What do Kramer's Baby Friendly Hospital Initiative PROBIT studies tell us? A review of a decade of research
ABSTRACT Kramer et al's PROBIT (Promotion of Breastfeeding Intervention Trial) research in Belarus studied effects of the Baby-Friendly Hospital Initiative (BFHI) training on breastfeeding duration, exclusivity, and health outcomes.
To critique inclusion criteria, context, approaches to data analysis, and health outcome results.
Twenty-two articles were retrieved from PubMed and the PROBIT Website for 2001-2010; 6 were excluded as not focusing on breastfeeding and health outcomes.
PROBIT data from the cluster randomized hospital comparisons included only breastfed babies since all non-breastfed babies were excluded from the research. Context may affect outcomes, knowing that Belarus has good basic health services, 3-year maternity leaves with little use of daycare, 95% breastfeeding initiation rate, and a well-educated population. PROBIT data were analyzed in 2 ways: (a) intent-to-treat analyses of breastfeeding and health differences by cluster randomized intervention and control site mother/baby pairs; and (b) as an observational cohort study of health outcomes for all mother/baby pairs, analyzed by various breastfeeding categorizations and controlling for biases. PROBIT demonstrated links between BFHI and longer breastfeeding duration (19.7% vs 11.4% at 12 months, P < .001) and exclusivity (43.3% vs 6.4% at 3 months, P < .001), reductions in gastrointestinal episodes and rashes, higher verbal IQ scores, and longer exclusive breastfeeding rates for subsequent children but no statistically significant differences in the child's body mass index, blood pressure, or dental health.
PROBIT provides foundational evidence for BFHI policy and follow-up care. Knowing that non-breastfed babies were excluded, caution must be exercised for health comparisons.
- SourceAvailable from: Catherine Kyobutungi
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- "The BFHI, a WHO and UNICEF global program launched in 1991 to protect, promote, and support breastfeeding in maternity wards has been found effective in improving breastfeeding practices particularly in high- and middle-income countries [49-52]. Of concern, however, is the fact that the BFHI mainly focuses on promoting breastfeeding in the hospital setting around the time of delivery, yet in some countries, very few women deliver in health facilities . "
ABSTRACT: Nutrition in the first 1,000 days of life (during pregnancy and the first two years) is critical for child growth and survival. Poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Kenya, with potential detrimental effects on child growth and survival. This is particularly a problem in slums, where most urban residents live. For example, exclusive breastfeeding for the first six months is only about two per cent. Innovative strategies to reach slum residents are therefore needed. Strategies like the Baby Friendly Hospital Initiative have proven effective in some settings but their effectiveness in resource-limited settings, including slums where many women do not deliver in hospital, is questionable. We propose to test the effectiveness of a home-based intervention on infant feeding practices, nutrition and health outcomes of infants born in two slums in Nairobi, Kenya. The study, employing a cluster-randomised study design, will be conducted in two slums in Nairobi: Korogocho and Viwandani where 14 community units (defined by the Government's health care system) will form the unit of randomization. A total of 780 pregnant women and their respective child will be recruited into the study. The mother-child pair will be followed up until the child is one year old. Recruitment will last approximately one year and three months from September 2012 to December 2013. The mothers will receive regular, personalised, home-based counselling by trained Community Health Workers on MIYCN. Regular assessment of knowledge, attitudes and practices on MIYCN will be done, coupled with assessments of nutritional status of the mother-child pairs and diarrhea morbidity for the children. Statistical methods will include analysis of covariance and multinomial logistic regression. Additionally, cost-effectiveness analysis will be done. The study is funded by the Wellcome Trust and will run from March 2012 to February 2015. Interventions aimed at promoting optimal breastfeeding and complementary feeding practices are considered to have high impact and could prevent a fifth of the under-five deaths in countries with high mortality rates. This study will inform policy and practice in Kenya and similar settings regarding delivery mechanisms for such high-impact interventions, particularly among urban poor populations.Trial registration: ISRCTN83692672.Trials 12/2013; 14(1):445. DOI:10.1186/1745-6215-14-445 · 1.73 Impact Factor
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ABSTRACT: In science, the key challenge is to discover the truth. In population neuroscience, this means separating real relationships between exposures and outcomes from false ones. By design, cohort studies similar to those described in Chapter 8 generate massive amounts of data: thousands of system-level and molecular phenotypes, thousands of genotypes and hundreds of exposures related to our physical and social environments. When searching for “the truth” in such vast datasets, we can, in principle, use the following two strategies: (1) build multivariate statistical models to capture key relationships in the dataset and (2) approach the data in a quasi-experimental manner. We will touch on the first approach in Chapter 10, when we discuss it in the context of risk/resilience profiling. Here, we will outline a few strategies that are suitable for approaching the rich set of collected data as an experimental laboratory—where all necessary ingredients are ready for us to use in careful “bench work”. In this context, we will talk about the use of meta-analyses for constructing hypotheses and discuss the importance of distinguishing between associations and causal relationships. We then reiterate the fact that MRI provides only a representation of the human brain: a few studies carried out in experimental animals will provide illustrations of how we can go beyond the “MR brain”. We close the chapter by pointing out a number of practical challenges, with a focus on incidental findings.Population Neuroscience, 01/2013: pages 139-152; , ISBN: 978-3-642-36449-5
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ABSTRACT: The first days after delivery of a newborn infant are critical for breastfeeding establishment. Successful initiation and continuation-especially of exclusive breastfeeding-have become public health priorities, but it is fraught with many individual- and systems-level barriers. In this article, we review how hospital newborn services can be constructed or restructured to support the breastfeeding mother-infant dyad so that they can achieve high levels of breastfeeding success. Important positive and negative factors from the prenatal period, and the preparation for hospital discharge are also discussed.Pediatric Clinics of North America 02/2013; 60(1):147-68. DOI:10.1016/j.pcl.2012.09.013 · 2.12 Impact Factor