Fadnes Lars T, Nankabirwa Victoria, Engebretsen Ingunn M, Sommerfelt Halvor, Birungi Nancy, Lombard Carl, Swanevelder Sonja, Van den Broeck Jan, Tylleskär Thorkild, Tumwine James K
Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway.
Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
BMC Public Health. 2016 Jul 12;16:555. doi: 10.1186/s12889-016-3234-3.
Breastfeeding promotion is regarded as one of the most effective interventions to improve child health, and could reduce under-5-mortality by 8 % globally. Few studies have assessed the health outcomes beyond infancy of interventions promoting exclusive breastfeeding.
This study assessed growth in under-five children who participated in a cluster-randomised trial in Eastern Uganda (ClinicalTrials.gov.no.NCT00397150). In the intervention arm, peer counsellors promoted exclusive breastfeeding during the first 6 months of infancy. There were no interventions after 6 months of age. Mother-infant pairs were interviewed at visits scheduled at 3, 6, 12 and 24 weeks after birth and follow-up visits at 2 and 5 years, with 765 included in the analyses.
The mean length/height-for-age and weight-for-age-z-score (HAZ, WAZ) decreased with increasing age in both the intervention and control arms. At the three weeks visit, HAZ in the intervention was -0.45 (-0.68;-0.21) and -0.32 (-0.56;-0.07) in the control arm. At the 2 year follow-up, the mean HAZ in the intervention was -1.85 (95 % CI -1.97;-1.73) compared to -1.61 (-1.87;-1.34) in the control. Similarly, at the 5 year follow-up, the mean HAZ in the intervention was -1.78 (-2.08;-1.47) compared to -1.53 (-1.79;-1.28) in the control arm. At the 2 year follow-up visit, 139 (45 %) were stunted (HAZ<-2) in the intervention compared to 109 (37 %) in the control arm, odds ratio (OR) 1.7 (1.1;2.4). Underweight (WAZ<-2) was also more common in the intervention arm than in the control at the five years follow-up (OR 1.7 (1.0;2.8)), with a mean WAZ of -1.28 (-1.47;-1.08) and -1.06 (-1.19;-0.92) in the intervention and control arm, respectively.
While stunting was widespread at 2 and 5 years of age in both arms, it was more common in the intervention arm. It is questionable whether community-based support from lay people with short training and focussing only on exclusive breastfeeding, is an appropriate strategy to improve child health and development.
ClinicalTrials.gov.no. NCT00397150 . Registered 7th of November 2006.
促进母乳喂养被视为改善儿童健康最有效的干预措施之一，在全球范围内可将五岁以下儿童死亡率降低8%。很少有研究评估促进纯母乳喂养的干预措施对婴儿期之后健康结局的影响。
本研究评估了参与乌干达东部一项整群随机试验（ClinicalTrials.gov编号：NCT00397150）的五岁以下儿童的生长情况。在干预组，同伴辅导员在婴儿期的前6个月促进纯母乳喂养。6个月龄后不再进行干预。母婴对在出生后3、6、12和24周安排的访视以及2岁和5岁的随访中接受访谈，分析纳入765对。
干预组和对照组中，年龄别身长/身高和年龄别体重Z评分（HAZ、WAZ）均随年龄增长而下降。在3周访视时，干预组的HAZ为-0.45（-0.68；-0.21），对照组为-0.32（-0.56；-0.07）。在2年随访时，干预组的平均HAZ为-1.85（95%CI -1.97；-1.73），而对照组为-1.61（-1.87；-1.34）。同样，在5年随访时，干预组的平均HAZ为-1.78（-2.08；-1.47），对照组为-1.53（-1.79；-1.28）。在2年随访时，干预组有139名（45%）发育迟缓（HAZ<-2），对照组为109名（37%），优势比（OR）为1.7（1.1；2.4）。在5年随访时，干预组体重不足（WAZ<-2）也比对照组更常见（OR 1.7（1.0；2.
