Impact of SMS Text Messages to Improve Exclusive Breastfeeding: A Randomized Controlled Trial in Myanmar
Authors: Hmone Myat (Crystal) Pan , Li Mu , Agho Kingsley , Dibley Michael J. 
Published: November 2023

OBJECTIVETo evaluate the impact of a mobile phone SMS text message intervention on the exclusiveness of breastfeeding (EBF) in infants 0–6 months.METHODSA two‐arm parallel randomized controlled trial was conducted by recruiting pregnant women at 24–38 weeks of gestation from antenatal clinics of Central Women's Hospital in Yangon, Myanmar. We hypothesize that the EBF rate at 6 months of age in the intervention group would be double that in the control group. Recruited women were randomized to intervention or control groups according to a computer generated allocation sequence to receive SMS containing either breastfeeding promotional messages or other maternal and child health care messages, from recruitment till postpartum six months. Messages were tailored for gestation in pregnancy and the child's age. The primary outcome is the EBF rate at one to six months of the infants' age and secondary outcomes are median durations of EBF and other infant feeding practices. Baseline data was collected at recruitment and outcomes at monthly calls to both groups by trained phone interviewers who were blinded to the trial aims, hypotheses and respondent's treatment group. Child morbidity and breastfeeding self‐efficacy were assessed at baseline and 1, 3 and 5 months after delivery and social desirability bias was assessed at postpartum 5 months. Outcomes were assessed each month and the prevalence of EBF and other feeding practices were compared between the treatment groups.RESULTS353 women were recruited, with 80% remaining in the trial until 6 months postpartum. No significant differences were found between treatment groups for baseline characteristics such as sociology‐economic status, previous breastfeeding, breastfeeding knowledge and self‐efficacy scales and social desirability bias. The intervention group had significantly higher EBF rate at 1 to 6 months' of age. At 6 months, the intervention group had almost tripled EBF rates (43%) compared to the control group (15%). Women from the intervention group were significantly less likely to introduce complementary foods earlier than those from the control group. However, no significant difference was seen between the two groups for predominant breast feeding. Women from the intervention group also had significantly higher current breastfeeding rates at 4–6 months than the control group. Women from the control group had a significantly higher risk of ceasing breastfeeding at or after 3 months, and to start bottle feeding compared to the intervention group. Women from the intervention group had higher self‐efficacy scores than those from the control group. Infants from the intervention group suffered lower prevalence of diarrhea/dysentery at 3 months and cough at 3 and 5 months compared to the control group.CONCLUSIONOur results show that mobile text messaging is an effective way to promote EBF in Myanmar. Further research is recommended to assess how this kind of model could be replicated in the broader community.Support or Funding InformationThe Sydney Medical School Foundation and Post Gradate Research Support Scheme, Sydney Medical School, University of Sydney, both provide grants for the development of the intervention and conduct of the trial.