title: Potential effectiveness of Community Health Strategy to promote exclusive breastfeeding in urban poor settings in Nairobi, Kenya: a quasi-experimental study.
abstract: Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Intervention (2012-2015; n=1110) and Comparison (2012-2014; n=487)], which followed mother-child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ(2) test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4-96.4), 84.3 (95% CI 40.7-174.6) and 3.9 (95% CI 1.8-8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: E W
authors.initials: EW
authors.lastname: Kimani-Murage
authors.affiliation: 3MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: S A
authors.initials: SA
authors.lastname: Norris
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: M K
authors.initials: MK
authors.lastname: Mutua
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: F
authors.initials: F
authors.lastname: Wekesah
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: M
authors.initials: M
authors.lastname: Wanjohi
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: N
authors.initials: N
authors.lastname: Muhia
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Muriuki
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: T
authors.initials: T
authors.lastname: Egondi
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: C
authors.initials: C
authors.lastname: Kyobutungi
authors.affiliation: 1African Population and Health Research Center (APHRC),Nairobi,Kenya.
authors.forename: A C
authors.initials: AC
authors.lastname: Ezeh
authors.affiliation: 4Department of Paediatrics,University of Nairobi,Nairobi,Kenya.
authors.forename: R N
authors.initials: RN
authors.lastname: Musoke
authors.affiliation: 2International Health Institute,Brown University,Providence,RI,USA.
authors.forename: S T
authors.initials: ST
authors.lastname: McGarvey
authors.affiliation: 5Centre for Global Health, Population, Poverty, and Policy University of Southampton,Southampton,UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Madise
authors.affiliation: 3MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: P L
authors.initials: PL
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000379:methods* / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000517:prevention & control*; D002675:Child, Preschool; D018672:Community Health Planning; D003153:Community Health Services; D003376:Counseling; D018479:Early Intervention, Educational; D005260:Female; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010353:Patient Education as Topic; D058996:Quality Improvement; D012107:Research Design; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult
keywords: Community health workers; Kenya; Urban slums; exclusive breastfeeding; sub-Saharan Africa