Abstract
Little evidence exists in Kenya on the potential of community health workers (CHWs) in promoting exclusive breastfeeding (EBF) and early breastfeeding initiation (EBI) in resource‐restricted settings where very low EBF rates (2% to 12%) have been documented. The study utilized CHWs and assessed their effectiveness in promoting EBF and EBI. The cluster‐randomized longitudinal design was used and sixteen villages from Kiandutu Slum in Thika randomly assigned into either intervention group (IG) or comparison group (CG). Pregnant women attending Maternal Child Health (MCH) clinic were recruited. The IG received nutrition education sessions conducted by CHWs at home, two prenatally and six postnatally, plus the routine MCH care. The CG went through routine MCH care only. Infants feeding data were collected at 6, 10, 14, and 24 weeks postpartum by research assistants blinded to the intervention allocation. Differences in EBF and EBI in the two groups were tested using χ 2 tests, Kaplan–Meier survival analysis and generalized estimating equations. Of the 526 recruited in the study, 431 remained and were included in the analysis (IG = 176) and CG (225). The prevalence of EBF at 24 weeks was 45.3% in the IG compared with 15.0% in the CG, revealing a statistically significant difference log rank = 20.277, (1, n = 314) p < .001. The difference was not statistically significant in EBI prevalence between the IG (58.2%) and CG (60.3%; χ 2 = 0.008, p = .928). The CHWs have potential effectiveness in promoting EBF but not EBI. The link between the health center and CHWs should be strengthened to promote EBF.
Highlights
Breastfeeding has the single largest potential impact on child survival among all preventive interventions (Bhandari, Kabir, & Salam, 2008; Du Plessis, 2009; World Health Organization (WHO), 2008) due to immunity factors found in breast milk
This study revealed low rates of early breastfeeding initiation (EBI) and exclusive breastfeeding (EBF) among the mothers, the prevalence of EBF was, higher in the intervention group (IG) with a statistically significant difference than the comparison group (CG) at the 6th month
These results indicate that Community Health Workers (CHWs) have potential effectiveness in promoting EBF
Summary
The study was conducted in Kiandutu slum in Kiambu County-Thika West District. Kiandutu slum is one (1) kilometer from Thika town, which is about 40 km Northeast of Nairobi. The informal settlement has 17 villages each with a village elder (Kariuki, 2012) and is served by two health centers, Kiandutu and Makongeni
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