In Bangladesh, mothers rarely breastfeed exclusively. The national programme
promoting exclusive breastfeeding has focused mainly on hospitals, but the majority of
mothers deliver at home, and it is important to reach them there. This research aimed to
assess the impact of community-based peer counsellors on the prevalence of exclusive
breastfeeding. Other objectives were to assess the impact on infant morbidity and
growth, and the acceptability of the lactational amenorrhoea method (LAM) for
contraception.
In Dhaka, 40 localities were randomised as intervention and control clusters. One
woman in each intervention cluster was trained as a peer counsellor. The intervention
comprised a minimum of fifteen counselling visits (two in the third trimester of
pregnancy, two within 5 days of delivery, one between 10-14 days and then fortnightly),
to help mothers establish and continue exclusive breastfeeding for 5 months.
A total of 726 mothers, with mean of 4.5 years of school, from the lower-middle socioeconomic class, were enrolled during 1996, of whom 573 completed 5 months of
follow-up. In the intervention group, 69% of mothers fed their infants colostrum as the
first food compared to 11% of the controls (p<0.0001), and 70% breastfed exclusively
for 5 months versus 6% of the controls (p<0.0001). Despite small differences in
morbidity from diarrhoea, cough and fever, there was a substantial impact on weight
gain. At the end of 5 months, the mean weight-for-length Z score was +0.1 (SD 0.8) in
the intervention group and -0.9 (SD 0.8) in the control group (p<0.0001). The majority
of mothers who breastfed exclusively, also accepted and practised the LAM (59% at 5
months).
This trial has demonstrated that trained community-based peer counsellors can
significantly increase exclusive breastfeeding and appropriate contraceptive practices,
with benefits to infant health. Inclusion of peer counsellors in mother and child health
programmes is recommended
