title: 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.
  
  
  METHODS
  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 facility-based 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.
  
  
  METHODS
  Kibera slum, Nairobi.
  
  
  METHODS
  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 = 4.01; 95% CI 2.30, 7.01; P=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.
authors.affiliation: Division of Human Nutrition, University of Stellenbosch, Cape Town, South Africa. sochola@yahoo.com
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Ochola
authors.forename: Demetre
authors.initials: D
authors.lastname: Labadarios
authors.forename: Ruth W
authors.initials: RW
authors.lastname: Nduati
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D016000:Cluster Analysis; D003376:Counseling; D005260:Female; D006801:Humans; D007630:Kenya; D010379:Peer Group; D010865:Pilot Projects; D011203:Poverty; D011247:Pregnancy; D064186:Prenatal Education / Q000379:methods*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult