Effectiveness of an implementation strategy for a breastfeeding guideline in Primary Care: cluster randomised trial.

BACKGROUND: The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age. METHOD/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain). The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader) of a breastfeeding guideline in primary care is more effective than usual diffusion. The number of patients required will be 240 (120 in each arm). It will be included all the mothers of infants born during the study period (6 months) who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age..Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide's recommendations, clinical variability can be reduced and the care received by patients can be improved. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01474096.

[Prevalence of breastfeeding and factors associated with the start and duration of exclusive breastfeeding in the Community of Madrid among participants in the ELOIN]. / Prevalencia de la lactancia materna y factores asociados con el inicio y la duración de la lactancia materna exclusiva en la Comunidad de Madrid entre los participantes en el estudio ELOIN.

INTRODUCTION: Breastfeeding has important benefits for population health. The aims of this study are: (i)to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii)analyse the reasons for not starting or abandoning of breastfeeding, and (iii)describe the factors associated with the initiation and duration of exclusive breastfeeding. MATERIAL AND METHODS: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2,627 children born in 2008-2009 from the Community of Madrid was studied. Logistic regression models were used. RESULTS: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6months 25.4%, and prevalence of breastfeeding at 2years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. CONCLUSIONS: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008-2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring.

Breastfeeding promotion plan in Madrid, Spain.

BACKGROUND: Promotion and protection of breastfeeding is a public health objective. In April 2009, health authorities in the Madrid region in central Spain signed a collaboration agreement with The United Nations Children's Fund and created a breastfeeding committee. OBJECTIVE: To report the creation and implementation of a plan to promote and improve the quality of breastfeeding care in public hospitals in the region of Madrid, according to the Baby-Friendly Hospital Initiative (BFHI) standards. METHODS: The action plan included institutional commitment; creation of a breastfeeding committee in each hospital; outcome analyses, staff training, creation of educational materials; and dissemination of activities. The plan was adopted by the 19 non-BFHI-designated public maternity units in the Madrid region. Each hospital completed a modified version of the World Health Organization self-assessment questionnaire in 2009 (pre-intervention) and again in 2011. RESULTS: Thirteen maternity units (68.4%) established a breastfeeding committee, and 32 months after implementation of the plan, the other 6 hospitals have created one. Nine training courses have been carried out to train professional experts on breastfeeding as trainers. The 271 trainers provided 18-hour breastfeeding courses for 1423 professionals. In 2009, there was only 1 BFHI-accredited hospital. Currently, 52.6% of the other 19 hospitals have some level of accreditation, and 2 are fully accredited. CONCLUSIONS: An intervention to improve the quality of breastfeeding care based on an organized regional approach to the BFHI was useful for BFHI implementation.