The Effect of a Peer Counseling Program on Breastfeeding Initiation and Longevity in a Low-income Rural Population Costs and effectiveness of community postnatal support workers: randomised controlled trial Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial Nutrition counseling increases weight gain among Brazilian children. Lactation counseling increases exclusive breast-feeding rates in Ghana. Breastfeeding training for health professionals and resultant changes in breastfeeding duration. Prenatal Breastfeeding Education: Its Effect on Breastfeeding Among WIC Participants First Steps for Mommy and Me: A Pilot Intervention to Improve Nutrition and Physical Activity Behaviors of Postpartum Mothers and Their Infants Interventions to increase the duration of breastfeeding in obese mothers: the Bassett Improving Breastfeeding Study. Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial Randomized controlled trial to determine effects of prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration. A Controlled Trial of the Father's Role in Breastfeeding Promotion Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs Does telephone lactation counselling improve breastfeeding practices? A randomised controlled trial. CD-ROM-based program for breastfeeding mothers. Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial Volunteer peer counselors increase breastfeeding duration among rural low-income women. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Evaluation of a community-based intervention to increase breastfeeding prevalence. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding Effect of breastfeeding education on the feeding pattern and health of infants in their first 4 months in the Islamic Republic of Iran. The effect of postpartum lactation counseling on the duration of breast-feeding in low-income women. A Randomized Controlled Trial of Breastfeeding Support and Education for Adolescent Mothers A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community. Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae. Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan. Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. A PROSPECTIVE STUDY OF INDIVIDUAL COURSES OF BREAST FEEDING Clinical support can make the difference in exclusive breastfeeding success among working women. Promoting breastfeeding through health education at the time of immunizations: a randomized trial from Guinea Bissau Effect of Peer Counselors on Breastfeeding Initiation, Exclusivity, and Duration Among Low-income Urban Women Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial. Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program. A breast-feeding promotion and support program a randomized trial in The Netherlands. 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Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. Effectiveness of exclusive breastfeeding promotion in low-income mothers: a randomized controlled study. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial Effects of a breastfeeding empowerment programme on Korean breastfeeding mothers: a quasi-experimental study. Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial Lactation nurse increases duration of breast feeding. The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. 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A randomized controlled trial of knowledge sharing practice with empowerment strategies in pregnant women to improve exclusive breastfeeding during the first six months postpartum. A randomized controlled trial of prenatal pediatric visits for urban, low-income families. Breastfeeding knowledge, breastfeeding confidence, and infant feeding plans: effects on actual feeding practices. Effect of Intervention to Improve Breastfeeding Technique on the Frequency of Exclusive Breastfeeding and Lactation-Related Problems Effect of an extended midwifery postnatal support programme on the duration of breast feeding: a randomised controlled trial. Does Breastfeeding Education Affect Nursing Staff Beliefs, Exclusive Breastfeeding Rates, and Baby-Friendly Hospital Initiative Compliance? The Experience of a Small, Rural Canadian Hospital The Effect of Individualized Professional Support on Duration of Breastfeeding: A Randomized Controlled Trial Postpartum positioning and attachment education for increasing breastfeeding: a randomized trial. A randomized controlled community-based trial to improve breastfeeding rates among urban low-income mothers. Effect of postnatal home visits on maternal/infant outcomes in Syria: a randomized controlled trial. The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial. [Controlled study of a regular telephone support program given by volunteers on the establishment of breastfeeding]. A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration. Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. The effect of a culture-specific education program to promote breastfeeding among Vietnamese women in Sydney. The impact of a hospital and clinic-based breastfeeding promotion programme in a middle class urban environment. Effectiveness of an early intervention on infant feeding practices and "tummy time": a randomized controlled trial. Are 2 weeks of daily breastfeeding support insufficient to overcome the influences of formula? PRENATAL BREASTFEEDING EDUCATION and Breastfeeding Outcomes Postnatal home visits in teenage mothers: a randomised controlled trial Effects of a Prenatal Intervention on Breastfeeding Initiation Rates in a Latina Immigrant Sample
