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Hasen H, Kusheta S, Abuhay E, Tumiso H, Leuel Y, Daniel D, Amare M, Samuel A, Habtu Y. Baby-friendly workplace initiatives in child feeding practice as predictors of infant and young child anthropometric indices in public health facilities of Southern Ethiopia. BMC Nutr 2024; 10:54. [PMID: 38566148 PMCID: PMC10988947 DOI: 10.1186/s40795-024-00862-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Baby-friendly workplace is an effective evidence based initiative developed by the World Health Organization to protect and support maternal knowledge, beliefs, and confidence in infant and young child feeding practices. However, studies that show the effect of the baby-friendly workplace initiative on the nutritional status of infant and young children are not available in Ethiopia. Therefore, this study aimed to assess the nutritional status among baby friendly initiatives service utlizers and non utlizers children age 6-24 months in public health facilities of Southern Ethiopia. METHODS We conducted a comparative cross-sectional study from 1 to 30 June 2022 among 220 mothers with children aged 6-24 months. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into Epidata Software version 4.2 and then exported to IBM SPSS version 26 software for analysis. Chi-square and Fisher exact test were used to assess the differences between users and non-users of the baby friendly workplace initiative. Logistic regression model was used to determine the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval was computed. P-values < 0.05 at a 95% confidence level were considered statistically significant. RESULT The mean (SD) scores of weight for age (WAZ), height for age (HAZ), and weight for height (WHZ) were - 0.38 (1.34),-0.17(2.62) and-0.35 (1.84) respectively. After adjusting for covariates, children aged 6-24 months who did not use baby friendly workplace initiatives were 2.26 times more likely to have stunting compared to the users of baby friendly workplace initiative (AOR 2.26, 95% CI: 1.05, 4.88). However, both wasting (AOR: 0.42; 95% CI:0.13, 1.37) and underweight (AOR: 1.09; 95% CI: 0.45, 2.60) were not significantly associated with the use of baby friendly workplace initiatives. CONCLUSION The use of baby friendly work place initiatives was successful in improving nutritional status, specifically chronic malnutrition in children. Strengthening and scaling up the baby friendly work place initiative program has the potential to reduce chronic malnutrition in Ethiopia and other similar settings with high burden of malnutrition areas, by implementing it in public facilities.
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Affiliation(s)
- Habtamu Hasen
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia.
| | - Samuel Kusheta
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
| | - Efrata Abuhay
- Department of midwifery, Hossana College of Health Science, Hossana, Ethiopia
| | - Hamdela Tumiso
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
| | - Yenatfanta Leuel
- Department of midwifery, Hossana College of Health Science, Hossana, Ethiopia
| | - Dinku Daniel
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
| | - Mesganew Amare
- School of midwifery, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abraham Samuel
- Department of emergency health service, Hossana College of Health Science, Hossana, Ethiopia
| | - Yitagesu Habtu
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia
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Dougherty L, Dadi C. Application of the integrated gateway model on child nutrition behaviors in Niger: An exploratory analysis. PLoS One 2024; 19:e0297466. [PMID: 38558005 PMCID: PMC10984541 DOI: 10.1371/journal.pone.0297466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/05/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To identify potential gateway factors and behaviors that are associated with infant and young child feeding (IYCF) practices in the Maradi and Zinder regions of Niger through application of the Integrated Gateway Model. METHODS We analyzed data from 2,727 married women of reproductive age including details on child feeding practices for their 2,551 children between the ages of 0 to 23 months. We assessed the association of three gateway behaviors (i.e., any antenatal care, facility delivery, and communication on nutrition practices) and gateway factors (i.e., behavioral determinants, exposure to information, decision-making agency, and woman's group participation) on four IYCF practices (i.e., early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency, and minimum dietary diversity) while controlling for age, parity, educational attainment, and household wealth. RESULTS We found antenatal care was associated with exclusive breastfeeding of children 0-5 months [adjusted odds ratio (aOR): 1.17 (95% confidence interval (CI): 1.03-1.33)], and minimum meal frequency of children 6-23 months [aOR: 1.10 (95% CI: 1.03-1.17)], and facility delivery was associated with early initiation of breastfeeding among children 0-5 months [aOR: 2.08 (95% CI: 1.39-3.12)]. We found negative associations with exclusive breastfeeding and communication on nutrition practices with husbands, family/friends, and health workers. Exposure to nutrition messages through radio, women's groups participation, and with health workers was positively associated with minimum dietary diversity. Self-efficacy was positively associated with both early initiation of breastfeeding, exclusive breastfeeding among children 0-5 months and minimum dietary diversity among children 6-23 months. Women's agency was positively associated with early initiation of breastfeeding. CONCLUSION The association of antenatal care and facility delivery with child nutrition outcomes suggest intervening before a woman becomes pregnant or early in her pregnancy could improve nutrition outcomes. Programs strengthening the continuum of care should identify gateway behaviors to maximize adoption of priority health behaviors.
