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Peer Counselling as an Approach to Improve Complementary Feeding Practices in Low- and Middle-Income Countries

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posted on 2024-02-19, 01:18 authored by Nabila Binte Haque

In many studies, counselling intervention has shown to be effective in improving infant and young child feeding practices (IYCF). But few studies have examined the effect of peer-counselling intervention to improve complementary feeding practices using the local community members as peer counsellors.

This thesis combined two study types: a narrative review in Chapter 3 and a cross-sectional study in Chapter 4. Both these studies have been prepared as independent publications and the thesis is written according to Macquarie University’s thesis by publication guidelines.

The aim of the narrative review was to determine the efficacy of different peer-counselling and peer support interventions to improve complementary feeding practices through evidence in existing literature. We found six studies and evaluated complementary feeding practices along with some additional indicators in children aged 5–24 months. Previously, many studies have focused on peer-counselling interventions to improve breastfeeding practices and used community health workers to deliver the counselling. Only a few studies have been conducted with community-based peer counselling using people from the local community that has been used for complementary feeding. The review of the six studies revealed different peer counselling techniques were used in different contexts, including various methodologies and implementation strategies. We also gained an understanding about child feeding practices and knowledge among the mothers from different countries. The outcome of the narrative review found effectiveness of peer counselling to improve breastfeeding and complementary feeding practices according to guidelines.

The aim of the cross-sectional study was to assess the effectiveness of a peer-counselling intervention using local women as peer counsellors to improve complementary feeding practices in children aged 6–12 months. The selected intervention areas were in Bangladesh: Badda, a lower middle-class area in Dhaka city, and Anowara, a subdistrict in Chattogram division. The study was a community-based cross-sectional survey at the end of a longitudinal project. The survey helped to compare the practices of mothers in the intervention and comparison areas with respect to appropriate complementary feeding practices. Quantitative results were analysed using descriptive statistics. The study results showed significant improvement in complementary feeding practices among children in intervention areas with regard to timely onset of complementary feeding, minimum meal frequency, minimum dietary diversity and minimum acceptable diet along with some other indicators such as meal consistency, animal food consumption or continuation of breastfeeding. The study provided further evidence in support of community-based peer counselling to improve complementary feeding practices in an effective and sustainable way. 

The thesis demonstrates the need for designing more behavioural interventions, using peer-counsellors, and to scale up peer-counselling interventions, which can help improve both breastfeeding and complementary feeding practices in children, especially in low- and middle-income countries. Further research maybe needed, especially to improve peer-counselling techniques and for ensuring larger coverage and sustainability.


Table of Contents

Chapter 1. General background -- Chapter 2. Thesis structure -- Chapter 3. Narrative review -- Chapter 4. A cross-sectional study -- Chapter 5. General discussion and conclusion

Awarding Institution

Macquarie University

Degree Type

Thesis MRes


Mater of Research

Department, Centre or School

Department of Health Sciences

Year of Award


Principal Supervisor

Seema Mihrshahi

Additional Supervisor 1

Rukhsana Haider Ma’am


Copyright: The Author Copyright disclaimer:




85 pages

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