title: Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study.
abstract: BACKGROUND
  We designed and tested an intervention that used dialogue-based groups to engage infants' fathers and grandmothers to support optimal infant feeding practices. The study's aim was to test the effectiveness of increased social support by key household influencers on improving mothers' complementary feeding practices.
  
  
  METHODS
  Using a quasi-experimental design, we enrolled mothers, fathers, and grandmothers from households with infants 6-9 months old in 3 rural communities (1 intervention arm with fathers, 1 intervention arm with grandmothers, and 1 comparison arm) in western Kenya. We engaged 79 grandmothers and 85 fathers in separate dialogue groups for 6 months from January to July 2012. They received information on health and nutrition and were encouraged to provide social support to mothers (defined as specific physical actions in the past 2 weeks or material support actions in the past month). We conducted a baseline household survey in December 2011 in the 3 communities and returned to the same households in July 2012 for an endline survey. We used a difference-in-difference (DiD) approach and logistic regression to evaluate the intervention.
  
  
  RESULTS
  We surveyed 554 people at baseline (258 mothers, 165 grandmothers, and 131 fathers) and 509 participants at endline. The percentage of mothers who reported receiving 5 or more social support actions (of a possible 12) ranged from 58% to 66% at baseline in the 3 groups. By endline, the percentage had increased by 25.8 percentage points (P=.002) and 32.7 percentage points (P=.001) more in the father and the grandmother intervention group, respectively, than in the comparison group. As the number of social support actions increased in the 3 groups, the likelihood of a mother reporting that she had fed her infant the minimum number of meals in the past 24 hours also increased between baseline and endline (odds ratio [OR], 1.14; confidence interval [CI], 1.00 to 1.30; P=.047). When taking into account the interaction effects of intervention area and increasing social support over time, we found a significant association in the grandmother intervention area on dietary diversity (OR, 1.19; CI, 1.01 to 1.40; P=.04). No significant effects were found on minimum acceptable diet.
  
  
  CONCLUSIONS
  Engaging fathers and grandmothers of infants to improve their knowledge of optimal infant feeding practices and to encourage provision of social support to mothers could help improve some feeding practices. Future studies should engage all key household influencers in a family-centered approach to practice and support infant feeding recommendations.
authors.affiliation: United States Agency for International Development (USAID) Infant and Young Child Nutrition Project., Washington, DC, USA. Now with USAID Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project, Arlington, VA, USA.
authors.forename: Altrena G
authors.initials: AG
authors.lastname: Mukuria
authors.affiliation: USAID Infant and Young Child Nutrition Project, Washington, DC, USA. Now with Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Martin
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Thaddeus
authors.initials: T
authors.lastname: Egondi
authors.affiliation: PATH, Seattle, WA, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Bingham
authors.affiliation: University of Nairobi, School of Public Health, Nairobi, Kenya.
authors.forename: Faith M
authors.initials: FM
authors.lastname: Thuita
mesh_terms: D000328:Adult; D005191:Family Characteristics; D005220:Fathers; D005247:Feeding Behavior; D005260:Female; D017144:Focus Groups; D000066502:Grandparents; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007630:Kenya; D016015:Logistic Models; D008297:Male; D062407:Meals; D009035:Mothers; D016017:Odds Ratio; D012424:Rural Population; D012944:Social Support