Breastfeeding rates among low-income women in the east-south- central United States are among the lowest in the country . This study examined the effect of a peer counseling program on breastfeeding initiation and duration in a low-income rural population in West Tennessee . A postpartum survey and chart review were conducted with WIC clients at nine health departments . Response rate was 99 % ( 291/293 ) .  Breastfeeding initiation and duration at 6 weeks were increased in the peer counselor group ( n= 156 ) compared with women in the no-peer counselor group ( n= 135 ) ( 53 % vs. 33%,p<0.001 , and 26 % vs. 13%,p=0.006 , respectively ) . Multivariate analysis revealed that women in the peer counselor group were significantly more likely to initiate breastfeeding ( OR=2.43 , 95 % CI=1.23 - 4.67 ) and to be breastfeeding at 6 weeks ( OR=2.78 , 95 % CI=2.08 - 9.5 1 ) , than those in the no-peer counselor group 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 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 To assess the impact on child growth of the nutrition-counseling component of the Integrated Management of Childhood Illnesses ( IMCI ) strategy , a r and omized trial was implemented . All 28 government health centers in a Southern Brazil city were paired according to baseline nutritional indicators . One center from each pair was r and omly selected and its doctors received 20-h training in nutrition counseling .  Thirty-three doctors were included and 12 - 13 patients < 18 mo of age from each doctor were recruited . The study included testing the knowledge of doctors , observing consultations and visiting the children at home 8 , 45 and 180 d after the initial consultation . Maternal knowledge , practice s and adherence to nutritional recommendations were assessed , and anthropometric measurements were taken . Day-long dietary intake was evaluated on a sub sample of children . Doctors in the intervention group had better knowledge of child nutrition and improved assessment and counseling practice s. Maternal recall of recommendations was higher in the intervention than in the control group , as was satisfaction with the consultation . Reported use of recommended foods was also increased . Daily fat intake was higher in the intervention than in the control group ; mean daily intakes of energy and zinc also tended to improve . Children 12 mo of age or older had improved weight gain and a positive but nonsignificant improvement in length .  Nutrition-counseling training  improved doctors ' performances , maternal practice s and the diets and weight gain of children . The r and omized design with blind outcome evaluation strongly supports a causal link . These results should be replicated in other setting 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 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 effect of prenatal breastfeeding education on breastfeeding incidence and duration was determined among 31 prenatal WIC participants . The subjects , assigned to a control group  ( n= 17 ) or experimental group  ( n= 14 ) , received prenatal nutrition education through the WIC program . The experimental group received at least one breastfeeding education class . There was no significant difference in breastfeeding incidence between the groups , however , there was a significant difference in breastfeeding incidence by parity ( p<0.05 ) . There was a significantly higher percentage of women still breastfeeding at 3 and 4 months postpartum in the experimental versus the control group ( p<0.05 ) . The control group breastfed for 29.5 + 43.6 days , while the experimental group breastfed for 76 days + 104.3 ( p=.05 ) . Multiparous women who had bottle-fed previous children breastfed for a shorter duration ( 18 + 22 days ) than primiparous women ( 60 87 days ) ( p<.07 ) To assess the feasibility of a pediatric primary care based intervention to promote healthful behaviors among 0–6 month old infants and their mothers . We enrolled  two intervention practice s ( 60 mother-infant pairs ) and one usual care control practice ( 24 pairs ) in a non-r and omized controlled trial . We completed visits and interviews with 80 ( 95 % ) pairs at birth and 6 months . The intervention included ( 1 ) brief focused negotiation by pediatricians , ( 2 ) motivational counseling by a health educator , and ( 3 ) group parenting workshops . We evaluated the intervention effects on infant feeding , sleep duration , TV viewing , and mothers ’ responsiveness to satiety cues . Maternal behavioral targets included postpartum diet , physical activity , TV and sleep . At 6 months , fewer intervention than control infants had been introduced to solid foods ( 57 % vs. 82 % ; P = 0.04 ) , and intervention infants viewed less TV ( mean 1.2 vs. 1.5 h/d ; P = 0.07 ) . Compared to control infants , intervention infants had larger increases in their nocturnal sleep duration from baseline to follow up ( mean increase 1.9 vs. 1.3 h/d ; P = 0.05 ) ; larger reductions in settling time ( mean reduction −0.70 vs. −0.10 h/d ; P = 0.02 ) ; and larger reductions in hours/day of nighttime wakefulness ( mean reduction −2.9 vs. −1.5 h/d ; P = 0.08 ) . There were no differences in breastfeeding , response to satiety cues , or maternal health behaviors . A program of brief focused negotiation by pediatricians , individual coaching by health educators using motivational interviewing , and group parenting workshops tended to improve infant feeding , sleep and media exposure , but had less impact on mothers ’ own health-related behaviors 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 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 Objective . To investigate whether supporting fathers to recognize the relevance of their role in the success of breastfeeding and teaching them how to prevent and to manage the most common lactation problems would result in more women breastfeeding . Methods . A controlled trial , in which the participating fathers were allocated in 2-month blocks to a child care training session , was conducted of 280 mothers considering breastfeeding and their 280 partners at a university obstetric department in Naples , Italy .  