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Member Research and Reports

Member Research and Reports

Ohio State Success with “Ten Steps” for Breastfeeding in DR Congo

A United States initiative to increase breastfeeding rates could have universal impact. Dr. Marcel Yotebieng, assistant professor in Ohio State’s College of Public Health division of epidemiology, recently led a trial of Ten Steps to Successful Breastfeeding in the Democratic Republic of the Congo.

Woman breastfeeding in DR Congo

The DR Congo has the third largest burden of child deaths worldwide, with top causes including diarrhea, pneumonia, and malaria.

“By 6 months of age, more than 10 percent of infants in this country are already stunted in growth, and 15 percent are underweight or emaciated,” said Dr. Yotebieng.

Researchers believe that increasing exclusive breastfeeding for children in the region could have a significant impact on their health through age 5. Implementation of the Ten Steps to Successful Breastfeeding, the key component of the UNICEF/WHO Baby-Friendly Hospital Initiative (BFHI) has been the main strategy to improve breastfeeding practices worldwide. However, successful implementation of BFHI is challenging in many countries in many resource poor settings because of the effort required for Step Ten, so they assess a shortcut implementation (without Step Ten). Click here to read the Ten Steps to Support Successful Breastfeeding.

Their results show that the training provided for the health professionals was associated not only with a rise in “optimum breastfeeding,” but also a significant reduction of diarrhea in infants. The papers states that a large-scale implementation of steps one through nine could possibly help reduce mortality in children younger than 5 years.

“Though we strongly believe that continuous support for nursing mothers following hospital discharge after delivery is critical for optimum infants feeding, because we can’t implement one of Step should not prevent us from implementing the nine others,” Dr. Yotebieng said.

Although there is already a great number of women who breastfeed already in the area, the Ten Steps resulted in more children who were exclusive breastfeeding at 6 months of age.

The study results challenges the need for additional support during well-child visits after implementation of steps one through nine. Researchers found “additional support based on the same training materials and locally available breastfeeding support materials, offered during well-child visits did not enhance this effect, and might have actually lessened it.”

In DR Congo, free formula milk is not provided through the national health care system and breastfeeding is almost universally initiated. In a pre-trial survey of the participating facilities published in a separate article, water supplementation was found to be a major contributor to the high rates of non-exclusive breastfeeding, a finding attributed to mothers not fully knowing either the quality of breastmilk or the recommended duration of exclusive breastfeeding. Hospital practices such as systematic provision of sugar water in the first hours after birth were also shown to contribute to low rates of exclusive breastfeeding and were a result of health care professionals who did not have formal training in breastfeeding support.

The article was recently published by The Lancet Global Health. Click here to read the full article.