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Efficacy of a Mobile Health App in Promoting Breastfeeding and Young Child Feeding Practices in Pakistan: Protocol
Rozina Nuruddin1, Rehama Iqbal2, Nuruddin Mohammed3
1Department of Community Health Sciences, Medical College, Aga Khan University, Stadium Road, Karachi, Sindh, 74800, Pakistan, 92 21 3486 483, 92 21 3493 4294.
Insights
This study evaluated a mobile health (mHealth) app to improve infant feeding practices in Pakistan. The Pehli Ghiza app, combined with standard care, aims to enhance exclusive breastfeeding and complementary feeding compared to standard care alone.
Area of Science:
- Public Health
- Digital Health Interventions
- Maternal and Child Nutrition
Background:
- Pakistan faces high under-5 mortality rates linked to malnutrition, including stunting, underweight, and wasting.
- Suboptimal exclusive breastfeeding (EBF) rates (48%) and very low minimum acceptable diet consumption (3.6%) highlight critical nutritional risks in early life.
- Mobile health (mHealth) offers a promising, low-cost strategy to improve infant and young child feeding practices (IYCFPs).
Purpose of the Study:
- To assess the effectiveness of a tailored mHealth coaching app ('Pehli Ghiza') in promoting EBF and IYCFPs.
- To compare the mHealth app intervention against traditional face-to-face (F2F) counseling for improving infant feeding.
Main Methods:
- A prospective, parallel-arm randomized controlled trial involving 300 pregnant women in Karachi, Pakistan.
- Intervention group received the 'Pehli Ghiza' mHealth app (educational content via videos/messages) plus standard F2F counseling.
- Control group received only standard F2F counseling; primary outcomes include EBF and timely introduction of complementary feeding.
Main Results:
- Participant recruitment began February 2, 2026, with 241 enrolled by May 18, 2026.
- Follow-up and outcome assessments are scheduled for completion by June 2027.
- Analysis will use intention-to-treat principles to determine a 20% absolute improvement in primary outcomes.
Conclusions:
- The 'Pehli Ghiza' mHealth intervention has the potential to significantly improve infant and young child feeding practices.
- Successful implementation could facilitate the integration of digital health tools into routine healthcare in Pakistan.
- This approach may offer a scalable model for similar low- and middle-income country settings facing nutritional challenges.
Background:
In Pakistan, one-third of under-5 deaths (58/1000 live births) are attributable to the high prevalence of stunting (40%), underweight (23%), and wasting (17.7%). Given the suboptimal prevalence of exclusive breastfeeding (EBF; 48%) and the alarmingly low consumption of a minimum acceptable diet (3.6%), mitigation of early-life nutritional risk provides a critical window of opportunity for intervention. Mobile health (mHealth) provides an innovative and low-cost option to improve infant and young child feeding practices (IYCFPs) among mothers.
Objective:
This study aims to assess the efficacy of a context-specific mHealth coaching app in promoting EBF and IYCFPs compared to face-to-face (F2F) counseling.
Methods:
This is a prospective, parallel-arm randomized controlled trial planned at a secondary care hospital in Karachi, Pakistan. The study will enroll 300 booked singleton pregnant women in the third trimester, who plan to stay in their respective areas for at least 1 year postdelivery, are registered for child immunization at the associated Family Health Center, own smartphones with internet access, are able to read Urdu, and provide consent. Participants in the intervention arm will receive the Pehli Ghiza mHealth app along with routine standard-of-care F2F counseling. The app will deliver context-specific educational content on breastfeeding and IYCFPs through short videos and messages sent 3 times per week, tailored to the stage of pregnancy and infant age. Participants in the control arm will receive only routine F2F counseling. The standard of care will be delivered at each follow-up visit, which is scheduled at birth, at 6, 10, and 14 weeks, and at 6, 9, and 12 months of the infant's age. Data will be collected at enrollment and at each follow-up visit using structured questionnaires. Primary outcomes are EBF and the introduction of age-appropriate complementary feeding. Secondary outcomes include early initiation of breastfeeding, continued breastfeeding at 1 year, minimum dietary diversity, meal frequency, minimum acceptable diet, and child health outcomes. Analysis will follow the intention-to-treat principle to detect a 20% absolute improvement in primary outcomes between the intervention and control groups over time and to evaluate between-group differences in feeding practices. Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit.
Results:
The study was approved by the Ethics Review Committee of the Aga Khan University and the National Ethics Committee. Participant recruitment started on February 2, 2026. As of May 18, 2026, 241 participants have been recruited. Follow-ups and outcome assessments are expected to be completed by June 2027.
Conclusions:
If effective, the Pehli Ghiza intervention could support the integration of digital health tools into standard of care in Pakistan and similar low- and middle-income country settings.
