Assessment of Effects of Pre- and Post-training Programme for Healthcare Professionals about Breastfeeding A Clinic-Based Breastfeeding Peer Counselor Intervention in an Urban, Low-Income Population Lactation counseling increases exclusive breast-feeding rates in Ghana. Breastfeeding Education and Support Trial for Overweight and Obese Women: A Randomized Trial Coparenting Breastfeeding Support and Exclusive Breastfeeding: A Randomized Controlled Trial Does telephone lactation counselling improve breastfeeding practices? A randomised controlled trial. Cognitive-Behavioral Counseling for Exclusive Breastfeeding in Rural Pediatrics: A Cluster RCT Effect of a peer support service on breast-feeding continuation in the UK: a randomised controlled trial. Predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa: a prospective study A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial. Lactation Support and Breastfeeding Duration in Jaundiced Infants: A Randomized Controlled Trial Antenatal Education to Increase Exclusive Breastfeeding: A Randomized Controlled Trial Costs and benefits of community postnatal support workers: a randomised controlled trial. Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial Ten Steps to Successful Breastfeeding programme to promote early initiation and exclusive breastfeeding in DR Congo: a cluster-randomised controlled trial. Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use. A randomized controlled trial of knowledge sharing practice with empowerment strategies in pregnant women to improve exclusive breastfeeding during the first six months postpartum. Effect of an extended midwifery postnatal support programme on the duration of breast feeding: a randomised controlled trial. Comparison of the effect of two systems for the promotion of exclusive breastfeeding Promotion of breastfeeding intervention trial (PROBIT): a cluster-randomized trial in the Republic of Belarus. Design, follow-up, and data validation. Effectiveness of an early intervention on infant feeding practices and "tummy time": a randomized controlled trial.
This retrospective study assessed the effects of pre- and post-training programme for  healthcare professionals  about breastfeeding . The study included 3,114 mothers who had children aged 1–72 month(s ) . Their knowledge and behaviours relating to breastfeeding were evaluated . The mothers were r and omly divided into two groups : the ‘ before ’  group included 2,000 women who were not informed about breastfeeding  , and the ‘ after  ’  group comprised 1,114 women who had been informed about breastfeeding .  56.2 % and 66.1 % of the mothers started  breastfeeding  within 30 minutes after delivery , respectively , in the before and the after group ( x2=29.31 , p<0.001 ) . 16.7 % and 36.5 % gave exclusive breastfeeding for six months ( x2=72.85 , p<0.001 ) , and 28.5 % and 23.7 % stopped breastfeeding within the first five months ( x2=17.20 , p=0.002 ) . Ninety-four percent delivered in a hospital or in a primary healthcare centre . Therefore , prenatal and postnatal breastfeeding education and support courses may improve a woman 's chance of starting and continuing to breastfeed her baby . In terms of the number of antenatal check-ups , since the differences between the two groups were significant ( x2=390.67 , p=0.000 ) , the importance of the training programme about breastfeeding was highlighted . Follow-up interventions after training are suggested Background : Whereas breastfeeding initiation rates have risen in all groups throughout the country , rates of breastfeeding duration have changed more slowly . Peer counseling has had some success in sustaining breastfeeding , but with intensive programs and variable effects . Objectives : We aim ed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally . We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention . Methods : One hundred twenty prenatal women underwent stratified r and omization based on breastfeeding attitude , measured by the Iowa Infant Feeding Attitude Scale ( IIFAS ) . The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery . Study groups were compared on breastfeeding outcomes , adjusting for IIFAS strata , and on interactions with self-efficacy . Results : One hundred three women were followed to at least 1 month . Women with positive attitudes had significantly higher rates of initiation ( 93 % vs 61 % ) and breastfeeding at 1 and 6 months ( 79 % vs 25 % and 12 % vs 0 % , respectively ) than those with negative attitudes , regardless of intervention . After adjusting for self-efficacy , women who received peer counseling had significantly higher breastfeeding rates at 1 month ( odds ratio = 3.2 ; 95 % confidence interval , 1.02 - 9.8 ) . The intervention group was marginally more likely to achieve their breastfeeding goal ( 43 % vs 22 % , P = .073 ) . Conclusion : Breastfeeding rates in all women improved during the study period . Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support . Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals 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 OBJECTIVE : To evaluate a specialized breastfeeding peer counseling ( SBFPC ) intervention promoting exclusive breastfeeding ( EBF ) among overweight/obese , low-income women . METHODS : We recruited 206 pregnant , overweight/obese , low-income women and r and omly assigned them to receive SBFPC or st and ard care ( controls )  at a Baby-Friendly hospital . SBFPC included 3 prenatal visits , daily in-hospital support , and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers . St and ard care involved routine access to breastfeeding support from hospital personnel , including staff peer counselors . Data collection included an in-hospital interview , medical record review , and monthly telephone calls through 6 months postpartum to assess infant feeding practice s , demographics , and health outcomes . Bivariate and logistic regression analyses were conducted . RESULTS : The intervention had no impact on EBF or breastfeeding continuation at 1 , 3 , or 6 months postpartum . In adjusted posthoc analyses , at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding ( adjusted odds ratio [ aOR ] : 3.76 [ 95 % confidence interval ( CI ) : 1.07–13.22 ] ) , and giving at least 50 % of feedings as breast milk ( aOR : 4.47 [ 95 % CI : 1.38–14.5 ] ) , compared with controls . Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth ( aOR : 0.24 [ 95 % CI : 0.07–0.86 ] ) . CONCLUSIONS : In a Baby-Friendly hospital setting , SBFPC targeting overweight/obese women did not impact EBF practice s but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth OBJECTIVE : To evaluate the effectiveness of a coparenting intervention on exclusive breastfeeding  among primiparous mothers and fathers . METHODS : A r and omized controlled trial was conducted in a large teaching hospital in Toronto , Canada . Couples were r and omized to receive either  usual care ( n = 107 ) or a coparenting breastfeeding support intervention ( n = 107 ) . Follow-up of exclusive breastfeeding and diverse secondary outcomes was conducted at 6 and 12 weeks postpartum . RESULTS : Significantly more mothers in the intervention group than in the control group continued to breastfeed at 12 weeks postpartum ( 96.2 % vs 87.6 % , P = .02 ) . Although proportionately more mothers in the intervention group were exclusively breastfeeding at 6 and 12 weeks , these differences were not significant . Fathers in the intervention group had a significantly greater increase in breastfeeding self-efficacy scores from baseline to 6 weeks postpartum compared with fathers in the control group ( P = .03 ) . In addition , significantly more mothers in the intervention group than in the control group reported that their partners provided them with breastfeeding help in the first 6 weeks ( 71 % vs 52 % , P = .02 ) and that they were satisfied with their partners ’ involvement with breastfeeding ( 89 % vs 78.1 % , P = .04 ) . Mothers in the intervention group were also more satisfied with the breastfeeding information they received ( 81 % vs 62.5 % , P < .001 ) . CONCLUSIONS : The significant improvements in breastfeeding duration , paternal breastfeeding self-efficacy , and maternal perceptions of paternal involvement and assistance with breastfeeding suggest that a coparenting intervention involving fathers warrants additional investigation 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 OBJECTIVE : To test the effectiveness of cognitive-behavioral counseling on the rate and duration of exclusive breastfeeding ( EBF )  during the first 6 months of an infant ’s life compared with routine counseling . METHODS : A single blind cluster-r and omized controlled trial was undertaken in 40 Union Councils of a rural district in the northwest province of Pakistan between May 2009 and April 2010 . By simple unmatched r and omization , 20 Union Councils were each allocated to intervention and control arms . Two hundred twenty-four third trimester pregnant women in the intervention and 228 third trimester pregnant women in the control arm were enrolled and followed-up biweekly until 6 months postpartum . Analyses were by intention to treat . Mothers in the intervention group received 7 sessions of cognitive-behavioral counseling from antenatal to 6 months postpartum , whereas the control group received an equal number of routine sessions . Proportion of mothers exclusively breastfeeding at 6 months postpartum and duration of EBF through these 6 months was assessed . RESULTS : At 6 months postpartum , 59.6 % of mothers in the intervention arm and 28.6 % in the control arm were exclusively breastfeeding . This translates into a 60 % reduced risk of stopping exclusively breastfeeding during the first 6 months ( adjusted hazard ratio , 0.40 [ 95 % confidence interval : 0.27–0.60 ] , P < .001 ) . Mothers in the intervention group were half as likely to use prelacteal feeds with their infants ( adjusted relative risk , 0.51 [ 95 % confidence interval : 0.34–0.78 ] ) . CONCLUSIONS : Compared with routine counseling , cognitive-behavioral counseling significantly prolonged the duration of EBF , doubling the rates of EBF at 6 months postpartum OBJECTIVE to assess the effectiveness of a peer support worker ( PSW ) service on breast-feeding continuation . DESIGN cluster r and omised controlled trial ( IS RCT N16126175 ) . SETTING Primary Care Trust , UK serving a multi-ethnic , socio-economically disadvantaged population . PARTICIPANTS 2,724 women giving birth following antenatal care from 66 clinics : 33 clinics ( 1,267 women ) r and omised to the PSW service and 33 clinics ( 1,457 women ) to usual care . 