Effect of women’s groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trial

Lewycka S, Mwansambo C, Rosato M, Kazembe P, Phiri T, Mganga A, Chapota H, Malamba F, Kainja E, Newell ML, Greco G, Pulkki-Brännström AM, Skordis-Worrall J, Vergnano S, Osrin D, Costello A

This study assessed the effect of women’s groups and peer counselors on mortality and breastfeeding rates in rural Malawi.

The investigators conducted a 2×2 factorial, cluster-randomised trial in 185,888 people in Mchinji district. 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems. 72 trained volunteer peer counsellors made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care. Primary outcomes for the women’s group intervention were maternal, perinatal, neonatal, and infant mortality rates (MMR, PMR, NMR, and IMR, respectively); and for the peer counselling were IMR and exclusive breastfeeding (EBF) rates. Analysis was by intention to treat. They monitored outcomes of 26,262 births between 2005 and 2009.

In the anaylsis, the authors found that in areas without women’s groups, where volunteer peer counsellors advised mothers about feeding and infant care, infant mortality rate fell by 36%, and overall infant morbidity by 42%. Exclusive breastfeeding rates increased more than two times, but after stratification the effect was only significant in areas with women’s group intervention. Both interventions were highly cost effective, averting 1 YLL for less than the per head gross domestic product of Malawi.

Lancet; May 2013 [Full Abstract]