title: Effects of an exclusive breastfeeding intervention for six months on growth patterns of 4-5 year old children in Uganda: the cluster-randomised PROMISE EBF trial.
abstract: Breastfeeding promotion is regarded as one of the most effective interventions to improve child health, and could reduce under-5-mortality by 8 % globally. Few studies have assessed the health outcomes beyond infancy of interventions promoting exclusive breastfeeding.
  
  
  
  This study assessed growth in under-five children who participated in a cluster-randomised trial in Eastern Uganda (ClinicalTrials.gov.no.NCT00397150). In the intervention arm, peer counsellors promoted exclusive breastfeeding during the first 6 months of infancy. There were no interventions after 6 months of age. Mother-infant pairs were interviewed at visits scheduled at 3, 6, 12 and 24 weeks after birth and follow-up visits at 2 and 5 years, with 765 included in the analyses.
  
  
  
  The mean length/height-for-age and weight-for-age-z-score (HAZ, WAZ) decreased with increasing age in both the intervention and control arms. At the three weeks visit, HAZ in the intervention was -0.45 (-0.68;-0.21) and -0.32 (-0.56;-0.07) in the control arm. At the 2 year follow-up, the mean HAZ in the intervention was -1.85 (95 % CI -1.97;-1.73) compared to -1.61 (-1.87;-1.34) in the control. Similarly, at the 5 year follow-up, the mean HAZ in the intervention was -1.78 (-2.08;-1.47) compared to -1.53 (-1.79;-1.28) in the control arm. At the 2 year follow-up visit, 139 (45 %) were stunted (HAZ<-2) in the intervention compared to 109 (37 %) in the control arm, odds ratio (OR) 1.7 (1.1;2.4). Underweight (WAZ<-2) was also more common in the intervention arm than in the control at the five years follow-up (OR 1.7 (1.0;2.8)), with a mean WAZ of -1.28 (-1.47;-1.08) and -1.06 (-1.19;-0.92) in the intervention and control arm, respectively.
  
  
  
  While stunting was widespread at 2 and 5 years of age in both arms, it was more common in the intervention arm. It is questionable whether community-based support from lay people with short training and focussing only on exclusive breastfeeding, is an appropriate strategy to improve child health and development.
  
  
  
  ClinicalTrials.gov.no. NCT00397150 . Registered 7th of November 2006.
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway. lars.fadnes@cih.uib.no.|Department of Clinical Dentistry, University of Bergen, Bergen, Norway. lars.fadnes@cih.uib.no.
authors.forename: Lars T
authors.initials: LT
authors.lastname: Fadnes
authors.affiliation: Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.|Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
authors.forename: Victoria
authors.initials: V
authors.lastname: Nankabirwa
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway.
authors.forename: Ingunn M
authors.initials: IM
authors.lastname: Engebretsen
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway.|Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.|Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.affiliation: Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Nancy
authors.initials: N
authors.lastname: Birungi
authors.affiliation: Medical Research Council, Cape Town, Francie Van Zyl Drive, 7535, South Africa.
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.affiliation: Medical Research Council, Cape Town, Francie Van Zyl Drive, 7535, South Africa.
authors.forename: Sonja
authors.initials: S
authors.lastname: Swanevelder
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway.
authors.forename: Jan
authors.initials: J
authors.lastname: Van den Broeck
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, 5020, Bergen, Norway.
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskär
authors.affiliation: Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
mesh_terms: D001835:Body Weight; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D009035:Mothers; D014454:Uganda; D019282:Wasting Syndrome / Q000517:prevention & control*; D015430:Weight Gain
keywords: Anthropometry; Exclusive breastfeeding; Growth; Peer-counselling; Uganda