848 women consented to additional follow-up by question naire at 6 months . INTERVENTION PSW service provided in the antenatal and postnatal period . MEASUREMENTS any and exclusive breast feeding at 10 - 14 days obtained from routine computerised records and at 6 weeks and 6 months from a question naire . FINDINGS follow-up : 94 % at 10 - 14 days , 67.5 % at 6 months . There was no difference in any breast feeding at 10 - 14 days between intervention and usual care , odds ratio ( OR ) 1.07 ( 95 % CI 0.87 - 1.31 , p=0.54 ) . Proportion of women reporting any breast feeding in the intervention group at 6 weeks was 62.7 % and 64.5 % in the usual care group OR 0.93 ( 95 % CI 0.64 - 1.35 ) ; and at 6 months was 34.3 % and 38.9 % , respectively , OR 1.06 ( 95 % CI 0.71 - 1.58 ) . KEY CONCLUSIONS universal antenatal peer support and postnatal peer support for women who initiated breast feeding did not improve breast-feeding rates up to 6 months in this UK population . IMPLICATION S FOR PRACTICE with high levels of professional support part of usual maternity care it may not be possible for low intensity peer support to produce additional benefit . More intensive or targeted programmes might be effective , but should have concurrent high quality evaluation Background Although breastfeeding is common in Democratic Republic of the Congo , the proportion of women who exclusively breastfeed their babies up to 6 months remains low . This study aim ed at identifying predictors of discontinuing exclusive breastfeeding before six months among mothers in Kinshasa . Methods A prospect i ve study was carried out from October 2012 to July 2013 among 422 mother-child pairs recruited shortly after discharge from twelve maternities in Kinshasa and followed up to six months .  Interviews were conducted at each woman ’s house during the first week after birth , and at one , two , three , four , five and six months . Collected data included history of child ’s feeding and mother ’s socio-demographic and psychosocial characteristics . The Cox Proportional Model was used to identify predictors of discontinuing exclusive breastfeeding before six months . Results The median duration of exclusive breastfeeding was 10.9 weeks ( Inter Quartile Range 4.3 to 14.9 ) . At six months , 2.8 % of infants were exclusively breastfed . The factors independently associated with the discontinuation of exclusive breastfeeding before six months were : not confident in the ability to breastfeed [ Adjusted hazard ratio ( AHR ) = 3.90 ; 95 % CI 1.66 , 9.16 ) ] , no plan on the duration of EBF ( AHR = 2.86 ; 95 % CI 1.91 , 4.28 ) , breastfeeding problems during the first week ( AHR = 1.54 ; 95 % CI 1.13 , 2.11 ) , low level of breastfeeding knowledge ( AHR = 1.52 ; 95 % CI 1.08 , 2.15 ) , and experienced less than five Baby-friendly practice s during the maternity stay ( AHR = 1.47 ; 95 % CI 1.05 , 2.06 ) . Conclusions Confidence in the ability to breastfeed and intention to exclusively breastfeed were the most important predictors of discontinuing exclusive breastfeeding before six months . To have a greater impact on the duration of exclusive breastfeeding , interventions should focus on these factors Background Breastfeeding has countless benefits to mothers , children and community at large , especially in developing countries . Studies from Lebanon report disappointingly low breastfeeding exclusivity and continuation rates . Evidence reveals that antenatal breastfeeding education , professional lactation support , and peer lay support are individually effective at increasing breastfeeding duration and exclusivity , particularly in low-income setting s. Given the complex nature of the breastfeeding ecosystem and its barriers in Lebanon , we hypothesize that a complex breastfeeding support intervention , which is centered on the three components mentioned above , would significantly increase breastfeeding rates . Methods / Design A multi-center r and omized controlled trial . Study population : 443 healthy pregnant women in their first trimester will be r and omized to control or intervention group . Intervention : A “ prenatal/postnatal ” professional and peer breastfeeding support package continuing till 6 months postpartum , guided by the Social Network