JMIR Publications

ABSTRACT

Background:

Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity and mortality. There are reported trials of peer counselling to improve breastfeeding; however, they did not examine the efficacy of peer counselling to improve complementary feeding or the long-term impacts on child growth and development.

Objective:

To assess if peer counselling of women improves breastfeeding and complementary feeding practices, child growth and reduces the prevalence of undernutrition in their children up to four years of age.

Methods:

This study will use a community-based, cluster randomized controlled trial (cRCT) with a superiority design and two parallel treatment arms. It will assess the impact of a peer-counselling starting in the late pregnancy to one year after delivery on child feeding practices, growth and development with follow-up until 48 months of age. The study site will be in Mirpur, a densely populated area in Dhaka. Using satellite maps and GIS mapping, we will construct 36 clusters with an average population of 5,000 people. We will recruit pregnant women in the third trimester aged 16-40 years, with no more than three living children. Trained peer counsellors will visit women at home twice before delivery, four times in the first month; then monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants will collect anthropometric measurements. The primary outcome will be differences in child stunting and mean length-for-age at 6, 12, 15, 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding, in the mean duration of any breastfeeding, in the percentage of children at 6 and 9 months of age who receive solid, semi-solid or soft foods and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15 and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months).

Results:

We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socio-economic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention, and 551 in the control group. From January 2015 to February 2017, we conducted the long term follow-up of the cohort. We have now completed the data collection and processing and have started analyses.

Conclusions:

This study will help fill the evidence gap about the short- and long-term impact of peer counselling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. Clinical Trial: NCT01333995