Breastfeeding Education and Support to Improve Early Initiation and Exclusive Breastfeeding Practices and Infant Growth: A Cluster Randomized Controlled Trial from a Rural Ethiopian Setting.

Misra Abdulahi,Jeanette H. Magnus,Alemayehu Argaw,Atle Fretheim

doi:10.3390/nu13041204

Abstract

Although peer-led education and support may improve breastfeeding practices, there is a paucity of evidence on the effectiveness of such interventions in the Ethiopian context. We designed a cluster-randomized trial to evaluate the efficacy of a breastfeeding education and support intervention (BFESI) on infant growth, early initiation (EI), and exclusive breastfeeding (EBF) practices. We randomly assigned 36 clusters into either an intervention group (n = 249) receiving BFESI by trained Women’s Development Army (WDA) leaders or a control group (n = 219) receiving routine care. The intervention was provided from the third trimester of pregnancy until five months postpartum. Primary study outcomes were EI, EBF, and infant growth; secondary outcomes included maternal breastfeeding knowledge and attitude, and child morbidity. The intervention effect was analysed using linear regression models for the continuous outcomes, and linear probability or logistic regression models for the categorical outcomes. Compared to the control, BFESI significantly increased EI by 25.9% (95% CI: 14.5, 37.3%; p = 0.001) and EBF by 14.6% (95% CI: 3.77, 25.5%; p = 0.010). Similarly, the intervention gave higher breastfeeding attitude scores (Effect size (ES): 0.85SD; 95% CI: 0.70, 0.99SD; p < 0.001), but not higher knowledge scores (ES: 0.15SD; 95% CI: −0.10, 0.41SD; p = 0.173). From the several growth and morbidity outcomes evaluated, the only outcomes with significant intervention effect were a higher mid-upper arm circumference (ES: 0.25cm; 95% CI: 0.01, 0.49cm; p = 0.041) and a lower prevalence of respiratory infection (ES: −6.90%; 95% CI: −13.3, −0.61%; p = 0.033). Training WDA leaders to provide BFESI substantially improves EI and EBF practices and attitude towards breastfeeding.

Highlights

This article is an open access articleGlobally, 2.5 million neonatal deaths occurred in 2017, accounting for 46% of all underfive mortality [1]
A systematic review of breastfeeding promotion interventions in lowand middle-income countries (LMICs) found that peer-led support strategies were effective in improving the rates of exclusive breastfeeding (EBF), while the provision of education alone was not effective [5]
It has been shown that community-based peer-support is an effective approach in increasing the rates of early initiation of breastfeeding (EI) and the duration of EBF in populations in LMICs [6]

Summary

Introduction

This article is an open access articleGlobally, 2.5 million neonatal deaths occurred in 2017, accounting for 46% of all underfive mortality [1]. A recent review concluded that the scale-up of breastfeeding protection, promotion, and support interventions is among the key strategies to achieve nutrition targets under the Sustainable Development Goals [2]. In this regard, community-based intervention approaches, including household service delivery, have been identified as effective for scaling-up breastfeeding promotion and support interventions and reaching the populations at most risk [4]. It has been shown that community-based peer-support is an effective approach in increasing the rates of early initiation of breastfeeding (EI) and the duration of EBF in populations in LMICs [6]. In Sub-Saharan Africa, a few studies that evaluated the effectiveness of community-based peer-support interventions reported increased optimal breastfeeding practices [7,8,9]

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Conclusion