三个非洲国家的早期婴儿喂养实践：促进同伴辅导员实施纯母乳喂养的 PROMISE-EBF 试验。
Early infant feeding practices in three African countries: the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors.
机构信息
Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
出版信息
Int Breastfeed J. 2014 Nov 18;9:19. doi: 10.1186/1746-4358-9-19. eCollection 2014.
BACKGROUND
Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO. We report its impact on early infant feeding practices from the PROMISE-EBF trial.
METHODS
PROMISE-EBF was a cluster randomised behaviour change intervention trial of exclusive breastfeeding (EBF) promotion by peer counsellors in Burkina Faso, Uganda and South Africa implemented during 2006-2008 among 2579 mother-infant pairs. Counselling started in the last pregnancy trimester and mothers were offered at least five postnatal visits. Early infant feeding practices: use of prelacteal feeds (any foods or drinks other than breast milk given within the first 3 days), expressing and discarding colostrum, and timing of initiation of breastfeeding are presented by trial arm in each country. Prevalence ratios (PR) with 95% confidence intervals (95%CI) are given.
RESULTS
The proportion of women who gave prelacteal feeds in the intervention and control arms were, respectively: 11% and 36%, PR 0.3 (95% CI 0.2, 0.6) in Burkina Faso, 13% and 44%, PR 0.3 (95% CI 0.2, 0.5) in Uganda and 30% and 33%, PR 0.9 (95% CI 0.6, 1.3) in South Africa. While the majority gave colostrum, the proportion of those who expressed and discarded it in the intervention and control arms were: 8% and 12%, PR 0.7 (95% CI 0.3, 1.6) in Burkina Faso, 3% and 10%, PR 0.3 (95% CI 0.1, 0.6) in Uganda and 17% and 16%, PR 1.1 (95% CI 0.6, 2.1) in South Africa. Only a minority in Burkina Faso (<4%) and roughly half in South Africa initiated breastfeeding within the first hour with no large or statistically significant differences between the trial arms, whilst in Uganda the proportion of early initiation of breastfeeding in the intervention and control arms were: 55% and 41%, PR 0.8 (95% CI 0.7, 0.9).
CONCLUSIONS
The PROMISE-EBF trial showed that the intervention led to less prelacteal feeding in Burkina Faso and Uganda. More children received colostrum and started breastfeeding early in the intervention arm in Uganda. Late breastfeeding initiation continues to be a challenge. No clear behaviour change was seen in South Africa.
TRIAL REGISTRATION
NCT00397150.
背景
分娩后立即开始并完全进行母乳喂养与新生儿存活率和儿童健康的提高有关，这也是世卫组织的建议。我们报告了其对 PROMISE-EBF 试验中早期婴儿喂养实践的影响。
方法
PROMISE-EBF 是一项在布基纳法索、乌干达和南非进行的、通过同伴顾问促进纯母乳喂养的群组随机行为改变干预试验，于 2006-2008 年期间在 2579 对母婴对中实施。咨询从最后一个妊娠期末开始，母亲至少接受五次产后访视。本文报告了在每个国家中，试验臂的早期婴儿喂养实践：使用代乳品（出生后前 3 天内除母乳以外的任何食物或饮料）、挤奶和丢弃初乳，以及开始母乳喂养的时间。给出了具有 95%置信区间（95%CI）的患病率比（PR）。
结果
干预组和对照组分别有 11%和 36%的妇女给予代乳品，PR 0.3（95%CI 0.2，0.6）在布基纳法索，分别有 13%和 44%的妇女给予代乳品，PR 0.3（95%CI 0.2，0.5）在乌干达，分别有 30%和 33%的妇女给予代乳品，PR 0.9（95%CI 0.6，1.3）在南非。尽管大多数妇女都给了初乳，但在干预组和对照组中，挤奶和丢弃初乳的比例分别为 8%和 12%，PR 0.7（95%CI 0.3，1.6）在布基纳法索，3%和 10%，PR 0.3（95%CI 0.1，0.6）在乌干达，17%和 16%，PR 1.1（95%CI 0.6，2.1）在南非。只有布基纳法索的少数人（<4%）和南非的近一半人在出生后 1 小时内开始母乳喂养，但试验臂之间没有大的或统计学显著差异，而在乌干达，干预组和对照组中早期开始母乳喂养的比例分别为：55%和 41%，PR 0.8（95%CI 0.7，0.9）。
结论
PROMISE-EBF 试验表明，干预措施导致布基纳法索和乌干达的代乳品喂养减少。更多的儿童接受初乳，在乌干达，干预组中更多的儿童在早期开始母乳喂养。母乳喂养开始较晚仍然是一个挑战。南非没有明显的行为改变。
试验注册
NCT00397150。
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