Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa: the cluster-randomised PROMISE EBF trial

Abstract

BackgroundIn this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities.MethodsA total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < −2), stunting (LAZ < −2) and underweight (WAZ < −2) were calculated at each data collection point.ResultsThe study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso −0.20 (95% CI −0.39 to −0.01) and in Uganda −0.23 (95% CI −0.43 to −0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95% CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95% CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different.ConclusionsThere were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms.Trial registration numberClinicalTrials.gov: NCT00397150

Effect of breastfeeding promotion interventions on child growth: a systematic review and meta‐analysis

“…And in the Engebretsen et al. study , the intervention was associated with higher prevalence of wasting at three weeks in South Africa, at three months in Burkina Faso and at six months in Uganda, possibly reflecting lower BMI in the intervention groups.…”

“…In these cases, one possible explanation could be that the interventions were not the same. On the other hand, in South Africa, the three studies all showed positive results, even though the interventions were different (18,19,24).…”

“…In most studies (12 of 16), the intervention was carried out in the community, mainly through home visits, delivered by community health workers (16,19,(21)(22)(23)(24) or peer counsellors (15,18,25). Four studies focused on strategies for special groups, three of them targeting groups at higher risk to have overweight/obese children: indigenous population (16), obese mothers (26) and mothers at increased risk of developing gestational diabetes (14).…”

Early infant feeding practices in three African countries: the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors

“…A full trial profile by arm and country is already published [12, 22]. The analysis included 2,579 singleton live children.…”

Assessing causal effects of early life‐course factors on early childhood caries in 5‐year‐old Ugandan children using directed acyclic graphs (DAGs): A prospective cohort study

“…Detailed information about the PROMISE-EBF trial has been published previously. 32,33 A total of 863 pregnant women were recruited at Exclusive breastfeeding (EBF) was assessed at the 24-week follow-up using 24-hour and 7-day recalls. A baby who did not receive any food or liquids other than breastmilk and medicines was classified as exclusively breastfed.…”