Cell phone based peer counselling can support exclusive breastfeeding: a randomized controlled trial in Kenya (119.5)

Abstract

Objective: To test whether exposure to community‐based continuous cell phone based peer support (CPS) or monthly peer‐led support groups (PSG) increases adoption and duration of exclusive breastfeeding (EBF), as compared to current standard of facility‐based support (Control).Methods: We randomized low‐income women attending antenatal care at a large hospital to receive one of three support strategies from late pregnancy (32‐26 weeks) to 3 months postpartum: CPS, PSG or Control. We compared EBF estimated by maternal 24 h recall of infant foods at 3 months age by intervention group.Results: Participant flow was adequate for power (753 women enrolled, 81% of eligible; 504 infants completed, including twins, 66.6%). Both interventions were associated with a higher proportion of EBF CPS: 90.9%, PSG: 82.8%, Control: 78.2%, p=0.007). Pairwise comparisons of 24 h EBF indicated a significant association of CPS with an 12.7% higher prevalence than Control (90.9 versus 78.2, a 16.2% greater EBF response rate than Control; Chi‐square = 9.8201, p=0.0017) and an 8.1% higher prevalence than PSG (90.9 versus 82.8, a 9.8% greater EBF response rate than PSG; Chi‐square = 4.5768, p=0.0324). Differences could not be attributed to baseline indicators, dropout rates or biases, prevalence and timing of breastfeeding initiation, or EBF prevalence one week after birth. They may be attributed to the frequency of advice.Conclusions: Cell phone based counselling approaches can be at least as effective in supporting EBF as peer support group and facility‐based approaches.Supported by Bill & Melinda Gates Foundation to FHI 360, through the Alive & Thrive Small Grants Program managed by UC Davis; Global Alliance for Improved Nutrition; Canada Research Chair program award.