title: Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial.
abstract: OBJECTIVE
  Breastfeeding has significant health benefits for mothers and infants. Despite recommendations from the WHO, by 6 months of age 40% of Australian infants are receiving no breast milk. Increased early postpartum breastfeeding support may improve breastfeeding maintenance. 2 community-based interventions to increase breastfeeding duration in local government areas (LGAs) in Victoria, Australia, were implemented and evaluated.
  
  
  METHODS
  3-arm cluster randomised trial.
  
  
  METHODS
  LGAs in Victoria, Australia.
  
  
  METHODS
  LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion. The LGA was the unit of randomisation, and maternal and child health centres in the LGAs comprised the clusters.
  
  
  METHODS
  Early home-based breastfeeding support by a maternal and child health nurse (home visit, HV) with or without access to a community-based breastfeeding drop-in centre (HV+drop-in).
  
  
  METHODS
  The proportion of infants receiving 'any' breast milk at 3, 4 and 6 months (women's self-report).
  
  
  RESULTS
  4 LGAs were randomised to the comparison arm and provided usual care (n=41 clusters; n=2414 women); 3 to HV (n=32 clusters; n=2281 women); and 3 to HV+drop-in (n=26 clusters; 2344 women). There was no difference in breastfeeding at 4 months in either HV (adjusted OR 1.04; 95% CI 0.84 to 1.29) or HV+drop-in (adjusted OR 0.92; 95% CI 0.78 to 1.08) compared with the comparison arm, no difference at 3 or 6 months, nor in any LGA in breastfeeding before and after the intervention. Some issues were experienced with intervention protocol fidelity.
  
  
  CONCLUSIONS
  Early home-based and community-based support proved difficult to implement. Interventions to increase breastfeeding in complex community settings require sufficient time and partnership building for successful implementation. We cannot conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol.
  
  
  BACKGROUND
  ACTRN12611000898954; Results.
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia School of Nursing and Midwifery, Bundoora, Victoria, Australia.
authors.forename: Helen L
authors.initials: HL
authors.lastname: McLachlan
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia The Royal Women's Hospital, Parkville, Victoria, Australia.
authors.forename: Della A
authors.initials: DA
authors.lastname: Forster
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Amir
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia.
authors.forename: Meabh
authors.initials: M
authors.lastname: Cullinane
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia.
authors.forename: Touran
authors.initials: T
authors.lastname: Shafiei
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia.
authors.forename: Lyndsey F
authors.initials: LF
authors.lastname: Watson
authors.affiliation: School of Nursing and Midwifery, Bundoora, Victoria, Australia.
authors.forename: Lael
authors.initials: L
authors.lastname: Ridgway
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia.
authors.forename: Rhian L
authors.initials: RL
authors.lastname: Cramer
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Small
mesh_terms: D000328:Adult; D001942:Breast Feeding; D016000:Cluster Analysis; D003153:Community Health Services / Q000379:methods*; D005260:Female; D006801:Humans; D009035:Mothers; D015397:Program Evaluation / Q000706:statistics & numerical data*; D014739:Victoria
keywords: NUTRITION & DIETETICS; PUBLIC HEALTH
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