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Exclusive breastfeeding for the first six months, as recommended by the World Health Organization, is vital for the growth and survival of the child. Exclusive breastfeeding means that the infant receives only breast milk. This is because breast milk contains adequate amounts of nutrients and water necessary for healthy growth, as well as immune factors necessary for the development of the infant’s immune system during the first 4-6 months of life.
Other benefits of breastfeeding include protection against common childhood illnesses such as diarrhea and pneumonia, and infant death. Increasing exclusive breastfeeding can prevent 823,000 child deaths each year and protect against overweight and diabetes.
There are also benefits for mothers. It has been shown to reduce the risk of breast and ovarian cancer, improve the spacing between births and reduce the risk of diabetes.
Kenya has made great efforts to increase the number of women breastfeeding their babies. Exclusive breastfeeding rates have increased over the years from 32% in 2008 to 61% in 2014, which is above the current global average of 43%.
But rates of exclusive breastfeeding in Kenya vary with age. For example, the percentage of exclusively breastfed infants decreases sharply from 84% of infants aged 0-1 months to 63% of infants aged 2 to 3 months and, in addition, to 42% of infants aged 4 to 5 months.
In order to address these trends, the Kenyan government has put in place a number of initiatives to promote exclusive breastfeeding for the first six months of a baby’s life.
One of them is the baby-friendly hospital initiative. Launched in 1991, it aims to expand 10 interventions in maternity hospitals to promote breastfeeding success. The initiative was effective in promoting exclusive breastfeeding during the first few weeks, but not as effective in maintaining it for the recommended six months.
This highlighted the need to step up breastfeeding promotion in communities, which led to the Baby Friendly Communities initiative. This gives primary health workers and community health volunteers the skills to help mothers breastfeed and feed their infants and young children. It also enables other family and community members to support breastfeeding mothers.
The intervention is important especially in regions like Africa where 60% of women give birth at home.
We conducted a study to assess the effectiveness of the Baby-Friendly Communities initiative in Koibatek, a rural area in the Rift Valley region of Kenya, where mothers exclusively breastfeed for an average of three months.
What we found
The study was carried out in 13 community units in Koibatek sub-county. Pregnant women aged 15 to 49 were recruited and followed until their children were at least six months old. Mothers in the intervention group received standard nutrition counseling and support for mothers, infants and young children from trained community health volunteers, health professionals, community support groups to mothers and mother-to-mother support groups. People in the control group received only standard counseling, consisting of messages on infant and young child nutrition. No support related to maternal and child nutrition was provided to mothers in the control group. Data on breastfeeding practices were collected.
A total of 823 pregnant women were recruited. Compared to mothers in the control group, the 351 mothers in the intervention group were three times more likely to exclusively breastfeed for six months and longer (19 more days).
The intervention used minimal resources as it was implemented within the existing health system by community health volunteers who were instrumental in providing information on maternal, infant and infant nutrition. of the young child.
They were required to visit mothers at home and provide support through community mother support groups and mother-to-mother support groups.
Mother-to-mother support groups consisted of 9 to 15 pregnant and breastfeeding women and, in some cases, fathers and grandmothers. The group has met monthly to discuss issues related to pregnancy and the diet and nutrition of young children. Community health volunteers and a responsible mother, who acted as the group leader, facilitated the meetings.
The community mother support group included a nutritionist, community health volunteers, a local administrator, a community leader and a primary mother. The role of the support group was to supervise, plan and execute community meetings at the initiative of the baby-friendly community; mobilize all members of the community to participate in its activities; support community health extension workers and nutritionists in monitoring and documenting monthly community level activities; and monthly monitor and document maternal, infant and young child nutrition activities.
Next steps
We believe our results show that supporting mothers in their communities has the potential to increase exclusive breastfeeding for longer.
Indeed, the assistance that women receive in their communities responds to some key reasons that have been identified for the decline in the number of women exclusively breastfeeding in the first six months. These are:
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Lack of information / knowledge about the importance of breastfeeding
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Tips and cultural beliefs and practices that negatively impact breastfeeding
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Poor breastfeeding positioning and latching
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Inadequate breastfeeding support
Our results showed that breastfeeding support in communities and the provision of information led to a significant increase in exclusive breastfeeding rates. We concluded from our results that the Baby-Friendly Communities initiative has the potential to improve exclusive breastfeeding rates in similar settings. It should be extended to Kenya and extended to other African countries.
Antonina Mutoro works for the African Center for Population and Health Research. It is affiliated with the University of Glasgow, UK
Elizabeth Kimani-Murage works for the African Center for Population and Health Research (APHRC). It receives funding from the Wellcome Trust, USAID, NIH. It is affiliated with Brown University, USA.
By Antonina Mutoro, Postdoctoral Fellow, African Center for Population and Health Research And
Elizabeth Kimani-Murage, Senior Scientist, African Center for Population and Health Research
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