Peer counseling increases exclusive breastfeeding rates

July 2011

Results of a community-based cluster-randomized trial, published in The Lancet in July 2011, demonstrated the impact of peer counseling and support on exclusive breastfeeding (EBF) and diarrhea prevalence in Burkina Faso, Uganda, and South Africa. Peer counselors provided information and home-based support and encouragement for six months of EBF. Mothers participating in the study were offered at least five visits, including one antenatal visit. Comparisons between groups showed higher EBF prevalence at 12 and 24 weeks (assessed by both 24-hour and 7-day recall) among mothers who received peer support in all countries. EBF prevalence was lower at 24 weeks than at 12 weeks in both groups, but the difference between groups was greater at the later assessment.

Although EBF prevalence among mothers receiving peer counseling in Burkina Faso and Uganda was 50 percent or higher at both assessments (7-day recall), in South Africa, prevalence reached only 8 percent at 12 weeks and fell to 2 percent at 24 weeks. The authors attribute this to mixed messages received by South African mothers resulting from promotion of infant formula under the Department of Health’s protein energy malnutrition scheme, previous provision of infant formula by the National Programme for Prevention of Mother-to-Child Transmission of HIV-1, and uncontrolled marketing of infant formula due to the lack of legislation enforcing the International Code of Marketing of Breast-milk Substitutes.

No differences due to the intervention were noted for the prevalence of diarrhea at age 12 weeks or 24 weeks. Since this finding contradicts the results of some similar studies, the authors speculate that breastfeeding may have less effect on diarrhea incidence than on its duration and severity, which were not measured in this study. They also note that in communities where predominant breastfeeding is common, such as Burkina Faso and Uganda, a shift to EBF may not result in large changes in diarrhea-associated morbidity.

The study demonstrates that fairly low-intensity peer counseling intervention may have the potential to significantly increase EBF in sub-Saharan Africa for infants aged up to 6 months.

Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial