a dietary intervention with or without breastfeeding support from a lactation consultant , or were assigned to a wait-list control group where the dietary intervention was issued at three months postpartum . Feasibility and acceptability was assessed by participation rates and question naire . Analysis of variance and covariance was conducted to determine any differences between groups . Sixty-nine per cent of the participants were still enrolled at six months postpartum . This pilot demonstrated some difficulties in recruiting women from antenatal clinics and retaining them in the trial . Although underpowered ; the results on weight ; biomarkers and breastfeeding outcomes indicated improved metabolic health OBJECTIVE : To evaluate a specialized breastfeeding peer counseling ( SBFPC ) intervention promoting exclusive breastfeeding ( EBF ) among overweight/obese , low-income women . METHODS : We recruited 206 pregnant , overweight/obese , low-income women and r and omly assigned them to receive SBFPC or st and ard care ( controls )  at a Baby-Friendly hospital . SBFPC included 3 prenatal visits , daily in-hospital support , and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers . St and ard care involved routine access to breastfeeding support from hospital personnel , including staff peer counselors . Data collection included an in-hospital interview , medical record review , and monthly telephone calls through 6 months postpartum to assess infant feeding practice s , demographics , and health outcomes . Bivariate and logistic regression analyses were conducted . RESULTS : The intervention had no impact on EBF or breastfeeding continuation at 1 , 3 , or 6 months postpartum . In adjusted posthoc analyses , at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding ( adjusted odds ratio [ aOR ] : 3.76 [ 95 % confidence interval ( CI ) : 1.07–13.22 ] ) , and giving at least 50 % of feedings as breast milk ( aOR : 4.47 [ 95 % CI : 1.38–14.5 ] ) , compared with controls . Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth ( aOR : 0.24 [ 95 % CI : 0.07–0.86 ] ) . CONCLUSIONS : In a Baby-Friendly hospital setting , SBFPC targeting overweight/obese women did not impact EBF practice s but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth Background Infants with latch-on problems cause stress for parents and staff , often result ing in early termination of breastfeeding . Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother ’s breast . This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem . Methods Mother-infant pairs with severe latch-on problems , that were not resolved during screening procedures at two maternity hospitals in Stockholm 1998–2004 , were r and omly assigned to skin-to-skin contact ( experimental group ) or not ( control group ) during breastfeeding . Breastfeeding counseling was given to both groups according to a st and ard model . Participants were unaware of their treatment group . Objectives were to compare treatment groups concerning the proportion of infants regularly latching on , the time from intervention to regular latching on and maternal emotions and pain before and during breastfeeding . Results On hundred and three mother-infant pairs with severe latch-on problems 1–16 weeks postpartum were r and omly assigned and analyzed . There was no significant difference between the groups in the proportion of infants starting regular latching-on ( 75 % experimental group , vs. 86 % control group ) . Experimental group infants , who latched on , had a significantly shorter median time from start of intervention to regular latching on than control infants , 2.0 weeks ( Q1 = 1.0 , Q3 = 3.7 ) vs. 4.7 weeks ( Q1 = 2.0 , Q3 = 8.0 ) , ( p-value = 0.020 ) . However , more infants in the experimental group ( 94 % ) , with a history of “ strong reaction ” during “ h and s-on latch intervention ” , latched-on within 3 weeks compared to 33 % in the control infants ( Fisher Exact test p-value = 0.0001 ) . Mothers in the experimental group ( n = 53 ) had a more positive breastfeeding experience according to the Breastfeeding Emotional Scale during the intervention than mothers in the control group ( n = 50 ) ( p-value = 0.022 ) . Conclusions Skin-to-skin contact during breastfeeding seems to immediately enhance maternal positive feelings and shorten the time it takes to resolve severe latch-on problems in the infants who started to latch . An underlying mechanism may be that skin-to-skin contact with the mother during breastfeeding may calm infants with earlier strong reaction to “ h and s on latch intervention ” and relieve the stress which may have blocked the infant ’s inborn biological program to find the breast and latch on . Trial registration Karolinska Clinical Trial Registration numbe rCT OBJECTIVE To determine the effects of a prenatal breastfeeding workshop on  maternal breastfeeding self-efficacy and breastfeeding duration . DESIGN R and omized controlled trial . SETTING Large tertiary hospital in Ontario , Canada . PARTICIPANTS 110 primiparous women expecting a single child , an uncomplicated birth , and planning to breastfeed . INTERVENTION 2.5-hour prenatal breastfeeding workshop based on adult learning principles and self-efficacy theory . MAIN OUTCOME MEASURE Maternal breastfeeding self-efficacy and the numbers of days and amount of breastfeeding were measured at four and eight weeks postpartum . RESULTS / DATA ANALYSIS : Over time , maternal breastfeeding self-efficacy scores increased in both groups . Women who attended the workshop had higher self-efficacy scores and a higher proportion were exclusively breastfeeding compared to women who did not attend the workshop . There was little difference in the average number of days of breastfeeding , but the intervention group had less weaning . CONCLUSIONS The workshop increased maternal breastfeeding self-efficacy and exclusive breastfeeding Aim : We conducted a r and omized controlled trial to assess the effectiveness of a support intervention delivered by health professionals to increase the rate and duration of breastfeeding . Methods : A r and omized controlled intervention study was conducted in the period 2000–2001 among 605 mothers who had given birth in a public maternity ward located in the city of Rome , Italy . The intervention consisted of a home visit by a midwife from the maternity ward of the hospital . The outcome of the study was the infant 's feeding habits , assessed by a 24‐h recall . The effect of the intervention on the duration of breastfeeding was estimated by the Kaplan‐Meier method and by the Cox multivariate regression model . Results : According to intention‐to‐treat analysis , there was no significant difference between the intervention and the control group , after controlling for confounding factors ( hazard ratio ( HR ) 1.04 ; 95 % confidence interval ( 95 % CI ) : 0.85–1.26 ) . The duration of breastfeeding was shorter ( HR 1.61 ; 95 % CI : 1.13–2.31 ) for women in the intervention group who refused the obstetric visit OBJECTIVE : To evaluate the effectiveness of a coparenting intervention on exclusive breastfeeding  among primiparous mothers and fathers . METHODS : A r and omized controlled trial was conducted in a large teaching hospital in Toronto , Canada . Couples were r and omized to receive either  usual care ( n = 107 ) or a coparenting breastfeeding support intervention ( n = 107 ) . Follow-up of exclusive breastfeeding and diverse secondary outcomes was conducted at 6 and 12 weeks postpartum . RESULTS : Significantly more mothers in the intervention group than in the control group continued to breastfeed at 12 weeks postpartum ( 96.2 % vs 87.6 % , P = .02 ) . Although proportionately more mothers in the intervention group were exclusively breastfeeding at 6 and 12 weeks , these differences were not significant . Fathers in the intervention group had a significantly greater increase in breastfeeding self-efficacy scores from baseline to 6 weeks postpartum compared with fathers in the control group ( P = .03 ) . In addition , significantly more mothers in the intervention group than in the control group reported that their partners provided them with breastfeeding help in the first 6 weeks ( 71 % vs 52 % , P = .02 ) and that they were satisfied with their partners ’ involvement with breastfeeding ( 89 % vs 78.1 % , P = .04 ) . Mothers in the intervention group were also more satisfied with the breastfeeding information they received ( 81 % vs 62.5 % , P < .001 ) . CONCLUSIONS : The significant improvements in breastfeeding duration , paternal breastfeeding self-efficacy , and maternal perceptions of paternal involvement and assistance with breastfeeding suggest that a coparenting intervention involving fathers warrants additional investigation Several pilot studies have provided evidence that mindfulness-based intervention is beneficial during pregnancy , yet its effects in mothers during the early parenting period are unknown . The purpose of the present pilot study was to examine the effectiveness of a  mindfulness-based intervention in breast-feeding mothers . We developed and tested an 8-week mindfulness-based intervention aim ed at improving maternal self-efficacy , mindfulness , self-compassion , satisfaction with life , and subjective happiness , and at reducing psychological distress . A r and omized controlled , between-groups design was used with treatment and control groups ( n = 26 ) and pretest and posttest measures . ANCOVA results indicated that , compared to the control group , mothers in the treatment group scored significantly higher on maternal self-efficacy , some dimensions of mindfulness ( observing , acting with awareness , non-judging , and non-reactivity ) , and self-compassion ( self-kindness , mindfulness , over- identification , and total self-compassion ) . In addition , mothers who received the treatment exhibited significantly less anxiety , stress , and psychological distress . The results supported previous research findings about the benefits of mindfulness-based intervention in women from the perinatal and postpartum periods through the early parenting period . Additional research is needed to vali date our findings in non-breast-feeding mothers and to examine the intervention ’s indirect benefits in terms of family relationships and child development OBJECTIVE To determine if supplementary structured breastfeeding counseling ( SSBC ) for both parents compared with conventional hospital breastfeeding support ( CHBS ) improves the duration of breastfeeding in very low-birth-weight infants up to 1 year old . DESIGN R and omized trial with longitudinal follow-up of infants at term , and ages 1 , 3 , 6 , and 12 months ( infant ages corrected for prematurity ) . SETTING A tertiary-level neonatal intensive care unit ( NICU ) and geographically defined region in central -west Ontario , Canada . PARTICIPANTS Parents of infants with a birth weight less than 1500 g , who planned to breastfeed . INTERVENTIONS The SSBC consisted of viewing a video on breastfeeding for preterm infants ; individual counseling by the research lactation consultant ; weekly personal contact in the hospital ; and frequent postdischarge contact through the infants ' first year or until breastfeeding was discontinued . The CHBS group had st and ard breastfeeding support from regular staff members confined to the period of hospitalization in the NICU . MAIN OUTCOME MEASURE Duration of breastfeeding . RESULTS At study entry , there were no statistically significant differences in major demographic characteristics between groups . The mean duration of breastfeeding was 26.1 weeks ( SD = 20.8 ; median , 17.4 ) in the SSBC group and 24.0 weeks ( SD = 20.5 ; median , 17.4 ) in the CHBS group ( not statistically significant ) . CONCLUSIONS Long-term breastfeeding counseling of parents of very low-birth-weight infants in this study did not demonstrate a significant difference in duration of breastfeeding . These results may be explained by the high motivation to breastfeed in both groups , a relatively advantaged population , and the availability of community breastfeeding re sources , which may have diminished any significant differences that could have result ed from a breastfeeding intervention . The results of this study , compared with previous studies of very low-birth-weight infants , indicate a new trend to longer duration of breastfeeding in preterm infants OBJECTIVES : Despite recent efforts to increase breastfeeding , young African American mothers continue to breastfeed at low rates , and commonly introduce complementary foods earlier than recommended . This study examines the effects of a community doula home visiting intervention on infant feeding practice s among young mothers . METHODS : Low-income , African American mothers ( n = 248 ) under age 22 years participated in a r and omized trial of a community doula intervention . Intervention-group mothers received services from paraprofessional doulas : specialized home visitors trained as childbirth educators and lactation counselors . Doulas provided home visits from pregnancy through 3 months postpartum , and support during childbirth . Control-group mothers received usual prenatal care . Data were obtained from medical records and maternal interviews at birth and 4 months postpartum . RESULTS : Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers ( 64 % vs 50 % ; P = .02 ) and were more likely to breastfeed longer than 6 weeks ( 29 % vs 17 % ; P = .04 ) , although few mothers still breastfed at 4 months . The intervention also impacted mothers ’ cereal/solid food introduction ( P = .008 ) : fewer doula-group mothers introduced complementary foods before 6 weeks of age ( 6 % vs 18 % ) , while more waited until at least 4 months ( 21 % vs 13 % ) compared with control-group mothers . CONCLUSIONS : Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines . The intervention ’s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting , and the doula ’s presence at the birth , where she supports early breastfeeding experiences Background We report a cluster-r and omised trial of a home-based counselling strategy , design ed for large-scale implementation , in a population of 1.2 million people in rural southern Tanzania . We hypothesised that the strategy would improve neonatal survival by around 15 % . Methods and Findings In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant ’s life in 65 wards , selected r and omly from all 132 wards in six districts in Mtwara and Lindi regions , constituting typical rural areas in Southern Tanzania . The remaining wards were comparison areas . Participants were not blinded to the intervention . The primary analysis was an intention-to-treat analysis comparing the neonatal mortality ( day 0–27 ) per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90 % . We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards , respectively . We also compared changes in neonatal mortality and newborn care practice s in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts . Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards , 59 % and 41 % received at least one volunteer visit during pregnancy and postpartum , respectively . Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts , respectively . There was no evidence of an impact of the intervention on neonatal survival ( odds ratio [ OR ] 1.1 , 95 % confidence interval [ CI ] 0.9–1.2 , p = 0.339 ) . Newborn care practice s reported by mothers were better in intervention than in comparison wards , including immediate breastfeeding ( 42 % of 7,287 versus 35 % of 7,008 , OR 1.4 , CI 1.3–1.6 , p < 0.001 ) , feeding only breast milk for the first 3 d ( 90 % of 7,557 versus 79 % of 7,307 , OR 2.2 , 95 % CI 1.8–2.7 , p < 0.001 ) , and clean h and s for home delivery ( 92 % of 1,351 versus 88 % of 1,799 , OR 1.5 , 95 % CI 1.0–2.3 , p = 0.033 ) . Facility delivery improved dramatically in both groups from 41 % of 22,243 in 2007 and was 82 % of 7,820 versus 75 % of 7,553 ( OR 1.5 , 95 % CI 1.2–2.0 , p = 0.002 ) in intervention and comparison wards in 2013 . Method ological limitations include our inability to rule out some degree of leakage of the intervention into the comparison areas and response bias for newborn care behaviours . Conclusion Neonatal mortality remained high despite better care practice s and childbirth in facilities becoming common . Public health action to improve neonatal survival in this setting should include a focus on improving the quality of facility-based childbirth care . Trial Registration Clinical Trials.gov Background Although several studies have shown short term health benefits of exclusive breastfeeding ( EBF ) , its long term consequences have not been studied extensively in low-income context s. This study assessed the impact of an EBF promotion initiative for 6 months on early childhood caries ( ECC ) and breastfeeding duration  in children aged 5 years in Mbale , Eastern Ug and a. Methods Participants were recruited from the Ug and an site of the PROMISE- EBF cluster r and omised trial ( Clinical Trials.gov no : NCT00397150 ) . A total of 765 pregnant women from 24 clusters were included in the ratio 1:1 to receive peer counselled promotion of EBF as the intervention or st and ard of care . At the 5 year follow-up , ECC was recorded under field conditions using the World Health Organization ’s decayed missing filled tooth ( dmft ) index . Adjusted negative binomial and linear regression were used in the analysis . Results Mean breastfeeding duration in the intervention and control groups ( n=417 ) were 21.8 ( CI 20.7–22.9 ) and 21.3(CI 20.7–21.9 ) months , respectively . The mean dmft was 1.5 ( st and ard deviation [ SD ] 2.9 ) and 1.7 ( SD 2.9 ) in the intervention and control groups , respectively . Corresponding prevalence estimates of ECC were 38 % and 41 % . Negative binomial regression analysis adjusted for cluster effects and loss-to-follow-up by inverse probability weights ( IPW ) showed an incidence-rate ratio ( IRR ) of 0.91 ( 95 % CI 0.65–1.2 ) . Comparing the effect of the trial arm on breastfeeding duration showed a difference in months of 0.48 ( -0.72 to 1.7 ) . Conclusion PROMISE EBF trial did not impact on early childhood caries or breastfeeding duration at 5 years of age . This study contributes to the body of evidence that promotion of exclusive breastfeeding does not raise oral health concerns . However , the high burden of caries calls for efforts to improve the oral health condition in this setting . Trial Registration Clinical Trials.gov Background Despite high levels of breastfeeding initiation in Australia , only 47 percent of women are breastfeeding ( exclusively or partially ) six months later , with marked differences between social groups . It is important to identify women who are at increased risk of early cessation of breastfeeding . Methods Data from the three arms of a r and omised controlled trial were pooled and analysed as a cohort using logistic regression to identify which factors predicted women continuing to feed any breast milk at six months postpartum . The original trial included 981 primiparous women attending a public , tertiary , women 's hospital in Melbourne , Australia in 1999–2001 . The trial evaluated the effect of two mid-pregnancy educational interventions on breastfeeding initiation and duration . In the 889 women with six month outcomes available , neither intervention increased breastfeeding initiation nor duration compared to st and ard care . Independent variables were included in the predictive model based on the literature and discussion with peers and were each tested individually against the dependent variable ( any breastfeeding at six months ) . Results Thirty-three independent variables of interest were identified , of which 25 qualified for inclusion in the preliminary regression model ; 764 observations had complete data available . Factors remaining in the final model that were positively associated with breastfeeding any breast milk at six months were : a very strong desire to breastfeed ; having been breastfed oneself as a baby ; being born in an Asian country ; and older maternal age . There was an increasing association with increasing age . Factors negatively associated with feeding any breast milk at six months were : a woman having no intention to breastfeed six months or more ; smoking 20 or more cigarettes per day pre-pregnancy ; not attending childbirth education ; maternal obesity ; having self-reported depression in the six months after birth ; and the baby receiving infant formula while in hospital . Conclusion In addition to the factors commonly reported as being associated with breastfeeding in previous work , this study found a negative association between breastfeeding outcomes and giving babies infant formula in hospital , a high maternal body mass index , and self-reported maternal depression or anxiety in the six months after the baby was born . Interventions that seek to increase breastfeeding should consider focusing on women who wish to breastfeed but are at high risk of early discontinuation Background Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality . Poor infant and young child feeding practice s are widely documented in Kenya , with potential detrimental effects on child growth , health and survival . Effective strategies to improve these practice s are needed . This study aims to pilot implementation of the Baby Friendly Community Initiative ( BFCI ) , a global initiative aim ed at promoting optimal infant and young child feeding practice s , to determine its feasibility and effectiveness with regards to infant feeding practice s , nutrition and health outcomes in a rural setting in Kenya . Methods The study , employing a cluster-r and omized trial design , will be conducted in rural Kenya . A total of 12 clusters , constituting community units within the government ’s Community Health Strategy , will be r and omized , with half allocated to the intervention and the other half to the control arm . A total of 812 pregnant women and their respective children will be recruited into the study . The mother-child pairs will be followed up until the child is 6 months old . Recruitment will last approximately 1 year from January 2015 , and the study will run for 3 years , from 2014 to 2016 . The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal , infant and young child nutrition . Regular assessment of  knowledge , attitudes  and practice s on maternal , infant and young child nutrition will be done , coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children . Statistical methods will include analysis of covariance , multinomial logistic regression and multilevel modeling . The study is funded by the NIH and USAID through the Program for Enhanced Research ( PEER ) Health . Discussion Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aim ed at promoting optimal breastfeeding and other infant feeding practice s. The intervention , if proved feasible and effective , will inform policy and practice in Kenya and similar setting s , particularly regarding implementation of the baby friendly community initiative . Trial registration IS RCT N03467700 ; Date of Registration : 24 September Although breastfeeding initiation rates are rising in Canada , rates of continued breastfeeding remain far below international recommendations . Two factors that can have a positive influence on breastfeeding outcomes are maternal confidence and support and education provided by public health nurses ( PHNs ) . The weighing of newborns by PHNs within the first days after birth is st and ard practice in monitoring neonatal health . However , little is known about the effect of the timing of PHN neonatal weighing on maternal confidence or on outcomes such as intended duration of breastfeeding and formula supplementation rates . This pilot study compared breastfeeding self-efficacy , intended duration of breastfeeding and formula supplementation rates in two groups of mothers and newborns r and omly assigned to different weighing protocol s. Newborns in the st and ard care group were weighed post hospital discharge on day 2 or 3 after birth ( n = 23 ) , while those in the experimental group were weighed on day 5 ( n = 26 ) . No statistically significant differences were found between the two groups . However , a statistically significant increase in formula supplementation over the two-week study period was observed in the st and ard-weighing group and not in the delayed-weighing group . This finding suggests that further research is needed to assess the impact of PHN infant weighing protocol s on breastfeeding outcomes Background . Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health , the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal . The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks . Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed , problems with the infant latching or suckling , and lack of individualized encouragement from their clinicians in the early postdischarge period . Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practice s during routine preventive visits . However , robust scientific evidence based on r and omized , controlled trials is currently lacking . Objective . The purpose of this study was to determine whether attending an early , routine , preventive , outpatient visit delivered in a primary care physician ’s office would improve breastfeeding outcomes . Design . The study was a prospect i ve , r and omized , parallel-group , open trial . Setting . Participants were recruited at a level 3 maternity facility , with an average of 2000 births per year , in France . Participants . A total of 231 mothers who had delivered a healthy singleton infant ( gestational age : ≥37 completed weeks ) and were breastfeeding on the day of discharge were recruited and r and omized ( 116 were assigned to the intervention group and 115 to the  control group ) between October 1 , 2001 , and May 31 , 2002 ; 226 mother-infant pairs ( 112 in the intervention group and 114 in the control group ) contributed data on outcomes . Intervention . Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members , a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge , provision of the telephone number of a peer support group , m and atory routine , preventive , outpatient visits at 1 , 2 , 3 , 4 , 5 , and 6 months of infant age , and 10 weeks of paid maternity leave ( extended to 18 weeks after the birth of the third child ) . In addition to the usual predischarge and postdischarge support , the mothers in the intervention group were invited to attend an individual , routine , preventive , outpatient visit in the office of 1 of the 17 participating primary care physicians ( pediatricians or family physicians ) within 2 weeks after the birth . The participating physicians received a 5-hour training program on breastfeeding , delivered in 2 parts in 1 month , before the beginning of the study . Outcome Measures . The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks ( defined as giving maternal milk as the only food source , with no other foods or liquids , other than vitamins or medications , being given ) . The secondary outcomes included any breastfeeding reported at 4 weeks , breastfeeding duration , breastfeeding difficulties , and satisfaction with breastfeeding experiences . Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall . Results . Ninety-two mothers ( 79.3 % ) assigned to the intervention group and 8 mothers ( 7.0 % ) assigned to the control group reported that they had attended the routine , preventive , outpatient visit in the office of 1 of the 17 primary care physicians participating in the study . Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks ( 83.9 % vs 71.9 % ; hazard ratio : 1.17 ; 95 % confidence interval [ CI ] : 1.01–1.34 ) and longer breastfeeding duration ( median : 18 weeks vs 13 weeks ; hazard ratio : 1.40 ; 95 % CI : 1.03–1.92 ) . They were less likely to report any breastfeeding difficulties ( 55.3 % vs 72.8 % ; hazard ratio : 0.76 ; 95 % CI : 0.62–0.93 ) . There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks ( 89.3 % vs 81.6 % ; hazard ratio : 1.09 ; 95 % CI : 0.98–1.22 ) and the rate of mothers fairly or very satisfied with their breastfeeding experiences ( 91.1 % vs 87.7 % ; hazard ratio : 1.04 ; 95 % CI : 0.95–1.14 ) . Conclusions . Although we can not exclude the possibility that findings might differ in other health care systems , this study provides preliminary evidence of the efficacy of breastfeeding support through an early , routine , preventive visit in the offices of trained primary care physicians . Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes . Multifaceted interventions aim ing to support breastfeeding should involve primary care physicians Since very few tools used in health education are carefully evaluated , the aim of this study was to examine the effect that a breastfeeding information booklet had on breastfeeding behaviour . Feedback about breastfeeding information needs from a preliminary study of 58 Perth mothers at 3 months postpartum provided the basis for the development of an information booklet . The sample consisted of 150 mothers of full-term infants who were breastfeeding for the first time . Upon discharge from hospital , a r and om sample of 75 mothers were sent the booklet . These mothers and a control group ( n = 75 ) were surveyed for 52 weeks to compare breastfeeding duration . Although the breastfeeding information booklet was found to be useful by 97 % of the experimental group , there was no significant difference noted for breastfeeding duration between groups . Study findings have implication s for clinical practice in highlighting the importance of breastfeeding information in increasing mothers ' confidence , providing suggestions for breastfeeding practice , and helping mothers not to feel alone in their concerns . Further research should include investigations into the association between mothers reaching their intended goal for breastfeeding duration and being satisfied with the breastfeeding experience . Success with breastfeeding tends to be measured by duration alone , but no research to date has specifically examined the criteria mothers use to determine if their breastfeeding experience was successful BACKGROUND Children of adolescent mothers may suffer because of parenting inadequacies . The use of volunteer home visitors to enhance parenting skills has not been well studied . OBJECTIVE To evaluate the effect of a volunteer model home visitation program on  adolescent parenting outcomes . DESIGN R and omized trial with assignment to home visitation or control group . SETTING Urban , African American community . PARTICIPANTS Adolescents aged 12 to 18 years at 28 or more weeks ' gestation or who had delivered a baby in the past 6 months were recruited between February 1996 and August 1999 . INTERVENTION Volunteers were recruited from the community and trained to implement a parenting curriculum during weekly home visits . Each volunteer was paired with one teenager . MAIN OUTCOME MEASURE Vali date d instruments measuring parenting stress , parenting behaviors , and mental health . RESULTS A total of 232 teenagers were successfully r and omized to home visitation and control groups . At baseline , the groups were comparable on demographic , social support , and mental health measures . Almost half the teenagers had poor mental health at baseline , and high rates persisted at follow-up in both groups . In multivariate models , the home visitation group demonstrated significantly better parenting behavior scores at follow-up than did the control group ( P = .01 ) but showed no differences in parenting stress or mental health . CONCLUSIONS The volunteer home visitation program significantly improved some parenting outcomes but not parental distress or poor mental health . Volunteers may be an effective means of providing parenting education , but interventions that include specific means of addressing poor mental health are likely to have greater effects BACKGROUND The American Academy of Pediatrics , the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) , and the World Health Organization recommend that infants receive only breast milk or formula for the first 4 to 6 months of life , followed by the introduction of complementary foods . Despite these recommendations , many infants , particularly those with adolescent mothers , receive solid foods ( often cereal mixed with formula in a bottle ) and liquids other than formula or breast milk in the first few weeks of life . Decisions on early feeding are often guided by gr and mothers and influenced by beliefs that infants need complementary food to counteract signals of hunger , reduce crying , and sleep through the night . OBJECTIVE This investigation evaluated the efficacy of an intervention to delay the early introduction of complementary feeding among first-time , black , adolescent mothers living in multigenerational households . The intervention focused on reducing the cultural barriers to the acceptance of the recommendations of the American Academy of Pediatrics , WIC , and World Health Organization on complementary feeding by highlighting 3 topics : 1 ) recognition of infants ' cues ; 2 ) nonfood strategies for managing infant behavior ; and 3 ) mother-gr and mother negotiation strategies . The intervention was delivered through a mentorship model in which a videotape made by an advisory group of black adolescent mothers was incorporated into a home-visiting program and evaluated through a r and omized , controlled trial . METHODS One hundred eighty-one first-time , low-income , black mothers < 18 years old , living in multigenerational households were recruited from 3 urban hospitals . Infants were born at term , with birth weight appropriate for gestational age and no congenital problems . Shortly after delivery , mothers and gr and mothers completed a baseline assessment and mothers were r and omized into an intervention or control group . Intervention group mothers received home visitation every other week for 1 year . At 3 months , a subset of 121 adolescent mothers reported on their infant 's intake through a food frequency question naire . Mothers who fed their infant only breast milk , formula , or water were classified as optimal feeders . Mothers who provided complementary foods other than breast milk , formula , or water were classified as less optimal feeders . RESULTS Sixty-one percent of the infants received complementary foods before 3 months old . Multivariate hierarchical logistic regression was used to evaluate the determinants of being in the optimal versus less optimal feeders group . After controlling for infant age and family income , mothers of infants in the optimal feeders group were more likely to report accurate messages from WIC regarding the timing of complementary food and nearly 4 times more likely to be in the intervention group . The most common complementary food was cereal mixed with formula in the bottle . CONCLUSIONS The success of this relatively brief intervention demonstrates the importance of using ecological theory and ethnographic research to design interventions that enable participants to alter their behavior in the face of contradictory cultural norms . The intervention focused on interpreting infants ' cues , nonfood methods of managing infant behavior , and mother-gr and mother negotiations . It was delivered through methods that were familiar and acceptable to adolescent mothers-a mentorship model incorporating home visits and videotape . The skill-oriented aspects of the intervention delivered in a culturally sensitive context may have enabled the young mothers to follow the guidelines that they received from WIC and from their pediatricians . Strategies , such as those used in this intervention , may be effective in promoting other caregiving recommendations , thereby enabling providers to meet the increasing dem and s from parents for advice regarding children 's early growth and development Background Different strategies have been used to improve the initiation and duration of breastfeeding .  Peer counsellors are reported to improve exclusive breastfeeding levels , but few studies have assessed the satisfaction of women with the support given , especially in Africa . In this paper we describe women 's experiences of peer counselling for exclusive breastfeeding  in an East African setting . Methods In the Ug and an site of PROMISE-EBF , a multi-centre community r and omised trial to evaluate the effect of peer counselling for exclusive breastfeeding on infant health , 370 women in the intervention arm participated in a study exit interview . Individual peer counselling was offered to women in 12 of the 24 study clusters , scheduled as five visits : before childbirth and during weeks 1 , 4 , 7 and 10 after childbirth . During the visits , the women were given information and skills to help them breastfeed exclusively . After the 10-week visit , they were interviewed about their feelings and experiences related to the peer counselling . Results Overall , more than 95 % of the women expressed satisfaction with the various aspects of peer counselling offered . Those who had received five or more visits were more likely to give positive responses about their experience with peer counselling than those who had received fewer visits . They explained their satisfaction with time spent with the peer counsellor in terms of how much she discussed with them . Most women felt their knowledge needs about breastfeeding were covered by the peer counsellors , while others expressed a desire to learn about complementary feeding and family planning . Attributes of the peer counsellors included their friendliness , being women and giving support in a familiar and relaxed way . Women were positive about the acquisition of knowledge and the benefit to their babies from the peer counselling . They preferred a peer counsellor to a health worker for support of exclusive breastfeeding because of their friendly approach . Conclusions Individual peer counselling to support exclusive breastfeeding was positively received by the women . Trial Registration clinical trials.gov no : NCT00397150 Background Becoming parents for the first time is challenging . Mothers need both social and professional support to h and le these challenges . Professionals ’ attitudes affect quality of care and support . So to improve professional support , an intervention consisting of a process-oriented training was performed . Due to the positive results of the intervention there is a need to illuminate the method ological approach further . The overall aim was therefore to describe a method ological approach to improve and evaluate health care professionals ’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing . Methods This study was a longitudinal r and omized control intervention study , in which groups of mothers received care in childbearing from midwives and child health nurses . These health professionals had gone through a process-oriented training , or not . In order to improve attitudes of health professionals the training was based on evidence , practical skills and reflective processes ( both private and professional experiences ) in relation to breastfeeding and parental support . Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45 . All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study . Mothers who accepted to participate were included in the interventions group ( n = 206 ) or control groups ( n = 162 , n = 172 respectively ) based on which municipality they belonged to . Results The results of the process-oriented training improved the professionals ’ attitudes toward breastfeeding and parental support . These improved attitudes in health professionals increased intervention-group  mother ’s satisfaction with professional and social support .  Intervention-group  mother ’s relation to and feelings for their baby as well as breastfeeding was also improved . Conclusion These results stress the importance of professionals ’ attitude in quality of care during childbearing , as well as pointing to the possibility to improve professionals ’ attitudes with a process-oriented training . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) , trial registration : ACTRN12611000354987 Breast-feeding promotion is an important intervention for the control of infant diarrhoea .  This study assesses the impact of a breast-feeding counselling programme on the prevalence of exclusive breast feeding in rural communities in Nigeria . Mothers attending primary care facilities because their infants had acute diarrhoea were r and omised into two groups . The study group ( n = 82 ) received individual , focused breast-feeding counselling , while the controls ( n = 79 ) had routine advice for diarrhoea . Both groups were monitored and followed with home visits to determine infant-feeding practice s. The results showed marked increases in exclusive breast-feeding prevalence for the intervention group at day 7 ( 49 % vs. 6 % control ; p < 0.0001 ) and day 21 ( 46 % vs. 8 % ; p < 0.0001 ) . Moreover , diarrhoea re-occurrence at day 21 was less in the intervention group ( 12 % ) than controls ( 18 % ) . It is concluded that focused breast-feeding counselling can increase exclusive breast feeding and reduce the prevalence of diarrhoea in rural communities BACKGROUND Exclusive breastfeeding rates in Malaysia remains low despite the implementation of the Baby Friendly Hospital Initiative ( BFHI ) policy in government hospitals . It has been suggested that any form of postnatal lactation support will lead to an increase in exclusive breastfeeding rates . OBJECTIVE To study the effectiveness of telephone lactation counselling on breastfeeding practice s. DESIGN Single blinded , r and omised controlled trial ( RCT ) . SETTING Maternity wards in a public hospital in Kuala Lumpur , Malaysia . PARTICIPANTS 357 mothers , each of whom had delivered a full term , healthy infant via spontaneous vaginal delivery . METHODS Mothers were followed up for 6 months . The intervention group ( n=179 ) received lactation counselling via telephone twice monthly by certified lactation counsellors in addition to receiving the current conventional care of postnatal breastfeeding support . The control group ( n=178 ) received the current conventional care of postnatal breastfeeding support . Definitions of breastfeeding practice s were according to World Health Organization ( WHO ) definitions . Participants answered a self-administered question naire during recruitment and were later followed up at one , four and 6-month intervals during the postpartum period via a telephone-based question naire . RESULTS At 1 month , a higher percentage of mothers in the intervention group practice d exclusive breastfeeding , compared to the control group ( 84.3 % vs. 74.7 % , OR 1.825 95 % , p=0.042 , CI=1.054 , 3.157 ) . At 4 and 6 months postpartum , similar percentages of mothers from the two groups practice d exclusive breastfeeding ( 41.98 % vs. 38.99 % ; 12.50 % vs. 12.02 % , no significant differences , both p>0.05 ) . Slightly higher numbers of mothers in the control group had completely stopped breastfeeding at the 1 , 4 and 6 month marks , compared to the intervention group ( 7.4 % vs. 5.4 % ; 12.6 % vs. 9.9 % ; 13.9 % vs. 9.4 % ; all p>0.05 ) . The reason cited by most mothers who had completely stopped breastfeeding during the early postpartum period was a low breast milk supply , while returning to work was the main reason for stopping breastfeeding later in the postpartum period . CONCLUSIONS Telephone lactation counselling provided by certified lactation counsellors from the nursing profession was effective in increasing the rate of exclusive breastfeeding for the first postpartum month but not during the 4 and 6month postpartum intervals We sought to assess the relationship between acculturative type and breastfeeding outcomes among low-income Latinas , utilising a multidimensional assessment of acculturation . We analysed data derived from a breastfeeding peer counselling r and omised trial . Acculturation was assessed during pregnancy using a modified Acculturation Rating Scale for Mexican Americans scale . Analyses were restricted to Latinas who completed the acculturation scale and had post-partum breastfeeding data ( n = 114 ) .  Cox survival analyses were conducted to evaluate differences in breastfeeding continuation and exclusivity by acculturative type . Participants were classified as integrated-high ( 23.7 % , n = 27 ) , traditional Hispanic ( 36.8 % , n = 42 ) , integrated-low ( 12.3 % , n = 14 ) and assimilated ( 27.2 % , n = 31 ) . The integrated-low group was significantly more likely to continue breastfeeding than the traditional Hispanic , assimilated , and integrated-high groups ( P < 0.05 , P < 0.05 , and P < 0.01 , respectively ) . The traditional Hispanic group was marginally more likely to continue breastfeeding than the integrated-high group ( P = 0.06 ) . Breastfeeding continuation rates vary significantly between acculturative types in this multinational , low-income Latina sample . Multidimensional assessment s of acculturation may prove useful in better tailoring future breastfeeding promotion interventions Background : Postnatal unit rooming-in promotes breastfeeding . Previous research indicates that side-cars ( 3-sided bassinets that lock onto the maternal bed frame ) facilitate breastfeeding after vaginal birth more than st and -alone bassinets ( st and ard rooming-in ) . No study has previously investigated side-car bassinet use after cesarean , despite the constraints on maternal-infant interactions that are inherent in recovery from this birth mode . Objective : To test the effect of the side-car bassinet on postnatal unit breastfeeding frequency and other maternal-infant behaviors compared to a st and -alone bassinet following cesarean birth . Methods : Participants were recruited and prenatally r and omized to receive the side-car or st and -alone bassinet for their postnatal unit stay between January 2007 and March 2009 in northeastern Engl and . Mother-infant interactions were filmed over the second postpartum night . Participants completed face-to-face interviews before and after filming . The main outcome measures were infant location , bassinet acceptability , and breastfeeding frequency . Other outcomes assessed were breastfeeding effort , maternal-infant contact , sleep states , midwife presence , and infant risk . Results : Differences in breastfeeding frequency , maternal-infant sleep overlap , and midwife presence were not statistically significant . The 20 dyads allocated to side-car bassinets breastfed a median of 0.6 bouts/ hour compared to 0.4 bouts/hour for the 15 st and -alone bassinet dyads . Participants expressed overwhelming preference for the side-car bassinets .  Bed sharing was equivalent between the groups , although the motivation for this practice may have differed . Infant h and ling was compromised with st and -alone bassinet use , including infants positioned on pillows while bed sharing with their sleeping mothers . Conclusions : Women preferred the side-car , but differences in breastfeeding frequency were not statistically significant . More infant risks were observed with st and -alone bassinet use PURPOSE The purpose of this study was to investigate the effects of the professional nurse 's postpartum breast-feeding support on breast-feeding prevalence for mothers who delivered in Baby-Friendly Hospitals ( BFH ) . METHODS This quasi experimental study was design ed with a nonequivalent control group post test . The subjects of this study were 55 mothers who were hospitalized in the delivery room of a university hospital which was selected as a BFH in Daegu from October 1 , 2005 to June 30 , 2006 . Twenty nine mothers were assigned to the experimental group and 26 mothers to the control group .  Postpartum breast-feeding support by nurses ' telephone calls to the experimental group was provided once a week for 4 weeks postpartum and then once a month for 16 weeks postpartum . Four post tests were given at postpartum week 4 , 8 , 12 , and 16 . The control group was given a telephone call at postpartum week 4 , 8 , 12 , and 16 . RESULTS The breastfeeding prevalence of the experimental group was significantly higher than that of the control group for each period . CONCLUSION Postpartum breast-feeding support by nurses may be a useful intervention to increase breast-feeding prevalence Background Very few Australian infants are exclusively breastfed to 6 months as recommended by the World Health Organization . There is strong empirical evidence that fathers have a major impact on their partner ’s decision to breastfeed and continuation of breastfeeding . Fathers want to participate in the breastfeeding decision making process and to know how they can support their partner to achieve their breastfeeding goals . The aim of the Parent Infant Feeding Initiative ( PIFI ) is to evaluate the effect on duration of any and exclusive breastfeeding of three breastfeeding promotion interventions of differing intensity and duration , targeted at couples but channelled through the male partner . The study will also undertake a cost-effectiveness evaluation of the interventions . Methods / design The PIFI study is a factorial r and omised controlled trial . Participants will be mothers and their male partners attending antenatal classes at selected public and private hospitals with maternity departments in Perth , Western Australia . Fathers will be r and omly allocated to either the usual care control group ( CG ) , one of two medium intensity ( MI1 and MI2 ) interventions , or a high intensity ( HI ) intervention . MI1 will include a specialised antenatal breastfeeding education session for fathers with supporting print material s. MI2 will involve the delivery of an antenatal and postnatal social support intervention delivered via a smartphone application and HI will include both the specialised antenatal class and the social support intervention . Outcome data will be collected from couples at baseline and at six and 26 weeks postnatally . A total of 1600 couples will be recruited . This takes into account a 25 % attrition rate , and will detect at least a 10 % difference in the proportion of mothers breastfeeding between any two of the groups at 26 weeks at 80 % power and 5 % level of significance , using a Log-rank survival test . Multivariable survival and logistic regression analyses will be used to assess the effect of the treatment groups on the outcomes after adjusting for covariates . Discussion The PIFI study will be the first Australian study to provide Level II evidence of the impact on breastfeeding duration of a comprehensive , multi-level , male-partner-focused breastfeeding intervention . Unique features of the intervention include its large sample size , delivery of two of the interventions by mobile device technology , a rigorous assessment of intervention fidelity and a cost-effectiveness evaluation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12614000605695 . Registered 6 June OBJECTIVE : The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) . As of 2008 , 50 % of WIC clients received services from local WIC agencies that offered peer counseling . Little is known about the effectiveness of these peer counseling programs . R and omized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration , but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally . We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation , duration , and exclusivity . METHODS : We r and omly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms : no peer counseling , 4 telephone contacts , or 8 telephone contacts . RESULTS : We combined 2 treatment arms because there was no difference in the distribution of peer contacts . Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group ( adjusted relative risk : 1.22 ; 95 % confidence interval [ CI ] : 1.10–1.34 ) but greater at 6 months for Spanish-speaking clients only ( adjusted relative risk : 1.29 ; 95 % CI : 1.10–1.51 ) . The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients ( adjusted odds ratio : 0.78 ; 95 % CI : 0.68–0.89 ) . CONCLUSIONS : A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women OBJECTIVE : To test the effectiveness of cognitive-behavioral counseling on the rate and duration of exclusive breastfeeding ( EBF )  during the first 6 months of an infant ’s life compared with routine counseling . METHODS : A single blind cluster-r and omized controlled trial was undertaken in 40 Union Councils of a rural district in the northwest province of Pakistan between May 2009 and April 2010 . By simple unmatched r and omization , 20 Union Councils were each allocated to intervention and control arms . Two hundred twenty-four third trimester pregnant women in the intervention and 228 third trimester pregnant women in the control arm were enrolled and followed-up biweekly until 6 months postpartum . Analyses were by intention to treat . Mothers in the intervention group received 7 sessions of cognitive-behavioral counseling from antenatal to 6 months postpartum , whereas the control group received an equal number of routine sessions . Proportion of mothers exclusively breastfeeding at 6 months postpartum and duration of EBF through these 6 months was assessed . RESULTS : At 6 months postpartum , 59.6 % of mothers in the intervention arm and 28.6 % in the control arm were exclusively breastfeeding . This translates into a 60 % reduced risk of stopping exclusively breastfeeding during the first 6 months ( adjusted hazard ratio , 0.40 [ 95 % confidence interval : 0.27–0.60 ] , P < .001 ) . Mothers in the intervention group were half as likely to use prelacteal feeds with their infants ( adjusted relative risk , 0.51 [ 95 % confidence interval : 0.34–0.78 ] ) . CONCLUSIONS : Compared with routine counseling , cognitive-behavioral counseling significantly prolonged the duration of EBF , doubling the rates of EBF at 6 months postpartum The vast majority of breastfeeding mothers in Western countries have routine access to multimedia and Internet re sources at home . The aim of this study was to assess the effectiveness of a CD-ROM-based intervention in increasing the rates of breastfeeding . We conducted a pre- and post-intervention study involving four control and four intervention maternity units in France . All breastfeeding mothers in intervention units were given a CD-ROM-based program addressing various breastfeeding topics . The primary outcome was any breastfeeding at 4 weeks assessed by follow-up  telephone interview .  The secondary outcomes included breastfeeding duration , breastfeeding difficulties after discharge and satisfaction with the breastfeeding experience . The rates of any breastfeeding at 4 weeks varied from 88.6 % ( 209/236 ) to 87.9 % ( 211/240 ) and from 86.0 % ( 222/258 ) to 88.0 % ( 228/259 ) for mothers enrolled in intervention and control maternity units , respectively ( P for interaction=0.54 ) . The hazard of breastfeeding discontinuation for mothers enrolled in intervention units did not vary significantly across study periods after adjusting for education level , epidural anaesthesia , breastfeeding assessment score and return to work ( P for interaction=0.18 ) . The rates of breastfeeding at 4 weeks remained unchanged when restricting the analysis to the mothers who actually received ( 87.8 % [ 173/197 ] ) or used [ 88.2 % ( 105/119 ) ] the CD-ROM during the post-intervention period . No significant differences were found in secondary outcomes between the two study groups . A CD-ROM-based intervention for breastfeeding mothers provides no additional benefit to usual post-natal care . Further study is needed to assess the effectiveness of multimedia packages as part of more intensive multifaceted interventions Background Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of setting s. Methods We conducted a cost analysis of a community cluster r and omised-controlled trial ( Promise-EBF ) , aim ed at promoting exclusive infant feeding in three sites in South Africa . The costs were considered from the perspective of health service providers . Peer supporters in this trial visited women to support exclusive infant feeding , once antenatally and four times postpartum . Results The total economic cost of the Promise-EBF intervention was US$ 393 656 , with average costs per woman and per visit of US$ 228 and US$ 52 , respectively . The average costs per woman and visit in an operational ‘ non research ’ scenario were US$ 137 and US$ 32 per woman and visit , respectively . Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers . Extending the tasks of multi-skilled community health workers ( CHWs ) to include promoting exclusive infant feeding is a potential option for reducing these costs . In order to avoid efficiency losses , we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs . Discussion This paper focuses on interventions for exclusive infant feeding , but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions , which are receiving increased focus in low income setting An attempted controlled trial of exclusively breast fed neonates with atopic parents , to assess the effectiveness of breast feeding in preventing atopic allergy , was not successfully achieved . Analysis of the data as an observational study , however , provided evidence that breast feeding offers some protection against eczema in genetically vulnerable infants .  Feeds of soya preparations were associated with eczema as often as cows ' milk based feeds More than 20 % of US children between ages 2 and 5 years are overweight suggesting efforts to prevent obesity must begin earlier . This study tested the independent and combined effects of two behavioral interventions delivered to parents , design ed to promote healthy infant growth in the first year . Mother-newborn dyads intending to breastfeed were recruited from a maternity ward . With a 2 × 2 design , 160 dyads were r and omized into one of four treatment cells to receive both , one , or no interventions delivered at two nurse home visits . The first intervention ( " Soothe/Sleep " ) instructed parents on discriminating between hunger and other sources of infant distress . Soothing strategies were taught to minimize feeding for non-hunger-related fussiness and to prolong sleep duration , particularly at night . The second intervention ( " Introduction of Solids " ) taught parents about hunger and satiety cues , the timing for the introduction of solid foods , and how to overcome infants ' initial rejection of healthy foods through repeated exposure . A total of 110 mother-infant dyads completed the year-long study . At 1 year , infants who received both interventions had lower weight-for-length percentiles ( P = 0.009 ) . Participants receiving both interventions had a mean weight-for-length in the 33rd percentile ; in contrast , those in other study groups were higher first intervention only--50th percentile ; second intervention only--56th percentile ; control group--50th percentile).This suggests that multicomponent behavioral interventions may have potential for long-term obesity prevention ( Clinical Trials.gov number , NCT00359242 ) Abstract Objectives : To evaluate impact of postnatal health education for mothers  on infant care and postnatal family planning practice s in Nepal . Design : R and omised controlled trial with community follow up at 3 and 6 months post partum by interview . Initial household survey of study areas to identify all pregnant women to facilitate follow up . Setting : Main maternity hospital in Kathm and u , Nepal . Follow up in urban Kathm and u and a periurban area southwest of the city . Subjects : 540 mothers r and omly allocated to one of four groups : health education immediately after birth and three months later ( group A ) , at birth only ( group B ) , at three months only ( group C ) , or none ( group D ) . Interventions : Structured baseline household question naire ; 20 minute , one to one health education at birth and three months later . Main outcome measures : Duration of exclusive breast feeding , appropriate immunisation of infant , knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea , knowledge of infant signs suggesting pneumonia , uptake of postnatal family planning . Results : Mothers in groups A and B ( received health education at birth ) were slightly more likely to use contraception at six months after birth compared with mothers in groups C and D ( no health education at birth ) ( odds ratio 1.62 , 95 % confidence interval 1.06 to 2.5 ) . There were no other significant differences between groups with regards to infant feeding , infant care , or immunisation . Conclusions : Our findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding , care , or immunisation , although uptake of family planning may be slightly enhanced . Key messages Health education is widely promoted in primary care , but there have been few rigorous evaluations of its impact , especially in developing countries A r and omised controlled trial of postnatal individual health education for mothers given by trained female health workers showed no significant impact on maternal knowledge and practice s of child care or on infant health outcomes , but there was a small improvement in uptake of family planning at six months after birth The efficacy of health education interventions that rely solely on giving people information to bring about a change in health behaviour is unproved ; interventions should be evaluated before being implemented on a large scale Alternative strategies for health promotion in developing countries such as interactions within families , peer groups , or communities may be more effective but are costly and difficult to implement on a large OBJECTIVE to assess the effectiveness of a peer support worker ( PSW ) service on breast-feeding continuation . DESIGN cluster r and omised controlled trial ( IS RCT N16126175 ) . SETTING Primary Care Trust , UK serving a multi-ethnic , socio-economically disadvantaged population . PARTICIPANTS 2,724 women giving birth following antenatal care from 66 clinics : 33 clinics ( 1,267 women ) r and omised to the PSW service and 33 clinics ( 1,457 women ) to usual care . 848 women consented to additional follow-up by question naire at 6 months . INTERVENTION PSW service provided in the antenatal and postnatal period . MEASUREMENTS any and exclusive breast feeding at 10 - 14 days obtained from routine computerised records and at 6 weeks and 6 months from a question naire . FINDINGS follow-up : 94 % at 10 - 14 days , 67.5 % at 6 months . There was no difference in any breast feeding at 10 - 14 days between intervention and usual care , odds ratio ( OR ) 1.07 ( 95 % CI 0.87 - 1.31 , p=0.54 ) . Proportion of women reporting any breast feeding in the intervention group at 6 weeks was 62.7 % and 64.5 % in the usual care group OR 0.93 ( 95 % CI 0.64 - 1.35 ) ; and at 6 months was 34.3 % and 38.9 % , respectively , OR 1.06 ( 95 % CI 0.71 - 1.58 ) . KEY CONCLUSIONS universal antenatal peer support and postnatal peer support for women who initiated breast feeding did not improve breast-feeding rates up to 6 months in this UK population . IMPLICATION S FOR PRACTICE with high levels of professional support part of usual maternity care it may not be possible for low intensity peer support to produce additional benefit . More intensive or targeted programmes might be effective , but should have concurrent high quality evaluation OBJECTIVE To compare office-based care ( OBC ) with a care model using a home nursing visit ( HNV ) as the initial postdischarge encounter for " well " breastfeeding newborns and mothers . DESIGN R and omized controlled trial . SETTING A single academic hospital . PARTICIPANTS A total of 1154 postpartum mothers intending to breastfeed and their 1169 newborns of at least 34 weeks ' gestation . INTERVENTIONS Home nursing visits were scheduled no later than 2 days after discharge ; OBC timing was physician determined . OUTCOME MEASURES Mothers completed telephone surveys at 2 weeks , 2 months , and 6 months . The primary outcome was unplanned health care utilization for mothers and newborns within 2 weeks of delivery . Other newborn outcomes were proportion seen within 2 days after discharge and breastfeeding duration . Maternal mental health , parenting competence , and satisfaction with care outcomes were assessed . Analyses followed an intent-to-treat paradigm . RESULTS At 2 weeks , hospital readmissions and emergency department visits were uncommon , and there were no study group differences in these outcomes or with unplanned outpatient visit frequency . Newborns in the HNV group were seen no more than 2 days after discharge more commonly than those in the OBC group ( 85.9 % vs 78.8 % ) ( P = .002 ) and were more likely to be breastfeeding at 2 weeks ( 92.3 % vs 88.6 % ) ( P = .04 ) and 2 months ( 72.1 % vs 66.4 % ) ( P = .05 ) but not 6 months . No group differences were detected for maternal mental health or satisfaction with care , but HNV group mothers had a greater parenting sense of competence ( P < .01 at 2 weeks and 2 months ) . CONCLUSIONS Home nursing visits are a safe and effective alternative to OBC for the initial outpatient encounter after maternity/nursery discharge with similar patterns of unplanned health care utilization and modest breastfeeding and parenting benefits AIM The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session , introduction of breastmilk substitutes and solids , and the duration of breastfeeding . MATERIAL S AND METHODS Ten municipalities in Sweden were r and omized to either the intervention or control groups . The intervention included a process-oriented training program for midwives and postnatal nurses in the intervention municipalities . Primiparas ( n=540 ) living in either an intervention or control municipality were asked to participate in a longitudinal study to evaluate the care given . Data collection for control group A ( CGA ) ( n=162 ) started before the intervention was initiated . Data for control group B ( CGB ) ( n=172 ) were collected simultaneously with the intervention group ( IG ) ( n=206 ) . The mothers responded to question naires at 3 days , 3 months , and 9 months postpartum . RESULTS As a result of the process-oriented training program for midwives and postnatal nurses , the IG mothers had a significantly longer duration of exclusive breastfeeding , even if the initial breastfeeding session did not occur within 2 hours after birth , than the corresponding group of CGA mothers ( p=0.01 ) . Fewer infants in the IG received  breastmilk substitutes  ( in the first week of life ) without medical reasons compared with the control groups ( p=0.01 ) . The IG infants were significantly older ( 3.8 months ) when breastmilk substitutes were introduced ( after discharge from the hospital ) compared with the infants in the control groups ( CGA , 2.3 months , p=0.01 ; CGB , 2.5 months , p=0.03 ) . CONCLUSION A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital This study was undertaken to determine the effects of a partner-support , incentive-baed educational program on breast feeding knowledge , attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women . Women who expressed a willingness to participate in the intervention were r and omly assigned to “ intervention ” and “ usual breast feeding ” ( control ) groups . Sixty-eight primipara women , with expected due date s between May and December , 1992 , volunteered to participate in the study . Of these , 34 were r and omly assigned to each of the two groups . Approximately 81 percent of the women completed the study , leaving n=29 in the control group and n-26 in the intervention group . The intervention consisted of special incentives ( prizes ) for women and their partners to participate in several breast feeding education and promotion activities . Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes . Furthermore , the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions . In addition , the partners of intervention group women were perceived to be more supportive of , breast feeding than control group partners . These findings suggest that incentives , such as donated prizes , can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions . Participation in such interventions can produce positive changes in breast feeding knowledge , attitudes , and support , and can have a dramatic effect in promoting breast feeding IMPORTANCE Evidence that longer-term and exclusive breastfeeding reduces child obesity risk is based on observational studies that are prone to confounding . OBJECTIVE To investigate effects of an intervention to promote increased duration and exclusivity of breastfeeding on child adiposity and circulating insulin-like growth factor (IGF)-I , which regulates growth . DESIGN , SETTING , AND PARTICIPANTS Cluster-r and omized controlled trial in 31 Belarusian maternity hospitals and their affiliated clinics , r and omized into 1 of 2 groups : breastfeeding promotion intervention  ( n = 16 ) or usual practice s ( n = 15 ) . Participants were 17,046 breastfeeding mother-infant pairs enrolled in 1996 and 1997 , of whom 13,879 ( 81.4 % ) were followed up between January 2008 and December 2010 at a median age of 11.5 years . INTERVENTION Breastfeeding promotion intervention modeled on the WHO/UNICEF Baby-Friendly Hospital Initiative ( World Health Organization/United Nations Children 's Fund ) . MAIN OUTCOME MEASURES Body mass index ( BMI ) , fat and fat-free mass indices ( FMI and FFMI ) , percent body fat , waist circumference , triceps and subscapular skinfold thicknesses , overweight and obesity , and whole-blood IGF-I. Primary analysis was based on modified intention-to-treat ( without imputation ) , accounting for clustering within hospitals and clinics . RESULTS The experimental intervention substantially increased breastfeeding duration and exclusivity when compared with the control ( 43 % vs 6 % exclusively breastfed at 3 months and 7.9 % vs 0.6 % at 6 months ) . Cluster-adjusted mean differences in outcomes at 11.5 years of age between experimental vs control groups were : 0.19 ( 95 % CI , -0.09 to 0.46 ) for BMI ; 0.12 ( -0.03 to 0.28 ) for FMI ; 0.04 ( -0.11 to 0.18 ) for FFMI ; 0.47 % ( -0.11 % to 1.05 % ) for percent body fat ; 0.30 cm ( -1.41 to 2.01 ) for waist circumference ; -0.07 mm ( -1.71 to 1.57 ) for triceps and -0.02 mm ( -0.79 to 0.75 ) for subscapular skinfold thicknesses ; and -0.02 st and ard deviations ( -0.12 to 0.08 ) for IGF-I. The cluster-adjusted odds ratio for overweight/obesity ( BMI ≥ 85th vs < 85th percentile ) was 1.18 ( 95 % CI , 1.01 to 1.39 ) and for obesity ( BMI ≥ 95th vs < 85th percentile ) was 1.17 ( 95 % CI , 0.97 to 1.41 ) . CONCLUSIONS AND RELEVANCE Among healthy term infants in Belarus , an intervention that succeeded in improving the duration and exclusivity of breastfeeding did not prevent overweight or obesity , nor did it affect IGF-I levels at age 11.5 years . Breastfeeding has many advantages but population strategies to increase the duration and exclusivity of breastfeeding are unlikely to curb the obesity epidemic . TRIAL REGISTRATION is rct n.org : IS RCT N37687716 ; and clinical trials.gov : NCT01561612 BACKGROUND Breastfeeding can ameliorate some of the complex health issues faced by low-income families . Women who breastfeed and their infants have lower health care costs compared with those who formula feed . Increasing the duration of breastfeeding is recognized as a national priority , particularly for low-income women . This community-based r and omized clinical trial involving low-income mothers compared usual care with an intervention comprising hospital and home visits , and telephone support by a community health nurse/peer counselor team for 6 months after delivery . METHODS Forty-one women were recruited after delivery of a full-term singleton infant and r and omly assigned to intervention or usual care groups . RESULTS Women receiving the community health intervention  breastfed longer than the women receiving usual care . The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group . The intervention cost ( $ 301/mother ) was partially offset by cost savings on formula and health care . CONCLUSIONS Community health nurse and peer counselor support can increase breastfeeding duration in low-income women , and has the potential to reduce total costs including the cost of support BACKGROUND The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow . METHODS The study was design ed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme . The intervention comprised peer counselling of pregnant women , support of breastfeeding mothers and local awareness-raising activities .  