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Interventions for promoting the initiation of breastfeeding

  1. Lisa Dyson*,
  2. Felicia M McCormick,
  3. Mary J Renfrew

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 20 APR 2005

Assessed as up-to-date: 30 JUL 2007

DOI: 10.1002/14651858.CD001688.pub2


How to Cite

Dyson L, McCormick FM, Renfrew MJ. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001688. DOI: 10.1002/14651858.CD001688.pub2.

Author Information

  1. University of York, Mother and Infant Research Unit, Department of Health Sciences, York, UK

*Lisa Dyson, Mother and Infant Research Unit, Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. ld518@york.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 APR 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

Background

Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups.

Objectives

To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained.

Selection criteria

Randomised controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem.

Data collection and analysis

One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information.

Main results

Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needs-based, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding in the USA (RR 4.02, 95% CI 2.63 to 6.14, P < 0.00001).

Authors' conclusions

This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Findings from these studies suggest that larger increases are likely to result from needs-based, informal repeat education sessions than more generic, formal antenatal sessions. These findings are based only on studies conducted in the USA, among women on low incomes with varied ethnicity and feeding intention, and this raises some questions regarding generalisability to other settings.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

Interventions for encouraging women to start breastfeeding

The World Health Organization recommends that all infants should be fed exclusively on breast milk from birth to six months of age. Breastfeeding is supported by extensive evidence for short-term and long-term health benefits, for both mother and baby. Babies who are not fully breastfed for the first three to four months are more likely to suffer health problems such as gastroenteritis, respiratory and ear infections, urinary tract infections, allergies and diabetes mellitus. Practical benefits include savings on buying artificial formulas, particularly where they are not subsidised. Yet many women choose to bottle feed their babies. Reasons include personal and social biases against breastfeeding such as attitudes of family and close friends, attitudes to breastfeeding in public and employment practices.

This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Studies were of low-income women in the USA, where baseline breastfeeding rates are typically low.

Eleven randomised controlled trials were included. Eight trials involving 1553 women contributed to the data. Five studies with 582 women on low incomes in the USA showed breastfeeding education clearly increased breastfeeding rates compared to providing routine care. One trial with 165 women showed peer support for women considering breastfeeding also increased breastfeeding rates. Needs-based, one-to-one, informal education or support sessions, delivered either before or before and after the birth by a trained breastfeeding professional or peer counsellor, was the most effective intervention among women of different ethnicity and feeding intention in three studies. The one evaluation of hospital breastfeeding promotion packs compared to formula-company produced materials about infant feeding showed this intervention to be ineffective. Approximately 40% of women in both groups reported receipt of formula company promotion items from sources other than their obstetric provider.

 

Abstrak

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

Intervensi untuk mempromosi inisiasi / permulaan penyusuan badan

Latar Belakang

Meskipun terdapat kelebihan kesihatan yang diketahui meluas mengenai kebaikan penyusuan badan berbanding pemakanan formula, kadar inisiasi secara relatif kekal rendah dalam negara-negara berpendapatan tinggi, terutamanya dalam kumpulan wanita berpendapatan rendah .

Matlamat

Untuk menilai keberkesanan intervensi yang bertujuan untuk menggalakkan wanita menyusu badan dalam aspek perubahan jumlah wanita yang memulakan penyusuan badan.

Kaedah Pencarian

Kami melakukan pencarian dalam Daftar Kajian Kumpulan Mengandung dan Kelahiran Cochrane (Julai 2007), mencari secara manual (‘handsearched’) Jurnal Penyusuan Manusia (Journal of Human Lactation), Majalah Health Promotion International and Health Education Quarterly dari mula diterbitkan hingga 15 Ogos 2007, dan mengimbas senarai rujukan dalam semua artikel yang diperolehi.

Kriteria Pemilihan

Kajian rawak terkawal, dengan atau tanpa pengabur ('blinding'), mana-mana intervensi yang mempromosi penyusuan badan dalam mana-mana kumpulan populasi kecuali di kalangan wanita dan bayi yang mempunyai masalah kesihatan yang spesifik.

