In Honduras a decreasing prevalence of exclusive breast feeding with over 50% of infants given su... more In Honduras a decreasing prevalence of exclusive breast feeding with over 50% of infants given supplemental liquids during the first 30 days was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding amenorrhea and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians provide updated information to at least 50 nurses through a workshop train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status health system affiliation reproductive history breastfeeding and infant feeding practices contraceptive use and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation interviews were conducted and 4 mother support groups were observed. BAs were given record-keeping forms and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
Although breastfeeding is an optimal source of nutrition that promotes the health and development... more Although breastfeeding is an optimal source of nutrition that promotes the health and development of infants, rates of breastfeeding have been declining. International conventions and strategies, such as the Innocenti Declaration and the 10 Steps to Successful Breastfeeding, are helping to educate society about the benefits of breastfeeding and to create supports for mothers and their children, but advocacy and education are still needed
Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to... more Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum nursing 4-6 mo (SF), and 3) introduction of complementary foods at 4 mo, with maintenance of base-line nursing frequency 4-6 mo (SF-M). After the intervention phase (4-6 mo; n= 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) mo. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast-fed to 9 mo and all but eight (6%) to 12 mo. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, number of food groups consumed, or overall food acceptance score. Frequency of consumption of foods from eight different food groups (dairy, meats, eggs, grains, beans, fruits, vegetables, tubers) was not significantly different among groups except that, at 9 mo only, the SF group (but not the SF-M group) consumed more vegetables than did the EBF group. These results indicate that delaying the introduction of complementary foods until 6 mo does not adversely affect appetite or food acceptance among breast-fed infants.
International journal of gynaecology and obstetrics, 1990
The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding pra... more The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1–2 months and the duration of any breastfeeding to 12 months. The second phase of the project sought to extend the program nationwide. One of the original pilot hospitals in San Pedro Sula was well along in breastfeeding promotion but felt there were still problems in breastfeeding education and the integration with family planning services. Following retraining of staff and the opening of a Breastfeeding Clinic and a Temporary Methods Family Planning Clinic, there have been improvements in both areas.
SummaryA significant increase occurred in the initiation and duration of breast-feeding among Hon... more SummaryA significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.
To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 ... more To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months, and to compare growth patterns of Honduran infants with those of breast-fed infants in the United States. Randomized intervention trial from 4 to 6 months and longitudinal study of infants from birth to 12 months. Low-income communities in San Pedro Sula, Honduras. Primiparous, breast-feeding mothers and their infants (n = 141) recruited from public maternity hospitals. Infants were randomly assigned to exclusive breast-feeding to 6 months, or exclusive breast-feeding with addition of hygienically prepared, nutritionally adequate complementary foods at 4 months, with or without maintenance of baseline breast-feeding frequency. After 6 months, mothers continued to breast-feed and also fed their infants home-prepared foods after receiving instruction in appropriate feeding practices. Infant weight was measured monthly during the first year of life and infant length monthly from 4 to 12 months. Growth parameters were compared between the Honduran and US cohorts using multiple-regression and repeated-measures analysis of variance. Stepwise multiple regression was used to identify determinants of infant growth. There were no differences in growth patterns by intervention group. Mean birth weight of the Honduran infants was significantly less than that of a cohort of breast-fed infants in an affluent US population (n = 46) (2889 +/- 482 vs 3611 +/- 509 g), but the Honduran infants exhibited rapid catch up in weight in the first few months of life, and the cohorts were similar in weight by 3 months. Mean weight and length gain were similar to those of the US cohort from 4 to 9 months but were lower from 9 to 12 months. Mean length for age was significantly less than that of the US cohort from 4 to 12 months; this was attributable to the difference in maternal height (12 cm shorter in Honduras on average). Within the Honduran cohort, growth velocity of low birth weight infants (< 2500 g; n = 28) was similar to that of their normal birth weight peers; thus, the former subgroup remained smaller than the latter throughout the first year of life. In poor populations, when breast-feeding is exclusive for the first 4 to 6 months, continues from 6 to 12 months, and is accompanied by generally adequate complementary foods, faltering in weight does not occur before 9 months among infants born with birth weights of more than 2500 g.
