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Nutrition and metabolism
Research
Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial
  1. Helen L McLachlan1,2,
  2. Della A Forster1,3,
  3. Lisa H Amir1,
  4. Meabh Cullinane1,
  5. Touran Shafiei1,
  6. Lyndsey F Watson1,
  7. Lael Ridgway2,
  8. Rhian L Cramer1,
  9. Rhonda Small1
  1. 1Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
  2. 2School of Nursing and Midwifery, Bundoora, Victoria, Australia
  3. 3The Royal Women's Hospital, Parkville, Victoria, Australia
  1. Correspondence to Dr Helen L McLachlan; h.mclachlan{at}latrobe.edu.au

Abstract

Objectives Breastfeeding has significant health benefits for mothers and infants. Despite recommendations from the WHO, by 6 months of age 40% of Australian infants are receiving no breast milk. Increased early postpartum breastfeeding support may improve breastfeeding maintenance. 2 community-based interventions to increase breastfeeding duration in local government areas (LGAs) in Victoria, Australia, were implemented and evaluated.

Design 3-arm cluster randomised trial.

Setting LGAs in Victoria, Australia.

Participants LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion. The LGA was the unit of randomisation, and maternal and child health centres in the LGAs comprised the clusters.

Interventions Early home-based breastfeeding support by a maternal and child health nurse (home visit, HV) with or without access to a community-based breastfeeding drop-in centre (HV+drop-in).

Main outcome measures The proportion of infants receiving ‘any’ breast milk at 3, 4 and 6 months (women's self-report).

Findings 4 LGAs were randomised to the comparison arm and provided usual care (n=41 clusters; n=2414 women); 3 to HV (n=32 clusters; n=2281 women); and 3 to HV+drop-in (n=26 clusters; 2344 women). There was no difference in breastfeeding at 4 months in either HV (adjusted OR 1.04; 95% CI 0.84 to 1.29) or HV+drop-in (adjusted OR 0.92; 95% CI 0.78 to 1.08) compared with the comparison arm, no difference at 3 or 6 months, nor in any LGA in breastfeeding before and after the intervention. Some issues were experienced with intervention protocol fidelity.

Conclusions Early home-based and community-based support proved difficult to implement. Interventions to increase breastfeeding in complex community settings require sufficient time and partnership building for successful implementation. We cannot conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol.

Trial registration number ACTRN12611000898954; Results.

  • NUTRITION & DIETETICS
  • PUBLIC HEALTH

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2015-008292

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