Effect of A Community Health Worker Led Intervention on the Practice of Exclusive Breastfeeding in Mwingi West Sub-County, Kenya; A Pretest-Posttest Experiment
Introduction: World Health Organization (WHO) recommends breast milk as the ideal food for newborns and infants. In 2011, suboptimal breastfeeding practices accounted for more than 800,000 deaths among children under five years of age. Though the 2014 Kenya Demographic and Health Survey reported Exclusive Breast-Feeding (EBF) prevalence at 61%, poor breastfeeding practices are widely documented in Kenya. In 2006, Kenya developed a new Community Health Worker (CHW) led Primary Health Care intervention referred to as the Community Health Strategy (CHS). In Mwingi West sub-county, CHS was initiated in 2011. The aim of this study was to assess the effect of CHS on EBF among infants in Mwingi west sub-county.
Methods: This was a pretest -posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents.
Results: CHS increased EBF prevalence marginally by 6.4% in intervention site. This increased EBF prevalence in Mwingi west sub-county from 7.9% at baseline to 13.9% at end term survey. In intervention site, infants in the end term survey were 1.4 times more likely to receive EBF compared to infants at baseline (Adj. OR=1.447, P<0.05; 95%CI: 1.145-1.829).
Conclusion and Recommendation: CHS was effective in marginally increasing EBF prevalence in intervention site compared to control. To improve EBF rates in arid and semi-arid rural areas in Kenya, the government needs to fast-track implementation of CHS in all counties.
Key words: Community Health Strategy, Community Health Workers, Exclusive Breast-feeding
Agunbiade OM, Ogunleye O V. Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: Implications for scaling up. Int Breastfeed J [Internet]. BioMed Central Ltd; 2012;7(1):5. Available from: http://www.internationalbreastfeedingjournal.com/content/7/1/5
Tampah-Naah AM, Kumi-Kyereme A. Determinants of exclusive breastfeeding among mothers in Ghana: a cross-sectional study. Int Breastfeed J [Internet]. International Breastfeeding Journal; 2013 Jan [cited 2014 Jun 5];8(1):13. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3852847&tool=pmcentrez&rendertype=abstract
Seid AM, Yesuf ME, Koye DN. Prevalence of Exclusive Breastfeeding Practices and associated factors among mothers in Bahirdar town, Northwest Ethiopia: a community based cross-sectional study. Int Breastfeed J [Internet]. International Breastfeeding Journal; 2013;8(1):14. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3815630&tool=pmcentrez&rendertype=abstract
Kimani-Murage EW, Madise NJ, Fotso J-C, Kyobutungi C, Mutua MK, Gitau TM, et al. Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya. BMC Public Health [Internet]. BioMed Central Ltd; 2011 Jan [cited 2014 Jun 2];11(1):396. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3118248&tool=pmcentrez&rendertype=abstract
World Health Organization, Unicef. Breastfeeding Advocacy Initiative For the best start in life [Internet]. New York: United Nations Children Fund; 2015. 9 p. Available from: https://www.unicef.org/nutrition/files/Breastfeeding_Advocacy_Strategy-2015.pdf
Stuebe A. The Risks of Not Breastfeeding for Mothers and Infants. Rev Obs Gynecol [Internet]. 2009;2(4):222–31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/pdf/RIOG002004_0222.pdf
Haroon S, Das J, Salam R, Imdad A, Bhutta Z. Breastfeeding promotion interventions and breastfeeding practices: A systematic review. BMC Public Health [Internet]. BioMed Central Ltd; 2013;13(Suppl 3):S20. Available from: http://www.biomedcentral.com/1471-2458/13/S3/S20nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3847366&tool=pmcentrez&rendertype=abstract
Miriam Labbok. Community interventions to promote optimal breastfeeding [Internet]. Washington DC: The Manoff Group; and University Research Co., LLC; 2011. Available from: http://www.iycn.org/files/IYCN_Literature_Review_Community_Breastfeeding_Interventions_Feb_121.pdf
Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC Public Health [Internet]. BMC Public Health; 2013;13(1):847. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3848754&tool=pmcentrez&rendertype=abstract
Perry H, Zulliger R. How Effective are Community Health Workers? An Overview of Current Evidence with Recommendations for Strengthening Community Health Worker Programs to Accelerate Progress in Achieving the Health-related Millennium Development Goals [Internet]. Baltimore: Johns Hopkins Bloomberg,School of Public Health; 2012. Available from: file:///D:/journal papers/review of chw effectiveness for mdgs-sept2012.pdf
http://apps.who.int/gho/data/view.main.NUT1730?lang=en; Breastfeeding Fact Sheet Updated September 2015. Accessed on 12th December 2016.
