human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: David Osrin and colleagues report findings from a cluster-r and omized trial conducted in Mumbai slums ; the trial aim ed to evaluate whether  facilitator-supported women 's groups  could improve perinatal outcomes BACKGROUND Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries OBJECTIVE To determine whether peer counselors impacted breastfeeding duration among premature infants in an urban population . DESIGN This was a r and omized controlled clinical trial . SETTING The trial was conducted in the Newborn Intensive Care Unit at Boston Medical Center , an inner-city teaching hospital with approximately 2000 births per year . PARTICIPANTS One hundred eight mother-infant pairs were enrolled between 2001 and 2004 . Pairs were eligible if the mother intended and was eligible to breastfeed per the 1997 guidelines from the American Academy of Pediatrics and if the infant was 26 to 37 weeks ' gestational age and otherwise healthy . INTERVENTION Subjects were r and omized to either a peer counselor who saw the mother weekly for 6 weeks or to st and ard of care . MAIN OUTCOME MEASURE The main outcome measure was any breast-milk feeding at 12 weeks postpartum . RESULTS Intervention and control groups were similar on all measured sociodemographic factors . The average  gestational age of infants was 32 weeks ( range , 26.3 - 37 weeks ) with a mean birth weight of 1875 g ( range , 682 - 3005 g ) . At 12 weeks postpartum , women with a peer counselor had odds of providing any amount of breast milk 181 % greater than women without a peer counselor ( odds ratio , 2.81 [ 95 % confidence interval , 1.11 - 7.14 ] ; P = .01 ) . CONCLUSIONS Peer counselors increased breastfeeding duration  among premature infants born in an inner-city hospital and admitted to the neonatal intensive care unit .  Peer counseling programs can help to increase breastfeeding in this vulnerable population BACKGROUND Women 's groups and health education by peer counsellors can improve the health of mothers and children . We assessed their effects on mortality and breastfeeding rates  in rural Malawi . METHODS We did a 2 × 2 factorial , cluster-r and omised trial in 185,888 people in Mchinji district . 48 equal-sized clusters were r and omly allocated to four groups with a computer-generated number sequence . 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems . 72 trained volunteer peer counsellors  made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care . Primary outcomes for the women 's group intervention were maternal , perinatal , neonatal , and infant mortality rates ( MMR , PMR , NMR , and IMR , respectively ) ; and for the peer counselling were IMR and exclusive breastfeeding ( EBF ) rates . Analysis was by intention to treat . The trial is registered as IS RCT N06477126 . FINDINGS We monitored outcomes of 26,262 births between 2005 and 2009 . In a factorial model adjusted only for clustering and the volunteer peer counselling intervention , in women 's group areas , for years 2 and 3 , we noted non-significant decreases in NMR ( odds ratio 0.93 , 0.64 - 1.35 ) and MMR ( 0.54 , 0.28 - 1.04 ) . After adjustment for parity , socioeconomic quintile , and baseline measures , effects were larger for NMR ( 0.85 , 0.59 - 1.22 ) and MMR ( 0.48 , 0.26 - 0.91 ) . Because of the interaction between the two interventions , a stratified analysis was done . For women 's groups , in adjusted analyses , MMR fell by 74 % ( 0.26 , 0.10 - 0.70 ) , and NMR by 41 % ( 0.59 , 0.40 - 0.86 ) in areas with no peer counsellors , but there was no effect in areas with counsellors ( 1.09 , 0.40 - 2.98 , and 1.38 , 0.75 - 2.54 ) . Factorial analysis for the peer counselling intervention for years 1 - 3 showed a fall in IMR of 18 % ( 0.82 , 0.67 - 1.00 ) and an improvement in EBF rates ( 2.42 , 1.48 - 3.96 ) . The results of the stratified , adjusted analysis showed a 36 % reduction in IMR ( 0.64 , 0.48 - 0.85 ) but no effect on EBF ( 1.18 , 0.63 - 2.25 ) in areas without women 's groups , and in areas with women 's groups there was no effect on IMR ( 1.05 , 0.82 - 1.36 ) and an increase in EBF ( 5.02 , 2.67 - 9.44 ) . The cost