and Social Support Theory . Control group will receive st and ard prenatal and postnatal care . Mothers will be followed up from early pregnancy till five years after delivery . Outcome measures : Total and exclusive breastfeeding rates , quality of life at 1 , 3 and 6 months postpartum , maternal breastfeeding knowledge and attitudes at 6 months postpartum , maternal exclusive breastfeeding rates of future infants up to five years from baseline , cost-benefit and cost-effectiveness analyses of the intervention . Statistical analysis : Descriptive and regression analysis will be conducted under the intention to treat basis using the most recent version of SPSS . Discussion Exclusive breastfeeding is a cost-effective public health measure that has a significant impact on infant morbidity and mortality . In a country with limited healthcare re sources like Lebanon , developing an effective breastfeeding promotion and support intervention that is easily replicated across various setting s becomes a priority . If positive , the results of this study would provide a generalizable model to bolster breastfeeding promotion efforts and contribute to improved child health in Lebanon and the Middle East and North Africa ( MENA ) region . Trial registration Current Controlled Trials IS RCT OBJECTIVE To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding ( EBF )  in a low-re source urban setting in Kenya . DESIGN A cluster r and omized controlled trial in which nine villages were assigned on a 1:1:1 ratio , by computer , to two intervention groups and a control group . The home-based intensive counselling group ( HBICG ) received seven counselling sessions at home by trained peers , one prenatally and six postnatally . The facility-based semi-intensive counselling group ( FBSICG ) received only one counselling session prenatally . The control group ( CG ) received no counselling from the research team . Information on infant feeding practice s was collected monthly for 6 months after delivery . The data -gathering team was blinded to the intervention allocation . The outcome was EBF prevalence at 6 months . SETTING Kibera slum , Nairobi . SUBJECTS A total of 360 HIV-negative women , 34 - 36 weeks pregnant , were selected from an antenatal clinic in Kibera ; 120 per study group . RESULTS Of the 360 women enrolled , 265 completed the study and were included in the analysis ( CG n 89 ; FBSICG n 87 ; HBICG n 89 ) . Analysis was by intention to treat . The prevalence of EBF at 6 months was 23.6 % in HBICG , 9.2 % in FBSICG and 5.6 % in CG . HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG ( adjusted relative risk = 4.01 ; 95 % CI 2.30 , 7.01 ; P=0.001 ) . There was no significant difference between EBF rates in FBSICG and CG . CONCLUSIONS EBF can be promoted in low socio-economic conditions using home-based intensive counselling . One session of facility-based counselling is not sufficient to sustain EBF Objectives Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period . We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants . Study Design We conducted a r and omized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants < 4 weeks of age . Mothers receiving the intervention met with an International Board-Certified Lactation Consultant in hospital and 1–3 times post discharge . Both groups received the st and ard care for jaundice . The primary outcome was exclusive breastfeeding at 3 months . To the exception of research assistants enrolling participants and completing qualitative interviews , all research staff , investigators and statisticians were blinded to group assignment . Qualitative interviews elicited feedback on breastfeeding experiences for both groups . Results 99 participants were recruited , and 86 analyzed for primary outcome . There was no difference in exclusive breastfeeding at 3 months between groups ( RR 0.84 , 95 % CI 0.56–1.24 , p = 0.40 ) or in the secondary outcomes . 31 participants were included in the qualitative analysis . Participants in the intervention group described an increase in comfort and confidence levels with breastfeeding . Participants in the control group reported limited lactation support . Conclusions Our hospital-based lactation support program did not result in a higher proportion of mothers exclusively breastfeeding at 3 months compared to current hospital st and ard care . Qualitative feedback from the intervention group suggests that mothers ’ confidence was increased , which is linked to breastfeeding duration . The decision to breastfeed is multifactorial and hospital-based lactation support may be only a small piece of the puzzle in hospitalized jaundiced infants . Further studies may be needed to fully eluci date the impact of an in-hospital lactation support program on successful breastfeeding for these infants . Trial Registration Clinical Trials.gov NCT00966719 https://www . clinical trials.gov/ct2/show/NCT00966719?term=Lactation+Support+ and + Breastfeeding+ Duration + in+Jaundiced+Infants%3A+a+R and OBJECTIVE : To evaluate the effectiveness of a professional one-to-one antenatal breastfeeding support and education intervention on the exclusivity and duration of breastfeeding . METHODS : A total of 469 primiparous women who attended the antenatal clinics of two geographically distributed public hospitals in Hong Kong were r and omized to receive either  st and ard antenatal care or a one-to-one antenatal breastfeeding support and education session . The primary outcome was the prevalence of exclusive breastfeeding at 6 weeks postpartum . Secondary outcomes were the prevalence of exclusive breastfeeding at 3 and 6 months postpartum as well as the overall duration of any and exclusive breastfeeding across the first 6 months postpartum . RESULTS : The exclusive breastfeeding rate in the intervention group was 37.8 % at 6 weeks postpartum compared with 36.4 % in the st and ard care group ( P=.77 ; 95 % confidence interval [ CI ] −0.08 to 0.11 ) . There were no significant differences between the two treatment groups in exclusive breastfeeding rates at 3 and 6 months or in the overall duration of any ( hazard ratio [ HR ] 1.11 , 95 % CI 0.88–1.40 ] or exclusive breastfeeding ( HR 0.96 , 95 % CI 0.79–1.17 ) . The study had a least 80 % power to detect a 50 % increase in the rate of exclusive breastfeeding at 6 weeks postpartum . CONCLUSION : In a setting with a high breastfeeding initiation rate , one-to-one antenatal breastfeeding support and education did not increase the exclusivity or duration of breastfeeding . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT01648114 . LEVEL OF EVIDENCE : OBJECTIVES This study aim ed to measure the effect and the total cost per woman of providing postnatal support at home , based on a Dutch model . The research hypothesis was furnished by some existing evidence that postnatal support could reduce the risk of postnatal depression and encourage breastfeeding . DESIGN The r and omised controlled trial aim ed to measure differences in health status in a group of women who were offered postnatal support from a community midwifery support worker ( SW ) compared with a  control group of women who were not offered this support .  Women were followed-up by postal question naire at 6 weeks and 6 months postnatally . SETTING AND SUBJECTS All women who delivered a baby at the recruiting hospital were eligible to take part in the trial if they lived within the study area , were aged 17 years or over , and could underst and English . INTERVENTION The intervention consisted of the SW offering practical and emotional support and to help women rest and recover after childbirth . The SW offered ten visits in the first 28 days postnatally , for up to 3 hours per day . The SW 's activities included housework , talking with the mother , and care for the baby or other siblings . The service was provided in addition to routine visits by the community midwife . MAIN OUTCOME MEASURES The primary outcome was the general health perception domain of the Short Form-36 at 6 weeks . Secondary outcomes were mean Edinburgh Postnatal Depression Scale ( EPDS ) , Duke Functional Social Support ( DUFSS ) scores and breastfeeding rates . RESULTS The 623 r and omised women were well-matched by group with a good response to follow-up . At 6 weeks there was no evidence of a significant difference between the two groups for the primary outcome . There was a non-significant trend for the control group to have better mean DUFSS and EPDS scores at 6 weeks . Breastfeeding rates were not significantly different at follow-up . At 6 months , both groups had similar health status . Satisfaction with the service was higher than for all other services received . The incremental cost of introducing the service comprised setting up and running the service . There were no differences between the groups in other re source use ( general practitioner contacts , hospital services , prescriptions or medicines bought for mothers and babies ) to 6-month follow-up . The total mean NHS cost to 6-month follow-up for the intervention group was pound180 per woman greater than for the control group ( confidence interval , pound79.60 , pound272.40 ) . CONCLUSIONS Although women valued the service , there was no evidence of any health benefit at the 6-week or 6-month follow-up , no difference in use of NHS services , and the additional cost of the service provision would be around pound 180 per woman 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 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 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 BACKGROUND Optimisation of breastfeeding practice s could reduce high mortality rates in children younger than 5 years , but in DR Congo , despite near-universal breastfeeding initiation and nine of ten children still breastfeeding at 1 year of age , exclusivity remains a difficulty . We assessed the effect on breastfeeding outcomes of a short-cut