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Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial

Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial
Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial
Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya.

Methods: We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received regular home-based nutritional counselling by CHWs trained on maternal infant and young child nutrition (MIYCN) and standard care while the control arm received optimized standard care that included home-based counselling by CHWs trained on primary health (which includes general community nutrition) and maternity care, but were not specifically trained on MIYCN as for the intervention CHVs. CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis.

Results: A total of 1,110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4-59.9) in the intervention group and 54.6% (95% CI 50.0-59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0-2 months (OR 1.27, 95% CI 0.55 to 2.96; p=0.550); 0-4 months (OR 1.15; 95% CI 0.54 to 2.42; p=0.696), and 0-6 months (OR 1.11, 95% CI 0.61 to 2.02; p=0.718).

Conclusions: EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.
1744-8603
Kimani-Murage, Elizabeth
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Griffiths, Paula
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Wekesah, Frederick
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Wanjohi, Milka
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Muhia, Nelson
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Muriuki, Peter
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Egondi, Thaddaeus
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Kyobutungi, Catherine
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Ezeh, Alex
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McGarvey, Stephen
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Musoke, Rachel
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Norris, Shane
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Madise, Nyovani J.
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Kimani-Murage, Elizabeth
a4307246-15a1-43a2-ae41-2d284285d945
Griffiths, Paula
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Wekesah, Frederick
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Wanjohi, Milka
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Muhia, Nelson
ae6f38a0-5de8-4a8f-8f85-6005f4a757b6
Muriuki, Peter
29e528cc-c5ba-4152-a706-0d328d1f593e
Egondi, Thaddaeus
d1694f8c-9325-4e25-a9ae-5eabcb3f87f4
Kyobutungi, Catherine
f3b869bc-df98-4c4b-9ad9-aaef6767a074
Ezeh, Alex
0963e9e8-c02b-4d39-a2d2-e28d73b06679
McGarvey, Stephen
37c555cc-f2ec-4eae-977f-b27caf0eb341
Musoke, Rachel
4fa7ae1f-5fe2-4a9b-9197-b5a8b2e320a6
Norris, Shane
02b3499d-0f21-4bc1-bb0e-864aa9ca46b2
Madise, Nyovani J.
2ea2fbcc-50da-4696-a0a5-2fe01db63d8c

Kimani-Murage, Elizabeth, Griffiths, Paula, Wekesah, Frederick, Wanjohi, Milka, Muhia, Nelson, Muriuki, Peter, Egondi, Thaddaeus, Kyobutungi, Catherine, Ezeh, Alex, McGarvey, Stephen, Musoke, Rachel, Norris, Shane and Madise, Nyovani J. (2017) Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial. Globalization and Health, 13 (90). (doi:10.1186/s12992-017-0314-9).

Record type: Article

Abstract

Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya.

Methods: We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received regular home-based nutritional counselling by CHWs trained on maternal infant and young child nutrition (MIYCN) and standard care while the control arm received optimized standard care that included home-based counselling by CHWs trained on primary health (which includes general community nutrition) and maternity care, but were not specifically trained on MIYCN as for the intervention CHVs. CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis.

Results: A total of 1,110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4-59.9) in the intervention group and 54.6% (95% CI 50.0-59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0-2 months (OR 1.27, 95% CI 0.55 to 2.96; p=0.550); 0-4 months (OR 1.15; 95% CI 0.54 to 2.42; p=0.696), and 0-6 months (OR 1.11, 95% CI 0.61 to 2.02; p=0.718).

Conclusions: EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.

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Accepted/In Press date: 23 November 2017
e-pub ahead of print date: 19 December 2017

Identifiers

Local EPrints ID: 416567
URI: http://eprints.soton.ac.uk/id/eprint/416567
ISSN: 1744-8603
PURE UUID: c2435312-9eed-4edf-b910-03e9bde74ddc
ORCID for Nyovani J. Madise: ORCID iD orcid.org/0000-0002-2813-5295

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Date deposited: 03 Jan 2018 17:30
Last modified: 06 Oct 2020 19:57

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