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      Support for healthy breastfeeding mothers with healthy term babies

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          Abstract

          There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.

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          Breastfeeding and child cognitive development: new evidence from a large randomized trial.

          Michael S Kramer (2008)
          The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother's behavior or her interaction with the infant. To assess whether prolonged and exclusive breastfeeding improves children's cognitive ability at age 6.5 years. Cluster-randomized trial, with enrollment from June 17, 1996, to December 31, 1997, and follow-up from December 21, 2002, to April 27, 2005. Thirty-one Belarussian maternity hospitals and their affiliated polyclinics. A total of 17,046 healthy breastfeeding infants were enrolled, of whom 13,889 (81.5%) were followed up at age 6.5 years. Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF. Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence, and teacher evaluations of academic performance in reading, writing, mathematics, and other subjects. The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months (43.3% for the experimental group vs 6.4% for the control group; P < .001) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures, with cluster-adjusted mean differences (95% confidence intervals) of +7.5 (+0.8 to +14.3) for verbal IQ, +2.9 (-3.3 to +9.1) for performance IQ, and +5.9 (-1.0 to +12.8) for full-scale IQ. Teachers' academic ratings were significantly higher in the experimental group for both reading and writing. These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development. isrctn.org Identifier: ISRCTN37687716.
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            Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial.

            Abdullah Baqui, Shams El-Arifeen, Gary Darmstadt … (2008)
            Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh. Therefore the project for advancing the health of newborns and mothers (Projahnmo) implemented a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality. In Sylhet district, 24 clusters (with a population of about 20 000 each) were randomly assigned in equal numbers to one of two intervention arms or to the comparison arm. Because of the study design, masking was not feasible. All married women of reproductive age (15-49 years) were eligible to participate. In the home-care arm, female community health workers (one per 4000 population) identified pregnant women, made two antenatal home visits to promote birth and newborn-care preparedness, made postnatal home visits to assess newborns on the first, third, and seventh days of birth, and referred or treated sick neonates. In the community-care arm, birth and newborn-care preparedness and careseeking from qualified providers were promoted solely through group sessions held by female and male community mobilisers. The primary outcome was reduction in neonatal mortality. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, number 00198705. The number of clusters per arm was eight. The number of participants was 36059, 40159, and 37598 in the home-care, community-care, and comparison arms, respectively, with 14 769, 16 325, and 15 350 livebirths, respectively. In the last 6 months of the 30-month intervention, neonatal mortality rates were 29.2 per 1000, 45.2 per 1000, and 43.5 per 1000 in the home-care, community-care, and comparison arms, respectively. Neonatal mortality was reduced in the home-care arm by 34% (adjusted relative risk 0.66; 95% CI 0.47-0.93) during the last 6 months versus that in the comparison arm. No mortality reduction was noted in the community-care arm (0.95; 0.69-1.31). A home-care strategy to promote an integrated package of preventive and curative newborn care is effective in reducing neonatal mortality in communities with a weak health system, low health-care use, and high neonatal mortality.
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              Promotion of Breastfeeding Intervention Trial (PROBIT)

              Michael S Kramer, Beverley Chalmers, Ellen Hodnett … (2001)
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                Author and article information

                Journal
                Journal ID (publisher-id): 146518
                Title: Cochrane Database of Systematic Reviews
                Publisher: Wiley
                ISSN (Electronic): 14651858
                Publication date (Electronic): February 28 2017
                Affiliations
                [1 ]University of Dundee; Mother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research; 11 Airlie Place Dundee Tayside UK DD1 4HJ
                [2 ]University of Dundee; evidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research; 11 Airlie Place Dundee UK DD1 4HJ
                [3 ]Institute of Child Health; Centre for Paediatric Epidemiology and Biostatistics; 30 Guilford St London UK WC1N 1 EH
                [4 ]Breastfeeding Network; Paisley Renfrewshire UK PA2 8YB
                [5 ]NHS Grampian, Aberdeen Maternity Hospital; Cornhill Road Aberdeen UK AB25 2ZL
                [6 ]Robert Gordon University; Faculty of Health and Social Care, School of Nursing and Midwifery; Garthdee Road Aberdeen UK AB10 7AQ
                Article
                DOI: 10.1002/14651858.CD001141.pub5
                PMC ID: 6464485
                PubMed ID: 28244064
                SO-VID: 3b22d692-06c0-4120-822b-f8c906664d38
                Copyright © © 2017
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