Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa: the cluster-randomised PROMISE EBF trial

BMC Public Health

Thorkild Tylleskär^1,10  Halvor Sommerfelt⁹  Chipepo Kankasa⁴  Philippe Van de Perre^1,11  Eva-Charlotte Ekström⁵  James K Tumwine⁸  Nicolas Meda⁷  Henry Wamani³  David Sanders²  Vundli Ramokolo⁶  Jolly Nankunda⁸  Sonja Swanvelder¹  Carl Lombard¹  Tanya Doherty⁶  Abdoulaye Hama Diallo⁷  Victoria Nankabirwa³  Lars Thore Fadnes^1,12  Debra Jackson²  Ingunn Marie Stadskleiv Engebretsen^1,10 

[1] Biostatistics Unit, Medical Research Council, 7505 Cape Town, South Africa;School of Public Health, University of Western Cape, P Bag X17, Bellville 7535, South Africa;School of Public Health, Makerere University, Kampala, Uganda;Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia;Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden;Health Systems Research Unit, Medical Research Council, 7505 Cape Town, South Africa;Centre MURAZ, Ministry of Health, PO Box 390, Bobo-Dioulasso, Burkina Faso;Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda;Department of International Public Health, Norwegian Institute of Public Health, N-0403 Oslo, Norway;Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway;Centre Hospitalier Universitaire Montpellier, Département de Bactériologie-Virologie, Montpellier, France;Department of Clinical Dentistry, University of Bergen, PO Box 7804, 5020 Bergen, Norway

关键词: Community randomised trial;    Undernutrition;    Underweight;    Wasting;    Stunting;    Anthropometry;    Child growth;    Peer counselling;    Exclusive breastfeeding promotion;   

Others  :  1129156
DOI  :  10.1186/1471-2458-14-633

 received in 2013-04-17, accepted in 2014-06-15,  发布年份 2014

【 摘 要 】

Background

In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities.

Methods

A total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < −2), stunting (LAZ < −2) and underweight (WAZ < −2) were calculated at each data collection point.

Results

The study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso −0.20 (95% CI −0.39 to −0.01) and in Uganda −0.23 (95% CI −0.43 to −0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95% CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95% CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different.

Conclusions

There were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms.