Pengumpulan Data dan Analisis

Seorang pengarang ulasan sistematik ini secara bersendirian telah mengekstrak data dan menilai kualiti kajian dan disemak oleh seorang pengarang yang lain. Kami menghubungi penyelidik-penyelidik kajian yang dimasukkan bagi mendapatkan informasi yang tidak lengkap.

Keputusan Utama

Sebelas kajian dimasukkan. Analisis statistik telah dilakukan ke atas data daripada lapan kajian (1553 wanita). Lima kajian (582 wanita) mengenai kalangan berpendapatan rendah di Amerika Syarikat yang khasnya mempunyai kadar penyusuan badan yang rendah menunjukkan bahawa pendidikan penyusuan badan mempunyai kesan yang signifikan ke atas penambahan kadar permulaan / inisiasi berbanding dengan jagaan standard (nisbah risiko (RR) 1.57, selang keyakinan 95% (95% CI) 1.15 kepada 2.15, P = 0.005). Analisis sub-kumpulan menunjukkan bahawa sesi pendidikan berulang yang tidak formal satu atas satu, berdasarkan keperluan dan sesi pendidikan pra-kelahiran yang formal generik, adalah berkesan menambah kadar penyusuan badan di kalangan wanita yang berpendapatan rendah, tidak kira bangsa dan tujuan penyusuan / pemberian makanan. Sokongan rakan sebaya yang tak formal mengikut keperluan sebelum ('antenatal') dan selepas kelahiran ('postnatal') juga menunjukkan ianya berkesan dalam satu kajian yang dijalankan di kalangan wanita Latina yang menunjukkan keinginan untuk penyusuan badan di Amerika Syarikat (RR 4.02, 95% CI 2.63 kepada 6.14, P < 0.00001).

Kesimpulan Pengarang

Ulasan sistematik ini menunjukkan bahawa pendidikan kesihatan dan intervensi sokongan rakan sebaya boleh menghasilkan beberapa penambahbaikan dalam bilangan wanita memulakan penyusuan badan. Penemuan dari kajian ini mencadangkan penambahan yang lebih besar mungkin akan terhasil daripada sesi pendidikan berulang secara tak formal bersandarkan keperluan berbanding dengan sesi antenatal yang generik dan formal. Penemuan ini adalah berlandaskan hanya kepada kajian yang dilakukan di Amerika Syarikat, di kalangan wanita berpendapatan rendah berbagai bangsa dan berbeza kehendaknya dalam penyusuan badan, dan ulasan ini menunjukkan beberapa persoalan mengenai ‘generalisability’ (bolehnya diaplikasikan) dalam situasi lain.

 

Ringkasan bahasa mudah

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

Intervensi untuk menggalakkan wanita memulakan penyusuan badan

Pertubuhan Kesihatan Sedunia mencadangkan semua bayi diberi penyusuan badan sepenuhnya mulai lahir hingga berumur enam bulan. Penyusuan badan disokong oleh bukti yang meluas untuk kebaikan kesihatan bagi jangkamasa pendek dan panjang, untuk kedua-duanya ibu dan bayi. Bayi-bayi yang tidak disusui badan sepenuhnya untuk tiga hingga empat bulan yang pertama lebih mudah mengalami masalah kesihatan seperti gastroenteritis, infeksi saluran pernafasan dan telinga, infeksi saluran air kencing, alergi dan kencing manis (‘diabetes mellitus’). Kelebihan praktikalnya termasuk penjimatan atas pembelian formula tiruan, terutamanya bila ianya tidak disubsidi. Walaupun demikian, ramai wanita memilih untuk menyusu botol bayi-bayi mereka. Alasannya termasuk isu-isu personal dan sosial yang berat sebelah terhadap penyusuan badan seperti sikap ahli keluarga dan rakan-rakan rapat, sikap terhadap penyusuan badan di kawasan awam dan amalan pekerjaan.

Ulasan sistematik ini menunjukkan pendidikan kesihatan dan intervensi sokongan rakan sebaya boleh menghasilkan peningkatan jumlah wanita yang memulakan penyusuan badan. Kajian di kalangan wanita berpendapatan rendah di Amerika Syarikat, di mana kadar penyusuan badan pada dasarnya (‘baseline’) adalah lazimnya rendah.