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Affiliation(s)
| | - Chaibou Dadi
- Conception Etudes Suivi Evaluation Appuis Formation, Niamey, Niger
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Tuthill EL, Maltby AE, Odhiambo BC, Hoffmann TJ, Nyaura M, Shikari R, Cohen CR, Weiser SD. "It has changed my life": unconditional cash transfers and personalized infant feeding support- a feasibility intervention trial among women living with HIV in western Kenya. Int Breastfeed J 2023; 18:64. [PMID: 38012644 PMCID: PMC10680175 DOI: 10.1186/s13006-023-00600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The syndemic effects of poverty, food insecurity and living with HIV are recognized as global health priorities, including through the United Nations Sustainability Goals 1, 2 and 3. Today, women and girls account for 63% of all new HIV infections in eastern and southern Africa, including Kenya. Pregnant and postpartum women living with HIV in this setting face unique challenges including increased financial insecurity as women leave the work force to care for their newborn infants. This contributes to poverty, food scarcity and stress. METHODS To address financial insecurity, improve infant feeding and reduce stress among mothers living with HIV in this setting, we developed a multilevel intervention, Supporting Healthy Mothers, consisting of 10 monthly unconditional cash transfers (10,000 KES, ~$75 USD/month) and personalized infant feeding support from pregnancy to 7 months postpartum. We conducted a non-randomized feasibility trial of this intervention among women engaged in HIV care in Kisumu, Kenya. From February 23, 2022 to March 23, 2022, we enrolled a total of 40 women who were 20-35 weeks pregnant-20 women to the intervention group at a public clinic, and 20 women to the control group at a similar clinic. Our aim was to assess feasibility, acceptability, and the potential impact of the intervention on food security, infant feeding and maternal mental health. RESULTS Analyzing data from all 40 participants, we found a significant reduction in food insecurity scores from baseline for the intervention group when compared to the control group at 6 weeks and 6 months postpartum (p = 0.0008 and p < 0.0001, respectively). Qualitative exit interviews with intervention group participants confirmed women felt more financially secure and had newly acquired practical knowledge and skills related to infant feeding. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing. CONCLUSIONS The Supporting Healthy Mothers intervention has potential to positively impact women across the perinatal period and beyond by increasing financial security and supporting women to overcome infant feeding challenges and should be assessed in larger trials. TRIAL REGISTRATION Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, initially published on February 1, 2022. CLINICALTRIALS gov ID: NCT05219552 Protocol ID: K23MH116807.
