Implementation of Steps 1–9 to Successful Breastfeeding Reduces the Frequency of Mild and Severe Episodes of Diarrhea and Respiratory Tract Infection Among 0–6 Month Infants in Democratic Republic of Congo
Global initiatives to improve breastfeeding practices have focused on the Ten Steps to Successful Breastfeeding. The aim of this study was to assess the effect of implementing Baby-Friendly Hospital Initiative (BFHI) steps 1–9 and BFHI steps 1–10 on incidence of diarrhea and respiratory illnesses in the first 6 months of life.
We reanalyzed a cluster randomized trial in which health-care clinics in Kinshasa, Democratic Republic of Congo, were randomly assigned to standard care (control group), BFHI steps 1–9, or BFHI steps 1–10. Outcomes included episodes of diarrhea and respiratory illness. Piecewise Poisson regression with generalized estimation equations to account for clustering by clinic was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI).
Steps 1–9 was associated with a decreased incidence of reported diarrhea (IRR 0.72, 95% CI 0.53, 0.99) and respiratory illness (IRR 0.48, 95% CI 0.37, 0.63), health facility visits due to diarrhea (IRR 0.60, 95% CI 0.42, 0.85) and respiratory illness (IRR 0.47, 95% CI 0.36, 0.63), and hospitalizations due to diarrhea (IRR 0.42, 95% CI 0.17, 1.06) and respiratory illness (IRR 0.33, 95% CI 0.11, 0.98). Addition of Step 10 attenuated this effect: episodes of reported diarrhea (IRR 1.24, 95% CI 0.93, 1.68) and respiratory illness (IRR 0.77, 95% CI 0.60, 0.99), health facility visits due to diarrhea (IRR 0.76, 95% CI 0.54, 1.08) and respiratory illness (IRR 0.75 95% CI 0.57, 0.97), and hospitalizations due to respiratory illness (IRR 0.48 95% CI 0.16, 1.40); but strengthened the effect against hospitalizations due to diarrhea (IRR 0.14, 95% CI 0.03, 0.60).
Implementation of steps 1–9 significantly reduced incidence of mild and severe episodes of diarrhea and respiratory infection in the first 6 months of life, addition of step 10 appeared to lessen this effect.
KeywordsDiarrhea Respiratory illness Infants Breastfeeding Baby-Friendly Hospital Initiative (BFHI).
We are grateful for the participation and time of the mothers and infants who participated in the study; the time and efforts of the personnel at the participating clinics (Esengo, Kikenda, Kitega, Libikisi, Lukunga, and Luyindu); the technical support of Drs. Aimee Lulebo, Dinah Kayembe, Landry Kiketa, Jean Lambert S. Chalachala, Mrs. Kathryn Salisbury, and Deidre Thompson; the data collection and data entry contributions of Clever Akili, Dyna Anambatu, Valerie B. Chalachala, Marie Dauly, Dydy Kayembe, Mamie Lulebo, Fanny Matadi, Myriam Mbonze, Espérance Mindia, Sarah Mushiya, Gisèle Mvumbi, Dodo Mwela, Jolly Ntirume, Ros Samba; and the administrative support of the UNC, KSPH, and Alive & Thrive administrative teams.
- Bhutta, Z. A., Das, J. K., Walker, N., Rizvi, A., Campbell, H., Rudan, I., & Black, R. E. (2013). Interventions to address deaths from childhood pneumonia and diarrhoea equitably: What works and at what cost? Lancet, 381(9875), 1417–1429. https://doi.org/10.1016/s0140-6736(13)60648-0.CrossRefPubMedGoogle Scholar
- Hoddinott, P., Craig, L., Maclennan, G., Boyers, D., & Vale, L. (2012). The FEeding Support Team (FEST) randomised, controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas. British Medical Journal Open, 2, e000652. https://doi.org/10.1136/bmjopen-2011-000652.Google Scholar
- Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment (Full Report), 153, 1–186.Google Scholar
- Ministere du Plan, Institut National de la Statistique, & UNICEF. (2010). Enquete par grappes a indicateurs multiples—RDC 2010: Resultat Preliminaires. http://www.childinfo.org/files/MICS_RDC_2010.pdf.
- UNICEF. (2005, January 12). The Baby-Friendly Hospital Initiative. http://www.unicef.org/nutrition/index_24806.html.
- Wang, H., Bhutta, Z. A., Coates, M. M., Coggeshall, M., Dandona, L., Diallo, K., et al. (2015). Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1725–1774. https://doi.org/10.1016/S0140-6736(16)31575-6.CrossRefGoogle Scholar
- WHO/UNICEF. (2009). Baby-friendly hospital initiative: Revised, updated and expanded for integrated care. http://www.unicef.org/nutrition/files/BFHI_2009_s3.1and2.pdf.
- WHO/UNICEF. (1989). Protecting, promoting and supporting breast-feeding: The special role of maternity services—A joint WHO/UNICEF statement. Geneva, Switzerland: WHO/UNICEF. http://www.who.int/nutrition/publications/infantfeeding/9241561300/en/index.html.
- Yotebieng, M., Chalachala, J. L., Labbok, M., & Behets, F. (2013). Infant feeding practices and determinants of poor breastfeeding behavior in Kinshasa, Democratic Republic of Congo: A descriptive study. International Breastfeeding Journal, 8(1), 11. https://doi.org/10.1186/1746-4358-8-11.CrossRefPubMedPubMedCentralGoogle Scholar
- Yotebieng, M., Labbok, M., Soeters, H. M., Chalachala, J. L., Lapika, B., Vitta, B. S., & Behets, F. (2015). Ten Steps to Successful Breastfeeding programme to promote early initiation and exclusive breastfeeding in DR Congo: A cluster-randomised controlled trial. The Lancet Global Health, 3(9), e546-555. https://doi.org/10.1016/s2214-109x(15)00012-1.CrossRefGoogle Scholar
- You, D., Hug, L., Ejdemyr, S., Idele, P., Hogan, D., Mathers, C., et al. (2015). Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. The Lancet, 386(10010), 2275–2286. https://doi.org/10.1016/S0140-6736(15)00120-8.CrossRefGoogle Scholar