of women 's groups was US$ 114 per year of life lost ( YLL ) averted and that of peer counsellors was $ 33 per YLL averted , using stratified data from single intervention comparisons . INTERPRETATION Community mobilisation through women 's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural population s in Africa . FUNDING Saving Newborn Lives , UK Department for International Development , and Wellcome Trust Complementary feeding practice s are often inadequate in developing countries , result ing in a significant nutritional decline between 6 and 18 mo of age . We assessed the effectiveness of an educational intervention to promote adequate complementary feeding practice s that would be feasible to sustain with existing re sources . The study was a cluster r and omized controlled trial in communities in the state of Haryana in India . We developed the intervention through formative research . Eight communities were pair matched on their baseline characteristics ; one of each pair was r and omly assigned to receive the intervention and the other to no specific feeding intervention . Health and nutrition workers in the intervention communities were trained to counsel on locally developed feeding recommendations .  Newborns were enrolled in all of the communities ( 552 in the intervention and 473 in the control ) and followed up every 3 mo to the age of 18 mo . The main outcome measures were weights and lengths at 6 , 9 , 12 , and 18 mo and complementary feeding practice s at 9 and 18 mo . All analyses were by intent to treat . In the overall analyses , there was a small but significant effect on length gain in the intervention group ( difference in means 0.32 cm , 95 % CI , 0.03 , 0.61 ) . The effect was greater in the subgroup of male infants ( difference in mean length gain 0.51 cm , 95 % CI 0.03 , 0.98 ) . Weight gain was not affected . Energy intakes from complementary foods overall were significantly higher in the intervention group children at 9 mo ( mean + /- SD : 1556 + /- 1109 vs. 1025 + /- 866 kJ ; P < 0.001 ) and 18 mo ( 3807 + /- 1527 vs. 2577 + /- 1058 kJ ; P < 0.001 ) . Improving complementary feeding practice s through existing services is feasible but the effect on physical growth is limited . Factors that limit physical growth in such setting s must be better understood to plan more effective nutrition programs Initiation of breast-feeding within 1 h after birth has been associated with reduced  neonatal mortality in a rural Ghanaian population . In South Asia , however , breast-feeding patterns and low birth weight rates differ and this relationship has not been quantified . Data were collected during a community-based r and omized trial of the impact of topical chlorhexidine antisepsis interventions on  neonatal mortality and morbidity in southern Nepal . In-home visits were conducted on d 1 - 4 , 6 , 8 , 10 , 12 , 14 , 21 , and 28 to collect longitudinal information on timing of initiation and pattern of breast-feeding . Multivariable regression modeling was used to estimate the association between death and breast-feeding initiation time . Analysis was based on 22,838 breast-fed newborns surviving to 48 h. Within 1 h of birth , 3.4 % of infants were breast-fed and 56.6 % were breast-fed within 24 h of birth . Partially breast-fed infants ( 72.6 % ) were at higher mortality risk [ relative risk ( RR ) = 1.77 ; 95 % CI = 1.32 - 2.39 ] than those exclusively breast-fed . There was a trend ( P = 0.03 ) toward higher mortality with increasing delay in breast-feeding initiation . Mortality was higher among late ( > or = 24 h ) compared with early ( < 24 h ) initiators ( RR = 1.41 ; 95 % CI = 1.08 - 1.86 ) after adjustment for low birth weight , preterm birth , and other covariates . Improvements in breast-feeding practice s in this setting may reduce neonatal mortality substantially . Approximately 7.7 and 19.1 % of all neonatal deaths may be avoided with universal initiation of breast-feeding within the first day or hour of life , respectively . Community-based breast-feeding promotion programs should remain a priority , with renewed emphasis on early initiation in addition to exclusiveness and duration of