Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial

Abstract

Objective: To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya. Design: A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facilitybased semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months. Setting: Kibera slum, Nairobi. Subjects: A total of 360 HIV-negative women, 34-36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group. Results: Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23?6 % in HBICG, 9?2 % in FBSICG and 5?6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk 5 4?01; 95 % CI 2?30, 7?01; P 5 0?001). There was no significant difference between EBF rates in FBSICG and CG. Conclusions: EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF. KeywordsExclusive breast-feeding Breast-feeding counselling Breast-feeding promotion Randomized controlled trial KenyaExclusive breast-feeding (EBF) promotion has been estimated to be the most effective intervention for saving the lives of young children, with the potential to prevent an estimated 13 % of deaths in low-resource settings (1) . WHO recommends EBF for 6 months (2) . In Africa only 32 % of infants less than 6 months of age are exclusively breast-fed. African countries making major strides in EBF for infants less than 6 months old include Rwanda (88 %), Ghana (63 %), Uganda (60 %) and Malawi (57 %) (3) . Despite an increase in EBF rate in Kenya from 13?2 % in 2003 (4) to 32?0 % in 2009 for infants less than 6 months of age, the number of children who exclusively breast-feed drops significantly with age to 13?2 % at 4-5 months (5)

Factors associated with exclusive breastfeeding in Kenya: a systematic review

“…26 Additionally, in a study conducted in Kibera slum Nairobi older mothers were more likely to breastfeed. 20 Conversely, younger mothers were more likely to practice exclusive breastfeeding as reported by Ogada. Another demographic factor found to influence exclusive breastfeeding was marital status.…”

“…19 Additionally, Ochola et al noted that increased workload hinders exclusive breastfeeding. 20 Housewives and mothers of lower socioeconomic status were predictors of exclusive breastfeeding. Working mothers were reported to have lower breastfeeding rates compared to non-working mothers and this could be due to lack of adequate time to exclusively breastfeed their infants.…”

“…22 Maternal knowledge and attitudes on duration of breastfeeding was also associated with exclusive breastfeeding. 20,23,[29][30][31] Another study carried out in Eldoret reported that barriers to exclusive breastfeeding were attributed to inadequate breastfeeding knowledge among mothers. 31 Another predictor of exclusive breastfeeding was maternal experience of breastfeeding complications.…”

“…23 Moreover, in a study conducted in Kibera, absence of breast health problems was a predictor of exclusive breastfeeding. 20 Multiple births have also been cited as a significant risk factor for failure to exclusive breastfeeding. 26 Further, time of initiation of breastfeeding after delivery has been reported to influence the practice of exclusive breastfeeding according to Odindo.…”

High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women

“…A systematic review in high-income settings indicated that successful counseling-based EBF interventions respond in real time to breastfeeding difficulties encountered during feeding, offer peer support, consist a long duration of followup after delivery, and maintain frequent contact with mothers. 24 These suggestions are supported by recent studies in Kenya, 25,26 Ghana, 27 and South Africa, 28 where peer mentorship and frequent counseling sessions over a long duration were required to influence EBF. EBF promotion efforts among HIV-infected women in sub-Saharan Africa feature additional barriers and challenges.…”