Sebelas kajian rawak terkawal dimasukkan. Data melibatkan lapan kajian dengan partisipan sebanyak 1553 wanita. Lima kajian dengan 582 wanita berpendapatan rendah di Amerika Syarikat menunjukkan pendidikan penyusuan badan jelas meningkatkan kadar penyusuan badan berbanding dengan pemberian jagaan rutin. Satu kajian dengan 165 wanita menunjukkan sokongan rakan sebaya untuk wanita yang sedang mempertimbangkan penyusuan badan juga meningkatkan kadar penyusuan badan. Dalam 3 kajian, pendidikan tak formal ataupun sesi sokongan berdasar keperluan, satu dengan satu, diberi samada sebelum sahaja atau sebelum dan selepas kelahiran oleh pakar penyusuan badan terlatih ataupun kaunselor rakan sebaya, merupakan intervensi paling efektif dalam kalangan wanita yang berlainan bangsa dan berlainan kehendaknya dalam memberi penyusuan badan. Satu penilaian pek promosi penyusuan badan oleh hospital berbanding dengan bahan yang dikeluarkan oleh syarikat yang menghasilkan formula mengenai pemakanan bayi menunjukkan intervensi sebegini tidak berkesan. Dianggarkan 40% wanita dalam kedua-dua kumpulan melapurkan penerimaan item-item promosi syarikat pengeluar formula daripada sumber yang selain dari pembekal obstetrik.

Catatan terjemahan

Diterjemahkan oleh Noor Salwah S Omar (Universiti Sains Malaysia). Disunting oleh Teguh Haryo Sasongko (Universiti Sains Malaysia). Untuk sebarang pertanyaan mengenai terjemahan ini sila hubungi salwah@usm.my atau teguhhs@usm.my

 

Resumo

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

Intervenções para promover o início da amamentação

Introdução

Apesar das vantagens amplamente conhecidas e divulgadas do aleitamento materno em relação a outras formas de alimentação para os bebês, as taxas de iniciação do aleitamento continuam relativamente baixas em muitos países desenvolvidos, particularmente entre as mulheres de baixa renda.

Objetivos

Avaliar a efetividade de intervenções que visam encorajar mulheres a amamentar sobre o número de mulheres que iniciam o aleitamento.

Métodos de busca

Pesquisamos a base de dados eletrônica Cochrane Pregnancy and Childbirth Group's Trials Register (Julho 2007). Fizemos buscas manuais nas seguintes revistas: Journal of Human Lactation, Health Promotion International e Health Education Quarterly, desde suas primeiras edições até 15 de agosto de 2007. Complementamos a busca analisando as listas de referências de todos os artigos obtidos.

Critério de seleção

Ensaios clínicos randomizados, com ou sem cegamento, que avaliaram qualquer intervenção para promoção da amamentação em qualquer grupo populacional de mulheres, exceto mulheres e lactentes com problemas de saúde específicos.

Coleta dos dados e análises

Um revisor extraiu os dados e avaliou a qualidade dos estudos; um segundo revisor verificou esses dados. Os autores dos estudos foram contatados para complementar informações, conforme necessário.

Principais resultados

Onze estudos foram incluídos na revisão. Foi possível realizar análises estatísticas com os dados de 8 estudos (1553 mulheres). Segundo 5 estudos (582 mulheres) envolvendo mulheres de baixa renda nos EUA com baixas taxas de amamentação, as intervenções educativas, em comparação com cuidados habituais, aumentaram de forma significativa taxa de iniciação de aleitamento materno (risco relativo (RR) 1,57, intervalo de confiança (IC) 95%: 1,15-2,15, p=0,005). A análise de subgrupo mostrou que orientação individualizada, baseada nas necessidades da lactante, sessões educacionais informais de reforço, assim como sessões educacionais oficiais e gerais no pré-natal, aumentam de forma efetiva a taxa de amamentação entre mulheres de baixa renda, independentemente de sua raça ou de sua intenção de amamentar . Segundo um estudo com mulheres latinas residentes nos EUA que estavam pensando em amamentar, o apoio informal de outras mulheres durante o pré-natal ou no pós-parto também foi efetivo (RR 4,02, CI 95%: 2,63-6,14 P < 0,00001).

