定制短信以改善缅甸仰光的母乳喂养行为：M528个体随机对照试验

Tailored text messages to improve breastfeeding practices in Yangon, Myanmar: the M528 individually randomized controlled trial.

作者信息

Hmone Myat Pan, Li Mu, Agho Kingsley Emwinyore, Alam Neeloy Ashraful, Chad Nina, Dibley Michael J

机构信息

Sydney School of Public Health, The University of Sydney, Australia; "MPH" Research Consultancy, Yangon, Myanmar.

Sydney School of Public Health, The University of Sydney, Australia.

出版信息

Am J Clin Nutr. 2023 Mar;117(3):518-528. doi: 10.1016/j.ajcnut.2023.01.003. Epub 2023 Jan 10.

DOI:10.1016/j.ajcnut.2023.01.003

PMID:36811470

Abstract

BACKGROUND

Text messages are a feasible delivery channel for breastfeeding promotion, but only a few articles have examined their effectiveness.

OBJECTIVE

To evaluate the impact of mobile phone text messages on breastfeeding practices.

DESIGN

We implemented a 2-arm, parallel, individually randomized controlled trial with 353 pregnant participants at the Central Women's Hospital, Yangon. The intervention group (n = 179) received breastfeeding-promotion text messages, and the control group (n = 174) received other maternal and child health care messages. The primary outcome was the exclusive breastfeeding rate at 1-6 mo postpartum. Secondary outcomes were other breastfeeding indicators, breastfeeding self-efficacy, and child morbidity. Using the intention-to-treat approach, the available outcome data were analyzed with generalized estimation equation Poisson regression models to estimate RR and 95% CIs, adjusted for within-person correlation and time, and tested for treatment group-by-time interactions.

RESULTS

Exclusive breastfeeding prevalence was significantly higher in the intervention than in the control group for the 6 follow-up visits combined (RR: 1.48; 95%CI: 1.35, 1.63; P < 0.001) and at each monthly follow-up visit. At 6 mo, exclusive breastfeeding was 43.4% in the intervention compared with 15.3% in the control group (RR: 2.74; 95%CI: 1.79, 4.19; P < 0.001). Also, at 6 mo, the intervention increased current breastfeeding (RR: 1.17; 95%CI: 1.07, 1.26; P < 0.001) and reduced bottle feeding (RR: 0.30; 95%CI: 0.17, 0.54; P < 0.001). Exclusive breastfeeding was progressively higher in the intervention group than in the control group at each follow-up (P for interaction < 0.001) and similarly for current breastfeeding. The intervention increased the mean breastfeeding self-efficacy score (adjusted mean difference 4.0; 95%CI: 1.36, 6.64; P = 0.030). Over the 6-month follow-up, the intervention significantly reduced diarrhea risk by 55% (RR: 0.45; 95%CI: 0.24, 0.82; P < 0.009).

CONCLUSIONS

Regular, targeted text messages delivered to urban pregnant women and mothers via mobile phones significantly improve breastfeeding practices and reduce infant morbidity during the first 6 mo of life.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12615000063516; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367704.

摘要

背景

短信是促进母乳喂养的一种可行传播渠道，但仅有少数文章研究过其有效性。

目的

评估手机短信对母乳喂养行为的影响。

设计

我们在仰光中央妇女医院对353名孕妇开展了一项双臂、平行、个体随机对照试验。干预组（n = 179）接收促进母乳喂养的短信，对照组（n = 174）接收其他母婴保健信息。主要结局是产后1至6个月的纯母乳喂养率。次要结局是其他母乳喂养指标、母乳喂养自我效能感和儿童发病率。采用意向性分析方法，利用广义估计方程泊松回归模型对可得结局数据进行分析，以估计风险比（RR）和95%置信区间（CI），并针对个体内相关性和时间进行调整，同时检验治疗组与时间的交互作用。

结果

在6次随访合并分析中，干预组的纯母乳喂养患病率显著高于对照组（RR：1.48；95%CI：1.35，1.63；P < 0.001），且在每月的随访中均如此。在6个月时，干预组的纯母乳喂养率为43.4%，而对照组为15.3%（RR：2.74；95%CI：1.79，4.19；P < 0.001）。此外，在6个月时，干预增加了当前的母乳喂养率（RR：1.17；95%CI：1.07，1.26；P < 0.001），并减少了奶瓶喂养率（RR：0.30；95%CI：0.17，0.54；P < 0.001）。在每次随访时，干预组的纯母乳喂养率均逐步高于对照组（交互作用P < 0.001），当前母乳喂养情况也类似。干预提高了平均母乳喂养自我效能感得分（调整后平均差值为4.0；95%CI：1.36，6.64；P = 0.030）。在6个月的随访期间，干预显著降低了腹泻风险55%（RR：0.45；95%CI：0.24，0.82；P < 0.009）。