Trial registration number

ClinicalTrials.gov: NCT00397150

【 授权许可】

   
2014 Engebretsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]WHO: Report of the Expert Consultation on the Optimal Duration of Exclusive Breastfeeding. Geneva, Switzerland: WHO/NHD/01.09; 2001.
• [2]Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M, Maternal and Child Undernutrition Study Group: What works? Interventions for maternal and child undernutrition and survival. Lancet 2008, 371(9610):417-440.
• [3]Kramer MS, Kakuma R: The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol 2004, 554:63-77.
• [4]Jolly K, Ingram L, Khan KS, Deeks JJ, Freemantle N, MacArthur C: Systematic review of peer support for breastfeeding continuation: metaregression analysis of the effect of setting, intensity, and timing. BMJ 2012, 344:d8287.
• [5]Kramer MS, Kakuma R: Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2012, 8:CD003517.
• [6]Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK: Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet 2003, 361(9367):1418-1423.
• [7]Britton C, McCormick FM, Renfrew MJ, Wade A, King SE: Support for breastfeeding mothers. Cochrane Database Syst Rev 2007, 1:CD001141.
• [8]Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S: Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics 2001, 108(4):E67.
• [9]Bahl R, Frost C, Kirkwood BR, Edmond K, Martines J, Bhandari N, Arthur P: Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bull World Health Organ 2005, 83(6):418-426.
• [10]Giugliani ERJ, Victora CG: Web Appendix 2: 'Breastfeeding promotion and infant growth' from: What works? Interventions for maternal and child undernutrition and survival. Lancet 2008, 371(9610):417-440.
• [11]Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley FJ, Kendall GE, Burton PR: Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ 1999, 319(7213):815-819.
• [12]Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS: Fetal nutrition and cardiovascular disease in adult life. Lancet 1993, 341(8850):938-941.
• [13]Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, Igumnov S, Fombonne E, Bogdanovich N, Ducruet T, Collet JP, Chalmers B, Hodnett E, Davidovsky S, Skugarevsky O, Trofimovich O, Kozlova L, Shapiro S, Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group: Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 2008, 65(5):578-584.
• [14]Michaelsen KF, Lauritzen L, Mortensen EL: Effects of breast-feeding on cognitive function. Adv Exp Med Biol 2009, 639:199-215.
• [15]Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS: Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008, 371(9609):340-357.
• [16]Cope MB, Allison DB: Critical review of the World Health Organization's (WHO) 2007 report on 'evidence of the long-term effects of breastfeeding: systematic reviews and meta-analysis' with respect to obesity. Obes Rev 2008, 9(6):594-605.
• [17]Horta B, Bahl R, Martnes J, Victora CG: Evidence of the Long-Term Effects of Breastfeeding: Systematic Reviews and Meta-Analysis. Geneva, Switzerland: World Health Organization Publication; 2007.
• [18]Tylleskar T, Jackson D, Meda N, Engebretsen IM, Chopra M, Diallo AH, Doherty T, Ekstrom EC, Fadnes LT, Goga A, Kankasa C, Klungsøyr JI, Lombard C, Nankabirwa V, Nankunda JK, Van de Perre P, Sanders D, Shanmugam R, Sommerfelt H, Wamani H, Tumwine JK, PROMISE-EBF Study Group: Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet 2011, 378(9789):420-427.
• [19]Demographic and health surveys [http://www.measuredhs.com/ webcite]
• [20]Zembe-Mkabile W, Doherty T, Sanders D, Jackson D, Chopra M, Swanevelder S, Lombard C, Surender R: Why do families still not receive the child support grant in South Africa? A longitudinal analysis of a cohort of families across South Africa. BMC Int Health Hum Rights 2012, 12:24.
• [21]WHO, Unicef: Breastfeeding Counselling: A Training Course. Geneva; 1993.
• [22]WHO: HIV and Infant Feeding Counselling Tools: Reference Guide. Geneva; 2005.
• [23]Daniels K, Nor B, Jackson D, Ekstrom EC, Doherty T: Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study. Hum Resour Health 2010, 8:6.
• [24]Nankunda J, Tylleskar T, Ndeezi G, Semiyaga N, Tumwine JK: Establishing individual peer counselling for exclusive breastfeeding in Uganda: implications for scaling-up. Matern Child Nutr 2010, 6(1):53-66.
• [25]Nor B, Ahlberg BM, Doherty T, Zembe Y, Jackson D, Ekstrom EC: Mother's perceptions and experiences of infant feeding within a community-based peer counselling intervention in South Africa. Matern Child Nutr 2011, 8(4):448-458.
• [26]Bland RM, Rollins NC, Solarsh G, Van den Broeck J, Coovadia HM: Maternal recall of exclusive breast feeding duration. Arch Dis Child 2003, 88(9):778-783.
• [27]Piwoz EG: Breastfeeding and Replacement Feeding Practices in the Context Of Mother-to-Child Transmission of HIV. An Assessment Tool for Research. WHO/RHR/01.12, WHO/CAH/01.21. Geneva, Switzerland: World Health Organization, Department of Reproductive Health and Research (RHR), Department of Child and Adolescent Health and Development (CAH); 2001.
• [28]Engebretsen IM, Wamani H, Karamagi C, Semiyaga N, Tumwine J, Tylleskar T: Low adherence to exclusive breastfeeding in Eastern Uganda: a community-based cross-sectional study comparing dietary recall since birth with 24-hour recall. BMC Pediatr 2007, 7:10.
• [29]Engebretsen IM, Shanmugam R, Sommerfelt AE, Tumwine JK, Tylleskar T: Infant feeding modalities addressed in two different ways in Eastern Uganda. Int Breastfeed J 2010, 5(1):2.