The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area . Data were collected by means of four self-completion question naires , two administered antenatally and two post-natally . The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time . RESULTS Of the 995 women enrolled in the study , data were available for analysis on 919 ( 92 per cent ) to 6 weeks postnatally . At booking , 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed . At delivery , the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls , and by 6 weeks post-natally , the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group . Using multivariate analysis to adjust for factors ( such as socio-economic status ) known to influence breastfeeding , the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [ odds ratio ( OR ) 2.0 ; 95 per cent confidence interval ( CI ) 1.2 - 3.1 , p = 0.006 ] . By 6 weeks post-natally the difference between the two groups was not statistically significant ( OR 1.8 ; 95 per cent CI 1.0 - 3.4 , p=0.07 ) . CONCLUSIONS As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally , it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities Background The duration and pattern of breastfeeding can influence the consumption of fruits and vegetables in later childhood . Objective To investigate the association between pattern and duration of breastfeeding  and consumption of fruits and vegetables in children aged between 4 and 7 years . Methods We conducted a secondary analysis using data from a former r and omized clinical trial with 323 adolescent mothers , their children , and maternal gr and mothers , when they cohabited . Information on infant feeding was collected monthly during the first 6 months of life , every two months until the child was 1 year old over and when children were between 4 and 7 years old . The associations between duration of breastfeeding and exclusive breastfeeding and consumption of fruits and vegetables  were tested by a logistic regression model . Results Approximately 60 % and 45 % of children consumed fruits and vegetables , respectively , five or more times a week . Consumption of vegetables among 4 - 7-year-old children was higher in children who were breastfed for 12 months or longer ( OR 2.7 ; 95%CI 1.49–4.93 ) ; however , exclusive breastfeeding  duration did not have a significant association with consumption of vegetables ( OR 1.5 ; 95%CI 0.70–3.04 ) . There was no association between weekly consumption of fruits and duration of breastfeeding  ( OR 1.3 ; 95%CI 0.71–2.30 ) or exclusive breastfeeding  ( OR 0.7 ; 95%CI 0.34–1.44 ) . Conclusions Longer duration of  breastfeeding  was positively associated with consumption of vegetables in children aged 4–7 years ; however , there was no association with consumption of fruits . Exclusive breastfeeding duration did not have influence on consumption of fruits or vegetables In a cluster r and omised controlled trial of a policy to provide  community breastfeeding support groups in Scotl and , breastfeeding rates declined in 3 of 7 intervention localities . From a preliminary study , we expected breastfeeding outcomes to vary and we prospect ively used qualitative and quantitative methods to ask why . Ethnographic in-depth interviews , focus groups , observations and survey data were analysed to build seven embedded case studies . A pyramidal model of how primary health service organisations implemented the policy was constructed prior to knowing trial outcomes to minimise bias . Informed by a realist approach , the model explained variation in ( a ) policy implementation ( b ) the breastfeeding outcomes , whereas the quantity of intervention delivered did not . In the three localities where breastfeeding rates declined , negative aspects of place including deprivation , unsuitable premises and geographical barriers to inter-professional communication ; personnel re sources including staff shortages , high workload and low morale ; and organisational change predominated ( the base model tiers ) . Managers focused on solving these problems rather than delivering the policy and evidence of progress to the higher model tiers was weak . In contrast , where breastfeeding rates increased the base tiers of the model were less problematic , there was more evidence of leadership , focus on the policy , multi-disciplinary partnership working and reflective action cycles ( the higher model tiers ) . We advocate an ethnographic approach to the design and evaluation of complex intervention trials and illustrate how this can assist in developing an explanatory model . More attention should be given to the complex systems within which policies and interventions occur , to identify and underst and the favourable conditions necessary for a successful intervention OBJECTIVE : To assess the impact of dietary counseling given to mothers during the first year of infants ’ lives on food consumption , nutritional status , and lipid profile of the children up to 7 to 8 years old . METHODS : The r and omized trial was conducted with 500 mothers who gave birth to full-term infants with birth weight ≥2500 g between October 2001 and June 2002 in São Leopoldo , Brazil . Mothers were r and omly assigned to intervention ( n = 200 ) and control groups ( n = 300 ) and those in the intervention group received counseling on breastfeeding and complementary feeding by 12 fieldworkers on 10 home visits during the first year of children ’s lives . Blinded fieldworkers assessed dietary and anthropometric data at 12 to 16 months , 3 to 4 years , and 7 to 8 years and lipid profiles at 3 to 4 years and 7 to 8 years old . The lipid profile was the primary outcome . RESULTS : Of the 500 recruited children , 397 underwent the 12- to 16-month , 354 the 3- to 4-year , and 315 the 7- to 8-year assessment . The energy-dense foods intake was significantly lower in the intervention group at 12 to 16 months and 3 to 4 years old . At 3 to 4 years , serum lipid levels did not differ between groups . At 7 to 8 years , high-density lipoprotein levels were 0.11 mmol/L higher ( 0.00 to 0.20 ) , and triglycerides concentration was 0.13 mmol/L lower ( −0.25 to −0.01 ) in intervention children but only among the girls . Overweight/obesity rates did not differ between groups . CONCLUSIONS : Dietary counseling for mothers during infancy decreased the energy-dense foods consumption and improved lipid profile BACKGROUND Despite numerous population -based r and omized intervention trials , the impact of such interventions on socioeconomic inequalities has rarely been examined . We used data from a large cluster-r and omized trial to assess the impact of a breastfeeding promotion intervention on socioeconomic inequalities in breastfeeding ( exclusivity and duration ) and in child cognitive ability at early school age . METHODS The  Promotion of Breastfeeding Intervention Trial ( PROBIT ) r and omized 31 Belarusian maternity hospitals and their affiliated polyclinics either to receive a breastfeeding promotion intervention modelled on the WHO/UNICEF Baby-Friendly Hospital Initiative or to continue the st and ard practice s in effect at the time of r and omization . We estimated and compared inequalities in discontinuation of exclusive breastfeeding before 3 months and of any breastfeeding before 12 months and in child verbal IQ at age 6.5 years , across maternal education strata between the two intervention arms . FINDINGS Socioeconomic inequalities in discontinuing exclusive breastfeeding before 3 months were negligible in the control group . However , grade d inequalities by maternal education emerged in the intervention group { relative risk [ RR ] = 1.12 [ 95 % confidence interval ( CI ) : 1.04 , 1.20 ] for partial university and RR = 1.20 [ 95 % CI : 1.11 , 1.31 ] for secondary education or less vs complete university ; risk difference [ RD ] = 0.06 [ 95 % CI : 0.03 , 0.09 ] and 0.10 [ 95 % CI : 0.06 , 0.14 ] , respectively}. For discontinuing any breastfeeding before 12 months , small socioeconomic gradients in the control group were widened in the intervention group ( RR = 1.04 and 1.16 , respectively , for mothers with secondary education or less ) . Despite these differential effects on breastfeeding , however , we observed a small , nonsignificant reduction in socioeconomic inequalities in child verbal IQ at age 6.5 years . CONCLUSIONS A population -based intervention to promote breastfeeding slightly widened socioeconomic inequalities in breastfeeding but not those in child cognitive ability OBJECTIVES In a community r and omized trial , we aim ed to promote exclusive breastfeeding and appropriate complementary feeding practice s in under-twos to ascertain the feasibility of using available channels for nutrition counselling , their relative performance and the relationship between intensity of counselling and behaviour change . We also assessed whether using multiple opportunities to impart nutrition education adversely affected routine activities . METHODS We conducted a community r and omized , controlled effectiveness trial in rural Haryana , India , with four intervention and four control communities . We trained health and nutrition workers in the intervention communities to counsel mothers at multiple contacts on breastfeeding exclusively for 6 months and on appropriate complementary feeding practice s thereafter . The intervention was not just training health and nutrition workers in counselling but included community and health worker mobilization . FINDINGS In the intervention group , about 32 % of caregivers were counselled by traditional birth attendants at birth . The most frequent sources of counselling from birth to 3 months were immunization sessions ( 45.1 % ) and home visits ( 32.1 % ) , followed closely by weighing sessions ( 25.5 % ) ; from 7 to 12 months , home visits ( 42.6 % ) became more important than the other two . An increase in the number of channels through which caregivers were counselled was positively associated with exclusive breastfeeding prevalence at 3 months ( p = 0.002 ) , consumption of milk/cereal gruel or mix use at 9 months ( p = 0.004 ) and 18 months ( p = 0.003 ) , undiluted milk at 9 months ( p<0.0001 ) and 24 hour non-breast-milk energy intakes at 18 months ( p = 0.023 ) , after controlling for potential confounding factors . Intervention areas , compared with the control , had higher coverage for vitamin A ( 45 % vs. 11.5 % ) and iron folic acid ( 45 % vs. 0.4 % ) supplementation . CONCLUSIONS Using multiple available opportunities and workers for counselling caregivers was feasible , result ed in high coverage and impact , and instead of disrupting ongoing services , result ed in their improvement Objective To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women . Design Cluster r and omised controlled trial with prospect i ve mixed method embedded case studies to evaluate implementation processes . Setting Primary care in Scotl and . Participants Pregnant women , breastfeeding mothers , and babies registered with 14 of 66 eligible clusters of general practice s ( localities ) in Scotl and that routinely collect breastfeeding outcome data . Intervention Localities set up new breastfeeding groups to provide population coverage ; control localities did not change group activity . Main outcome measures Primary outcome : any breast feeding at 6 - 8 weeks from routinely collected data for two pre-trial years and two trial years . Secondary outcomes : any breast feeding at birth , 5 - 7 days , and 8 - 9 months ; maternal satisfaction . Results Between 1 February 2005 and 31 January 2007 , 9747 birth records existed for intervention localities and 9111 for control localities . The number of breastfeeding groups increased from 10 to 27 in intervention localities , where 1310 women attended , and remained at 10 groups in control localities . No significant differences in breastfeeding outcomes were found . Any breast feeding at 6 - 8 weeks declined from 27 % to 26 % in intervention localities and increased from 29 % to 30 % in control localities ( P=0.08 , adjusted for pre-trial rate ) . Any breast feeding at 6 - 8 weeks increased from 38 % to 39 % in localities not participating in the trial . Women who attended breastfeeding groups were older ( P<0.001 ) than women initiating breast feeding who did not attend and had higher income ( P=0.02 ) than women in the control localities who attended postnatal groups . The locality cost was £ 13 400 ( € 14 410 ; $ 20 144 ) a year . Conclusion A policy for providing breastfeeding groups in relatively deprived areas of Scotl and did not improve breastfeeding rates at 6 - 8 weeks . The costs of running groups would be similar to the costs of visiting women at home . Trial registration Current Controlled Trials IS RCT N44857041 Abstract Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding .  Design R and omised controlled trial . Setting 32 general practice s in London and south Essex . Participants 720 women considering breast feeding . Main outcome measures Primary outcome was prevalence of any breast feeding at six weeks . Secondary outcomes were the proportion of women giving any breast feeds , or bottle feeds at four months , duration of any breast feeding , time to introduction of bottle feeds , and satisfaction with breast feeding . Results Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks ( 65 % ( 218/336 ) in the intervention group and 63 % ( 213/336 ) in the control group ; relative risk 1.02 , 95 % confidence interval 0.84 to 1.24 ) . Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups . Not all women in the intervention group contacted counsellors postnatally , but 73 % ( 123/179 ) of those who did rated them as very helpful . More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources . Conclusions Women valued the support of a counsellor in breast feeding , but the intervention did not significantly increase breastfeeding rates , perhaps because some women did not ask for help Objectives Breastfeeding has significant health benefits for mothers and infants . Despite recommendations from the WHO , by 6 months of age 40 % of Australian infants are receiving no breast milk . Increased early postpartum breastfeeding support may improve breastfeeding maintenance . 2 community-based interventions to increase breastfeeding duration in local government areas ( LGAs ) in Victoria , Australia , were implemented and evaluated . Design 3-arm cluster r and omised trial . Setting LGAs in Victoria , Australia . Participants LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion . The LGA was the unit of r and omisation , and maternal and child health centres in the LGAs comprised the clusters . Interventions Early home-based breastfeeding support by a maternal and child health nurse ( home visit , HV ) with or without access to a community-based breastfeeding drop-in centre ( HV+drop-in ) . Main outcome measures The proportion of infants receiving ‘ any ’ breast milk at 3 , 4 and 6 months ( women 's self-report ) . Findings 4 LGAs were r and omised to the comparison arm and provided usual care ( n=41 clusters ; n=2414 women ) ; 3 to HV ( n=32 clusters ; n=2281 women ) ; and 3 to HV+drop-in ( n=26 clusters ; 2344 women ) . There was no difference in breastfeeding at 4 months in either HV ( adjusted OR 1.04 ; 95 % CI 0.84 to 1.29 ) or HV+drop-in ( adjusted OR 0.92 ; 95 % CI 0.78 to 1.08 ) compared with the comparison arm , no difference at 3 or 6 months , nor in any LGA in breastfeeding before and after the intervention . Some issues were experienced with intervention protocol fidelity . Conclusions Early home-based and community-based support proved difficult to implement . Interventions to increase breastfeeding in complex community setting s require sufficient time and partnership building for successful implementation . We can not conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol . Trial registration number ACTRN12611000898954 ; Results Background The United Nations ’ Millennium Development Goals call for improving maternal and child health status . Their progress , however , has been minimal and uneven across countries . The continuum of care is a key to strengthening maternal , newborn , and child health . In this context , the Japanese government launched the Ghana Ensure Mothers and Babies Regular Access to Care ( EMBRACE ) Implementation Research Project in collaboration with the Ghanaian government . This study aims to evaluate the implementation process and effects of an intervention to increase the continuum of care for maternal , newborn , and child health status in Ghana . Methods / Design We will conduct a cluster r and omized controlled trial using an effectiveness-implementation hybrid design in Dodowa , Kintampo , and Navrongo , Ghana . We will provide an intervention package to women living in r and omly allocated intervention clusters . The study population is women of reproductive age between the ages of 15 and 49 years . The package includes : 1 ) use of a new continuum of care card , 2 ) continuum of care orientation for health workers , 3 ) 24-hour health facility retention of mothers and newborns after delivery , and 4 ) postnatal care by home visits . We will measure maternal , newborn , and child health outcomes for both intervention and implementation impacts . The intervention outcomes are continuum of care completion rate , rate of postnatal care within 48 hours , complication rate requiring mothers ' and newborns ' hospitalizations , and perinatal and neonatal mortality . The implementation outcomes are intervention coverage of the target population , intervention adoption and fidelity , implementation cost , and sustainability . Discussion In this trial , we will investigate how successful continuum of care can contribute to improving maternal , newborn , and child health outcomes . If successful , this model will then be implemented further in Ghana and other neighboring countries . Trial registration Current Controlled Trials IS RCT N90618993 . Registered on 3 September 2014 This quasi-experimental study was conducted in Shiraz , the Islamic Republic of Iran , on 120 pairs of mothers and infants in a maternity hospital that had a rooming-in programme . All 59 mothers in the study group received breastfeeding education , face-to-face , after delivery and during follow-up for 4 months in the mother and child health ( MCH ) centre or in their homes ; the remaining 61 mothers comprised the control group .  Exclusive breastfeeding rates were significantly higher in the study group ( 54 % ) than in the control group ( 6.5 % ) , but 5 % and 18 % of infants , respectively , in the study and control groups had stopped breastfeeding by the age of 4 months . The mean number of days of diarrhoea experienced by infants in the study group were significantly lower ( P < or = 0.004 ) than in the control group . At the end of 4 months , the mean weight and length of the infants were significantly higher ( both P < 0.05 ) in the study group than in the control group . The findings indicate that rooming-in is very important for promoting exclusive breastfeeding and that there is a need for continuous breastfeeding education of mothers OBJECTIVES To determine whether the outcomes of routine home visiting by public health nurses ( PHN ) after early obstetrical discharge differ from those of a screening telephone call design ed to identify mothers who need further intervention . METHODS Primiparas delivering a singleton infant and eligible for postpartum follow-up were r and omized to a  home visit or screening telephone call . Data were collected by telephone from 733 participants located at two tertiary care centres in Ontario . Outcomes included maternal confidence at two weeks , health problems of the infants between discharge and four weeks postpartum , breastfeeding rates at six months and costs of the two models . RESULTS Differences between the sample s at the two sites necessitated stratified analyses . No differences were detected between the groups in maternal confidence ( p = 0.96 ) , health problems of infants ( p = 0.87 ) , or rates of breastfeeding at six months ( p = 0.22 ) . However , at both sites the cost of routine home visits was found to be higher than that of screening by telephone . CONCLUSION Although universal access to postpartum support is important , the results suggest that a routine home visit is not always necessary to identify the women who need it . These results can be generalized only to low-risk women and infants Background Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence . However , there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa . This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children . Methods Data were obtained from a community r and omized trial conducted in Ug and a between 2006–2008 , and supplemented with evidence from several studies in sub-Saharan Africa . In the trial , peer counselling was offered to women in intervention clusters . In the control and intervention clusters , women could access st and ard health facility breastfeeding promotion services ( HFP ) . Thus , two methods of breastfeeding promotion were compared : community based peer counselling ( in addition to HFP ) and st and ard HFP alone . A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies . The model estimated changes in breastfeeding prevalence and disability adjusted life years . Costs were estimated from a provider perspective . Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis . Findings Peer counselling more than doubled the breastfeeding prevalence as reported by mothers , but there was no observable impact on diarrhoea prevalence . Estimated incremental cost-effectiveness ratios were US$ 68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year ( DALY ) averted . The findings were robust to parameter variations in the sensitivity analyses Conclusions Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Ug and a , because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Ug and a ’s GDP per capita ( US$ 1653 ) . However , since the intervention significantly increases prevalence of exclusive or predominant breastfeeding , it could be adopted in Ug and a if benefits other than reducing the occurrence of diarrhoea are believed to be important Background Breastfeeding has countless benefits to mothers , children and community at large , especially in developing countries . Studies from Lebanon report disappointingly low breastfeeding exclusivity and continuation rates . Evidence reveals that antenatal breastfeeding education , professional lactation support , and peer lay support are individually effective at increasing breastfeeding duration and exclusivity , particularly in low-income setting s. Given the complex nature of the breastfeeding ecosystem and its barriers in Lebanon , we hypothesize that a complex breastfeeding support intervention , which is centered on the three components mentioned above , would significantly increase breastfeeding rates . Methods / Design A multi-center r and omized controlled trial . Study population : 443 healthy pregnant women in their first trimester will be r and omized to control or intervention group . Intervention : A “ prenatal/postnatal ” professional and peer breastfeeding support package continuing till 6 months postpartum , guided by the Social Network and Social Support Theory . Control group will receive st and ard prenatal and postnatal care . Mothers will be followed up from early pregnancy till five years after delivery . Outcome measures : Total and exclusive breastfeeding rates , quality of life at 1 , 3 and 6 months postpartum , maternal breastfeeding knowledge and attitudes at 6 months postpartum , maternal exclusive breastfeeding rates of future infants up to five years from baseline , cost-benefit and cost-effectiveness analyses of the intervention . Statistical analysis : Descriptive and regression analysis will be conducted under the intention to treat basis using the most recent version of SPSS . Discussion Exclusive breastfeeding is a cost-effective public health measure that has a significant impact on infant morbidity and mortality . In a country with limited healthcare re sources like Lebanon , developing an effective breastfeeding promotion and support intervention that is easily replicated across various setting s becomes a priority . If positive , the results of this study would provide a generalizable model to bolster breastfeeding promotion efforts and contribute to improved child health in Lebanon and the Middle East and North Africa ( MENA ) region . Trial registration Current Controlled Trials IS RCT BACKGROUND One of the most common complaints of nursing mothers in a few days after delivery is insufficient lactation . This is known to be partly due to the mothers ' deficient knowledge of proper breastfeeding and often results in the beginning of bottlefeeding , which finally diminishes or ceases their breastfeeding . Considering the valuable effects of breastfeeding on nutritional , immunologic , and emotional aspects of infants ' health , we planned this study to find out whether training of nursing mothers for breastfeeding can enhance their lactation ; also , we tried to compare the effects of metoclopramide on lactation with those of training . METHODS Throughout 2006 , we consecutively enrolled 20 primipara nursing mothers who were referred to Tabriz Children 's Hospital , Tabriz , Iran for counseling about prescription of infant formula as a response to their complaint of insufficient lactation during a couple of months after parturition . Only those mothers were included in this study whose newborns had failed to gain appropriate weight , determined by their age and birth weight . First , all newborns were weighed , and all mothers passed a short training course about " perfect practice of breastfeeding " ; then we r and omly allocated them in two equal groups of 10 mothers-one group received a metoclopramide tablet ( 10 mg/dose every 8 hours ) , and the other just placebo , both for a period of 15 days . Thereafter we weighed the newborns again and compared the two recorded weights of each infant and the average weight of the two groups with each other to assess the sufficiency of breastfeeding and effects of training and galactogogue . RESULTS Eighteen of the 20 newborns studied ( 90 % ) showed an appropriate weight gain : 12 newborns gained 385 - 415 g ( mean , 400 + /- 15 g ) , six neonates gained 270 - 315 g ( mean , 292.5 + /- 22.5 g ) , but the remaining two newborns gained 150 - 235 g ( mean , 192.5 + /- 42.5 g ) . Statistical analysis revealed that training of nursing mothers for perfect breastfeeding ( with or without metoclopramide consumption ) has a significant improving role in infants ' weight gain ( p < 0.001 ) ; however , there was no statistically meaningful difference between the two treatment groups ( with and without administration of metoclopramide , p = 0.68 ) . CONCLUSIONS Counseling nursing mothers for proper lactation before delivery and their continued training thereafter are the main clinical pathways toward a successful and sustained breastfeeding Background Malaria is the second highest contributor to the disease burden in Africa and there is a need to identify low cost prevention strategies . The objectives of this study were to estimate the prevalence of malaria parasitaemia among infants and to measure the association between peer counselling for exclusive breastfeeding ( EBF ) , vitamin A supplementation , anthropometric status ( weight and length ) and malaria parasitaemia . Methods A cluster r and omized intervention trial was conducted between 2006 and 2008 where 12 of 24 clusters , each comprising one or two villages , in Eastern Ug and a were allocated to receive peer counselling for EBF .  Women in their third trimester of pregnancy ( based on the last normal menstrual period ) were recruited in all 24 clusters and followed up until their children 's first birthday . Blood was drawn from 483 infants between 3 and 12 months of age , to test for malaria parasitaemia .  Results The prevalence of malaria parasitaemia was 11 % in the intervention areas and 10 % in the control areas . The intervention did not seem to decrease the prevalence of malaria ( PR 1.7 ; 95 % CI : 0.9 , 3.3 ) . After controlling for potential confounders , infants not supplemented with Vitamin A had a higher prevalence for malaria compared to those who had been supplemented ( PR 6.1 ; 95 % CI : 2.1 , 17.6 ) . Among children supplemented with vitamin A , every unit increase in length-for-age Z ( LAZ ) scores was associated with a reduced prevalence in malaria ( PR 0.5 ; 95 % CI:0.4 , 0.6 ) . There was no association between LAZ scores and malaria among children that had not been supplemented . Conclusion Peer counselling for exclusive breastfeeding did not decrease the prevalence of malaria parasitaemia .  Children that had not received Vitamin A supplementation had a higher prevalence of malaria compared to children that had been supplemented . Trial registration Clinical trials.gov : NCT00397150 Background In this multi-country cluster-r and omized behavioural intervention trial promoting exclusive breastfeeding ( EBF ) in Africa , we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities . Methods A total of 82 clusters in Burkina Faso , Ug and a and South Africa were r and omised to either the intervention or the  control  arm . Feeding data and anthropometric measurements were collected at visits scheduled 3 , 6 , 12 and 24 weeks post-partum . We calculated weight-for-length ( WLZ ) , length-for-age ( LAZ ) and weight-for-age ( WAZ ) z-scores . Country specific adjusted Least Squares Means with 95 % confidence intervals ( CI ) based on a longitudinal analysis are reported . Prevalence ratios ( PR ) for the association between peer counselling for EBF and wasting ( WLZ < −2 ) , stunting ( LAZ < −2 ) and underweight ( WAZ < −2 ) were calculated at each data collection point . Results The study included a total of 2,579 children . Adjusting for socio-economic status , the mean WLZ at 24 weeks were in Burkina Faso −0.20 ( 95 % CI −0.39 to −0.01 ) and in Ug and a −0.23 ( 95 % CI −0.43 to −0.03 ) lower in the intervention than in the control arm . In South Africa the mean WLZ at 24 weeks was 0.23 ( 95 % CI 0.03 to 0.43 ) greater in the intervention than in the control arm . Differences in LAZ between the study arms were small and not statistically significant . In Ug and a , infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks ( PR 2.36 ; 95 % CI 1.11 to 5.00 ) . Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different . Conclusions There were small differences in mean anthropometric indicators between the intervention and control arms in the study , but in Ug and a and Burkina Faso , a tendency to slightly lower ponderal growth ( weight-for-length z-scores ) was found in the intervention arms . Trial registration number Clinical Trials.gov : Background The risks of not breastfeeding for mother and infant are well established , yet in Australia , although most women initiate breastfeeding many discontinue breastfeeding altogether and few women exclusively breastfeed to six months as recommended by the World Health Organization and Australian health authorities . We aim to determine whether proactive telephone peer support during the postnatal period increases the proportion of infants who are breastfed at six months , replicating a trial previously found to be effective in Canada . Design / Methods A two arm r and omised controlled trial will be conducted , recruiting primiparous women who have recently given birth to a live baby , are proficient in English and are breastfeeding or intending to breastfeed . Women will be recruited in the postnatal wards of three hospitals in Melbourne , Australia and will be r and omised to peer support or to ‘ usual ’ care . All women recruited to the trial will receive usual hospital postnatal care and infant feeding support . For the intervention group , peers will make two telephone calls within the first ten days postpartum , then weekly telephone calls until week twelve , with continued contact until six months postpartum . Primary aim : to determine whether  postnatal telephone peer support increases the proportion of infants who are breastfed for at least six months . Hypothesis : that  telephone peer support  in the postnatal period will increase the proportion of infants receiving any breast milk at six months by 10 % compared with usual care ( from 46 % to 56 % ) . Outcome data will be analysed by intention to treat . A supplementary multivariate analysis will be undertaken if there are any baseline differences in the characteristics of women in the two groups which might be associated with the primary outcomes . Discussion The costs and health burdens of not breastfeeding fall disproportionately and increasingly on disadvantaged groups . We have therefore deliberately chosen trial sites which have a high proportion of women from disadvantaged background s. This will be the first Australian r and omised controlled trial to test the effectiveness and cost effectiveness of proactive peer telephone support for breastfeeding . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12612001024831 OBJECTIVE To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge , skills , and involvement among pregnant American Indian adolescents . DESIGN R and omized controlled trial comparing a family-strengthening intervention with a breastfeeding education program . SETTING One Apache and 3 Navajo communities . PARTICIPANTS Fifty-three pregnant American Indian adolescents were r and omly assigned to intervention ( n = 28 ) or control ( n = 25 ) groups . Follow-up data were available for 19 intervention and 22 control participants . Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants ' homes from 28 weeks ' gestation to 6 months post partum . MAIN OUTCOME MEASURES Child care knowledge , skills , and involvement . RESULTS Mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months ( adjusted mean difference [ AMD ] , + 14.9 [ 95 % confidence interval ( CI ) , + 7.5 to + 22.4 ] ) and 6 months post partum ( AMD , + 15.3 [ 95 % CI , + 5.9 to + 24.7 ] ) . Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum ( AMD , + 1.5 [ 95 % CI , -0.02 to + 3.02 ] ) , and scores approached significance at 6 months post partum ( AMD , + 1.1 [ 95 % CI , -0.06 to + 2.2 ] ) . No between-group differences were found for child care skills . CONCLUSIONS A paraprofessional-delivered , family-strengthening home-visiting program significantly increased mothers ' child care knowledge and involvement . A longer and larger trial is needed to underst and the intervention 's potential to improve adolescent parenting and related child outcomes in American Indian communities Introduction The pattern and duration of breastfeeding ( BF ) and the age at onset of complementary feeding , as well as its quality , have been associated with the prevalence of overweight in childhood . Objective To assess the effect of a pro-BF and healthy complementary feeding intervention , targeted to adolescent mothers and maternal gr and mothers , on growth and prevalence of overweight and obesity in children at preschool age . This intervention had a positive impact on duration of BF and timing of onset of complementary feeding . Methods This r and omized clinical trial involved 323 adolescent mothers , their infants , and the infants ’ maternal gr and mothers , when they cohabited . Mothers and gr and mothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home ( 7 , 15 , 30 , 60 , and 120 days after delivery ) . When children were aged 4 to 7 years , they underwent anthropometric assessment and collection of data on dietary habits . Multivariable Poisson regression with robust estimation was used for analysis . Results BMI -for-age and height-for-age were similar in the intervention and control groups , as was the prevalence of overweight ( 39 % vs. 31 % respectively ; p=0.318 ) . There were no significant between-group differences in dietary habits . Conclusion Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding , it had no impact on growth or prevalence of overweight at age 4 to 7 years . Trial Registration Clinical Trials.gov OBJECTIVE To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding ( EBF )  in a low-re source urban setting in Kenya . DESIGN A cluster r and omized controlled trial in which nine villages were assigned on a 1:1:1 ratio , by computer , to two intervention groups and a control group . The home-based intensive counselling group ( HBICG ) received seven counselling sessions at home by trained peers , one prenatally and six postnatally . The facility-based semi-intensive counselling group ( FBSICG ) received only one counselling session prenatally . The control group ( CG ) received no counselling from the research team . Information on infant feeding practice s was collected monthly for 6 months after delivery . The data -gathering team was blinded to the intervention allocation . The outcome was EBF prevalence at 6 months . SETTING Kibera slum , Nairobi . SUBJECTS A total of 360 HIV-negative women , 34 - 36 weeks pregnant , were selected from an antenatal clinic in Kibera ; 120 per study group . RESULTS Of the 360 women enrolled , 265 completed the study and were included in the analysis ( CG n 89 ; FBSICG n 87 ; HBICG n 89 ) . Analysis was by intention to treat . The prevalence of EBF at 6 months was 23.6 % in HBICG , 9.2 % in FBSICG and 5.6 % in CG . HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG ( adjusted relative risk = 4.01 ; 95 % CI 2.30 , 7.01 ; P=0.001 ) . There was no significant difference between EBF rates in FBSICG and CG . CONCLUSIONS EBF can be promoted in low socio-economic conditions using home-based intensive counselling . One session of facility-based counselling is not sufficient to sustain EBF Objectives Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period . We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants . Study Design We conducted a r and omized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants < 4 weeks of age . Mothers receiving the intervention met with an International Board-Certified Lactation Consultant in hospital and 1–3 times post discharge . Both groups received the st and ard care for jaundice . The primary outcome was exclusive breastfeeding at 3 months . To the exception of research assistants enrolling participants and completing qualitative interviews , all research staff , investigators and statisticians were blinded to group assignment . Qualitative interviews elicited feedback on breastfeeding experiences for both groups . Results 99 participants were recruited , and 86 analyzed for primary outcome . There was no difference in exclusive breastfeeding at 3 months between groups ( RR 0.84 , 95 % CI 0.56–1.24 , p = 0.40 ) or in the secondary outcomes . 31 participants were included in the qualitative analysis . Participants in the intervention group described an increase in comfort and confidence levels with breastfeeding . Participants in the control group reported limited lactation support . Conclusions Our hospital-based lactation support program did not result in a higher proportion of mothers exclusively breastfeeding at 3 months compared to current hospital st and ard care . Qualitative feedback from the intervention group suggests that mothers ’ confidence was increased , which is linked to breastfeeding duration . The decision to breastfeed is multifactorial and hospital-based lactation support may be only a small piece of the puzzle in hospitalized jaundiced infants . Further studies may be needed to fully eluci date the impact of an in-hospital lactation support program on successful breastfeeding for these infants . Trial Registration Clinical Trials.gov NCT00966719 https://www . clinical trials.gov/ct2/show/NCT00966719?term=Lactation+Support+ and + Breastfeeding+ Duration + in+Jaundiced+Infants%3A+a+R and Background Breastfeeding is associated with significant positive health outcomes for mothers and infants . However , despite recommendations from the World Health Organization , exclusive breastfeeding for six months is uncommon . Increased breastfeeding support early in the postpartum period may be effective in improving breastfeeding maintenance . This trial will evaluate two community-based interventions to increase  breastfeeding duration in Local Government Areas ( LGAs ) in Victoria , Australia . Methods / Design A three-arm cluster r and omised controlled trial design will be used . Victorian LGAs with a lower than average rate of any breastfeeding at discharge from hospital and more than 450 births per year that agree to participate will be r and omly allocated to one of three trial arms : 1 ) st and ard care ; 2 ) home-based breastfeeding support ; or 3 ) home-based breastfeeding support plus access to a community-based breastfeeding drop-in centre . The services provided in LGAs allocated to ‘ st and ard care ’ are those routinely available to postpartum women . LGAs allocated to the home-based visiting intervention will provide home-visits to women who are identified as at risk of breastfeeding cessation in the early postnatal period . These visits will be provided by Maternal and Child Health Nurses who have received training to provide the intervention ( SILC-MCHNs ) . In areas allocated to receive the second intervention , in addition to home-based breastfeeding support , community breastfeeding drop-in centres will be made available , staffed by a SILC-MCHN . The interventions will run in LGAs for a nine to twelve month period depending on birth numbers . The primary outcome is the proportion of infants receiving any breast milk at four months of age . Breastfeeding outcomes will be obtained from routinely collected Maternal and Child Health centre data and from a new data item collecting infant feeding ‘ in the last 24 hours ’ . Information will also be obtained directly from women via a postal survey . A comprehensive process evaluation will be conducted . Discussion This study will determine if early home-based breastfeeding support by a health professional for women at risk of stopping breastfeeding , with or without access to a community-based breastfeeding drop-in centre , increases breastfeeding duration in Victorian LGAs with low breastfeeding rates . Trial registration Australian New Zeal and Clinical Trials Registry : ACTRN12611000898954 We investigated the effectiveness of a program of intensive postpartum support for low-income , breast-feeding women and identified potential predictors of prolonged breast-feeding in this population . Ninety-seven low-income women were r and omized to receive intensive postpartum education and support for breast-feeding or to receive only the routine assistance provided by the obstetrical nurses .  