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Affiliation(s)
- Emily L Tuthill
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Ann E Maltby
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Belinda C Odhiambo
- Global Programs for Research and Training, University of California San Francisco, Kisumu, Kenya
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, and Office of Research School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Maureen Nyaura
- Global Programs for Research and Training, University of California San Francisco, Kisumu, Kenya
| | - Rosemary Shikari
- Ambercare Medical Centre and Mamatoto Childbirth and Breastfeeding Educative Services, Kisumu, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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George CM, Coglianese N, Bauler S, Perin J, Kuhl J, Williams C, Kang Y, Thomas ED, François R, Ng A, Presence AS, Jean Claude BR, Tofail F, Mirindi P, Cirhuza LB. Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program). MATERNAL & CHILD NUTRITION 2022; 18:e13340. [PMID: 35313062 PMCID: PMC9218309 DOI: 10.1111/mcn.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/05/2022]
Abstract
The objective of this study was to investigate the association between dietary diversity, child growth and child developmental outcomes. This was a prospective cohort study. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6‐month follow‐up visit. Height and weight were measured at baseline and a 6‐month follow‐up. Baseline minimum dietary diversity (MDD) for children 6–23 months old was defined by consumption of five or more of the following food groups: (1) breast milk; (2) grains, roots and tubers; (3) legumes and nuts; (4) dairy products; (5) flesh foods; (6) eggs; (7) vitamin A‐rich fruits and vegetables and (8) other fruits and vegetables. Participants were 117 children 6–23 months of age. Linear growth faltering was defined as a significant decline (p < 0.05) in length‐for‐age Z‐scores (LAZ) between baseline and follow‐up. Regression models were performed. The study was conducted in rural eastern Democratic Republic of the Congo (DRC). MDD was positively associated with change in LAZ (coefficient: 0.87 [95% confidence interval [CI]: 0.33, 1.40]), and a reduced odds of stunting (LAZ < −2) (odds ratio: 0.21 [95% CI: 0.07, 0.61]). MDD was also associated with a significantly higher combined EASQ‐Z‐scores (coefficient: 0.34 [95% CI: 0.003, 0.68], higher communication EASQ‐Z‐scores [0.50 {95% CI: 0.14, 0.85}], and higher personal social EASQ‐Z‐scores [0.46 {95% CI: 0.11, 0.82}]). This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children. Dietary diversity was low among young children in our study setting in rural eastern Democratic Republic of the Congo. Low dietary diversity was associated with linear growth faltering and lower child developmental outcomes. This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children to improve child health.
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Affiliation(s)
- Christine Marie George
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | - Sarah Bauler
- Health Division Food for the Hungry Phoenix Arizona USA
| | - Jamie Perin
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Jennifer Kuhl
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Camille Williams
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Yunhee Kang
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Elizabeth D. Thomas
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ruthly François
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Angela Ng
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | | | - Fahmida Tofail
- Nutrition Division International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
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Mwenda V, Makena I, Ogweno V, Obonyo J, Were V. Effectiveness of interactive text messaging and structured psychosocial support groups on developmental milestones of children from adolescent pregnancies in Kenya: a quasi-experimental study (Preprint). JMIR Pediatr Parent 2022; 6:e37359. [PMID: 37126373 DOI: 10.2196/37359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/23/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. OBJECTIVE We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development. METHODS This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. RESULTS We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). CONCLUSIONS An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse.
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Affiliation(s)
- Valerian Mwenda
- Department of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- Field Epidemiology Society of Kenya, Nairobi, Kenya
| | - Ireen Makena
- Department of Biological Sciences, Chuka University, Chuka, Kenya
| | - Vincent Ogweno
- Department of Pediatrics, University of Nairobi, NAIROBI, Kenya
| | - James Obonyo
- County Department of Health, Homa Bay County, Homa Bay, Kenya
| | - Vincent Were
- Kenya Medical Research Institute-Wellcome trust, Nairobi, Kenya
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Macharia PM, Joseph NK, Snow RW, Sartorius B, Okiro EA. The impact of child health interventions and risk factors on child survival in Kenya, 1993-2014: a Bayesian spatio-temporal analysis with counterfactual scenarios. BMC Med 2021; 19:102. [PMID: 33941185 PMCID: PMC8094495 DOI: 10.1186/s12916-021-01974-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During the millennium development goals period, reduction in under-five mortality (U5M) and increases in child health intervention coverage were characterised by sub-national disparities and inequities across Kenya. The contribution of changing risk factors and intervention coverage on the sub-national changes in U5M remains poorly defined. METHODS Sub-national county-level data on U5M and 43 factors known to be associated with U5M spanning 1993 and 2014 were assembled. Using a Bayesian ecological mixed-effects regression model, the relationships between U5M and significant intervention and infection risk ecological factors were quantified across 47 sub-national counties. The coefficients generated were used within a counterfactual framework to estimate U5M and under-five deaths averted (U5-DA) for every county and year (1993-2014) associated with changes in the coverage of interventions and disease infection prevalence relative to 1993. RESULTS Nationally, the stagnation and increase in U5M in the 1990s were associated with rising human immunodeficiency virus (HIV) prevalence and reduced maternal autonomy while improvements after 2006 were associated with a decline in the prevalence of HIV and malaria, increase in access to better sanitation, fever treatment-seeking rates and maternal autonomy. Reduced stunting and increased coverage of early breastfeeding and institutional deliveries were associated with a smaller number of U5-DA compared to other factors while a reduction in high parity and fully immunised children were associated with under-five lives lost. Most of the U5-DA occurred after 2006 and varied spatially across counties. The highest number of U5-DA was recorded in western and coastal Kenya while northern Kenya recorded a lower number of U5-DA than western. Central Kenya had the lowest U5-DA. The deaths averted across the different regions were associated with a unique set of factors. CONCLUSION Contributions of interventions and risk factors to changing U5M vary sub-nationally. This has important implications for targeting future interventions within decentralised health systems such as those operated in Kenya. Targeting specific factors where U5M has been high and intervention coverage poor would lead to the highest likelihood of sub-national attainment of sustainable development goal (SDG) 3.2 on U5M in Kenya.
