Cognitive-behavioral counseling for exclusive breastfeeding in rural pediatrics: a cluster RCT
Siham Sikander1, Joanna Maselko2, Shamsa Zafar3
1Human Development Research Foundation, Islamabad, Pakistan; siham.sikander@hrdfoundation.org.
Insights
Cognitive-behavioral counseling significantly increased exclusive breastfeeding (EBF) rates and duration in Pakistan. This intervention doubled EBF at six months postpartum compared to routine counseling.
Area of Science:
- Public Health
- Maternal and Child Health
- Behavioral Science
Background:
- Exclusive breastfeeding (EBF) is crucial for infant health but challenging to maintain.
- Rates of EBF decline significantly within the first six months postpartum.
- Effective interventions are needed to support prolonged EBF.
Purpose of the Study:
- To evaluate the impact of cognitive-behavioral counseling (CBC) on EBF rates and duration.
- To compare CBC effectiveness against routine counseling in a rural Pakistani population.
- To assess CBC's influence on infant feeding practices, including prelacteal feeds.
Main Methods:
- A cluster-randomized controlled trial involving 40 Union Councils in rural Pakistan.
- 224 pregnant women received CBC, and 228 received routine counseling.
- Follow-up occurred biweekly until 6 months postpartum, with intention-to-treat analysis.
Main Results:
- At 6 months, 59.6% of mothers in the CBC group practiced EBF versus 28.6% in the control group.
- CBC reduced the risk of stopping EBF by 60% (aHR 0.40, P < .001).
- Mothers receiving CBC were half as likely to use prelacteal feeds (aRR 0.51).
Conclusions:
- Cognitive-behavioral counseling significantly prolongs EBF duration.
- CBC effectively doubles EBF rates at six months postpartum compared to routine counseling.
- This intervention shows promise for improving infant feeding practices in similar settings.
Objective:
To test the effectiveness of cognitive-behavioral counseling on the rate and duration of exclusive breastfeeding (EBF) during the first 6 months of an infant's life compared with routine counseling.
Methods:
A single blind cluster-randomized controlled trial was undertaken in 40 Union Councils of a rural district in the northwest province of Pakistan between May 2009 and April 2010. By simple unmatched randomization, 20 Union Councils were each allocated to intervention and control arms. Two hundred twenty-four third trimester pregnant women in the intervention and 228 third trimester pregnant women in the control arm were enrolled and followed-up biweekly until 6 months postpartum. Analyses were by intention to treat. Mothers in the intervention group received 7 sessions of cognitive-behavioral counseling from antenatal to 6 months postpartum, whereas the control group received an equal number of routine sessions. Proportion of mothers exclusively breastfeeding at 6 months postpartum and duration of EBF through these 6 months was assessed.
Results:
At 6 months postpartum, 59.6% of mothers in the intervention arm and 28.6% in the control arm were exclusively breastfeeding. This translates into a 60% reduced risk of stopping exclusively breastfeeding during the first 6 months (adjusted hazard ratio, 0.40 [95% confidence interval: 0.27-0.60], P < .001). Mothers in the intervention group were half as likely to use prelacteal feeds with their infants (adjusted relative risk, 0.51 [95% confidence interval: 0.34-0.78]).
Conclusions:
Compared with routine counseling, cognitive-behavioral counseling significantly prolonged the duration of EBF, doubling the rates of EBF at 6 months postpartum.
More Related Videos
07:11Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling
Published on: February 5, 2019
06:28E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Related Concept Videos
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:24Rational Emotive Behavior Therapy
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
01:24Operant Conditioning Intervention
In operant conditioning, behaviors that are...
01:30Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...
01:23Methods of Documentation V: CBE
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...