| BackgroundAccording to Global Strategy for Infant and Young Child Feeding joinedly developed by World Health Organzition (WHO) and United Nations International Children’s Emergency Fund (UNICEF), exclusive breastfeeding is recommended up to6months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. However, the infant feeding situation is not optimistic all over the world. The main problems of infant feeding are the low rate of breastfeeding and complemantary feeding improper. It was estimated that the exclusive breastfeeding rate was34.8%among the infant younger than six month and most of them received other foods when feeding. Complementary feeding frequently begins too early or too late, and foods are often nutritionally inadequate and unsafe.The2008Fourth National Health Services Survey Report showed,exclusive breastfeeding rate of0～6months was only27.6%. The continued breastfeeding rate of12～15was only37.0%. In complementary feeding aspect, the complementary feeding rate of6～9was43.3%ans the urban areas were all lower than rural areas. Studies have shown that infant and children feeding education could improve mothers’infant feeding practices and the growth and development of children.In recent years, mobile phones text messages were being used for disease management, and improving patients’health behavior and health care services. For example, mobile phone played an important role in malaria control and promotion of HIV-infected individuals to adhere to antiretroviral therapy. But there were not many on promting appropriate infant feeding.ObjectivesUsing short message service and the Internet to promote infant feeding practices and evaluating the effects of the interventions, which based on existing community maternal and child health service system in Shanghai.Methods This study is a community-based quasi-experimental trial. The study sites are4community health service centers in Shanghai, including Longhua, Caohejing community health service centers in Xuhui District and Meilong, Xinzhuang community health service centers in Minhang District. The research participants were pregnant women who came to the study sites registering and meeting the inclusion criteria during September2010and February2011.The main interventions:combined demand for mothers of different periods and infant development by Fetion and Frontline SMS to send an intervention short messages service per week. Other supporting interventions were using SMS/Fetion/QQ for consultation; creating QQ mother group for peer support; regularly asking about breastfeeding status, and providing breastfeeding encouragement. Intervention:, weekly setting an intervention text messages. The control group mothers received routine maternal and children care from community healthcare centers.Interventions started from28weeks of gestation. Evaluate the6,8and12postpartum month infant feeding and growth.Results1. Follow up rate582pregnant women were enrolled in the baseline survey, with281in the intervention group and301in the control group. The follow-up rate of postpartum breastfeeding visit at six month was94.85%, with96.22%%at8month and89.18%at12month postpartum. The follow-up rate of one-year-old child body length and weight was81.27%. The follow-up rate of one-year-old infant feeding survey was75.78%.2. The implementation of intervention, intervention mothers receiveing the short message and the participation of mothers to SMS programmeThe researchers have sent19108SMS to281intervention group mothers with each mother sent an average of68SMS.The intervention group mothers one, four and nine month postpartum Breastfeeding status reply rate were72.95%,56.94%and48.40%, respectively.99.6%intervention group mothers have received the infant feeding SMS at the postpartum visit.89.5%mothers read these SMS carefully. The data collected from one-year-old infant feeding survey showed that97.8%mothers had received infant feeding SMS when child was less than one-year-old.4. Effectiveness of interventions on breastfeeding (1) Effectiveness of intervention on exclusive breastfeeding rate of6monthThe exclusive breastfeeding rates of6month were14.98%in intervention group and6.27%in control group. Using the exclusive breastfeeding rate of6month as dependent variable and the following influence factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals, return to work at6months postpartum, maternal age, breastfeeding self-efficacy scores within42days postpartum and baseline breastfeeding knowledge scores. The multiple logistic regression analysis showed that after controling other factors, exclusive breastfeeding rate of6month in the intervention group was significantly higher than that of the control group (OR=3.109,95%CI:1.636～5.946).(2) Using survival analysis to evaluate the effectiveness of intervention on exclusive breastfeedingKaplan-Meier survival analysis showed that the control group and the intervention group estimates the median duration of exclusive breastfeeding were4.000weeks and14.000weeks. Using the duration of exclusive breastfeeding (weeks) as the dependent variable, the following possible influencing factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals, postpartum work status, maternal age, breastfeeding self-efficacy scores within42days postpartum and baseline feeding knowledge scores. The Cox’s proportional hazards regression analysis showed that after controling other factors, the stopping exculsive breastfeeding hazard ratio of the intervention group was significantly lower than that of the control group (HR=0.651,95%CI:0.539～0.786).(3) Using survival analysis to evaluate the effectiveness of intervention on breastfeedingKaplan-Meier survival analysis showed that the differences of the median duration of breastfeeding between the intervention group and the control group were no significant. Using the duration of breastfeeding (months) as the dependent variable, the following possible influencing factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals, postpartum work status, maternal age, breastfeeding self-efficacy scores within42days postpartum and baseline feeding knowledge scores. The Cox’s proportional hazards regression analysis also showed that there was no difference in the risk of stopping breastfeeding between the intervention group and the control group (HR=0.892,95%CI:0.728-1.093).