Breast-feeding counselling has been identified as the intervention with the greatest potential for reducing child deaths, but there is little experience in delivering breast-feeding counselling at scale within routine health systems. The study aim was to compare rates of exclusive breast-feeding associated with a breast-feeding counselling intervention in which community health agents (CHA) received 20 h of training directed at counselling and practical skills with rates pre-intervention when CHA received 4 h of didactic teaching.

Cross-sectional surveys of breast-feeding practices were conducted pre- and post-intervention in random samples of 1266 and 1245 infants aged 0–5·9 months, respectively.

Recife, Brazil, with a population of 2 million.

CHA (n 1449) of Brazil's Family Health Programme were trained to provide breast-feeding counselling at home visits.

Rates of exclusive breast-feeding improved when CHA were trained to provide breast-feeding counselling and were significantly higher by 10–13 percentage points at age 3–5·9 months when compared with pre-intervention rates (P < 0·05). Post-intervention point prevalence of exclusive breast-feeding for infants aged <4 months was 63 % and for those aged <6 months was 50 %.

Multifunctional CHA were able to deliver breast-feeding counselling at scale within a routine health service and this was associated with a significant increase in rates of exclusive breast-feeding. The study reinforces the need to focus training on counselling and practical skills; a key component was an interactive style that utilized the knowledge and experience of CHA. The findings are relevant to the call by international organizations to scale up breast-feeding counselling.

To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya.

A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facility-based semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months.

Kibera slum, Nairobi.

A total of 360 HIV-negative women, 34–36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group.

Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23·6 % in HBICG, 9·2 % in FBSICG and 5·6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk = 4·01; 95 % CI 2·30, 7·01; P = 0·001). There was no significant difference between EBF rates in FBSICG and CG.

EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF.

To evaluate the factors associated with discontinuation of breast-feeding before 12 months in order to make suggestions for achieving long-term breast-feeding.

A descriptive cross-sectional study.

Gazi University Medical School, Ankara, Turkey.

Mothers of 1230 children who discontinued breast-feeding at least 15 d before the last visit were asked to fill out a questionnaire about the discontinuation process. Logistic regression analysis was performed to assess the independent effects of factors that might influence breast-feeding discontinuation.

Mean breast-feeding duration of the study group was 11·04 (sd 7·45) months. Introduction of bottle-feeding correlated with discontinuation of breast-feeding (r = 0·507, P = 0·001). Important risk factors for discontinuation of breast-feeding before the first 12 months were not exclusively breast-feeding at 3 and 6 months, prematurity, not having a plan about breast-feeding duration and maternity leave duration of ≤91 d for working mothers. The common reasons for abandoning breast-feeding in the first and second 6 months were similar, namely the mother’s concerns about the sufficiency of breast milk. After 12 months and 18 months the reasons for discontinuation were the baby’s unwillingness to eat solid foods while breast-feeding and the mother’s perception that ‘the baby is old enough’, respectively.

The factors that improve long-term breast-feeding are successful exclusive breast-feeding in the first few months, intention of the mother to breast-feed and sufficient duration of maternity leave. This study emphasizes the importance of successful breast-feeding counselling during the first few months to achieve the desired long-term breast-feeding.