Haider R, Ashworth A, Kabir I, Huttley SRA. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomized controlled trial, The Lancet 356:1643-1647, 2000.

Although Bangladesh has high breastfeeding initiation and duration rates, exclusive breastfeeding is rare. With 95% of pregnant women delivering their infants at home, hospital-based exclusive breastfeeding promotion activities have limited effect.

Therefore researchers designed and tested a peer, homebased intervention to improve exclusive breastfeeding rates. Peer counsellors were trained for 40 hours in breastfeeding counselling skills, were responsible for 12-25 mothers, and paid an honorarium. The counsellors visited mothers 15 times within the 2 last trimesters, 3 early postpartum, and every 2 weeks until the child was 5 months old. There were 363 women enrolled in each the control and the visited (intervention) groups. The mothers were also interviewed about the birth and at monthly intervals for 5 months about breastfeeding status.

Results showed a strong beneficial effect of peer counselling. At 5 months, 70% of the visited group were still breastfeeding exclusively, compared with only 6% of the control group. Other results showed that breastfeeding was started earlier in the visited group and fewer prelacteal foods (31%) were given compared with the control group (89%). 70% of the controls and 54% of the visited groups started complementary foods during the first 4 months.

Mothers in the control groups said that they started other foods because they thought they did not have enough breastmilk, while mothers in the visited groups started other foods because the mothers returned to work.

Cattaneo A, Davanzo R, Ronfani L. Are data on the prevalence and duration of breastfeeding reliable? The case of Italy, Acta Paediatrica 89: 88-93, 2000.

Breastfeeding promotion activities are carried on world-wide in order to fulfil the WHO and UNICEF recommendations that infants be exclusively breastfed for about 6 months, then the introduction of complementary foods and continued breastfeeding well into the second year. In order to design promotional activities and set goals, national breastfeeding rates need to be assessed. Researchers in Italy analyzed 16 national studies in order to judge the reliability of these studies.

They found that most studies chose a non-representative sample, that only 2 of the studies used the WHO standardized definition of breastfeeding, and that all the studies used a recall time different from the recommended 24-hour period. They concluded that these studies failed to represent the actual prevalence and duration of breastfeeding, and that "should the Ministry of Health decide to establish objectives and targets for breastfeeding, well designed studies, using the WHO definitions and recall periods, will have to be periodically conducted on representative samples of children under 2 years of age".

Ojofeitimi EO, Esimal OA, Owolabi OO, Oluwabusi, Olaobaju OF, Olanuga TO. Breast feeding practices in urban and rural health centres: Impact of Baby Friendly Hospital Initiative in Ile-Ife, Nigeria, Nutrition and Health 14: 119-125, 2000.

The UNICEF-WHO Baby Friendly Hospital Initiative (BFHI) has shown itself to be an effective method of improving breastfeeding practices world-wide.

Researchers in Nigeria compared breastfeeding practices among mothers delivering in an urban BFHI designated hospital with mothers delivering in a rural, non BFHI health center. Breastfeeding mothers in both groups were mostly engaged in farming, petty trading and office work.

Results showed that 61% of mothers started breastfeeding within 30 minutes after birth in the BFHI facility, while only 39% started within 30 minutes in the non-BFHI hospital. With regards to exclusive breastfeeding, three-quarters of the mothers from the BFHI facility exclusively breastfed as compared with 35% from the non-BFHI hospital. Contrary to other studies of developing countries, data in this study showed higher education of the mothers was associated with higher exclusive breastfeeding rates. 81% of the mothers in the BFHI facility put their babies to the breast in a satisfactory position compared to 19% in the non-BFHI facility.

The authors conclude that BFHI training needs to spread from the urban centres into the rural health facilities in order to give babies there the best start in life.

Vogel A, Hutchison BL, Mitchell EA. Factors associated with the duration of breastfeeding, Acta Paediatrica 88: 1320-1326, 1999.

In view of the many health benefits to mothers and children afforded by breastfeeding, governments have set goals for breastfeeding practices and rates. Because these goals are not being met in New Zealand, researchers there designed a study to learn what factors play a role in determining how long a mother breast-feeds. 350 mother-infant pairs were recruited, 91% of whom were followed up for one year. Breastfeeding was started by 97.4% of the mothers, with a median duration of 7.6 months. 30% were still partially breastfeeding at 1 year.

The most common reason for stopping breastfeeding was perceived insufficient milk in the first months. Most mothers stopped breastfeeding in the second half of the first year more often because they believed they had fed long enough. Younger maternal age and a return to full-time work during the first year also were associated with a shorter length of breast-feeding. Mothers who stated that they had no plans as to how long to breastfeed tended to have shorter duration, while those planning to breastfeed 6 months or longer had the longest duration. Also, the use of a bottle, whether it contained formula, breastmilk or juice, was associated with more than double the risk of shorter duration. Having mastitis and sharing the mother's bedroom was associated with longer breastfeeding duration.

Guise J-M, Freed G. Resident physicians' knowledge of breastfeeding and infant growth, Birth 27(1): 49-53, 2000.

It is well documented that breastfed babies have a different growth pattern than formula-fed babies. Breastfed babies show a slower gain starting around 4 months. Judging breastfed infant growth using a bottle-fed infant growth chart can lead to stopping breastfeeding or premature introduction of complementary foods. Researchers in the USA surveyed 107 resident doctors about their plotting infant growth. None of them used growth charts for breastfed babies when plotting growth of breastfed babies. Only 5% knew that breastfed babies grow at a slower rate than artificially fed infants.