Effectiveness of a Community-Based Breastfeeding Intervention in Ethiopia: a Cluster Randomized Controlled Trial

Peer-led breastfeeding education and support provided during the antenatal and postnatal periods are known to improve optimal breastfeeding practices; however, there is a paucity of evidence on the effectiveness of such interventions in Ethiopia. The aims of this thesis were to adapt and validate existing breastfeeding knowledge and attitudes instruments, determine the levels of breastfeeding knowledge and attitudes among low literacy women, and evaluate the effectiveness of a breastfeeding education and support intervention on early initiation and exclusive breastfeeding practices, and infant growth in a rural setting in Southwest Ethiopia. We conducted a cross-sectional study to assess validity and reliability of Breastfeeding knowledge questionnaire and Iowa infant feeding attitude scale and determined the levels of the knowledge attitudes towards breastfeeding in rural women. Then, we conducted a cluster-randomized controlled single-blind two-arm trial in the Mana district in 36 randomly selected clusters to evaluate the effectiveness of peer-led breastfeeding education and support on early initiation, exclusive breastfeeding and infant growth. We found that the translated Breastfeeding knowledge questionnaire and the Iowa infant feeding attitude scale are reliable and valid instruments for measuring maternal breastfeeding knowledge and attitudes. In addition, we found that the majority of rural women with low literacy had neutral attitudes towards breastfeeding and only half of them had adequate knowledge about breastfeeding. The peer-support intervention increased the prevalence of early initiation, exclusive breastfeeding and attitudes towards breastfeeding. Although we observed a higher maternal knowledge in the intervention group, the difference was not statistically significant. Except for a higher mid-upper arm circumference and a lower prevalence of respiratory infection, we did not find statistically significant intervention effects on other infant growth or morbidity outcomes