Strenthening capacity of Frontline Workers/TBAs: a sustainable way to improve Early Breastfeeding Practices

INTRODUCTION: The objective of this operational research was to test whether community volunteers training could be an effective way of improving behaviors and whether it was cost effective to add supervision to the training a in relatively isolated, low-income rural area of Bangladesh.  

METHODS:  The study was randomized by union and a total of 124 villages from 9 unions of three upazilas were included in project. Front line worker from the two intervention areas received a 5-day training course. A baseline and at the end of this project an endline was carried out in both intervention and control areas among mothers of children aged 0-5 months using a similar questionnaire.

RESULTS: The proportion initiating breastfeeding within one hour increased greatly in both intervention groups between end line and baseline. The practice of offering prelacteal feeds declined in all three areas but training decreased it more and supervision more still. Exclusive breastfeeding (among children <3 months of age) was also increased, though similarly in the Intervention 1 and Intervention 2 areas. The proportion of mothers who had heard about skin-to-skin contact between mother and child after delivery increased dramatically from 10% to 68.6% in Intervention 1 and from 11.8% to 61.5% in Intervention 2, while there was only a marginal 8% increase in the control group. Adding the cost of employing a supervisor more than doubled the cost of the intervention and also increased impact but not cost effective.  

CONCLUSIONS: While further research is needed on a larger scale, this study already provides evidence adequate to argue that TBAs in rural Bangladesh should be provided with a modified training course on IYCF issues and they can make substantial influence over practices.