Support and advice about breastfeeding was provided to all of the mothers . Among the fathers of the intervention group , the training session included the management of breastfeeding ; among those of the control group , it did not . Primary outcome was the prevalence of full breastfeeding at 6 months . Secondary outcomes were the proportion of women who perceived their milk to be insufficient , who stopped breastfeeding because of problems , and who reported to have received help in breastfeeding management by their partners . Results The prevalence of full breastfeeding at 6 months was 25 % ( 35 of 140 ) in the intervention group and 15 % ( 21 of 140 ) in the control group and that of any breastfeeding at 12 months was 19 % ( 27 ) and 11 % ( 16 ) , respectively . Perceived milk insufficiency was significantly more frequent among the mothers of the control group ( 38 [ 27 % ] of 140 vs 12 [ 8.6 % ] of 140 ) , as well as breastfeeding interruption because of problems with lactation ( 25 [ 18 % ] of 140 vs 6 [ 4 % ] of 140 ) . Moreover , significantly more women in the intervention group reported receiving support and relevant help with infant feeding management from their partners ( 128 [ 91 % ] of 140 vs 48 [ 34 % ] of 140 ) . Among the women who had reported difficulties with lactation in the intervention and control groups ( 96 [ 69 % ] and 89 [ 64 % ] , respectively ) , the prevalence of full breastfeeding at 6 months was 24 % and 4.5 % , respectively . Conclusions Teaching fathers how to prevent and to manage the most common lactation difficulties is associated with higher rates of full breastfeeding at 6 months 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 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 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 In rural India , most births take place in the home , where high-risk care practice s are common . We developed an intervention of behaviour change management , with a focus on prevention of hypothermia , aim ed at modifying practice s and reducing neonatal mortality . METHODS We did a cluster-r and omised controlled efficacy trial in Shivgarh , a rural area in Uttar Pradesh . 39 village administrative units ( population 104,123 ) were allocated to one of three groups : a control group , which received the usual services of governmental and non-governmental organisations in the area ; an intervention group , which received a preventive package of interventions for essential newborn care ( birth preparedness , clean delivery and cord care , thermal care [ including skin-to-skin care ] , breastfeeding promotion , and danger sign recognition ) ; or another intervention group , which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator ( ThermoSpot ) . In the intervention clusters , community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations . Outcome measures included changes in newborn-care practice s and neonatal mortality rate compared with the control group . Analysis was by intention to treat . This study is registered as International St and ard R and omised Control Trial , number NCT00198653 . FINDINGS Improvements in birth preparedness , hygienic delivery , thermal care ( including skin-to-skin care ) , umbilical cord care , skin care , and breastfeeding were seen in intervention arms . There was little change in care-seeking . Compared with controls , neonatal mortality rate was reduced by 54 % in the essential newborn-care intervention ( rate ratio 0.46 [ 95 % CI 0.35 - 0.60 ] , p<0.0001 ) and by 52 % in the essential newborn care plus ThermoSpot arm ( 0.48 [ 95 % CI 0.35 - 0.66 ] , p<0.0001 ) . INTERPRETATION A socioculturally context ualised , community-based intervention , targeted at high-risk newborn-care practice s , can lead to substantial behavioural modification and reduction in neonatal mortality . This approach can be applied to behaviour change along the continuum of care , harmonise vertical interventions , and build community capacity for sustained development . FUNDING USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation BACKGROUND The purpose of this demonstration project was to test the effectiveness of a volunteer peer counseling program for promoting breastfeeding in a community . METHODS The two-year project was conducted in Iowa from September 1994 to September 1996 . Both intervention and control groups were rural low-income pregnant and postpartum women who qualified for the Women , Infants and Children 's ( WIC ) nutritional program . The intervention was initiated in two counties with 143 clients , of whom 72 completed the project . The control group was drawn from six counties that had received no significant breastfeeding promotion programs during the previous three years . The intervention was the assignment of trained volunteers with previous successful personal experience with breastfeeding as peer counselors  to low-income pregnant women . Both before and after the baby was born , the volunteers taught a series of in-home , one-to-one lessons about healthy diet and breastfeeding , and maintained informal contact to answer questions or help with concerns . RESULTS Women in the intervention group improved dietary intake when compared with the control group . Knowledge of breastfeeding and good nutrition improved slightly . Eighty-two percent of intervention compared with 31 percent of control group women initiated breastfeeding . Mean duration of breastfeeding for intervention and control group women was 5.7 and 2.5 weeks , respectively . At 4 weeks , 56 percent of intervention and 10 percent of control group women were still breastfeeding . CONCLUSION A