ImportanceRates of exclusive breastfeeding are declining despite the numerous benefits to mothers and their children.ObjectiveTo assess the effectiveness of conditional and unconditional social transfers on exclusive breastfeeding rates and child growth.Design, Setting, and ParticipantsThis is a prospective, parallel, 3-armed randomized clinical trial conducted between August 2022 and October 2023. The trial was conducted in 4 districts of Vientiane, Lao People’s Democratic Republic. Mothers identified from a large birth cohort were randomized into 2 intervention groups (conditional social transfer or unconditional social transfer) or a control group at a ratio of 1:1:1. Data analysis was conducted from December 2023 to January 2024.InterventionsTwo interventions were tested: (1) conditional social transfer, in which the mother received the social transfer only if still exclusively breastfeeding at 6 months, and (2) unconditional social transfer, in which the mother received the social transfer at 6 months regardless of breastfeeding status. Mothers in the control group received educational material only.Main Outcomes and MeasuresThe primary outcome was the proportion of women exclusively breastfeeding at 6 months post partum. Secondary outcomes included exclusive breastfeeding duration (in months) and child growth (height, weight, and head circumference).ResultsA total of 298 mothers (mean [SD] age, 27.2 [6.5] years) were identified from a large birth cohort and randomized into a conditional social transfer group (n = 100), an unconditional social transfer group (n = 97), or a control group (n = 101). The adjusted odds ratio of exclusive breastfeeding at 6 months post partum was 4.60 (95% CI, 2.10-10.07; P < .001) for the conditional social transfer group and 2.51 (95% CI, 1.11-5.66; P = .03) for the unconditional social transfer group compared with the control group. The risk of early exclusive breastfeeding cessation was lower for participants who received the unconditional social transfer (adjusted hazard ratio [aHR], 0.68; 95% CI, 0.49-0.92; P = .02) or conditional social transfer (aHR, 0.60; 95% CI, 0.44-0.83; P = .002) compared with participants in the control group. There were no significant differences between groups for child growth at 6 months post partum.Conclusions and RelevanceThe findings suggest that social transfers can substantially improve exclusive breastfeeding rates at 6 months post partum, with particularly large benefits for conditional transfers. Continued evaluation at 1, 2, and 3 years post partum will be conducted to assess the long-term outcomes of social transfers on complementary breastfeeding and child health and development over time.Trial RegistrationClinicalTrials.gov Identifier: NCT05665049

中文翻译：

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有条件和无条件的社会转移、生命早期营养和儿童成长


重要性尽管纯母乳喂养对母亲及其孩子有很多好处，但纯母乳喂养率却在下降。目的评价有条件和无条件社会转移对纯母乳喂养率和儿童生长的有效性。设计、设置和参与者这是一项前瞻性、平行、3 臂随机临床试验，于 2022 年 8 月至 2023 年 10 月期间进行。该试验在老挝人民民主共和国万象的 4 个地区进行。从大型出生队列中确定的母亲以 1：1：1 的比例随机分为 2 个干预组（有条件社会转移或无条件社会转移）或对照组。数据分析于 2023 年 12 月至 2024 年 1 月进行。干预措施测试了两种干预措施：（1） 有条件的社会转移，其中母亲只有在 6 个月大时仍保持纯母乳喂养的情况下才能接受社会转移，以及 （2） 无条件的社会转移，其中母亲在 6 个月大时接受社会转移，无论母乳喂养状况如何。对照组的母亲只接受了教育材料。主要结局和测量主要结局是产后 6 个月纯母乳喂养的妇女比例。次要结局包括纯母乳喂养持续时间（月）和儿童生长（身高、体重和头围）。结果从大型出生队列中确定了 298 名母亲 （平均 [SD] 年龄，27.2 [6.5] 岁），并随机分为有条件社会转移组 （n = 100）、无条件社会转移组 （n = 97） 或对照组 （n = 101）。产后 6 个月纯母乳喂养的校正比值比为 4.60 （95% CI，2.10-10.07;P < .001） 用于有条件的社会转移组和 2.51 （95% CI，1.11-5.66;P = .03）。接受无条件社会转移的参与者早期停止纯母乳喂养的风险较低（校正风险比 [aHR]，0.68;95% CI，0.49-0.92;P = .02） 或有条件的社会转移 （aHR， 0.60;95% CI， 0.44-0.83;P = .002）。产后 6 个月儿童生长情况组间无显著差异。结论和相关性研究结果表明，社会转移可以显著提高产后 6 个月的纯母乳喂养率，对有条件转移的好处尤其大。将在产后 1、2 和 3 年进行持续评估，以评估社会转移对补充母乳喂养和儿童健康和发育的长期结果。试验注册临床试验。gov 标识符： NCT05665049