Loughborough University
Leicestershire, UK
LE11 3TU
+44 (0)1509 263171
Loughborough University

Loughborough University Institutional Repository

Please use this identifier to cite or link to this item: https://dspace.lboro.ac.uk/2134/27663

Title: Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: A cluster randomized controlled trial
Authors: Kimani-Murage, Elizabeth W.
Griffiths, Paula L.
Wekesah, Frederick
Wanjohi, Milka
Muhia, Nelson
Muriuki, Peterrock
Egondi, Thaddaeus
Kyobutungi, Catherine
Ezeh, Alex C.
McGarvey, Stephen T.
Musoke, Rachel N.
Norris, Shane A.
Madise, Nyovani J.
Keywords: Exclusive breastfeeding
Infant feeding practices
Child nutrition
Cluster randomized controlled trials
Sub-Saharan Africa
Urban slums
Issue Date: 2018
Publisher: © the Authors. Published by BioMed Central
Citation: KIMANI-MURAGE, E.W. ...et al., 2018. 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, Article 90.
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.
Description: This is an Open Access Article. It is published by BioMed Central under the Creative Commons Attribution 4.0 Unported Licence (CC BY). Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/
Sponsor: This study was funded by the Wellcome Trust, Grant # 097146/Z/11/Z.
Version: Published
DOI: 10.1186/s12992-017-0314-9
URI: https://dspace.lboro.ac.uk/2134/27663
Publisher Link: https://doi.org/10.1186/s12992-017-0314-9
ISSN: 1744-8603
Appears in Collections:Published Articles (Sport, Exercise and Health Sciences)

Files associated with this item:

File Description SizeFormat
s12992-017-0314-9.pdfPublished version662.85 kBAdobe PDFView/Open


SFX Query

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.