volunteer peer counseling program that provides low-income women with role models , accurate information , support , and encouragement can increase the duration of breastfeeding , and thus contribute to healthier infants 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 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 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 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 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 OBJECTIVE To examine associations between doula care , early breastfeeding outcomes , and breastfeeding duration . DESIGN Prospect i ve cohort . SETTING Regional hospital in northern California . PARTICIPANTS Low-income , full gestation primiparae receiving doula care ( n=44 ) or st and ard care ( n=97 ) . MEASURES Birth outcomes and newborn feeding data obtained from the hospital record . Follow-up interviews conducted at day 3 to record the timing of onset of lactogenesis and breastfeeding behavior and at 6 weeks to obtain current breastfeeding status . RESULTS Adjusting for baseline differences , women receiving doula care were significantly more likely to have a short stage II labor , a noninstrumental vaginal delivery , and to experience onset of lactogenesis within 72 hours postpartum ( timely onset of lactogenesis ) . Overall , 68 % of women receiving doula care and 54 % of women receiving st and ard care were breastfeeding at 6 weeks . In the subset with a prenatal stressor ( n=63 ) , the doula care group was more than twice as likely to be breastfeeding at 6 weeks ( 89 % vs. st and ard care , 40 % ) . Breastfeeding at 6 weeks was also significantly associated with timely onset of lactogenesis and maternal report that the infant " sucked well " at day 3 . CONCLUSIONS Doula care was associated with improved childbirth outcomes and timely onset of lactogenesis . Both directly and as mediated by timely onset of lactogenesis , doula care was also associated with higher breastfeeding prevalence at 6 weeks AIMS The objectives of this study were to design a structured prenatal education programme on breastfeeding and to evaluate the effectiveness of the programme . Indicators of effectiveness were selected based on Kirkpatrick 's Training Evaluation Model , including satisfaction with the programme , breastfeeding knowledge , breastfeeding attitude , breastfeeding satisfaction , breastfeeding problems and rate of exclusive breastfeeding . METHODS This study applied a quasi-experimental design . The experimental group included 46 women who received a 90-minute group educational programme on breastfeeding during their 20th-36th week of pregnancy . Each experimental subject was matched by a control subject according to age , educational level , work status and pregnancy gestational age . Control subjects did not receive any intervention . Data were collected through self-administered question naires at preintervention , postintervention , three days postpartum and one month postpartum . RESULTS Satisfaction with the programme was high . The experimental group had higher scores in breastfeeding knowledge and breastfeeding attitude at three days postpartum . The experimental group showed higher breastfeeding satisfaction at three days and one month postpartum . There were no significant differences in experiencing breastfeeding problems . The rate of exclusive breastfeeding was higher for the experimental group at three days and one month postpartum , but the differences were not statistically significant . CONCLUSION This study demonstrated the effectiveness of a prenatal education programme on maternal knowledge , attitude and satisfaction toward breastfeeding . RELEVANCE TO CLINICAL PRACTICE Other hospitals could apply this model to plan and evaluate their prenatal education programme on breastfeeding 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 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 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 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 As an intervention against diarrhoea , promotion of breastfeeding has been suggested by the World Health Organization ( WHO ) . In the present study from Guinea Bissau we tested the possibilities of promoting breastfeeding at a local health centre . A total of 1250 children were allocated r and omly into two groups . Mothers in the intervention group were given health education according to WHO 's recommendations ; about exclusive breastfeeding for at least the first 4 mo , prolonged breastfeeding and family planning methods . At 4 mo of age introduction of weaning food was delayed in the intervention group ( risk rate 1.18 ( 95 % CI 1.03‐1.38 ) and more mothers had an IUD inserted ( risk rate 2.45 ( 1.27‐4.70 ) . The median length of breastfeeding was 23 mo in both groups . There was no difference in the number of children weaned early . Although exclusive breastfeeding was promoted by the intervention , early weaning of children in special risk groups was not avoided . An evaluation of the impact of the WHO recommendations in different setting s is warranted . □ Breastfeeding promotion , intervention study , Guinea Bissau , epidemiology , WHO 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 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 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 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 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 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 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 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 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 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 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 OBJECTIVES