中低收入国家同伴咨询师促进纯母乳喂养（PROMISE-EBF）：一项整群随机试验

Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial.

机构信息

Centre for International Health, University of Bergen, PO Box 7800, 5020 Bergen, Norway.

出版信息

Lancet. 2011 Jul 30;378(9789):420-7. doi: 10.1016/S0140-6736(11)60738-1.

DOI:10.1016/S0140-6736(11)60738-1

PMID:21752462

Abstract

BACKGROUND

Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. The effect of breastfeeding counselling by peer counsellors was assessed in Africa.

METHODS

24 communities in Burkina Faso, 24 in Uganda, and 34 in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering team were masked to the intervention allocation. The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00397150.

FINDINGS

2579 mother-infant pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n=402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 (79%) of 392 and 139 (35%) of 402, respectively, in Burkina Faso (prevalence ratio 2·29, 95% CI 1·33-3·92); 323 (82%) of 396 and 161 (44%) of 369, respectively, in Uganda (1·89, 1·70-2·11); and 56 (10%) of 535 and 30 (6%) of 485, respectively, in South Africa (1·72, 1·12-2·63). The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 (77%) and 94 (23%), respectively, in Burkina Faso (3·27, 2·13-5·03); 305 (77%) and 125 (34%), respectively, in Uganda (2·30, 2·00-2·65); and 41 (8%) and 19 (4%), respectively, in South Africa (1·98, 1·30-3·02). At 24 weeks, the prevalences based on 24-h recall were 286 (73%) in the intervention cluster and 88 (22%) in the control cluster in Burkina Faso (3·33, 1·74-6·38); 232 (59%) and 57 (15%), respectively, in Uganda (3·83, 2·97-4·95); and 12 (2%) and two (<1%), respectively, in South Africa (5·70, 1·33-24·26). The prevalences based on 7-day recall were 279 (71%) in the intervention cluster and 38 (9%) in the control cluster in Burkina Faso (7·53, 4·42-12·82); 203 (51%) and 41 (11%), respectively, in Uganda (4·66, 3·35-6·49); and ten (2%) and one (<1%), respectively, in South Africa (9·83, 1·40-69·14). Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 (5%) and 36 (9%), respectively, in Burkina Faso (0·57, 0·27-1·22); 39 (10%) and 32 (9%), respectively, in Uganda (1·13, 0·81-1·59); and 45 (8%) and 33 (7%), respectively, in South Africa (1·16, 0·78-1·75). The prevalence at age 24 weeks in the intervention and control clusters was 26 (7%) and 32 (8%), respectively, in Burkina Faso (0·83, 0·45-1·54); 52 (13%) and 59 (16%), respectively, in Uganda (0·82, 0·58-1·15); and 54 (10%) and 33 (7%), respectively, in South Africa (1·31, 0·89-1·93).

INTERPRETATION

Low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings.

FUNDING

European Union Sixth Framework International Cooperation-Developing Countries, Research Council of Norway, Swedish International Development Cooperation Agency, Norwegian Programme for Development, Research and Education, South African National Research Foundation, and Rockefeller Brothers Foundation.

摘要

背景

在低收入环境中，纯母乳喂养（EBF）被报道为一种救命干预措施。在非洲评估了由同伴顾问进行母乳喂养咨询的效果。

方法

在布基纳法索、乌干达和南非，24 个社区以 1:1 的比例随机分配到对照组或干预组，使用计算机生成的随机序列。在干预组中，我们计划安排一次产前母乳喂养同伴咨询访问和四次产后由经过培训的同伴进行的访问。数据收集小组对干预分配情况不知情。主要结局是母亲报告的婴儿 12 周和 24 周时的 EBF 和腹泻流行率。针对簇效应和地点，对国家特异性流行率比进行了调整。分析采用意向治疗。本研究在 ClinicalTrials.gov 注册，编号为 NCT00397150。

结果

布基纳法索（n=392 和 n=402）、乌干达（n=396 和 n=369）和南非（n=535 和 n=485）分别有 2579 对母婴被分配到干预组或对照组。在 12 周时，根据 24 小时回忆，干预组和对照组的 EBF 流行率分别为 392 例中的 310 例（79%）和 402 例中的 139 例（35%），布基纳法索为 2.29（95%CI 1.33-3.92）；396 例中的 323 例（82%）和 369 例中的 161 例（44%），乌干达为 1.89（1.70-2.11）；535 例中的 56 例（10%）和 485 例中的 30 例（6%），南非为 1.72（1.12-2.63）。在 7 天回忆时，干预组和对照组的 EBF 流行率分别为 392 例中的 300 例（77%）和 402 例中的 94 例（23%），布基纳法索为 3.27（2.13-5.03）；396 例中的 305 例（77%）和 369 例中的 125 例（34%），乌干达为 2.30（2.00-2.65）；535 例中的 41 例（8%）和 485 例中的 19 例（4%），南非为 1.98（1.30-3.02）。在 24 周时，根据 24 小时回忆，干预组的流行率为 286 例（73%），对照组为 88 例（22%），布基纳法索为 3.33（1.74-6.38）；396 例中的 232 例（59%）和 369 例中的 57 例（15%），乌干达为 3.83（2.97-4.95）；535 例中的 12 例（2%）和 485 例中的 2 例（<1%），南非为 5.70（1.33-24.26）。根据 7 天回忆，干预组的流行率为 279 例（71%），对照组为 38 例（9%），布基纳法索为 7.53（4.42-12.82）；396 例中的 203 例（51%）和 369 例中的 41 例（11%），乌干达为 4.66（3.35-6.49）；535 例中的 10 例（2%）和 485 例中的 1 例（<1%），南非为 9.83（1.40-69.14）。在 12 周龄时，腹泻的流行率在干预组和对照组中分别为 20 例（5%）和 36 例（9%），布基纳法索为 0.57（0.27-1.22）；39 例（10%）和 32 例（9%），乌干达为 1.13（0.81-1.59）；45 例（8%）和 33 例（7%），南非为 1.16（0.78-1.75）。在 24 周龄时，腹泻的流行率在干预组和对照组中分别为 26 例（7%）和 32 例（8%），布基纳法索为 0.83（0.45-1.54）；52 例（13%）和 59 例（16%），乌干达为 0.82（0.58-1.15）；54 例（10%）和 33 例（7%），南非为 1.31（0.89-1.93）。