Conclusion
The PROMISE-EBF trial showed that breastfeeding counselling by peers was associated with less prelacteal feeding in Burkina Faso and Uganda. More children received colostrum and started breastfeeding early in Uganda which means that in Uganda, mothers might have perceived the “exclusive” and “immediate” message to a large extent. There were substantial country variations, while no clear behaviour change was seen in South Africa. There is a need to understand safe and efficient ways to improve early infant feeding practices and how to create efficient and sustainable strategies for this. Public services and community health workers or peers would need to streamline messages to the pregnant women. This would demand regular health worker refresher training, supervision and remuneration: willingness and resources.