1. Using short message service to improve infant
feeding practices in Shanghai, China: feasibility,
acceptability and results at 12 months
Hong Jiang1, Mu Li2*, Liming Wen2,3, Qiaozhen, Hu1, DonglingYang1,
Gengsheng He1, Louise A Baur2,4, Michael J Dibley2, Xu Qian1
SYDNEY MEDICAL SCHOOL

2. The Problem
› Infant feeding practices can have long-term effects for
children.
› Despite efforts to promote breastfeeding in China, rates
are very low. Exclusive breastfeeding in children younger
than 6 months - 15% in major cities and 28% in rural
areas.
› Improving infant and young child feeding is needed not
only to reduce mortality and morbidity, researches also
show that children who were breastfed have lower levels
of obesity than those who were formula fed.

3. MCH services in Shanghai
pregnancy
BF promotion
1 trimester
register
CHC MH Dr
Antenatal
care
Maternity Hop
Antenatal class
childbirth
Delivery
Maternity Hop
10 steps of
successful BF
1st month
postpartum
Home visit
CHC MH Dr
BF advice
6wks postpartum
exam
Check up
Maternity Hop
BF advice
Up to 2 years
Check up
CH /Paediatric
BF advice
2&3 trimester
Antenatal class
3

4. The Approach
›We have developed a community-based health
promotion program to support new mothers to
breastfeed their babies and to adopt healthy
infant feeding practices.
› The study was carried out in four Community
Health Centers (CHCs). Two CHCs were assigned to
the intervention group and two other CHCs were
assigned as the control group.

5. The Approach
› Communications technologies such as SMS
have enabled us to deliver the innovative
public health program.
5

6. The Approach
Stage
Focus of messages
Advice on mother’s nutrition and physical activity, preparation for
breastfeeding, instructions for breastfeeding after vaginal delivery or
caesarean section, tips for avoiding baby reflux etc.
First week to Rapid response to problems of breastfeeding initiation, specific
age 2 months. guidance for women had caesarean section delivery
3rd trimester
Child’s age 2- Encouragement for exclusively breastfeeding and advice not
4 months
starting complementary food at this period. For mothers who would
return to work soon, encouragements and advice for continuing
breastfeeding.
Child’s age 4- 1) For mothers go back to work: how to adapt to their work
6 months
environment and continue breastfeeding. 2) For mothers who still
breastfed exclusively: continue to EBF until 6 months and
preparation for starting solids at 6 months.
Child’s age
Encouragement for continuing breastfeeding and adopting
appropriate infant feeding practices
after 6
months
6

7. The Results
›Delivering health promotion intervention by SMS
appears not only feasible but is well accepted by
new mothers with a high retention rate of 89% at
12 months
›Compared with the control group, the intervention
group had a significantly longer median duration
of EBF at 6 months (11.41 weeks, 95% confidence
interval [CI] 10.25 - 12.57 vs 8.87 weeks, 95% CI
7.84 - 9.89; P<0.001)

8. The Results
Total
No. (%)
Interventio
n
No. (%)
Control
No. (%)
AOR(95%
CI)
P
at the 6th month*(n=549)
Yes
58 (10.6)
40 (15.1)
18 (6.3)
0.002
No
491(89.4)
225 (84.9)
266(93.7)
2.67(1.454.91)
1
before the 4th month* (n=551)
Yes
15 (2.7)
4 (1.5)
11 (3.8)
0.039
No
261 (98.5)
275(96.5)
0.27(0.080.94)
1
Variables
Exclusive breastfeeding
Introduction of solid food regularly
536(97.3)
8

9. Implications
›A cluster RCT is planned, we expect that the
intervention can be embedded in the healthcare
system to achieve sustainable long term impacts
›More broadly, this could be a model for culturallyacceptable healthy infant feeding and childhood
obesity prevention in other countries undergoing
rapid socio-economic and nutrition transitions like
China