Counselling on breastfeeding: assessing knowledge and skills

Reported are the results of a randomized controlled trial to assess the eff ectiveness of the WHO/UNICEF 40-hour course "Breastfeeding counselling: a t raining course". The course was conducted in a maternity hospital which pro vides care to a low-income population in a metropolitan area in Sao Paulo, Brazil, Health workers from 60 health units were randomly assigned to be ei ther participants (20) or controls (40), and their breastfeeding knowledge and skills were assessed before and immediately after the course, as well a s 3 months later. Immediately after the course the participants' knowledge of breastfeeding had increased significantly compared to controls. Both the ir clinical and counselling skills also improved significantly. When assess ed 3 months later, the scores remained high with only a small decrease. The implementation of the course was also evaluated. The methods used were participatory observation, key interviews and focus group discussion. In th e 33 sessions of the course, the average score was 8.43 out of 10. Scores w ere highest for content and methodology of the theory sessions, and lowest for "use of time", "clinical management of lactation", and "discussion of c linical practice". "Breastfeeding counselling: a training course" therefore effectively increa ses health workers' knowledge and their clinical and counselling skills for the support of breastfeeding. The course can be conducted adequately using the material and methodology proposed, but could be more satisfactory if t he time allocated to exercises and clinical practice sessions were increase d.