implementation of a programme called the Ten Steps to Successful Breastfeeding , the key component of the Baby-Friendly Hospital Initiative ( BFHI ) . METHODS We did a cluster-r and omised controlled trial and r and omly assigned  health-care clinics in Kinshasa , DR Congo , to st and ard care ( control group ) , BFHI steps 1 - 9 ( steps 1 - 9 group ) , or BFHI steps 1 - 9 plus additional support during well-child visits ( steps 1  -  10 group ) with computer-generated r and om numbers used to assign matched pairs to study groups . Mothers at these clinics who had given birth to one healthy baby during enrolment , and who expressed their intentions of visiting a well-baby session at the same clinic , were eligible and received the treatment assigned to their clinic . Mother-infant pairs were excluded if the mothers intended to attend well-baby clinic visits at a different health facility , or to travel before the child was aged at least 6 months . Participants and independent interviewers were masked to group assignment ( ie , they were recruited after r and omisaion and training of the clinic staff and were not informed of the study scheme ) , but clinical staff were unmasked . BFHI steps 1 - 9 and 1 - 10 were given by health-care staff trained with the WHO/UNICEF BFHI course . The primary outcomes were breastfeeding initiation within 1 h of birth and exclusive breastfeeding at age 14 and 24 weeks , assessed at face-to-face interviews in the clinic . Analysis was by intention to treat . Prevalence ratios ( PR ) were adjusted for cluster effects and baseline characteristics . This trial is registered at Clinical Trials.gov , number NCT01428232 , and is closed to new participants . FINDINGS Between May 24 , and Aug 25 , 2012 , we r and omly assigned two eligible clinics to control , two to BFHI steps 1 - 9 , and two to BFHI steps 1 - 10 . We enrolled 975 eligible mother-infant pairs ( 304 in the control group , 363 in the steps 1 - 9 group , and 308 in the steps 1 - 10 group ) . 230 ( 76 % ) of infants in the control group , 263 ( 72 % ) in the steps 1 - 9 group , and 220 ( 71 % ) in the steps 1 - 10 group were breastfed within 1 h of birth ; these results did not differ significantly between groups . Prevalence of exclusive breastfeeding at age 14 weeks was 89 ( 29 % ) in the control group , 237 ( 65 % ) in the steps 1 - 9 group ( adjusted PR 2·20 , 95 % CI 1·73 - 2·77 ) , and 129 ( 42 % ) in the steps 1 - 10 group ( 1·40 , 1·13 - 1·74 ) . At age 24 weeks , the prevalence of exclusive breastfeeding was 36 ( 12 % ) in the control group , 131 ( 36 % ) in the steps 1 - 9 group ( 3·50 , 2·76 - 4·43 ) , and 43 ( 14 % ) in the steps 1 - 10 group ( 1·31 , 0·91 - 1·89 ) . INTERPRETATION In the setting of health-care clinics in DR Congo with a high proportion of mothers initiating breastfeeding , implementation of basic training in BFHI steps 1 - 9 had no additional effect on initiation of breastfeeding but significantly increased exclusive breastfeeding at 6 months of age . Additional support based on the same training material s and locally available breastfeeding support material s , offered during well-child visits ( ie , step 10 ) did not enhance this effect , and might have actually lessened it OBJECTIVE To determine whether infants of women r and omized to a prenatal and postpartum lactation support intervention  incur fewer otitis media- , respiratory tract- , or gastrointestinal-related visits than controls . DESIGN R and omized , unmasked controlled trial recruiting women from prenatal care setting s. Breastfeeding sensitive ( BFS ) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months . SETTING Two urban community health centers . PARTICIPANTS Analytic sample of 338 low-income , primarily Hispanic and /or black mother-infant dyads ( n = 163 for the intervention group and n = 175 for the control group ) . INTERVENTION Study lactation consultants attempted 2 prenatal meetings , 1 postpartum hospital and /or home visit , and telephone calls as needed . Controls received the st and ard of care . MAIN OUTCOME MEASURES Combined outpatient and emergency department visits with illness and BFS illness diagnoses . RESULTS There was a significant interaction between treatment and Medicaid ; among those not receiving Medicaid , the number of otitis media visits was higher among controls ( P</=.03 ) . Visits for any illness and BFS , gastrointestinal , or respiratory tract illnesses did not differ by treatment group . Intervention group infants received more breast milk than controls , but exclusive breastfeeding rates remained low and did not differ between groups at any point . CONCLUSIONS Only the number of otitis media visits was reduced , in a subset of the intervention group . The intervention did not reduce visits for respiratory tract or gastrointestinal illness . Limited intervention contact and low exclusive breastfeeding rates may have attenuated intervention effects . Future interventions design ed to yield markedly