Arch Public Health. 2025 Nov 24. doi: 10.1186/s13690-025-01796-w. Online ahead of print.
ABSTRACT
BACKGROUND: Exclusive breastfeeding (EBF) promotes optimal growth and health in infants. Despite national and global initiatives, EBF rates in Malaysia remain below the 70% target set for 2030. This study evaluated the impact of structured breastfeeding education supplemented with WhatsApp follow-up on infant feeding practices, growth, and health outcomes.
METHODS: A quasi-experimental study was conducted at six public health clinics in Gombak District, Selangor. Mothers of healthy-term infants were assigned to either an intervention group (structured education with WhatsApp follow-up) or a comparison group (routine care). A total of 500 mother-infant pairs were enrolled. Data on feeding practices, anthropometric indicators, length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length z-scores (WLZ) and common illnesses, including upper respiratory tract infection (URTI), gastroenteritis (GE), contact dermatitis (CD), bowel disorders (BD), and other illnesses (OI), were collected at Months 1, 3, and 6. Analyses included descriptive statistics, linear mixed-effects models, and generalised logistic mixed models.
RESULTS: Of the 602 mothers screened, 500 were enrolled across six purposively selected clinics, and 460 (220 in the comparison group and 240 in the intervention group) were included in the final analysis. Baseline maternal and infant characteristics were comparable between groups. EBF prevalence was initially higher in the comparison group but increased more significantly in the intervention group by Month 6. Although some baseline z-scores were negative, descriptive trends showed modest, non-significant improvements in LAZ, WAZ, and WLZ over time, indicating overall upward growth trajectories. Linear mixed-effects models confirmed significant time effects, but no group-by-time interactions were observed. Illness prevalence decreased with age, with significant reductions observed for GE and OI and a borderline improvement for URTI in the intervention group. Overall, the intervention improved EBF practices and selected morbidity outcomes but did not significantly alter growth trajectories.
CONCLUSIONS: Structured breastfeeding education, combined with WhatsApp follow-up, effectively enhanced exclusive breastfeeding practices and reduced certain infant illnesses, but showed no significant short-term effects on growth. Longer-term follow-up is warranted to assess the sustained effects on growth and health.
PMID:41276849 | DOI:10.1186/s13690-025-01796-w
