Some success in improving infant-feeding practices in South Africa

Effect of an integrated community-based package for maternal and newborn care on feeding patterns during the first 12 weeks of life: a cluster-randomized trial in a South African township.

Ijumba P, Doherty T, Jackson D, Tomlinson M, Sanders D, Swanevelder S, Persson LA. Public Health Nutr. 2015 Oct;18(14):2660-8. doi: 10.1017/S1368980015000099. Epub 2015 Feb 9.

Objective: To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth, and to study whether the effect differs by maternal HIV status, educational level or household wealth.

Design: Cluster-randomized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers. Infant feeding data were collected using 24 h recall of nineteen food and fluid items.

Setting: A township near Durban, South Africa.

Subjects: Pregnant women (1894 intervention and 2243 control) aged 17 years or more.

Results: Twelve weeks after birth, 1629 (intervention) and 1865 (control) mother-infant pairs were available for analysis. Socio-economic conditions differed slightly across intervention groups, which were considered in the analyses. There was no effect on early initiation of breast-feeding. At 12 weeks of age the intervention doubled exclusive breast-feeding (OR=2.29; 95 % CI 1.80, 2.92), increased exclusive formula-feeding (OR=1.70; 95 % CI 1.28, 2.27), increased predominant breast-feeding (OR=1.71; 95 % CI 1.34, 2.19), decreased mixed formula-feeding (OR=0.68; 95 % CI 0.55, 0.83) and decreased mixed breast-feeding (OR=0.54; 95 % CI 0.44, 0.67). The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers (P=0.01), while the effect on mixed formula-feeding was significant only among HIV-positive mothers (P=0.03). The effect on exclusive feeding was not different by household wealth or maternal education levels.

Conclusions: A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.

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Editor’s notes: This trial assesses the provision of an integrated package of motivational interviewing-based counselling during home visits by systematically supervised, remunerated full-time community health workers on breastfeeding practices. It found stronger effects among HIV negative mothers than mothers living with HIV. This is particularly important in the context of a setting where exclusive breast feeding is practised by only 8% of mothers and where messages have been mixed about the safety of breastfeeding among mothers living with HIV. The smaller effect among mothers living with HIV may be a legacy of the free provision of formula to these mothers from 2002 to 2011, and cultural feeding practices. Exit interviews with the community health workers revealed that no mothers had exclusively breast-fed their babies, and this may have influenced their delivery of the programme. Further work is necessary to communicate messages on the need for exclusive breast feeding among mothers living with HIV.

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