SYDNEY MEDICAL SCHOOL

Using short message service to improve infant feeding practices in Shanghai, China: feasibility, acceptability and results at 12 months

Hong Jiang1, Mu Li2*, Liming Wen2,3, Qiaozhen, Hu1, DonglingYang1, Gengsheng He1, Louise A Baur2,4, Michael J Dibley2, Xu Qian1

The Problem

› Infant feeding practices can have long-term effects for children.

› Despite efforts to promote breastfeeding in China, rates are very low. Exclusive breastfeeding in children younger than 6 months - 15% in major cities and 28% in rural areas.

› Improving infant and young child feeding is needed not only to reduce mortality and morbidity, researches also show that children who were breastfed have lower levels of obesity than those who were formula fed.

MCH services in Shanghai

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2&3 trimester

register

Home visit

Antenatal care

1st month postpartum

BF promotionpregnancy

Antenatal classCHC MH Dr

childbirth

6wks postpartum exam

Check upUp to 2 years

Maternity Hop

Maternity Hop

CHC MH Dr

Maternity Hop

CH /Paediatric

Antenatal class

10 steps of successful BF

BF advice

BF advice

BF advice

1 trimester

Delivery

Check up

The Approach

›We have developed a community-based health promotion program to support new mothers to breastfeed their babies and to adopt healthy infant feeding practices.

› The study was carried out in four Community Health Centers (CHCs). Two CHCs were assigned to the intervention group and two other CHCs were assigned as the control group.

The Approach

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› Communications technologies such as SMS have enabled us to deliver the innovative public health program.

The Approach

Stage Focus of messages

3rd trimester Advice on mother’s nutrition and physical activity, preparation for breastfeeding, instructions for breastfeeding after vaginal delivery or caesarean section, tips for avoiding baby reflux etc.

First week to age 2 months.

Rapid response to problems of breastfeeding initiation, specific guidance for women had caesarean section delivery

Child’s age 2-4 months

Encouragement for exclusively breastfeeding and advice not starting complementary food at this period. For mothers who would return to work soon, encouragements and advice for continuing breastfeeding.

Child’s age 4-6 months

1) For mothers go back to work: how to adapt to their work environment and continue breastfeeding. 2) For mothers who still breastfed exclusively: continue to EBF until 6 months and preparation for starting solids at 6 months.

Child’s age after 6 months

Encouragement for continuing breastfeeding and adopting appropriate infant feeding practices

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The Results

›Delivering health promotion intervention by SMS appears not only feasible but is well accepted by new mothers with a high retention rate of 89% at 12 months

›Compared with the control group, the intervention group had a significantly longer median duration of EBF at 6 months (11.41 weeks, 95% confidence interval [CI] 10.25 - 12.57 vs 8.87 weeks, 95% CI 7.84 - 9.89; P<0.001)

The Results

   

AOR(95% CI)

 PVariables Total

No. (%)Intervention

No. (%)

ControlNo. (%)

Exclusive breastfeedingat the 6th month*(n=549)          Yes 58 (10.6) 40 (15.1) 18 (6.3) 2.67(1.45-

4.91)0.002

No 491(89.4) 225 (84.9) 266(93.7) 1   

Introduction of solid food regularlybefore the 4th month* (n=551)

Yes 15 (2.7) 4 (1.5) 11 (3.8) 0.27(0.08- 0.94)

0.039

No 536(97.3) 261 (98.5) 275(96.5) 1  

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Implications

›A cluster RCT is planned, we expect that the intervention can be embedded in the healthcare system to achieve sustainable long term impacts

›More broadly, this could be a model for culturally-acceptable healthy infant feeding and childhood obesity prevention in other countries undergoing rapid socio-economic and nutrition transitions like China