Effect of community-based peer counselling on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomized controlled trial
Haider, R. et al. The Lancet 356:1643-1647, 2000

Exclusive breastfeeding for the recommended period of about six months is rarely practised, yet health benefits are well documented. In Bangladesh, national policy recommends exclusive breastfeeding until the sixth month (after the infant completes 5 months). Breastfeeding is almost fully practised but is not exclusive. In this randomized, controlled trial, the authors tested the impact of trained peer counsellors in enabling mothers to breastfeed exclusively until the infant completes 5 months.

Infants exclusively breastfed chart

Peer counsellors were selected from women with personal breastfeeding experience, and who had completed 40 hours of training including parts of the WHO/UNICEF breastfeeding counselling course. The mothers in the intervention group received 15 home-based counselling visits.

Three hundred and sixty-three pregnant women, selected during the last trimester were enrolled in each group. The impact of peer counselling was highly effective. The prevalence of exclusive breastfeeding for five full months for mothers receiving counselling support was 70 per cent compared to 6 per cent for the control group. The mothers in the counselled group initiated breastfeeding earlier, were less likely to give prelacteal and postlacteal foods. The authors also noted that in the counselled group, infant weight gain and the duration of lactational amenorrhoea were greater.

Antibacterial properties of xanthine oxidase in human milk
Stevens, C. R. et al. The Lancet 356:829-830, 2000

Infants who are fed human milk have significantly less incidence of infective gastroenteritis. Although the incidence is greater in developing countries, it is also prevalent in industrialized countries. Human milk is a rich source of the enzyme xanthine oxidase. This enzyme is capable of producing mild microbicidal superoxide and hydrogen peroxide. Both these compounds convey antimicrobial protection to the infant's stomach Additionally the xanthine oxidase operating in the low pH and low O2 of the infant stomach is able to generate nitric oxide from nitrates and nitrites available.

The researchers propose an antibiotic role for the nitric oxide derived from xanthine oxidase activity. Using breastmilk samples from 25 fullterm mothers, samples were collected from days 2 to 112 postpartum.

All 175 samples analyzed showed nitric oxide activity with the greatest activity seen in hind milk samples. Greatest nitric oxide activity was measured during the first 3 weeks postpartum, but activity remained during the 112 days. No activity was detected in any formula preparations tested.

Breastfeeding Patters in Exclusively Breastfed Infants:
A Longitudinal Prospective Study in Uppsala, Sweden

Homell, A. et al. Acta Pediatrica 88:203-211,1999

Exclusive breastfeeding for the first six months of life has documented benefits. This longitudinal study records the daily breastfeeding patters of 506 mother and infant pairs in Uppsala, Sweden and provides much needed detail of how exclusive breastfeeding is practised in this cultural setting. A full read of this detailed study is indispensable.

Some interesting data emerging from this study: frequency of feeds: 95% of infants were fed on demand; the median frequencies of daytime feeds stayed at about 6 during the first 26 weeks; the median number of night feeds showed more variation -- 2.2 feeds at 2 weeks; 1.3 at 12 weeks and 1.8 at 12 weeks.

Breastfeeding duration: the duration was 100% at 2 weeks; 85 per cent at 6 months and 21 per cent at 12 months.

Longer breastfeeding duration and longer duration of exclusive breastfeeding were associated with higher frequency of breastfeeds, longer breastfeeding of previous child and higher education.

Pacifier use was associated with shorter duration of exclusive breastfeeding and shorter total duration Thirty-six per cent of infants using pacifiers during the first 6 months were still exclusively fed at 4 months compared to 49 per cent of non pacifier users.

The authors concluded that, "every mother and infant pair needs to be understood as a unique diad throughout lactation. These data demonstrate a wide range of patterns among women who are exclusively breastfeeding and indicate that it would be inappropriate to put pressure on individual families to adopt preconceived patterns of infant feeding".

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