The impact of a primary health care intervention on infant feeding practices: a cluster randomised controlled trial in Brazil

• Published in: Journal of human nutrition and dietetics 2019-02, Vol.32 (1), p.21-30
• Main Authors: Ferreira, V. R., Sangalli, C. N., Leffa, P. S., Rauber, F., Vitolo, M. R.
• Format: Article
• Language: English
• Subjects: Baby foods; Brazil; child; child health services; Children; Cluster Analysis; Clusters; complementary feeding; Confidence intervals; Control methods; Cookies; Diet; Diet - methods; Diet - psychology; Diet Surveys; Diet, Healthy - statistics & numerical data; Feeding; Feeding Behavior; feeding practices; Female; Health care; Health Education - methods; Health Personnel - education; Humans; Infant; Infant Food - analysis; Infants; Intervention; intervention studies; Male; Meat; Medical personnel; Poverty - psychology; Primary care; Primary Health Care; Quality assessment; Randomization; Risk management; Sugar; Tea; Workers
• ISSN: 0952-3871; 1365-277X
• DOI: 10.1111/jhn.12595

Background Proper feeding practices in early life can enhance the full human potential development of children. We aimed to evaluate the impact of a primary health care intervention on infant feeding practices among children from low‐income families. Methods A cluster randomised controlled trial was conducted in Porto Alegre, Brazil. Healthcare centres were randomised into intervention (n = 9) and control (n = 11) groups. In intervention sites, health workers were trained in accordance with the national guidelines. Infant feeding practices were assessed in children at 6 months (n = 617) and 12 months (n = 516) of age. Feeding practice quality was assessed using the Infant and Child Feeding Index (ICFI). Additionally, we evaluated the introduction of nonrecommended foods. Results At 6 months, the mean ICFI score was higher in the intervention group [MD = 0.22; 95% confidence interval (CI) = 0.24–1.11]. The prevalence of infants who met the recommendation for meat into the food‐frequency score was higher in the intervention than the control group [relative risk (RR) = 1.63; 95% CI = 1.26–2.11]. At 12 months of age, the ICFI mean (MD = 0.23; 95% CI = 0.35–0.56) and the prevalence of children who met the recommendation for dietary diversity (RR = 1.11; 95% CI = 1.01–1.22) and meal frequency (RR = 4.68; 95% CI = 1.34–16.36) were higher in the intervention group, although only among children who had more than seven follow‐up appointments during the first year of life. The children from intervention group had a significant delay for added sugar (MD = 0.51; 95% CI = 0.13–0.89), tea (mean = 0.47; 95% CI = 0.13–0.82), jelly (MD = 0.35; 95% CI = 0.11–0.58) and filled cookies (MD = 0.29; 95% CI = 0.06–0.52) compared to the control group. Conclusions The health workers’ training was effective with respect to improving infant feeding practices.