This quasi-experimental study examined the effects of a new breastfeeding empowerment programme provided to post-partum mothers within 3 days of entering post-partum care centres on their breastfeeding empowerment , problems and practice rate . METHOD The study employed a non-equivalent control group non-synchronized design . Participants who conformed with the selection criteria were selected from two post-partum care centres affiliated with hospitals in a city in South Korea . Each of the two study groups included 30 participants . The breastfeeding empowerment programme comprised four 60-minute sessions , and was applied for 4 weeks to mothers in the experimental group . RESULTS The breastfeeding empowerment scores were higher in the experimental group than in the control group ( p=0.007 ) , and there were fewer breastfeeding problems in the former group ( p=0.012 ) and the breastfeeding rates were higher in the former group ( p=0.017 , 0.002 and 0.002 at 4 , 8 and 12 weeks post-partum , respectively ) . CONCLUSIONS These results indicate that the provision of breastfeeding empowerment programmes to help mothers to identify and solve problems by themselves can improve breastfeeding empowerment , problem and practice rates , and hence should be considered useful as a post-partum nursing intervention in clinical setting s. The effectiveness of the various components of the breastfeeding empowerment programme developed in this study should be verified in field trials BACKGROUND WHO and UNICEF launched the Integrated Management of Childhood Illness ( IMCI ) strategy in the mid-1990s to reduce deaths from diarrhoea , pneumonia , malaria , measles , and malnutrition in children younger than 5 years . We assessed the effect of IMCI on health and nutrition of children younger than 5 years in Bangladesh . METHODS In this cluster r and omised trial , 20 first-level government health facilities in the Matlab subdistrict of Bangladesh and their catchment areas ( total population about 350 000 ) were paired and r and omly assigned to either IMCI ( intervention ; ten clusters ) or usual services ( comparison ; ten clusters ) . All three components of IMCI-health-worker training , health-systems improvements , and family and community activities-were implemented beginning in February , 2002 . Assessment included household and health facility surveys tracking intermediate outputs and outcomes , and nutrition and mortality changes in intervention and comparison areas . Primary endpoint was mortality in children aged between 7 days and 59 months .  Analysis was by intention to treat . This study is registered , number IS RCT N52793850 . FINDINGS The yearly rate of mortality reduction in children younger than 5 years ( excluding deaths in first week of life ) was similar in IMCI and comparison areas ( 8.6%vs 7.8 % ) . In the last 2 years of the study , the mortality rate was 13.4 % lower in IMCI than in comparison areas ( 95 % CI -14.2 to 34.3 ) , corresponding to 4.2 fewer deaths per 1000 livebirths ( 95 % CI -4.1 to 12.4 ; p=0.30 ) . Implementation of IMCI led to improved health-worker skills , health-system support , and family and community practice s , translating into increased care-seeking for illnesses . In IMCI areas , more children younger than 6 months were exclusively breastfed ( 76%vs 65 % , difference of differences 10.1 % , 95 % CI 2.65 - 17.62 ) , and prevalence of stunting in children aged 24 - 59 months decreased more rapidly ( difference of differences -7.33 , 95 % CI -13.83 to -0.83 ) than in comparison areas . INTERPRETATION IMCI was associated with positive changes in all input , output , and outcome indicators , including increased exclusive breastfeeding and decreased stunting . However , IMCI implementation had no effect on mortality within the timeframe of the assessment . FUNDING Bill & Melinda Gates Foundation , WHO 's Department of Child and Adolescent Health and Development , and US Agency for International Development 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 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 This study compared breastfeeding attitudes , intention , and initiation among low-income women exposed or not exposed to the Best Start program .  A between- ( experimental vs control group ) and within-factor ( pretest vs posttest ) repeated measures design was employed . A nonprobability sample of 54 subjects was r and omly assigned to a control group ( n = 28 ) or an experimental group ( n = 26 ) . Using the Breastfeeding Attrition Prediction Tool , statistically significant group by time interaction effects were found for negative breastfeeding sentiment , positive breastfeeding sentiment , and breastfeeding control scales . Compared to the control group , the experimental group had significantly increased positive breastfeeding sentiment ( P < .01 ) , decreased negative breastfeeding sentiment ( P < .01 ) , and increased breastfeeding control ( P < .01 ) from pretest to posttest . Following exposure to the Best Start program , subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group . Practical implication s are discussed . J Hum Lact . 