Improving infant and young child feeding practices: Assessing the effectiveness of breastfeeding promotion program (randomized controlled trial) using mobile phone as a communications tools in Yangon and nearby regions, Myanmar.

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Myanmar has high under –five and infant mortality rates with 56 and 50 per 1,000 live births (MICS, 2010). Under nutrition is a major cause of under-five children deaths and to practice correct infant and young child feeding (IYCF) practices is important for better nutrition outcomes. Although 76 per cent of newborns have timely initiation of breastfeeding within 1 hour after birth, only 24 percent of infants in Myanmar are exclusively breastfeed, and Myanmar has 3rd lowest exclusive breastfeeding rate in Asia-Pacific region. Scientific study and well cited literature evidences prove that appropriate exclusive breast and complementary feeding practices with high coverage could save millions of children’s lives. It is important to understand the underlying socio-economic and cultural values of pregnant women if we really want to narrow down the knowledge and practice gap and we conducted a formative study prior to RCT intervention and findings have been incorporated into the design of RCT. The research aims to implement a breastfeeding promotion intervention using mobile phones as a communication tool & will conduct at the largest public women’s hospital in Yangon. There is no published randomized controlled trial intervention using mobile phone to promote exclusive breast feeding practices in Myanmar. This study could not be realistic two years ago where possession of mobile phone is considered a luxury asset. The study will be the first study conducted in Myanmar using mobile phone as a communications tools in health promotion intervention program and we design the study in line with changing socio- economics and political situations in Myanmar as mobile phone prices in the country have plunged from $1,000 in 2011 to $15 in 2014-15. The study has received official ethical approval from Myanmar ethical review committee and approval letter from Department of Health. The study aims to collect high quality evidence about whether or not a mobile phone communications package that promotes appropriate breastfeeding practices, starting in late pregnancy and continuing till the child is six months of age will: Increase the rate of exclusive breastfeeding in the first 6 months of life, increase the duration of exclusive breastfeeding and the rate of early initiation of breastfeeding, reduce the rate of bottle feeding and early introduction of semi-solid foods. Our primary hypothesis is the percentage of women from the intervention group exclusively breastfeeding their infants in their sixth month of life will be doubled compared to the control group receiving usual programs. Our secondary hypotheses will be: women in the intervention group will have a higher rate of early initiation of breastfeeding, an increased median duration of exclusive breastfeeding, a decreased rate of bottle feeding, & a decreased rate of children receiving early introduction of solid, semi-solid or soft foods. The primary outcome will be exclusive breastfeeding rate of women during the sixth month after delivery. The secondary outcomes will be early initiation of breastfeeding rate within 1 hour after birth, exclusive breastfeeding rate at one and three months after delivery, median duration of exclusive breastfeeding rate, predominant and other type of breastfeeding rates at one, three, five and six months after delivery, rate of infant receiving bottle feeding at one, three , five and six months , rate of children receiving early introduction of solid, semi-solid or soft foods at one, three, five and six months and proportion of women in intervention group satisfying use of mobile phone as a communication tools to receive breastfeeding promotional messages. We will recruit pregnant women in their 3rd trimester and follow- up till child reach 6 months of age. We will collect baseline questionnaires such as socio-economics, past breastfeeding history, breastfeeding knowledge, intention and confidence, and self-efficiency scale by using tablet. We will have two groups called intervention and control groups where former group will receive breast feeding related health promotional messages via SMS ( short message services) and the latter group will receive non-breastfeeding related health promotional messages and message contents will be more on mother and child health care. Intervention group will receive reminder phone calls at 1, 3 and 5 months after delivery and during phone calls, will provide women to have an opportunity to discuss their challenges. Outcomes will be measured at 1,3 , 5 and 6 months after delivery to both groups based on which outcome we would like to measure. The study is called ‘M528 project’ where ‘M’ refers to mobile phone or mother and ‘528’stands for the bonding between mother and baby in Myanmar culture. After the study outcomes will be measured between two groups and we expect to scale up the mentioned study design in future, not limited to breastfeeding promotion alone.