Table 2 Characteristics of studies measuring the secondary outcomes of breastfeeding initiation, duration, and rates (n = 5, with 3 papers reporting the same study)
Author (year); country | Study design; sample size and characteristics | Follow-up schedule | Intervention (breastfeeding training programme for midwives); control group | Outcome(s) and measure(s) | Results |
|---|---|---|---|---|---|
Zakarija-Grkovic et al. (2012); Croatia [30] | Quasi-experimental design Intervention group: 385 mothers Control group: 388 mothers Mother/infant pairs were followed over a 12-month period both before and after training of maternity staff | Baseline and 3, 6, and 12 months postpartum | Intervention group: Programme: the UNICEF/WHO 20-h course Content: breastfeeding promotion and support Duration: 15.5 h of theory and 4.5 h of practice Providers: a neonatologist, a gynaecologist, a paediatrician, an economist/representative of a voluntary parenting group, a psychologist, and a general practitioner who is also a board-certified lactation consultant, midwife, and community nurse Materials: standard course materials including guidelines of course facilitators, outlines for course sessions, and PowerPoint slides for the course Control group: No training | Breastfeeding rate and initiation: self-designed questionnaires | • Compared with the control group, the proportion of newborns exclusively breastfed during the first 48 h after birth in the hospital was significantly higher in the intervention group (p < 0.01) • The proportion of mothers who initiated breastfeeding in the hospital in the control group was higher than that in the intervention group (p < 0.05) • No significant differences were seen in breastfeeding rates at 3, 6, or 12 months postpartum between the two groups |
Ekström et al. (2012); Sweden [31] | RCT Intervention group (IG): 206 mothers Control group A (CGA; data were collected before the study period): 162 mothers Control group B (CGB; data were collected simultaneously with the intervention group): 172 mothers | Baseline, 3 days, 3 months, and 9 months postpartum | Intervention group: Programme: a process-oriented training programme Format: lectures and discussion Content: lectures on breastfeeding management and promotion, including discussions about counselling skills and attitudes, and reflection on personal breastfeeding experience Duration: 7 days Control group: No training | Breastfeeding duration and introduction of breastmilk substitutes: self-designed questionnaires and birth records | • IG mothers had a significantly longer duration of exclusive breastfeeding than the CGA mothers (p < 0.05) • Fewer IG infants received breast milk substitutes in the first week of life without medical reasons compared with CGA and CGB (p < 0.05) • IG infants were significantly older (3.8 months) when breast milk substitutes were introduced after discharge from the hospital compared with CGA and CGB infants (CGA = 2.3 months, p < 0.05; CGB = 2.5 months, p < 0.05) |
Blixt et al.(2014); Sweden [32] | Breastfeeding problems and counselling satisfaction: self-designed questionnaires | • Among mothers with an exclusive breastfeeding duration < 3 months, IG mothers were more satisfied with the breastfeeding counselling provided (p < 0.01) and felt that the breastfeeding counselling was more coherent (p < 0.01) compared with CGA and CGB mothers • Fewer mothers with an exclusive breastfeeding duration < 3 months in the IG ended their breastfeeding due to insufficient breast milk supply compared with CGA and CGB (p < 0.05) | |||
Ekström; et al.(2015); Sweden [33] | Breastfeeding initiation, duration, challenges, and introduction of breast-milk substitutes: self-designed questionnaires | • IG mothers reported earlier initiation (within 24 h), higher frequency (within 24 h), and longer duration of breastfeeding compared with CGA and CGB mothers (p < 0.05) • Less use of breast-milk substitutes in the first week of life without medical reasons and later introduction of breast milk substitutes after discharge from the hospital were reported by IG mothers compared with CGA and CGB mothers (p < 0.05) • IG mothers reported fewer breastfeeding challenges (e.g. insufficiency in breast-milk) than CGA and CGB mothers (p < 0.05) | |||
Shamim et al. (2017); Bangladesh [34] | Pragmatic cluster RCT Baseline (pre-test): Control group (CG; provided services by midwives with no training): 461 mothers Intervention group (IG; provided services by midwives with breastfeeding training): 400 mothers Supervised group (SG, provided services by midwives with breastfeeding training and supervision): 321mothers Post-test: CG: 437 mothers IG: 358 mothers SG: 353 mothers | A pragmatic cluster RCT (baseline and 6 months after training) | Intervention group: Programme: breastfeeding training Theories/models: 2 separate training modules were developed by modifying the existing WHO/United Nations Children’s Fund 5-day breastfeeding counselling training guidelines Format: group facilitation, role plays, case studies, group work, demonstrations, field trips, and problem-solving discussions, Content: breastfeeding support Duration: 5 days Control group: No training | Self-designed questionnaires | • After training, the IG and SG had significantly higher proportions of mothers who reported early initiation of breastfeeding and avoidance of prelacteal feeds compared with the CG (p < 0.05) • No significant differences were seen in outcomes between the IG and SG • After training, exclusive breastfeeding rate was not significantly different among the groups |