The Shishu Pushti Trial – extended peer counseling for improving feeding practices and reducing undernutrition in children aged 0-48 months in urban Bangladesh: Protocol for a cluster-randomized controlled trial

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  • Seema Mihrshahi
  • Ara, Gulshan
  • Mansura Khanam
  • Sabrina Rasheed
  • Kingsley Emwinyore Agho
  • Iqbal Kabir
  • S K Roy
  • Rukhsana Haider
  • Jena Derakhshani Hamadani
  • Fahmida Tofail
  • Ashraful Alam
  • Michael J Dibley

Background: The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. 

Objective: Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. 

Methods: This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). 

Results: We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. 

Conclusions: This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development.

TidsskriftJMIR Research Protocols
Udgave nummer2
Antal sider14
StatusUdgivet - 2022
Eksternt udgivetJa

Bibliografisk note


Funding Information:
We used the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guideline [31] to prepare this protocol. It was peer reviewed by the Australian National Health and Medical Research Council (NHMRC) grant review panels in 2009 (GNT63329) and 2013 (GNT1071005) and by the Research Review Committee of the International Centre for Diarrheal Disease Research-Bangladesh (icddr,b). The University of Sydney Human Ethics committee and the Ethics Review Committee of ICDDR-B approved the protocols. This report combines the 2 approved protocols.

Funding Information:
This trial was funded by the National Health and Medical Research Council of Australia (#GNT633229 in 2010 and extended with #GNT1071005 in 2014). We also received a grant from the Australian High Commission in Bangladesh.

Publisher Copyright:
©Seema Mihrshahi, Gulshan Ara, Mansura Khanam, Sabrina Rasheed, Kingsley Emwinyore Agho, AKM Iqbal Kabir, S K Roy, Rukhsana Haider, Jena Derakhshani Hamadani, Fahmida Tofail, Ashraful Alam, Michael J Dibley.

ID: 324268198