Mobile device based educational support for breast feeding technique in multigravida mothers improved exclusive breast feeding practice during the COVID-19 pandemic -A facility based single-Blind, Parallel-Randomised, Controlled Trial

Background: COVID 19 pandemic disrupted the daily life for pregnant women, and maternity care services. During the lockdown, social isolation rendered one to one support difficult and there has been a rapid switch to the access of the support provided remotely including in the domains of breastfeeding support. We aimed to assess the breastfeeding behaviour following education through a video on breastfeeding techniques using smartphones. Methods: A facility-based randomized controlled trial enrolled 144 multigravida postnatal mothers in a community maternity centre. The Intervention group was educated antenatally with a video on breastfeeding techniques and shared to the mother's smartphone through "Whatsapp application". All mothers received education with ongoing public health programs. Breastfeeding self-confidence assessed by the breastfeeding self-efficacy scale short form (BSES-SF) and breast-feeding technique by Bristol breastfeeding assessment tool (BBAT) was assessed in both groups 24 -48 hours postpartum. Infant feeding practice was recorded telephonically at two, four and six months. Results: BSES-SF scores improved in both groups post-intervention.There was no statistically significant difference in breastfeeding technique assessed by the BBAT, post intervention. In the intervention group, the exclusive breast-feeding (EBF) rates at the end of two, four, and six months were significantly higher and mothers were 2.64 times more likely to exclusively breastfeed. Conclusion: Video-based health education in the peripartum period and self-reinforcement through availability of educational material on their smartphones improved the EBF rate.