20(3):300 - 305 Research ers attempted to increase the initiation of breastfeeding and its duration to 6 months among a group of low-income , Hispanic women through an intervention program which included prenatal education and home based postpartum support . All participants were telephoned after delivery to determine infant feeding method . Duration of breastfeeding was determined by counting the number of days from initiation to the last day the baby was put to the breast . The Bayesian approach was used for the statistical analyses . In the intervention group , the propensity to initiate breastfeeding exceeded that of the control group . Results indicate the intervention group had twice ( 2.31 ) the odds of starting breastfeeding , twice ( 1.84 - 3.15 ) the odds of continuing to breastfeed for 6 months , and only half ( .50-.54 ) the tendency to quit at any one time than did the control group 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 OBJECTIVE : To address the impact of simple antenatal educational interventions on breastfeeding practice . METHODS : A r and omized controlled trial was carried out in a tertiary referral center from May 2002 to December 2004 . A r and om sample of eligible low-risk antenatal patients was recruited from clinics in the National University Hospital , Singapore . Group A received breastfeeding educational material and individual coaching from a lactation counselor . Group B received breastfeeding educational material with no counseling . Group C received routine antenatal care only . RESULTS : A total of 401 women were recruited . Mothers receiving individual counseling and educational material  practice d exclusive and predominant breastfeeding more often than mothers receiving routine care alone at 3 months ( odds ratio [ OR ] 2.6 , 95 % confidence interval [ CI ] 1.2–5.4 ) and 6 months ( OR 2.4 , 95 % CI 1.0–5.7 ) postpartum . More mothers practice d exclusive and predominant breastfeeding at 6 months among women receiving individual counseling compared with women exposed to educational material alone ( OR 2.5 , 95 % CI 1.0–6.3 ) . CONCLUSION : Where breastfeeding practice s are suboptimal , simple one-encounter antenatal education and counseling significantly improve breastfeeding practice up to 3 months after delivery . Provision of printed or audiovisual educational material is not enough . Health care workers should make every effort to have one face-to-face encounter to discuss breastfeeding with expectant mothers before they deliver . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT002770192 LEVEL OF EVIDENCE : 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 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 BACKGROUND Postpartum hospital stays seem likely to remain limited even under new laws which m and ate that insurers cover 48-hour hospitalization after uncomplicated delivery . Clinicians , who are increasingly practicing in capitated arrangements , need better information to maximize clinical benefit to mothers and newborns using finite re sources . OBJECTIVE AND INTERVENTIONS : This study 's aim was to evaluate the clinical outcomes , patient perceptions , and costs of a revised model of perinatal care services . In this model , a new postpartum care center was established for routine follow-up of newborns within 48 hours after hospital discharge , educational efforts were shifted from the postpartum hospitalization to the prenatal period , and lactation consultant hours were increased . DESIGN AND PARTICIPANTS Controlled , nonr and omized ( double cohort ) study that compared mothers and newborns with hospital stays of 48 hours or less during the Baseline Care ( preintervention ) study period ( N = 344 ) with those under the Revised Care ( postintervention ) study period ( N = 456 ) . SETTING The Hayward , California , medical center of Kaiser Permanente , a nonprofit health maintenance organization .  DATA COLLECTION Telephone interviews were attempted with all mothers 3 weeks after delivery . Data on rehospitalizations , emergency department ( ED ) and clinic visits , and costs during the first 14 postpartum days were collected from computerized data bases and chart review . OUTCOME MEASURES The combined clinical outcome was defined as any undesirable health event , including rehospitalization , an ED visit , or an urgent clinic visit by either the mother or newborn within the first 14 days postpartum , or breastfeeding discontinuation within the first 21 days postpartum . Maternal satisfaction and costs were also studied . RESULTS Of 876 attempted interviews , 800 were completed ( 91 % ) . Analyses were adjusted for age , race , education , parity , breastfeeding experience , and other relevant variables . Among the interviewed mother-newborn pairs , 45 % in the Revised Care group experienced the combined clinical outcome , compared with 52 % in the Baseline Care group . Newborns in the Revised Care group ( 29 % ) were significantly less likely to make urgent clinic visits during the first 14 days of life than those in the Baseline Care group ( 36 % ) . There were no differences between groups in newborn ED visits or rehospitalizations , maternal clinical outcomes , or breastfeeding continuation . Mothers in the Revised Care group expressed higher satisfaction with the newborn 's care , the amount of information they received about newborn care and breastfeeding , and the amount of help they received with breastfeeding . Planned hospital care , planned follow-up visits , and unplanned care costs decreased by $ 149 per delivery , while the new prenatal class and increased lactation consultant services cost $ 58 per delivery , for an estimated overall reduction in cost . CONCLUSIONS We conclude that the revised model of perinatal care in this health maintenance organization medical center improved clinical outcomes and maternal satisfaction for low-risk mothers and newborns without increasing costs BACKGROUND Although there are many benefits to breastfeeding , its prevalence and duration in many countries is still lower than the international recommendation for 6-month exclusive breastfeeding . The objective of the present study was to investigate whether a knowledge sharing practice s with empowerment strategies ( KSPES ) program on antenatal education and postnatal support strategies improves the rates of 6-month exclusive breastfeeding during the first six months postpartum compared with a st