Conclusão dos autores

Esta revisão mostrou que as intervenções educacionais de saúde e as intervenções baseadas em apoio mútuo entre mulheres, podem aumentar o número de mulheres que iniciam a amamentação. Segundo os resultados dos estudos, os melhores efeitos são obtidos com intervenções informais, de reforço e baseadas nas necessidades individuais das mulheres, do que com sessões educacionais formais durante o pré-natal. Estas conclusões foram baseadas apenas em estudos realizados nos EUA, entre mulheres de baixa renda de várias raças e com diferentes intenções em relação a amamentação. Portanto, isso levanta algumas questões a respeito da validade externa dos achados, para outros contextos.

 

Resumo para leigos

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

Intervenções para encorajar as mulheres a iniciar o aleitamento materno

A Organização Mundial da Saúde recomenda que todos os bebês sejam alimentados exclusivamente com leite materno até os seis meses de idade. Existe ampla evidência indicando que o aleitamento materno traz benefícios para a saúde materna e infantil, a curto e a longo prazo. Os bebês que não são amamentados exclusivamente no peito nos primeiros três a quatro meses são mais sujeitos a terem problemas de saúde como gastroenterites, infecções respiratórias e de ouvido, infecções urinárias, alergias e diabetes mellitus. Os benefícios práticos do aleitamento materno incluem menor gastos na compra de fórmulas artificiais, especialmente nos locais onde não existem subsídios para a compra de leite em pó. No entanto, muitas mulheres optam por dar mamadeiras para seus bebês. As razões incluem preconceitos pessoais e sociais contra a amamentação, tais como as atitudes da família e amigos próximos, atitudes em relação à amamentação em lugares públicos e dificuldades para amamentar no emprego.

Esta revisão concluiu que as classes de educação em saúde e o apoio de outras mulheres que estejam amamentando podem levar a um aumento no número de mulheres que começam a amamentar. Os estudos incluídos nesta revisão eram todos de mulheres americanas de baixa renda que tipicamente tem baixas taxas de amamentação.

Onze ensaios clínicos randomizados foram incluídos. Oito estudos envolvendo 1.553 mulheres foram usados nas análises. Segundo 5 estudos com 582 mulheres americanas de baixa renda, a educação sobre amamentação, em comparação com cuidados de rotina, aumentou claramente as taxas de aleitamento materno. Um estudo com 165 mulheres mostrou que o apoio de outras mulheres também aumentou as taxas de amamentação entre mulheres que estavam pensando em amamentar. Segundo 3 estudos, as formas de intervenção mais efetivas foram as sessões de educação informais individuais ou em grupo, baseadas nas necessidades das mulheres, conduzidas antes ou antes e depois do parto, por um profissional treinado em amamentação ou por uma mulher amamentando . Esse efeito ocorreu independente da raça ou da intenção de amamentar das participantes. Apenas um estudo avaliou o uso de material educativo produzido por hospitais comparado a material produzido por empresas de leites artificiais; a conclusão foi que esta intervenção era ineficaz. Aproximadamente 40% das mulheres em ambos os grupos relataram ter recebido brindes de companhias produtoras de leite artificial, de outras fontes que não seus obstetras.

Notas de tradução

Traduzido por: Brazilian Cochrane Centre
Tradução patrocinada por: None

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

背景

促進啟動母乳哺餵的相關措施

儘管哺餵母乳對健康的好處已被廣泛記載,在許多高收入國家啟動率仍然相對較低,特別是在低收入群體的婦女。

目標

依據開始哺餵母乳的婦女數目上的變化,評估鼓勵婦女哺乳相關措施的成效。

搜尋策略

在我們搜群了the Cochrane Pregnancy and Childbirth Group's Trials Register (2006年五月30日), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2003年刊號1)以及後續從開始到2002年10月的資料庫: MEDLINE, CINAHL, ERIC, Applied Social Sciences, PsychLIT, EMBASE, British Nursing Index, BIDS, EPIcentre.我們也搜尋了在2002年10月之後的灰色文學: 'SIGLE, DHSS Data, and Dissertation Abstracts. 我們還搜尋了從開始到1998年10月的the Journal of Human Lactation, Health Promotion International and Health Education Quarterly。 我們還檢視了所有獲得文章的參考

