201963 Preliminary results from the multi-center cluster-randomized behaviour intervention trial PROMISE EBF: Exclusive breastfeeding promotion in Sub-Saharan Africa

Wednesday, November 11, 2009: 1:00 PM

Debra J. Jackson, MPH DSc , School of Public Health, University of the Western Cape, Cape Town, South Africa
Thorkild Tylleskar , Centre for International Health, University of Bergen, Bergen, Norway
Mickey Chopra, MSc , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Hama Diallo , Epidemiology & Public Health, Centre MURAZ, Bobo Dioulasso, Burkina Faso
Tanya Doherty, MPH PhD , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Eva Charlotte Ekstrom , Women's and Children's Health, International Maternal and Child Health (IMCH), University of Uppsala, Uppsala, Sweden
Ingunn Engebretsen , Centre for International Health, University of Bergen, Bergen, Norway
Ameena Goga, MBCHB , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Chipepo Kankasa , Pediatrics and Child Health, University of Zambia, Lusaka, Zambia
Jorn Klunsoyr , Centre for International Health, University of Bergen, Bergen, Norway
Carl Lombard , Biostatistics Unit, Medical Research Council, Tygerberg, South Africa
Nicolas Meda , Epidemiology & Public Health, Centre MURAZ, Bobo Dioulasso, Burkina Faso
Victoria Nankanbirwa , Centre for International Health, University of Bergen, Bergen, Norway
Jolly Nankunda , Paediatric and Child Health, Mulago Hospital, Kampala, Uganda
Philippe Van de Perre , CHU Montpellier, laboratoire de bactériologie-virologie, University Montpellier, Montpellier, France
Rebecca Shanmugam , Biostatistics Unit, Medical Research Council, Tygerberg, South Africa
Chafye Siuluta , Pediatrics and Child Health, University of Zambia, Lusaka, Zambia
Halvor Sommerfelt , Centre for International Health, University of Bergen, Bergen, Norway
James Tumwine , College of Health Sciences, Medical School, Pediatrics and Child Health, Makarere University, Kampala, Uganda
Henry Wamani , Centre for International Health, University of Bergen, Bergen, Norway
For PROMISE EBF Study Group , Centre for International Health, University of Bergen, Bergen, Norway
  
Background: Exclusive breastfeeding for the first six months is an effective child survival strategy. The PROMISE-EBF trial (Clinicaltrials.gov: NCT00397150) in sub-Saharan Africa assessed the effect of individual breastfeeding counselling by peer-counsellors. We report preliminary results of one primary outcome: exclusive breastfeeding rates at 12 weeks of age based on 24-hour dietary recalls.

Methods: PROMISE-EBF is a multicentre community cluster-randomised trial in four African countries, Burkina Faso, Uganda, Zambia and South Africa. In each country 24-34 clusters were randomised (12-17 intervention and 12-17 control, >800 mother-infant pairs/country). Eligibility criteria: pregnant women residing in and intending to continue living in the study areas who consented to study participation. Infants with severe illness preventing breastfeeding were excluded. Five peer visits, from antenatal visit through 10-16 weeks after birth of the infant, were scheduled for mothers in intervention clusters. Control clusters received standard care. Data collection (2006-2008) was by independent interviewers via a series of five home visits to determine feeding patterns, infant morbidity, anthropometry and survival. All analyses adjusted for cluster effects.

Results: Exclusive breastfeeding rates at 12 weeks of age increased in Burkina Faso, Uganda and South Africa (Zambian data analysis ongoing). Preliminary results in the intervention and control groups were: 83% and 36% in Burkina Faso (Prevalence Ratio (PR) 2.34; 95%CI 1.31-4.16), 87% and 49% in Uganda (PR 1.78; 95%CI 1.59-1.98), and 11% and 7% in South Africa (PR 1.69; 95%CI 1.08-2.65), respectively.

Conclusion: Preliminary results suggest a positive effect of peer-counselling on exclusive breastfeeding rates, with large country differences observed.

Learning Objectives:
Discuss findings from a cluster randomized trial on exclusive breastfeeding in Sub-Saharan Africa

Keywords: Breast Feeding, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an APHA member. I was a co-principal investigator on this project. My expertise is perinatal epidemiology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Birth practices and newborn feeding in developing countries
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