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Affiliation(s)
- Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA USA
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Macharia PM, Joseph NK, Sartorius B, Snow RW, Okiro EA. Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993-2014. BMJ Glob Health 2021; 6:e004544. [PMID: 33858833 PMCID: PMC8054106 DOI: 10.1136/bmjgh-2020-004544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya. METHODS Twenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014. RESULTS Nationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993-2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria. CONCLUSION The heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.
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Affiliation(s)
- Peter M Macharia
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K Joseph
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ojha S, Elfzzani Z, Kwok TC, Dorling J. Education of family members to support weaning to solids and nutrition in later infancy in term-born infants. Cochrane Database Syst Rev 2020; 7:CD012241. [PMID: 32710657 PMCID: PMC7388772 DOI: 10.1002/14651858.cd012241.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Education of family members about infant weaning practices could affect nutrition, growth, and development of children in different settings across the world. OBJECTIVES To compare effects of family nutrition educational interventions for infant weaning with conventional management on growth and neurodevelopment in childhood. SEARCH METHODS We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5), MEDLINE via PubMed (1966 to 26 June 2018), Embase (1980 to 26 June 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 June 2018). We searched clinical trials databases, conference proceedings, and references of retrieved articles. We ran an updated search from 1 January 2018 to 12 December 2019 in the following databases: CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA We included randomised controlled trials that examined effects of nutrition education for weaning practices delivered to families of infants born at term compared to conventional management (standard care in the population) up to one year of age. DATA COLLECTION AND ANALYSIS Two review authors independently identified eligible trial reports from the literature search and performed data extraction and quality assessments for each included trial. We synthesised effect estimates using risk ratios (RRs), risk differences (RDs), and mean differences (MDs), with 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 21 trials, recruiting 14,241 infants. Five of the trials were conducted in high-income countries and the remaining 16 were conducted in middle- and low-income countries. Meta-analysis showed that nutrition education targeted at improving weaning-related feeding practices probably increases both weight-for-age z scores (WAZ) (MD 0.15 standard deviations, 95% CI 0.07 to 0.22; 6 studies; 2551 infants; I² = 32%; moderate-certainty evidence) and height-for-age z scores (0.12 standard deviations, 95% CI 0.05 to 0.19; 7 studies; 3620 infants; I² = 49%; moderate-certainty evidence) by 12 months of age. Meta-analysis of outcomes at 18 months of age was heterogeneous and inconsistent in the magnitude of effects of nutrition education on WAZ and weight-for-height z score across studies. One trial that assessed effects of nutrition education on growth at six years reported an uncertain effect on change in height and body mass index z score. Two studies investigated effects of nutrition education on neurodevelopment at 12 to 24 months of age with conflicting results. No trials assessed effects of nutrition education on long-term neurodevelopmental outcomes. AUTHORS' CONCLUSIONS Nutrition education for families of infants may reduce the risk of undernutrition in term-born infants (evidence of low to moderate certainty due to limitations in study design and substantial heterogeneity of included studies). Modest effects on growth during infancy may not be of clinical significance. However, it is unclear whether these small improvements in growth parameters in the first two years of life affect long-term childhood growth and development. Further studies are needed to resolve this question.
