Understanding the Effect of Community‐Based Health and Nutrition Program on Uptake of Iron and Folic Acid Supplementation and Breastfeeding Practices in a Pastoralist Community in Rural Ethiopia

Abstract

Maternal and child health and nutrition are important issues to address in Ethiopia. Poor socioeconomic context and inadequate healthcare affects availability, access, and utilization of health services. The Community‐Based Maternal and Neonatal Health and Nutrition (CBMNH‐N) project by the Micronutrient Initiative aimed at strengthening the health system capacity to improve access and quality of maternal and newborn health and nutrition services by increasing the knowledge and skill of community health workers, traditional birth attendants, and health care providers. We undertook a qualitative inquiry from the endline data from four intervention and six comparison woredas to understand the effect of CBMNH‐N project on iron and folic acid supplementation and breastfeeding practices in the Afar community in Ethiopia. We used open coding to identifying themes and analyzed 46 key informant interviews from fathers, health extension workers, midwives, traditional birth attendants, and clan leaders, and 11 focus‐group discussions with pregnant and lactating mothers. Overall, mothers, health workers, and community members in the intervention woredas were more knowledgeable about the use of iron and folic acid supplementation and showed improvement in early initiation and exclusively breastfeeding practices as compared to the comparison woredas. Mothers noted that health extension workers were instrumental in increasing knowledge and awareness of iron and folic acid supplements, and trained traditional birth attendants helped with follow‐up and compliance in taking the supplements. Program efforts helped the community, including clan leaders to be more aware and supportive of the importance of iron and folic acid supplementation during pregnancy and the post‐partum period. Community members and clan leaders also noted the importance of early initiation and exclusive breastfeeding. Most respondents also discussed the change from traditional feeding practices such as providing the baby with goat milk to putting the baby to the breast immediately after birth and exclusively breastfeeding. Mothers, health extension workers, and traditional birth attendants were aware of the health benefits of exclusively breastfeeding. Several respondents attributed their knowledge of infant feeding to health education provided by the health extension workers and traditional birth attendants. Our findings suggest that community‐based programs can build capacity, increase knowledge, and improve health practices that can ultimately promote maternal and child health and nutrition.Support or Funding InformationFunding: Micronutrient Initiative