Impact of peer counselling breast-feeding support programme protocols on any and exclusive breast-feeding discontinuation in low-income women

摘要

ObjectivePeer counselling (PC) programmes have been shown to improve breast-feeding outcomes in populations at risk for early discontinuation. Our objective was to describe associations between programme components (individual and combinations) and breast-feeding outcomes (duration and exclusivity) in a PC programme for low-income women.DesignSecondary analysis of programme data. Multivariable-adjusted Cox proportional hazards models were used to examine associations between type and quantity of peer contacts with breast-feeding outcomes. Types of contacts included in-person (hospital or home), phone or other (e.g. mail, text). Quantities of contacts were considered a€?optimala€? if they adhered to standard programme guidelines.SettingProgramme data collected from 2005 to 2011 in Michigana€?s Breastfeeding Initiative Peer Counseling Program.SubjectsLow-income (n 5886) women enrolled prenatally.ResultsFor each additional home, phone and other PC contact there was a significant reduction in the hazard of discontinuing any breast-feeding by 6 months (hazard ratio (HR)=0?·90 (95 % CI 0?·88, 0?·92); HR=0?·89 (95 % CI 0?·87, 0?·90); and HR=0?·93 (95 % CI 0?·90, 0?·96), respectively) and exclusive breast-feeding by 3 months (HR=0?·92 (95 % CI 0?·89, 0?·95); HR=0?·90 (95 % CI 0?·88, 0?·91); and HR=0?·93 (95 % CI 0?·89, 0?·97), respectively). Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breast-feeding discontinuation compared with those who were considered to have optimum quantities of contacts (HR=0?·17 (95 % CI 0?·14, 0?·20) and HR=0?·28 (95 % CI 0?·23, 0?·35), respectively).ConclusionsSpecific components of a large PC programme appeared to have an appreciable impact on breast-feeding outcomes. In-person contacts were essential to improving breast-feeding outcomes, but defining optimal programme components is complex.