Exclusive Breastfeeding Promotion Utilizing Targeted Client Communication via Text Messaging in Roatán, Honduras

Abstract Background: Exclusive breastfeeding (EBF) for 6 months provides significant benefits, including decreased incidence of respiratory and GI infections. Promoting EBF is a cost-effective method to improve infant health and survival. Roatán is a Honduran island where infant mortality is more than triple the country’s average. Data on infant feeding practices and EBF prevalence in Roatan is limited. Objective: To determine if breastfeeding support and education through TCCMD will increase the prevalence of exclusive breastfeeding for 2-month-old infants in Roatán, Honduras. Methods: From 08/16-05/17, a cross-sectional baseline survey assessed infant feeding practices and EBF prevalence at 2, 4, and 6 months of age. From 9/17-11/19, we recruited mothers of term infants with intention to breastfeed, access to a mobile device from Roatan Public Hospital’s postpartum ward to receive 158 text messages promoting EBF over 6 months. Surveys assessing EBF were collected at 2, 4, and 6 months of age (+/- 14 days). EBF was defined as given only breastmilk in the last 24 hours. Results: 581 mothers were enrolled in the intervention group, 227, 171, and 89 surveys were completed at 2, 4, and 6 months of age, respectively. EBF prevalence for the intervention group at 2 months was 37.9% compared to 13.6% in the historical control group (p<0.0001). At 4 and 6 months, 28.7% and 13.5% of the intervention group reported EBF vs. 16.7% and 8.7% of the historical control group, p<0.05 and 0.73 respectively. Odds of EBF at 2 months, adjusted for mother’s age, education, occupation, and SES indicators, were 4.2 times higher in the intervention group compared to baseline group (p<0.0001, 95% CI [2.2, 8.1]). Across all ages 0-6 months, the baseline group reported shorter duration of any breastfeeding compared to intervention group p<0.0001. Conclusion: The prevalence of EBF in Roatan is significantly below the global and Honduran national averages. EBF TCCMD resulted in a statistically significant increase in EBF for the first 2 months, as well as longer duration of any breastfeeding. As this study cannot rule-out a temporal trend, further study with a randomized trial would provide stronger evidence.