title: Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa: the cluster-randomised PROMISE EBF trial.
abstract: BACKGROUND
  In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities.
  
  
  METHODS
  A total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < -2), stunting (LAZ < -2) and underweight (WAZ < -2) were calculated at each data collection point.
  
  
  RESULTS
  The study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso -0.20 (95% CI -0.39 to -0.01) and in Uganda -0.23 (95% CI -0.43 to -0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95% CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95% CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different.
  
  
  CONCLUSIONS
  There were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00397150.
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway. ingunn.engebretsen@cih.uib.no.
authors.forename: Ingunn Marie Stadskleiv
authors.initials: IM
authors.lastname: Engebretsen
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.forename: Lars Thore
authors.initials: LT
authors.lastname: Fadnes
authors.forename: Victoria
authors.initials: V
authors.lastname: Nankabirwa
authors.forename: Abdoulaye Hama
authors.initials: AH
authors.lastname: Diallo
authors.forename: Tanya
authors.initials: T
authors.lastname: Doherty
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.forename: Sonja
authors.initials: S
authors.lastname: Swanvelder
authors.forename: Jolly
authors.initials: J
authors.lastname: Nankunda
authors.forename: Vundli
authors.initials: V
authors.lastname: Ramokolo
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Henry
authors.initials: H
authors.lastname: Wamani
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
authors.forename: Eva-Charlotte
authors.initials: EC
authors.lastname: Ekström
authors.forename: Philippe
authors.initials: P
authors.lastname: Van de Perre
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskär
mesh_terms: D000328:Adult; D001835:Body Weight; D001942:Breast Feeding / Q000706:statistics & numerical data; D002050:Burkina Faso / Q000453:epidemiology; D002675:Child, Preschool; D003376:Counseling; D005260:Female; D006128:Growth; D006130:Growth Disorders / Q000453:epidemiology / Q000517:prevention & control*; D006293:Health Promotion; D006801:Humans; D007223:Infant; D008297:Male; D010379:Peer Group; D049590:Postpartum Period; D015995:Prevalence; D012111:Residence Characteristics; D013019:South Africa / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology / Q000517:prevention & control*; D014454:Uganda / Q000453:epidemiology; D019282:Wasting Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D015430:Weight Gain; D055815:Young Adult