Impact of Mother-to-Mother Support Groups in Promoting Exclusive Breastfeeding in a Low-Resource Rural Community in Kenya: A Randomized Controlled Trial

Abstract

Breastfeeding is the single most effective intervention for growth, health, development and survival of infants. Exclusive breastfeeding (EBF) for 6 months alone can reduce under-five child mortality by up to 13%. Community-based strategies such as Mother-to-Mother Support Groups (MTMSGs) have improved the rates of EBF by increasing the length of maternal support before and after delivery. The rate of EBF in the study area was 18.6%, which was lower than national rate of 32% at the time of the study. Currently, the Kenyan national rate is 61% but with high regional variability. This study was designed to assess the impact of community-based MTMSGs with or without income generating activities in promoting EBF in low socio-economic rural setting in Kenya. This was a cluster randomized controlled trial in which 3 health centres in Igembe South Sub-County in Meru County, Kenya were randomly allocated to three study groups, on a ratio of 1:1:1; to two treatment groups and a control group. The target population was pregnant mothers in their third trimester (33-37 weeks) and registered at ante-natal clinics in any of the 3 health centres. Total sample size was 249. Mothers in the first treatment group received breastfeeding education and support during seven monthly meetings by trained breastfeeding peer educators. Mothers in the second treatment group received breastfeeding education and support at the same frequency as those in first group in addition to conducting income generating activities facilitated by the research team. Mothers in the control group received no breastfeeding education. Infant feeding practices were determined based on 24–hour recall. Data was collected on monthly basis for 6 months postpartum by interviewers blinded to the study hypotheses. The primary outcome was EBF prevalence at six months while secondary outcome was cumulative EBF at six months. Mothers in the first and second treatment groups were two times more likely to exclusively breastfed at 6 months compared to mothers in the control group [RR=2.42;CI 1.36-4.28;(p=0.004] and [RR=1.89;CI 1.02-3.49;(p=0.033)] respectively. There was no significant difference in the EBF rates at 6 months in the 2 treatment groups. Median duration of cumulative EBF for the control group was significantly lower at 0.7 months compared with first treatment group at 2.8 months (p<0.001) and second treatment group at 3.4 months (p<0.001). Mother-to-mother support groups is an effective strategy in promoting exclusive breastfeeding in low socio-economic rural settings and should therefore be strengthened in Kenya and similar circumstances.