Breastfeeding Interpersonal Communication, Mobile Phone Support, and Mass Media Messaging Increase Exclusive Breastfeeding at 6 and 24 Weeks Among Clients of Private Health Facilities in Lagos, Nigeria

Inequalities in large-scale breastfeeding programmes in Bangladesh, Burkina Faso and Vietnam

Inequalities in breastfeeding programmes and practices have slowed global progress in providing the life-saving protection of breastfeeding for millions of infants despite well-known life-long impacts. As breastfeeding interventions are scaled up, inequalities in coverage and breastfeeding practices should be tracked, particularly in disadvantaged groups, who are likely to suffer the most serious health and developmental impacts of poor childhood nutrition. The literature provides evidence of inequalities in breastfeeding practices, but research is limited on socioeconomic disparities in the coverage of breastfeeding interventions. This paper (1) compares inequalities in breastfeeding practices in intervention and nonintervention areas and (2) documents inequalities in programme coverage by type of intervention. We disaggregated endline evaluation surveys in Bangladesh, Burkina Faso and Vietnam, where rigorous evaluations had documented significant overall improvements, and analysed whether inequalities in breastfeeding practices and programme coverage differed by treatment areas. We used Erreygers index to quantify inequalities and found that breastfeeding practices were largely pro-poor; intervention coverage was not consistently pro-poor. While counselling coverage often favoured women from the poorest quintile, public education/media coverage consistently favoured better-off women. Inequalities favoured more educated mothers in the coverage of combined interventions. None of the programmes had explicit equality objectives. The results indicate the need for introducing specific actions to reduce inequalities in breastfeeding policies and programmes. This is a priority unfinished agenda for nutrition programming.

Assessing the effect of mHealth on child feeding practice in African countries: systematic and meta-analysis

INTRODUCTION

Poor child feeding practice is a public health problem in Africa. Mobile health (mHealth) is a supportive intervention to improve this problem; however, the evidence available in the current literature is inconsistent and inconclusive in Africa. Some studies state that exclusive breastfeeding is not different between controls and mHealth interventions in the first month. Other studies state that health providers need additional training for the success of mHealth interventions.

OBJECTIVE

This systematic review and meta-analysis aims to provide the summarized effect of mHealth on child-feeding practices in Africa to improve future planning and decisions.

METHOD

We conducted a systematic review and meta-analysis based on the published and unpublished evidence gathered from PubMed, Web of Science, Cochrane Library, and Embase databases between January 1, 2000, and March 1, 2022. Studies included were randomized control trials and experimental studies that compared mHealth to standards of care among postpartum women. Preferred Reporting Items for Systematic Review and Meta-analysis guidelines followed for the reporting.

RESULTS

After screening 1188 studies, we identified six studies that fulfilled the study criteria. These studies had 2913 participants with the number of total intervention groups 1627 [1627/2913 = 56%]. Five studies were completed within 24 weeks while one required 12 weeks. We included two RCTs, two cluster RCTs, and two quasi-experimental studies all used mHealth as the major intervention and usual care as controls. We found significant improvement in child-feeding practices among intervention groups.

CONCLUSION

This systematic review and meta-analysis showed that the application of mHealth improved child-feeding practices in Africa. Although the finding is compelling, the authors recommend high-quality studies and mHealth interventions that consider sample size, design, regional differences, and environmental constraints to enhance policy decisions. The place of residence, access, low socioeconomic development, poor socio-demographic characteristics, low women empowerment, and low women's education might cause high heterogeneity in the included regions and need consideration during interventions.

REGISTRATION NUMBER

PROSPERO: CRD42022346950.

Continuous Lactation Support Provided Through the WhatsApp Messaging Application: A Randomized Controlled Trial

BACKGROUND

Although WhatsApp can be used to provide continuous lactation support, there are few studies on this subject.

RESEARCH AIMS

To determine the influence of lactation support provided through WhatsApp on the duration and exclusivity of breastfeeding, initiation of complementary feeding, breastfeeding problems, breastfeeding difficulties score, and the use of bottles and pacifiers.

METHODS

We conducted a randomized controlled trial assessing the efficacy of education and support provided through the cell phone based WhatsApp application. There were 129 primiparous participants recruited while attending a Baby-Friendly Hospital in Istanbul, Turkey. Participants were randomized to intervention (n = 64) and control (n = 65) groups. All participants received the same routine postpartum breastfeeding education in the hospital, and the intervention group received additional continuous breastfeeding education for 6 months. For both groups, data was collected by telephone interview on Days 7 and 15, and Months 1, 2, 4, and 6 months. T-tests were used to assess inter-group differences in duration of exclusivity of breastfeeding. Mixed-model ANOVA was used to compare breastfeeding difficulties scores. Chi-square tests were used to compare breastfeeding problems, feeding practices, and the proportion of the use of bottles and pacifiers.

RESULTS

The mean duration of exclusive breastfeeding for groups receiving breastfeeding support was higher (4.75, SD = 1.72) than that of the control group (2.21, SD = 1.98; p = 0.001). The change in the mean breastfeeding difficulties severity score between the initial and final measurements (17.03, SD = 8.66) was more in the intervention group than the control group (11.42, SD = 10.34, F = 4.081, p = 0.001). The proportion of exclusive breastfeeding in the 6th month was higher in the intervention group (62.5%) than in the control group (10.8%; p = 0.001).

