Abstract
The baby‐friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby‐friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized study was conducted in 13 community units in Koibatek sub‐county. Pregnant women aged 15–49 years were recruited and followed up until their children were 6 months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling, support from trained community health volunteers, health professionals and community and mother support groups, whereas those in the control group received standard counselling only. Data on breastfeeding practices were collected longitudinally. The probability of EBF up to 6 months of age and the restricted mean survival time difference were estimated. A total of 823 (intervention group n = 351) pregnant women were recruited. Compared with children in the control group, children in the intervention group were more likely to exclusively breastfeed for 6 months (79.2% vs. 54.5%; P < .05). Children in the intervention group were also exclusively breastfed for a longer time, mean difference (95% confidence interval [CI]) 0.62 months (0.38, 0.85; P < .001). The BFCI implemented within the existing health system and including community and mother support groups led to a significant increase in EBF in a rural Kenyan setting. This intervention has the potential to improve EBF rates in similar settings.
Highlights
Exclusive breastfeeding (EBF) for the first 6 months of a child's life and continued breastfeeding thereafter for up to 2 years, with timely introduction of appropriate complementary feeding at 6 months, is essential for optimal child growth and development
A total of 901 pregnant women and their respective children were assessed for eligibility, 823 were enrolled in the study, randomized and followed up, and 579 participants were included in the analysis (Figure 1)
A comparison of the characteristics of the subjects included in the analysis, and those lost to follow-up showed no statistically significant differences (Table S1)
Summary
Exclusive breastfeeding (EBF) for the first 6 months of a child's life and continued breastfeeding thereafter for up to 2 years, with timely introduction of appropriate complementary feeding at 6 months, is essential for optimal child growth and development. Financial, social and economic benefits of EBF have been documented (Victora et al, 2016). Despite the documented benefits of EBF to children and their families, EBF rates remain low in most parts of the world. The 2019 Global Breastfeeding Scorecard reported that 41% of children under 6 months are exclusively breastfed (WHO & UNICEF, 2019). In Kenya, EBF rates are at 61%, and this is a significant increase from 2008, there is a still a need for further improvement (Kenya National Bureau of Statistics, 2010, 2015). It is important to note that the rates are based on self-report and are subject to recall and report bias
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