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.
