Community-based behavior change promoting child health care: a response to socio-economic disparity.
BACKGROUND
Early initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger.


METHODS
A quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers.


RESULTS
The gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4-2.7; 1.3-3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9-1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4-2.9).


CONCLUSIONS
A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.
Independent consultant in Behavior change communication, Maternal child health and nutrition, Paris, France. Naoko.Horii@gmail.com.
Naoko
N
Horii
Census mapping division, National Institute of Statistics, Niamey, Niger.
Oumarou
O
Habi
Census mapping division, National Institute of Statistics, Niamey, Niger.
Alio
A
Dangana
Census mapping division, National Institute of Statistics, Niamey, Niger.
Abdou
A
Maina
Census mapping division, National Institute of Statistics, Niamey, Niger.
Souleymane
S
Alzouma
Centre Population & Développement, Paris Descartes University, Paris, France.
Yves
Y
Charbit
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000208:ethnology; D002662:Child Health Services; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006293:Health Promotion; D054624:Health Status Disparities; D006801:Humans; D006920:Hygiene / Q000193:education; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000193:education; D009548:Niger; D018673:Nutrition Policy; D009749:Nutrition Surveys; D010349:Patient Compliance / Q000208:ethnology; D000067074:Peer Influence; D011204:Poverty Areas; D012189:Retrospective Studies; D012423:Rural Health / Q000208:ethnology; D055815:Young Adult
Behavior change; Breastfeeding; Neonatal care; Vulnerability