实施成功母乳喂养的步骤1至9可降低刚果民主共和国0至6个月婴儿轻度和重度腹泻及呼吸道感染的发病频率。
Implementation of Steps 1-9 to Successful Breastfeeding Reduces the Frequency of Mild and Severe Episodes of Diarrhea and Respiratory Tract Infection Among 0-6 Month Infants in Democratic Republic of Congo.
作者信息
Zivich Paul, Lapika Bruno, Behets Frieda, Yotebieng Marcel
机构信息
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
, 135 Dauer Drive 2101 McGavran-Greenberg, CB #7435, Chapel Hill, NC, 27599, USA.
出版信息
Matern Child Health J. 2018 May;22(5):762-771. doi: 10.1007/s10995-018-2446-9.
INTRODUCTION
Global initiatives to improve breastfeeding practices have focused on the Ten Steps to Successful Breastfeeding. The aim of this study was to assess the effect of implementing Baby-Friendly Hospital Initiative (BFHI) steps 1-9 and BFHI steps 1-10 on incidence of diarrhea and respiratory illnesses in the first 6 months of life.
METHODS
We reanalyzed a cluster randomized trial in which health-care clinics in Kinshasa, Democratic Republic of Congo, were randomly assigned to standard care (control group), BFHI steps 1-9, or BFHI steps 1-10. Outcomes included episodes of diarrhea and respiratory illness. Piecewise Poisson regression with generalized estimation equations to account for clustering by clinic was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI).
RESULTS
Steps 1-9 was associated with a decreased incidence of reported diarrhea (IRR 0.72, 95% CI 0.53, 0.99) and respiratory illness (IRR 0.48, 95% CI 0.37, 0.63), health facility visits due to diarrhea (IRR 0.60, 95% CI 0.42, 0.85) and respiratory illness (IRR 0.47, 95% CI 0.36, 0.63), and hospitalizations due to diarrhea (IRR 0.42, 95% CI 0.17, 1.06) and respiratory illness (IRR 0.33, 95% CI 0.11, 0.98). Addition of Step 10 attenuated this effect: episodes of reported diarrhea (IRR 1.24, 95% CI 0.93, 1.68) and respiratory illness (IRR 0.77, 95% CI 0.60, 0.99), health facility visits due to diarrhea (IRR 0.76, 95% CI 0.54, 1.08) and respiratory illness (IRR 0.75 95% CI 0.57, 0.97), and hospitalizations due to respiratory illness (IRR 0.48 95% CI 0.16, 1.40); but strengthened the effect against hospitalizations due to diarrhea (IRR 0.14, 95% CI 0.03, 0.60).
CONCLUSIONS
Implementation of steps 1-9 significantly reduced incidence of mild and severe episodes of diarrhea and respiratory infection in the first 6 months of life, addition of step 10 appeared to lessen this effect.
TRIAL REGISTRATION
NCT01428232.
引言
全球改善母乳喂养做法的倡议聚焦于成功母乳喂养的十项步骤。本研究的目的是评估实施爱婴医院倡议（BFHI）步骤1至9以及BFHI步骤1至10对出生后头6个月腹泻和呼吸道疾病发病率的影响。
方法
我们重新分析了一项整群随机试验，其中刚果民主共和国金沙萨的医疗诊所被随机分配至标准护理组（对照组）、BFHI步骤1至9组或BFHI步骤1至10组。结局包括腹泻和呼吸道疾病发作情况。采用带有广义估计方程的分段泊松回归以考虑诊所聚类情况，来估计发病率比（IRR）和95%置信区间（CI）。
结果
步骤1至9与报告的腹泻发病率降低相关（IRR 0.72，95% CI 0.53，0.99）以及呼吸道疾病（IRR 0.48，95% CI 0.37，0.63）、因腹泻进行的医疗机构就诊（IRR 0.60，95% CI 0.42，0.85）和呼吸道疾病（IRR 0.47，95% CI 0.36，0.63），以及因腹泻住院（IRR 0.42，95% CI 0.17，1.06）和呼吸道疾病（IRR 0.33，95% CI 0.11，0.98）。增加步骤10减弱了这种效果：报告的腹泻发作情况（IRR 1.24，95% CI 0.93，1.68）和呼吸道疾病（IRR 0.77，95% CI 0.60，0.99）、因腹泻进行的医疗机构就诊（IRR 0.76，95% CI 0.54，1.08）和呼吸道疾病（IRR 0.75，95% CI 0.57，0.97），以及因呼吸道疾病住院（IRR 0.48，95% CI 0.16，1.40）；但增强了预防因腹泻住院的效果（IRR 0.14，95% CI 0.03，0.60）。
结论
实施步骤1至9显著降低了出生后头6个月轻度和重度腹泻及呼吸道感染发作的发病率，增加步骤10似乎减弱了这种效果。
试验注册
NCT01428232。
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