An operations research project organized by the Instituto Hondureno de Seguridad Social (IHSS) of... more An operations research project organized by the Instituto Hondureno de Seguridad Social (IHSS) of the Ministry of Health of Honduras seeks to demonstrate the impact of postpartum services that promote both breastfeeding and family planning. The control group consisted of 360 women who gave birth in the IHSS hospital in January-February 1987 and were exposed to the existing system of postpartum care that included some promotion of breastfeeding for reasons of child health but no information on family planning services available from the hospital. The experimental group consists of an equal number of women who gave birth at the IHSS facility in September-October 1987 but are being given extensive practical advice on breastfeeding techniques and contraceptive methods. Preliminary findings are now available on the 360 controls and on 32 women from the experimental group. Among controls the percentage of mothers exclusively breastfeeding fell dramatically from 44% at 1 month postpartum t...
PROALMA (Proyecto en Apoyo a la Lactancia Materna) is a project to support breastfeeding intended... more PROALMA (Proyecto en Apoyo a la Lactancia Materna) is a project to support breastfeeding intended to be organized in Honduras in 1983-1985 under the auspices of USAID with the cooperation of the Honduran Ministries of Health Welfare and Social Security. Even before the project officially began certain birthing rooming-in and initial feeding routines in selected urban hospitals resulted in declines in infant morbidity due to septicemia and diarrhea. The primary goals for the 1st year of PROALMA were education of hospital personnel in theory and practice of breastfeeding support an changes in hospital practices through courses and a national seminar. The seminar encouraged regional hospitals to institute rooming-in and stimulated the Ministry of Health to commit to a national policy of breastfeeding support. In the 2nd year implementation of changes in birthing practices and solution of problems in breastfeeding encountered by mothers were emphasized. Breast pumps were obtained and br...
In Honduras a decreasing prevalence of exclusive breast feeding with over 50% of infants given su... more In Honduras a decreasing prevalence of exclusive breast feeding with over 50% of infants given supplemental liquids during the first 30 days was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding amenorrhea and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians provide updated information to at least 50 nurses through a workshop train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status health system affiliation reproductive history breastfeeding and infant feeding practices contraceptive use and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation interviews were conducted and 4 mother support groups were observed. BAs were given record-keeping forms and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
Although breastfeeding is an optimal source of nutrition that promotes the health and development... more Although breastfeeding is an optimal source of nutrition that promotes the health and development of infants, rates of breastfeeding have been declining. International conventions and strategies, such as the Innocenti Declaration and the 10 Steps to Successful Breastfeeding, are helping to educate society about the benefits of breastfeeding and to create supports for mothers and their children, but advocacy and education are still needed
Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to... more Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum nursing 4-6 mo (SF), and 3) introduction of complementary foods at 4 mo, with maintenance of base-line nursing frequency 4-6 mo (SF-M). After the intervention phase (4-6 mo; n= 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) mo. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast-fed to 9 mo and all but eight (6%) to 12 mo. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, number of food groups consumed, or overall food acceptance score. Frequency of consumption of foods from eight different food groups (dairy, meats, eggs, grains, beans, fruits, vegetables, tubers) was not significantly different among groups except that, at 9 mo only, the SF group (but not the SF-M group) consumed more vegetables than did the EBF group. These results indicate that delaying the introduction of complementary foods until 6 mo does not adversely affect appetite or food acceptance among breast-fed infants.
International journal of gynaecology and obstetrics, 1990
The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding pra... more The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1–2 months and the duration of any breastfeeding to 12 months. The second phase of the project sought to extend the program nationwide. One of the original pilot hospitals in San Pedro Sula was well along in breastfeeding promotion but felt there were still problems in breastfeeding education and the integration with family planning services. Following retraining of staff and the opening of a Breastfeeding Clinic and a Temporary Methods Family Planning Clinic, there have been improvements in both areas.
SummaryA significant increase occurred in the initiation and duration of breast-feeding among Hon... more SummaryA significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.
To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 ... more To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months, and to compare growth patterns of Honduran infants with those of breast-fed infants in the United States. Randomized intervention trial from 4 to 6 months and longitudinal study of infants from birth to 12 months. Low-income communities in San Pedro Sula, Honduras. Primiparous, breast-feeding mothers and their infants (n = 141) recruited from public maternity hospitals. Infants were randomly assigned to exclusive breast-feeding to 6 months, or exclusive breast-feeding with addition of hygienically prepared, nutritionally adequate complementary foods at 4 months, with or without maintenance of baseline breast-feeding frequency. After 6 months, mothers continued to breast-feed and also fed their infants home-prepared foods after receiving instruction in appropriate feeding practices. Infant weight was measured monthly during the first year of life and infant length monthly from 4 to 12 months. Growth parameters were compared between the Honduran and US cohorts using multiple-regression and repeated-measures analysis of variance. Stepwise multiple regression was used to identify determinants of infant growth. There were no differences in growth patterns by intervention group. Mean birth weight of the Honduran infants was significantly less than that of a cohort of breast-fed infants in an affluent US population (n = 46) (2889 +/- 482 vs 3611 +/- 509 g), but the Honduran infants exhibited rapid catch up in weight in the first few months of life, and the cohorts were similar in weight by 3 months. Mean weight and length gain were similar to those of the US cohort from 4 to 9 months but were lower from 9 to 12 months. Mean length for age was significantly less than that of the US cohort from 4 to 12 months; this was attributable to the difference in maternal height (12 cm shorter in Honduras on average). Within the Honduran cohort, growth velocity of low birth weight infants (< 2500 g; n = 28) was similar to that of their normal birth weight peers; thus, the former subgroup remained smaller than the latter throughout the first year of life. In poor populations, when breast-feeding is exclusive for the first 4 to 6 months, continues from 6 to 12 months, and is accompanied by generally adequate complementary foods, faltering in weight does not occur before 9 months among infants born with birth weights of more than 2500 g.
An operations research project organized by the Instituto Hondureno de Seguridad Social (IHSS) of... more An operations research project organized by the Instituto Hondureno de Seguridad Social (IHSS) of the Ministry of Health of Honduras seeks to demonstrate the impact of postpartum services that promote both breastfeeding and family planning. The control group consisted of 360 women who gave birth in the IHSS hospital in January-February 1987 and were exposed to the existing system of postpartum care that included some promotion of breastfeeding for reasons of child health but no information on family planning services available from the hospital. The experimental group consists of an equal number of women who gave birth at the IHSS facility in September-October 1987 but are being given extensive practical advice on breastfeeding techniques and contraceptive methods. Preliminary findings are now available on the 360 controls and on 32 women from the experimental group. Among controls the percentage of mothers exclusively breastfeeding fell dramatically from 44% at 1 month postpartum t...
PROALMA (Proyecto en Apoyo a la Lactancia Materna) is a project to support breastfeeding intended... more PROALMA (Proyecto en Apoyo a la Lactancia Materna) is a project to support breastfeeding intended to be organized in Honduras in 1983-1985 under the auspices of USAID with the cooperation of the Honduran Ministries of Health Welfare and Social Security. Even before the project officially began certain birthing rooming-in and initial feeding routines in selected urban hospitals resulted in declines in infant morbidity due to septicemia and diarrhea. The primary goals for the 1st year of PROALMA were education of hospital personnel in theory and practice of breastfeeding support an changes in hospital practices through courses and a national seminar. The seminar encouraged regional hospitals to institute rooming-in and stimulated the Ministry of Health to commit to a national policy of breastfeeding support. In the 2nd year implementation of changes in birthing practices and solution of problems in breastfeeding encountered by mothers were emphasized. Breast pumps were obtained and br...
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