Both groups were telephoned 6 weeks post partum to determine the method of infant feeding then , and those still breast-feeding were contacted monthly until complete weaning had occurred . No significant difference in breast-feeding duration between the two groups was noted . There was no association between duration of nursing and race , marital status , or the need to return to work or school . Earlier age at introduction of supplement , younger maternal age , and participation in prenatal classes predicted breast-feeding duration by logistic regression Assessed is a breast-feeding training course that was attended by health professionals at the Santos Lactation Center ( SLC ) , Santos , São Paulo , Brazil , as well as its impact on the implementation of breast-feeding programmes in maternity hospitals . Eight maternity hospitals were studied -- four were r and omly allocated to the experimental group and sent three health professionals to attend an 18-day course at SLC ; the remaining four institutions constituted the  control group . The compliance of all eight hospitals with WHO/UNICEF 's " Ten steps for successful breast-feeding " was determined using scores obtained before and 6 months after the training course . Institutions in the experimental group had an improved score , but those in the control group did not . The SLC training course was efficient since it enabled the participants to promote breast-feeding practice s. However , in order to succeed in implementing breast-feeding programmes , health professionals require also to develop skills to apply the knowledge they acquire in the course , as well as to involve the whole maternity unit team in the activities Despite substantial evidence of maternal and infant benefits of breastfeeding , adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter duration s when compared to their adult counterparts . A r and omized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant — peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers . Study participants ( N = 289 ) enrolled from multiple prenatal clinic and school setting s , were 15 to 18 years old , and predominately African American , single , and primiparous . The intervention , which started in the second trimester of pregnancy and extended through 4 weeks postpartum , positively influenced breastfeeding duration ( p < .001 ) within the experimental group , but not breastfeeding initiation or exclusive breastfeeding rates . This education/support intervention was partially effective in enhancing breastfeeding outcomes . Implication s for research and practice are described OBJECTIVE To assess the efficacy of peer counseling to promote exclusive breastfeeding ( EBF ) among low-income inner-city women in Hartford , Conn. DESIGN Participants recruited prenatally were r and omly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support ( peer counseling group [ PC ] ) or only conventional breastfeeding support ( control group [ CG ] ) and followed through 3 months post partum . SETTING Low-income predominantly Latina community . PARTICIPANTS Expectant mothers , less than 32 weeks gestation and considering breastfeeding ( N = 162 ) . Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits , daily perinatal visits , 9 postpartum home visits , and telephone counseling as needed . MAIN OUTCOME MEASURES Exclusive breastfeeding rates at hospital discharge , 1 , 2 , and 3 months post partum ( n = 135 ) . RESULTS At hospital discharge , 24 % in the CG compared with 9 % in the PC had not initiated breastfeeding , with 56 % and 41 % , respectively , nonexclusively breastfeeding . At 3 months , 97 % in the CG and 73 % in the PC had not exclusively breastfed ( relative risk [ RR ] = 1.33 ; 95 % CI , 1.14 - 1.56 ) during the previous 24 hours . The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC ( 99 % vs 79 % ; RR = 1.24 ; 95 % CI , 1.09 - 1.41 ) . Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months ( 33 % vs 52 % ; RR = 0.64 ; 95 % CI , 0.43 - 0.95 ) . The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC ( 18 % vs 38 % ; RR = 2.15 ; 95 % CI , 1.16 - 3.97 ) . CONCLUSION Well-structured , intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income , inner-city women in the United States PURPOSE This study was done to investigate the effects of breast-feeding education and support services on rate of breast-feeding three and six months after birth , and the effect on infant 's growth ( weight , height , body mass index [ BMI ] ) . The experimental group which had both education and support services was compared with the control group which had only breast-feeding education . METHODS This study was a quasi-experimental study with a time-series design . The participants were 39 mothers who were hospitalized for childbirth . Twenty mother were assigned to the experimental group and 19 mothers , to the control group . The breast feeding education was done during hospitalization , and support services were provided once a week after discharge for a month ( a total 4 times ) by a maternity ward nurse . Data regarding breastfeeding rate at one month after childbirth was collected by phone call ; the breast-feeding rates at three and six months after childbirth were collected in a visit to the families . The child 's weight and height were also measured during the visit . RESULTS The experimental group had a statistically significant higher rate for frequency of breast-feeding at one , three and six months after childbirth than the control group . However , there was no meaningful difference between the two groups for infant growth . CONCLUSION The results of this study suggest that breast-feeding education is helpful for a start , but support services are also necessary to sustain breast-feeding The effectiveness of an in-hospital lactation education session on breastfeeding duration and satisfaction among postpartum women was investigated . In equal number , a total of 150 women were r and omly assigned to a st and ardized curriculum ( experimental group ) or a routine-care control group . No differences were found between the groups regarding breastfeeding duration , mother 's satisfaction level , or her perceived support . Item-scale analyses , however , were promising ( a=0 . 77 ) and a preliminary factor analysis suggested three underlying subscales : professional encouragement , satisfaction , and familial relationships . Based on a stepwise , multiple regression analysis three variables were related to length of breastfeeding experience , that is , level of satisfaction , educational level of the mother , and expected length of breastfeeding . Implication s of these results toward lactation education programs and further scale development are discussed Objective To evaluate the affect of an antenatal educational breastfeeding intervention on women 's breastfeeding duration BACKGROUND Adolescent mothers living with their mothers may be at greater risk of early weaning . This study aims to assess the influence of a breastfeeding promotion strategy directed at adolescent mothers living with their mothers on the prevalence of breastfeeding in the first year of life . METHOD A r and omized clinical trial with 323 adolescent mothers . Participants were divided into two groups : those who lived with their mothers and those who did not . Participants were r and omly assigned to control or intervention groups . Intervention consisted of breastfeeding counseling sessions held at the maternity ward and at home ( at 7 , 15 , 30 , 60 , and 120 days postpartum ) . The intervention effect was assessed by comparing survival curves for breastfeeding in the first 12 months of life . RESULTS The risk of weaning before 12 months of age was significantly lower in the intervention group for adolescent mothers not living with their mothers ; whereas the risk was not statistically different between intervention and control groups for those living with their mothers . CONCLUSIONS The positive influence of systematic counseling sessions on the prevalence of breastfeeding in the first year of life was significant for adolescent mothers . Living with their mothers reduced such influence Even with the gradual upward trends in breastfeeding initiation and duration , breastfeeding rates at 6 months continue to lag well behind the 50 % target set for any breastfeeding and the 25 % target set for exclusive breastfeeding by the Healthy People 2010 initiatives . Overall evidence is limited in identifying effective interventions that promote breastfeeding duration and more research needs to be focused on specific nursing strategies and their effect on breastfeeding outcomes . The aim of this study was to test the efficacy of a daily feeding log , guided by B and ura ’s social cognitive learning theory , on breastfeeding duration and exclusivity in primiparous mothers . The study used a r and omized , controlled , two-group experimental design with a sample of 86 primiparous mothers . The experimental group completed a daily breastfeeding log for a minimum of 3 weeks and breastfeeding outcomes were examined over 6 months . The breastfeeding outcome variable was analyzed using survival analysis and Cox proportional hazards regression procedures . Subjects in the experimental group did not breastfeed significantly longer than the control group , however , a larger proportion of subjects in the experimental group reported full breastfeeding at 6 months as compared with subjects in the control group . Additional predictor variables were  WIC enrollment , planned duration of breastfeeding , feeding frequency and feeding length at 1 week . The findings from the study suggest that the breastfeeding log may be a valuable tool in self-regulating breastfeeding and promoting a longer duration of full breastfeeding , but its acceptability may be impacted by socio-demographic variables BACKGROUND Breastfeeding peer counseling has improved breastfeeding rates in developing countries ; however , its impact in this country has not been adequately evaluated . OBJECTIVE To evaluate the effectiveness of an existing , breastfeeding peer counseling program within the United States . DESIGN R and omized , prospect i ve , controlled trial in which participants were recruited prenatally and r and omly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling . SETTING An urban hospital serving a large population of low-income Latinas . PARTICIPANTS Pregnant women ( < or = 26 weeks ' gestation ) were recruited from the hospital 's prenatal clinic . Inclusion criteria specified that participants be low income , be considering breastfeeding , have delivered a healthy , full-term singleton , and have access to a telephone . Intervention Breastfeeding peer counseling services included 1 prenatal home visit , daily perinatal visits , 3 postpartum home visits , and telephone contact as needed . MAIN OUTCOME MEASURES Breastfeeding rates at birth and 1 , 3 , and 6 months postpartum . RESULTS The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls ( 8/90 [ 9 % ] vs 17/75 [ 23 % ] ; relative risk , 0.39 ; 95 % confidence interval , 0.18 - 0.86 ) . The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month ( 36 % vs 49 % ; relative risk , 0.72 ; 95 % confidence interval , 0.50 - 1.05 ) and 3 months ( 56 % vs 71 % ; relative risk , 0.78 ; 95 % confidence interval , 0.61 - 1.00 ) . CONCLUSION These findings demonstrate that , in the United States , peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum R and omized trials conducted in developing countries have demonstrated that breastfeeding peer counseling increases rates of breastfeeding initiation and improves the duration of breastfeeding ( Morrow et al. 1999 ; Haider et al. 2000 ) . We are conducting a r and omized community trial , design ed to evaluate the effectiveness of an existing  community-based breastfeeding peer counseling program serving mostly low income Latinas ( i.e. , women from Spanish-speaking countries in Latin America or the Caribbean ) in Hartford , CT . Preliminary data from this on-going study previously have shown that subjects r and omized to receive breastfeeding peer counseling  have a median breastfeeding duration one month greater than their counterparts who did not receive breastfeeding peer counseling  ( 1.75 mo vs. 0.8 mo , P<0.05 ) ( Chapman et al. 2002 ) . The objectives of this analysis are to : a ) report on a process evaluation of the program , focusing on actual coverage of pre- , peri- , and postnatal services ; and b ) determine if differences in the degree and timing of the exposure to breastfeeding peer counseling services are associated with breastfeeding duration OBJECTIVE To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth , and to study whether the effect differs by maternal HIV status , educational level or household wealth . DESIGN Cluster-r and omized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers . Infant feeding data were collected using 24 h recall of nineteen food and fluid items . SETTING A township near Durban , South Africa . SUBJECTS Pregnant women ( 1894 intervention and 2243 control ) aged 17 years or more . RESULTS Twelve weeks after birth , 1629 ( intervention ) and 1865 ( control ) mother-infant pairs were available for analysis . Socio-economic conditions differed slightly across intervention groups , which were considered in the analyses . There was no effect on early initiation of breast-feeding . At 12 weeks of age the intervention doubled exclusive breast-feeding ( OR=2·29 ; 95 % CI 1·80 , 2·92 ) , increased exclusive formula-feeding ( OR=1·70 ; 95 % CI 1·28 , 2·27 ) , increased predominant breast-feeding ( OR=1·71 ; 95 % CI 1·34 , 2·19 ) , decreased mixed formula-feeding ( OR=0·68 ; 95 % CI 0·55 , 0·83 ) and decreased mixed breast-feeding ( OR=0·54 ; 95 % CI 0·44 , 0·67 ) . The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers ( P=0·01 ) , while the effect on mixed formula-feeding was significant only among HIV-positive mothers ( P=0·03 ) . The effect on exclusive feeding was not different by household wealth or maternal education levels . CONCLUSIONS A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding , exclusive formula-feeding and decreasing mixed feeding Infant feeding studies are typically presented as single-event models , without considering the dynamic nature of feeding . We analyzed the determinants of infant feeding duration using both single- and multiple-event Cox regression models . The Cox model was compared with parametric survival models , which were used to estimate feeding-state transition probabilities . Data were taken from a community r and omized trial promoting exclusive breastfeeding ( EBF ) in Ug and a from 2005 to 2008 . Peer counselors visited intervention mothers once antenatally and 4 times after birth . Results showed that children in the  control group were more likely to be switched from  exclusive breastfeeding (EBF)/predominant breastfeeding ( PBF )  to  mixed feeding (MF)/replacement feeding ( RF ) .  Children in intervention clusters ( hazard ratio = 0.33 , 95 % confidence interval : 0.26 , 0.42 ) and rural areas ( hazard ratio = 0.79 , 95 % confidence interval : 0.63 , 0.99 ) had a lower risk of EBF/PBF cessation . Based on the Akaike Information Criterion , parametric models were better fitted than the Cox model . The analytical approach to assessing infant feeding duration used in this study takes into account transitions between feeding categories , allowing for multiple events . This will enhance underst and ing of infant feeding practice s and give policy-makers a better picture of the versatility of infant feeding BACKGROUND Postpartum home visiting by nurses can benefit higher-risk families . Yet , little is known about the effects of universal services which provide care for all families including those at lowest risk ( e.g. , provision by health visitors-United Kingdom specialist community public health nurses ) . OBJECTIVE It was to determine the effect of frequency of health visitors ' home visits on ' low-risk ' first-time families ' outcomes to 8 weeks postpartum and 7 months follow-up . DESIGN A cluster r and omised controlled trial . SETTING Within one health and social care managerial area in Northern Irel and . PARTICIPANTS First-time ' low risk ' mothers who had given birth during 2002 - 2004 and were visited by a health visitor who had agreed to take part in the study , were invited to participate . In total , n=39 health visitors were allocated to ' intervention ' and n=41 to ' control ' . Of n=295 ' low-risk ' first-time mothers who agreed to take part , n=136 with intervention health visitors were offered six home visits 2 - 8 weeks postpartum and n=159 within the control group were offered one planned visit . METHODS Self-completed measures of parenting , maternal wellbeing and service use were gathered pre-intervention , 8 weeks and 7 months postpartum . The main outcome was the Edinburgh Postnatal Depression Scale ( EPDS ) . At 8 weeks and 7 months postpartum , n=129 and n=115 intervention mothers , also n=151 and n=141 control mothers completed outcome measures . RESULTS An intention to treat analysis was performed using multilevel modelling analysis which statistically controlled for pre-home visit outcomes , clinic attendance and antenatal contact . The intervention had no impact on most outcomes , however , it was associated with an increased EPDS score ( after adjustment : 0.16 , 2.36 95 % CI ) at 8 weeks ( before accounting for outliers ) but not at 7 months ( -0.62 , 1.65 95 % CI ) . Intervention mothers had higher service satisfaction ( 7.7 , 21.28 , 95 % CI 8 weeks ; 4.69 , 22.71 , 7 months ) and were less likely to have used emergency medical services for their infants to 8 weeks ( OR : 0.15 , 0.85 , 95 % CI ) . CONCLUSION Weekly postpartum visits to ' low-risk ' mothers had variable effects , therefore , practitioners and research ers should consider further development and application of effective , evidence based home visiting content OBJECTIVE Harmful effects of short postpartum hospital stays include dehydration and malnutrition of breastfed infants . These may be prevented by adequate breastfeeding frequency ; however , rigorous research to determine the relative effectiveness of various follow-up strategies in supporting breastfeeding frequency is absent . This study addressed the question , " Is there a difference in breastfeeding frequency or infant weight gain for singleton infants discharged within 36 hours ' postpartum who received either community nurse ( home visit ) or hospital nurse ( clinic ) follow-up ? " METHODS A r and omized , controlled trial was conducted at a university teaching hospital ( 3700 births/y ) and affiliated community health centers . A consecutive sample of 586 healthy mother-infant pairs were recruited from January 1997 to September 1998 before discharge ; 513 ( 87.5 % ) contributed data on 1 or more outcomes . Forty-eight-hour postpartum telephone contact and day 3 nurse contact in the home ( experimental ) or at the hospital ( control ) were provided . The main outcomes measured were breastfeeding frequency and infant weight gain assessed at 2 weeks ' postpartum by maternal diary and weight at home by research assistants , masked to group allocation . RESULTS No clinical ly important or statistically significant group differences were found in daily breastfeeding frequency ( mean difference experimental minus control = 0.1 feeds [ 95 % confidence interval : -0.1 - 0.3 ] ) or daily rate of infant weight gain ( -1.1 g [ -2.5 - 0.3 ] ) based on intention-to-treat analyses . CONCLUSIONS Follow-up by nurses after short postpartum hospital stays , in either the home or a hospital-based clinic , of healthy infants discharged at < 36 hours seems associated with satisfactory infant breastfeeding outcomes BACKGROUND Recently enacted federal legislation m and ates insurance coverage of at least 48 hours of postpartum hospitalization , but most mothers and newborns in the United States will continue to go home before the third postpartum day . National guidelines recommend a follow-up visit on the third or fourth postpartum day , but scant evidence exists about whether home or clinic visits are more effective . METHODS We enrolled 1163 medically and socially low-risk mother-newborn pairs with uncomplicated delivery and r and omly assigned them to receive home visits by nurses or pediatric clinic visits by nurse practitioners or physicians on the third or fourth postpartum day . In contrast with the 20-minute pediatric clinic visits , the home visits were longer ( median : 70 minutes ) , included preventive counseling about the home environment , and included a physical examination of the mother . Clinical utilization and costs were studied using computerized data bases . Breastfeeding continuation , maternal depressive symptoms , and maternal satisfaction were assessed by means of telephone interviews at 2 weeks ' postpartum . RESULTS Comparing the 580 pairs in the home visit group and the 583 pairs in the pediatric clinic visit group , no significant differences occurred in clinical outcomes as measured by maternal or newborn rehospitalization within 10 days postpartum , maternal or newborn urgent clinic visits within 10 days postpartum , or breastfeeding discontinuation or maternal depressive symptoms at the 2-week interview . The same was true for a combined clinical outcome measure indicating whether a mother-newborn pair had any of the above outcomes . In contrast , higher proportions of mothers in the home visit group rated as excellent or very good the preventive advice delivered ( 80 % vs 44 % ) , the provider 's skills and abilities ( 87 % vs 63 % ) , the newborn 's posthospital care ( 87 % vs 59 % ) , and their own posthospital care ( 75 % vs 47 % ) . On average , a home visit cost $ 255 and a pediatric clinic visit cost $ 120 . CONCLUSIONS For low-risk mothers and newborns in this integrated health maintenance organization , home visits compared with pediatric clinic visits on the third or fourth postpartum hospital day were more costly , but were associated with equivalent clinical outcomes and markedly higher maternal satisfaction . This study had limited power to identify group differences in rehospitalization , and may not be generalizable to higher-risk population s without comparable access to integrated hospital and outpatient care Mothers need consistent , sustained information and support to develop and meet personal breastfeeding goals , but often receive insufficient assistance and conflicting and incorrect advice . The use of technology may be helpful in supplementing existing health care professional breastfeeding education and support efforts . We developed and evaluated a computer-based animated , interactive agent design ed to provide breastfeeding information and support to mothers interested in breastfeeding . A r and omized controlled study of a first-generation system was conducted to determine the feasibility of ( 1 ) use of the Computer Agent ; ( 2 ) the recruitment plan ; and ( 3 ) the planned outcome evaluation ( assessing the impact of the intervention on intent to breastfeed , attitudes towards breastfeeding , and breastfeeding self-efficacy ) . The pilot study ( N = 15 ) showed that the use of the Computer Agent , the recruitment plan , and the planned outcome evaluation were all feasible . Mothers who used the Computer Agent  had greater intentions to exclusively breastfeed after exposure to the Agent ( intent to exclusively breastfeed for 6 months 1–7 scale score of 6.14 ( post ) vs. 5.14 ( pre ) ; p < 0.05 ) . Non-statistically significant trends in improvement with use of the Computer Agent breastfeeding support system were also seen in the between subjects analyses of intent to breastfeed and breastfeeding self-efficacy . The pilot study demonstrated the feasibility of using a Computer Agent to support breastfeeding mothers and informed the design of a larger r and omized clinical trial . An interactive Computer Agent may be helpful in improving rates of exclusive breastfeeding , particularly when there is not adequate health care professional support OBJECTIVE The purpose of this study was to compare breastfeeding duration in mothers after delivery who were assigned r and omly to a behavioral educational intervention vs enhanced usual care . STUDY DESIGN We conducted a r and omized trial . Self-identified black and Latina mothers early after delivery were assigned r and omly to receive a behavioral educational intervention or enhanced usual care . The 2-step intervention aim ed to prepare and educate mothers about postpartum symptoms and experiences ( including tips on breastfeeding and breast/nipple pain ) and to bolster social support and self-management skills . Enhanced usual care participants received a list of community re sources and received a 2-week control call . Intention-to-treat analyses examined breastfeeding duration ( measured in weeks ) for up to 6 months of observation . This study was registered with clinical trial.gov ( NCT01312883 ) . RESULTS Five hundred forty mothers were assigned r and omly to the intervention ( n = 270 ) vs control subjects ( n = 270 ) . Mean age was 28 years ( range , 18 - 46 years ) ; 62 % of the women were Latina , and 38 % were black .  Baseline sociodemographic , clinical , psychosocial , and breastfeeding characteristics were similar among intervention vs control subjects . Mothers in the intervention arm breastfed for a longer duration than did the control subjects ( median , 12.0 vs 6.5 weeks , respectively ; P = .02 ) Mothers in the intervention arm were less likely to quit breastfeeding over the first 6 months after delivery ( hazard ratio , 0.79 ; 95 % confidence interval , 0.65 - 0.97 ) . CONCLUSION A behavioral educational intervention increased breastfeeding duration  among low-income , self-identified black and Latina mothers during the 6-month postpartum period Although most Hispanic/Latino-American mothers initiate breastfeeding , duration and exclusivity of breastfeeding remain low . We explored whether a motivational interviewing ( MI ) intervention could help rural Mexican-American mothers continue breastfeeding . We used a two-group ( MI intervention n = 26 , attention control [ AC ] n = 27 ) repeated measures experimental design . Assessment s and interventions occurred at 3 days , 2 weeks , and 6 weeks postpartum ( time points when mothers are particularly vulnerable to discontinuing breastfeeding ) , with a final phone assessment at 6 months postpartum . We collected demographic data and measured intent to breastfeed for 6 months ( intent question ) , self-efficacy ( Breastfeeding Self-Efficacy Scale-Short Form ) , and collected breastfeeding information ( breastfeeding assessment question naire ) . Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences ( α = 0.05 ) . High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention . No significant differences were found between groups for any of the outcome variables ( intent to breastfeed for 6 months , breastfeeding self-efficacy , and duration of breastfeeding ) . Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so , most did not breastfeed for 6 months . At 6 months , mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22 % of the mothers in each group were still breastfeeding at some level . Because of the impact of attrition during this study , we discuss factors that contributed to attrition and approaches to lessen this problem in future studies . Such efforts may require a greater investment of time and re sources and should be budgeted accordingly . Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals , thus providing an opportunity to reduce their children 's risk of multiple diseases and obesity . Only when we address these considerations will we have an opportunity to decrease health disparities , promote healthy behaviors , and be trusted health care partners Abstract . A prospect i ve study of the course of breast feeding was carried out in 75 r and omly selected women . Weekly interviews were performed from the day after delivery until the termination of breast feeding , but in no case for longer than 6 months . In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding . A second group of 71 mothers , also r and omly selected , was interviewed in retrospect only , 6 months after delivery , and served as controls . Twenty‐four weeks after delivery 47 % of the mothers in the weekly interview group were still breast feeding . The corresponding figure in the control group was 38 % . In both groups only few mothers terminated lactation for medical reasons , while about one fourth stopped for some other reason and about one half because of a combination of factors . Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding OBJECTIVE Our purpose was to compare an early postpartum discharge program versus st and ard postpartum care . STUDY DESIGN A r and omized controlled trial in a 637-bed university hospital included 175 healthy women recruited at 32 to 38 weeks gestation from physicians ' offices and sonograms . Experimental intervention consisted of discharge 6 to 36 hours post partum with nursing care available by telephone or at home at 34 to 38 weeks ' gestation and at < or = 48 hours and at 3 , 5 , and 10 days post partum . The control included a postpartum stay of 48 to 72 hours and st and ard follow-up . RESULTS At 1 month no significant differences were seen in perceived maternal competence ( Experimental-Control = 4.3 points [ 95 % confidence interval-7.7 to 16.3 ] ) , infant weight gain ( 1.2 gm/ day [ -2.8 to 5.2 ] ) ; identification of significant neonatal hyperbilirubinemia ( rate ratio 0.50 [ 0.10 to 2.51 ] ) , infant utilization of health services ( rate ratio 0.88 [ 0.45 to 1.73 ] ) , or predominant breast-feeding ( adjusted odds ratio 1.25 [ 0.88 to 1.75 ] ) . Program participants did have significantly less frequent infant bilirubin testing ( rate ratio 0.39 [ 0.17 to 0.94 ] ) . The program also enhanced perceived maternal competence in recent immigrants ( 26.9 points [ 2.7 to 51.5 ] ) . CONCLUSIONS Early postpartum discharge coupled with prenatal , postnatal , and home contacts leads to no apparent disadvantage and may yield benefits for some mothers and infants Exclusive breastfeeding has generally been considered incompatible with working separated from the infant . This prospect i ve , controlled intervention trial shows that breastfeeding support , including anticipatory counseling and monthly clinical follow-up of the mother and infant , can significantly increase the percentage of infants exclusively fed with breastmilk at the end of 6 months of life . Over 80 per cent of women from control and intervention groups expressed a desire to breastfeed for more than 6 months and more than 50 per cent thought it was best for the infant to be exclusively breastfed for 6 months . Only 6 per cent of women in the control group were able to complete 6 months of exclusive breastmilk feeding compared to 53 per cent of those in the intervention group . The most important difference between the strategies used by both groups of mothers for maintaining exclusive breastmilk feeding after returning to work was that only 23 per cent of the control group practice d milk expression compared to 66 per cent in the intervention group . All women from the supported group stated that they would advise a friend to combine exclusive breastfeeding and work and that they would like to do so again with another child BACKGROUND Several studies have demonstrated the positive effects of peer support on various breastfeeding outcomes , but no study has assessed women 's and peer volunteers ' views on , or the nature and intensity of , the supportive intervention . The objective of this study was to describe maternal and peer volunteer perceptions of their experience while participating in a breastfeeding peer support trial . METHODS A r and omized controlled trial was conducted to evaluate the effect of telephone-based peer ( mother-to-mother ) support on breastfeeding duration .  Two hundred and fifty-six primiparous breastfeeding women were r and omly allocated to receive either conventional care or conventional care plus peer support . Three primary outcome measures were peer volunteer activity logs , maternal perceptions of peer support , and evaluations of the peer volunteer experience . RESULTS Question naires were completed by 98.5 percent ( n=130 ) of the mothers in the peer support group . Mothers reported their peer volunteers were available when difficulties were experienced , increased their confidence , decreased their concerns , and assisted them in reaching their breastfeeding goals . These supportive interactions result ed in 81.5 percent of mothers ( n=106 ) being satisfied with their peer support experience and suggesting that every new mother should be offered this intervention . Similarly , all the peer volunteers interviewed ( n=30 ) viewed their experience positively . They suggested some intervention modifications as follows : ensure that mothers enrolled in the program want peer support ; provide peer volunteers with ongoing educational sessions and opportunities to " socialize " with other volunteers ; and disseminate the results of peer support efforts . CONCLUSIONS Both mothers and peer volunteers perceived their intervention experiences positively . Whereas maternal satisfaction was related to the number and duration of peer volunteer contacts , peer volunteers enjoyed their training session and the opportunity to assist mothers for a variety of reasons . Specific intervention modifications should be implemented to enhance peer volunteer satisfaction and retention Exclusive breastfeeding ( EBF ) has the potential to significantly reduce infant mortality , but is frequently not practice d in low-income setting s where infants are vulnerable to malnutrition and infections including human immunodeficiency virus ( HIV ) . This study explores mothers ' experiences of infant feeding after receiving peer counselling promoting exclusive breast or formula feeding . This qualitative study was embedded in a cluster r and omized peer counselling intervention trial in South Africa that aim ed to evaluate the effect of peer counselling on EBF .  Participants were selected from the three districts that were part of the trial reflecting different socio-economic conditions , rural-urban locations and HIV prevalence rates . Seventeen HIV-positive and -negative mothers allocated to intervention clusters were recruited . Despite perceived health and economic benefits of breastfeeding , several barriers to EBF remained , which contributed to a preference for mixed feeding . The underst and ing of the promotional message of ' exclusive ' feeding was limited to ' not mixing two milks ' : breast or formula and did not address early introduction of foods and other liquids . Further , a crying infant or an infant who did not sleep at night were given as strong reasons for introducing semi-solid foods as early as 1 month . In addition , the need to adhere to the cultural practice of ' cleansing ' and the knowledge that this practice is not compatible with EBF appeared to promote the decision to formula feed in HIV-positive mothers . Efforts to reduce barriers to EBF need to be intensified and further take into account the strong cultural beliefs that promote mixed feeding Background Maternal malnutrition and poor gestational weight gain are the most important causes of low birthweight and infant mortality in Bangladesh . Objective To assess the effect of short-term nutrition education on weight gain in the third trimester of pregnancy , birth outcomes , and breastfeeding . Methods Three hundred pregnant women participated in this r and omized , controlled trial during a 3-month intervention period . The study was conducted in two antenatal clinics in urban Dhaka . One group of women was given monthly education sessions during the third trimester of pregnancy to promote consumption of khichuri , while the control group received only routine services from the health facilities .  Birthweight was recorded within 24 hours after delivery . Breastfeeding practice s were observed for 1 month after delivery . Results In the intervention group , maternal weight gain in the third trimester was 60 % higher ( 8.60 vs. 5.38 kg , p = .011 ) , mean birthweight was 20 % higher ( 2.98 vs. 2.49 kg , p < .001 ) , the rate of low birth-weight was 94 % lower ( 2.7 % vs. 44.7 % , p < .001 ) , and the rate of initiation of breastfeeding within 1 hour after birth was 52 % higher ( 86.0 % vs. 56.7 % , p < .001 ) , in comparison with the control group . Birthweight was associated with frequency of intake of khichuri ( p < 0.001 ) . Conclusions Nutrition education with a focus on promoting consumption of khichuri during the third trimester of pregnancy significantly reduced the rate of low birthweight and increased maternal weight gain Eating and physical activity behaviors associated with adult obesity have early antecedents , yet few studies have focused on obesity prevention interventions targeting very young children . Efforts to prevent obesity beginning at birth seem particularly important in population s at risk for early-onset obesity . National estimates indicate that American Indian ( AI ) children have higher rates of overweight and obesity than children of other races/ethnicities . The Prevention of Toddler Obesity and Teeth Health Study ( PTOTS ) is a community-partnered r and omized controlled trial design ed to prevent obesity beginning at birth in AI children . PTOTS was developed to test the effectiveness of a multi-component intervention design ed to : promote breastfeeding , reduce sugar-sweetened beverage consumption , appropriately time the introduction of healthy solid foods , and counsel parents to reduce sedentary lifestyles in their children . A birth cohort of 577 children from five AI tribes is r and omized by tribe to either the intervention ( three tribes ) or the comparison condition ( two tribes ) . The strengths and weaknesses of PTOTS include a focus on a critical growth phase , placement in the community , and intervention at many levels , using a variety of approaches OBJECTIVES To assess the effectiveness of home visits advising mothers about breast feeding and weaning in reducing symptoms of respiratory morbidity at the age of 12 months . METHODS A r and omized field trial was conducted with mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo ( 2001/2002 ) . The intervention group received dietary advice during the first year based on a Brazilian national health policy for primary care , which is based on WHO guidelines .  