Table 3 Lessons learnt

   • Training rural women as peer counsellors for support of exclusive breastfeeding is feasible

   • Introducing an activity in a community can be a long process requiring multiple visits starting with the district down to the lowest level to ensure community involvement. This is important for the community to accept the peer counsellors.

   • It is our impression that completely voluntary work is difficult to maintain in this rural Ugandan setting; discussions on how to compensate the peer counsellors for their time should be part of an exclusive breastfeeding intervention.

The training

   • The trainers should be fluent in the local language in order to explain the concepts in a way that is easily understood by the peer counsellors.

   • The training materials should be suitable for the local needs with appropriate illustrations and visual aids.

   • Peer counsellors need more hands-on practice during training especially on the counselling skills using role-plays and more practice with real mothers during the training than provided in our course.

Follow-up

   • The peer counsellors were able to use the knowledge acquired to help their peers in their communities and were easily accepted by their peers in the communities.

   • For effective support supervision, supervisors need to be dedicated, for instance by being contracted on full time basis and paid.

   • We also assessed the possibility of individual randomization in a larger study but concluded that it would be difficult to randomize individual mothers since they interact with each other and share their breastfeeding experiences; community randomization is probably a more feasible option.