Browsing by Author "Engebretsen, Ingunn M. S."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Cost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Uganda
    (Public Library of Science, 2015) Chola, Lumbwe; Fadnes, Lars T.; Engebretsen, Ingunn M. S.; Nkonki, Lungiswa; Nankabirwa, Victoria; Sommerfelt, Halvor; Tumwine6, James K.; Tylleskar, Thorkild; Robberstad, Bjarne; PROMISE-EBF Study Group
    Background: Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children. Methods: Data were obtained from a community randomized trial conducted in Uganda between 2006–2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis. Findings: Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses Conclusions: Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda’s GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.
  • Thumbnail Image
    Item
    Translating new evidence into clinical practice : a quasi-experimental controlled before–after study evaluating the effect of a novel outreach mentoring approach on knowledge, attitudes and confidence of health workers providing HIV and infant feeding counselling in South Africa
    (BMJ Publishing, 2020-10) Goga, Ameena; Doherty, Tanya; Manda, Samuel; Nkwenika, Tshifhiwa; Haskins, Lyn; John, Vaughn; Engebretsen, Ingunn M. S.; Feucht, Ute; Dhansay, Ali; Rollins, Nigel; Kroon, Max; Sanders, David; Kauchali, Shuaib; Tylleskär, Thorkild; Horwood, Christiane
    Objectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding. Design Quasi-experimental controlled before–after study. Setting Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa. Participants All HWs providing infant feeding counselling in selected facilities were invited. Interventions Three 1–2 hours, on-site workshops over 3–6 weeks. Primary outcome measures Knowledge (22 binary questions), attitude (21 questions—5-point Likert Scale) and confidence (19 questions—3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison groups postintervention, adjusting for the mean score difference between them at baseline. Analyses were adjusted for participant baseline characteristics and clustering at health facility level. Results In intervention and comparison sites, respectively: 289 and 131 baseline and 253 and 114 follow-up interviews were conducted (August–December 2017). At baseline there was no difference in mean number of correctly answered knowledge questions; this differed significantly at follow-up (15.2 in comparison; 17.2 in intervention sites (p<0.001)). At follow-up, the mean attitude and confidence scores towards breast feeding were better in intervention versus comparison sites (p<0.001 and p=0.05, respectively). Controlling for confounders, interactions between time and intervention group and preintervention values, the attitude score was 5.1 points significantly higher in intervention versus comparison groups. Conclusion A participatory, low-intensity on-site mentoring approach to disseminating updated infant feeding guidelines improved HWs’ knowledge, attitudes and confidence more than standard dissemination via a circular. Further research is required to evaluate the effectiveness, feasibility and sustainability of this approach at scale.