breast-feeding Exclusive  breastfeeding ( EBF ) for 6 months is recommended for optimal infant health , but the evidence for longer‐term impacts is weak . We examined whether r and omization to receive EBF counselling ( BFC ) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition To assess the feasibility of a pediatric primary care based intervention to promote healthful behaviors among 0–6 month old infants and their mothers . We enrolled  two intervention practice s ( 60 mother-infant pairs ) and one usual care control practice ( 24 pairs ) in a non-r and omized controlled trial . We completed visits and interviews with 80 ( 95 % ) pairs at birth and 6 months . The intervention included ( 1 ) brief focused negotiation by pediatricians , ( 2 ) motivational counseling by a health educator , and ( 3 ) group parenting workshops . We evaluated the intervention effects on infant feeding , sleep duration , TV viewing , and mothers ’ responsiveness to satiety cues . Maternal behavioral targets included postpartum diet , physical activity , TV and sleep . At 6 months , fewer intervention than control infants had been introduced to solid foods ( 57 % vs. 82 % ; P = 0.04 ) , and intervention infants viewed less TV ( mean 1.2 vs. 1.5 h/d ; P = 0.07 ) . Compared to control infants , intervention infants had larger increases in their nocturnal sleep duration from baseline to follow up ( mean increase 1.9 vs. 1.3 h/d ; P = 0.05 ) ; larger reductions in settling time ( mean reduction −0.70 vs. −0.10 h/d ; P = 0.02 ) ; and larger reductions in hours/day of nighttime wakefulness ( mean reduction −2.9 vs. −1.5 h/d ; P = 0.08 ) . There were no differences in breastfeeding , response to satiety cues , or maternal health behaviors . A program of brief focused negotiation by pediatricians , individual coaching by health educators using motivational interviewing , and group parenting workshops tended to improve infant feeding , sleep and media exposure , but had less impact on mothers ’ own health-related behaviors Background Despite efforts to reduce under-5 mortality rates worldwide 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: David Osrin and colleagues report findings from a cluster-r and omized trial conducted in Mumbai slums ; the trial aim ed to evaluate whether  facilitator-supported women 's groups  could improve perinatal outcomes BACKGROUND Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries OBJECTIVE To determine whether peer counselors impacted breastfeeding duration among premature infants in an urban population . DESIGN This was a r and omized controlled clinical trial . SETTING The trial was conducted in the Newborn Intensive Care Unit at Boston Medical Center , an inner-city teaching hospital with approximately 2000 births per year . PARTICIPANTS One hundred eight mother-infant pairs were enrolled between 2001 and 2004 . Pairs were eligible if the mother intended and was eligible to breastfeed per the 1997 guidelines from the American Academy of Pediatrics and if the infant was 26 to 37 weeks ' gestational age and otherwise healthy . INTERVENTION Subjects were r and omized to either a peer counselor who saw the mother weekly for 6 weeks or to st and ard of care . MAIN OUTCOME MEASURE The main outcome measure was any breast-milk feeding at 12 weeks postpartum . RESULTS Intervention and control groups were similar on all measured sociodemographic factors . The average  gestational age of infants was 32 weeks ( range , 26.3 - 37 weeks ) with a mean birth weight of 1875 g ( range , 682 - 3005 g ) . At 12 weeks postpartum , women with a peer counselor had odds of providing any amount of breast milk 181 % greater than women without a peer counselor ( odds ratio , 2.81 [ 95 % confidence interval , 1.11 - 7.14 ] ; P = .01 ) . CONCLUSIONS Peer counselors increased breastfeeding duration  among premature infants born in an inner-city hospital and admitted to the neonatal intensive care unit .  Peer counseling programs can help to increase breastfeeding in this vulnerable population BACKGROUND Women 's groups and health education by peer counsellors can improve the health of mothers and children . We assessed their effects on mortality and breastfeeding rates  in rural Malawi . METHODS We did a 2 × 2 factorial , cluster-r and omised trial in 185,888 people in Mchinji district . 