and ard knowledge of breastfeeding techniques . MATERIAL AND METHOD A r and omized controlled trial was conducted . Pregnant women of more than 32 weeks ' gestation were r and omly assigned to receive a routine st and ard knowledge of breastfeeding techniques alone ( control group ) or with KSPES on antenatal education and postnatal support strategies ( study group ) . The primary outcome was the rate of exclusive breastfeeding at 6-month postpartum . The secondary outcomes were rates at 7 days , 14 days , 1 , 2 , 3 , 4 , and 5 months postpartum . RESULTS Rates of exclusive breastfeeding in the study group were significantly higher when compared with those in the control group at 14 days ( 82.5 % vs. 52.6 % , p = 0.005 ) , 1 month ( 77.5 % vs. 52.6 % , p = 0.021 ) , 2 months ( 62.5 % vs. 368 % , p = 0.023 ) , 4 months ( 35.0 % vs. 7.9 % , p = 0.008 ) , 5 months ( 25.0 % vs. 2.6 % , p = 0.012 ) , and 6 months postpartum ( 20.0 % vs. 0 % , p = 0.005 ) . CONCLUSION KSPES on antenatal education and postnatal support strategies significantly improve rates of exclusive breastfeeding at 6-month postpartum . These strategies also significantly improve rates of exclusive breastfeeding at 14 days , 1 , 2 , 4 , 5 , and 6 months postpartum BACKGROUND Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues , establish a supportive relationship , and provide pediatric practice information to parents . We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions , health care behaviors , health care utilization , and the doctor-patient relationship . METHODS We conducted a r and omized controlled trial of  prenatal pediatric visits for urban , low-income families to measure the impact on breastfeeding decisions , infant car safety seat use , circumcision , health maintenance , and emergency room visits and the pediatrician 's perception that he/she would know the mother better . Pregnant women were recruited prenatally from the obstetrics clinic . Outcomes were measured by maternal interview prenatally and when the infant was 2 months old , in addition to review of the nursery record . Physicians were interviewed after the 2-month visit . Health care utilization was measured by chart review at 7 months . RESULTS A total of 156 pregnant women were enrolled and r and omized , 81 to the intervention group and 75 to the control group . Of mothers who breastfed , 45 % in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14 % in the control group . Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits , 0.58 compared with 1.0 . Pediatricians were more likely to think that they knew mothers in the intervention group well , 54 % versus 29 % in the control group , yet 67 % of mothers in both groups agreed their pediatrician knew them well . There were no differences between groups in initiation or duration of breastfeeding at 30 or 60 days , infant car safety seat use , circumcision , or health maintenance visits . CONCLUSIONS Prenatal pediatric visits have potential impact on a variety of health care outcomes . Among urban , low-income mothers , we found beneficial effects on breastfeeding decisions , a decrease in emergency department visits , and an initial impact on the doctor-patient relationship . We suggest urban practice s actively promote prenatal pediatric visits OBJECTIVE To explore relationships among breastfeeding knowledge , breastfeeding confidence , and infant feeding plans and their effects on feeding practice s in first-time breastfeeding mothers . DESIGN Prospect i ve descriptive design . SETTING Telephone interviews were conducted prenatally and at 6 weeks , 3 months , and 6 months postpartum . PARTICIPANTS Seventy-four of 83 first-time mothers with prenatal intentions to breastfeed completed all study requirements . The majority were White ( 95 % ) , between the ages of 21 and 30 years ( 73 % ) , with a post-high school education ( 85 % ) , and household incomes of more than 200 % of the federal poverty guideline ( 88 % ) . MAIN OUTCOME MEASURES Breastfeeding knowledge , breastfeeding confidence , planned infant feeding method , planned breastfeeding duration , weeks of daily human milk substitute feeding , breastfeeding duration , achievement of breastfeeding goals . RESULTS Breastfeeding knowledge was strongly correlated with breastfeeding confidence ( r = .262 ; p = .025 ) and actual lactation duration ( r = .455 ; p = .0001 ) . Compared with women planning to exclusively breastfeed their infants , those planning to combination feed planned shorter breastfeeding duration ( p = .022 ) , reported shorter actual duration ( p = .004 ) , and were less likely to meet their breastfeeding goal ( p = .034 ) . The variables maternal education , breastfeeding knowledge , and weeks of daily human milk substitute feeding  were used to develop a prediction equation that correctly categorized 93 % of participants who met their breastfeeding goal and 90 % of those who did not . CONCLUSIONS Expectations and the actual breastfeeding experience differed among women planning to combination feed and those planning to exclusively breastfeed . Whether a cause or consequence , daily human milk substitute feeding was associated with negative breastfeeding outcomes 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 The effectiveness of a breastfeeding education intervention consisting of a 11/2-hour m and ated session for all nursing staff , with an optional self-paced tutorial , was evaluated in a small rural Canadian hospital . The intervention was design ed to increase exclusive breastfeeding rates , create positive beliefs and attitudes among staff members , and increase compliance with the World Health Organization/UNICEF Baby-Friendly Hospital Initiative ( BFHI ) . Staff surveys and chart audits were conducted at both the intervention and