同伴咨询母乳喂养支持项目方案对低收入女性纯母乳喂养及完全停止母乳喂养的影响
Impact of peer counselling breast-feeding support programme protocols on any and exclusive breast-feeding discontinuation in low-income women.
作者信息
Rozga Mary R, Kerver Jean M, Olson Beth H
机构信息
1Department of Food Science and Human Nutrition,Michigan State University,East Lansing,MI,USA.
2Department of Epidemiology and Biostatistics,Michigan State University,East Lansing,MI,USA.
出版信息
Public Health Nutr. 2015 Feb;18(3):453-63. doi: 10.1017/S1368980014000603. Epub 2014 May 8.
OBJECTIVE
Peer counselling (PC) programmes have been shown to improve breast-feeding outcomes in populations at risk for early discontinuation. Our objective was to describe associations between programme components (individual and combinations) and breast-feeding outcomes (duration and exclusivity) in a PC programme for low-income women.
DESIGN
Secondary analysis of programme data. Multivariable-adjusted Cox proportional hazards models were used to examine associations between type and quantity of peer contacts with breast-feeding outcomes. Types of contacts included in-person (hospital or home), phone or other (e.g. mail, text). Quantities of contacts were considered 'optimal' if they adhered to standard programme guidelines.
SETTING
Programme data collected from 2005 to 2011 in Michigan's Breastfeeding Initiative Peer Counseling Program.
SUBJECTS
Low-income (n 5886) women enrolled prenatally.
RESULTS
For each additional home, phone and other PC contact there was a significant reduction in the hazard of discontinuing any breast-feeding by 6 months (hazard ratio (HR)=0·90 (95% CI 0·88, 0·92); HR=0·89 (95% CI 0·87, 0·90); and HR=0·93 (95% CI 0·90, 0·96), respectively) and exclusive breast-feeding by 3 months (HR=0·92 (95% CI 0·89, 0·95); HR=0·90 (95% CI 0·88, 0·91); and HR=0·93 (95% CI 0·89, 0·97), respectively). Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breast-feeding discontinuation compared with those who were considered to have optimum quantities of contacts (HR=0·17 (95% CI 0·14, 0·20) and HR=0·28 (95% CI 0·23, 0·35), respectively).
CONCLUSIONS
Specific components of a large PC programme appeared to have an appreciable impact on breast-feeding outcomes. In-person contacts were essential to improving breast-feeding outcomes, but defining optimal programme components is complex.
目的
同伴咨询（PC）项目已被证明可改善有提前断奶风险人群的母乳喂养结局。我们的目的是描述在一项针对低收入女性的PC项目中，项目组成部分（个体及组合）与母乳喂养结局（持续时间和纯母乳喂养情况）之间的关联。
设计
对项目数据进行二次分析。采用多变量调整的Cox比例风险模型来检验同伴接触的类型和数量与母乳喂养结局之间的关联。接触类型包括面对面（医院或家中）、电话或其他方式（如邮件、短信）。如果接触数量符合标准项目指南，则视为“最佳”数量。
背景
2005年至2011年从密歇根州母乳喂养倡议同伴咨询项目收集的项目数据。
研究对象
产前登记的低收入女性（n = 5886）。
结果
每增加一次家中、电话及其他PC接触，6个月内停止任何母乳喂养的风险显著降低（风险比（HR）分别为0.90（95%置信区间0.88, 0.92）；HR = 0.89（95%置信区间0.87, 0.90）；HR = 0.93（95%置信区间0.90, 0.96）），3个月内纯母乳喂养的风险也显著降低（HR分别为0.92（95%置信区间0.89, 0.95）；HR = 0.90（95%置信区间0.88, 0.91）；HR = 0.93（95%置信区间0.89, 0.97））。与被认为接触数量最佳的参与者相比，接受面对面接触多于最佳数量且电话接触少于最佳数量的参与者停止任何及纯母乳喂养的风险降低（HR分别为0.17（95%置信区间0.14, 0.20）和HR = 0.28（95%置信区间0.23, 0.35））。
结论
一项大型PC项目的特定组成部分似乎对母乳喂养结局有显著影响。面对面接触对于改善母乳喂养结局至关重要，但确定最佳项目组成部分较为复杂。
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