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Affiliation(s)
- Shalini Ojha
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
- Children's Hospital, University Hospitals of Derby and Burton, Derby, UK
| | - Zenab Elfzzani
- Academic Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | | | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Samburu BM, Young SL, Wekesah FM, Wanjohi MN, Kimiywe J, Muriuki P, Griffiths PL, McGarvey ST, Madise NJ, Kimani-Murage EW. Effectiveness of the baby-friendly community initiative in promoting exclusive breastfeeding among HIV negative and positive mothers: a randomized controlled trial in Koibatek Sub-County, Baringo, Kenya. Int Breastfeed J 2020; 15:62. [PMID: 32664987 PMCID: PMC7362439 DOI: 10.1186/s13006-020-00299-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya. Methods A community-based cluster-randomized controlled trial was implemented from April 2015 to December 2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12 personalized home-based counselling sessions on infant feeding by trained community health volunteers from their first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings targeting influencers. The control group received standard health education at the facility and during monthly routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regression. Results At 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm compared to the control arm (81.7% versus 42.2% p = 0.001). HIV positive mothers in the intervention arm had higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus 58.4%; p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the intervention arm than in the control (92.1% versus 60.7% p = 0.001). Among HIV positive mothers, such knowledge was high among both the intervention and control groups (96% versus 100%, p > 0.1). HIV negative and positive mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the control (84.5% versus 62.1%, p = 0.001) and (94.6% versus 53.8% to p = 0.001) respectively. Conclusions BFCI interventions can complement facility-based interventions to improve exclusive and continued breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.
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Affiliation(s)
- Betty Mogesi Samburu
- Formerly Division of Nutrition and Dietetics, Ministry of Health in Kenya, Nairobi, Kenya. .,United Nations Children's Fund (UNICEF) Kenya Country Office, Nairobi, Kenya.
| | - Sera Lewise Young
- Institute of Policy Research, Northwestern University, Evanston, USA
| | - Frederick Murunga Wekesah
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Milkah Njeri Wanjohi
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Judith Kimiywe
- Department of Foods, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Peter Muriuki
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,Institute of Global Health Equity Education, University of Global Health Equity, Kigali, Rwanda
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Stephen T McGarvey
- International Health Institute, Brown University School of Public Health, Providence, USA
| | | | - Elizabeth W Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.,International Health Institute, Brown University School of Public Health, Providence, USA.,Wellcome Trust, London, UK.,Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK.,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre, Stellenbosch University, Stellenbosch, South Africa
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10
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Maingi M, Kimiywe J, Iron-Segev S. Maternal knowledge in complementary feeding following Baby Friendly Community Initiative in Koibatek, Kenya. MATERNAL AND CHILD NUTRITION 2020; 16:e13027. [PMID: 32495498 PMCID: PMC7507556 DOI: 10.1111/mcn.13027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 01/04/2023]
Abstract
The Kenyan Ministry of Health has developed a National Strategy on Infant and Young Child Feeding with the goal of improving feeding practices for infants and children. In order to promote appropriate infant feeding, the government has explored implementation of the Baby Friendly Community Initiative (BFCI). This study assessed maternal knowledge of attributes of complementary feeding following implementation of BFCI in Koibatek, Kenya. A randomized control study composed of 270 mother–infant pairs previously enrolled in a BFCI programme in Koibatek was conducted. The study found that a significantly greater number of mothers in the intervention group were more knowledgeable about proper breastfeeding and complementary feeding aspects compared with controls (P ≤ 0.001). About half (53%) of mothers in the intervention group had high knowledge scores in comparison with 20% of mothers in the control group. When the relationship between mothers' knowledge and complementary feeding practices (minimum meal frequency, minimum dietary diversity and minimum acceptable diet) was assessed, significant associations were observed (P = 0.010, P ≤ 0.001 and P ≤ 0.001, respectively). The odds of having a high knowledge score regarding complementary feeding practices were significantly higher for the intervention group compared with the control group (odds ratio [OR]: 25.98, 95% confidence interval [CI] 13.62–49.55, P ≤ 0.001). The BFCI intervention effectively improved mothers' knowledge on complementary feeding and correlated with improved feeding practices.
