Abstract
BackgroundImmediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO. We report its impact on early infant feeding practices from the PROMISE-EBF trial.MethodsPROMISE-EBF was a cluster randomised behaviour change intervention trial of exclusive breastfeeding (EBF) promotion by peer counsellors in Burkina Faso, Uganda and South Africa implemented during 2006-2008 among 2579 mother-infant pairs. Counselling started in the last pregnancy trimester and mothers were offered at least five postnatal visits. Early infant feeding practices: use of prelacteal feeds (any foods or drinks other than breast milk given within the first 3 days), expressing and discarding colostrum, and timing of initiation of breastfeeding are presented by trial arm in each country. Prevalence ratios (PR) with 95% confidence intervals (95%CI) are given.ResultsThe proportion of women who gave prelacteal feeds in the intervention and control arms were, respectively: 11% and 36%, PR 0.3 (95% CI 0.2, 0.6) in Burkina Faso, 13% and 44%, PR 0.3 (95% CI 0.2, 0.5) in Uganda and 30% and 33%, PR 0.9 (95% CI 0.6, 1.3) in South Africa. While the majority gave colostrum, the proportion of those who expressed and discarded it in the intervention and control arms were: 8% and 12%, PR 0.7 (95% CI 0.3, 1.6) in Burkina Faso, 3% and 10%, PR 0.3 (95% CI 0.1, 0.6) in Uganda and 17% and 16%, PR 1.1 (95% CI 0.6, 2.1) in South Africa. Only a minority in Burkina Faso (<4%) and roughly half in South Africa initiated breastfeeding within the first hour with no large or statistically significant differences between the trial arms, whilst in Uganda the proportion of early initiation of breastfeeding in the intervention and control arms were: 55% and 41%, PR 0.8 (95% CI 0.7, 0.9).ConclusionsThe PROMISE-EBF trial showed that the intervention led to less prelacteal feeding in Burkina Faso and Uganda. More children received colostrum and started breastfeeding early in the intervention arm in Uganda. Late breastfeeding initiation continues to be a challenge. No clear behaviour change was seen in South Africa.Trial registrationNCT00397150.Electronic supplementary materialThe online version of this article (doi:10.1186/1746-4358-9-19) contains supplementary material, which is available to authorized users.
Highlights
Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO
The study was conducted in three countries: 1) Banfora in south-west Burkina Faso, a rural area dominated by subsistence farming; 2) in eastern Uganda, the sites comprised rural Bungokho where both subsistence farming and petty trading are common, and urban Mbale Municipality characterised by informal settlements and small industries; and 3) in South Africa, three geographically separate sites included Paarl, a commercial farming area in the Western Cape Province, peri-urban Umlazi, and the rural Rietvlei in KwaZulu-Natal
A small proportion was interviewed for the early infant feeding recall at 6 weeks and at 12 weeks, respectively: Burkina Faso: 47/794 (5.9%), Uganda: 25/765 (3.3%), South Africa: 49/1020 (4.8%) and Burkina Faso: 18/794 (2.3%), Uganda: 3/765 (0.4%), South Africa: 14/ 1020 (1.4%)
Summary
Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO. Despite substantial reduction in child mortality, an almost stagnant risk of death within the first weeks of life is a reality in sub-Saharan Africa [1]. Recent reports found an annual rate of reduction in neonatal mortality from 40.5/1000 in 2000 to 35/1000 in 2010 [1]. Efforts have been made to identify interventions that are safe, affordable, acceptable and can be scaled up in order to effectively reduce early child morbidity and mortality [2]. In 2006 delayed and non-exclusive breastfeeding were described as major risk factors for neonatal deaths in a large cohort from a vitamin A trial in Ghana (ObaapaVitA trial) [3]. The three public health early infant feeding pillars include a) initiating breastfeeding as early as possible, and not later than 1 hour after birth, b) exclusive breastfeeding that includes avoiding pre-lacteal feeds, and c) giving the colostrum to the child [5]
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