Psychosocial impacts of Baby Friendly Spaces for Rohingya refugee mothers in Bangladesh: A pragmatic cluster-randomized controlled trial

Abstract

Background: This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports. Methods: In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters. Results: Significant within-group improvements in BFSIE were observed for distres (À.48, p = .014), functional impairment (À.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = À.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons. Discussion: Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research. Impact statementAs maternal mental health and child health are clearly linked, supporting maternal mental health and well-being is critical to the promotion of child development and care practices that can ultimately promote positive child health outcomes. Addressing maternal mental health is particularly critical in settings of adversity where exposure to traumatic events, deprivation and ongoing stressors threaten the well-being of both caregivers and child. However, scant research addresses how to support the integration of evidence-based mental health and psychosocial support (MHPSS) services into other care settings, such as child nutrition. Conducting rigorous research to grow this evidence is complicated in real-world humanitarian settings where logistical challenges and ethical constraints render some research designs infeasible. This paper presents a study designed to evaluate the impact of Baby Friendly Spaces (BFS), a psychosocial support program for mothers of malnourished young children, delivered in Rohingya refugee camps in Cox's Bazar, Bangladesh. In this study, mothers and babies participated in BFS as part of a broader package of child nutrition care. Because all operating Integrated Nutrition Centers offered BFS, it was not possible to randomize participants or centers to treatment and control conditions. Instead, we provided additional implementation support in half of the centers to determine the added value of improving existing programming and found that doing so improved the mental health impacts for mothers in the program. This study adds to a growing body...