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Promoting breastfeeding by peer counselling in Bangladesh

November 08, 2000

Peer counselling is highly effective in promoting exclusive breastfeeding in less-developed countries, and should be incorporated in mother and child health programmes, concludes research published in this week’s issue of THE LANCET.

Most mothers breastfeed in Bangladesh, but they rarely practise exclusive breastfeeding. Hospital-based strategies for breastfeeding promotion cannot reach them because about 95% have home deliveries. Rukhsana Haider and colleagues from the London School of Hygiene and Tropical Medicine, UK, postulated that with the intervention of trained peer counsellors, mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months.

40 adjacent zones in Dhaka, Bangladesh, were randomised to intervention or control groups. Women were enrolled during the last three months of pregnancy between February and December, 1996. In the intervention group, 15 home-based counselling visits were scheduled, with two visits in the last three months of pregnancy, three shortly after birth (within 48 hours), on day 5, between days 10 and 14, and fortnightly thereafter until the infant was 5 months old. Peer counsellors were local mothers who had received training for 10 days.

363 women were enrolled in each group. Peer counselling significantly improved breastfeeding practices. The prevalence of exclusive breastfeeding at 5 months - the primary outcome - was 202/228 (70%) for the intervention group and 17/285 (6%) for the control group. For the secondary outcomes, mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods. At day 4, significantly more mothers in the intervention group breastfed exclusively than controls.

In an accompanying Commentary (p 1620), Anna Coutsoudis from the University of Natal, Durban, South Africa, considers the implications of Haider and colleagues’ study with regard to HIV-1 infection. She concludes: “At the individual level, HIV-1 infected women should receive counselling according to the UNAIDS guidelines, which should include information about the risks and benefits of different infant-feeding options, and specific guidance for enabling women to select the option most suitable to their particular circumstances. Women should be supported in whatever choice they make. Because of the benefits of breastfeeding, those women who opt for this form of feeding should be encouraged and supported to breastfeed exclusively for up to 6 months. Haider and colleagues’ study has shown that it is possible to bring about change in breastfeeding practice that is important for HIV-1- infected women who breastfeed”.

Contact: Dr Sharon Huttly, c/o Alice Dickens, London School of Hygiene & Tropical Medicine, 50 Bedford Square, LONDON WC1B 3DP, UK; T) +44 (0)20 7299 4654; F) +44 (0)20 7323 0638; E) alice.dickens@lshtm.ac.uk

Dr Anna Coutsoudis, Department of Paediatrics and Child Health, University of Natal, Durban 4001, South Africa; T) +27 31 209 1254; F) +27 31 209 8633; E) coutsoud@nu.ac.za

Lancet