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Document Abstract
Published: 28 Jul 2016

Impact of a peer-counseling intervention on breastfeeding practices in different socioeconomic strata: results from the equity analysis of the PROMISE-EBF trial in Uganda

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Background: Undernutrition is highly prevalent among infants in Uganda. Optimal infant feeding practices may improve nutritional status, health, and survival among children.

Objective:  Our  study  evaluates  the  socioeconomic  distribution  of  exclusive  breastfeeding  (EBF)  and  growth outcomes among infants included in a trial, which promoted EBF by peer counselors in Uganda.

Design:   Twenty-four  clusters   comprising   one   to   two   communities   in   Uganda  were   randomized   into intervention  and  control  arms,  including  765  mother-infant  pairs.  Intervention  clusters  received  the  promotion  of  EBF  by  peer  counselors  in addition to standard care. Breastfeeding and growth outcomes were compared according to wealth quintiles and  intervention/control  arms.  Socioeconomic  inequality  in  breastfeeding  and  growth  outcomes  were measured  using  the  concentration  index  12  and  24  weeks  postpartum.  We  used  the  decomposition  of  the concentration index to identify factors contributing to growth inequality at 24 weeks.

Results:  EBF  was  significantly  concentrated  among  the  poorest  in  the  intervention  group  at  24  weeks postpartum, concentration index - 0.060. The control group showed a concentration of breastfeeding among the richest part of the population, although not statistically significant. Stunting, wasting, and underweight were  similarly  significantly  concentrated  among  the  poorest  in  the  intervention  group  and  the  total population at 24 weeks, but showing non-significant concentrations for the control group.

Conclusion:  This  study  shows  that  EBF  can  be  successfully  promoted  among  the  poor.  In  addition, socioeconomic inequality in growth outcomes starts early in infancy, but the breastfeeding intervention was not strong enough to counteract this influence.

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K.T. Eide

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