A Randomized Trial Assessing the Efficacy of Peer Counseling on Exclusive Breastfeeding in a Predominantly Latina Low-Income Community

Anderson, Alex Kojo; Damio, Grace; Young, Sara; Chapman, Donna J.; Pérez‐Escamilla, Rafael

doi:10.1001/archpedi.159.9.836

Cited by 170 publications

(246 citation statements)

References 28 publications

(26 reference statements)

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“…On the other hand, the facility-based semi-intensive counselling significantly improved EBF rate at 1 month only. Table 3 The impact of counselling strategies on maternal infant feeding practice of exclusive breast-feeding by time and study group: HIVnegative women (n 360), 34-36 weeks pregnant at baseline, Kibera slum, Nairobi, Kenya This demonstrates the critical role of frequent counselling and continuous support in the sustenance of EBF; a finding in agreement with those of other studies (6)(7)(8)(10)(11)(12)(13)15,16) . In the present study, at 6 months, there was a fourfold increased likelihood for mothers in the HBICG to practise EBF compared with mothers in the CG.…”

Section: Discussionsupporting

confidence: 81%

“…Despite an increase in EBF rate in Kenya from 13?2 % in 2003 (4) to 32?0 % in 2009 for infants less than 6 months of age, the number of children who exclusively breast-feed drops significantly with age to 13?2 % at 4-5 months (5) . Peer counselling has been demonstrated to promote and sustain EBF rates (6)(7)(8)(9)(10)(11)(12)(13) ; however, there is limited evidence of this from Africa (14) . At the time of the present study there was only one study that tested the impact of high-intensity individual peer counselling to promote EBF among HIV-infected women in KwaZulu Natal, South Africa (10) .…”

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confidence: 99%

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Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial

Ochola

Labadarios

Nduati

2012

Public Health Nutr.

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Objective: To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya. Design: A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facilitybased semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months. Setting: Kibera slum, Nairobi. Subjects: A total of 360 HIV-negative women, 34-36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group. Results: Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23?6 % in HBICG, 9?2 % in FBSICG and 5?6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk 5 4?01; 95 % CI 2?30, 7?01; P 5 0?001). There was no significant difference between EBF rates in FBSICG and CG. Conclusions: EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF. KeywordsExclusive breast-feeding Breast-feeding counselling Breast-feeding promotion Randomized controlled trial KenyaExclusive breast-feeding (EBF) promotion has been estimated to be the most effective intervention for saving the lives of young children, with the potential to prevent an estimated 13 % of deaths in low-resource settings (1) . WHO recommends EBF for 6 months (2) . In Africa only 32 % of infants less than 6 months of age are exclusively breast-fed. African countries making major strides in EBF for infants less than 6 months old include Rwanda (88 %), Ghana (63 %), Uganda (60 %) and Malawi (57 %) (3) . Despite an increase in EBF rate in Kenya from 13?2 % in 2003 (4) to 32?0 % in 2009 for infants less than 6 months of age, the number of children who exclusively breast-feed drops significantly with age to 13?2 % at 4-5 months (5)

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial

Ochola

Labadarios

Nduati

2012

Public Health Nutr.

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“…Also, our study controlled for multiple potential confounding factors. The fact that both studies have found similar results despite differences in study designs suggests that PC improves breast-feeding initiation not only in clinical trial settings (6)(7)(8)14) but in public health programme settings as well. In addition to finding a positive impact of the PC programme on breast-feeding initiation, our study also shows that the impact is highest among those who enrol in WIC for a longer duration before delivery.…”

Section: Discussionmentioning

confidence: 81%

Evaluation of the Missouri WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) breast-feeding peer counselling programme

Yun

Liu

Mertzlufft

et al. 2009

Public Health Nutr.

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Objective: To evaluate the effectiveness of the peer counselling (PC) programme on breast-feeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Missouri, and to identify factors that facilitate breast-feeding initiation.Design: We used the data from the 2006 Missouri Pregnancy Nutrition Surveillance System, Missouri Live Birth Records and the Missouri WIC programme to compare breast-feeding initiation rates between PC and non-PC agencies. We used multilevel logistic regression, with individual participants being nested within agencies, to control for individual-and agency-level characteristics. Results: The breast-feeding initiation rate in PC agencies was significantly higher than in non-PC agencies among prenatal participants, but the difference was not significant among postpartum participants. After controlling for maternal sociodemographic characteristics, compared with prenatal cases in non-PC agencies, prenatal cases in PC agencies were more likely to initiate breast-feeding (OR 5 1?21; 95 % CI 1?03, 1?43), whereas postpartum cases were less likely to initiate breast-feeding. Among prenatal participants in PC agencies, longer duration of prenatal WIC enrolment was associated with a higher rate of breast-feeding initiation. After adjusting for maternal sociodemographic characteristics and other agency-level characteristics, participants of PC agencies with an international board-certified lactation consultant were more likely to initiate breast-feeding than participants of PC agencies without such a consultant (OR 5 1?21; 95 % CI 1?01, 1?45). Conclusions: Prenatal participation in the WIC breast-feeding PC programme (especially participation early during pregnancy) was associated with an increased rate of breast-feeding initiation in Missouri.

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“…The 1 study that reported increases in exclusive breastfeeding offered 3 prenatal visits, daily hospital visits, and 9 postpartum visits. 24 By contrast, the intervention in our study was based almost exclusively on telephone peer support with at most 8 contacts from pregnancy to 4 months postpartum for the high-frequency group only. The modal frequency was 1 prenatal and $1 postpartum telephone contacts.…”

Section: Figurementioning

confidence: 84%

Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial

Reeder¹,

Joyce

Sibley³

et al. 2014

Pediatrics

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OBJECTIVE: The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity. METHODS: We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts. RESULTS: We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10–1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10–1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68–0.89). CONCLUSIONS: A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.

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A Randomized Trial Assessing the Efficacy of Peer Counseling on Exclusive Breastfeeding in a Predominantly Latina Low-Income Community

Abstract: Well-structured, intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income, inner-city women in the United States.

Cited by 170 publications

References 28 publications

Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial

Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial

Evaluation of the Missouri WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) breast-feeding peer counselling programme

Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial

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