control site hospitals prior to the intervention and 7 months after the intervention . Over a 7-month period , the intervention hospital experienced an increase in BFHI compliance ( 24.4 vs. 31.9 , P<.01 ) , breastfeeding beliefs ( 55.0 vs. 58.8 , P<.05 ) , and exclusive breastfeeding rates ( 31 % vs. 54 % of breastfed babies , P<.05 ) but no change in breastfeeding attitudes ( 44.0 vs. 44.9 , P=.80 ) . The control site experienced no change in BFHI compliance , beliefs , or attitudes but a significant decrease in exclusive breastfeeding rates ( 43 % vs. 0 % , P<.05 ) 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 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 The goal of this controlled trial was to evaluate the impact of a volunteer telephone support program on the ability of the mothers  to reach their breastfeeding objectives and to reduce the number of difficulties while nursing . Two hundred expectant women were r and omly assigned to two groups . The first group received the usual services from the professionals and the second had the extra service from a trained volunteer . By comparing the proportions of women still breastfeeding at each month , the present study showed that this type of support was ineffective in meeting the objectives . The gap between the intended length of breastfeeding and the duration achieved was equally large in both groups . Only 30 % breastfed for the length of time envisaged during pregnancy . Strategies to increase the effectiveness of this type of service are suggested 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 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 Hospital interventions in support of breastfeeding have been highly successful in areas where the indigenous population has a well established environment of breastfeeding . However , programmes design ed to improve breastfeeding patterns in urban population s have met with mixed success . This paper presents a prospect i ve intervention study with a control group in which a health system-based breastfeeding promotion programme was initiated to support optimal breastfeeding for both child health and child spacing . Following collection of control data , a four-step intervention programme ( Breastfeeding Promotion Program ) was instituted . This paper reports the process of the development of the intervention programme as well as the comparison of the control and study population s. Major findings include significant increases in duration of full breastfeeding from 31.6 per cent at 6 months in the control group to 66.8 per cent in the intervention group . The duration of lactational amenorrhea was similarly increased : 22 per cent of the control mothers and 56 per cent of the intervention group women were in amenorrhoea at 180 days . The cost-effectiveness of the hospital changes is illustrated 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 examine the impact of various breastfeeding outcomes of three cohorts receiving different methods of prenatal breastfeeding education . Methods Retrospective cohort design with patients attending a breastfeeding education class at an Army medical center . Controls were matched for sponsor rank , marital status , and smoking status . One hundred ninety-four mothers who expressed intent to breastfeed received breastfeeding education  as follows : ( a ) a class that used video demonstration and group teaching by a lactation consultant , ( b ) a new mothers ' support group with one-on-one teaching prenatally and weekly meetings postpartum , taught by a lactation consultant and a pediatrician , and ( c ) a control group educated at prenatal visits only . Descriptive statistics , chi-square , ANOVA , unpaired t test , and logistic regression were used to analyze the data . Results Women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls ( p = .01 ) . There was no significant difference in rates between types of classes offered ( p = .45 ) . Clinical Implication sPrenatal breastfeeding education can influence the amount of time women breastfeed . All providers of prenatal care should consider offering such classes in order to improve breastfeeding rates 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 A r and omized controlled trial study design was used to investigate the effectiveness of a Healthy Families America model prenatal intervention for increasing breastfeeding rates among Latina immigrants residing in an impoverished New York City community . Exposure to the intervention did not affect mother report of any breastfeeding ( ABF ) during the first week postpartum , but it did affect mother report of exclusive breastfeeding ( EBF ) . Thirty-two percent ( 44/137 ) of mothers exposed to the intervention reported EBF during the first week postpartum compared to 20 % ( 20/101 ) of mothers not exposed to the intervention ( odds ratio 1.92 ; 95 % confidence interval 1.05 - 3.52 ) . This positive effect of the intervention on EBF remained statistically significant after controlling for the negative effect of household income on EBF ( adjusted odds ratio , 1.89 ; 95 % confidence interval , 1.02 - 3.50 ) . Additional research is needed on the effectiveness of breastfeeding promotion programs targeting low-income Latinas . J Hum Lact . 25(4):404 - 411
Introduction Exclusive Breastfeeding ( EBF ) rates remain low in both low-income and high-income countries despite World Health Organization recommendations for EBF till 6 months .
Breastfeeding has been shown to have a protective effect against gastrointestinal infections , among other benefits .
Large-scale interventions focusing on educating mothers about breastfeeding have the potential to increase breastfeeding prevalence , especially EBF , up to recommended st and ards and also to decrease infant morbidity .