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

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dc.contributor.authorKimani-Murage, Elizabeth W.en_ZA
dc.contributor.authorGriffiths, Paula L.en_ZA
dc.contributor.authorWekesah, Frederick Murungaen_ZA
dc.contributor.authorWanjohi, Milkaen_ZA
dc.contributor.authorMuhia, Nelsonen_ZA
dc.contributor.authorMuriuki, Peteren_ZA
dc.contributor.authorEgondi, Thaddaeusen_ZA
dc.contributor.authorKyobutungi, Catherineen_ZA
dc.contributor.authorEzeh, Alex C.en_ZA
dc.contributor.authorMcGarvey, Stephen T.en_ZA
dc.contributor.authorMusoke, Rachel N.en_ZA
dc.contributor.authorNorris, Shane A.en_ZA
dc.contributor.authorMadise, Nyovani J.en_ZA
dc.date.accessioned2019-02-05T08:15:06Z
dc.date.available2019-02-05T08:15:06Z
dc.date.issued2017
dc.descriptionCITATION: 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.
dc.descriptionThe original publication is available at https://globalizationandhealth.biomedcentral.com
dc.description.abstractBackground: 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.en_ZA
dc.description.urihttps://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-017-0314-9
dc.description.versionPublisher's version
dc.format.extent16 pages
dc.identifier.citationKimani-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
dc.identifier.issn1744-8603 (online)
dc.identifier.otherdoi:10.1186/s12992-017-0314-9
dc.identifier.urihttp://hdl.handle.net/10019.1/105385
dc.language.isoen_ZAen_ZA
dc.publisherBMC (part of Springer Nature)
dc.rights.holderAuthor retains copyright
dc.subjectExclusive breastfeedingen_ZA
dc.subjectBreastfeeding promotion -- Keniaen_ZA
dc.subjectInfants -- Nutritionen_ZA
dc.subjectCommunity health services -- Keniaen_ZA
dc.subjectClinical trialsen_ZA
dc.subjectNutritional councillingen_ZA
dc.titleEffectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi : a cluster randomized controlled trialen_ZA
dc.typeArticleen_ZA
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