Potential effectiveness of Community Health Strategy to promote exclusive breastfeeding in urban poor settings in Nairobi, Kenya: a quasi-experimental study.

E W Kimani-Murage,S A Norris,R N Musoke,S T Mcgarvey,N Muhia,T Egondi,M K Mutua,M Wanjohi,N J Madise,F Wekesah,A C Ezeh,P L Griffiths,C Kyobutungi,P Muriuki

doi:10.1017/s2040174415007941

Abstract

Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Intervention (2012-2015; n=1110) and Comparison (2012-2014; n=487)], which followed mother-child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ(2) test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4-96.4), 84.3 (95% CI 40.7-174.6) and 3.9 (95% CI 1.8-8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.

Highlights

Promotion of breastfeeding is considered one of the high impact nutrition interventions.[1,2] Implementing interventions which promote breastfeeding could prevent about 13% of under-five deaths in countries with high mortality rates.[3]
There was higher prevalence of reported exclusive breastfeeding (EBF) at all the study points (2, 4 and 6 months) among children in the MIYCNIntervention and MIYCN-Control groups compared with the Pre-intervention group and the Comparison group
This paper presents results of a quasi-experimental study designed to control for secular trends in EBF, and constructed using data from a Pre-intervention study done in 2007–2011, an Intervention study in 2012–2014 and a Comparison study in 2012–2015

Summary

Introduction

Promotion of breastfeeding is considered one of the high impact nutrition interventions.[1,2] Implementing interventions which promote breastfeeding could prevent about 13% of under-five deaths in countries with high mortality rates.[3]. Non-EBF in the first 6 months has been associated with higher morbidity and mortality compared with EBF, and likewise, no breastfeeding at all has been associated with higher risk of morbidity and mortality in children 6–23 months compared with breastfeeding.[9,10] Recent evidence by Victora et al.[11] based on a prospective, population-based birth cohort study launched in 1982 in Pelotas, Brazil further indicates that the duration of total breastfeeding improves intelligence quotient, educational attainment and income in adulthood

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Results

Conclusion