Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi : a cluster randomized controlled trial
Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a homebased
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 home-based nutritional
counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child
nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in
MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family
planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community
nutrition). 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 1110 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.
Description
CITATION: Kimani-Murage, E. W., et al. 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.
The original publication is available at https://globalizationandhealth.biomedcentral.com
The original publication is available at https://globalizationandhealth.biomedcentral.com
Keywords
Exclusive breastfeeding, Breastfeeding promotion -- Kenia, Infants -- Nutrition, Community health services -- Kenia, Clinical trials, Nutritional councilling
Citation
Kimani-Murage, E. W., et al. 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