KwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support the initiation and sustaining of breastfeeding, implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in infant feeding practices in KZN over this time period. Two cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N = 4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N = 900). All caregivers aged ≥15 years attending the clinic with infants aged 13- < 16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points. At KIBS1 (May2014- March2015), 4172 interviews were conducted with carers, of whom 3659 (87.6%) were mothers. At KIBS2 (January–August 2017), 929 interviews were conducted which included 788 (84.8%) mothers. Among all carers the proportion exclusively breastfeeding was 44.6 and 50.5% (p = 0.1) at KIBS1 and KIBS2 respectively, but greater improvements in EBF were shown among mothers (49.9 vs 59.1: p = 0.02). There were reductions in mixed breastfeeding among all infants (23.2% vs 16.3%; p = 0.016). Although there was no change in the proportion of carers who reported not breastfeeding (31.9% vs 32.8%; p = 0.2), the duration of breastfeeding among mothers who had stopped breastfeeding was longer at KIBS2 compared to KIBS1 (p = 0.0015). Mothers who had returned to work or school were less likely to be breastfeeding (adjusted odds ratio [AOR] 3.76; 95% CI 3.1–4.6), as were HIV positive mothers (AOR 2.1; 95% CI 1.7–2.6). Despite improvements to exclusive breastfeeding, failure to initiate and sustain breastfeeding is a challenge to achieving optimal breastfeeding practices. Interventions are required to address these challenges and support breastfeeding particularly among working mothers and HIV positive mothers.

中文翻译：

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我们做得够吗？在14周时改善了母乳喂养方式，但仍面临着不开始母乳喂养和尽早停止母乳喂养的挑战：南非夸祖鲁-纳塔尔省连续两次横断面调查的结果。

夸祖鲁-纳塔尔省（KZN）母乳喂养倡议（KIBS）是一项多管齐下的干预措施，旨在支持母乳喂养的开始和维持，于2014年至2017年实施。我们介绍了KIBS实施前后的两项调查的结果，以评估婴儿喂养的变化在这段时间内在KZN中进行操作。在初级保健诊所进行了两次横断面调查。采用多阶段分层随机抽样来选择诊所和参与者。计算样本量可提供基线时（KIBS1）的14周纯母乳喂养（EBF）率的地区估计值以及终点时（KIBS2）的省估计值。在KIBS1，所需样本为11个地区中的9个参与诊所（99个诊所），每个地区369名参与者（N = 4059），在KIBS2，KZN有30家诊所，每个诊所有30名参与者（N = 900）。所有年龄≥15岁且年龄在13- <16周龄的婴儿就诊的护理人员都有资格参加。数据是使用Android设备上的结构化访谈收集的。多变量逻辑回归用于调整时间点之间的差异的比值比。在KIBS1（2014年5月至2015年3月），对护老者进行了4172次访谈，其中3659名（87.6％）是母亲。在KIBS2（2017年1月至8月）上，进行了929次访谈，其中包括788位（84.8％）母亲。在所有照顾者中，KIBS1和KIBS2的纯母乳喂养比例分别为44.6和50.5％（p = 0.1），但母亲的EBF改善更大（49.9 vs 59.1：p = 0.02）。所有婴儿的混合母乳喂养有所减少（23.2％对16.3％；p = 0.016）。尽管报告没有母乳喂养的看护者的比例没有变化（31.9％比32.8％； p = 0.2），但在停止母乳喂养的母亲中，母乳喂养的持续时间比KIBS1更长（p = 0.0015）。重返工作或上学的母亲哺乳的可能性较小（调整后的优势比[AOR] 3.76； 95％CI 3.1-4.6），艾滋病毒呈阳性的母亲也是如此（AOR 2.1； 95％CI 1.7-2.6）。尽管对纯母乳喂养有所改进，但无法启动和维持母乳喂养仍然是实现最佳母乳喂养实践的挑战。需要采取干预措施来应对这些挑战并支持母乳喂养，特别是在职业母亲和艾滋病毒呈阳性母亲中。与KIBS1相比，在KIBS2中停止母乳喂养的母亲的母乳喂养持续时间更长（p = 0.0015）。重返工作或上学的母亲哺乳的可能性较小（调整后的优势比[AOR] 3.76； 95％CI 3.1–4.6），艾滋病毒呈阳性的母亲也是如此（AOR 2.1； 95％CI 1.7–2.6）。尽管对纯母乳喂养进行了改进，但无法启动和维持母乳喂养仍然是实现最佳母乳喂养实践的挑战。需要采取干预措施来应对这些挑战并支持母乳喂养，特别是在职业母亲和艾滋病毒呈阳性母亲中。与KIBS1相比，在KIBS2中停止母乳喂养的母亲的母乳喂养持续时间更长（p = 0.0015）。重返工作或上学的母亲哺乳的可能性较小（调整后的优势比[AOR] 3.76； 95％CI 3.1–4.6），艾滋病毒呈阳性的母亲也是如此（AOR 2.1； 95％CI 1.7–2.6）。尽管对纯母乳喂养有所改进，但无法启动和维持母乳喂养仍然是实现最佳母乳喂养实践的挑战。需要采取干预措施来应对这些挑战并支持母乳喂养，特别是在职业母亲和艾滋病毒呈阳性母亲中。1–4.6），艾滋病毒呈阳性的母亲也是如此（AOR 2.1； 95％CI 1.7–2.6）。尽管对纯母乳喂养进行了改进，但无法启动和维持母乳喂养仍然是实现最佳母乳喂养实践的挑战。需要采取干预措施来应对这些挑战并支持母乳喂养，特别是在职业母亲和艾滋病毒呈阳性母亲中。1–4.6），艾滋病毒呈阳性的母亲也是如此（AOR 2.1； 95％CI 1.7–2.6）。尽管对纯母乳喂养进行了改进，但无法启动和维持母乳喂养仍然是实现最佳母乳喂养实践的挑战。需要采取干预措施来应对这些挑战并支持母乳喂养，尤其是在职业母亲和艾滋病毒呈阳性母亲中。