Effect of Breastfeeding Promotion on Early Childhood Caries and Breastfeeding Duration among 5 Year Old Children in Eastern Uganda: A Cluster Randomized Trial.
BACKGROUND
Although several studies have shown short term health benefits of exclusive breastfeeding (EBF), its long term consequences have not been studied extensively in low-income contexts. This study assessed the impact of an EBF promotion initiative for 6 months on early childhood caries (ECC) and breastfeeding duration in children aged 5 years in Mbale, Eastern Uganda.


METHODS
Participants were recruited from the Ugandan site of the PROMISE- EBF cluster randomised trial (ClinicalTrials.gov no: NCT00397150). A total of 765 pregnant women from 24 clusters were included in the ratio 1:1 to receive peer counselled promotion of EBF as the intervention or standard of care. At the 5 year follow-up, ECC was recorded under field conditions using the World Health Organization's decayed missing filled tooth (dmft) index. Adjusted negative binomial and linear regression were used in the analysis.


RESULTS
Mean breastfeeding duration in the intervention and control groups (n=417) were 21.8 (CI 20.7-22.9) and 21.3(CI 20.7-21.9) months, respectively. The mean dmft was 1.5 (standard deviation [SD] 2.9) and 1.7 (SD 2.9) in the intervention and control groups, respectively. Corresponding prevalence estimates of ECC were 38% and 41%. Negative binomial regression analysis adjusted for cluster effects and loss-to-follow-up by inverse probability weights (IPW) showed an incidence-rate ratio (IRR) of 0.91 (95% CI 0.65-1.2). Comparing the effect of the trial arm on breastfeeding duration showed a difference in months of 0.48 (-0.72 to 1.7).


CONCLUSIONS
PROMISE EBF trial did not impact on early childhood caries or breastfeeding duration at 5 years of age. This study contributes to the body of evidence that promotion of exclusive breastfeeding does not raise oral health concerns. However, the high burden of caries calls for efforts to improve the oral health condition in this setting.


BACKGROUND
ClinicalTrials.gov NCT00397150.
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Nancy
N
Birungi
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Lars T
LT
Fadnes
Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
Isaac
I
Okullo
Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
Arabat
A
Kasangaki
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America.
Victoria
V
Nankabirwa
Department of Paediatrics and Child health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Grace
G
Ndeezi
Department of Paediatrics and Child health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
James K
JK
Tumwine
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
Thorkild
T
Tylleskär
Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Stein Atle
SA
Lie
Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Anne Nordrehaug
AN
Åstrøm
D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003731:Dental Caries / Q000453:epidemiology*; D003817:Dentition; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult