SMS to improve infant feeding in Shanghai. Dr Mu Li, School of Public Health.


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SMS to improve infant feeding in Shanghai. Dr Mu Li, School of Public Health.

  1. 1. 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 SYDNEY MEDICAL SCHOOL
  2. 2. 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.
  3. 3. MCH services in Shanghai pregnancy BF promotion 1 trimester register CHC MH Dr Antenatal care Maternity Hop Antenatal class childbirth Delivery Maternity Hop 10 steps of successful BF 1st month postpartum Home visit CHC MH Dr BF advice 6wks postpartum exam Check up Maternity Hop BF advice Up to 2 years Check up CH /Paediatric BF advice 2&3 trimester Antenatal class 3
  4. 4. 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.
  5. 5. The Approach › Communications technologies such as SMS have enabled us to deliver the innovative public health program. 5
  6. 6. The Approach Stage Focus of messages 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 Rapid response to problems of breastfeeding initiation, specific age 2 months. guidance for women had caesarean section delivery 3rd trimester Child’s age 2- Encouragement for exclusively breastfeeding and advice not 4 months starting complementary food at this period. For mothers who would return to work soon, encouragements and advice for continuing breastfeeding. Child’s age 4- 1) For mothers go back to work: how to adapt to their work 6 months 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 Encouragement for continuing breastfeeding and adopting appropriate infant feeding practices after 6 months 6
  7. 7. 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)
  8. 8. The Results Total No. (%) Interventio n No. (%) Control No. (%) AOR(95% CI) P at the 6th month*(n=549) Yes 58 (10.6) 40 (15.1) 18 (6.3) 0.002 No 491(89.4) 225 (84.9) 266(93.7) 2.67(1.454.91) 1 before the 4th month* (n=551) Yes 15 (2.7) 4 (1.5) 11 (3.8) 0.039 No 261 (98.5) 275(96.5) 0.27(0.080.94) 1 Variables Exclusive breastfeeding Introduction of solid food regularly 536(97.3) 8
  9. 9. 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 culturallyacceptable healthy infant feeding and childhood obesity prevention in other countries undergoing rapid socio-economic and nutrition transitions like China