The effect of participatory women's groups on infant feeding and child health knowledge, behaviour and outcomes in rural Bangladesh: a controlled before-and-after study

Abstract

BackgroundDespite efforts to reduce under-5 mortality rates worldwide, an estimated 6.6 million under-5 children die every year. Community mobilisation through participatory women's groups has been shown to improve maternal and newborn health in rural settings, but little is known about the potential of this approach to improve care and health in children after the newborn period.MethodsFollowing on from a cluster-randomised controlled trial to assess the effect of participatory women's groups on maternal and neonatal health outcomes in rural Bangladesh, 162 women's groups continued to meet between April 2010 and December 2011 to identify, prioritise and address issues that affect the health of children under 5 years. A controlled before-and-after study design and difference-in-difference analysis was used to assess morbidity outcomes and changes in knowledge and practices related to child feeding, hygiene and care-seeking behaviour.FindingsSignificant improvements were measured in mothers’ knowledge of disease prevention and management, danger signs and hand washing at critical times. Significant increases were seen in exclusive breast feeding for at least 6 months (15.3% (4.2% to 26.5%)), and mean duration of breast feeding (37.9 days (17.4 to 58.3)). Maternal reports of under-5 morbidities fell in intervention compared with control areas, including reports of fever (−10.5% (−15.1% to −6.0%)) and acute respiratory infections (−12.2% (−15.6% to −8.8%)). No differences were observed in dietary diversity scores or immunisation uptake.ConclusionsCommunity mobilisation through participatory women's groups can be successfully adapted to address health knowledge and practice in relation to child's health, leading to improvements in a number of child health indicators and behaviours.

Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications

“…A randomized controlled trial in Kenya found that women who received intensive home-based breast-feeding counselling addressing prevention and management of breast-feeding challenges were more likely to exclusively breast-feed than women who received semi-intensive counselling at a health facility (93) . In a cluster-randomized controlled trial carried out in Bangladesh, the implementation of participatory women's groups led to significant increases in EBF for 6 months (15 %) and mean duration of breast-feeding (+38 d) in intervention v. control areas and pre-v. postintervention (92) . Similarly, in India, peer counselling through mother support groups showed improved initiation within an hour of birth, EBF and decreased prelacteal feeding at 2 and 5 years post-baseline (94) .…”

“…The success of large-scale IYCF programmes lies in the importance of IYCF counselling and community support, in tandem with community awareness (90) . Several randomized controlled trials have demonstrated that community-led interventions, with an attention to quality, content and frequency of counselling, show positive effects on EBF (91,92) . A randomized controlled trial in Kenya found that women who received intensive home-based breast-feeding counselling addressing prevention and management of breast-feeding challenges were more likely to exclusively breast-feed than women who received semi-intensive counselling at a health facility (93) .…”

Growth and body composition of children aged 2–4 years after exposure to community mobilisation women’s groups in Bangladesh

“…Despite no changes in care-seeking, there were significant improvements in mothers’ knowledge of disease prevention and management, including giving anthelminthics, danger signs and handwashing at critical times. Reduced maternal reports of under 5 years' morbidities and duration of illness were also observed 10. Significant increases were also seen in the intervention group for both exclusive breast feeding for at least 6 months, and the mean duration of breast feeding 10.…”

“…Furthermore, verbal autopsy data from the trial suggest that reductions in deaths due to neonatal infections may have largely contributed to impacts on neonatal mortality. Formative evaluation of the PWG intervention on postneonatal child health in a subset of groups supports a link with improved hygiene 10. Despite no changes in care-seeking, there were significant improvements in mothers’ knowledge of disease prevention and management, including giving anthelminthics, danger signs and handwashing at critical times.…”

“…Reduced maternal reports of under 5 years' morbidities and duration of illness were also observed 10. Significant increases were also seen in the intervention group for both exclusive breast feeding for at least 6 months, and the mean duration of breast feeding 10. We did not measure maternal dietary intake or energy expenditure during pregnancy, although dietary advice was a core component of the PWGs.…”