The WHO recommend exclusive breastfeeding until six months of age for infants in less-developed coun-tries; previous research has suggested that exclusive breastfeeding for the first six months can protect against diarrheal disease, although there are concerns that exclusive breastfeeding could be associated with reduced infant growth. Dr. Robert Black of the Department of International Health Johns Hopkins Bloomberg School of Public Health, Dr. Maharaj Bhan of the All India Institute of Medical Sciences, New Delhi, India and other 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 counseling 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 counseling compared with the control group (46%); diarrhea 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 diarrhea. 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 counselors, and several hospital and clinic based programs. Our findings are, however, especially important since behavior 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."
Journal
The Lancet