Integrating Infant Feeding Counselling With Psychosocial Stimulation

Study design It was a randomized controlled trial of integrating infant feeding counselling and psychosocial stimulation in slums of Mirpur, Dhaka. The trial was conducted in slum communities on the edge of Dhaka with 10 clusters of city blocks for each of the 2 study groups (167 mothers/infant pairs in each group). The two groups 1) Psychosocial stimulation + feeding counselling group and 2) Control group. The peer counselling education and psychosocial stimulation intervention will be delivered to the mothers, by locally recruited and trained peer counsellors, starting in the third trimester of pregnancy until the child is one year of age. The peer counselling education was offered to eligible pregnant women identified by household survey over 2 months in each community cluster in the intervention groups. Using a similar approach to recruitment, a cohort of mother-infant dyads, who received standard maternal and child health care programmes,were identified in the control clusters. Outcome assessments conducted with all the mother-infant pairs recruited in the community clusters in the study, with an expected total of 334 mother-infant dyads. There was a baseline assessment of demographic information and further assessments of growth every 3 months from birth until the children are 12 months of age. The developmental assessments in children will be conducted at 12 months of age.

Sampling scheme A community based randomized controlled trial namely "Mirpur Shishu Pushti Trial" is ongoing in 36 clusters within 4 wards of Mirpur municipality. The average population of a "Ward" is 350,000 people. There are approximately five "Mahallas" per "Ward" with an average population of 70,000 people. The unit of randomization for this trial was city block clusters (CBC) with a population of about 6,000. A list of 36 CBC has already been prepared using established GIS methods to map and census the households. These CBC are being used in the ongoing community trial (Shishu Pusti trial). This ongoing study includes two arms; a peer-counselling (Infant and Young Child Feeding) arm and a control arm and the aims are to assess if the peer-counselling program improves children's growth through an improvement in child-feeding program. In this present study, two stage cluster sampling will be used, at the first stage 10 cluster will be randomly selected from 36 pre-defined clusters under this study area, on the second stage, 5 clusters will be randomly allocated for each of the treatment group. As the duration of the present study is only 18 months, utilization of the same study field along with GIS mapping and population census will allow us to minimize time as well as cost for the current study.

Trained field assistants identified women who were in their third trimester of pregnancy by systematic door-to-door surveys across the "clusters" over two months period. Pregnant women aged 16 to 49 years were included. Women who plan to migrate from the Mirpur area after delivery was excluded.

There will be two types of intervention: one providing breast-feeding and complementary feeding counselling and the other breast-feeding and complementary feeding counselling + psychosocial stimulation interventions. The proposed individual peer counselling education will be of sufficient intensity to alter infant and young child feeding practices and to improve the growth and development of the young children, hence prevent malnutrition and developmental delay. The interventions will be delivered to the women starting in last trimester of pregnancy and until their child is one year of age.

a. Description of intervention