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Haque Rema, Sanjida (2019) A low cost, sustainable, locally delivered intervention to promote exclusive breastfeeding practices in rural Bangladeshi women. Doctoral thesis, London Metropolitan University.
Background:
Breastfeeding is a well-accepted customary practice in Bangladesh. However, there are barriers to exclusive breastfeeding including the tradition of potentially harmful practices such as prelacteal feeding (PF) and early additional feeding (ADF). Most breastfeeding promotion programmes are unable to support mothers in rural areas who deliver at home, assisted by locally practiced dai or a traditional birth attendant (TBA). With adequate training and knowledge in optimum infant feeding, TBAs could establish a locally acceptable and sustainable custom of breastfeeding practices amongst mothers in rural areas.
Methods:
A controlled trial was conducted in the Dohar Upazila of Dhaka district to evaluate the impact of a TBA-led education intervention on early and exclusive breastfeeding practices in the first six months post-natally. Two community clinics (CCs) were selected as the intervention and control centres respectively. TBAs were trained to deliver breastfeeding and infant feeding advice to mothers, both pre- and post-natally. Demographic characteristics were collected via questionnaires. Infant weight, length, BMI and age were recorded across four clinic visits between birth and 5-6 months and converted to z-scores using WHO growth references. Where possible, infant birth weight was recorded. Infant feeding histories were collected via questionnaires together with reported occurrences of infant illnesses.
Results:
A total of 269 mothers were recruited during 2014-2015, of whom 265 mothers with a mean age of 23.6±5.0 years completed the final 5-6 months of follow-up. The majority of mothers (78.3%) either had received primary education or were uneducated. More than 96% stayed at home and 43.4% were pregnant for the first time. Significantly more mothers (86.8%) in the intervention group breastfed their infants within the first hour post-natally compared to 31.5% in the control group (p<0.0001). 8.3% of infants in the intervention group received PF in the first week compared to 82.3% in the control group (p<0.0001). Significantly more mothers (78.6%) in the intervention group exclusively breastfed between birth and 5-6 months post-natally compared to 29.2% in the control group (p<0.0001). The intervention tended to show better outcomes for the infants with respect to z-weight, z-length and z-BMI up to age 5-6 months, although statistical significance varied at time points and between anthropometric measurements. Infants in the intervention group tended to present with fewer illnesses across the study period compared to the control group.
Conclusion:
The study successfully found that the TBA-led breastfeeding education intervention resulted in better outcomes for infant feeding, growth and illness. It is likely that the better infant growth and illness resulted from improved breastfeeding practice. These findings suggest that the training of local TBAs could lead to a low cost and sustainable way to promote exclusive breastfeeding practices in rural Bangladeshi women which feasibly could be extended across the country.
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