Community support groups improved feeding practices in infants and young children in remote areas in Vietnam

Abstract

BackgroundIn remote areas in Vietnam, prevailing customs, poor economic conditions, and difficulties in accessing healthcare facilities lead to suboptimal infant and young child feeding (IYCF) practices, and thus poor child growth and development. To address these barriers, from November 2011, Alive & Thrive (A&T) Vietnam initiated 801 IYCF support groups in 267 villages of 78 remote communes across 9 Vietnam provinces. This support model was nested within the public health system: facilitators were collaborators in health, population, nutrition, and women with the support of commune health staff and village heads. The hour‐long support group meetings typically included 10–15 participants and occurred in a village hall. During the facilitated meetings, mothers shared experiences and were given information and supported each other. This assessment was conducted to examine the functionality and effectiveness of the support group model in improving IYCF practices.MethodsFunctionality of the model was assessed by reviewing of the protocol, reports, monitoring data, and budget. Effectiveness of the model was evaluated by a cross‐sectional survey in 12 communes with IYCF support groups and 12 matched communes without (referred as INT and CON communes). The sample size was 559 mothers in INT communes and 551 mothers in CON communes. Analyses compared the prevalence of IYCF practices in INT with CON communes, adjusted for potential confounding factors and commune‐level clustering.FindingsA&T trained 1,513 community‐based workers to facilitate the support groups. This model reached ~70% of pregnant women and mothers with children < 6 months old and ~60% of mothers with children 6–23 months old in INT villages. During 32 months of intervention, community‐based workers provided support to ~33,000 unique clients, with a total of ~166,000 client contacts. The average cost was 15 USD per client and 3 USD per contact. At the end of the A&T support (September 2014), this model has been sustained and expanded to new communes (additional 45 support groups) within existing provinces using funding from the National Nutrition Program.Survey participants in INT and CON communes had similar maternal, child, and household characteristics. About two‐thirds of mothers in INT communes participated in at least one meeting. Breastfeeding practices were better in INT than in CON communes: breastfeeding within 1 hour after birth (70% vs. 58%), no prelacteal feedings in the first 3 days (60% vs. 24%), and exclusive breastfeeding < 6 months (63% vs. 13%), p < 0.05 for all comparisons. The prevalence of minimum acceptable diet in children 6–23 months old was higher in INT than CON communes (71% vs. 58%, p < 0.05), which was attributed to a higher minimum dietary diversity prevalence (81% vs. 73%, p < 0.05). Multiple logistic regression models showed that living in INT communes was associated with significantly higher odds of early initiation of breastfeeding (OR: 1.7; 95%CI: 1.1,2.7) and exclusive breastfeeding < 6 months (OR: 12.5; 95% CI: 6.7,23.4).ConclusionThe IYCF support group model was functional and effective in reaching populations residing in remote areas and likely contributed to the better IYCF practices.Support or Funding InformationBill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360