BACKGROUND:
The most effective intervention to reduce child morbidity and mortality both in developed and developing countries is the promotion of optimal breastfeeding practices. Breastfeeding practices are usually affected by influential people in the family, such as the husband. Whether involving the husband in breastfeeding education interventions reduces the episodes of infant morbidities or not is unclear in Ethiopia. This study aimed to evaluate the effect of a couple-based optimal breastfeeding promotion and support interventions on the incidence of child morbidity in central Ethiopia.

METHODS:
A two-arm, parallel, cluster randomized controlled trial was carried out among couples in a community setting in the Hadiya Zone, Central Ethiopia. A total of 408 couples from 16 clusters were randomly assigned to either the intervention group (n = 204) or the control group (n = 204). The intervention arm received breastfeeding education and support interventions, while those in the control arm received existing routine care. A zero-inflated negative binomial regression (ZINB) model was applied to analyze the count data. The incidence rate ratio (IRR) with a 95% CI was used to show independent determinants of child morbidity.

RESULTS:
The study showed that 34.5% of the children were not diseased, while the maximum child morbidity occurred six times (3.53%) over six months. In this trial, the incidence of morbidity was decreased by 92.7% (IRR = 0.073, 95% CI: 0.039 – 0.138, p<0.001) for infants whose parents received optimal breastfeeding promotion and support interventions compared to infants whose mother received routine care during the intervention period. Child morbidity did not show a significant difference by gender, birth weight, or order of birth.

CONCLUSIONS:
Couple-based optimal breastfeeding promotion and support intervention has shown a protective effect against the incidence of child morbidity, highlighting the need to involve the husband in optimal breastfeeding counselling in community settings.