Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: PROMISE EBF: Promoting Infant Health and Nutrition in Sub-Saharan Africa: Safety and Efficacy of Exclusive Breastfeeding Promotion in the Era of HIV
Brief Summary: The objective of the project is to develop and test an intervention to promote exclusive breastfeeding (EBF), to assess its impact on infant health in African contexts where a high prevalence of HIV is a barrier, and to strengthen the evidence base regarding the optimal duration for EBF.

Promotion of EBF is the most effective child health intervention currently feasible for implementation at the population level in low-income countries. It can lower infant mortality by 13%, and by an additional 2% were it not for the fact that breastfeeding transmits HIV. Only recently proven to be possible in hot and even dry climates, EBF without even offering water is still little appreciated by mothers or supported by health workers. EBF rates are especially low in Africa but the potential for rapid implementation may be high. A few studies elsewhere suggest that peer counselling can often achieve dramatic increases. Thus the investigators will run the first randomised trial to develop and test models for applying this approach in four African countries and to quantify health benefits, cost-effectiveness, and implications for the health care system.

While experts realize that the HIV threat ought not to present much of a biological constraint to promoting EBF, in heavily affected countries it does represent a cultural constraint. Overcoming this will require the development of a safe and effective means of promoting EBF that is HIV-sensitive by taking into account the need to minimise postnatal HIV transmission.

Another scientific constraint to the promotion of exclusive breastfeeding for six months, as recommended by the World Health Organization (WHO), is uncertainty about its impact on the micronutrient status of infants. In a substudy, the investigators will carefully follow markers of infant micronutrient status to see how they vary by feeding pattern, including EBF, for a longer period than has been examined previously.


Options:
A: Arm Label: Screening by community health workers; Type: ACTIVE_COMPARATOR; Interventions: Other: Active comparator: Screening by community health workers | Arm Label: Screening by mothers; Type: EXPERIMENTAL; Interventions: Other: Screening by mothers | Intervention Type: OTHER; Name: Screening by mothers; Assigned to Arm(s): Screening by mothers | Intervention Type: OTHER; Name: Active comparator: Screening by community health workers; Assigned to Arm(s): Screening by community health workers
B: Arm Label: Zalewa; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Household model | Arm Label: Ligowe and Magaleta; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Household model | Arm Label: Neno District Hospital and Neno Parish; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Household model | Arm Label: Matope; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Household model | Arm Label: Matandani and Nsambe; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Household model | Arm Label: Luwani, Nkula, and Midzemba; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Household model | Intervention Type: BEHAVIORAL; Name: Household model; Assigned to Arm(s): Ligowe and Magaleta, Luwani, Nkula, and Midzemba, Matandani and Nsambe, Matope, Neno District Hospital and Neno Parish, Zalewa
C: Arm Label: Proactive Community Case Management (ProCCM); Type: EXPERIMENTAL; Interventions: Other: Proactive Community Case Management, Other: Removal of point-of-care user fees, Other: Infrastructure improvements at primary health centre, Other: Training of primary health centre staff | Arm Label: integrated Community Case Management (iCCM); Type: ACTIVE_COMPARATOR; Interventions: Other: Integrated Community Case Management, Other: Removal of point-of-care user fees, Other: Infrastructure improvements at primary health centre, Other: Training of primary health centre staff | Intervention Type: OTHER; Name: Proactive Community Case Management; Assigned to Arm(s): Proactive Community Case Management (ProCCM) | Intervention Type: OTHER; Name: Integrated Community Case Management; Assigned to Arm(s): integrated Community Case Management (iCCM) | Intervention Type: OTHER; Name: Removal of point-of-care user fees; Assigned to Arm(s): Proactive Community Case Management (ProCCM), integrated Community Case Management (iCCM) | Intervention Type: OTHER; Name: Infrastructure improvements at primary health centre; Assigned to Arm(s): Proactive Community Case Management (ProCCM), integrated Community Case Management (iCCM) | Intervention Type: OTHER; Name: Training of primary health centre staff; Assigned to Arm(s): Proactive Community Case Management (ProCCM), integrated Community Case Management (iCCM)
D: Arm Label: Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: Peer-support for exclusive breastfeeding | Arm Label: No intervention; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: Peer-support for exclusive breastfeeding; Assigned to Arm(s): Intervention

Answer: D