選擇標準

選入的研究包括所有隨機對照試驗,不論有或沒有致盲設計,也包括在任何人口族群的任何母乳哺育的促進措施,但是排除婦女和小孩有特殊的健康問題者。

資料收集與分析

ㄧ位審查作者單獨提取資料和評估試驗的品質,再由第二位作者檢查。我們與研究者取得聯繫去獲得失落的信息。

主要結論

七個試驗包含了1388位婦女。其中五個試驗包含了582位在美國低收入婦女的分析發現提供母乳哺育相關教育比起僅提供一般照顧能明顯增加起始哺育率。(RR 1.53, 95% CI 1.25 to 1.88)

作者結論

從這篇文章得到的證據顯示各種形式的母乳哺育教育可以有效提高美國低收入婦女的母乳哺餵起始率。

翻譯人

本摘要由周產期醫學會(Taiwan Society of Perinatology)林孝祖翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

各種形式的母乳哺育教育是可以有效提高美國低收入婦女支母乳哺餵起始率。哺餵母乳對嬰兒和母親兩者的健康都是有好處是廣為人知的。儘管這樣,許多婦女選擇不進行母乳哺育自己的嬰兒,特別是婦女生活在母乳哺育並不普遍的國家或社區。本篇文章目的是評估哪些母乳哺育的促進方案成功地提升婦女開始哺育母乳的人數。有找出五個方案全顯示出成功地提升在美國的貧窮婦女開始以母乳哺育他們的嬰兒。

 

Laički sažetak

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Abstrak
  5. Ringkasan bahasa mudah
  6. Resumo
  7. Resumo para leigos
  8. 摘要
  9. Laički sažetak

Intervencije koje potiču žene da počnu dojiti

Svjetska zdravstvena organizacija preporučuje da se sva djeca hrane isključivo ljudskim mlijekom od rođenja do šest mjeseci starosti. Brojni dokazi upućuju na kratkoročne i dugoročne prednosti dojenja za zdravlje majke i djeteta. Dojenčad koja nisu pretežno dojena tijekom prva 3-4 mjeseca češće obolijevaju od bolesti poput upale želuca i crijeva (gastroenteritisa), upale uha i dišnih putova, upale mokraćnih putova, alergija i šećerne bolesti. Praktične prednosti uključuju uštede na mliječnim formulama, pogotovo kada nisu subvencionirane. Usprkos tome, mnoge majke odlučuju hraniti svoju djecu bočicom. Uzroci uključuju osobne i društvene predrasude prema dojenju, zatim stavove prijatelja i bliske rodbine, kao i stavove prema dojenju u javnosti te praksu na radnom mjestu.

Ovaj Cochrane sustavni pregled je pokazao da intervencije poput izobrazbe o zdravlju kao i potpora iskusnih dojilja mogu dovesti do nekih poboljšanja glede broja žena koje započinju s dojenjem. Istraživanja su provedena među ženama niskog socioekonomskog statusa u SAD-u, kod kojih je stopa započinjanja dojenja obično niska.

U sustavni pregled uključeno je 11 randomiziranih kontroliranih studija. Podatci o 1553 žena iz osam studija su analizirani. Pet studija, s ukupno 582 žena niskih primanja iz SAD-a su jasno pokazali da izobrazba žena dovedi do povećanja stope dojenja u odnosu na rutinsku skrb. Jedna studija sa 165 žena je pokazala da potpora ˝žena ženi˝ koje razmatraju mogućnost dojenja također povećava stope dojenja. Izobrazba prema potrebi, izobrazba jedan-na-jedan, neformalna izobrazba ili podrška, pružena prije ili prije i poslije poroda, koju pruža profesionalna savjetnica za dojenje ili iskusna majka bila je najučinkovitija intervencija među ženama svih nacionalnosti i usmjerenja glede hranjenja djeteta u tri istraživanja. Jedna studija koja je proučila utjecaj bolničkih paketa koji promiču dojenje u odnosu na pakete o prehrani djece koje su nudili proizvođači formule nije pokazala intervenciju učinkovitom. Otprilike 40% žena u obje skupine su izvijestile da su dobile promotivne materijale od proizvođača formule iz izvora pored njihovih ginekologa.

Bilješke prijevoda

Cochrane Hrvatska
Prevela: Irena Zakarija Grković
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr