Abstract
BackgroundEvery year, nearly one million deaths occur due to suboptimal breastfeeding. If universally practiced, exclusive breastfeeding alone prevents 11.6% of all under 5 deaths. Among strategies to improve exclusive breastfeeding rates, counselling by peers or health workers, has proven to be highly successful. With growing availability of cell phones in India, they are fast becoming a medium to spread information for promoting healthcare among pregnant women and their families. This study was conducted to assess effectiveness of cell phones for personalized lactation consultation to improve breastfeeding practices.MethodsThis was a two arm, pilot study in four urban maternity hospitals, retrained in Baby Friendly Hospital Initiative. The enrolled mother-infant pairs resided in slums and received healthcare services at the study sites. The control received routine healthcare services, whereas, the intervention received weekly cell phone counselling and daily text messages, in addition to counselling the routine healthcare services.Results1036 pregnant women were enrolled (518 - intervention and 518 - control). Rates of timely initiation of breastfeeding were significantly higher in intervention as compared to control (37% v/s 24%, p < 0.001). Pre-lacteal feeding rates were similar and low in both groups (intervention: 19%, control: 18%, p = 0.68). Rate of exclusive breastfeeding was similar between groups at 24 h after delivery, but significantly higher in the intervention at all subsequent visits (control vs. intervention: 24 h: 74% vs 74%, p = 1.0; 6 wk.: 81% vs 97%, 10 wk.: 78% vs 98%, 14 wk.: 71% vs 96%, 6 mo: 49% vs 97%, p < 0.001 for the last 4 visits). Adjusting for covariates, women in intervention were more likely to exclusively breastfeed than those in the control (AOR [95% CI]: 6.3 [4.9–8.0]).ConclusionUsing cell phones to provide pre and postnatal breastfeeding counselling to women can substantially augment optimal practices. High rates of exclusive breastfeeding at 6 months were achieved by sustained contact and support using cell phones. This intervention shows immense potential for scale up by incorporation in both, public and private health systems.Trial registrationThis study was retrospectively registered with Clinical Trial Registry of India (http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=3060) Trial Number: CTRI/2011/06/001822 on date 20/06/2011.
Highlights
Every year, nearly one million deaths occur due to suboptimal breastfeeding
We evaluated the cost-effectiveness of cell phones to increase exclusive breastfeeding rates at 6 months of infant’s age
Women with presence of complications in pregnancy that could affect exclusive breastfeeding such as severe anemia (Hb < 6 g/dL), at the risk of eclampsia or pre-eclampsia, consuming drugs contraindicated in pregnancy or Human Immunodeficiency Virus (HIV) positivity were excluded
Summary
Nearly one million deaths occur due to suboptimal breastfeeding. Exclusive breastfeeding alone prevents 11.6% of all under 5 deaths. This study was conducted to assess effectiveness of cell phones for personalized lactation consultation to improve breastfeeding practices. Universal practice of exclusive breastfeeding has the potential to avert 11.6% of under -5 deaths [1]. All-cause neonatal mortality could be reduced by 22.3%, just by timely initiation of breastfeeding (defined by the World Health Organization as putting the newborn to the breast within 1 h of birth). Exclusive breastfeeding protects against ear infections, allergies, anaemia in infants and has large ‘programming’ effects on risks for hypertension, hypercholesterolemia, obesity, cancer, autoimmune disease, and cognitive function later in life [5, 6]
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