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Affiliation(s)
- Mildred Maingi
- School of Nutritional Sciences, The Hebrew University of Jerusalem and The International School of Agricultural Sciences, Rehovot, Israel
| | - Judith Kimiywe
- School of Public Health and Applied Human Sciences, Department of Food Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Sharon Iron-Segev
- School of Nutritional Sciences, The Hebrew University of Jerusalem and The International School of Agricultural Sciences, Rehovot, Israel.,School of Nutritional Sciences, Peres Academic Center, Rehovot, Israel
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Mohamed MJ, Ochola S, Owino VO. A Qualitative Exploration of the Determinants of Exclusive Breastfeeding (EBF) Practices in Wajir County, Kenya. Int Breastfeed J 2020; 15:44. [PMID: 32423487 PMCID: PMC7236358 DOI: 10.1186/s13006-020-00284-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 04/28/2020] [Indexed: 12/01/2022] Open
Abstract
Background The World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya. Method This study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences. Results The exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding. Conclusions Deeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law’s and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders.
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Affiliation(s)
- Mahat Jimale Mohamed
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya.
| | - Sophie Ochola
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
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12
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Lassi ZS, Kedzior SGE, Bhutta ZA. Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries. Cochrane Database Syst Rev 2019; 2019:CD007647. [PMID: 31686427 PMCID: PMC6828589 DOI: 10.1002/14651858.cd007647.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems. OBJECTIVES To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost). SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables. MAIN RESULTS We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33. AUTHORS' CONCLUSIONS This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.
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Affiliation(s)
- Zohra S Lassi
- University of AdelaideRobinson Research InstituteAdelaideAustraliaAustralia
| | - Sophie GE Kedzior
- Robinson Research Institute, University of AdelaideFaculty of Health and Medical SciencesAdelaideAustralia
| | - Zulfiqar A Bhutta
- The Hospital for Sick ChildrenCentre for Global Child HealthTorontoCanada
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Faye CM, Fonn S, Kimani‐Murage E. Family influences on child nutritional outcomes in Nairobi's informal settlements. Child Care Health Dev 2019; 45:509-517. [PMID: 30986888 PMCID: PMC6563089 DOI: 10.1111/cch.12670] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/07/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improving child nutritional status is an important step towards achieving the Sustainable Development Goals 2 and 3 in developing countries. Most child nutrition interventions in these countries remain variably effective because the strategies often target the child's mother/caregiver and give limited attention to other household members. Quantitative studies have identified individual level factors, such as mother and child attributes, influencing child nutritional outcomes. METHODS We used a qualitative approach to explore the influence of household members on child feeding, in particular, the roles of grandmothers and fathers, in two Nairobi informal settlements. Using in-depth interviews, we collected data from mothers of under-five children, grandmothers, and fathers from the same households. RESULTS Our findings illustrate that poverty is a root cause of poor nutrition. We found that mothers are not the sole decision makers within the household regarding the feeding of their children, as grandmothers appear to play key roles. Even in urban informal settlements, three-generation households exist and must be taken into account. Fathers, however, are described as providers of food and are rarely involved in decision making around child feeding. Lastly, we illustrate that promotion of exclusive breastfeeding for 6 months, as recommended by the World Health Organization, is hard to achieve in this community. CONCLUSIONS These findings call for a more holistic and inclusive approach for tackling suboptimal feeding in these communities by addressing poverty, targeting both mothers and grandmothers in child nutrition strategies, and promoting environments that support improved feeding practices such as home-based support for breastfeeding and other baby-friendly initiatives.
