Effect of distribution of educational material to mothers on duration and severity of diarrhoea and pneumonia, Midlands Province, Zimbabwe: A cluster randomized controlled trial

Background: Exclusive breastfeeding rates remain low in most countries in sub-Saharan Africa. We assessed the effects of a mother-based intervention on duration of diarrhoea and pneumonia in communities that were trained and those not trained in community infant and young child feeding (cIYCF) in Midlands Province, Zimbabwe. Methods: We evaluated communities with village health workers who received training in cIYCF and the distribution of educational materials (newsletter) to mothers in promotion of exclusive breastfeeding using a two-by-two factorial cluster randomized controlled trial. The trial arms included clusters trained in cIYCF only, clusters with mothers that received a newsletter only, clusters that received both interventions and clusters receiving no intervention. Consenting mother-infant pairs identified within 72 hours of delivery were followed up at 14 and 20 weeks where duration of diarrhoea and pneumonia as well as severity of diarrhoea was assessed. Clusters were facility catchment areas assigned by an independent statistician using randomization generated by a computer using Stata 10. All admitting facilities and facilities at borders were excluded as buffer zones and eight clusters were analysed. Nutritionists who collected data were not aware of the hypothesis being tested and analysis was by intention-to-treat. Results: A total of 357 mother-infant pairs were available for analysis in all the clusters. The interaction between cIYCF training and the newsletter was statistically significant at 14 weeks (p = 0.022). The mean duration of diarrhoea was 2.9 (SD = 0.9) days among infants of mothers who resided in communities trained and received a newsletter compared to 5.2 (SD = 1.1) days in communities that received neither. The protective efficacy of the cIYCF plus newsletter was 76% during the first 20 weeks of life. In the two way ANOVA, the newsletter was more effective on duration of pneumonia (p = 0.010) at 14 weeks and remained significantly effective at 20 weeks (p < 0.0001). Conclusions: A combined community and distribution of a newsletter to mothers on promotion of exclusive breastfeeding reduces duration of diarrhoea at 14 weeks. At 20 weeks, the newsletter worked better for both duration of diarrhoea and pneumonia compared to cIYCF training alone.