Ijumba Petrida, Doherty Tanya, Jackson Debra, Tomlinson Mark, Sanders David, Swanevelder Sonja, Persson Lars-Åke
1Health Systems Research Unit,Medical Research Council,Tygerberg,South Africa.
3School of Public Health,University of the Western Cape,Cape Town,South Africa.
Public Health Nutr. 2015 Oct;18(14):2660-8. doi: 10.1017/S1368980015000099. Epub 2015 Feb 9.
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.
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.
A township near Durban, South Africa.
Pregnant women (1894 intervention and 2243 control) aged 17 years or more.
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.
A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.
分析基于社区的咨询对出生后前12周喂养模式的影响，并研究该影响是否因母亲的艾滋病毒感染状况、教育水平或家庭财富而异。
整群随机试验，每组有15个群组，以评估由社区卫生工作者提供的综合方案，包括两次孕期家访和五次产后家访。使用对19种食物和液体项目的24小时回顾来收集婴儿喂养数据。
南非德班附近的一个城镇。
年龄17岁及以上的孕妇（干预组1894名，对照组2243名）。
出生12周后，有1629对母婴（干预组）和1865对母婴（对照组）可供分析。各干预组的社会经济状况略有差异，分析时已予以考虑。对早期开始母乳喂养没有影响。在12周龄时，干预使纯母乳喂养率翻倍（比值比=2.29；95%置信区间1.80，2.92），增加了纯配方奶喂养率（比值比=1.70；95%置信区间1.28，2.27），增加了主要母乳喂养率（比值比=1.71；95%置信区间1.34，2.19），降低了混合配方奶喂养率（比值比=0.68；95%置信区间0.55，0.83），并降低了混合母乳喂养率（比值比=0.54；95%置信区间0.44，0.67）。12周时对纯母乳喂养的影响在艾滋病毒阴性母亲中比艾滋病毒阳性母亲更强（P=0.01），而对混合配方奶喂养的影响仅在艾滋病毒阳性母亲中显著（P=0.03）。对纯喂养的影响在家庭财富或母亲教育水平方面没有差异。
由社区卫生工作者提供的围产期干预方案在增加纯母乳喂养、纯配方奶喂养和减少混合喂养方面是有效的。
