Effectiveness of policy to provide breastfeeding groups ( BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial
Effectiveness of policy to provide breastfeeding groups ( BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial
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DOI：
10.1136/bmj.a3026
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发表时间：
2009-01-30
影响因子：
105.7
通讯作者：
Godden, David J.
中科院分区：
文献类型：
--
作者：
Hoddinott, Pat;Britten, Jane;Godden, David J.
目的评估为孕妇和哺乳期妇女提供母乳喂养小组的政策的临床效果和成本效益。设计前瞻性混合方法嵌入病例研究的随机对照试验，以评估实施过程。背景苏格兰的初级保健。参与者孕妇，哺乳期母亲，在66个合格的全科诊所中，干预地区设立新的母乳喂养小组，以覆盖人口;对照地区并没有改变组活动。2主要结果测量主要结果：根据两个试验前年度和两个试验年度的常规收集数据，在6- 8周时的任何母乳喂养。次要结局：结果2005年2月1日至2007年1月31日，干预地区有9747例出生记录，对照地区有9111例出生记录。在干预地区，母乳喂养小组的数量从10个增加到27个，有1 310名妇女参加，在对照地区，母乳喂养小组的数量保持在10个。在干预地区，6- 8周的母乳喂养率从27%下降到26%，在对照地区从29%上升到30%（P= 0.08，根据试验前的比例进行调整）。在未参与试验的地区，6- 8周的任何母乳喂养从38%增加到39%。参加母乳喂养组的妇女年龄比未参加母乳喂养组的妇女大（P< 0.001），收入比参加产后组的对照地区妇女高（P= 0.02）。当地成本为13 400（（欧元）14 410;$20 144）a year.Conclusion提供母乳喂养组在苏格兰相对贫困地区的政策并没有提高母乳喂养率在6- 8周。运行组的成本将类似于访问妇女在家里的成本。
Objective To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women.Design Cluster randomised controlled trial with prospective mixed method embedded case studies to evaluate implementation processes.Setting Primary care in Scotland.Participants Pregnant women, breastfeeding mothers, and babies registered with 14 of 66 eligible clusters of general practices ( localities) in Scotland that routinely collect breastfeeding outcome data.Intervention Localities setup new breastfeeding groups to provide population coverage; control localities did not change group activity.Main outcome measures Primary outcome: any breast feeding at 6- 8 weeks from routinely collected data for two pre- trial years and two trial years. Secondary outcomes: any breast feeding at birth, 5- 7 days, and 8- 9 months; maternal satisfaction.Results Between 1 February 2005 and 31 January 2007, 9747 birth records existed for intervention localities and 9111 for control localities. The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found. Any breast feeding at 6- 8 weeks declined from 27% to 26% in intervention localities and increased from 29% to 30% in control localities (P= 0.08, adjusted for pre- trial rate). Any breast feeding at 6- 8 weeks increased from 38% to 39% in localities not participating in the trial. Women who attended breastfeeding groups were older ( P< 0.001) than women initiating breast feeding who did not attend and had higher income (P= 0.02) than women in the control localities who attended postnatal groups. The locality cost was 13 400 ( (euro)14 410; $ 20 144) a year.Conclusion A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6- 8 weeks. The costs of running groups would be similar to the costs of visiting women at home.Trial registration Current Controlled Trials ISRCTN44857041.