The impact of a primary health care intervention on infant feeding practices: a cluster randomised controlled trial in Brazil.

Abstract

Proper feeding practices in early life can enhance the full human potential development of children. We aimed to evaluate the impact of a primary health care intervention on infant feeding practices among children from low-income families. A cluster randomised controlled trial was conducted in Porto Alegre, Brazil. Healthcare centres were randomised into intervention (n=9) and control (n=11) groups. In intervention sites, health workers were trained in accordance with the national guidelines. Infant feeding practices were assessed in children at 6months (n=617) and 12months (n=516) of age. Feeding practice quality was assessed using the Infant and Child Feeding Index (ICFI). Additionally, we evaluated the introduction of nonrecommended foods. At 6months, the mean ICFI score was higher in the intervention group [MD=0.22; 95% confidence interval (CI)=0.24-1.11]. The prevalence of infants who met the recommendation for meat into the food-frequency score was higher in the intervention than the control group [relative risk (RR)=1.63; 95% CI=1.26-2.11]. At 12months of age, the ICFI mean (MD=0.23; 95% CI=0.35-0.56) and the prevalence of children who met the recommendation for dietary diversity (RR=1.11; 95% CI=1.01-1.22) and meal frequency (RR=4.68; 95% CI=1.34-16.36) were higher in the intervention group, although only among children who had more than seven follow-up appointments during the first year of life. The children from intervention group had a significant delay for added sugar (MD=0.51; 95% CI=0.13-0.89), tea (mean=0.47; 95% CI=0.13-0.82), jelly (MD=0.35; 95% CI=0.11-0.58) and filled cookies (MD=0.29; 95% CI=0.06-0.52) compared to the control group. The health workers' training was effective with respect to improving infant feeding practices.