JMIR Publications

ABSTRACT

Background:

Children in Lao People’s Democratic Republic (Lao PDR) continue to receive sub-optimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have tried to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions are the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer.

Objective:

The aim of our project was to conduct a randomized control trial (RCT) designed to assess whether social transfers can increase breastfeeding rates in Vientiane province, Lao PDR.

Methods:

A prospective, parallel cluster-RCT was conducted among 300 mothers with a recent birth who initiated breastfeeding. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until three years postpartum (2026). Participants were randomly assigned to one of three groups: 1) control group, no social transfer 2) intervention group one, an unconditional social transfer at six months postpartum, and 3) intervention group two, a social transfer at six months postpartum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end-point will be exclusive breastfeeding at six-months postpartum. Secondary endpoints will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information.

Results:

As of November 2023, the study as enrolled 300 participants. Study participation is ongoing until December 2027 at minimum. Over the study lifetime, 93% have completed all visits.

Conclusions:

We see potential for a long-term program that may be implemented to other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth. Clinical Trial: The trial was retrospectively registered on October 21, 2022 (NCT05665049).