Saving Lives, One Child One Community at a time.
Nutrition in the first 1000 days of life is critical for child growth wellbeing and survival, interventions promoting optimal infant and young child nutrition (IYCN) could prevent a fifth of under 5 deaths. Cases of IYCN are rife and widely documented in Kenya like in any other developing countries. To mitigate the situation, in 2007 the Country’s Division of Nutrition developed a national strategy to promote optimal IYCN practices actualized through the baby friendly hospital initiatives (BFHI) in maternity wards. This however has not changed much as 2 out of 5 women deliver in health facilities and further IYCN practices are greatly influenced by traditional beliefs and practices hence the impact of the baby friendly hospital initiatives has been minimal.
“Nutrition in the first 1000 days of life is critical for child growth wellbeing and survival”
Figure 1:One of the trainers illustrating attachment and positioning while breastfeeding
Figure 2 CHVs singing a song on breastfeeding
Recognizing the need to reach women at the community level in order to provide them with a comprehensive support system to improve breastfeeding practices and other maternal, infant and young child nutrition practices at the community level, considerations of implementing Baby Friendly Community Initiative (BFCI) have been fronted by the Division of Nutrition. The initiative which employs similar principles to the earlier hospital initiative is being piloted, solid evidence on its effectiveness, how best it works and its cost effectiveness in the Kenyan contexts are being sort to promote political buy in, budgetary allocation and effective implementation at the national level. A team being led by Prof. Judith Kimiywe – Department of Food, Nutrition and Dietetics is carrying out the pilot community trial in rural setting to determine the project’s viability.
The Intervention Plan.
A cluster-randomized study has been adopted where 13 clusters constituting community units were identified with half being dedicated to the intervention and the other half to control. Overall 800 mother-child pair are engaged and are being followed up until child is six months. The community support groups for mothers comprises of about 20 mothers per group including a supportive team comprising of a community health extension worker, an older woman and a community leader. The mothers in the group meet regularly: ideally, once a month to offer each other peer-counseling and support with regards to breastfeeding and other maternal, infant and young child nutrition practices. Group members role include;
•Community Health Worker serves as group facilitator.
•The older woman is viewed as a model mother and serves a resource person. (She is carefully selected, based on knowledge and experience with infant feeding)
•The community leader, (may be the area chief or village elder), also a resource person particularly on administrative issues.
•The extension worker, who may be a skilled nurse offers technical advice to the group.
Content of Counselling Sessions
| Maternal nutrition:
Food portions during pregnancy and lactation
Expressing breast milk, storage and cup feeding
“Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition are to be done coupled with nutritional status of the mother-child pairs and morbidity for the children”.
Field Experiences and Visits
In September and October, the field workers teams visited Simotwet Community Unit where one of the mothers had delivered 3 months earlier. The baby was born weighing 3.3 kgs and had increased to 6.6 kgs at 3 months. In Solian Community Unit the team visited two mothers one 15 years old with a one week old baby weighing 3.2 kgs born at home and taken taken to the hospital after three (3) days. Despite Solian being an intervention community Unit the young mother had not been visited by a Community Health Volunteer even during her pregnancy. The same case applied to the second household visited.
At Kiptuno Community Unit the team visited two household, the first young mother had a one month old baby weighing 3.2kgs, she delivered at home with her mother’s help and the reason of home delivery was abrupt labour, she visited the hospital after 3 days. Apart from breastfeeding, she was giving her baby traditional herbs sagitiek this is despite her admission that the baby did not have any health problems to warrant the herbs being administered, this was done following her mother’s insistence. The other mother a trained teacher had a normal delivery at the local health centre. The 1month 2weeks baby weighed 3.2 kgs at birth and had increased to 5.1 kgs. Other than breastfeeding well, she gave water to the baby once in a while.
An overall sample of the mothers from both the intervention and control group revealed that most had intentions to exclusively breastfeed for 6 months and later introduce complementary feeding while continuing to breastfeed until the 2 years and beyond.
Community Health Workers in both intervention and control areas are given a motivation package which includes a seed grant to the whole group to initiate an income-generating activity, and train mothers on income-generating activities.
Income Generating Activities
Listed are activities undertaken across the 13 community Units
Farming Cabbages, Oats, potatoes, tree nursery, rabbit keeping, bee keeping, poultry farming, flower farming.
The importance of breastfeeding and optimal infant feeding promotion in child-survival cannot be overemphasized. Identification of feasible and effective strategies for promotion of optimal infant feeding is of utmost importance. The results from this trial are expected to provide evidence regarding the feasibility of implementing the BFCI in Kenya and its effectiveness on breastfeeding, morbidity from diarrhea, and nutritional status among infants. This is expected to inform policy and practice regarding child survival in Kenya and other Low and Middle Income Countries (LIMCs). It is expected to inform the roll-out of the BFCI in Kenya and other LIMCs where it is under consideration, which goes beyond the BFHI to promote optimal breastfeeding and other infant feeding practices at the community level.
Prof. Judith Kimiywe
Department of Food, Nutrition and Dietetics, School of Applied Human Sciences
Project financed by: National Academy of Sciences
Download Paper published:Feasibility and effectiveness of the baby friendly community initiative in rural Kenya:study protocol for a randomized controlled trial