Effect of Breastfeeding Promotion on Early Childhood Caries and Breastfeeding Duration among 5 Year Old Children in Eastern Uganda: A Cluster Randomized Trial

BackgroundAlthough several studies have shown short term health benefits of exclusive breastfeeding (EBF), its long term consequences have not been studied extensively in low-income contexts. This study assessed the impact of an EBF promotion initiative for 6 months on early childhood caries (ECC) and breastfeeding duration in children aged 5 years in Mbale, Eastern Uganda.MethodsParticipants were recruited from the Ugandan site of the PROMISE- EBF cluster randomised trial (ClinicalTrials.gov no: NCT00397150). A total of 765 pregnant women from 24 clusters were included in the ratio 1:1 to receive peer counselled promotion of EBF as the intervention or standard of care. At the 5 year follow-up, ECC was recorded under field conditions using the World Health Organization’s decayed missing filled tooth (dmft) index. Adjusted negative binomial and linear regression were used in the analysis.ResultsMean breastfeeding duration in the intervention and control groups (n=417) were 21.8 (CI 20.7–22.9) and 21.3(CI 20.7–21.9) months, respectively. The mean dmft was 1.5 (standard deviation [SD] 2.9) and 1.7 (SD 2.9) in the intervention and control groups, respectively. Corresponding prevalence estimates of ECC were 38% and 41%. Negative binomial regression analysis adjusted for cluster effects and loss-to-follow-up by inverse probability weights (IPW) showed an incidence-rate ratio (IRR) of 0.91 (95% CI 0.65–1.2). Comparing the effect of the trial arm on breastfeeding duration showed a difference in months of 0.48 (-0.72 to 1.7).ConclusionPROMISE EBF trial did not impact on early childhood caries or breastfeeding duration at 5 years of age. This study contributes to the body of evidence that promotion of exclusive breastfeeding does not raise oral health concerns. However, the high burden of caries calls for efforts to improve the oral health condition in this setting.Trial RegistrationClinicalTrials.gov NCT00397150

背景：尽管已有多项研究证实纯母乳喂养（exclusive breastfeeding, EBF）可带来短期健康获益，但在低收入环境中，其长期影响尚未得到充分研究。本研究针对乌干达东部姆巴莱地区的5岁儿童，评估了为期6个月的纯母乳喂养推广举措对早期儿童龋（early childhood caries, ECC）及母乳喂养时长的影响。
方法：研究对象招募自PROMISE-EBF集群随机试验的乌干达分中心（ClinicalTrials.gov注册号：NCT00397150）。本研究纳入来自24个集群的765名孕妇，按1:1比例随机分配至干预组（接受同伴咨询式纯母乳喂养推广）与对照组（接受标准护理）。在5年随访阶段，采用世界卫生组织的龋失补牙数（decayed missing filled tooth, dmft）指数在现场条件下记录早期儿童龋发病情况。分析过程中采用了调整后的负二项回归与线性回归模型。
结果：干预组与对照组（n=417）的平均母乳喂养时长分别为21.8个月（95%置信区间CI：20.7~22.9）与21.3个月（95%CI：20.7~21.9）。干预组与对照组的平均dmft值分别为1.5（标准差SD：2.9）与1.7（SD：2.9），对应的早期儿童龋患病率分别为38%与41%。经集群效应与失访逆概率加权（inverse probability weights, IPW）调整后的负二项回归分析显示，发生率比（incidence-rate ratio, IRR）为0.91（95%CI：0.65~1.2）。对比两组试验分组对母乳喂养时长的影响，其时长差异为0.48个月（95%CI：-0.72~1.7）。
结论：PROMISE-EBF试验未对5岁儿童的早期儿童龋发病情况及母乳喂养时长产生影响。本研究为纯母乳喂养推广不会增加口腔健康风险这一论点增添了新的证据。但该人群中较高的龋病负担仍提示，需要采取措施改善当地的口腔健康状况。
试验注册：ClinicalTrials.gov NCT00397150