CONCLUSIONS

The use of cellphone applications are accessible to both patients and health workers and offer a low-cost alternative for providing uninterrupted breastfeeding support.

Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive

Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self-efficacy and shift social norms. The initiative used data for design and evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of children and use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messages and employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencers and mass media campaign development, which governments and other implementers can adapt and replicate.

A systematic review of health communication strategies in Sub-Saharan Africa-2015-2022

Background: Health communication strategies have become critical in managing public health issues across sub-Saharan Africa. In the literature, health communication strategies have been well documented. The studies are often narrow, focusing on individual countries or specific health issues. No research documented and consolidated the health communication strategies across sub-Saharan Africa. This review attempts to catalogue prevalent health communication strategies, how the various countries have implemented these strategies and the barriers to effective health communication practices in Africa. Methods: We systematically reviewed existing literature on health communication strategies in sub-Saharan Africa to answer formulated questions. A Google search was performed in October 2022 with the keywords 'health communication', 'strategies', 'promotion,' 'education,' and 'engagement,' The data reported in this article included evidence published between 2013 and 2023. Selected documents were content analyzed, and significant sections were mapped against specific strategies/themes. These subsets of data were used to present the results and analysis. Results:The review indicates that different health communication strategies have been deployed across Africa. In some countries, specific strategies are used to tackle specific health issues, while a combination of strategies is used in others. In some countries, the strategies are unclear, and implementation is improvised, sometimes misapplied, or truncated by bureaucratic red tape and incompetence. The prevalent strategies are mainly those prescribed from outside with little input from the beneficiaries. Conclusion: The review suggests that using a holistic or multi-pronged health communication approach that is context-specific and participatory could attract more uptakes of health messages.

Tailored text messages to improve breastfeeding practices in Yangon, Myanmar: the M528 individually randomized controlled trial

BACKGROUND

Text messages are a feasible delivery channel for breastfeeding promotion, but only a few articles have examined their effectiveness.

OBJECTIVE

To evaluate the impact of mobile phone text messages on breastfeeding practices.

DESIGN

We implemented a 2-arm, parallel, individually randomized controlled trial with 353 pregnant participants at the Central Women's Hospital, Yangon. The intervention group (n = 179) received breastfeeding-promotion text messages, and the control group (n = 174) received other maternal and child health care messages. The primary outcome was the exclusive breastfeeding rate at 1-6 mo postpartum. Secondary outcomes were other breastfeeding indicators, breastfeeding self-efficacy, and child morbidity. Using the intention-to-treat approach, the available outcome data were analyzed with generalized estimation equation Poisson regression models to estimate RR and 95% CIs, adjusted for within-person correlation and time, and tested for treatment group-by-time interactions.

RESULTS

Exclusive breastfeeding prevalence was significantly higher in the intervention than in the control group for the 6 follow-up visits combined (RR: 1.48; 95%CI: 1.35, 1.63; P < 0.001) and at each monthly follow-up visit. At 6 mo, exclusive breastfeeding was 43.4% in the intervention compared with 15.3% in the control group (RR: 2.74; 95%CI: 1.79, 4.19; P < 0.001). Also, at 6 mo, the intervention increased current breastfeeding (RR: 1.17; 95%CI: 1.07, 1.26; P < 0.001) and reduced bottle feeding (RR: 0.30; 95%CI: 0.17, 0.54; P < 0.001). Exclusive breastfeeding was progressively higher in the intervention group than in the control group at each follow-up (P for interaction < 0.001) and similarly for current breastfeeding. The intervention increased the mean breastfeeding self-efficacy score (adjusted mean difference 4.0; 95%CI: 1.36, 6.64; P = 0.030). Over the 6-month follow-up, the intervention significantly reduced diarrhea risk by 55% (RR: 0.45; 95%CI: 0.24, 0.82; P < 0.009).

CONCLUSIONS

Regular, targeted text messages delivered to urban pregnant women and mothers via mobile phones significantly improve breastfeeding practices and reduce infant morbidity during the first 6 mo of life.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12615000063516; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367704.

The Financial Costs of Mass Media Interventions Used for Improving Breastfeeding Practices in Bangladesh, Burkina Faso, Nigeria, and Vietnam

Breastfeeding is essential for child survival but globally less than fifty percent of infants receive adequate breastfeeding. Gaps in breastfeeding knowledge and misinformation are widespread. Mass media aims to motivate mothers and families, encourage care-seeking, improve social norms, and counteract misleading advertising. However, the costs and coverage of mass media are not well documented. Our study provides a cost-accounting of four large-scale mass media interventions and coverage obtained through mass media. We retrospectively calculated annual costs and costs per beneficiary of mass media interventions based on expenditure records in four countries. The interventions were a part of multi-component breastfeeding strategies in Bangladesh, Burkina Faso, Nigeria, and Vietnam. Annual costs ranged from 566,366 USD in Nigeria to 1,210,286 USD in Vietnam. The number of mothers of children under two years and pregnant women ranged from 685,257 to 5,566,882, and all designated recipients reached during the life of programs ranged from 1,439,040 to 11,690,453 in Burkina Faso and Bangladesh, respectively. The cost per mother varied from USD 0.13 USD in Bangladesh to 0.85 USD in Burkina Faso. Evaluations showed that mass media interventions reached high coverage and frequent exposure. This analysis documents the financial costs and budgetary needs for implementing mass media components of large-scale breastfeeding programs. It provides annual costs, cost structures, and coverage achieved through mass media interventions in four low- and middle-income countries.