title: Early infant feeding practices in three African countries: the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors.
abstract: BACKGROUND
  Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO. We report its impact on early infant feeding practices from the PROMISE-EBF trial.
  
  
  METHODS
  PROMISE-EBF was a cluster randomised behaviour change intervention trial of exclusive breastfeeding (EBF) promotion by peer counsellors in Burkina Faso, Uganda and South Africa implemented during 2006-2008 among 2579 mother-infant pairs. Counselling started in the last pregnancy trimester and mothers were offered at least five postnatal visits. Early infant feeding practices: use of prelacteal feeds (any foods or drinks other than breast milk given within the first 3 days), expressing and discarding colostrum, and timing of initiation of breastfeeding are presented by trial arm in each country. Prevalence ratios (PR) with 95% confidence intervals (95%CI) are given.
  
  
  RESULTS
  The proportion of women who gave prelacteal feeds in the intervention and control arms were, respectively: 11% and 36%, PR 0.3 (95% CI 0.2, 0.6) in Burkina Faso, 13% and 44%, PR 0.3 (95% CI 0.2, 0.5) in Uganda and 30% and 33%, PR 0.9 (95% CI 0.6, 1.3) in South Africa. While the majority gave colostrum, the proportion of those who expressed and discarded it in the intervention and control arms were: 8% and 12%, PR 0.7 (95% CI 0.3, 1.6) in Burkina Faso, 3% and 10%, PR 0.3 (95% CI 0.1, 0.6) in Uganda and 17% and 16%, PR 1.1 (95% CI 0.6, 2.1) in South Africa. Only a minority in Burkina Faso (<4%) and roughly half in South Africa initiated breastfeeding within the first hour with no large or statistically significant differences between the trial arms, whilst in Uganda the proportion of early initiation of breastfeeding in the intervention and control arms were: 55% and 41%, PR 0.8 (95% CI 0.7, 0.9).
  
  
  CONCLUSIONS
  The PROMISE-EBF trial showed that the intervention led to less prelacteal feeding in Burkina Faso and Uganda. More children received colostrum and started breastfeeding early in the intervention arm in Uganda. Late breastfeeding initiation continues to be a challenge. No clear behaviour change was seen in South Africa.
  
  
  BACKGROUND
  NCT00397150.
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Ingunn Marie S
authors.initials: IM
authors.lastname: Engebretsen
authors.affiliation: School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Victoria
authors.initials: V
authors.lastname: Nankabirwa
authors.affiliation: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa ; School of Public Health, University of the Western Cape, Cape Town, South Africa.
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.affiliation: Centre MURAZ, Ministry of Health, Bobo-Dioulasso, Burkina Faso.
authors.forename: Abdoulaye Hama
authors.initials: AH
authors.lastname: Diallo
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Jolly
authors.initials: J
authors.lastname: Nankunda
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway ; Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Lars Thore
authors.initials: LT
authors.lastname: Fadnes
authors.affiliation: Department Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Eva-Charlotte
authors.initials: EC
authors.lastname: Ekström
authors.affiliation: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa.
authors.forename: Vundli
authors.initials: V
authors.lastname: Ramokolo
authors.affiliation: Centre MURAZ, Ministry of Health, Bobo-Dioulasso, Burkina Faso.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway ; Department of Global Public Health, Norwegian Institute of Public Health, Kragujevac, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa ; UNICEF, New York, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskär
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
keywords: Colostrum; Exclusive breastfeeding; Peer-counselling; Prelacteal feeding; Trial