مقايسه تاثير حمايت همتا و آموزش توسط مراقبين بهداشتي بر زمان شروع اولين تغذيه با شير مادر در زنان نخست زاي مشهد در سال 1389

Comparing the Effect of Peer Support and the Education of Health Care Providers on Breastfeeding Initiation Time among Primiparous Women in Mashhad

مقدمه: زمان شروع شيردهي تاثير قابل توجهي بر عملكرد شيردهي دارد. آغاز شيردهي در نيم ساعت اول زندگي و تغذيه انحصاري با شيرمادر عامل مهمي در كاهش عوارض و ميزان مرگ و مير نوزادان مي باشد. عوامل مختلفي نظير حمايت رواني و آموزش بر زمان شروع شيردهي موثر مي باشند. به همين دليل دو گروه استراتژي بيمارستان محور و جامعه محور براي شروع زودرس شيردهي توصيه شده است. از آنجا كه تاكنون مطالعه اي جهت مقايسه آن انجام نشده، لذا مطالعه حاضر با هدف مقايسه تاثير حمايت همتا (جامعه محور) و آموزش توسط مراقبين بهداشتي (بيمارستان محور) بر زمان شروع اولين شيردهي در زنان نخست زا انجام شد. روش كار: اين مطالعه كارآزمايي باليني 3 گروهه در سال 1389 بر روي 105 زن نخست باردار انجام شد. 16 مركز و پايگاه بهداشتي به صورت خوشه اي انتخاب و به طور تصادفي در 3 گروه حمايت همتا، آموزش توسط مراقبين بهداشتي و كنترل قرار گرفتند. 16 نفر از افراد واجد شرايط گروه همتا انتخاب و به مدت 15 ساعت آموزش ديدند و 7 نفر از گروه مراقب بهداشتي 2 ساعت آموزش دريافت كردند. در گروه حمايت همتا يك بار حمايت توسط همتا و در گروه آموزش يك جلسه آموزش انفرادي توسط مراقبين بهداشتي در هفته هاي 38-36 بارداري انجام شد و گروه كنترل مراقبت هاي معمول را دريافت كردند. گردآوري داده ها توسط پرسشنامه و تجزيه و تحليل آن با استفاده از نرم افزار آماري SPSS (نسخه 5/11) و آزمون هاي كراسكال واليس و دقيق فيشر انجام شد. يافته ها: تنها 20% از افراد گروه هاي حمايت همتا، 7/14% از افراد آموزش توسط مراقبين بهداشتي و 4/19% گروه كنترل در نيم ساعت اول پس از زايمان، شيردهي را شروع كردند. 4/51% از افراد گروه هاي حمايت همتا، 8/61% آموزش توسط مراقبين بهداشتي و 6/55% گروه كنترل، اولين شيردهي را در فاصله زماني 24-1 ساعت پس از زايمان شروع كردند. افراد 3 گروه از نظر زمان شروع اولين شيردهي تفاوت معني داري نداشتند (852/0=p). نتيجه گيري: حمايت همتا و آموزش توسط مراقبين بهداشتي در دوران بارداري بر شروع شيردهي تآثيري ندارد.

Introduction: Breastfeeding initiation time has a significant effect on lactation performance. Breastfeeding initiation within a half-hour of birth and exclusive breastfeeding are important strategies to reduce neonatal morbidity and mortality. Different factors such as psychosocial support and received education affect breastfeeding initiation time. Therefore, hospital-based and community-based strategies are recommended for early breastfeeding initiation. So far, no study has been conducted to compare these two methods. Therefore, this study has been performed to compare the effect of peer support (community-based) and the education received by health care providers (Hospital-based) on the time of breastfeeding initiation among primiparous women. Methods: This clinical trial was performed on 3-group with 105 primigravida women participants. 16 health care centers were selected via cluster selection method and then were allocated randomly into 3 different groups: peer support receivers, education receiver by health care provider and control group. 16 eligible volunteers were selected as peer support receivers and trained for 15 hours. 7 women were selected as education receivers by health care providers and were trained for 2 hours. For peer support receivers, a single peer support was received by peer support providers, and educational group participants received one individual training session in 36-38 weeks of pregnancy by health care provider. The control group received only routine care. Data were collected by a questionnaire and were analyzed by SPSS software version 11.5. Kruskal-Wallis and Fisher’s Exact tests were used to analyze data. Results: Only 20% of peer support receivers, 14.7% of education receivers (by health care providers) and 19.4% of control group members initiate breastfeeding within the half-hour of delivery. 51.4% of peer support receivers, 61.8% of education receivers and 55.6% of control group member began their first breastfeeding within the period of 1- 24 hours after delivery. There were no significant difference at the time of breastfeeding initiation among three groups (p=0.852). Conclusion: The present study did not provide any evidence in terms of impact of peer support and education received by health care providers on the time of breastfeeding initiation; Whereas, some studies have shown positive effect of peer support during labor on breastfeeding initiation time. So, it seems that further study regarding effect of peer support during labor and effect of medication during labor may be needed.