title: A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial.
abstract: BACKGROUND
  Breastfeeding has countless benefits to mothers, children and community at large, especially in developing countries. Studies from Lebanon report disappointingly low breastfeeding exclusivity and continuation rates. Evidence reveals that antenatal breastfeeding education, professional lactation support, and peer lay support are individually effective at increasing breastfeeding duration and exclusivity, particularly in low-income settings. Given the complex nature of the breastfeeding ecosystem and its barriers in Lebanon, we hypothesize that a complex breastfeeding support intervention, which is centered on the three components mentioned above, would significantly increase breastfeeding rates.
  
  
  METHODS
  A multi-center randomized controlled trial.
  
  
  METHODS
  443 healthy pregnant women in their first trimester will be randomized to control or intervention group.
  
  
  METHODS
  A "prenatal/postnatal" professional and peer breastfeeding support package continuing till 6 months postpartum, guided by the Social Network and Social Support Theory. Control group will receive standard prenatal and postnatal care. Mothers will be followed up from early pregnancy till five years after delivery.
  
  
  METHODS
  Total and exclusive breastfeeding rates, quality of life at 1, 3 and 6 months postpartum, maternal breastfeeding knowledge and attitudes at 6 months postpartum, maternal exclusive breastfeeding rates of future infants up to five years from baseline, cost-benefit and cost-effectiveness analyses of the intervention.
  
  
  METHODS
  Descriptive and regression analysis will be conducted under the intention to treat basis using the most recent version of SPSS.
  
  
  CONCLUSIONS
  Exclusive breastfeeding is a cost-effective public health measure that has a significant impact on infant morbidity and mortality. In a country with limited healthcare resources like Lebanon, developing an effective breastfeeding promotion and support intervention that is easily replicated across various settings becomes a priority. If positive, the results of this study would provide a generalizable model to bolster breastfeeding promotion efforts and contribute to improved child health in Lebanon and the Middle East and North Africa (MENA) region.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN17875591.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon. mn04@aub.edu.lb.
authors.forename: Mona
authors.initials: M
authors.lastname: Nabulsi
authors.forename: Haya
authors.initials: H
authors.lastname: Hamadeh
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.forename: Tamar
authors.initials: T
authors.lastname: Kabakian
authors.forename: Lama
authors.initials: L
authors.lastname: Charafeddine
authors.forename: Nadine
authors.initials: N
authors.lastname: Yehya
authors.forename: Durriyah
authors.initials: D
authors.lastname: Sinno
authors.forename: Saadieh
authors.initials: S
authors.lastname: Sidani
mesh_terms: D000352:Africa, Northern; D001942:Breast Feeding; D003906:Developing Countries; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007861:Lebanon; D049590:Postpartum Period; D011247:Pregnancy; D011788:Quality of Life; D012944:Social Support