Greetings, and welcome to a new issue of Child Survival Technical Support’s (CSTS+) Bookmarks! This edition of Bookmarks! features an article on community-based promotion of exclusive breastfeeding up to six months.

The following summary is taken from the Lancet 2003; 361: 1418-23.

The entire article can be accessed online after registering at the site. Registration is free. To access the article, please point your browser to:

http://www.thelancet.com/journal/vol361/iss9367/full/llan.361.9367.original_research.25412.1

Please note that if the line above wraps on your screen, you will need to manually copy and paste the entire address into your browser window. If you would prefer to receive a PDF copy of this article, please send your request to csts@macrointernational.com.

-------------------------------------

“Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial”

Nita Bhandari, Rajiv Bahl, Sarmila Mazumdar, Jose Martines, Robert E Black, Maharaj K Bhan, and the other members of the Infant Feeding Study Group

SUMMARY

Background
Exclusive breastfeeding is recommended until age 6 months. We assessed the feasibility, effectiveness, and safety of an educational intervention to promote exclusive breastfeeding for this length of time in India.

Methods
We developed the intervention through formative research, pair-matched eight communities on their baseline characteristics, and randomised one of each pair to receive the intervention and the other to no specific intervention. We trained health and nutrition workers in the intervention communities to counsel mothers for exclusive breastfeeding at multiple opportunities. We enrolled 1115 infants born in the 9 months after training--552 in the intervention and 473 in the control communities. Feeding at age 3 months, and anthropometry and of diarrhoea prevalence at age 3 months and 6 months were assessed. All analyses were by intention to treat.

Findings
We assessed 483 and 412 individuals at 3 months in the intervention and control groups, respectively, and 468 and 412 at 6 months. At 3 months, exclusive breastfeeding rates were 79% (381) in the intervention and 48% (197) in the control communities (odds ratio 4·02, 95% CI 3·01-5·38, p<0·0001). The 7-day diarrhoea prevalence was lower in the intervention than in the control communities at 3 months (0·64, 0·44-0·95, p=0·028) and 6 months (0·85, 0·72-0·99, p=0·04). The mean weights and lengths, and the proportion with weight-for-height or height-for-age Z scores of 2 or less, at age 3 months and 6 months did not differ much between groups. Intervention effect on exclusive breastfeeding, diarrhoeal morbidity, and anthropometry at age 6 months in the low-birthweight subgroup was similar to that for all births.

Interpretation
Promotion of exclusive breastfeeding until age 6 months in a developing country through existing primary health-care services is feasible, reduces the risk of diarrhoea, and does not lead to growth faltering.