• [30]Jackson DJ, Chopra M, Doherty TM, Colvin MS, Levin JB, Willumsen JF, Goga AE, Moodley P: Operational effectiveness and 36 week HIV-free survival in the South African programme to prevent mother-to-child transmission of HIV-1. AIDS 2007, 21(4):509-516.
• [31]WHO: Physical status: The use and interpretation of anthropometry. In WHO Technical Report Series 854. Geneva; 1995:452.
• [32]Ayele B, Aemere A, Gebre T, Tadesse Z, Stoller NE, See CW, Yu SN, Gaynor BD, McCulloch CE, Porco TC, Emerson PM, Lietman TM, Keenan JD: Reliability of measurements performed by community-drawn anthropometrists from rural ethiopia. PLoS One 2012, 7(1):e30345.
• [33]de Onis M, Onyango A, Borghi E, Siyam A, Pinol AJ: WHO Child Growth Standards Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age Methods and development. Edited by Organization WH. Geneva: Department of Nutrition for Health and Development, World Health Organization; 2006.
• [34]Filmer D, Pritchett LH: Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography 2001, 38(1):115-132.
• [35]Engebretsen IM, Tylleskar T, Wamani H, Karamagi C, Tumwine JK: Determinants of infant growth in Eastern Uganda: a community-based cross-sectional study. BMC Public Health 2008, 8:418.
• [36]Pagel C, Prost A, Lewycka S, Das S, Colbourn T, Mahapatra R, Azad K, Costello A, Osrin D: Intracluster correlation coefficients and coefficients of variation for perinatal outcomes from five cluster-randomised controlled trials in low and middle-income countries: results and methodological implications. Trials 2011, 12:151.
• [37]Wamani H, Astrom AN, Peterson S, Tumwine JK, Tylleskar T: Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr 2007, 7:17.
• [38]Wamani H, Astrom AN, Peterson S, Tumwine JK, Tylleskar T: Predictors of poor anthropometric status among children under 2 years of age in rural Uganda. Public Health Nutr 2006, 9(3):320-326.
• [39]Li L, Shen C, Li X, Robins JM: On weighting approaches for missing data. Stat Methods Med Res 2011, 22(1):14-30. doi: 10.1177/0962280211403597
• [40]Nankabirwa V, Tumwine JK, Tylleskar T, Nankunda J, Sommerfelt H: Perinatal mortality in eastern Uganda: a community based prospective cohort study. PLoS One 2011, 6(5):e19674.
• [41]Diallo AH, Meda N, Ouedraogo WT, Cousens S, Tylleskar T: A prospective study on neonatal mortality and its predictors in a rural area in Burkina Faso: can MDG-4 be met by 2015? J Perinatol 2011, 31(10):656-663.
• [42]Diallo AH, Meda N, Zabsonre E, Sommerfelt H, Cousens S, Tylleskar T: Perinatal mortality in rural Burkina Faso: a prospective community-based cohort study. BMC Pregnancy Childbirth 2010, 10:45.
• [43]Nor B, Zembe Y, Daniels K, Doherty T, Jackson D, Ahlberg BM, Ekstrom EC: "Peer but not peer": considering the context of infant feeding peer counseling in a high HIV prevalence area. J Hum Lact 2009, 25(4):427-434.
• [44]Doherty T, Sanders D, Jackson D, Swanevelder S, Lombard C, Zembe W, Chopra M, Goga A, Colvin M, Fadnes LT, Engebretsen IM, Ekström EC, Tylleskär T, PROMISE EBF study group: Early cessation of breastfeeding amongst women in South Africa: an area needing urgent attention to improve child health. BMC Pediatr 2012, 12:105.
• [45]WHO: WHO Child Growth Standards Growth Velocity Based on Weight, Length and Head Circumference Method and Development. Geneva: Department of Nutrition for Health and Development of the World Health Organization; 2009.
• [46]WHO: Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 2006, 450:56-65.
• [47]Nkonki LL, Chopra M, Doherty TM, Jackson D, Robberstad B: Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa. Int J Equity Health 2011, 10:13.
• [48]Engebretsen IM, Moland KM, Nankunda J, Karamagi CA, Tylleskar T, Tumwine JK: Gendered perceptions on infant feeding in Eastern Uganda: continued need for exclusive breastfeeding support. Int Breastfeed J 2010, 5(1):13.
• [49]Fadnes LT, Engebretsen IM, Moland KM, Nankunda J, Tumwine JK, Tylleskar T: Infant feeding counselling in Uganda in a changing environment with focus on the general population and HIV-positive mothers - a mixed method approach. BMC Health Serv Res 2010, 10:260.
• [50]Wuehler SE, Ouedraogo AW: Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso. Matern Child Nutr 2011, 7(Suppl 1):35-62.
• [51]Nankunda J, Tumwine JK, Nankabirwa V, Tylleskar T: "She would sit with me": mothers' experiences of individual peer support for exclusive breastfeeding in Uganda. Int Breastfeed J 2010, 5:16.
• [52]Chola L, Fadnes LT, Engebretsen IM, Tumwine JK, Tylleskar T, Robberstad B: Infant feeding survival and markov transition probabilities among children under age 6 months in Uganda. Am J Epidemiol 2013, 177(5):453-462.
• [53]Fadnes LT, Engebretsen IM, Wamani H, Semiyaga NB, Tylleskar T, Tumwine JK: Infant feeding among HIV-positive mothers and the general population mothers: comparison of two cross-sectional surveys in Eastern Uganda. BMC Public Health 2009, 9:124.
• [54]Jakobsen MS, Sodemann M, Biai S, Nielsen J, Aaby P: Promotion of exclusive breastfeeding is not likely to be cost effective in West Africa, A randomized intervention study from Guinea-Bissau. Acta Paediatr 2008, 97(1):68-75.
• [55]de Onis M, Dewey KG, Borghi E, Onyango AW, Blossner M, Daelmans B, Piwoz E, Branca F: The World Health Organization's global target for reducing childhood stunting by 2025: rationale and proposed actions. Matern Child Nutr 2013, 9(Suppl 2):6-26.