title: Effect of an integrated community-based package for maternal and newborn care on feeding patterns during the first 12 weeks of life: a cluster-randomized trial in a South African township.
abstract: OBJECTIVE
  To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth, and to study whether the effect differs by maternal HIV status, educational level or household wealth.
  
  
  METHODS
  Cluster-randomized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers. Infant feeding data were collected using 24 h recall of nineteen food and fluid items.
  
  
  METHODS
  A township near Durban, South Africa.
  
  
  METHODS
  Pregnant women (1894 intervention and 2243 control) aged 17 years or more.
  
  
  RESULTS
  Twelve weeks after birth, 1629 (intervention) and 1865 (control) mother-infant pairs were available for analysis. Socio-economic conditions differed slightly across intervention groups, which were considered in the analyses. There was no effect on early initiation of breast-feeding. At 12 weeks of age the intervention doubled exclusive breast-feeding (OR=2·29; 95 % CI 1·80, 2·92), increased exclusive formula-feeding (OR=1·70; 95 % CI 1·28, 2·27), increased predominant breast-feeding (OR=1·71; 95 % CI 1·34, 2·19), decreased mixed formula-feeding (OR=0·68; 95 % CI 0·55, 0·83) and decreased mixed breast-feeding (OR=0·54; 95 % CI 0·44, 0·67). The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers (P=0·01), while the effect on mixed formula-feeding was significant only among HIV-positive mothers (P=0·03). The effect on exclusive feeding was not different by household wealth or maternal education levels.
  
  
  CONCLUSIONS
  A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.
authors: 1Health Systems Research Unit,Medical Research Council,Tygerberg,South Africa.
authors: Petrida
authors: P
authors: Ijumba
authors: 1Health Systems Research Unit,Medical Research Council,Tygerberg,South Africa.
authors: Tanya
authors: T
authors: Doherty
authors: 3School of Public Health,University of the Western Cape,Cape Town,South Africa.
authors: Debra
authors: D
authors: Jackson
authors: 5Department of Psychology,Stellenbosch University,Stellenbosch,South Africa.
authors: Mark
authors: M
authors: Tomlinson
authors: 3School of Public Health,University of the Western Cape,Cape Town,South Africa.
authors: David
authors: D
authors: Sanders
authors: 6Biostatistics Unit,Medical Research Council,Tygerberg,South Africa.
authors: Sonja
authors: S
authors: Swanevelder
authors: 2International Maternal and Child Health (IMCH),Department of Women's and Children's Health,Uppsala University,Akademiska sjukhuset,SE-751 85 Uppsala,Sweden.
authors: Lars-Åke
authors: LÅ
authors: Persson
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003150:Community Health Workers; D003376:Counseling; D005247:Feeding Behavior; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D041943:Infant Formula; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D000068101:Maternal-Child Health Services; D009035:Mothers; D016017:Odds Ratio; D011181:Postnatal Care; D011247:Pregnancy; D011248:Pregnancy Complications; D015397:Program Evaluation; D012923:Social Class; D013019:South Africa; D055815:Young Adult
keywords: Community health workers; Counselling; Educational level; HIV; Household wealth; Infant feeding