Morbidity data was assessed in 397 children at 12 months . RESULTS A total of 23.3 % of the children in the intervention group and 39.7 % of the controls had one or more of the following symptoms during the month preceding assessment : cough , stuffy nose , runny nose , or breathlessness . The risk of respiratory morbidity symptoms was 41 % lower for the intervention group ( RR : 0.59 ; 95 % CI : 0.43 - 0.81 ) . The number of families needed to be visited to avoid one children presenting symptoms of respiratory morbidity ( Number Needed to Treat ) was 6.1 . The intervention-group status was also associated with a longer duration of exclusive ( RR:1.59 ; 95 % CI : 1.21 - 2.07 ; p=0.001 ) and total breastfeeding ( RR : 1.25 ; 95 % CI:1.02 - 1.55 ; p=0.032 ) later introduction of solid foods ( RR:1.11 ; 95 % CI : 1.02 - 1.21 ; p=0.023 ) , and a lower proportion of current medication use ( RR:0.56 ; 95 % CI:0.34 - 0.91;p=0.016 ) . CONCLUSION A nutrition education program during the first year of life has a positive impact on reducing respiratory symptoms in infants A secondary analysis of a r and omized clinical trial in which the control group received routine breast-feeding care , consisted of women planning to breast-feed their low-birth-weight ( LBW ) premature infants  , was conducted . The purpose of this secondary analysis was to examine the nutrition of healthy premature LBW infants and its impact on their development . A longitudinal prospect i ve descriptive design was implemented measuring the same group of 50 healthy breast-feeding LBW premature infants from birth to 6 months corrected age . Developmental screening was performed at 6 months corrected age using the Bayley Scales of Infant Development to assess development in Mental scale , Motor scale , and Infant Behavioral record . Repeated measures analyses of variance were performed between the 3 gestational age groups and between the breast-fed and non – breast-fed groups . Bayley Scales of Infant Development Mental and Motor scales showed significant differences between the breast-fed and non – breast-fed groups at 6 months corrected age ( P < .014 and P < .013 , respectively ) . The nutrition of healthy premature LBW infants over time was recorded and described . Nutritional assessment indicated that human milk intake in some quantity decreased from 40 weeks corrected age to 6 months corrected age : 70 % to 26 % . These findings can be utilized in anticipatory guidance when caring for neonates and mothers in the neonatal intensive care unit to encourage mothers to provide their own milk and strive to breast-feed AIMS To evaluate the effectiveness of home-based peer counselling to increase breastfeeding rates for unfavourably low birthweight babies . METHODS R and omized clinical trial carried out in maternity hospitals and households in Fortaleza , one of the regions in Brazil with very low income ; 1003 mothers and their newborns were selected in eight maternity hospitals . Newborns needed were healthy and weighed less than 3000 g. INTERVENTION Breastfeeding counselling , conducted by lay counsellors from the community , during home visits carried out on days 5 , 15 , 30 , 60 , 90 and 120 after birth . MAIN OUTCOME MEASURE Feeding methods in the fourth month of life . RESULTS The intervention increased exclusive breastfeeding ( 24.7 % vs 19.4 % ; p=0.044 ) , delayed the introduction of formula and increased the time infants substituted breastfeeding to bottle milk ( bottle milk 33.4 % in the control group and 20.1 % in the intervention group ; p=0.00002 ) . When comparing the frequency of artificial breastfeeding  versus all other forms of breastfeeding ( exclusive+predominant+partial ) , the intervention increased breastfeeding rates in 39 % ( RR=0.61 ; CI 95 % : 0.50 - 0.75 ) ; 15 % of children were free from artificial feeding ( absolute risk reduction ) . The number of families to be visited to avoid one child receiving artificial feeding ( NNT ) was 7 ( CI 95 % : 5 - 13 ) . CONCLUSIONS Breastfeeding counselling , promoted by lay counsellors , can impact favourably on exclusive breastfeeding rates and contribute to delaying the utilization of milk formula and weaning . The intervention has great application potential because most cities in the northeast of Brazil count on community health workers that could do the counselling This study examined the effect of support from trained peer counselors on breastfeeding initiation , duration , and exclusivity among low-income urban women .  Training of counselors , under the supervision of a registered nurse certified in lactation , adapted education techniques from Paulo Freire to provide information about lactation management and other health care issues . The study compared infant feeding practice s of women who planned to breastfeed and received support from counselors ( counselor group , N=59 ) to women who requested counselors but , owing to inadequate numbers of trained counselors , did not have a counselor ( No-counselor group , N=43 ) . Women in the counselor group had significantly greater ( p<.05 ) breastfeeding initiation ( 93 percent vs. 70 percent ) , exclusivity ( 77 percent vs. 40 percent ) , and duration ( mean of 15 weeks vs. mean of 8 weeks ) than women in the no-counselor group . The findings suggest that peer counselors , well-trained , and with on-going supervision , can have a positive effect on breastfeeding practice s among low-income urban women who intend to breastfeed BACKGROUND Despite high levels of breastfeeding initiation in Australia , only 46 percent of women are still breastfeeding ( exclusively or partially ) 6 months later , with marked differences between social groups . This study aim ed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge , and on the duration of breastfeeding . METHODS A r and omized controlled trial to compare two strategies for increasing the initiation and duration of breastfeeding was conducted , in which 981 primiparas who attended a public , tertiary women 's hospital in Melbourne , Australia , were r and omized to one of two interventions or to st and ard care ( 327 in each group ) . The interventions were a 1.5-hour class on practical aspects of breastfeeding using a previously tested tool ( Practical Skills ) , and two 1-hour classes exploring family and community attitudes toward , and experiences of , breastfeeding ( Attitudes ) . Both interventions took place in interactive small groups when women were in mid-pregnancy . Breastfeeding initiation was ascertained by interview 2 to 4 days after birth , and breastfeeding duration was assessed by telephone interview 6 months after birth . RESULTS Neither intervention increased breastfeeding initiation or duration compared with st and ard care . Rates at initiation were 97 percent ( 296/306 ) for the Practical Skills intervention , 95 percent ( 291/308 ) for the Attitudes intervention , and 96 percent ( 297/310 ) for st and ard care . Rates at 6 months were , respectively , 55 percent ( 162/297 ) , 50 percent ( 146/293 ) , and 54 percent ( 162/299 ) . CONCLUSIONS In setting s where breastfeeding initiation is already high , neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration OBJECTIVE To determine the effects of a partner-supported , incentive-based educational program on rates and duration of breast-feeding among low-income women . DESIGN Women who expressed a willingness to participate in the breast-feeding educational program  were r and omly assigned to one of two groups : an intervention group and a control group who received usual breast-feeding education . SETTING Clinics of the Special Supplemental Food Program for Women , Infants , and Children in Flagstaff , Ariz. SUBJECTS Sixty-eight primiparous pregnant women with expected due date s between May 1992 and December 1992 were willing to participate in the study . Of these , 34 were r and omly assigned to the intervention group and 34 to the control group . Approximately 81 % of the women completed the study : 29 in the control group and 26 in the intervention group . INTERVENTION The intervention consisted of special incentives ( prizes ) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth . Women were also encouraged to use a breast-feeding support program in which peers serve as role models . MAIN OUTCOME MEASURES The primary outcome measure was infant feeding method . Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks , 6 weeks , and 3 months postpartum . STATISTICAL ANALYSES PERFORMED Binomial proportional analyses of the feeding data were performed . RESULTS Women in the intervention group reported a higher percentage of breast-feeding at all measurement times . APPLICATIONS These findings suggest that incentives , such as donated prizes , can be used to attract primiparous women from lower socioeconomic groups , along with their partners , to participate in educational interventions design ed to promote breast-feeding . Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding This study was part of a r and omized controlled trial in which verbal and written advice about exclusive breast-feeding for 6 months was provided to Dutch women expecting a child with a high risk of developing asthmatic traits . Eighty-nine women completed a theory-based self-report question  naire between the third and sixth months of pregnancy , which served as the baseline measurement . The aim of this study was to examine the factors that influence the duration of exclusive breast-feeding . Cox multiple regression analysis showed a positive significant association between the duration of exclusive breast-feeding and the mother 's breast-feeding knowledge ( P < 0.01 ) , her intended hours of work per week after maternity leave ( P < 0.01 ) and her age ( P < or= 0.05 ) . Short-term , that is < 5 weeks , or no previous breast-feeding experience of multiparous women appeared to be negatively associated with the duration of breast-feeding ( P < 0.001 ) . Furthermore , women who received the educational programme were more likely to succeed in breast-feeding exclusively for 6 months than the control group ( 48 % versus 27 % , P < 0.05 ) . This study suggests that extra educational support is beneficial , and especially necessary for multiparous women with an earlier short-term , < 5 weeks , or no breast-feeding experience , since they are at risk of discontinuing exclusive breast-feeding before completing the advisable 6-month period BACKGROUND In the Netherl and s , the initiation rate of breast-feeding ( BF ) was 80 % in 2002 , but only 35 % of the mothers continued to breast-feed for 3 months . This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding . METHODS A cluster-r and omized intervention trial was used . Ten child health care centers in three regions of the home health care were r and omly allocated to the program or usual care . Elements in the program were health counseling , measures to enhance cooperation , early signaling of breast-feeding problems and continuity of care , and lactation consultancy .  Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum ( n = 683 ) . The primary outcome measure was the continuation of breast-feeding until at least 3 months . RESULTS The 3-month breast-feeding rate was 32 % in the intervention and 38 % in the control groups ( OR = 0.79 , 95 % CI = 0.58 - 1.08 ) . CONCLUSION The program was not effective . We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program , such as the categories of caregivers involved and the number and duration of contacts after parturition Abstract Objective : To compare the differences in practicing continuous primary nursing care ( CPNC ) versus task-centered nursing care ( TCNC ) with regard to patient satisfaction with nursing care and early postpartum health problems for hospitalized pregnant women . Design : All participants filled out the satisfaction with nursing care question naire , breastfeeding knowledge question naire , and early postpartum problem question naire . Setting : Participants in the CPNC group received continuous individualized primary nursing care and participants in the TCNC group received task-centered nursing care during their perinatal period . Participants : Using a r and omized controlled trial , 470 hospitalized pregnant women participated in the study with 230 pregnant women in the CPNC group and 240 in TCNC group . Data Analysis : Question naire data were collected , calculated , and statistically analyzed using independent t-tests or χ2 tests along with power analysis . Results : Participants in the CPNC group reported significantly higher overall satisfaction with nursing care ( t(468 ) = 5.936 , p < .001 ) , had more breastfeeding knowledge ( t(468 ) = 5.633 , p < .001 ) , and were more likely to breast feed six weeks after delivery ( χ2 ( 1 ) = 39.237 , p < .001 ) than those in the TCNC group . Participants in the CPNC group also showed a significantly lower occurrence of postpartum urinary retention ( Fisher exact test was used , p < .002 ) and breast discomfort ( χ2 ( 3 ) = 34.482 , p < .001 ) than those in the TCNC group . Conclusion : Practicing continuous primary nursing care was more effective than practicing traditional task-centered nursing care for hospitalized pregnant women in increasing satisfaction with nursing care , enhancing breastfeeding , and reducing early postpartum problems BACKGROUND Exclusive breastfeeding is recommended until age 6 months . We assessed the feasibility , effectiveness , and safety of an educational intervention to promote exclusive breastfeeding for this length of time in India . METHODS We developed the intervention through formative research , pair-matched eight communities on their baseline characteristics , and r and omised one of each pair to receive the intervention and the other to no specific intervention . We trained health and nutrition workers in the intervention communities to counsel mothers for exclusive breastfeeding at multiple opportunities . We enrolled 1115 infants born in the 9 months after training-552 in the intervention and 473 in the control communities . Feeding at age 3 months , and anthropometry and of diarrhoea prevalence at age 3 months and 6 months were assessed . All analyses were by intention to treat . FINDINGS We assessed 483 and 412 individuals at 3 months in the intervention and control groups , respectively , and 468 and 412 at 6 months . At 3 months , exclusive breastfeeding rates were 79 % ( 381 ) in the intervention and 48 % ( 197 ) in the control communities ( odds ratio 4.02 , 95 % CI 3.01 - 5.38 , p<0.0001 ) . The 7-day diarrhoea prevalence was lower in the intervention than in the control communities at 3 months ( 0.64 , 0.44 - 0.95 , p=0.028 ) and 6 months ( 0.85 , 0.72 - 0.99 , p=0.04 ) . The mean weights and lengths , and the proportion with weight-for-height or height-for-age Z scores of 2 or less , at age 3 months and 6 months did not differ much between groups . Intervention effect on exclusive breastfeeding , diarrhoeal morbidity , and anthropometry at age 6 months in the low-birthweight subgroup was similar to that for all births . INTERPRETATION Promotion of exclusive breastfeeding until age 6 months in a developing country through existing primary health-care services is feasible , reduces the risk of diarrhoea , and does not lead to growth faltering Objective To determine whether a single one‐to‐one in‐hospital education session could increase the rate of breastfeeding at 17 weeks BACKGROUND Breastfeeding conveys many benefits , but women often encounter difficulties in the first few weeks . The objective of this study was to examine women 's perspectives on the information , advice , and support they receive with breastfeeding . METHODS A qualitative analysis was conducted of women 's responses to open questions about their experiences of breastfeeding support . Participants were recruited as part of a r and omized controlled trial of additional support from volunteer breastfeeding counselors , and they completed question naires when their babies were 6 weeks old . RESULTS Of the 720 women recruited to the trial , 654 began breastfeeding and completed postnatal question naires ; 492 ( 75 % ) participants were first-time mothers and 200 ( 31 % ) were of minority ethnic origin . At 6 weeks , 249 ( 38 % ) women were exclusively breastfeeding , 183 ( 28 % ) were both breastfeeding and bottle-feeding , whereas 222 ( 34 % ) were exclusively bottle-feeding . Although many women commented positively on their experiences , others thought they did not receive the information and support they needed . Thematic analysis of women 's responses to open questions identified five components of the support that women wanted : information about breastfeeding and what to expect , practical help with positioning the baby to breastfeed , effective advice and suggestions , acknowledgment of mothers ' experiences and feelings , and reassurance and encouragement . CONCLUSIONS Maternity services should address the components identified by the study findings as constituting good breastfeeding support . Guidance and information for family members and training for those involved in peer or professional initiatives should take into account women 's views on what support they want , together with when and how they want it provided OBJECTIVE To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care , can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding . DESIGN , SETTING AND PARTICIPANTS In a cluster r and omised trial of smoking education and breast-feeding interventions in the lower North Isl and , New Zeal and , midwives were stratified by locality and r and omly allocated into a control group and three intervention groups . The control group provided usual care . Midwives in the intervention groups delivered either a programme of education and support for smoking cessation or reduction , a programme of education and support for breast feeding or both programmes .  Sixty-one midwives recruited a total of 297 women . INTERVENTIONS Structured programmes provided by midwives . FINDINGS Women receiving only the smoking cessation or reduction programme were significantly more likely to have reduced , stopped smoking or maintained smoking changes than women in the control group , at 28 weeks and 36 weeks gestation . Women receiving both the smoking cessation and breast-feeding education and support programmes were significantly more likely than women in the control group to have changed their smoking behaviour at 36 weeks gestation . There was no difference in rates of cessation or reduction between the groups in the postnatal period . There was no difference in rates of full breast feeding between the control and intervention groups for women who planned to breast feed . KEY CONCLUSIONS Education and support by midwives , as part of primary midwifery , can facilitate smoking cessation and reduction during pregnancy BACKGROUND to report anthropometry and morbidity among term low birth weight infants and anthropometry of their first time mothers during the first six months in relation to breastfeeding practice . METHODS we examined data from a r and omized controlled trial in Manila , the Philippines . Of the 204 mothers r and omized , 68 mothers received eight postpartum breastfeeding counseling sessions , the rest did not . Maternal and infant anthropometric data at birth , 2 , 4 and 6 months were taken . During seven follow-up hospital visits , an independent interviewer recorded feeding data . RESULTS the 24 infants exclusively breastfed from birth to six months did not have diarrhea  compared to 134 partially breastfed ( mean 2.3 days ) and 21 non-breastfed infants ( mean 2.5 days ) . Partially breastfed and non-breastfed infants compared to exclusively breastfed infants had more frequent , as well as more severe episodes of respiratory infections . At six months , neither overall gain in infant weight , length and head circumferences nor mean maternal weight and body mass index differed significantly between the feeding groups . CONCLUSIONS exclusive breastfeeding for 6 months can be recommended in term low birth weight infants , who were protected from diarrhea , had fewer respiratory infections , required no hospitalization and had catch up growth . Exclusively breastfeeding mothers did not differ from mothers who breastfed partially or those who did not breastfeed with regard to weight changes at six months BACKGROUND Differences between mothers who do and do not succeed in breastfeeding are likely to confound associations of lactation with later maternal adiposity . OBJECTIVE We compared  adiposity and blood pressure ( BP ) in women r and omly assigned to an intervention to promote prolonged and exclusive breastfeeding or usual care .  DESIGN We performed a cluster-r and omized trial at 31 hospitals in Belarus in 1996 - 1997 . RESULTS Of 17,046 women enrolled at delivery , we assessed 11,867 women ( 69.6 % ) at 11.5 y postpartum . The prevalence of exclusive breastfeeding ≥3 mo was 44.5 % in 6321 women in the intervention group and 7.1 % in 5546 women in the control group . At 11.5 y postpartum , mean ( ±SD ) body mass index ( BMI ; in kg/m(2 ) ) was 26.5 ± 5.5 , the percentage of body fat was 33.6 % ± 8.3 % , and systolic BP was 124.6 ± 14.6 mm Hg . On intention-to-treat analysis ( without imputation ) with adjustment for clustering by hospital , mean outcomes were lower in intervention compared with control mothers for BMI ( mean difference : -0.27 ; 95 % CI : -0.91 , 0.37 ) , body fat ( -0.49 % ; 95 % CI : -1.25 % , 0.27 % ) , and systolic BP ( -0.81 mm Hg ; 95 % CI : -3.33 , 1.71 mm Hg ) , but effect sizes were small , CIs were wide , and results were attenuated further toward the null after adjustment for baseline characteristics . Results were similar in sensitivity analyses [ ie , by using conventional observational analyses disregarding treatment assignment , instrumental variable analyses to estimate the causal effect of breastfeeding , and multiple imputation to account for missing outcome measures ( n = 17,046 ) ] . CONCLUSION In women who initiated breastfeeding , an intervention to promote longer breastfeeding duration did not result in an important lowering of adiposity or BP . This trial was registered at clinical trials.gov as NCT01561612 and at Current Controlled Trials as IS RCT N37687716 This study assesses the impact of an intervention known as the Ten Steps to Healthy Feeding : A Nutritional Guide for Children under Two on nutritional conditions and infant health in low-income families . Two hundred newborns were r and omized to the intervention group and three hundred to the control group . Parents of the intervention group received nutritional orientation during the child 's first year of life . Both groups received visits at 6 and 12 months and routine follow-up by their pediatricians . The results ( n = 397 ) showed that the intervention was associated with a higher proportion of exclusive breastfeeding at 4 months ( RR = 1.58 ; 95%CI : 1.21 - 2.06 ) and 6 months ( RR = 2.34 ; 95%CI : 1.37 - 3.99 ) and breastfeeding at 12 months ( RR = 1.26 ; 95%CI : 1.02 - 1.55 ) and a lower proportion of children with diarrhea ( RR = 0.68 ; 95%CI : 0.51 - 0.90 ) , respiratory problems ( RR = 0.63 ; 95%CI : 0.46 - 0.85 ) , use of medication ( RR = 0.56 ; 95%CI : 0.34 - 0.91 ) , and dental caries ( RR = 0.56 ; 95%CI : 0.32 - 0.96 ) in the 12 - 16 month bracket . The intervention had no effect on the occurrence of anemia , hospitalization , or nutritional status . The results suggest that the nutritional orientation program led to positive changes in infant feeding practice s and health conditions , but that it was insufficient to prevent iron deficiency anemia OBJECTIVE . Continuous support during the childbirth process ultimately may strengthen the mother 's self-esteem and her capacity to interact with and nurture her infant and also may improve paternal involvement in general . In the present study , we investigated whether mothers , who were attended by midwives and nurses who had had a process-oriented training program in breastfeeding counseling  , perceived stronger maternal feelings for their infant than mothers who had received only routine care . METHODS . In a previous study , an intervention that included a process-oriented program on breastfeeding counseling for health professionals and continuity in family classes through childbirth was conducted . The 10 largest municipalities were classified in pairs that were similar in size and had similar figures of breastfeeding duration . The municipalities were r and omized pairwise to either an intervention or a control group . The present study is a follow-up study on women 's feelings for their infants in relation to the kind of care that they had had and was undertaken between April 2000 and January 2003 . The sampling frame was based on women who were cared for at either the intervention clinic or control clinics . The mothers at the control clinics had received st and ard routine care and had attended family classes through the point of birth . Data collection for control group A started before effects of the intervention could be studied . Data for control group B were collected simultaneously with data collection for the intervention group ( n = 540 ) . The mothers responded to 3 question naires at 3 days and at 3 and 9 months postpartum . Background data of the mothers were collected . The perception of support that was provided by the health professionals and the perception of mother – infant relationship and feelings for the infant were rated on Likert scales . RESULTS . At 3 days postpartum , both the intervention group and control group B versus the control group A thought that their underst and ing of the infant was better , they perceived more strongly that the infant as their own , and they enjoyed more breastfeeding and resting with the infant . Although there was no significant difference between the intervention group and control group B at 3 days and 3 months observation , mothers in the intervention group talked more to their infant , perceived their infant to be more beautiful than other infants , and perceived more strongly that the infant was their own than did the mothers in control group B at 9 months observation . In addition , the mothers in the intervention group felt significantly more confident with the infant and felt the infant to be closer than did the mothers in control group B. CONCLUSION . A process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention that guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant A r and omized controlled trial was conducted to evaluate two interventions for prolonging the duration of breast-feeding in a multiethnic sample of 343 low-income urban women . One intervention compared research breast-feeding bedside counseling by a trained counselor , who also made eight telephone calls during the first 3 months of the infant 's life , with the routine breast-feeding counseling provided in the hospital by nurses . The other intervention compared commercial discharge packs provided by formula companies with research discharge packs design ed to be consistent with the WHO Code of Marketing of Breastmilk Substitutes . When infants were 4 months old , a telephone interviewer unaware of treatment status contacted 95 % ( 324/343 ) of the women to determine the infants ' feeding and health histories . Compared with routine counseling , research counseling delayed the first introduction of solid foods to the infant 's diet ( P = .03 , one-tailed ) but did not exert a statistically significant effect on breast-feeding by 4 months ' postpartum . Women who received the research discharge pack , compared with those who received the commercial pack , were more likely to prolong exclusive breast-feeding ( P = .004 , one-tailed ) , to be partially breast-feeding at 4 months postpartum ( P = .04 , one-tailed ) , and to delay the daily use of solid foods in the infant 's diet ( P = .017 , one-tailed ) . Among the women who received research counseling , the research discharge pack was associated with lower rates of rehospitalization of infants than was the commercial pack ( 1 % v 14 % ; P = .014 , two-tailed ) . We conclude that in high-risk maternity population s , commercial discharge material s for breast-feeding women should be replaced by material s consistent with the WHO Code BACKGROUND Exclusive breastfeeding is recommended worldwide but not commonly practised . We undertook a r and omised controlled study of the efficacy of home-based peer counselling to increase the proportion of exclusive breastfeeding among mothers and infants residing in periurban Mexico City . METHODS Two intervention groups with different counselling frequencies , six visits ( 44 ) and three visits ( 52 ) , were compared with a control group ( 34 ) that had no intervention .  From March , 1995 , to September , 1996 , 170 pregnant women were identified by census and invited to participate in the study . Home visits were made during pregnancy and early post partum by peer counsellors recruited from the same community and trained by La Leche League . Data were collected by independent interview . Exclusive breastfeeding was defined by WHO criteria . FINDINGS 130 women participated in the study . Only 12 women refused participation . Study groups did not differ in baseline factors . At 3 months post partum , exclusive breastfeeding was practised by 67 % of six-visit , 50 % of three-visit , and 12 % of control mothers ( intervention groups vs controls , p<0.001 ; six-visit vs three-visit , p=0.02 ) . Duration of breastfeeding was significantly ( p=0.02 ) longer in intervention groups than in controls , and fewer intervention than control infants had an episode of diarrhoea ( 12 % vs 26 % , p=0.03 ) . INTERPRETATION This is the first reported community-based r and omised trial of breastfeeding promotion . Early and repeated contact with peer counsellors was associated with a significant increase in breastfeeding exclusivity and duration . The two-fold decrease in diarrhoea demonstrates the importance of breastfeeding promotion to infant health OBJECTIVE To assess the impact of experiential learning method ologies in primiparous women on their choice and maintenance of an infant feeding method . STUDY DESIGN A prospect i ve controlled study into experiential learning methods applied to patients with four months ' follow up . Seventy-three primiparous women attending the antenatal clinic at the West Suffolk Hospital for their 32 weeks check were allocated to two groups on the basis of date of attendance . Multiple pregnancy and serious illness were excluded . Thirty-three women attended a two hour seminar on breast feeding using experiential techniques .  Forty had routine antenatal care and acted as controls .  Breast feeding rates of the two groups were recorded at various stages . Assessment also included comments from question naires . RESULTS The two groups did not differ significantly in the number of women proposing to breast feed their infants ( Z = -0.0490 , P = 0.9609 ) nor in the numbers of women breast feeding on day one ( Z = -0.6203 , P = 0.5350 ) . There were proportionally more women breast feeding their infants at two weeks ( Z = -1.4944 , P = 0.1351 ) in the subject group , but this was not statistically significant . However , the difference at four months was significant , ( Z = -2.5784 , P = 0.0099 ) , more than double the percentage of controls maintaining some breast feeding to four months in the subject group . CONCLUSIONS Experiential learning was associated with increased rates of prolonged breast feeding , possibly due to increased patient confidence in their choice . This learning approach could be applied to other areas of patient health education BACKGROUND Most mothers stop breast-feeding before the recommended 6 months post partum . A systematic review showed that breast-feeding support programs by health care professionals did not substantially improve breast-feeding outcomes beyond 2 months post partum . We conducted a r and omized controlled trial to evaluate the effect of peer ( mother-to-mother ) support on breast-feeding duration among first-time breast-feeding mothers . METHODS We recruited 256 breast-feeding mothers from 2 semi-urban community hospitals near Toronto and r and omly assigned them to a control group ( conventional care ) or a peer support group ( conventional care plus telephone-based support , initiated within 48 hours after hospital discharge , from a woman experienced with breast-feeding who attended a 2.5-hour orientation session ) . Follow-up of breast-feeding duration , maternal satisfaction with infant feeding method and perceptions of peer support received was conducted at 4 , 8 and 12 weeks post partum . RESULTS Significantly more mothers in the peer support group than in the control group continued to breast-feed at 3 months post partum ( 81.1 % v. 66.9 % , p = 0.01 ) and did so exclusively ( 56.8 % v. 40.3 % , p = 0.01 ) . Breast-feeding rates at 4 , 8 and 12 weeks post partum were 92.4 % , 84.8 % and 81.1 % respectively among the mothers in the peer support group , as compared with 83.9 % , 75.0 % and 66.9 % among those in the control group ( p < or = 0.05 for all time periods ) . The corresponding relative risks were 1.10 ( 95 % confidence interval [ CI ] 1.01 - 2.72 ) at 4 weeks , 1.13 ( 95 % CI 1.00 - 1.28 ) at 8 weeks and 1.21 ( 95 % CI 1.04 - 1.41 ) at 12 weeks post partum . In addition , when asked for an overall rating of their feeding experience , significantly fewer mothers in the peer support group than in the control group were dissatisfied ( 1.5 % v. 10.5 % ) ( p = 0.02 ) . Of the 130 mothers who evaluated the peer support intervention , 81.6 % were satisfied with their peer volunteer experience and 100 % felt that all new breast-feeding mothers should be offered this peer support intervention . INTERPRETATION The telephone-based peer support intervention was effective in maintaining breast-feeding to 3 months post partum and improving satisfaction with the infant feeding experience . The high satisfaction with and acceptance of the intervention indicates that breast-feeding peer support programs , in conjunction with professional health services , are effective INTRODUCTION Although the disadvantages of introducing non-breast milk and the early introduction of complementary foods are known , such practice s are common worldwide . OBJECTIVE To evaluate the efficacy of counseling about breastfeeding and complementary feeding in preventing the introduction of non-breast milk and complementary foods in the first 6 months . METHODS This r and omized clinical trial enrolled 323 adolescent mothers and their newborns and 169 maternal gr and mothers ; 163 mothers and 88 gr and mothers received five  counseling sessions on breastfeeding while in the hospital and at 7 , 15 , 30 , and 60 days , and one session on complementary feeding at 120 days . Data about infant feeding were collected monthly . The impact was evaluated by comparing the Kaplan-Meier survival curves for the time of introduction of non-breast milk and complementary foods of the control and intervention groups . Median time of introduction of milk was calculated in the two groups . RESULTS The survival curves showed that the intervention postponed the introduction of non-breast milk and complementary foods .  At 4 months , 41 % ( 95 % CI , 32.8 - 49.2 ) of the infants in the control group received complementary foods in comparison to 22.8 % ( 95 % CI , 15.9 - 29.7 ) of the intervention group . Counseling postponed the introduction of non-breast milk , which occurred at 95 days ( 95 % CI , 8.7 - 111.3 ) in the control group and at 153 days ( 95 % CI , 114.6 - 191.4 ) in the intervention group . CONCLUSIONS Counseling sessions on infant 's first 4 months were an efficacious strategy to prevent the introduction of non-breast milk and complementary foods in the 6 months of life This pilot study aim ed to test the effectiveness of a structured telephonic counselling ( STC ) on  exclusive breastfeeding ( EB ) on healthy babies .  The study was carried out on 114 primiparous women from February to March 2009 . After r and omization , women were divided into two groups : 55 receiving STC and 59 receiving conventional counselling . At 1 , 3 and 5 months after delivery , a nurse specialist evaluated the EB rates , the influence of mother 's educational level and employment status on EB . Breastfeeding rates in STC were higher compared to conventional counselling ( P < 0.01 ) ; resuming work was not an EB discouraging variable as 74.5 % women in the STC resumed work vs. 54.2 % of the conventional counselling . Breastfeeding promotion should start during pregnancy , advising women about benefits for the child in receiving human milk . STC should be used to improve EB in primiparous women Objective To examine whether breast feeding is associated with behavioural development in children aged 5 years . Design The authors used data from a large , prospect i ve , nationally representative UK cohort , the Millennium Cohort Study . Participants 10 037 mother – child pairs from white ethnic background ( 9525 term and 512 preterm children ) were included in the analyses . Methods Duration of breast feeding ( at all or exclusively ) was ascertained from parental interview at study baseline , when the children were aged 9 months . Child behaviour was assessed using a  parent-completed question naire , the Strengths and Difficulties Question naire ( SDQ ) . The authors used logistic regression to investigate the associations of breastfeeding duration with abnormal parent-rated SDQ total and subscores at age 5 in term and preterm children separately . Results Abnormal SDQ scores were less common in term children ( n=1129/9525 , 12 % ) than pre-term ( n=78/512 , 15 % ) children . Term children breast fed for 4 months or longer ( n=2741/9525 , 29 % ) had lower odds of an abnormal total SDQ score ( multivariable-adjusted OR compared with never breastfed children ( n=3292/9525 , 35 % ) 0.67 , 95 % CI : 0.54 to 0.83 ) . This effect was similar for all the SDQ subscores . In preterm children , longer duration of breast feeding was generally associated with lower odds of abnormal SDQ total and subscores but the effect estimates were imprecise . The associations between exclusive breast feeding and abnormal SDQ scores were similar to those of any breast feeding and abnormal SDQ scores . Conclusions The findings suggest that , at least in term children , longer duration of breast feeding is associated with fewer parent-rated behavioural problems in children aged 5 years Background / Objectives : Low birth weight ( LBW ) , defined as the body weight at birth of less than 2500 g , is a major public health problem in Bangladesh , where 37 % of the babies are born with LBW . The objective of this study is to see the impact of nutrition education on growth of LBW babies with early initiation and exclusive breastfeeding compared to control group . Subjects/ Methods : A total of 184 LBW babies and their mothers who attended the Maternal Care and Health Training Institute and Dhaka Medical College Hospital were r and omly allocated to either intervention or control group .  Enrollment of the study population started in May 2008 and was completed in October 2008 .  Nutrition education was given to mothers twice weekly for 2 months , on initiation of breastfeeding within 1 h , exclusive breastfeeding and increasing their dietary intake . Nutritional status of LBW babies was assessed for length and weight every 2 weeks . Data were analyzed using SPSS/Window 's version 12 . Comparison of mean of data was done using st and ard Student 's t-test . Results : Mean initial body weight and length of LBW babies were similar in both groups ( 2261±198 g vs 2241±244 g , P=0.535 and 43.0±1.3 cm vs 43.0±1.7 cm , P=0.77 ) . Body weight and length of the LBW babies after 2 months increased significantly ( 3620±229 g vs 3315±301 g , P<0.001 and 50.2±1.3 cm vs 48.7±1.6 cm , P<0.001 ) . It was found that the intervention group suffered less from respiratory illness compared with the control group ( 39 % vs 66 % , P<0.001 ) . The rate of early initiation of breastfeeding was also significantly higher with nutrition intervention ( 59.8 % vs 37.2 % , P<0.001 ) . Exclusive breastfeeding rate was significantly higher in intervention group ( 59.8 % vs 37 % , P=0.003 ) . Conclusions : The present study showed that weight and length gain of  LBW  babies significantly increased by breastfeeding and nutrition education . Therefore , nutrition education on breastfeeding proves to be a strong tool to reduce the high risk of malnutrition and mortality of the LBW babies BACKGROUND The advantages of breastfeeding have been well established for both mothers and their infants . Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success . The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home setting s on breastfeeding outcomes and maternal satisfaction for mothers of term and near-term newborns who experienced st and ard or early discharge . METHODS In a r and omized controlled trial with prognostic stratification for gestational age , 101 term and 37 near-term ( 35 - 37 weeks ' gestational age ) mother-newborn pairs were r and omized to either a st and ard care group ( st and ard care and st and ard length of hospitalization ) or an experimental group ( st and ard hospital care with early discharge and home support from nurses who were certified lactation consultants ) . Data collection occurred before r and omization , at discharge from hospital , and from 5 to 12 days postpartum . Primary outcomes included breastfeeding rates and maternal satisfaction . RESULTS More mothers of term newborns in the experimental group were breastfeeding exclusively at follow-up ( p = 0.02 ) compared with the control group . No significant breastfeeding differences occurred among mothers with near-term newborns in the experimental and st and ard care groups . CONCLUSIONS In-home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns . This may also be a beneficial model of postpartum care for mothers of near-term newborns ; however , further research is required . The findings suggest implication s for health caregivers and policy makers with respect to postpartum lactation and health care services Objective . To determine whether an individualized , prenatal and postnatal , lactation consultant intervention result ed in increased cumulative intensity of breastfeeding up to 52 weeks . Design . The r and omized , nonblinded , controlled trial recruited women from prenatal care . Baseline prenatal interviews covered demographic data and breastfeeding experience , intention , and knowledge . Interviews at 1 , 2 , 3 , 4 , 6 , 8 , 10 , and 12 months after birth collected data on weekly feeding patterns , infant illness , and infant health care use . Setting . Two community health centers serving low-income , primarily Hispanic and /or black women . Participants . The analytic sample included 304 women ( intervention : n = 145 ; control : n = 159 ) with ≥1 postnatal interview . Intervention . Study lactation consultants attempted 2 prenatal meetings , a postpartum hospital visit , and /or home visits and telephone calls . Control subjects received the st and ard of care .  Outcome Measures . Cumulative breastfeeding intensity at 13 and 52 weeks , based on self-reports of weekly feeding , on a 7-level scale . Results . The intervention group was more likely to breastfeed through week 20 ( 53.0 % vs 39.3 % ) . Exclusive breastfeeding rates were low and did not differ according to group . In multivariate analyses , control subjects had lower breastfeeding intensity at 13 weeks ( odds ratio [ OR ] : 1.90 ; 95 % confidence interval [ CI ] : 1.13–3.20 ) and 52 weeks ( OR : 2.50 ; 95 % CI : 1.48–4.21 ) . US-born control subjects had lowest breastfeeding intensity at 13 weeks ( OR : 5.22 ; 95 % CI : 2.43–11.22 ) and 52 weeks ( OR : 5.25 ; 95 % CI : 2.44–11.29 ) . There were no significant differences in breastfeeding intensity among the US-born intervention , foreign-born intervention , and foreign-born control groups . Conclusions . This “ best- practice s ” intervention was effective in increasing breastfeeding duration and intensity . Breastfeeding promotion should focus on US-born women and exclusive breastfeeding Abstract Problem : Breastfeeding rates and related hospital practice s need improvement in Italy and elsewhere . Training of staff is necessary , but its effectiveness needs assessment . Context : Eight hospitals in different regions of Italy . Design : Controlled , non-r and omised study . Data collected in three phases . Training after the first phase in group 1 hospitals and after the second phase in group 2 . Strategies for change : Training of trainers and subsequent training of health workers with a slightly adapted version of the 18 hour Unicef course on breastfeeding management and promotion . Key measures for improvement : Hospital practice s , knowledge of 571 health workers  , and  breastfeeding rates at discharge , three , and six months in 2669 mother and baby pairs . Effects of change : After training hospitals improved their compliance with the “ ten steps to successful breast feeding , ” from an average of 2.4 steps at phase one to 7.7 at phase three . Knowledge scores of health professionals increased from 0.41 to 0.72 in group 1 ( training after phase one ) and from 0.53 to 0.75 in group 2 ( after phase two ) . The rate of exclusive breast feeding at discharge increased significantly after training : 41 % to 77 % in group 1 and 23 % to 73 % in group 2 , as did the rates of full ( exclusive plus predominant ) breast feeding at three months ( 37 % to 50 % in group 1 v 40 % to 59 % in group 2 ) and any breast feeding at six months ( 43 % to 62 % in group 1 v 41 % to 64 % in group 2 ) . Lessons learnt : Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practice s , knowledge of health workers , and breastfeeding rates OBJECTIVE Recognizing that an expectant father may influence a mother 's decision to breast- or formula-feed , we tested the effectiveness of a simple , educational intervention that was design ed to encourage fathers to advocate for breastfeeding and to assist his partner if she chooses to breastfeed . STUDY DESIGN We conducted a r and omized controlled trial in which expectant fathers ( n = 59 ) were assigned r and omly to attend either a 2-hour intervention class on infant care and breastfeeding promotion ( intervention ) or a class on infant care only ( control group ) . The classes , which were led by a peer-educator , were interactive and informal and utilized different media to create an accessible environment for participants . Couples were recruited during the second trimester from a university obstetrics practice . RESULTS Overall , breastfeeding was initiated by 74 % of women whose partners attended the intervention class , as compared with 41 % of women whose partners attended the control class ( P = .02 ) . CONCLUSION Expectant fathers can be influential advocates for breastfeeding , playing a critical role in encouraging a woman to breastfeed her newborn infant OBJECTIVE To evaluate the impact of a dietary counseling in reducing the intake of energy-dense foods by infants . DESIGN A r and omized controlled trial . SETTING AND PARTICIPANTS São Leopoldo , Brazil . Mothers and infants of a low-income-group population were r and omized into  intervention ( n = 163 ) and received dietary counseling during 10 home visits , or control  ( n = 234 ) groups . MAIN OUTCOMES MEASURES Child consumption of sugar-dense ( SD ) and lipid-dense ( LD ) foods at 12 to 16 months . ANALYSIS The effect of the intervention was expressed by relative risks and 95 % confidence intervals . Poisson regression analysis was used to determine the association between exclusive breastfeeding and the energy-dense foods intake . RESULTS A smaller proportion of infants from the intervention group consumed c and y , soft drinks , honey , cookies , chocolate , and salty snacks . In the intervention group , there was a reduction of 40 % and 50 % in the proportion of infants who consumed LD and SD foods , respectively . Being breastfed up to 6 months reduced the risk for consumption of LD and SD foods by 58 % and 67 % , respectively . CONCLUSIONS AND IMPLICATION S Dietary counseling to mothers may be effective in reducing the consumption of energy-dense foods among infants , and it is helpful in improving early dietary habits PURPOSE Adolescent mothers breastfeed less often and for a shorter duration than adult mothers . This r and omized controlled trial was design ed to evaluate the effect of telephone peer support on breastfeeding duration  among adolescents . METHODS Five adolescents who had previously breastfed were trained to provide peer support .  Seventy-eight breastfeeding mothers were r and omly assigned to an intervention group that received telephone calls from the peer support persons ( n = 38 ) or to a control group that did not receive support ( n = 40 ) . An independent interviewer telephoned all new mothers weekly to document feeding patterns . Peer support persons , subjects , and the interviewer were all blinded to the research hypothesis and to group assignment . The primary outcome variable was " any breastfeeding " duration , i.e. , the age at complete breastfeeding cessation . A secondary outcome variable was exclusive breastfeeding , i.e. , the age at first introduction of any supplement . RESULTS " Any breastfeeding " duration did not differ significantly between the groups ( median 75 days in the intervention group vs. 35 days in the control group , p = 0.26 ) . Among the 13 intervention and 11 control mothers who were exclusively breastfeeding at the time of hospital discharge , the duration of exclusive breastfeeding was increased in the intervention group ( median 35 days vs. 10 days , p = 0.004 ) . CONCLUSIONS This study did not demonstrate a significant effect of peer support on " any breastfeeding " duration . In contrast , exclusive breastfeeding duration appeared to be extended by peer support . This latter finding would benefit from confirmation in future studies . However , unless better methods are developed for retaining peers , this is likely to be a labor-intensive approach to extending exclusive breastfeeding duration among adolescent mothers This study aims to identify those most responsive to  breastfeeding peer counseling ( PC ) using data from a US-based r and omized trial . The authors ran a series of logistic regression models to identify differential responses to PC , using breastfeeding status at 0 , 1 , 3 , and 6 months postpartum as the dependent variables . Three subgroups were found to be most responsive to breastfeeding PC .  Multiparae receiving PC  were 6 times more likely to initiate breastfeeding than were multiparous controls ( odds ratio [ OR ] = 6.4 ; 95 % confidence interval [ CI ] = 1.9 - 20.8 ) . Similarly , those with uncertain prenatal breastfeeding intentions in the PC group were 7 times ( OR = 7.4 ; 95 % CI = 1.5 - 37.0 ) more likely to initiate breastfeeding than their control group counterparts . Among subjects partially breastfeeding on day 1 postpartum , those receiving PC were 12 times ( OR = 11.9 ; 95 % CI = 1.2 - 111.1 ) more likely to breastfeed through 3 months postpartum than were controls . These findings have important implication s to the Supplemental Food Program for Women , Infants and Children BACKGROUND The study documented Australian primigravidas ' perceptions about breastfeeding . OBJECTIVES To examine women 's perspectives of their breastfeeding experiences during the first 12 weeks postpartum . DESIGN A Journal was introduced to an  intervention group ( n=149 ) attending prenatal classes at a private hospital at 36 antenatal weeks . Using quantitative data at two days and 12 weeks postpartum , the intervention group was compared with a control group  ( n=154 ) that delivered at the same hospital . Qualitative data were also collected about the women 's perceptions about breastfeeding to further illuminate their experience . Qualitative data from 203 women at two days postpartum and 252 women at 12 weeks postpartum represented the combined comments from the intervention and control groups . PARTICIPANTS Participants were recruited as part of a r and omised controlled trial of the effects of a Breastfeeding Journal on breastfeeding prevalence , self-efficacy , support , and influence from conflicting advice . The convenience sample of middle class , well-educated primiparous women from a Western Australian hospital had given birth to a singleton infant that was greater than 34 weeks gestation . METHODS An open-ended question on a question naire sought mothers ' comments about their breastfeeding experiences . Data were analysed using inductive content analysis . FINDINGS These mothers described trying to ' get breastfeeding right ' . Getting it right included enhancing factors , factors with mixed effect , and negative factors . CONCLUSIONS Middle class mothers share breastfeeding perceptions with women in more vulnerable groups , including encountering conflicting and unhelpful advice and feeding pressures from health care professionals , family , and community members AIM This paper presents the findings of research comparing the incremental costs associated with the provision of home-based vs. hospital-based support for breastfeeding by nurse lactation consultants for term and near-term neonates during the first week of life . BACKGROUND A consequence of both consumer dem and s and increasing health re source constraints is that alternative care delivery models for safe , efficacious and cost-effective breastfeeding programmes have steadily evolved . To date , the economic impact of the setting ( home or hospital ) where lactation support is delivered has received little research attention . METHODS Mother-infant dyads were stratified by gestational age as term ( > 37 weeks gestational age ; n = 101 ) or near term ( 35 - 37 weeks gestational age ; n = 37 ) and r and omized to st and ard hospital care and postpartum follow-up ( st and ard care ) , or to st and ard hospital care plus home support from certified nurse lactation consultants ( experimental ) . Data collection occurred at study entry , hospital discharge and at a seventh day postpartum follow-up session . Costs to the family ( out-of-pocket and time costs ) and to the healthcare system ( during hospitalization and after hospital discharge ) were measured . Total societal costs were defined as the sum of both family and healthcare system costs . RESULTS Compared with st and ard hospital-based care , home support by nurse lactation consultants showed no statistically significant differences in either time costs to the family or total societal costs . Term infants who received home support had statistically significantly greater postdischarge system costs ( P < 0.0001 ) , with a trend towards lower out-of-pocket expenses to their families ( P = 0.12 ) . There were no statistically significant differences between the two groups in overall combined family and healthcare system costs . CONCLUSIONS These results suggest that the cost of home lactation support programmes were comparable with the costs of hospital-based st and ard care . Breastfeeding support at home by lactation consultants should be considered as an option as it was no more costly than support from lactation consultants in the hospital setting . The findings for near-term infants need to be interpreted with caution , given the small sample size OBJECTIVE To evaluate the effectiveness of a breastfeeding promotion program in the Women , Infant and Children ( WIC ) Supplemental Nutrition Program participants . STUDY DESIGN This r and omized clinical trial included 52 women in the intervention group who received one-to-one pre- and postnatal breastfeeding education and support from a lactation consultant . Women ( n = 52 ) r and omized to controls received  st and ard breastfeeding services . Data regarding their infants ' feeding ( classified as exclusive , partial , and bottle ) during the first 7 days , 1 , 2 , and 3 months of age were compared . Additionally , the mothers were surveyed to assess their knowledge , attitude , and beliefs regarding breastfeeding . RESULTS Among the 104 enrolled women , 91 ( 87.5 % ) were Hispanic . Almost all the pregnant women had planned to breastfeed their infants . Although the majority of women reported breastfeeding their infants , 45.6 % in the intervention group and 28.9 % of controls practice d exclusive breastfeeding during the first 7 days . By 3 months , the rate of exclusive breastfeeding in the intervention and control groups had dropped to 13.9 % and 10.5 % , respectively . Parity , mode of delivery , previous experience with breastfeeding , rooming in , and return to work did not significantly affect the exclusive breastfeeding rate . Maternal knowledge , attitude , and beliefs regarding breastfeeding were comparable between the study groups at the baseline stage as well as 3 months postpartum . CONCLUSIONS Participation in the proposed breastfeeding promotion program by the low-income mothers was associated with an insignificant increase in the exclusive breastfeeding rate during the first 3 postpartum months This pilot study evaluated how the scores from each of two breastfeeding assessment tools correlated with breastfeeding satisfaction and problems . A convenience sample of 30 first-time breastfeeding mothers participated . Mothers were r and omly assigned to use either the LATCH or Infant Breastfeeding Assessment Tool ( IBFAT ) . The Maternal Breastfeeding Evaluation Scale ( MBFES ) and Potential Early Breastfeeding Problem Tool ( PEBPT ) were used to evaluate the association of the scores of each assessment tool with breastfeeding satisfaction and breastfeeding problems . As scores on the both the LATCH and IBFAT increased , maternal satisfaction scores tended to increase , but not significantly , and breastfeeding problem scores tended to decrease ( r=-0.5 , p=0.06 and r=-0.49 , p=0.06 ; respectively ) BACKGROUND Exclusive breastfeeding for the first 6 months postpartum is promoted internationally as the preferred method of feeding infants . Infants of parents with a history of asthma in particular could benefit from a longer period ( 6 months ) of breastfeeding , because this may reduce the chance of developing an allergic disease . The aim of this study was to identify psychosocial behavioral determinants of the intended duration and actual initiation of breastfeeding in families with a predisposition to asthma . METHODS This prospect i ve study was part of a r and omized trial in which breastfeeding for 6 months was promoted . The 89 women participating completed a breastfeeding question naire based on the Attitude-Social Influence-Self-Efficacy model in the second trimester of their pregnancy . This served as the baseline measurement . RESULTS Multiple linear and logistic regression analyses showed that attitudinal beliefs were significantly associated with the intended duration to breastfeed ( p = 0.01 ) and the intention was the strongest predictor for the actual initiation of breastfeeding ( OR : 8.2 ; 95 % CI : 1.5 to 44.3 ) . CONCLUSION Breastfeeding promotion needs to focus on the health advantages and other advantages of breastfeeding for 6 months , especially in high-risk groups , in order to increase the intention to breastfeed , which appeared to be a strong predictor for actual behavior The purpose of this quasi-experimental study was to test the effects of home visits and telephone contacts on mothers ' compliance to breastfeeding in Taiwan . A total of 180 mothers was assigned to three groups : home visit , telephone contact , and control . No significant differences were found between groups . However , multiparas showed a significantly longer duration of breastfeeding and a more positive experience of breastfeeding than primiparas . The best subsets to predict breastfeeding duration were level of breastfeeding easiness and a home visit , which accounted for 20 % of the total variance OBJECTIVE To describe an intervention to provide support and encouragement to mothers of preterm newborns and to evaluate its effect on breastfeeding rates in the first 6 months after hospital discharge . METHODS One hundred newborns and their mothers were selected consecutively and prospect ively according to order of birth . The mother-infant dyads were alternately assigned to one of two groups : one group received routine care ( routine group ) , and the other group received the intervention ( intervention group ) . The intervention consisted of individualized support in addition to the routine support provided in the Neonatology Service . Before delivery , one of the research ers was introduced to the mother and offered her information about the delivery . The research er was also present at delivery , made an early visit to the infant in the intensive care unit , provided constant support for the mother to express breast milk and to maintain lactation , gave the mother information about maternal and infant hospital discharge , and provided outpatient follow-up after discharge . RESULTS Thirty-six dyads completed the study . The characteristics of mothers and infants , as well as causes of exclusion , were similar in the two groups . In the routine group , 38.9 % of the infants were being breastfed at hospital discharge , and median breastfeeding duration was 54 days . In the intervention group , 80.5 % were being breastfed at discharge , and median breastfeeding duration was 91 days ( p<0.01 ) . CONCLUSIONS Simple support measures offered to mothers during hospitalization and outpatient follow-up had a very positive effect on breastfeeding rates BACKGROUND Exclusive breastfeeding ( EBF ) is reported to be a life-saving intervention in low-income setting s. The effect of breastfeeding counselling by peer counsellors was assessed in Africa . METHODS 24 communities in Burkina Faso , 24 in Ug and a , and 34 in South Africa were assigned in a 1:1 ratio , by use of a computer-generated r and omisation sequence , to the control or intervention clusters . In the intervention group , we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers . The data gathering team were masked to the intervention allocation . The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks .  Country-specific prevalence ratios were adjusted for cluster effects and sites . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT00397150 . FINDINGS 2579 mother-infant pairs were assigned to the intervention or control clusters in Burkina Faso ( n=392 and n=402 , respectively ) , Ug and a ( n=396 and n=369 , respectively ) , and South Africa ( n=535 and 485 , respectively ) .  The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 ( 79 % ) of 392 and 139 ( 35 % ) of 402 , respectively , in Burkina Faso ( prevalence ratio 2·29 , 95 % CI 1·33 - 3·92 ) ; 323 ( 82 % ) of 396 and 161 ( 44 % ) of 369 , respectively , in Ug and a ( 1·89 , 1·70 - 2·11 ) ; and 56 ( 10 % ) of 535 and 30 ( 6 % ) of 485 , respectively , in South Africa ( 1·72 , 1·12 - 2·63 ) . The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 ( 77 % ) and 94 ( 23 % ) , respectively , in Burkina Faso ( 3·27 , 2·13 - 5·03 ) ; 305 ( 77 % ) and 125 ( 34 % ) , respectively , in Ug and a ( 2·30 , 2·00 - 2·65 ) ; and 41 ( 8 % ) and 19 ( 4 % ) , respectively , in South Africa ( 1·98 , 1·30 - 3·02 ) . At 24 weeks , the prevalences based on 24-h recall were 286 ( 73 % ) in the intervention cluster and 88 ( 22 % ) in the control cluster in Burkina Faso ( 3·33 , 1·74 - 6·38 ) ; 232 ( 59 % ) and 57 ( 15 % ) , respectively , in Ug and a ( 3·83 , 2·97 - 4·95 ) ; and 12 ( 2 % ) and two ( < 1 % ) , respectively , in South Africa ( 5·70 , 1·33 - 24·26 ) . The prevalences based on 7-day recall were 279 ( 71 % ) in the intervention cluster and 38 ( 9 % ) in the control cluster in Burkina Faso ( 7·53 , 4·42 - 12·82 ) ; 203 ( 51 % ) and 41 ( 11 % ) , respectively , in Ug and a ( 4·66 , 3·35 - 6·49 ) ; and ten ( 2 % ) and one ( < 1 % ) , respectively , in South Africa ( 9·83 , 1·40 - 69·14 ) . Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 ( 5 % ) and 36 ( 9 % ) , respectively , in Burkina Faso ( 0·57 , 0·27 - 1·22 ) ; 39 ( 10 % ) and 32 ( 9 % ) , respectively , in Ug and a ( 1·13 , 0·81 - 1·59 ) ; and 45 ( 8 % ) and 33 ( 7 % ) , respectively , in South Africa ( 1·16 , 0·78 - 1·75 ) . The prevalence at age 24 weeks in the intervention and control clusters was 26 ( 7 % ) and 32 ( 8 % ) , respectively , in Burkina Faso ( 0·83 , 0·45 - 1·54 ) ; 52 ( 13 % ) and 59 ( 16 % ) , respectively , in Ug and a ( 0·82 , 0·58 - 1·15 ) ; and 54 ( 10 % ) and 33 ( 7 % ) , respectively , in South Africa ( 1·31 , 0·89 - 1·93 ) . INTERPRETATION Low-intensity individual breastfeeding peer counselling is achievable and , although it does not affect the diarrhoea prevalence , can be used to effectively increase EBF prevalence in many sub-Saharan African setting s. FUNDING European Union Sixth Framework International Cooperation-Developing Countries , Research Council of Norway , Swedish International Development Cooperation Agency , Norwegian Programme for Development , Research and Education , South African National Research Foundation , and Rockefeller Brothers Foundation OBJECTIVE antenatal smoking is more prevalent among young women with low socio-economic status . The aim of our study is to assess whether the VoorZorg programme , compared to usual care , is effective in reducing cigarette smoking among young high risk pregnant women . Furthermore , the effect of VoorZorg on pregnancy outcomes and on breast feeding will be described . DESIGN a r and omised controlled trial of VoorZorg , a nurse home visitation intervention , was undertaken over a 2½ year period from 2007 to 2009 . Data were collected between 16 and 28 weeks gestation , 32 weeks gestation and at two months post partum on cigarette smoking status plus six months post partum for breastfeeding prevalence . Neonatal birth weight and gestation at birth were also collected . SETTING participants living in 20 municipalities in the Netherl and s. PARTICIPANTS 460 pregnant women were recruited by different professionals . Inclusion criteria were age < 26 years , ≤28 weeks pregnancy with the first child , low educational level and some knowledge of the Dutch language . INTERVENTIONS women in the intervention group received , in addition to usual care , the VoorZorg programme which consisted of 40 - 60 home visits by specialised nurses from pregnancy until two years after birth . FINDINGS the percentage of smokers was significantly lower in the intervention group ( 40 % ) compared to the control group ( 48 % ) during pregnancy ( p=0.03 ) and at two months post birth ( 49 % and 62 % ; p=0.02 ) . During pregnancy the number of daily cigarettes smoked was reduced in both groups . After birth , the intervention group smoked 50 % less cigarettes compared to the control group ( C : 8±10 ; I : 4±7 ( mean±st and ard deviation ( SD ) ) , p=0.01 ) . Furthermore , women in the intervention group did not smoke near the baby ( C : 2±5 ; I : 0±0 ( mean±SD ) p=0.03 ) . Birth weight and gestational age were similar in both groups ( C : 3147 g , 40 weeks ; I : 3144 g , 39 weeks ( p=0.94 , p=0.17 ) ) . Significantly more women in the intervention group were still breast feeding their baby at six months post -birth ( C : 6 % ; I : 13 % , p=0.04 ) . KEY CONCLUSIONS VoorZorg seemed to be effective in reducing cigarette smoking and in increasing breastfeeding duration . No effect was found on pregnancy outcomes BACKGROUND Despite the current World Health Organization recommendation that infants be exclusively breastfed for 6 mo , this practice remains unusual in both developed and developing countries . OBJECTIVE The objective was to compare health and development outcomes at age 6.5 y in children who were exclusively breastfed for 3 mo ( EBF3 ) or for 6 mo ( EBF6 ) ;  in the  EBF3 group , the children continued partial breastfeeding for > or = 6 mo . DESIGN This was a prospect i ve cohort study nested within a large , cluster-r and omized trial of a  breastfeeding promotion intervention in the Republic of Belarus . Outcomes compared at 6.5 y included anthropometric measurements , systolic and diastolic blood pressure , intelligence quotient , teachers ' ratings of academic performance , parent- and teacher-rated behavior , atopic symptoms , allergen skin-prick tests , and dental caries . All statistical analyses were adjusted for cluster- and individual-level covariates and for clustering of outcomes within the clinics at which the children were examined . RESULTS The 2427 EBF3 and 524 EBF6 children who were followed up represented 84.7 % and 89.4 % , respectively , of those followed for the first year of life . The only significant differences observed between the 2 groups were in mean body mass index , triceps skinfold thickness , and hip circumference , all of which were higher in the EBF6 group . CONCLUSIONS We observed no demonstrable beneficial or adverse long-term effects on child health of exclusive breastfeeding for 6 mo . Higher adiposity measures in the EBF6 group probably reflect reverse causality rather than a causal effect of prolonged exclusive breastfeeding . Established benefits appear to be limited to the period of exclusive breastfeeding In a r and omised controlled trial a lactation nurse assisted mothers  during the early weeks after parturition both in hospital and at home . All mothers who started breast feeding were entered into the trial . The lactation nurse significantly extended duration in the study group compared with controls , particularly during the first four weeks and among women of lower social class In rural Bangladesh , most births take place at home . There is little evidence regarding the influence of traditional birth attendants ( TBAs ) or community volunteers ( CVs ) on early infant feeding practice s. We conducted a pragmatic cluster r and omized controlled trial in Panchagarh District to examine the effects of training and post-training supervision of TBAs/CVs on early breastfeeding practice s. Nine unions were r and omized into three groups of three unions . We compared outcomes between mothers in a control group ( CG ) , those living in unions where TBAs/CVs had received a 5-day training in early feeding practice s ( TG ) and those living in unions where TBAs/CVs were both trained and supervised ( SG ) . A total of 1182 mothers of infants aged 0 - 6 months were interviewed at baseline . After 6 months of intervention , an endline survey was conducted on a different sample of 1148 mothers of infants aged 0 - 6 months in the same areas . In both intervention areas , TBAs/CVs made regular home visits and attended births whenever possible . Rates of early initiation of breastfeeding , avoidance of prelacteal feeds and exclusive breastfeeding were compared between groups using cluster-controlled mixed model logistic regression . At endline , both intervention groups had significantly higher proportions of mothers who reported early initiation of breastfeeding ( CG : 88 % , TG : 96 % , SG : 96 % ) and avoidance of prelacteal feeds ( CG : 48 % , TG : 80 % , SG : 88 % ) compared with the control group ; there were no significant differences between the two intervention groups . The endline rates of reported exclusive breastfeeding were not significantly different among groups ( CG : 67 % , TG : 76 % , SG : 83 % ) Objective To evaluate the efficacy , safety , and maternal satisfaction of a newly established integrative postpartum community-based clinic providing comprehensive support for mothers during the first month after discharge from the hospital . Our primary interests were breastfeeding rates , readmission and patient satisfaction . Methods A r and omized controlled trial was conducted in Ottawa , Canada , where 472 mothers were r and omized via a 1:2 ratio to either receive st and ard of care  ( n = 157 ) or to  attend the postpartum breastfeeding clinic  ( n = 315 ) . Outcome data were captured through question naires completed by the participants at 2 , 4 , 12 and 24 weeks postpartum . Unadjusted and adjusted logistic regression models were conducted to determine the effect of the intervention on exclusive breastfeeding at 12 weeks ( primary outcome ) . Secondary outcomes included breastfeeding rate at 2 , 4 and 24 weeks , breastfeeding self-efficacy scale , readmission rate , and satisfaction score . Results More mothers in the intervention group ( n = 195 , 66.1 % ) were exclusively breastfeeding at 12 weeks compared to mothers in the control group ( n = 81 , 60.5 % ) , however no statistically significant difference was observed ( OR = 1.28 ; 95 % CI:0.84–1.95 ) ) . The rate of emergency room visits at 2 weeks for the intervention group was 11.4 % compared to the st and ard of care group ( 15.2 % ) ( OR = 0.69 ; 95 % CI : 0.39–1.23 ) . The intervention group was significantly more satisfied with the overall care they received for breastfeeding compared to the control group ( OR = 1.96 ; 95 % CI : 3.50–6.88 ) ) . Conclusion This new model of care did not significantly increase exclusive breastfeeding at 12 weeks . However , there were clinical ly meaningful improvements in the rate of postnatal problems and satisfaction that support this new service delivery model for postpartum care . A community-based multidisciplinary postpartum clinic is feasible to implement and can provide appropriate and highly satisfactory care to mother-baby dyads . This model of care may be more beneficial in a population that is not already predisposed to breastfeed . Trial Registration Clinical Trials.gov BACKGROUND Peer support may improve  breastfeeding rates  but the evidence is inconclusive . Previous studies and review s recommend trials in different healthcare setting s. AIM To test if a specified programme of peer support affects the initiation and /or the duration of breastfeeding . DESIGN OF STUDY A two-group r and omised controlled trial of peer support for breastfeeding with evaluation of breastfeeding initiation and duration on an intention-to-treat basis . SETTING General practice in Ayrshire , Scotl and . METHOD Following informed consent , 225 women at 28 weeks gestation were allocated to control or peer support group by post-recruitment concealed allocation . All peer support and control group mothers received normal professional breastfeeding support . Additionally , those in the  peer support group still breastfeeding on return home from hospital had peer support until 16 weeks . RESULTS Thirty-five of the 112 ( 31 % ) women in the peer support group were breastfeeding at 6 weeks compared to 33/113 ( 29 % ) in the control group , a difference of 2 % ( 95 % confidence interval = -10 % to 14 % ) . The median breastfeeding duration for all women in the peer support group was 2 days compared to 1 day for the control group and the Kaplan-Meier survival plot shows the peer support group overall breastfeeding slightly longer than the control group , with no statistically significant difference by logrank test ( P = 0.5 ) . The median breastfeeding duration among primagravidae in the peer support group was 7 days , compared to 3 days for the control group . Among women who started to breastfeed the medians were 72 days in the peer support group and 56 days in the control group . These differences were not statistically significant . CONCLUSIONS Peer support did not increase breastfeeding in this population by a statistically significant amount OBJECTIVE To determine whether a Web-based interactive breastfeeding monitoring system increased breastfeeding duration , exclusivity , and intensity as primary outcomes and decreased symptoms of postpartum depression as a secondary outcome . DESIGN Two-arm , r and omized controlled trial . SETTING Three hospitals in the Midwestern United States . PARTICIPANTS One hundred forty one ( 141 ) mother-newborn dyads were recruited before discharge . METHODS Postpartum women were r and omly assigned to the control or intervention groups . Women in the control group ( n = 57 ) followed the st and ard hospital protocol , whereas women in the intervention group ( n = 49 ) were given access to an online interactive breastfeeding monitoring system and were prompted to record breastfeeding and infant output data for 30 days . A follow-up online survey was sent to both groups at 1 , 2 , and 3 months to assess breastfeeding outcomes and postpartum depression . RESULTS For mothers and infants , there were no significant differences in demographics between groups . No significant differences in breastfeeding outcomes were found between groups at discharge ( p = .707 ) . A significant difference in breastfeeding outcomes was found between groups at 1 , 2 , and 3 months ( p = .027 , p < .001 , and p = .002 , respectively ) . Members of the intervention group had greater exclusive breastfeeding rates at 1 , 2 , and 3 months . By the end of the third month , 84 % of the intervention group was breastfeeding compared with 66 % of the control group . Postpartum depression symptom scores decreased for both groups at 1 , 2 , and 3 months ( control group : 4.9 ± 3.9 , 4.3 ± 4.9 , and 3.2 ± 3.9 , respectively ; intervention group : 4.7 ± 4.5 , 3.0 ± 3.4 , and 2.8 ± 3.6 , respectively ) . However , there was no significant difference between groups at 1 , 2 , and 3 months ( p = .389 , .170 , and .920 , respectively ) for depression . CONCLUSION The Web-based interactive breastfeeding monitoring system may be a promising intervention to improve breastfeeding duration , exclusivity , and intensity Objectives : To assess whether a telephone-based breastfeeding intervention delivered by lactation educators influenced exclusive breastfeeding rates among low-income Hispanic women in the USA . Design : R and omised two-group design . Setting : Pregnant low-income Hispanic women ( 298 ) were recruited from community health clinics in Los Angeles County ( USA ) and r and omly assigned to either a control or an intervention group . Methods : Data relating to the factors associated with breastfeeding were collected during the third trimester . Breastfeeding outcome data were collected at 72 hours , 1 month , 3 months and 6 months postpartum . Results : There were no differences between the groups in rates of breastfeeding initiation . There was a significant difference in the duration of exclusive breastfeeding among participants during the infant ’s first week of life . While not significant , after controlling for covariates and intent to breastfeed at third trimester , the duration of exclusive breastfeeding among all participants was , on average , longer for intervention group mothers than control group mothers . Additionally , the intervention group mothers were more likely to report exclusive and only breastfeeding at all data points compared to the control group and less likely to discontinue breastfeeding . Conclusion : Findings from this study suggest that telephone-based breastfeeding interventions delivered by a lactation educator show promise as a cost-effective strategy for improving both the quantity and the duration of breastfeeding among low-income Hispanic women in the USA . Intervention group mothers not only sustained breastfeeding for a longer duration s but also provided their infants with greater amounts of breast milk over these longer duration New parents have fewer supports today than in previous decades due to factors such as short postpartum hospital stay , fragmentation of services , and long-distance families . This controlled trial evaluated the frequency of use of a 24-hour , in-hospital telephone line  by 130 parents r and omly invited to use the service and 130 who were not aware of this service . A special line with a separate extension was installed on the postpartum unit . R and omly arranged , sealed envelopes were given to 260 women at the time of discharge , containing a congratulations message or description of a new 24-hour telephone line for advice given by postpartum nurses . Of 53 calls requesting help , 36 were received on the special line and 17 on regular ward telephones ; 28 percent of those invited to call back did so , and 13 percent of those without an invitation called on the regular extension , ( P = 0.015 ) . Recommendations for future program planning are based on the results of this study We interviewed women who participated in a breast-feeding promotion intervention study about whether and how participation affected their infant feeding choices , and if they would recommend such an intervention to others . The larger study , a r and omized controlled trial ( RCT ) of an individualized , pre- and post-natal lactation consultant ( LC ) intervention , enrolled 382 low-income primarily Black and Hispanic women in New York City . Twenty-one women completed qualitative exit interviews  for this study ( 11 from the Intervention group and 10 Controls ) . Several of the Controls stated that the post-partum study interviews were a source of support , and made them more conscious of how they fed their infant . The Intervention Group was asked about contacts with the study ' Mother-Baby specialist ' ( i.e. LC ) , including what was and was n't helpful . The Intervention Group participants described the Mother-Baby Specialist as key in their decision to initiate and maintain breastfeeding . They credit her direct skills and positive reinforcement with their confidence and perseverance to breastfeed . The success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement , guidance and support The purpose of this study was to evaluate the effects of massage on infant weight gain and exclusive maternal breast-feeding of an intervention that involved teaching mothers to massage  their full-term infants . The sample included 100 healthy newborn infants who were receiving primary healthcare at 3 health centers in a low-income neighborhood of Santiago , Chile . The control group included 65 infants and the massage group included 35 infants . During their second well-child clinic visit , clinic nurses provided instruction to massage-group mothers about how to massage their infants , based on the methods of the Baby 's First Massage program ( http://www.babysfirstmassage.com/Scripts/default.asp ) . Mothers were encouraged to massage their infants for 10 to 15 minutes at least once a day , starting when their infants were 15 days old . There was no difference in the mean weights of the infants between the massage and control groups at baseline , but at age 2 months , massage group infants weighed significantly more than control-group infants . There were no weight differences between the 2 groups at age 4 months . There were no differences between the 2 groups on the incidence of exclusive maternal breast-feeding at age 2 or 4 months . The findings suggest that teaching mothers to massage their newborn infants may have a beneficial effect on the infant 's early weight gain . There is a need for additional studies to evaluate the effect of maternal massage on other health and welfare outcomes for both mothers and infants BACKGROUND Despite an extensive well-child health service , 30 % of New Zeal and 's 2- to 4-y old children are overweight or obese . This suggests that additional intervention is necessary to establish healthy nutrition behaviors . OBJECTIVE The aim of this study was to assess the effect of intervention from 0 to 18 mo of age on food and nutrient intake , eating behaviors , and parental feeding practice s in 18- to 24-mo-old children . DESIGN In total , 802 families with healthy infants were r and omly allocated to 1 of 4 groups : Usual Care ( UC ) ; Food , Activity , and Breastfeeding ( FAB ) ; Sleep ; or FAB and Sleep ( Combination ) . All groups received st and ard " well-child " care . The FAB intervention comprised 7 - 8 additional contacts for education and support around breastfeeding , food , and activity . The Sleep intervention comprised 2 additional contacts for guidance about sleeping habits . Combination families received both interventions . A vali date d food-frequency question naire assessed food intake at 2 y. A question naire assessed eating behaviors and parental feeding practice s at 18 and 24 mo . RESULTS At 2 y , there were no statistically significant differences in food and nutrient intake or eating behaviors in the groups receiving the FAB intervention ( FAB , Combination ; 325 children ) compared with the groups who did not ( Sleep , UC ; 341 children ) . With the use of a 5-point scale , small but statistically significant differences in parental feeding practice s were observed in the groups receiving the FAB intervention : greater child control over eating ( difference : 0.14 ; 95 % CI : 0.02 , 0.26 ) and less pressure to eat ( difference : 0.18 ; 95 % CI : 0.04 , 0.32 ) at 18 mo , as well as greater encouragement of nutrient-dense foods at 24 mo ( difference : 0.16 ; 95 % CI : 0.03 , 0.30 ) . No statistically significant differences were observed between the groups who received the Sleep intervention ( Sleep , Combination ; 313 children ) and those who did not , except higher meat intake in the former ( 11 g/d ) . CONCLUSION Additional education and support for parents from birth did not improve nutrition behaviors in this population at 2 y of age . This trial was registered at clinical trials.gov as NCT00892983 BACKGROUND Much postpartum physical and psychological morbidity is not addressed by present care , which tends to focus on routine examinations . We undertook a cluster r and omised controlled trial to assess community postnatal care that has been re design ed to identify and manage individual needs . METHODS We r and omly allocated 36 general practice clusters from the West Midl and s health region of the UK to intervention ( n=17 ) or control ( 19 ) care . Midwives from the practice s recruited women and provided care . 