Siraneh Yibeltal, Woldie Mirkuzie, Birhanu Zewdie
Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Risk Manag Healthc Policy. 2021 Aug 24;14:3483-3503. doi: 10.2147/RMHP.S324762. eCollection 2021.
Suboptimal breastfeeding (BF) contributes to a significant number of infant deaths. A positive deviance approach (PDA) was not studied in Ethiopia, whether it improve exclusive breastfeeding (EBF) practice. Therefore, we determined the effectiveness of positive deviant approached intervention in increasing the proportion of EBF practice.
A cluster-randomized controlled trial was employed in Jimma town from February 01 to September 30, 2018. Six randomly selected clusters (kebeles) were randomized into two arms. Then, 260 mothers who met the eligibility criteria were enrolled in either the intervention or control arm depending on where they lived. Women in the intervention group received counseling and social support in addition to the usual service to promote EBF, from women identified and trained as positive deviants in their community, while those in the control groups received the usual community-based services from urban health extension professionals. Data on primary and secondary outcome variables were collected at three points, and statistical difference was estimated using Chi- or Fisher exact test. The net effect of the intervention was calculated. The magnitude of the intervention effect was estimated using the relative risk. For all statistical tests, 95% CI with a P-value of <0.05 was used.
The overall response rate at the endline was 98.8%. Exclusive BF was significantly different between the groups at mid and end points, while no difference at baseline. A higher proportion of mothers in the intervention group reported EBF compared to the control group at mid and end-line. The rate of EBF increased by 18.5% (P=0.01) in the intervention group while 0.2% in the counterparts, with a net effect of +18.2%. The probability of practicing EBF was significantly higher for the intervention group compared to the control group. At baseline, the relative risk of avoiding EBF (RR:1.112) was similar among the two groups. However, at follow-up, mothers in the intervention group were 2 times more likely to practice EBF (RR: 2.294) compared to those in the control group.
The PD approach is an effective intervention to promote EBF and also positively affected frequency and duration of BF. Therefore, we recommend the promotion and use of positive deviance approach as a strategy to improve EBF practice in urban settings.
Clinical trial PACTR201805003379263, 23 May 2018.
母乳喂养不达标导致大量婴儿死亡。埃塞俄比亚尚未研究积极偏差方法（PDA）是否能改善纯母乳喂养（EBF）情况。因此，我们确定了积极偏差方法干预在提高纯母乳喂养比例方面的有效性。
2018年2月1日至9月30日在吉姆马镇进行了一项整群随机对照试验。随机选取6个整群（社区），随机分为两组。然后，根据居住地点，将260名符合入选标准的母亲纳入干预组或对照组。干预组的妇女除了接受促进纯母乳喂养的常规服务外，还从在其社区中被确定并培训为积极偏差者的妇女那里获得咨询和社会支持，而对照组的妇女则从城市卫生推广专业人员那里获得常规的社区服务。在三个时间点收集主要和次要结局变量的数据，并使用卡方检验或费舍尔精确检验估计统计学差异。计算干预的净效应。使用相对风险估计干预效果的大小。对于所有统计检验，使用95%置信区间和P值<0.05。
终点时的总体应答率为98.8%。两组在中点和终点时纯母乳喂养情况有显著差异，而基线时无差异。与对照组相比，干预组在中点和终点时有更高比例的母亲报告纯母乳喂养。干预组的纯母乳喂养率增加了18.5%（P = 0.01），而对照组增加了0.2%，净效应为+18.2%。干预组进行纯母乳喂养的概率显著高于对照组。在基线时，两组中避免纯母乳喂养的相对风险（RR：1.112）相似。然而，在随访时，干预组的母亲进行纯母乳喂养的可能性是对照组的2倍（RR：2.294）。
积极偏差方法是促进纯母乳喂养的有效干预措施，对母乳喂养的频率和持续时间也有积极影响。因此，我们建议推广和使用积极偏差方法作为改善城市地区纯母乳喂养情况的策略。
临床试验PACTR201805003379263，2018年5月23日。