increased breastfeeding rates may show greater effects in low-income multiethnic sample s. Health coverage for visits may moderate intervention effects BACKGROUND 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 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 BACKGROUND Promotion of breastfeeding is an important child-survival intervention , yet little is known about which promotional strategies are the most effective . We aim ed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil -- a hospital-based system and the same system combined with a programme of home visits . METHODS In February , 2001 , maternity staff from two hospitals in Pernambuco , Brazil , were trained according to the Baby-Friendly Hospital Initiative ( BFHI ) . In a r and omised trial between March and August , 2001 , 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding ( n=175 ) or no home visits ( n=175 ) . Breastfeeding practice s were studied on days 1 , 10 , 30 , 60 , 90 , 120 , 150 , and 180 by research ers unaware of group allocation . The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months . Analyses were by intention to treat . FINDINGS The hospital-training intervention achieved a high rate ( 70 % ) of exclusive breastfeeding in the hospitals , but this rate was not sustained at home and at 10 days of age only 30 % of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10 - 180 differed significantly ( p<0.0001 ) , with a mean aggregated prevalence of 45 % among the group assigned home visits compared with 13 % for the group assigned none . INTERPRETATION The BFHI achieves high rates of exclusive breastfeeding in hospital ; however , in Brazil at least , the rates fall rapidly thereafter . Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed . A combination of promotional systems ( hospital-based and in the community ) is needed This paper summarizes the objectives , design , follow-up , and data validation of a cluster-r and omized trial of a breastfeeding promotion intervention modeled on the WHO/UNICEF Baby-Friendly Hospital Initiative ( BFHI ) . Thirty-four hospitals and their affiliated polyclinics in the Republic of Belarus were r and omized to receive  BFHI training of medical , midwifery , and nursing staffs ( experimental group  ) or to continue their routine practice s ( control group ) . All breastfeeding mother-infant dyads were considered eligible for inclusion in the study if the infant was singleton , born at > or = 37 weeks gestation , weighed > or = 2500 grams at birth , and had a 5-minute Apgar score > or = 5 , and neither mother nor infant had a medical condition for which breastfeeding was contraindicated . One experimental and one control site refused to accept their r and omized allocation and dropped out of the trial . A total of 17,795 mothers were recruited at the 32 remaining sites , and their infants were followed up at 1 , 2 , 3 , 6 , 9 , and 12 months of age . To our knowledge , this is the largest r and omized trial ever undertaken in area of human milk and lactation . Monitoring visits of all experimental and control maternity hospitals and polyclinics were undertaken prior to recruitment and twice more during recruitment and follow-up to ensure compliance with the r and omized allocation . Major study outcomes include the occurrence of > or = 1 episode of gastrointestinal infection , > or = 2 respiratory infections , and the duration of breastfeeding , and are analyzed according to r and omized allocation ( " intention to treat " ) . One of the 32 remaining study sites was dropped from the trial because of apparently falsified follow-up data , as suggested by an unrealistically low incidence of infection and unrealistically long duration of breastfeeding , and as confirmed by subsequent data audit of polyclinic charts and interviews with mothers of 64 r and omly-selected study infants at the site . Smaller r and om audits at each of the remaining sites showed extremely high concordance between the PROBIT data forms and both the polyclinic charts and maternal interviews , with no evident difference in under- or over-reporting in experimental vs control sites . Of the 17,046 infants recruited from the 31 participating study sites , 16,491 ( 96.7 % ) completed the study and only 555 ( 3.3 % ) were lost to follow-up . PROBIT 's results should help inform decision-making for clinicians , hospitals , industry , and governments concerning the support , protection , and promotion of breastfeeding 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
BACKGROUND The World Health Organization ( WHO ) recommends that mothers practice exclusive breastfeeding ( EBF ) of their infants for 6 months .
Various breastfeeding support interventions have been developed to encourage mothers to maintain breastfeeding practice s. Research aim : This study aims to review how effectively breastfeeding support interventions enable mothers to practice EBF for 6 months and to suggest the best intervention strategies .