(4) Effectiveness of intervention on breastfeeding rate of6,8and12monthThe breastfeeding rates of6month were73.23%in intervention group and72.24%in control group. The breastfeeding rates of8month were49.64%in intervention group and48.24%in control group. The breastfeeding rates of12month were20.31%in intervention group and19.16%in control group.Using the breastfeeding rate of6,8and12month as dependent variable and the following influence factors as independent variables:group, time, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals, postpartum work status, maternal age, breastfeeding self-efficacy scores within42days postpartum and baseline feeding knowledge scores. The generalized estimating equation analysis showed that after controling other factors, breastfeeding rate of intervention group was significantly higher than that of the control group (OR:1.398,95%CI:1.000-1.956).(5)The impact of interventions on feeding knowledge scoresThe mean breastfeeding knowledge scores of intervention group and control group were4.65and4.32. Useing the overall feeding knowledge scores as dependent variable and the following influence factors as independent variables:group, mother educational level, monthly family income, participate in pregnant school, maternity hospitals, maternal age, and baseline feeding knowledge scores. The multiple linear regression analysis showed that after controling other factors, the feeding knowledge scores of the intervention group was significantly higher than that of the control group, P<0.0001.5. Effectiveness of intervention on complemantary feedingUsing younger than4month solid food introduction rate as the dependent variable and the following factors as independent variables:group, mother educational level, rent house, monthly family income, household registration, participate in pregnant school, maternity hospitals,4months postpartum work status, maternal age, breastfeeding self-efficacy scores within42days postpartum and baseline feeding knowledge scores. The multiple logistic regression analysis showed that after controling other factors, the4month solid food introduction rate of intervention group was significantly lower than control group (OR=0.219,95%CI:0.051-0.983).Using younger than6month solid food introduction rate as the dependent variable and the following factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals,6months postpartum work status, maternal age, breastfeeding self-efficacy scores within42days postpartum and baseline feeding knowledge scores. The multiple logistic regression analysis showed that after controling other factors, the difference of food reward rate between intervention group and control group was no statistically significant (OR=0.882,95%CI:0.598-1.301).6. Effectiveness of interventions on specific infant feeding practices(1) Cup usageUsing the mothers’awareness rate of cup usage critical time as the dependent variable and the following factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals,12months postpartum work status, maternal age breastfeeding self-efficacy scores within42days postpartum and baseline breastfeeding knowledge scores. The multiple logistic regression analysis showed that after controling other factors, the awareness rate o of cup usage critical time in the intervention group was significantly higher than that of the control group (OR=2.679,95%CI:1.594-4.501).1year old infant feeding survey showed that the12months cup usage rates of the intervention group and the control group infants were46.98%and54.05%, respectively. Using cup usage rate at12months as the dependent variable and the following factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals,12months postpartum work status, maternal age breastfeeding self-efficacy scores within42days postpartum and baseline breastfeeding knowledge scores. The multiple logistic regression analysis showed that after controling other factors, the difference of cup usage rate at12months between intervention group and control group was no statistically significant (OR=1.308,95%CI:0.855-1.999).(2) Food reward1year old feeding survey results show that the intervention group mothers and the control group’s food reward rate were44.63%and32.40%, respectively. Using food reward rate as the dependent variable and the following factors as independent variables: group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals,12months postpartum work status, grantparents takeing care, maternal age and baseline breastfeeding knowledge scores. The multiple logistic regression analysis showed that after controling other factors, the difference of food reward rate between intervention group and control group was no statistically significant (OR=1.502,95%CI:0.972-2.320).7. Effectiveness of interventions on child growth and development(1)12-month infant BMI values comparisonThe mean values of12-month infant BMI intervention group and control group were17.085and17.157, respectively. Useing the BMI values as dependent variable and the following influence factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals, maternal age, baseline breastfeeding knowledge scores, exclusive breastfeeding duration, baby continuous sleep at night time,1year old illness and1-year-old food allergies. The multiple linear regression analysis showed that after controling other factors, the difference of12-month infant BMI values between these two groups was no statistically significant (P=0.767>0.05).(2)12-month infant BMI Z SCORE value comparisonWe defined BMI Z SCORE>+1.34as overweight, then compared the1year old overweight rate between two groups. Applying1-year-old children’s overweight rate as dependent variable and the following influence factors as independent variables:group, mother educational level, monthly family income, household registration, participate in pregnant school, maternity hospitals, maternal age, baseline breastfeeding knowledge scores, exclusive breastfeeding duration, baby continuous sleep at night time,1year old illness and1-year-old food allergies as an independent variable. The multiple logistic regression analysis showed that after controling other factors, the overweight rate difference of one year old children between these two groups was no statistically significant (OR=0.571,95%CI:0.296-1.099)ConclusionShort message service intervention can effectively promote breastfeeding rate and exclusive breastfeeding rate. And using SMS intervention can effectively prolong the duration time of excluisive breastfeeding. The intervention can effectively reduce the harzard of stopping exclusive breastfeeding. The intervention resulted in later introduction of solid food within four months. The intervention impact on specific feeding behaviors and infant overweight remains to be further studied. |
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