Impact of Exclusive Breast-Feeding in Guinea Bissau
Condition: Nutritional Status
Study type: Interventional
Phase: Phase 4

Summary: 
      Exclusive breastfeeding is promoted by the World Health Organization (WHO) with the aim of
      improving infant health. The specific objective of the study was to examine the effect of
      exclusive breast-feeding on morbidity and mortality in a randomised prospective study.
      Children born by mothers recorded as living in the study area during pregnancy was randomised
      at birth. WHO recommendations to postpone introduction of water and weaning food were told to
      the mother by 2-weekly home visits. All study children were followed from birth till 1 year
      of age according to morbidity, hospitalisation and mortality.
    

Detailed description: 
      Examine in a randomised trial whether postponing of introduction of water and weaning food as
      recommended by WHO reduces infant morbidity and mortality. Results obtained from
      observational studies are likely to be due to reverse causality as the mother her self
      chooses when to introduce water and weaning food. Only a few randomised studies have examined
      the effect on infant morbidity, and no study has investigated the impact on infant mortality
      in a low-income country. The study was conducted at Bandim Health Project (BHP) which has
      conducted a demographic health surveillance system since 1978. Mothers and children were
      identified by the BHP routine registration. All children born between March 1 2000 until
      February 28th 2001 in the study area and whose mothers were recorded as living in the area
      during pregnancy were eligible for inclusion. Children who died within 7 days of birth were
      excluded in order to avoid birth related morbidity and mortality leaving a total of 1300
      children for the study. At birth all children were allocated to an intervention group or a
      control group. All mother and child pairs were visited bi-weekly by a local, special trained
      health worker. By individual health education the mothers were motivated to delay
      introduction of water and weaning food to 6 months of age according to recommendations given
      by WHO. All mother and child pairs in the control group were visited by the same health
      assistant. By these visits only information on feeding status was obtained and no
      intervention given. Further more all study children were followed by assistants blinded to
      the randomisation with: bi-weekly diarrhoea morbidity interview, monthly anthropometry,
      including weight, height and arm circumference. All children were followed up to 12 months of
      age. Demographic as well as socio-economic data, data on hospitalisation, deaths and
      migrations were obtained from the BHP routine registration system. These data will be
      collected until the age of 3 years of the child.
    

Intervention name(s): Health education according to WHO recommendations
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Exclusive breast-feeding; Mortality; Morbidity; Nutrition; Low income country