Coutinho Sonia Bechara, de Lira Pedro Israel Cabral, de Carvalho Lima Marilia, Ashworth Ann
Department of Maternal and Child Health, Federal University of Pernambuco, Recife, Brazil.
Lancet. 2005;366(9491):1094-100. doi: 10.1016/S0140-6736(05)67421-1.
Promotion of breastfeeding is an important child-survival intervention, yet little is known about which promotional strategies are the most effective. We aimed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil--a hospital-based system and the same system combined with a programme of home visits.
In February, 2001, maternity staff from two hospitals in Pernambuco, Brazil, were trained according to the Baby-Friendly Hospital Initiative (BFHI). In a randomised trial between March and August, 2001, 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding (n=175) or no home visits (n=175). Breastfeeding practices were studied on days 1, 10, 30, 60, 90, 120, 150, and 180 by researchers unaware of group allocation. The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months. Analyses were by intention to treat.
The hospital-training intervention achieved a high rate (70%) of exclusive breastfeeding in the hospitals, but this rate was not sustained at home and at 10 days of age only 30% of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10-180 differed significantly (p<0.0001), with a mean aggregated prevalence of 45% among the group assigned home visits compared with 13% for the group assigned none.
The BFHI achieves high rates of exclusive breastfeeding in hospital; however, in Brazil at least, the rates fall rapidly thereafter. Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed. A combination of promotional systems (hospital-based and in the community) is needed.
促进母乳喂养是一项重要的儿童生存干预措施，但对于哪种促进策略最为有效，人们了解甚少。我们旨在比较巴西两种母乳喂养促进系统对母乳喂养率的影响——一种是基于医院的系统，另一种是该系统与家访计划相结合的系统。
2001年2月，巴西伯南布哥州两家医院的产科工作人员按照爱婴医院倡议（BFHI）接受了培训。在2001年3月至8月的一项随机试验中，在这些医院分娩的350名母亲被分配接受十次产后家访以促进和支持母乳喂养（n = 175）或不接受家访（n = 175）。由不知道分组情况的研究人员在第1、10、30、60、90、120、150和180天对母乳喂养情况进行研究。主要结局指标是从出生到6个月的纯母乳喂养率。分析采用意向性分析。
医院培训干预在医院中实现了较高的纯母乳喂养率（70%），但在家中这一比率未能维持，在10日龄时只有30%的婴儿纯母乳喂养。两个试验组在第10 - 180天的纯母乳喂养模式差异显著（p<0.0001），接受家访组的平均总体患病率为45%，而未接受家访组为13%。
BFHI在医院中实现了较高的纯母乳喂养率；然而，至少在巴西，此后这一比率迅速下降。应重新评估将BFHI作为母乳喂养促进策略的做法。需要将促进系统（基于医院和社区的）相结合。