48 equal-sized clusters were r and omly allocated to four groups with a computer-generated number sequence . 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems . 72 trained volunteer peer counsellors  made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care . Primary outcomes for the women 's group intervention were maternal , perinatal , neonatal , and infant mortality rates ( MMR , PMR , NMR , and IMR , respectively ) ; and for the peer counselling were IMR and exclusive breastfeeding ( EBF ) rates . Analysis was by intention to treat . The trial is registered as IS RCT N06477126 . FINDINGS We monitored outcomes of 26,262 births between 2005 and 2009 . In a factorial model adjusted only for clustering and the volunteer peer counselling intervention , in women 's group areas , for years 2 and 3 , we noted non-significant decreases in NMR ( odds ratio 0.93 , 0.64 - 1.35 ) and MMR ( 0.54 , 0.28 - 1.04 ) . After adjustment for parity , socioeconomic quintile , and baseline measures , effects were larger for NMR ( 0.85 , 0.59 - 1.22 ) and MMR ( 0.48 , 0.26 - 0.91 ) . Because of the interaction between the two interventions , a stratified analysis was done . For women 's groups , in adjusted analyses , MMR fell by 74 % ( 0.26 , 0.10 - 0.70 ) , and NMR by 41 % ( 0.59 , 0.40 - 0.86 ) in areas with no peer counsellors , but there was no effect in areas with counsellors ( 1.09 , 0.40 - 2.98 , and 1.38 , 0.75 - 2.54 ) . Factorial analysis for the peer counselling intervention for years 1 - 3 showed a fall in IMR of 18 % ( 0.82 , 0.67 - 1.00 ) and an improvement in EBF rates ( 2.42 , 1.48 - 3.96 ) . The results of the stratified , adjusted analysis showed a 36 % reduction in IMR ( 0.64 , 0.48 - 0.85 ) but no effect on EBF ( 1.18 , 0.63 - 2.25 ) in areas without women 's groups , and in areas with women 's groups there was no effect on IMR ( 1.05 , 0.82 - 1.36 ) and an increase in EBF ( 5.02 , 2.67 - 9.44 ) . The cost of women 's groups was US$ 114 per year of life lost ( YLL ) averted and that of peer counsellors was $ 33 per YLL averted , using stratified data from single intervention comparisons . INTERPRETATION Community mobilisation through women 's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural population s in Africa . FUNDING Saving Newborn Lives , UK Department for International Development , and Wellcome Trust Complementary feeding practice s are often inadequate in developing countries , result ing in a significant nutritional decline between 6 and 18 mo of age . We assessed the effectiveness of an educational intervention to promote adequate complementary feeding practice s that would be feasible to sustain with existing re sources . The study was a cluster r and omized controlled trial in communities in the state of Haryana in India . We developed the intervention through formative research . Eight communities were pair matched on their baseline characteristics ; one of each pair was r and omly assigned to receive the intervention and the other to no specific feeding intervention . Health and nutrition workers in the intervention communities were trained to counsel on locally developed feeding recommendations .  Newborns were enrolled in all of the communities ( 552 in the intervention and 473 in the control ) and followed up every 3 mo to the age of 18 mo . The main outcome measures were weights and lengths at 6 , 9 , 12 , and 18 mo and complementary feeding practice s at 9 and 18 mo . All analyses were by intent to treat . In the overall analyses , there was a small but significant effect on length gain in the intervention group ( difference in means 0.32 cm , 95 % CI , 0.03 , 0.61 ) . The effect was greater in the subgroup of male infants ( difference in mean length gain 0.51 cm , 95 % CI 0.03 , 0.98 ) . Weight gain was not affected . Energy intakes from complementary foods overall were significantly higher in the intervention group children at 9 mo ( mean + /- SD : 1556 + /- 1109 vs. 1025 + /- 866 kJ ; P < 0.001 ) and 18 mo ( 3807 + /- 1527 vs. 2577 + /- 1058 kJ ; P < 0.001 ) . Improving complementary feeding practice s through existing services is feasible but the effect on physical growth is limited . Factors that limit physical growth in such setting s must be better understood to plan more effective nutrition programs Initiation of breast-feeding within 1 h after birth has been associated with reduced  neonatal mortality in a rural Ghanaian population . In South Asia , however , breast-feeding patterns and low birth weight rates differ and this relationship has not been quantified . Data were collected during a community-based r and omized trial of the impact of topical chlorhexidine antisepsis interventions on  neonatal mortality and morbidity in southern Nepal . In-home visits were conducted on d 1 - 4 , 6 , 8 , 10 , 12 , 14 , 21 , and 28 to collect longitudinal information on timing of initiation and pattern of breast-feeding . Multivariable regression modeling was used to estimate the association between death and breast-feeding initiation time . Analysis was based on 22,838 breast-fed newborns surviving to 48 h. Within 1 h of birth , 3.4 % of infants were breast-fed and 56.6 % were breast-fed within 24 h of birth . Partially breast-fed infants ( 72.6 % ) were at higher mortality risk [ relative risk ( RR ) = 1.77 ; 95 % CI = 1.32 - 2.39 ] than those exclusively breast-fed . There was a trend ( P = 0.03 ) toward higher mortality with increasing delay in breast-feeding initiation . Mortality was higher among late ( > or = 24 h ) compared with early ( < 24 h ) initiators ( RR = 1.41 ; 95 % CI = 1.08 - 1.86 ) after adjustment for low birth weight , preterm birth , and other covariates . Improvements in breast-feeding practice s in this setting may reduce neonatal mortality substantially . Approximately 7.7 and 19.1 % of all neonatal deaths may be avoided with universal initiation of breast-feeding within the first day or hour of life , respectively . Community-based breast-feeding promotion programs should remain a priority , with renewed emphasis on early initiation in addition to exclusiveness and duration of breast-feeding Exclusive  breastfeeding ( EBF ) for 6 months is recommended for optimal infant health , but the evidence for longer‐term impacts is weak . We examined whether r and omization to receive EBF counselling ( BFC ) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition To assess the feasibility of a pediatric primary care based intervention to promote healthful behaviors among 0–6 month old infants and their mothers . We enrolled  two intervention practice s ( 60 mother-infant pairs ) and one usual care control practice ( 24 pairs ) in a non-r and omized controlled trial . We completed visits and interviews with 80 ( 95 % ) pairs at birth and 6 months . The intervention included ( 1 ) brief focused negotiation by pediatricians , ( 2 ) motivational counseling by a health educator , and ( 3 ) group parenting workshops . We evaluated the intervention effects on infant feeding , sleep duration , TV viewing , and mothers ’ responsiveness to satiety cues . Maternal behavioral targets included postpartum diet , physical activity , TV and sleep . At 6 months , fewer intervention than control infants had been introduced to solid foods ( 57 % vs. 82 % ; P = 0.04 ) , and intervention infants viewed less TV ( mean 1.2 vs. 1.5 h/d ; P = 0.07 ) . Compared to control infants , intervention infants had larger increases in their nocturnal sleep duration from baseline to follow up ( mean increase 1.9 vs. 1.3 h/d ; P = 0.05 ) ; larger reductions in settling time ( mean reduction −0.70 vs. −0.10 h/d ; P = 0.02 ) ; and larger reductions in hours/day of nighttime wakefulness ( mean reduction −2.9 vs. −1.5 h/d ; P = 0.08 ) . There were no differences in breastfeeding , response to satiety cues , or maternal health behaviors . A program of brief focused negotiation by pediatricians , individual coaching by health educators using motivational interviewing , and group parenting workshops tended to improve infant feeding , sleep and media exposure , but had less impact on mothers ’ own health-related behaviors Background Despite efforts to reduce under-5 mortality rates worldwide 
    Output:
    