ArticlesEffect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial
Introduction
The results of two randomised controlled trials1, 2 and some observational studies3, 4, 5, 6, 7, 8, 9, 10 have shown a protective effect of breastfeeding against diarrhoea compared with other forms of feeding. In developing countries, breastfeeding is common but exclusive breastfeeding is not.1, 11, 12 No large-scale trial has assessed promotion of exclusive breastfeeding in a population with high breastfeeding rates. In a fairly small trial,1 which was designed to assess this possibility, diarrhoea was reduced in the first 3 months of life in a secondary analysis. To justify large-scale interventions, a reduction in diarrhoea and other illnesses through promotion of exclusive breastfeeding in developing countries during the first 6 months of life needs to be shown.
WHO, in its guidelines,13 recommends exclusive breastfeeding for the first 6 months rather than the first 4–6 months. There are concerns that exclusive breastfeeding for this long might be difficult, however, particularly where maternal malnutrition is common.13 Also, few data exist on physical growth that provide reassurance that exclusive breastfeeding for 6 months does not lead to growth faltering, particularly in low-birthweight infants.14
Two strategies have been successful in the promotion of exclusive breastfeeding: the Baby Friendly Hospital Initiative, which increased the likelihood of exclusive breastfeeding in Belarus, where most births take place in health facilities, 2 and the use of peer counsellors in settings where most babies are delivered at home.1, 12 The second approach, based on recruitment of workers dedicated to a single intervention, is unlikely to be sustainable in health systems with few resources.
Our aim was to assess the success, and effects on prevalence of diarrhoea and physical growth, of a community based intervention to promote exclusive breastfeeding until age 6 months and complementary feeding thereafter. Our findings on effects on complementary feeding will be reported separately.
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Participants
Between Jan 1, 1998, and March 31, 2002, we did a cluster randomised controlled trial in the state of Haryana, India, in communities located 3–5 km from the main highway.
Before we selected the study sites we sought collaboration from the local health system, who ultimately became a partner in the study. We also sought oral permission from community leaders to include their area in the study, and obtained written informed consent from all parents of infants. The study was approved by the ethics
Results
In Haryana, the literacy rates are low; 50% of women and 15% of men have never been to school.11 The common occupations for men are agriculture and employment in factories. Water supply is through community hand pumps. Families normally defecate in the fields. Maternal undernutrition rates are high; 26% of married women have a body-mass index of less than 18·5 kg/m2.11 Health care is provided through primary-health centres, each of which serves a population of about 30 000 through two or three
Discussion
Our findings indicate that promotion of exclusive breastfeeding until age 6 months in a developing country setting through existing primary-health-care services is feasible, does not lead to growth faltering, and reduces the risk of diarrhoea. Additionally, educational intervention greatly improved the rates of exclusive breastfeeding, as previously indicated by the results of two community-based trials, which assessed the use of peer counsellors, and several hospital and clinic based
References (24)
- et al.
Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial
Lancet
(1999) - et al.
Breastfeeding and health in the 1980s: a global epidemiologic review
J Pediatr
(1991) - et al.
Differences in morbidity between breastfed and formula fed infants
J Pediatr
(1995) - et al.
Relation between infant feeding and infections during the first 6 months of life
J Pediatr
(1995) - et al.
Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition
Am J Clin Nutr
(1999) - et al.
Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial
Lancet
(2000) - et al.
Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras
Am J Clin Nutr
(1999) - et al.
Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras
Lancet
(1994) - et al.
Promotion of breastfeeding intervention trials (PROBIT): a randomised trial in the Republic of Belarus
JAMA
(2001) - et al.
Impact of breastfeeding on admission for pneumonia during postneonatal period in Brazil: nested case control study
BMJ
(1999)
Protective effects of breastfeeding against infection
BMJ
Breastfeeding protects against illness and infection in infants and children: a review of the evidence
Breastfeed Rev
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