Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial
Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial
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DOI：
10.1186/s12992-017-0314-9
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发表时间：
2017-12-19
影响因子：
10.8
通讯作者：
Madise, Nyovani J.
中科院分区：
文献类型：
--
作者：
Kimani-Murage, Elizabeth W.;Griffiths, Paula L.;Madise, Nyovani J.
纯母乳喂养（EBF）可改善婴儿健康和存活率。我们测试的有效性，以家庭为基础的干预，使用社区卫生工作者（CHW）EBF六个月的城市贫困settinginKeny.Methods：我们进行了一个集群随机对照试验，在科罗戈乔和维万达尼贫民窟在内罗毕。我们招募了孕妇，并跟踪她们，直到婴儿的第一个生日。14个社区集群被随机分配到干预组或对照组。干预组在定期访问期间接受以家庭为基础的营养咨询，由经过培训的CHW提供特定的孕产妇、婴儿和幼儿营养（MIYCN）信息和标准护理。对照组由未接受过MIYCN培训的社区卫生工作者访问，他们提供标准护理（包括产前和产后护理、计划生育、水、环境卫生和个人卫生、熟练助产、免疫接种和社区营养等方面）。两个小组的社区卫生工作者分发了关于MIYCN的类似信息材料。干预状态的EBF差异进行了测试，使用卡方和logistic回归，采用意向治疗analysis.Results：共1110母子对参与，约一半在每个arm. At基线，人口和社会经济因素是相似的两个武器之间。6个月的EBF率从干预前的2%增加到干预组的55.2%（95%CI 50.4-59.9）和对照组的54.6%（95%CI 50.0-59.1）。调整后的EBF几率（根据基线特征调整后）干预组略高于对照组，但无显著差异：0-2个月（OR 1.27，95% CI 0.55 - 2.96; p = 0.550）; 0-4个月（OR 1.15; 95% CI 0.54 - 2.42; p = 0.696），0-6个月（OR 1.11，95% CI 0.61至2.02; p = 0.718）。6个月的EBF显着增加，表明使用社区卫生工作者提供家庭为基础的咨询母亲的潜在有效性。在两组中EBF率没有任何差异表明潜在的污染控制臂保留的信息干预arm. However，这项研究表明了巨大的潜力，使用CHWs时，他们被激励和监测作为一个有效的模式，促进EBF，特别是在城市贫困的设置。鉴于两组的结果相当，研究表明，在基本初级保健培训中向社区卫生工作者提供基本营养培训和/或提供信息材料可能足以提高社区的EBF率。然而，可能需要对此进行进一步调查。这些研究结果对实施科学的一个贡献是难以找到一个适当的反事实为基础的社区教育干预措施。
Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a home-based intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya.Methods: We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant's first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis.Results: A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4-59.9) in the intervention group and 54.6% (95% CI 50.0-59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0-2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0-4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0-6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718).Conclusions: EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.