Promotion of Breastfeeding Intervention Trial (PROBIT): A Randomized Trial in the Republic of Belarus

• Published in: JAMA : the journal of the American Medical Association 2001-01, Vol.285 (4), p.413-420
• Main Authors: Kramer, Michael S, Chalmers, Beverley, Hodnett, Ellen D, Sevkovskaya, Zinaida, Dzikovich, Irina, Shapiro, Stanley, Collet, Jean-Paul, Vanilovich, Irina, Mezen, Irina, Ducruet, Thierry, Shishko, George, Zubovich, Vyacheslav, Mknuik, Dimitri, Gluchanina, Elena, Dombrovskiy, Viktor, Ustinovitch, Anatoly, Kot, Tamara, Bogdanovich, Natalia, Ovchinikova, Lydia, Helsing, Elisabet, for the PROBIT Study Group
• Format: Article
• Language: English
• Subjects: Adult; Babies; Biological and medical sciences; Breast Feeding - statistics & numerical data; Breastfeeding & lactation; Eczema - epidemiology; Female; Gastrointestinal Diseases - epidemiology; Health Promotion; Humans; Infant; Infant Welfare; Infant, Newborn; Male; Medical research; Medical sciences; Mothers; Prevention and actions; Preventive medicine; Public health. Hygiene; Public health. Hygiene-occupational medicine; Republic of Belarus; Respiratory Tract Infections - epidemiology; Specific populations (family, woman, child, elderly...)
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.285.4.413

CONTEXT Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries. OBJECTIVE To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants. DESIGN The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996–December 1997 with a 1-year follow-up. SETTING Thirty-one maternity hospitals and polyclinics in the Republic of Belarus. PARTICIPANTS A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up. INTERVENTIONS Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies. MAIN OUTCOME MEASURES Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups. RESULTS Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P