Health benefits of training mothers in developing countries to breastfeed exclusively for 6 months

Reducing diarrhoeal disease among infants in less-developed countries could be assisted by the implementation of straightforward community-based health programmes to promote exclusive breastfeeding for six months after childbirth, conclude authors of a study in this week's issue of THE LANCET.

The WHO recommend exclusive breastfeeding until six months of age for infants in less-developed countries; previous research has suggested that exclusive breastfeeding for the first six months can protect against diarrhoeal disease, although there are concerns that exclusive breastfeeding could be associated with reduced infant growth. Maharaj Bhan from the All India Institute of Medical Sciences, New Delhi, India, and colleagues assessed the feasibility, effectiveness, and safety of an educational intervention to promote exclusive breastfeeding for this length of time in a rural Indian community.

Health-care workers were trained to give exclusive breastfeeding counselling within the existing health-care infrastructure, and mothers of 1115 infants born within nine months of this training were randomly allocated to an intervention or control group.

Exclusive breastfeeding rates were higher (79%) for mothers given counselling compared with the control group (46%); diarrhoea was reduced by a third in the intervention group at three months and by around 15% at six months. There were no differences between length and weight of infants between the two groups, overall, and in the subgroup of low-birthweight infants.

Maharaj Bhan comments: "Our findings indicate that promotion of exclusive breastfeeding until age 6 months in a developing country setting through existing primary-health-care services is feasible, does not lead to growth faltering, and reduces the risk of diarrhoea. Additionally, educational intervention greatly improved the rates of exclusive breastfeeding, as previously indicated by the results of two community-based trials, which assessed the use of peer counsellors, and several hospital and clinic based programmes. Our findings are, however, especially important since behaviour change was achieved with an approach that is feasible on a large scale and is sustainable, because it was implemented through the routine health and nutrition services."

Contact: Professor Maharaj K Bhan, Department of Paediatrics, Division of Gastroenterology & Enteric Infections, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 1029, India;
T) 91-116-963-822;
F) 91-116-862-663;
E) community.research@cih.uib.no

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