Breastfeeding
Conditions
Keywords
Breastfeeding, Baby Friendly Hospital Initiative, Well-child clinics
Brief summary
A cluster-randomized controlled trial will be conducted in the Democratic Republic of Congo to compare rates of early initiation and exclusive breastfeeding between mothers who give birth in hospitals with the current standard of care, mothers who give birth in hospitals that have implemented the first nine steps of the Baby-Friendly Hospital Initiative, and mothers who give birth in hospitals that have implemented all ten steps of the Baby-Friendly Hospital Initiative, with the 10th step being the provision of breastfeeding support during well-child clinic visits.
Detailed description
If at least 90% of children were exclusively breastfed for the first 6-months of life, the potential reduction in mortality that can be achieved will be higher than for any other interventions with sufficient evidence of effect. In the DRC \>500,000 under-five deaths occurred in 2008. While \>95% of children were breastfed at some point, 18% received something other than breast milk before initiation of breastfeeding, and half received something other than human milk by 1.4 months. Pre- and post-partum breastfeeding support has been shown to best improve the rate of exclusive breastfeeding (EBF). The global initiatives to improve breastfeeding practices have focused on maternity-level policies and procedures known as the Ten Steps to Successful Breastfeeding, which served as the basis for the Baby-Friendly Hospital Initiative. These quality of care steps impact hospital breastfeeding rates as well as breastfeeding rates throughout the 6 months postpartum period. However, EBF rates fall off rapidly in the DRC. In the proposed cluster randomized controlled trial, we plan to evaluate the effect of breastfeeding support provided by well-child clinic staff including the use of culturally appropriate messages in addition to the implementation of BFHI steps 1-9 Steps in maternities on the rate of breastfeeding initiation within 1 hour of birth and EBF throughout 6 months postpartum. If effective, this approach has great potential for scale up where most needed.
Interventions
OTHERimplementation of the Baby-Friendly Hospital Initiative
Implementation of BFHI steps 1-9 in maternities
OTHERBFHI steps 1-9 +well-child clinic
Implementation of BFHI steps 1-9 in maternities and provision of breastfeeding support including culturally appropriate educational messages and metaphors as the ongoing aspect of step 10 in well-child clinic
Sponsors
Kinshasa School of Public Health (DR, Congo)
Centre for the Coordination of Social Science Research and Documentation in Africa South of the Sahara (CERDAS) (DR,Congo)
Bureau Diocésain des Œuvres Médicales de Kinshasa (BDOM), (DR, Congo)
Salvation Army (DR, Congo)
Ministry of Public Health, Democratic Republic of the Congo
University of North Carolina, Chapel Hill
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 3 Days
Healthy volunteers
Yes
Inclusion criteria
* mothers of healthy infants being discharged from participating maternities who intend to attend well-baby clinic visits in the same health care facilities until the child will be at least 6 months
Exclusion criteria
* refusal to participate, not speaking Lingala nor French, unable to breastfeed
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Early initiation of breastfeeding | Within 1 hour of birth | initiation of breastfeeding within one hour of birth |
| Exclusive breastfeeding rate | up to 6 months after birth | Infants will be classified as exclusively breastfed if they received only breast milk (no water, other liquids, or solids) |
Secondary
| Measure | Time frame |
|---|---|
| Partial Breastfeeding rate | up to 6 months after birth |
| Number of hospitalization | in the first 6 months of life |
| Episodes of diarrhea | in the first 6 months of life |
| Amount and type of breastfeeding support given by Health care provider to mothers | in the first 6 months after birth |
| Number of mothers seeking breastfeeding help | in the first 6 months of life |
| Episodes of Lower Respiratory Track Infection | in the first 6 months of life |
Countries
Republic of the Congo
Outcome results
None listed