Kenya National Bureau of Statistics (KNBS) and ICF Micro. Kenya Demographic and Health Survey, Key Indicators, 2014 [Internet]. Calverton, Maryland: KNBS and ICF Macro.; 2014. Available from: http://dhsprogram.com/pubs/pdf/PR55/PR55.pdf
Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, Musoke RN, et al. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. Matern Child Nutr [Internet]. 2015;11(3):314–32. Available from: http://onlinelibrary.wiley.com/doi/10.1111/mcn.12161/epdf
Ministry of Health. Taking the Kenya Essential Package for Health to the COMMUNITY A Strategy for the Delivery of level one services [Internet]. Nairobi: Health Sector Reform Secretariat , Government of Kenya; 2006. Available from: http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/community_strategy.pdf
Nzioki JM, Onyango RO, Ombaka JH. Efficiency and factors influencing efficiency of community health strategy in providing maternal and child health services in Mwingi district, Kenya: An expert opinion perspective. Pan Afr Med J [Internet]. 2015;20:1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450026/pdf/PAMJ-20-88.pdf
Kenya National Bureau of Statistics (KNBS). The 2009 Kenya Population and Housing Census: Population Distribution by Age, Sex and Administrative Units [Internet]. Vol. IC. Nairobi: Kenya National Bureau of Statistics; 2010. Available from: http://statistics.knbs.or.ke/nada/index.php/catalog/55
County Government of Kitui. First County Integrated Development Plan; Planning for Sustainable Socio-Economic Growth and Development [Internet]. Nairobi: County Government of Kitui; 2013. Available from: http://www.kitui.go.ke/images/downloads/CGoKTI_CIDP_Final_Report_26_2_2015.pdf
Fisher A.A, Laing J.E, Stoeckel J.E. TJW. Handbook for Family Planning Operations Research. Second Edi. New York: Population Council; 1998.
Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ [Internet]. 2011 Jun 27 [cited 2014 Jul 10];2:53–5. Available from: http://www.ijme.net/archive/2/cronbachs-alpha/
Quayyum Z, Khan MNU, Quayyum T, Nasreen HE, Chowdhury M, Ensor T. “Can community level interventions have an impact on equity and utilization of maternal health care” – Evidence from rural Bangladesh. Int J Equity Health [Internet]. International Journal for Equity in Health; 2013;12(1):22. Available from: http://www.equityhealthj.com/content/12/1/22/abstractnhttp://www.equityhealthj.com/content/12/1/22nhttp://www.equityhealthj.com/content/pdf/1475-9276-12-22.pdf
Olayo R, Wafula C, Aseyo E, Loum C, Kaseje D. A quasi-experimental assessment of the effectiveness of the Community Health Strategy on health outcomes in Kenya. BMC Health Serv Res [Internet]. BioMed Central Ltd; 2014;14(Suppl 1):S3. Available from: http://www.biomedcentral.com/bmchealthservres/content/14/S1/S3
Harris A, McGregor J, Perencevich E, Furuno J, Zhu J, Peterson D, et al. The Use and interpreatation of Quasi-Experimental Studies in Medical Informatics. J Am Med Inf Assoc. 2006;13(1):16–23.
Adam MB, Dillmann M, Chen M-K, Mbugua S, Ndung’u J, Mumbi P, et al. Improving maternal and newborn health: effectiveness of a community health worker program in rural kenya. PLoS One [Internet]. 2014;9(8):e104027. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4121293&tool=pmcentrez&rendertype=abstract
Irvin VL, Kaplan RM. Screening mammography & breast cancer mortality: Meta-analysis of quasi-experimental studies. PLoS One. 2014;9(6).
Kenya National Bureau of Statistics (KNBS) and ICF Micro. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro.; 2010. 455 p.
Nzioki JM, Ombaka JH, Onyango RO. Perceived Socio-Cultural and Economic Factors Influencing Maternal and Child Health : Qualitative Insights from Mwingi District , Kenya. Ann Community Heal [Internet]. 2015;3(1):13–22. Available from: http://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/article/view/114
World Health Organization, Global Health Workforce Alliance. Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals : [Internet]. Geneva: World Health Organization; 2012. Available from: http://www.who.int/workforcealliance/knowledge/publications/CHW_FullReport_2010.pdf?ua=1
Das A, Chatterjee R, Karthick M, Mahapatra T, Chaudhuri I. The influence of seasonality and community-based health worker provided counselling on exclusive breastfeeding -Findings from a cross-sectional survey in India. PLoS One. 2016;11(8):1–17.
Wangalwa G, Cudjoe B, Wamalwa D, Machira Y, Ofware P, Ndirangu M, et al. Effectiveness of Kenya’s Community Health Strategy in delivering community-based maternal and newborn health care in Busia County, Kenya: non-randomized pre-test post test study. Pan Afr Med J [Internet]. 2012 Jan;13 Suppl 1(Supp 1):12. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3587017&tool=pmcentrez&rendertype=abstract
|Indexed/Listed in:||Follows recommendations by:|
Plagarism Check by