BACKGROUND Early initiation and exclusive breastfeeding for 6 months reduces infant morbidity and mortality and can positively impact on cognitive function. In Uganda, exclusive breastfeeding for 6 months is recommended but many women introduce alternative feeds early. Interventions to scale-up peer support provision for exclusive breastfeeding are limited. We explored the barriers, facilitators and solutions to scaling-up of peer counselling support for exclusive breastfeeding in Uganda. METHODS A qualitative study was conducted in Mbale District and Kampala City between April and July 2014. Data were collected through 15 key informant interviews with health workers and managers of organizations involved in child and maternal health as well as seven focus group discussions with peer counsellors who took part in the PROMISE EBF Trial (2006-2008), VHT members, mothers and fathers of children aged 1 year and below. Data were analysed using the content thematic approach. RESULTS The need for peer support for exclusive breastfeeding, especially for young and first-time mothers, was highlighted by most study participants. While mothers, mothers-in-law, friends and husbands were mentioned as major stakeholders regarding infant feeding, they were perceived to lack adequate information on breastfeeding. Health workers were mentioned as a key source of support, but their constraints of heavy workloads and lack of education materials on breastfeeding were highlighted. High community expectations of peer counsellors, the perceived inadequacy of breast milk, general acceptability of complimentary feeding, household food insecurity, heavy workload for women and unsupportive 'work-places' were key barriers to scaling-up of peer counselling support for breastfeeding. The peer counsellors who were part of the PROMISE EBF trial in Mbale, the village health team programme, health facilities, community groups, the media and professional associations emerged as potential facilitators that can aid the scaling-up of peer counselling support for breastfeeding. CONCLUSIONS Peer support for breastfeeding is highly valued in this setting. The health system and health workers are regarded as the main facilitators to scaling-up of peer support for exclusive breastfeeding. Partnerships with village health teams (VHTs), community groups, role models, professional associations and the media are other potential facilitators to this scaling-up.

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“如果我有钱，我就不能让我的孩子只母乳喂养……”在乌干达扩大纯母乳喂养同伴咨询的障碍和促进因素。


背景 早期开始纯母乳喂养 6 个月可降低婴儿发病率和死亡率，并对认知功能产生积极影响。在乌干达，建议纯母乳喂养 6 个月，但许多妇女很早就开始采用替代喂养。扩大纯母乳喂养同伴支持的干预措施有限。我们探讨了在乌干达扩大纯母乳喂养同伴咨询支持的障碍、促进因素和解决方案。方法 2014 年 4 月至 7 月期间，在姆巴莱区和坎帕拉市进行了一项定性研究。通过对涉及儿童和孕产妇健康的卫生工作者和组织管理人员进行 15 次关键知情人访谈，以及与同伴咨询师进行 7 次焦点小组讨论来收集数据。参加过 PROMISE EBF 试验（2006-2008）的 VHT 会员、1 岁及以下儿童的母亲和父亲。使用内容主题方法对数据进行分析。结果 大多数研究参与者都强调了纯母乳喂养需要同伴支持，特别是对于年轻妈妈和第一次当妈妈的人。虽然母亲、婆婆、朋友和丈夫被认为是婴儿喂养的主要利益相关者，但他们被认为缺乏有关母乳喂养的足够信息。卫生工作者被认为是支持的主要来源，但他们的工作量大和缺乏母乳喂养教育材料的限制也被强调。社区对同伴咨询员的高期望、母乳不足的认知、免费喂养的普遍接受性、家庭粮食不安全、妇女的繁重工作量和不支持的“工作场所”是扩大同伴咨询对母乳喂养的支持的主要障碍。 参与姆巴莱 PROMISE EBF 试验的同伴咨询师、村庄卫生团队计划、卫生设施、社区团体、媒体和专业协会成为潜在的促进者，可以帮助扩大对母乳喂养的同伴咨询支持。结论 在这种情况下，同伴对母乳喂养的支持受到高度重视。卫生系统和卫生工作者被视为扩大同伴对纯母乳喂养支持的主要推动者。与村卫生队（VHT）、社区团体、榜样、专业协会和媒体的合作是扩大规模的其他潜在促进因素。