Assessing Cost and Effectiveness of Training and Supervision of Front Line Workers on Early Breastfeeding Practices

Study Overview
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Brief Summary
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The aim of this operational research is to compare the cost-effectiveness of two methods for capacity building of existing TBAs/CVs to improve rates of delayed cord clamping, early skin to skin contact and infant-led initiation of breastfeeding, to reduce prelacteal feeding and increase early exclusive breastfeeding in research areas of rural Bangladesh.

Detailed Description
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Suboptimal early infant feeding practices are the norm in Bangladesh, and contribute to its poor infant health and nutrition. However, the modern health services are unable to help because approximately 85% of births take place at home. The Government has begun the huge process of training the informal community traditional birth attendants (TBAs) who, along with community volunteers (CVs), deliver the majority of babies, especially in the rural areas. The proposed operations research will take place in one of the poorest rural districts. It will compare the cost effectiveness of practical training of these relatively uneducated community members, with or without supportive supervision in improving early infant feeding practices, using a cluster-randomized study design. The practices to be measured before and after on probability samples include: 1) delayed cord clamping, 2) early skin to skin contact and 3) newborn-led initiation of breastfeeding within one hour of birth, 4) avoidance of the traditional prelacteal feeds, and 5) exclusive breastfeeding, at least for the early months. Costs will be carefully monitored so as to compare the cost per behavior improved per infant.

Official Title
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Assessing the Cost and Effectiveness of Training and Supervision of Front Line Workers on Early Breastfeeding Practices (Bangladesh)

Conditions
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Malnutrition

Intervention / Treatment
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* Behavioral: Improve Early Breastfeeding


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Lactating women of children ages 0 to 5 months and pregnant women with second and third trimester Exclusion Criteria: First trimester women and lactating women of children ages 6 to 23 months.

Ages Eligible for Study
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Minimum Age: 1 Day
Maximum Age: 5 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Only training<br>Training on Early Breastfeeding Practices to front line health workers | Behavioral: Improve Early Breastfeeding<br>* One arm got only training, another arm training and supervision and third arm without any intervention as control.<br>* Other names: IYCFCH;|
| Active Comparator: Training and supervision<br>Training as well as supervision by field supervisor for six months intervention | Behavioral: Improve Early Breastfeeding<br>* One arm got only training, another arm training and supervision and third arm without any intervention as control.<br>* Other names: IYCFCH;|
| No Intervention: Control<br>No intervention such as training or supervision | Behavioral: Improve Early Breastfeeding<br>* One arm got only training, another arm training and supervision and third arm without any intervention as control.<br>* Other names: IYCFCH;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Increased proportions of mothers who follow the recommended infant feeding behaviors | Practice related to early breastfeeding and cord clumping | six months intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improve practice on breastfeeding, early initiation and cord clumping . | Evaluation studies are carried out before and after six months of intervention | six months intervention | 
| Improved capacity of TBAs on breastfeeding counseling and knowledge. | Increase capacity of TBAs on breastfeeding counseling and knowledge. | Six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exclusive Breastfeeding, Skin to skin contact, Cord Clumping, Prelactial feeding