Suchergebnisse

Background: Suboptimal breastfeeding contributes to >800,000 global child deaths annually. Optimal breastfeeding includes early initiation (EI) and exclusive breastfeeding (EBF) for the first 6 mo. Objectives: We tested the hypothesis that an intervention targeting context and infant age-specific barriers to EI and EBF will achieve a higher EI and EBF prevalence than those of women participating in the concurrently conducted 2015 Zimbabwe Demographic Health Survey (Z-DHS). Methods: We designed an intervention to promote EI and EBF, and implemented it within the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Intervention modules were delivered at 4 perinatal time points by government-employed village health workers. We compared EI and EBF prevalence among SHINE women who provided outcomes at 1 mo (n = 2442) and 3 mo (n = 2728), with women in the 2015 Z-DHS. Results: In cross-sectional analyses EI prevalence was 86.6% and 64.3% in the SHINE and Z-DHS samples, respectively; absolute difference (95% CI) = 22.4% (17.5%, 27.3%). EBF prevalence was similarly high (>80%) in both surveys during the first month of life; during 1 to <2 mo, 2 to <3 mo, 3 to <4 mo, 4 to <5 mo, and 5 to <6 mo, EBF prevalence was, respectively, 85%, 90%, 90%, 84%, and 75% in SHINE, and 71%, 65%, 35%, 26%, and 25% in Z-DHS; absolute difference (95% CI) = 50.2% (34.7%, 65.7%) at 5 to <6 mo. Cesarean delivery, mother's belief that intimate partner violence was sometimes justifiable, and having a male infant negatively modified the effects of the intervention. Conclusions: The SHINE intervention achieved a high prevalence of EI and EBF. Concurrently addressing gender norms will be critical to make further progress. Formative studies to identify context- and infant age-specific barriers to EI and EBF may inform improvement of breastfeeding practices elsewhere. Important work remains to scale up this intervention beyond a research setting. SHINE was registered at www.clinicaltrials.gov as NCT01824940. ; Bill and Melinda Gates Foundation (OPP1021542 and OPP1143707) ; United Kingdom Department for International Development (DFID/UKAID) ; Wellcome Trust (093768/Z/10/Z and 108065/Z/15/Z ; Swiss Agency for Development and Cooperation

We agree with Karen Levy and Joseph Eisenberg that observational studies of water, sanitation, and hygiene (WASH) interventions with carefully designed counterfactuals can play a valuable role in generating evidence on effectiveness, particularly in urban settings. Randomised controlled trials for community-level WASH infrastructure interventions are not always feasible in urban settings, because of the political and logistical constraints of defining treatment and control groups; strong observational designs could help fill the gap.1 With increasing urbanisation in Asia and Africa, WASH intervention studies in low-income urban communities will be crucial for informing strategies to meet Sustainable Development Goal (SDG) target 6.1: to achieve universal and equitable access to safe and affordable drinking water for all. ; AJPi, BFA, CN, MR, and CPS report grants and other support from the Bill & Melinda Gates Foundation, during this study. JMC received salary support and University of California, Berkeley, received the prime award funding for the conduct of the WASH Benefits trials in Bangladesh and Kenya. JHH reports grants from the Bill & Melinda Gates Foundation, the Department for International Development (UK Government), and Swiss Agency for Development and Cooperation