Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial

Abstract

Objectives: Breastfeeding has significant health benefits for mothers and infants. Despite recommendations from the WHO, by 6 months of age 40% of Australian infants are receiving no breast milk. Increased early postpartum breastfeeding support may improve breastfeeding maintenance. 2 community-based interventions to increase breastfeeding duration in local government areas (LGAs) in Victoria, Australia, were implemented and evaluated.

Design: 3-arm cluster randomised trial.

Setting: LGAs in Victoria, Australia.

Participants: LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion. The LGA was the unit of randomisation, and maternal and child health centres in the LGAs comprised the clusters.

Interventions: Early home-based breastfeeding support by a maternal and child health nurse (home visit, HV) with or without access to a community-based breastfeeding drop-in centre (HV+drop-in).

Main outcome measures: The proportion of infants receiving 'any' breast milk at 3, 4 and 6 months (women's self-report).

Findings: 4 LGAs were randomised to the comparison arm and provided usual care (n=41 clusters; n=2414 women); 3 to HV (n=32 clusters; n=2281 women); and 3 to HV+drop-in (n=26 clusters; 2344 women). There was no difference in breastfeeding at 4 months in either HV (adjusted OR 1.04; 95% CI 0.84 to 1.29) or HV+drop-in (adjusted OR 0.92; 95% CI 0.78 to 1.08) compared with the comparison arm, no difference at 3 or 6 months, nor in any LGA in breastfeeding before and after the intervention. Some issues were experienced with intervention protocol fidelity.

Conclusions: Early home-based and community-based support proved difficult to implement. Interventions to increase breastfeeding in complex community settings require sufficient time and partnership building for successful implementation. We cannot conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol.

Trial registration number: ACTRN12611000898954; Results.

Keywords: NUTRITION & DIETETICS; PUBLIC HEALTH.

Figure 1

CONSORT flow chart (LGA, local government area; MCH, maternal and child health; SILC, Supporting breastfeeding In Local Communities.

Figure 2

Primary outcome data collection question, asked at routine 4-month maternal and child health visit.

Figure 3

Any breast milk feeding at 4 months of age at baseline and post-intervention in all local government areas (LGAs). Baseline: n=397 in comparison arm; n=482 in home visit arm; n=475 in home visit plus drop-in centre arm. Intervention: n=1300 in comparison arm; n=1429 in home visit arm; n=1276 in home visit plus drop-in centre arm.