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Affiliation(s)
- Cheikh Mbacké Faye
- Research DivisionAfrican Population and Health Research CenterNairobiKenya,School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sharon Fonn
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
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Ahoya B, Kavle JA, Straubinger S, Gathi CM. Accelerating progress for complementary feeding in Kenya: Key government actions and the way forward. MATERNAL & CHILD NUTRITION 2019; 15 Suppl 1:e12723. [PMID: 30748122 PMCID: PMC6594063 DOI: 10.1111/mcn.12723] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023]
Abstract
Optimal complementary feeding practices, a critical component of infant and young child feeding, has been demonstrated to prevent micronutrient deficiencies, stunting, overweight, and obesity. In Kenya, while impressive gains have been made in exclusive breastfeeding, progress in complementary feeding has been slow, and the country has failed to meet targets. Recent 2014 Kenya Demographic and Health Survey reveal that only 22% of Kenyan children, 6-23 months, met criteria for a minimum acceptable diet. This case study describes key actions for complementary feeding put in place by the Kenya Ministry of Health as well as approaches for improving and monitoring complementary feeding within existing health platforms. Experience from USAID's Maternal and Child Survival Program and Ministry of Health on development of 23 complementary feeding recipes through application of a national guide for recipe development and Trials of Improved Practices is described. Challenges in how to prepare, modify, and cook foods, including meat, for young children 6-23 months of age was relayed by mothers. Addressing cultural beliefs around complementary feeding meant providing reassurance to mothers that young children are developmentally able to digest fruit and vegetables and ready to consume animal-source protein. Through the Baby Friendly Community Initiative platform, cooking demonstrations and key hygiene actions were integrated with complementary feeding messages. Future programming for complementary feeding should consider development of context specific counselling messages on consumption of animal source foods, strengthen production and use of local foods through agriculture-nutrition linkages, and include complementary indicators through routine health monitoring systems to track progress.
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Affiliation(s)
- Brenda Ahoya
- USAID's Maternal and Child Survival Program/PATHKisumuKenya
| | - Justine A. Kavle
- USAID's Maternal and Child Survival Program/PATHWashingtonDistrict of ColumbiaUSA
| | - Sarah Straubinger
- USAID's Maternal and Child Survival Program/PATHWashingtonDistrict of ColumbiaUSA
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Kavle JA, Ahoya B, Kiige L, Mwando R, Olwenyi F, Straubinger S, Gathi CM. Baby-Friendly Community Initiative-From national guidelines to implementation: A multisectoral platform for improving infant and young child feeding practices and integrated health services. MATERNAL & CHILD NUTRITION 2019; 15 Suppl 1:e12747. [PMID: 30748118 PMCID: PMC6635904 DOI: 10.1111/mcn.12747] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 01/26/2023]
Abstract
The Baby-Friendly Community Initiative (BFCI) is an extension of the 10th step of the Ten Steps of Successful Breastfeeding and the Baby-Friendly Hospital Initiative (BFHI) and provides continued breastfeeding support to communities upon facility discharge after birth. BFCI creates a comprehensive support system at the community level through the establishment of mother-to-mother and community support groups to improve breastfeeding. The Government of Kenya has prioritized community-based programming in the country, including the development of the first national BFCI guidelines, which inform national and subnational level implementation. This paper describes the process of BFCI implementation within the Kenyan health system, as well as successes, challenges, and opportunities for integration of BFCI into health and other sectors. In Maternal and Child Survival Program (MCSP) and UNICEF areas, 685 community leaders were oriented to BFCI, 475 health providers trained, 249 support groups established, and 3,065 children 0-12 months of age reached (MCSP only). Though difficult to attribute to our programme, improvements in infant and young child feeding practices were observed from routine health data following the programme, with dramatic declines in prelacteal feeding (19% to 11%) in Kisumu County and (37.6% to 5.1%) in Migori County from 2016 to 2017. Improvements in initiation and exclusive breastfeeding in Migori were also noted-from 85.9% to 89.3% and 75.2% to 92.3%, respectively. Large gains in consumption of iron-rich complementary foods were also seen (69.6% to 90.0% in Migori, 78% to 90.9% in Kisumu) as well as introduction of complementary foods (42.0-83.3% in Migori). Coverage for BFCI activities varied across counties, from 20% to 60% throughout programme implementation and were largely sustained 3 months postimplementation in Migori, whereas coverage declined in Kisumu. BFCI is a promising platform to integrate into other sectors, such as early child development, agriculture, and water, sanitation, and hygiene.
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Affiliation(s)
| | - Brenda Ahoya
- USAID's Maternal and Child Survival Program/PATHKisumuKenya
| | | | - Rael Mwando
- Department of NutritionMinistry of HealthKisumu CountyKenya
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