1087 ( 53 % ) of 2064 women were in practice s r and omly assigned to the  intervention  group , with 977 ( 47 % ) women in practice s assigned to the  control group . Care was led by midwives , with no routine contact with general practitioners , and was extended to 3 months . Midwives used symptom checklists and the Edinburgh postnatal depression scale ( EPDS ) to identify health needs and guidelines for the management of these needs . Primary outcomes at 4 months were obtained by postal question naire and included the women 's short form 36 physical ( PCS ) and mental ( MCS ) component summary scores and the EPDS . Secondary outcomes were women 's views about care . Multilevel analysis accounted for possible cluster effects . FINDINGS 801 ( 77 % ) of 1087 women in the intervention group and 702 ( 76 % ) of 977 controls responded at 4 months . Women 's mental health measures were significantly better in the intervention group ( MCS , 3.03 [ 95 % CI 1.53 - 4.52 ] ; EPDS -1.92 [ -2.55 to -1.29 ] ; EPDS 13 + odds ratio 0.57 [ 0.43 - 0.76 ] ) than in controls , but the physical health score did not differ . INTERPRETATION Re design of care so that it is midwife-led , flexible , and tailored to needs , could help to improve women 's mental health and reduce probable depression at 4 months ' postpartum OBJECTIVE . The objective of this study was to assess the long-term effects of  breastfeeding  on  child behavior and maternal adjustment .  METHODS . We followed up children who were in the Promotion of Breastfeeding Intervention Trial , a cluster-r and omized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children 's Fund Baby-Friendly Hospital Initiative . A total of 17046 healthy , breastfeeding mother – infant pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics ; 13889 ( 81.5 % ) were followed up at 6.5 years . Mothers and teachers completed the  Strengths and Difficulties Question naire and supplemental questions bearing on internalizing and externalizing behavioral problems . Mothers also responded to questions concerning their relationships to their partner and child and their breastfeeding of subsequently born children . RESULTS . The experimental intervention led to a large increase in exclusive breastfeeding at 3 months ( 43.3 % vs 6.4 % ) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months . No significant treatment effects were observed on either the mother or the teacher Strengths and Difficulties Question naire ratings of total difficulties , emotional symptoms , conduct problems , hyperactivity , peer problems , or prosocial behavior or on the supplemental behavioral questions . We found no evidence of treatment effects on the parent 's marriage or on the mother 's satisfaction with her relationships with her partner or child , but the experimental intervention significantly increased the duration of any breastfeeding , and mothers in the experimental group were nearly twice as likely to breastfeed exclusively the next-born child for at least 3 months . CONCLUSIONS . On the basis of the largest r and omized trial ever conducted in the area of human lactation , we found no evidence of risks or benefits of prolonged and exclusive breastfeeding for child and maternal behavior . Breastfeeding promotion does , however , favorably affect breastfeeding of the subsequent child CONTEXT Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies . Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries . OBJECTIVE To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants . DESIGN The Promotion of Breastfeeding Intervention Trial ( PROBIT ) , a cluster-r and omized trial conducted June 1996-December 1997 with a 1-year follow-up . SETTING Thirty-one maternity hospitals and polyclinics in the Republic of Belarus . PARTICIPANTS A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed , 16491 ( 96.7 % ) of which completed the entire 12 months of follow-up . INTERVENTIONS Sites were r and omly assigned to receive an experimental intervention ( n = 16 ) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children 's Fund , which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support , or a control intervention ( n = 15 ) of continuing usual infant feeding practice s and policies . MAIN OUTCOME MEASURES Duration of any breastfeeding , prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection , 2 or more episodes of respiratory tract infection , and atopic eczema during the first 12 months of life , compared between the intervention and control groups . RESULTS Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months ( 19.7 % vs 11.4 % ; adjusted odds ratio [ OR ] , 0.47 ; 95 % confidence interval [ CI ] , 0.32 - 0.69 ) , were more likely to be exclusively breastfed at 3 months ( 43.3 % vs 6.4 % ; P<.001 ) and at 6 months ( 7.9 % vs 0.6 % ; P = .01 ) , and had a significant reduction in the risk of 1 or more gastrointestinal tract infections ( 9.1 % vs 13.2 % ; adjusted OR , 0.60 ; 95 % CI , 0.40 - 0.91 ) and of atopic eczema ( 3.3 % vs 6.3 % ; adjusted OR , 0.54 ; 95 % CI , 0.31 - 0.95 ) , but no significant reduction in respiratory tract infection ( intervention group , 39.2 % ; control group , 39.4 % ; adjusted OR , 0.87 ; 95 % CI , 0.59 - 1.28 ) . CONCLUSIONS Our experimental intervention increased the duration and degree ( exclusivity ) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life . These results provide a solid scientific underpinning for future interventions to promote breastfeeding BACKGROUND Optimisation of breastfeeding practice s could reduce high mortality rates in children younger than 5 years , but in DR Congo , despite near-universal breastfeeding initiation and nine of ten children still breastfeeding at 1 year of age , exclusivity remains a difficulty . We assessed the effect on breastfeeding outcomes of a short-cut implementation of a programme called the Ten Steps to Successful Breastfeeding , the key component of the Baby-Friendly Hospital Initiative ( BFHI ) . METHODS We did a cluster-r and omised controlled trial and r and omly assigned  health-care clinics in Kinshasa , DR Congo , to st and ard care ( control group ) , BFHI steps 1 - 9 ( steps 1 - 9 group ) , or BFHI steps 1 - 9 plus additional support during well-child visits ( steps 1  -  10 group ) with computer-generated r and om numbers used to assign matched pairs to study groups . Mothers at these clinics who had given birth to one healthy baby during enrolment , and who expressed their intentions of visiting a well-baby session at the same clinic , were eligible and received the treatment assigned to their clinic . Mother-infant pairs were excluded if the mothers intended to attend well-baby clinic visits at a different health facility , or to travel before the child was aged at least 6 months . Participants and independent interviewers were masked to group assignment ( ie , they were recruited after r and omisaion and training of the clinic staff and were not informed of the study scheme ) , but clinical staff were unmasked . BFHI steps 1 - 9 and 1 - 10 were given by health-care staff trained with the WHO/UNICEF BFHI course . The primary outcomes were breastfeeding initiation within 1 h of birth and exclusive breastfeeding at age 14 and 24 weeks , assessed at face-to-face interviews in the clinic . Analysis was by intention to treat . Prevalence ratios ( PR ) were adjusted for cluster effects and baseline characteristics . This trial is registered at Clinical Trials.gov , number NCT01428232 , and is closed to new participants . FINDINGS Between May 24 , and Aug 25 , 2012 , we r and omly assigned two eligible clinics to control , two to BFHI steps 1 - 9 , and two to BFHI steps 1 - 10 . We enrolled 975 eligible mother-infant pairs ( 304 in the control group , 363 in the steps 1 - 9 group , and 308 in the steps 1 - 10 group ) . 230 ( 76 % ) of infants in the control group , 263 ( 72 % ) in the steps 1 - 9 group , and 220 ( 71 % ) in the steps 1 - 10 group were breastfed within 1 h of birth ; these results did not differ significantly between groups . Prevalence of exclusive breastfeeding at age 14 weeks was 89 ( 29 % ) in the control group , 237 ( 65 % ) in the steps 1 - 9 group ( adjusted PR 2·20 , 95 % CI 1·73 - 2·77 ) , and 129 ( 42 % ) in the steps 1 - 10 group ( 1·40 , 1·13 - 1·74 ) . At age 24 weeks , the prevalence of exclusive breastfeeding was 36 ( 12 % ) in the control group , 131 ( 36 % ) in the steps 1 - 9 group ( 3·50 , 2·76 - 4·43 ) , and 43 ( 14 % ) in the steps 1 - 10 group ( 1·31 , 0·91 - 1·89 ) . INTERPRETATION In the setting of health-care clinics in DR Congo with a high proportion of mothers initiating breastfeeding , implementation of basic training in BFHI steps 1 - 9 had no additional effect on initiation of breastfeeding but significantly increased exclusive breastfeeding at 6 months of age . Additional support based on the same training material s and locally available breastfeeding support material s , offered during well-child visits ( ie , step 10 ) did not enhance this effect , and might have actually lessened it OBJECTIVE To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income , inner-city population . DESIGN A r and omized , nonblinded clinical control trial . Patients were followed up through pregnancy , delivery , and the first year of the infant 's life or until the time of weaning from the breast , whichever came first . SETTING The ambulatory care center for prenatal and pediatric care and the inpatient maternity unit of a primary care center that serves a low-income , inner-city population . PATIENTS There were a total of 108 patients : 51 were r and omized to the intervention group that received prenatal and postnatal lactation instruction from a lactation consultant , and 57 were r and omized to the control group that  received the st and ard of care at the institution . Patients in the control group were not seen by the lactation consultant . The two groups were similar demographically . INTERVENTION This program consisted of individual prenatal lactation consultation , daily rounds by the lactation consultant on the postpartum unit , and outpatient follow-up at 48 hours after discharge , at the time that the infant was 1 week of age , and at all future health supervision visits for infants up to 1 year of age . MAIN OUTCOME MEASURES The incidence and duration of breast-feeding . RESULTS There was a markedly higher incidence of breast-feeding in the intervention group , as compared with that of the control group ( 61 % vs 32 % , respectively ; P = .002 ) . The duration of breast-feeding was also significantly longer in the intervention group ( P = .005 ) . CONCLUSIONS This lactation program increased the incidence and duration of breast-feeding in our low-income cohort . We suggest that similar efforts that are applied to analogous population s may increase the incidence and duration of breast-feeding in low-income population s in the United States OBJECTIVE To determine whether infants of women r and omized to a prenatal and postpartum lactation support intervention  incur fewer otitis media- , respiratory tract- , or gastrointestinal-related visits than controls . DESIGN R and omized , unmasked controlled trial recruiting women from prenatal care setting s. Breastfeeding sensitive ( BFS ) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months . SETTING Two urban community health centers . PARTICIPANTS Analytic sample of 338 low-income , primarily Hispanic and /or black mother-infant dyads ( n = 163 for the intervention group and n = 175 for the control group ) . INTERVENTION Study lactation consultants attempted 2 prenatal meetings , 1 postpartum hospital and /or home visit , and telephone calls as needed . Controls received the st and ard of care . MAIN OUTCOME MEASURES Combined outpatient and emergency department visits with illness and BFS illness diagnoses . RESULTS There was a significant interaction between treatment and Medicaid ; among those not receiving Medicaid , the number of otitis media visits was higher among controls ( P</=.03 ) . Visits for any illness and BFS , gastrointestinal , or respiratory tract illnesses did not differ by treatment group . Intervention group infants received more breast milk than controls , but exclusive breastfeeding rates remained low and did not differ between groups at any point . CONCLUSIONS Only the number of otitis media visits was reduced , in a subset of the intervention group . The intervention did not reduce visits for respiratory tract or gastrointestinal illness . Limited intervention contact and low exclusive breastfeeding rates may have attenuated intervention effects . Future interventions design ed to yield markedly increased breastfeeding rates may show greater effects in low-income multiethnic sample s. Health coverage for visits may moderate intervention effects BACKGROUND Exclusive breastfeeding for 6 months is acknowledged universally as the optimal feeding method for infants in order to provide the greatest health and well-being gains for the infant and mother . Despite this , many women stop short of attaining this desired outcome for their infant . With the permeation of the Internet into most of society , the aim of this study was to evaluate the effect of a breastfeeding support Internet intervention on breastfeeding outcomes on women living in regional Western Australia . MATERIAL S AND METHODS A nested intervention design within a longitudinal cohort titled the Regional Infant Feeding Study examined the effect of an Internet support Web site on the infant feeding practice s of women living in regional Western Australia . RESULTS In total , 414 women participated in the Internet study and were r and omly assigned to the control group ( n=207 ) or the intervention group ( n=207 ) . Women enrolled in the intervention were significantly more likely to be exclusively breastfeeding at 6 months postpartum compared with control group participants . Those women experiencing breastfeeding problems were more likely to access the Internet . CONCLUSIONS This breastfeeding support intervention study demonstrated a positive effect on longer-term exclusive breastfeeding for those enrolled in the intervention group . Together with more traditional methods of support , the Internet provides another possible method for promoting positive long-term breastfeeding outcomes OBJECTIVES To pilot test a newly developed breastfeeding self-efficacy intervention . DESIGN Pilot r and omized controlled trial ( RCT ) . SETTING An acute care hospital located in Northwestern Ontario that is the sole provider of maternity care for the city and referral center for the region . PARTICIPANTS One-hundred- and -fifty primiparous women intending to breastfeed their healthy , term , singleton infant . INTERVENTION A st and ardized , individualized nursing intervention protocol was design ed and administered to increase mothers ' breastfeeding self-efficacy . Participants were r and omly allocated to the intervention group or control group using sealed , opaque envelopes . Participants in the intervention group received three individualized , self-efficacy enhancing sessions with the research er : two in-hospital and one by telephone . Participants in the control group received st and ard in-hospital and community care . MAIN OUTCOME MEASURES Feasibility , compliance , and the acceptability of the breastfeeding self-efficacy intervention . Other outcomes assessed were breastfeeding self-efficacy , duration , and exclusivity . RESULTS Findings suggest that the intervention was feasible ; there was a high degree of protocol compliance , and the majority of mothers reported that the intervention was beneficial . Mothers in the intervention group had higher rates of breastfeeding self-efficacy , duration , and exclusivity at 4 and 8 weeks postpartum . However , the differences between groups were not statistically significant . CONCLUSION The pilot RCT provided valuable information in examining the feasibility of the trial design and intervention OBJECTIVE To test the effects of the Healthy Steps for Young Children program ( HS ) ( which supports parents managing children 's developmental and behavioral issues)-with  and without a prenatal component-on child health and development , parenting practice s , and parental well-being . DESIGN A concurrent comparison with clinic-level assignment to intervention or usual care status . Nested in the intervention arm , a r and omized trial compared HS with and without a prenatal component . SETTING Five primary care clinics in an integrated delivery system in the Pacific Northwest . PARTICIPANTS A consecutive sample of 439 pregnant women ( 80 % of eligible ) were enrolled . Follow-up data were obtained for 78 % when the child was 30 months old . Intervention Families in intervention clinics received HS services , including developmental and behavioral advice and risk factor screening . In addition , those r and omized to prenatal services received 3 home visits during pregnancy . MAIN OUTCOME MEASURES Assessed by telephone interview in the 3 domains of child health and development , parenting practice s , and parental well-being . RESULTS Intervention was associated with positive outcomes in timely well-child care , immunization rates , breastfeeding , television viewing , injury prevention , and discipline strategies . Prenatal initiation of services was associated with larger expressive vocabularies at age 24 months . Mothers who received the intervention reported more depressive symptoms , but there was no increase in the proportion with clinical ly significant depression . CONCLUSIONS For members of an integrated delivery system , the HS intervention was associated with positive effects on children 's health and parenting practice s. There was little evidence of any additional benefit of HS services initiated during the prenatal period Our aim was to investigate whether the duration of breastfeeding , at all or exclusively , is associated with educational achievement at age 5 . We used data from a prospect i ve , population -based UK cohort study , the Millennium Cohort Study ( MCS ) . 5489 children from White ethnic background born at term in 2000 - 2001 , attending school in Engl and in 2006 , were included in our analyses . Educational achievement was measured using the Foundation Stage Profile ( FSP ) , a statutory assessment undertaken by teachers at the end of the child 's first school year .  Breastfeeding  duration was ascertained from interviews with the mother when the child was 9 months old . We used modified Poisson 's regression to model the association of breastfeeding duration with having reached a good level of achievement overall ( ≥78 overall points and ≥6 in ' personal , social and emotional development ' and ' communication , language and literacy ' points ) and in specific areas ( ≥6 points ) of development . Children who had been breastfed for up to 2 months were more likely to have reached a good level of overall achievement [ adjusted rate ratio ( RR ) : 1.09 , 95 % confidence interval ( CI ) : 1.01 , 1.19 ] than never breastfed children . This association was more marked in children breastfed for 2 - 4 months ( adjusted RR : 1.17 , 95 % CI : 1.07 , 1.29 ) and in those breastfed for longer than 4 months ( adjusted RR : 1.16 , 95 % CI : 1.07 , 1.26 ) . The associations of exclusive breastfeeding with the educational achievement were similar . Our findings suggest that longer duration of breastfeeding , at all or exclusively , is associated with better educational achievement at age 5 To study the effects of prolonged and exclusive breast-feeding on  dental caries  , we followed up children participating in the Promotion of Breastfeeding Intervention Trial ( PROBIT ) , a cluster-r and omized trial of a breast-feeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative . A total of 17,046 healthy , mother-infant breast-feeding pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics , of whom 13,889 ( 81.5 % ) were followed up at 6.5 years . At follow-up , polyclinic pediatricians transcribed the reports of a st and ard dental examination performed by public health dentists at age 6 years and recorded in the children ’s polyclinic charts . Analysis was based on intention to treat , with a statistical model that accounts for clustering within hospitals/clinics to permit inferences at the individual level . The experimental intervention led to a large increase in exclusive breast-feeding at 3 months ( 43.3 vs. 6.4 % , p < 0.001 ) and a significantly higher prevalence of any breast-feeding at all ages up to and including 12 months . No significant intervention effects were observed on dental caries . Our results , based on the largest r and omized trial ever conducted in the area of human lactation , provide no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early school age BACKGROUND Inconsistent findings leave uncertainty about the impact of pacifier use on effective breastfeeding technique . The purpose of this study was to investigate how breastfeeding technique and pacifier use were related to  breastfeeding problems  and  duration of breastfeeding .  METHODS Data were collected from the intervention group of a r and omized trial in which health visitors followed up with mothers for 6 months after childbirth . The health visitors classified the breastfeeding technique at approximately 1 week after birth and repeated the observation if a correction was necessary . Effective technique included positioning , latch , sucking , and milk transfer . Data on breastfeeding problems and pacifier use were obtained from self-reported question naires . The study population included 570 mother-baby pairs with complete information on breastfeeding technique and pacifier use . The primary outcome was duration of exclusive breastfeeding . RESULTS One-half of the mothers showed ineffective breastfeeding technique at the first\ observation , most frequently ineffective position ( 61 % ) and latch ( 52 % ) . In the unadjusted analysis , only sucking and milk transfer were associated with breastfeeding duration . In the adjusted analysis , ineffective technique was significantly associated with mothers reporting early breastfeeding problems , which thereby influenced the breastfeeding duration . Pacifier use had an independent negative impact on duration of breastfeeding . A single correction of the breastfeeding technique was not associated with duration or occurrence of problems . CONCLUSIONS Observation of breastfeeding technique may help mothers in the stage of when they are establishing breastfeeding to avoid early and later problems , but breastfeeding technique is less useful in predicting breastfeeding duration . Use of a pacifier should be avoided in the first weeks after birth BACKGROUND Smoking in the postpartum period may contribute to early weaning , although the nature and temporal aspect of the relationship are poorly understood . The objective of this study was to examine the association between early weaning and smoking relapse among women who stopped smoking during pregnancy . METHODS A secondary analysis of data from a r and omized controlled trial was conducted . The participants were 228 women who had stopped smoking for pregnancy , who participated in a smoking relapse prevention trial , and who breastfed .  Women who relapsed to daily smoking postpartum were compared with those who remained abstinent or smoked occasionally . The dependent variable was  breastfeeding for less than 26 weeks ( early weaning ) . Potential covariates included intended duration of breastfeeding , parity , partner 's smoking , nicotine dependence , emotional health , return to paid employment , and various sociodemographic variables . RESULTS Approximately two-thirds ( 65.1 % ) of the women who relapsed to daily smoking weaned before 26 weeks compared with 33.8 percent of the women who remained abstinent or smoked occasionally . Controlling for intended duration of breastfeeding , education , and return to paid employment , women who resumed daily smoking were almost four times more likely to wean early than those who abstained or smoked occasionally . CONCLUSIONS Early weaning may result from psychological or physiological changes associated with tobacco use . Smoking relapse prevention in the postpartum period may be one of the most effective interventions in ensuring that women who stop smoking for pregnancy remain stopped and breastfeed their babies for the recommended duration AIM Exclusive breastfeeding increases survival and optimizes growth of low-birthweight ( LBW ) infants . If supported , mothers can overcome the unique difficulties associated with breastfeeding from birth to 6 mo . We tested the efficacy of postnatal peer counselling among first-time mothers that aim ed to increase exclusive breastfeeding of term LBW infants . METHODS In a Manila hospital , 204 mothers were r and omized into three groups .  Two intervention groups receiving home-based counselling visits , one by counsellors trained in breastfeeding counselling ( n=68 ) , the other by counsellors trained in general childcare ( n=67 ) , were compared with a control group of mothers ( n=69 ) who did not receive counselling . RESULTS Eighty-eight per cent of the participating pairs completed the trial . At 6 mo , 44 % of the breastfeeding counselled mothers , 7 % childcare-counselled mothers and none of the mothers in the control group were exclusively breastfeeding . More mothers in the breastfeeding counselled group than in the other groups were still breastfeeding at 6 mo . Twenty-four infants who were exclusively breastfed for 6 mo did not have any diarrhoea . All groups had improved mean weight-for-age Z-scores at 6 mo . CONCLUSION This study has provided fundamental evidence of successful intervention to achieve 6 mo of exclusive breastfeeding among term LBW infants . By improving health outcomes , enhanced breastfeeding offers a distinct possibility of disrupting the intergenerational cycle of undernourished women giving birth to LBW infants BACKGROUND Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh . Therefore the project for advancing the health of newborns and mothers ( Projahnmo ) implemented a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality . METHODS In Sylhet district , 24 clusters ( with a population of about 20 000 each ) were r and omly assigned in equal numbers to one of two intervention arms or to the comparison arm . Because of the study design , masking was not feasible . All married women of reproductive age ( 15 - 49 years ) were eligible to participate . In the home-care arm , female community health workers ( one per 4000 population ) identified pregnant women , made two antenatal home visits to promote birth and newborn-care preparedness , made postnatal home visits to assess newborns on the first , third , and seventh days of birth , and referred or treated sick neonates . In the community-care arm , birth and newborn-care preparedness and careseeking from qualified providers were promoted solely through group sessions held by female and male community mobilisers . The primary outcome was reduction in neonatal mortality . Analysis was by intention to treat . The study is registered with Clinical Trials.gov , number 00198705 . FINDINGS The number of clusters per arm was eight . The number of participants was 36059 , 40159 , and 37598 in the home-care , community-care , and comparison arms , respectively , with 14 769 , 16 325 , and 15 350 livebirths , respectively . In the last 6 months of the 30-month intervention , neonatal mortality rates were 29.2 per 1000 , 45.2 per 1000 , and 43.5 per 1000 in the home-care , community-care , and comparison arms , respectively . Neonatal mortality was reduced in the home-care arm by 34 % ( adjusted relative risk 0.66 ; 95 % CI 0.47 - 0.93 ) during the last 6 months versus that in the comparison arm . No mortality reduction was noted in the community-care arm ( 0.95 ; 0.69 - 1.31 ) . INTERPRETATION A home-care strategy to promote an integrated package of preventive and curative newborn care is effective in reducing neonatal mortality in communities with a weak health system , low health-care use , and high neonatal mortality OBJECTIVE To explore the midwife 's role in providing education and support for changes in smoking behaviour during usual primary maternity care . DESIGN A qualitative study using a thematic approach to analysis of data collected in face-to-face interviews . SETTING AND PARTICIPANTS Eleven women who had participated in the intervention groups of the MEWS Study , a cluster r and omised trial of education and support for women who smoke , and 16 midwives from the intervention and control arms of the trial . The trial was set in the lower North Isl and of New Zeal and in 2000 . FINDINGS Midwives acknowledged that asking women about smoking was part of their role as maternity care providers . However , many found it difficult to know how to ask women about their smoking , how to identify the women who would be receptive to advice and how to support them to make changes to their smoking . Midwives were also concerned about making women feel guiltier than they already did about their smoking , and about the impact of providing smoking cessation on their relationship with women . In contrast , women expected their midwife to ask them about their smoking . When women wanted to quit their midwife was an extremely valuable source of information and support . Midwives were also in a position to help women who did not want to quit to make other changes to their smoking behaviour . Even women who did not want to quit were prepared to be asked about their smoking . Problems arose when the way the midwife asked and the frequency of her enquiries were not appropriate for the stage of the change cycle the woman was in . IMPLICATION S FOR PRACTICE Midwives can effectively provide education and support for smoking change during pregnancy if they match the woman 's readiness to make changes with the type of advice and support they provide Background Promotion of healthy eating and physical activity in early childhood is recommended as a global chronic disease prevention strategy . Centre-based childcare services represent a promising setting to provide children with opportunities to improve healthy eating and physical activity . Evidence to inform implementation of childcare obesity prevention guidelines into routine practice in childcare , however , is lacking . This study aims to assess the effectiveness of an intervention , delivered to childcare staff , aim ing to increasing service implementation of healthy eating and physical activity-promoting policies and practice s. Methods and analysis A pragmatic parallel group r and omised controlled trial will be undertaken with 165 childcare services in the Hunter New Engl and region of New South Wales , Australia . Services will be r and omised to receive either a 10-month evidence -based performance review intervention with other re sources to support practice change , or to a waitlist control group . The primary trial outcome is the proportion of services implementing all of the following recommended healthy eating and physical activity promoting practice s : written nutrition , physical activity and small screen recreation policies ; providing information to families regarding healthy eating ( including breastfeeding ) , physical activity and small screen time ; providing twice weekly healthy eating learning experiences to children ; providing water and only plain milk to children ; providing fundamental movement skills activities for children every day ; and limiting and using electronic screen time more for educational purpose s and learning experiences . Effectiveness will be assessed using a telephone interview of practice implementation with childcare staff at baseline and 12 months following baseline . Ethics and dissemination The study was approved by the Hunter New Engl and Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee . Study findings will be disseminated widely through peer- review ed publications and conference presentations . Trial registration number Australian New Zeal and Clinical Trials Registry ACTRN12614000972628 This r and omized clinical trial compared frequencies of exclusive breastfeeding  and lactationrelated problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward , and 137 controls . The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days ( 79.7 % vs 82.5 % , respectively ) and 30 days ( 60.8 % vs 53.3 % ) . There was no difference between groups in the frequency of sore nipples at 7 and 30 days , in breast engorgement and mastitis , and in the quality of breastfeeding technique at 30 days . Therefore , a single intervention at maternity was not sufficient to improve breastfeeding technique , increase exclusive breastfeeding rates , and reduce the incidence of breastfeeding problems during the first month OBJECTIVE to evaluate the effects of an extended midwifery support ( EMS ) programme on the proportion of women who breast feed fully to six months . DESIGN r and omised controlled trial . SETTING large public teaching hospital in Australia . PARTICIPANTS 849 women who had given birth to a healthy , term , singleton baby and who wished to breast feed . INTERVENTION participants were allocated at r and om to EMS , in which they were offered a one-to-one postnatal educational session and weekly home visits with additional telephone contact by a midwife until their baby was six weeks old ; or st and ard postnatal midwifery support ( SMS ) . Participants were stratified for parity and tertiary education . MEASUREMENTS the main outcome measures were prevalence of full and any breast feeding at six months postpartum . FINDINGS there was no difference between the groups at six months postpartum for either full breast feeding [ EMS 43.3 % versus SMS 42.5 % , relative risk ( RR ) 1.02 , 95 % confidence interval ( CI ) 0.87 - 1.19 ] or any breast feeding ( EMS 63.9 % versus SMS 67.9 % , RR 0.94 , 95%CI 0.85 - 1.04 ) . CONCLUSIONS the EMS programme did not succeed in improving breast-feeding rates in a setting where there was high initiation of breast feeding . Breast-feeding rates were high but still fell short of national goals . IMPLICATION S FOR PRACTICE continuing research of programmes design ed to promote breast feeding is required in view of the advantages of breast feeding for all mothers and babies Atrialwas conducted with 51women r and omly assigned either to a conventional nursing care group or to an individualized professional support group ;  to examine the effect of professional support on breastfeeding status at 4 weeks postpartum . All participants identified themselves as having no prior support . At 4 weeks postpartum , 17 out of 25 ( 68 % ) and 26 out of 26 ( 100 % ) women in the control and intervention groups , respectively , continued to breastfeed ( P=.005 ) . Results indicate that postpartum care augmented with individualized professional support commenced in the hospital and continued in the community significantly increases the duration of breastfeeding among women who identify themselves as being without support for the first month postpartum BACKGROUND Despite numerous advantages of breastfeeding , in Democratic Republic of the Congo , the rate of children exclusively breastfed up to six months remains low . The lack of breastfeeding support received by mothers from health care providers is an important factor of early cessation of breastfeeding . This study aim ed to evaluate the effect of the training of health care providers , in the Baby Friendly Hospital Initiative , on the duration of  exclusive breastfeeding ( EBF ) in Kinshasa . METHODS A total of 422 mothers , recruited during the first antenatal care visit in 12 maternities and followed up to six months after delivery , were included in a cluster r and omized trial . In the experimental group , health care providers were trained using the " 20-Hour Course For Maternity Staff " . Cox proportional hazards model was used to determine the effect of the intervention on the duration of EBF . RESULTS The rate of EBF at six months was 2.8 % ; the median duration of EBF was 10.9 weeks ( IQR 4.3 to 14.9 ) . The hazard of discontinuing EBF before six month was 1.4 times higher in the control group ( adjusted HR [95%CI]=1.40 ( 1.10 - 1.78 ) , P=0.007 ) . CONCLUSION In this study , training of health care providers in the Baby Friendly Hospital Initiative was associated with a significant improvement in the duration of EBF . Extending this training to different maternities could improve the coverage of EBF in Kinshasa BACKGROUND Promotion of breastfeeding is an important child-survival intervention , yet little is known about which promotional strategies are the most effective . We aim ed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil -- a hospital-based system and the same system combined with a programme of home visits . METHODS In February , 2001 , maternity staff from two hospitals in Pernambuco , Brazil , were trained according to the Baby-Friendly Hospital Initiative ( BFHI ) . In a r and omised trial between March and August , 2001 , 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding ( n=175 ) or no home visits ( n=175 ) . Breastfeeding practice s were studied on days 1 , 10 , 30 , 60 , 90 , 120 , 150 , and 180 by research ers unaware of group allocation . The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months . Analyses were by intention to treat . FINDINGS The hospital-training intervention achieved a high rate ( 70 % ) of exclusive breastfeeding in the hospitals , but this rate was not sustained at home and at 10 days of age only 30 % of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10 - 180 differed significantly ( p<0.0001 ) , with a mean aggregated prevalence of 45 % among the group assigned home visits compared with 13 % for the group assigned none . INTERPRETATION The BFHI achieves high rates of exclusive breastfeeding in hospital ; however , in Brazil at least , the rates fall rapidly thereafter . Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed . A combination of promotional systems ( hospital-based and in the community ) is needed BACKGROUND Although lactation experts suggest that a correct positioning and attachment technique reduces breastfeeding problems and enhances long-term breastfeeding , evidence from r and omized trials is lacking . The objective of this study was to evaluate the effect of postpartum positioning and attachment education on breastfeeding outcomes in first-time mothers . METHOD A r and omized trial was performed in a public hospital in Adelaide , South Australia , where 160 first-time mothers were r and omly allocated to receive either structured one-to-one education ( experimental group ) or usual postpartum care ( control group ) within 24 hours of birth . The primary outcome was breastfeeding at 6 weeks and 3 and 6 months postpartum ; other outcomes were nipple pain and trauma in hospital and at 6 weeks and 3 and 6 months , and satisfaction with breastfeeding . RESULTS No significant differences occurred in breastfeeding rates between the groups at each endpoint , although a trend in the direction of lower rates was seen at each endpoint in the experimental group . This group reported less nipple pain on days 2 ( p = 0.004 ) and 3 ( p = 0.04 ) , but this was not sustained on follow-up . No differences were observed in nipple trauma in hospital or in self-reported nipple pain and /or trauma at the three endpoints . Experimental group women were less satisfied with breastfeeding at 3 and 6 months postpartum when using a one-item measure ; however , a multiple-item measure showed no significant differences at the three endpoints . CONCLUSIONS The intervention did not increase breastfeeding duration at any assessment time or demonstrate any differences between the groups on secondary outcomes . The trend toward lower breastfeeding rates in the experimental group suggests a need for a larger trial to evaluate whether or nor postpartum positioning and attachment education may negatively affect breastfeeding OBJECTIVE The purpose of this study was to assess whether providing a breastfeeding support team results in higher breastfeeding rates at 6 , 12 , and 24 weeks postpartum among urban low-income mothers . METHODS DESIGN A r and omized controlled trial with mother-infant dyads recruited from 2 urban hospitals . PARTICIPANTS Breastfeeding mothers of full-term infants who were eligible for Special Supplemental Nutrition Program for Women , Infants , and Children ( n=328 ) were r and omized to intervention ( n=168 ) or usual-care group ( n=160 ) . INTERVENTION The 24-week intervention included hospital visits by a breastfeeding support team , home visits , telephone support , and 24-hour pager access . The usual-care group received st and ard care . OUTCOME MEASURE Breastfeeding status was assessed by self-report at 6 , 12 , and 24 weeks postpartum . RESULTS There were no differences in the sociodemographic characteristics between the groups : 87 % were African American , 80 % single , and 51 % primiparous . Compared with the usual-care group , more women reported breastfeeding in the intervention at 6 weeks postpartum , 66.7 % vs 56.9 % ( odds ratio , 1.71 ; 95 % confidence interval , 1.07 - 2.76 ) . The difference in rates at 12 weeks postpartum , 49.4 % vs 40.6 % , and 24 weeks postpartum , 29.2 % vs 28.1 % , were not statistically significant . CONCLUSIONS The intervention group was more likely to be breastfeeding at 6 weeks postpartum compared with the usual-care group , a time that coincided with the most intensive part of the intervention OBJECTIVE Early postpartum home visiting is universal in many Western countries . Studies from developing countries on the effects of home visits are rare . In Syria , where the postpartum period is rather ignored , this study aim ed to assess whether a community-based intervention of postnatal home visits has an effect on maternal postpartum morbidities ; infant morbidity ; uptake of postpartum care ; use of contraceptive methods ; and on selected neonatal health practice s. DESIGN A r and omized controlled trial was carried out in Damascus . Three groups of new mothers were r and omly allocated to receive either 4 postnatal home visits ( A ) , one visit ( B ) , or no visit ( C ) . SAMPLE A total of 876 women were allocated and followed up . INTERVENTION Registered midwives with special training made a one or a series of home visits providing information , educating , and supporting women . RESULTS A significantly higher proportion of mothers in Groups A and B reported exclusively breastfeeding their infants ( 28.5 % and 30 % , respectively ) as compared with Group C ( 20 % ) , who received no visits . There were no reported differences between groups in other outcomes . CONCLUSIONS While postpartum home visits significantly increased exclusive breastfeeding , other outcomes did not change . Further studies framed in a nonbiomedical context are needed . Other innovative approaches to improve postnatal care in Syria are needed INTRODUCTION Women 's traditional way of breastfeeding has altered in Jordan with rates declining in recent years . OBJECTIVE The objectives of this study were to test whether the introduction of an educational program supporting breastfeeding would increase the proportion of women who breastfed fully to six months , improve the women 's level of breastfeeding knowledge , and decrease the proportion of infants admitted to hospitals due to gastrointestinal illnesses . METHODS A r and omized controlled trial was conducted in 90 primiparous women who had given birth to a healthy , full term , singleton baby at two hospitals in the southern region of Jordan . Women were r and omly allocated to either the intervention group  ( n=45 ) , in which they were offered a one-to-one postnatal educational session and follow-up phone calls at two months and four months postpartum , or the control group  ( n=45 )  , in which they received routine postnatal care . The primary outcomes were the proportion of women fully breastfeeding their babies at six months and the women 's level of breastfeeding knowledge at six months postpartum . RESULTS The postnatal education and support program significantly improved breastfeeding knowledge measured by differences between mean pre- and post-test scores . This was statistically significant for the intervention group ( p<0.001 ) but was not significant for the control ( p=0.23 ) . The proportion of women fully breastfeeding their babies at 6 months was not found to be statistically significantly different between the intervention group ( 39 % ) and the control group ( 27 % ) , percentage difference=12 % ( 95 % confidence interval [ -9 % to 30 % ] , Chi squared : χ(2)=3.54 , p>0.05 ) . CONCLUSIONS Although the postnatal education and support program improved breastfeeding knowledge among women in the study , this increase in knowledge did not translate to an increase in the duration of full breastfeeding to six months T HE U.S. DEPARTMENT OF HEALTH and Human Services ( 1994 ) published the Healthy People 2000 guidelines as a statement of national concerns regarding health in the U.S. One Healthy People 2000 objective is to increase the percentage of women who continue to breastfeed for the first 6 months of their infant 's life . The American Academy of Pediatrics recommends that women breastfeed their infant 's for the first year of life ( Gartner , 1997 ) . An intervention that increases the duration of breastfeeding in low-income women offers health benefits to mothers and babies ( Krebs & Murtaugh , 1997 ) . The benefits of breastfeeding are well established . Women who breastfeed are less likely to develop osteoporosis and some forms of cancer ( Cummings , Kelsey , & Nevitt , 1985 ; Michels et al. , 1996 ; Schneider , 1987 ) . Furthermore , breastfeeding is empowering for low-income minority women ( Locklin & Naber , 1993 ) . Infants who are breastfed for at least 4 months are less likely to die of BACKGROUND Social support has been shown to be greatly important for breastfeeding success . The objective of this study was to investigate if  mothers who were attended by midwives and nurses specially trained in breastfeeding counseling  perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care . METHOD Ten municipalities , each with an antenatal center and child health center , in southwest Sweden were r and omized either to intervention or control municipalities . The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers . Primiparas were asked to evaluate the care given , and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups . The 540 mothers responded to 3 question naires at 3 days and at 3 and 9 months postpartum . The perception of support provided by the health professionals and from the family classes was rated on Likert scales . RESULTS Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups , and better than control group B mothers at 3 months postpartum ; compared with both control groups , intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby 's needs . At 9 months , intervention group mothers were more satisfied with knowledge about social rights , information about the baby 's needs , and their social network than control group B mothers . Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy . At 3 and 9 months , intervention group mothers perceived that postnatal nurses were more sensitive and underst and ing compared with both control groups . CONCLUSIONS After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care , the mothers were more satisfied with emotional and informative support during the first 9 months postpartum . The results lend support to family classes incorporating continuity of care BACKGROUND Little is known about what influences health visitors ' breastfeeding support . The objective was to describe health visitors ' breastfeeding experiences , beliefs , knowledge and self-efficacy in breastfeeding guidance and determine the impact of a training course on these factors , and how they were reflected in practice . METHODS A r and omized intervention study enrolled 52 health visitors in the intervention group and 57 in the comparison group . The intervention group participated in an 18-hour pre- study training course that focused on knowledge about lactation and how to guide the mother to learn the mechanisms of breastfeeding . Data were collected through self-administered question naires before the intervention and after the follow-up period . One hundred and six ( 97 % ) health visitors and 1302 ( 82 % ) mothers responded . RESULTS At baseline no substantial differences were seen between the two groups on years since education , own breastfeeding experiences , beliefs or self-efficacy in breastfeeding guidance except that health visitors in the intervention group , who had completed the course , demonstrated significantly higher scores on knowledge questions ( P < 0.01 ) . After the intervention health visitors in the intervention group reported significantly higher self-efficacy in guidance on three of five breastfeeding problems ( P < 0.01 ) . Mothers in the intervention group reported having received more support than mothers in the comparison group . CONCLUSION An interactive course increased the health visitors '  knowledge of breastfeeding practice . After the intervention period the health visitors in the intervention group had increased their self-efficacy in helping mothers with common breastfeeding problems . The mothers in the intervention group reported more informational and instrumental breastfeeding support OBJECTIVE To determine whether postnatal ' h and s off ' care by midwives on positioning and attachment of the newborn baby improves breast-feeding duration . DESIGN Mothers were r and omised at the first postnatal feed  to receive either care by a midwife trained in the experimental protocol or by a control midwife undertaking routine care . SETTING Eight wards in four English Midl and s hospitals . PARTICIPANTS 370 primiparous mothers with term babies who intended to breast feed , and could sit out of bed to do so . INTERVENTIONS Experimental protocol of verbal-only advice on positioning and attachment , delivered at the first postnatal ward feed compared with routine care by a qualified midwife . MAIN OUTCOME MEASURES Duration of breast feeding up to 17 weeks as assessed by diaries and interviews with mothers and protocol adherence from self-completed checklist by the midwife . The mothers ' self-reported experience of care and support before , during and after delivery were assessed at 6 weeks , and feeding outcomes and employment status at 17 weeks . FINDINGS Experimental group mothers more often held the baby across their lap and received ' h and s off advice ' , but fewer babies in the experimental than control groups attached and fed : 59 % ( 106/180 ) vs. 67 % ( 118/175 ) , p=0.1 . No significant differences were found in the numbers of mothers breast feeding at 6 or 17 weeks in the experimental and control groups ( stopped exclusive breast feeding : 76 % ( 130/172 ) vs. 77 % ( 126/163 ) at 6 weeks ; 96 % ( 167/174 ) vs. 96 % ( 161/168 ) at 17 weeks ; odds ratio 1.02 , 95 % CI 0.77 to 1.22 ; p=0.8 ; stopped any breast feeding : 35 % ( 61/172 ) vs. 32 % ( 53/167 ) at 6 weeks ; 63 % ( 109/173 ) vs. 60 % ( 101/167 ) at 17 weeks ; odds ratio 1.10 , 0.84 to 1.45 ; p=0.5 ) . There were no significant differences in the incidence of problems with breast feeding and care experienced by mothers before or during hospitalisation ( other than at the first postnatal ward feed ) , nor after discharge home . CONCLUSIONS No significant beneficial effect was found on breast-feeding duration of the verbal- only advice on positioning and attachment , perhaps because aspects of the intervention are already within routine UK practice . Other care practice s at subsequent feeds may negate benefits of care at earlier feeds . ' H and s off ' care at the first feed may be less important to subsequent feeding than achieving a first feed under supervision in the postnatal ward . IMPLICATION S FOR PRACTICE Midwives can be trained in a 4-hr workshop to achieve improved knowledge of ' h and s off ' positioning and attachment care , and these can be translated into clinical practice . Future studies should differentiate the elements of the care that are effective in achieving postnatal feeds , and apply this advice consistently at successive feeds UNLABELLED Despite known health benefits , exclusive breast-feeding for at least 4 months is uncommon in many countries . In Mexico , most mothers initiate breast-feeding but few breast-feed exclusively . OBJECTIVE The objective was to examine the effectiveness of home visits by lay peer counselors to increase exclusive breast-feeding among mothers in a periurban area of Mexico . METHODS An ethnographic assessment conducted in 1994 that identified key maternal beliefs , practice s , and needs was used to guide educational strategies . Lay counselors were recruited from the same community and trained by La Leche League . From March 1995 through September 1996 , pregnant women were identified by community census and invited to participate . Women were enrolled into a r and omized , controlled study of 3 groups : no intervention ( control ) , 3 visits , and 6 visits during pregnancy and early postpartum . Data collection was performed by a social worker apart from the counselors . Exclusive breast-feeding was defined by WHO criteria . RESULTS The study enrolled 130 women ; 52 were in the 3-visit group , 44 in the 6-visit group , and 34 in the control group . Study groups did not differ in the maternal characteristics or initiation of breast-feeding ( 96 % ) . At 3 months postpartum , exclusive breast-feeding was practice d by only 12 % of controls vs. 52 % in the 3-visit group and 67 % in the 6-visit group ( P < 0.001 , log rank test ) . In the first 3 months , significantly ( P = 0.037 ) fewer intervention than control infants had an episode of diarrhea ( 11 % vs. 26 % , respectively ) . Intervention effectiveness was independent of maternal factors or birth hospital . CONCLUSIONS This unique experimental study demonstrated a dramatic increase in exclusive breast-feeding and a significant reduction in infant illness in an urban community through well- design ed maternal support including early intervention and repeated contact OBJECTIVE To evaluate the relative effects introducing motivational videotapes and /or peer counseling in Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) clinics serving African-American women have on breast-feeding duration . DESIGN Experimental intervention study . Pregnant women were enrolled at or before 24 weeks gestation and were followed up until postpartum week 16 . Women were interviewed at enrollment , 7 to 10 days , 8 weeks , and 16 weeks postpartum . SUNJECTS/ SETTING : One hundred fifteen African-American WIC participants who initiated breast-feeding and who had been enrolled in 1 of 4 clinics . INTERVENTION Two-by-two factorial design , in which 4 clinics were r and omly assigned to receive either no intervention , a motivational video package intervention , a peer-counseling intervention , or both interventions . MAIN OUTCOME MEASURES Breast-feeding duration in weeks and relative risk ratios for breast-feeding cessation before 16 weeks postpartum . STATISTICAL ANALYSIS PERFORMED Contingency table analysis , including chi2 tests and log-rank tests ; multivariate analysis using Cox proportional hazards regression analysis . RESULTS A higher proportion of women were breast-feeding at 8 and 16 weeks postpartum in the intervention clinics than in the control clinic . The proportion of women reporting breast-feeding declined at 8 and 16 weeks postpartum , but the rate of decline was slower in the 3 intervention clinics than in the control clinic . Being younger than 19 years of age or older than 25 years of age , having a male infant , and returning to work or school all negatively affected breastfeeding duration , whereas previous breast-feeding experience positively influenced breast-feeding duration . APPLICATIONS/ CONCLUSIONS WIC-based peer counselor support and motivational videos can positively affect the duration of breast-feeding among African-American women . WIC nutritionists and other health professionals in contact with this population should exp and their efforts toward promoting increased duration of breast-feeding The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam . To counteract this trend , a language and culture specific education program was developed . An experimental design was used to test the effectiveness of this program . The sample consisted of 182 prenatal Vietnamese women . Data collection included question naires and interviews . Results suggested that the education program had significant effects on knowledge , attitudes , planned and actual behaviour towards breastfeeding . However , the effect did not sustain until 6 months postpartum . Implication s for nursing practice and further research are discussed We compared the lactation performance of 165 healthy mothers who planned to breastfeed and gave birth by vaginal delivery , without complications to a healthy infant in either a nursery ( NUR ) ( n = 58 ) or a rooming-in hospital where formula supplementation was not allowed . In the rooming-in hospital , women were r and omly assigned to a group that received breastfeeding guidance during the hospital stay ( RIBFG ) ( n = 53 ) or to a control group ( RI ) ( n = 54 ) . Women were interviewed in the hospital and at 8 , 70 and 135 days post-partum ( pp ) . The groups were similar in socio-economic , demographic , anthropometric , previous breastfeeding experience and prenatal care variables . Non-parametric survival analyses adjusting for potential confounding factors show that breastfeeding guidance had a positive impact ( P < or = 0.05 ) on breastfeeding duration  among primiparous women who delivered in the rooming-in hospital . Among primiparae , the RI and RIBFG groups had higher ( P < or = 0.05 ) full breastfeeding rates than the NUR group in the short term . In the longer term , only the difference between the RIBFG and the NUR group remained statistically significant . The maternity ward system did not have a statistically significant effect on the lactation performance of multiparae The purpose of this study was to discover factors related to  breastfeeding duration .  Of the 131 women who volunteered to complete question naires at one , three and six months postpartum , 46 provided baseline data , and 37 and 48 ( r and omly assigned ) constituted low and high intervention groups respectively . Comparisons were made between breastfeeding and bottle feeding . Factors shown at three and six months to be related to duration of breastfeeding  at the p < .05 level were : identified high risk factors in labor and delivery , admission of the infant to the intensive care nursery , and length of mother 's and /or infant 's hospitalization . The three months ' data also showed a significant relationship between spontaneous births and ` breastfeeding only ' . No positive relationship was found between breastfeeding duration and support from nursing staff . The results suggest that when mothers and infants experience intrapartum high risk factors , delivery by cesarean section and long hospital stay , the mothers are likely to stop breastfeeding early OBJECTIVE Breastfeeding Friendly Primary Care Initiative comprises educational activities focused on primary care units . The To evaluate the effectiveness of a strategy on breastfeeding promotion to the Family Health Program team . METHODS A controlled intervention study was performed with 20 family health care teams r and omly selected into intervention and control group in Montes Claros , Southeastern Brazil , in 2006 . The teams r and omly selected into intervention and control group , and the intervention group took part in a 24-hour training program on breastfeeding promotion for health providers , modeled on the Baby-Friendly Hospital Initiative . It was emphasized health provider 's support for breastfeeding and management of major lactation problems . The control group received routine breastfeeding training .  Mothers of all children under two cared by the teams were interviewed at home before ( n=1,423 ) and 12 months after the intervention ( n=1,491 ) and answered questions about breastfeeding practice s. Survival curves of breastfeeding were plotted and compared for both time points studied using the log rank test . RESULTS There was a significant increase in exclusive breastfeeding after the educational activities for the Family Health Program teams . Survival curves of exclusive breastfeeding at the fi rst time point studied showed no statistical significance difference between the groups by log rank test ( p=0.502 ) . After the intervention , survival curves of exclusive breastfeeding were significantly different by the log rank test ( p=0.001 ) . CONCLUSIONS The training of Family Health Program teams as proposed by the Baby-Friendly Hospital Initiative proved to be an effective , low-cost strategy for raising awareness among health providers , providing consistent information , and assuring the required support to mothers with breastfeeding issues OBJECTIVE To assess the effectiveness of a home-based early intervention on infant feeding practice s and " tummy time " for infants in the first year of life . DESIGN R and omized controlled trial with follow-up measures scheduled at 6 and 12 months . SETTING Socially and economically disadvantaged areas of Sydney , Australia . PARTICIPANTS We recruited 667 first-time mothers and their infants in 2007 and 2008 . INTERVENTIONS The intervention consisted of 5 or 6 home visits from a specially trained research nurse delivering a staged home-based intervention in the antenatal period and at 1 , 3 , 5 , 9 , and 12 months . MAIN OUTCOME MEASURE Changes in infant feeding practice s and " tummy time . " RESULTS The intervention group had a significantly higher median duration of breastfeeding at 12 months than the control group ( 17 weeks [ 95 % confidence interval , 13.9 - 20.4 weeks ] vs 13 weeks [ 95 % confidence interval , 10.1 - 15.0 weeks ] ; P = .03 ) . Compared with the control group , the hazard ratio for stopping breastfeeding in the intervention group was 0.82 ( 95 % confidence interval , 0.68 - 0.99 ) . The intervention also result ed in a significantly later introduction of solid foods ( P < .001 for trend ) , reducing the proportion of mothers who introduced solids before 6 months by 12 % ( 95 % confidence interval , 4%-20 % ) from 74 % to 62 % . The intervention also decreased the age at which infants started tummy time ( P = .03 for trend ) and increased the daily practice of tummy time by 7 % from 76 % to 83 % ( P = .05 ) . CONCLUSION The home-based early intervention delivered by trained community nurses significantly improved some infant feeding practice s and result ed in earlier daily practice of tummy time . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN012607000168459 OBJECTIVE To evaluate the effectiveness of proactive telephone breastfeeding support in low-income , primiparous , primarily Latina women on 1 ) duration and exclusivity of breastfeeding  , 2 ) satisfaction with feeding , 3 ) rationale for discontinuing breastfeeding and 4 ) health care utilization . METHODS R and omized controlled trial comparing usual care to 2 weeks of daily telephone calls by nurses by using culturally informed scripted protocol s ; and qualitative study of focused interviews on a sample of women in the intervention group ( n = 40 ) . RESULTS Breastfeeding duration and exclusivity rates , feeding method satisfaction , and reasons for stopping breastfeeding did not differ significantly between intervention ( n = 161 ) and control ( n = 180 ) groups , with 74 % of both breastfeeding at 1 month and 28 % and 37 % , respectively , at 6 months . Insufficient milk supply was the main reason for stopping in both groups . Intervention infants were less likely to have a sick visit by 1 month ( 25 % ) than controls ( 35 % , P = .05 ) . Qualitative interviews revealed that the intervention was informative and helpful , with breastfeeding reported as healthier but harder ; formula was a good alternative . Intervention mothers reporting < or = 2 supplemental formula feedings on day 4 were more likely than mothers reporting > or =3 supplemental feedings to breastfeed at 1 month ( odds ratio 7.7 ; 95 % confidence interval 2.4 - 24.3 ) . CONCLUSIONS Two weeks of daily telephone support did not increase breastfeeding duration but was associated with a decrease in sick visits in the first month . Early supplementation and the perception of formula as a good alternative to dealing with the breastfeeding difficulties appeared to be factors in failure of the intervention PURPOSE To evaluate the efficacy of counseling sessions on breast-feeding for adolescent mothers and maternal gr and mothers on the reduction of unnecessary water and herbal teas intake on breast-fed infants . METHODS A r and omized clinical trial was conducted involving adolescent mothers , newborn infants , and maternal gr and mothers allocated into four groups :  mother and gr and mother not cohabitating , without intervention ; mother and gr and mother not cohabitating , with intervention directed only toward mother ; mother and gr and mother cohabitating , without intervention ; and  mother and gr and mother cohabitating , with intervention directed toward both . The intervention consisted of six counseling sessions on breastfeeding : in the maternity ward , and after birth on days 7 , 15 , 30 , 60 , and 120 at home . The data about feeding practice s were collected by telephone every month until the end of the sixth month of the baby 's life . The effect of the intervention was measured by comparing the medians and the survival curves for initiation of water and /or tea intake in the first 6 months of life , and Cox regression was used to estimate its magnitude . RESULTS The intervention had a positive effect for the group in which the adolescent mothers cohabitated with the baby 's gr and mother ( hazard ratio = .53 ; 95 % confidence interval = .35-.80 ) , and also for the group in which they did not cohabitate with the baby 's gr and mother ( hazard ratio = .48 ; 95 % confidence interval = .31-.76 ) . By comparing the medians of the time of initiation of water and /or tea intake between control and intervention groups , it was observed that the intervention postponed the use of these liquids in 67 days in the group in which mothers and gr and mothers cohabitated and in 44 days in the group in which they did not live together . CONCLUSION Multiple counseling sessions on infant feeding in the first 4 months postpartum for adolescent mothers and maternal gr and mothers , when they cohabitate , proved to be an effective strategy to postpone the unnecessary water and /or tea intake of breast-fed infants BACKGROUND Teenage pregnancies are associated with negative socioeconomic effects . Our aim was to ascertain whether a postnatal home-visiting service for teenage mothers younger than age 18 years could reduce the frequency of adverse neonatal outcomes and improve knowledge of contraception , breastfeeding , and infant vaccination schedules in this parent group . METHODS We enrolled 139 adolescents , attending a teenage pregnancy clinic , in a r and omised controlled trial . After completing an antenatal question naire design ed to assess their knowledge of contraception , infant vaccination , and breastfeeding , we assigned participants to either receive five structured postnatal home visits by nurse-midwives ( n=65 ) or not ( n=71 ) . Assessment interviews were done 6 months postpartum . Our primary endpoint was unadjusted difference in knowledge between groups , and incidence of predefined adverse neonatal outcomes . Analysis was by intention to treat . FINDINGS Three women withdrew before r and omisation because of late fetal loss , 11 mothers withdrew because of adverse neonatal outcomes  ( adverse neonatal outcome was a primary endpoint , but result ed in withdrawal from the study for knowledge outcomes ) , and one left voluntarily . Follow-up data were , therefore , available for 124 teenagers . Postnatal home visits were associated with a reduction in adverse neonatal outcomes ( intervention : 2 ; control : 9 ; relative risk 0.24 , 95 % CI 0.05 - 1.08 ) , and a significant increase in contraception knowledge ( mean difference 0.92 , 95 % CI 0.32 - 1.52 ) . However , there was no significant increase in knowledge with respect to breastfeeding or infant vaccination schedules associated with the home visits . INTERPRETATION Postnatal home-visiting services by nurse-midwives reduce adverse neonatal events and improve contraception outcomes , but do not affect breastfeeding or infant vaccination knowledge or compliance OBJECTIVE To estimate the causal effect of a  Michigan peer counselor ( PC ) breastfeeding support program for low-income women on infant health outcomes .  DATA SOURCES Program referral forms , program forms ( enrollment , birth , and exit data ) , and state administrative data from the Women Infants and Children program , Medicaid , and Vital Records . STUDY DESIGN Quasi-r and om enrollment due to the excess dem and for PC breastfeeding support services  allowed us to compare the infants of women who requested services and were enrolled in the program ( the treatment group , N = 274 ) to the infants of women who requested services and were not enrolled ( the control group , N = 572 ) . Data were analyzed using regression . PRINCIPAL FINDINGS The PC program increased the fraction breastfeeding at birth by 19.3 percent and breastfeeding duration by 2.84 weeks . Program participation also reduced the fraction of infants with gastrointestinal disorders by a statistically significant 7.9 percent . The program , if anything , increased the overall health care utilization . CONCLUSIONS This Michigan PC breastfeeding support program result ed in improvements in breastfeeding and infant health outcomes as measured by the diagnosis of ailments while increasing health care utilization Although the benefits of breastfeeding in reducing morbidity and mortality from gastrointestinal and respiratory infections , sudden infant death syndrome , and ( in preterm infants ) necrotizing enterocolitis are well-established , long-term health effects are more controversial . The evidence is conflicting concerning the " programming " effect of breastfeeding in protecting against child obesity , hyperlipidemia , hypertension , type 2 diabetes , and atopic disease . Accelerated neurocognitive development has been associated with breastfeeding in many studies , although doubts remain about the potential for residual confounding due to cognitive and behavioural differences between mothers who breastfeed ( or those who breastfeed for a longer duration or more exclusively ) and those who do not . Most of this paper will summarize the methods and results of a large , cluster-r and omized trial of a breastfeeding promotion intervention in the Republic of Belarus . Its experimental design and intention-to-treat analysis have yielded important findings bearing on several of these longer-term health and developmental outcomes
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding .
In 2003 , the World Health Organization recommended that infants be breastfed exclusively until six months of age , with breastfeeding continuing as an important part of the infant 's diet until at least two years of age .
However , current breastfeeding rates in many countries do not reflect this recommendation .
OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies , the timing of the interventions and the setting s in which they have been used .
To examine the effectiveness of different modes of offering similar supportive interventions ( for example , whether the support offered was proactive or reactive , face-to-face or over the telephone ) , and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone .
To examine the effectiveness of different care providers and ( where information was available ) training .
To explore the interaction between background breastfeeding rates and effectiveness of support .