Rethinking current recommendations to introduce solid food between four and six months to exclusively breastfeeding infants

The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Services Task Force

PURPOSE

We wanted to systematically review whether primary care-based interventions improve initiation and duration of breastfeeding.

METHODS

Studies were found by searching MEDLINE (1966-2001), Health-STAR, the Cochrane Database of Systematic Reviews, the National Health Service Centre for Reviews and Dissemination Databases, and bibliographies of identified trials and review articles. Studies were included if they originated in the primary care setting and were conducted in a developed country, written in English, and contained a concurrent control group.

RESULTS

Thirty randomized and nonrandomized controlled trials and 5 systematic reviews of breastfeeding counseling were included. Educational programs had the greatest effect of any single intervention on both initiation (difference 0.23; 95% confidence interval [CI], 0.12-0.34) and short-term duration (difference 0.39; 95% CI, 0.27-0.50). Support programs conducted by telephone, in person, or both increased short-term (difference 0.11; 95% CI, 0.03-0.19) and long-term duration (difference 0.08; 95% CI, 0.02-0.16). In contrast, written materials such as pamphlets did not significantly increase breastfeeding. Data were insufficient to determine whether the combination of education with support was more effective than education alone.

CONCLUSIONS

Educational programs were the most effective single intervention. One woman would breast-feed for up to 3 months for every 3 to 5 women attending breastfeeding educational programs. Future research and policy should focus on translating these findings into more widespread practice in diverse primary care settings.

Human milk: an invisible food resource

Human milk is an invaluable food resource for infants and young children in Sub-Saharan Africa. Statistics on production of human milk at local and national levels are lacking. In this article, estimates of the quantity of human milk production in Mali, Senegal, Nigeria, and Zimbabwe were calculated. Annual production in the urban and rural areas in Mali was 13 and 17 kg per capita, respectively. National annual median production ranged from 93,000 (Zimbabwe) to 1.3 million metric tons (Nigeria), and from 9 (Zimbabwe) to 15 kg per capita (Mali). Given a value of (US)$1 per liter, inclusion of human milk in calculations of the gross national product (GNP) for these countries would increase this value by more than 5% for Mali, and nearly 2% for Senegal. Human milk is a significant food source to children in this region and should be included in national food statistics due to its nutritional and economic importance.

The concept of weaning: definitions and their implications

"Weaning" is usually said to refer to the entire process during which the infant changes from full dependence on breast milk to complete independence from it. However, "wean" is sometimes used to refer to provision of an "educational diet" during the first six months when exclusive breastfeeding is the ideal; to complementary feeding; to replacement of breastmilk; or to the cessation of breastfeeding. The processes involved are illustrated by a graph that theoretically compares the infant's nutritional needs with the proportion of those needs that can come from breastmilk under ideal circumstances. The development of consistent, relevant research, policies and programs on young child feeding may be particularly hindered by the failure to discriminate between complementation and replacement.