Breast-feeding counselling in a diarrhoeal disease hospital

Abstract

Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother-infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practices.

PIP: When infants afflicted with diarrhea were brought to the Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Dhaka, Bangladesh, 125 mother-infant pairs received at least three lactation counseling sessions on the benefits of exclusive breast feeding. Researchers compared data on these 125 pairs with data on 125 other mother-infant pairs who were also at ICDDR,B due to diarrhea but did not receive any counseling. Infants in the intervention group had a shorter hospital stay than those in the control group (4.3 vs. 3 days; p .001). The controls left before diarrhea ended, while cases were discharged after diarrhea ended. At discharge, mothers in the intervention group were more likely than controls to be predominantly breast feeding (breast milk plus oral rehydration solution [ORS]) (30% vs. 19%) as well as exclusively breast feeding (60% vs. 6%) (p .001). Two weeks after discharge, when ORS was stopped, mothers in the intervention group were more likely to be exclusively breast feeding than those in the control group (75% vs. 8%), while those in the control group were more likely to bottle feed than cases (49% vs. 12%) (p .001). Infants in the control group were more likely to have another episode of diarrhea within 2 weeks than those in the intervention group (15 vs. 4; p = .05; odds ratio = 2.92). These findings indicate that individual lactation counseling had a strong influence on mothers to begin exclusive breast feeding during hospitalization and to continue to do so at home. Thus, staff at maternal and child health facilities should integrate lactation counseling into their program to improve infant feeding practices.