Effectiveness of the Baby-Friendly Community Initiative in Promoting Exclusive Breastfeeding among HIV Negative and Positive Mothers: A Randomized Controlled Trial in Koibatek Sub-County, Baringo, Kenya
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Date
2020
Authors
Samburu, Betty Mogesi
Young, Sera Lewise
Wekesah, Frederick Murunga
Wanjohi, Milkah Njeri
Kimiywe, Judith
Muriuki, Peter
Griffiths, Paula L.
McGarvey, Stephen T.
Nyovani, Janet Madise
Kimani-Murage, Elizabeth W.
Journal Title
Journal ISSN
Volume Title
Publisher
International Breastfeeding Journal
Abstract
Background: Although the baby-friendly community initiative (BFCI) has been proposed as a community-level
approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We
conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive
breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya.
Methods: A community-based cluster-randomized controlled trial was implemented from April 2015 to December
2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12
personalized home-based counselling sessions on infant feeding by trained community health volunteers from their
first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions
at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings
targeting influencers. The control group received standard health education at the facility and during monthly
routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates
of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding
breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regressionResults: At 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm
compared to the control arm (81.7% versus 42.2% p = 0.001). HIV positive mothers in the intervention arm had
higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus
58.4%; p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the
intervention arm than in the control (92.1% versus 60.7% p = 0.001). Among HIV positive mothers, such knowledge
was high among both the intervention and control groups (96% versus 100%, p > 0.1). HIV negative and positive
mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the
control (84.5% versus 62.1%, p = 0.001) and (94.6% versus 53.8% to p = 0.001) respectively.
Conclusions: BFCI interventions can complement facility-based interventions to improve exclusive and continued
breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.
Description
article
Keywords
Baby friendly community initiative, Exclusive breastfeeding, HIV, Attitudes, Practices, Kenya, Peer counsellors
Citation
Samburu, B.M., Young, S.L., Wekesah, F.M. et al. Effectiveness of the baby-friendly community initiative in promoting exclusive breastfeeding among HIV negative and positive mothers: a randomized controlled trial in Koibatek Sub-County, Baringo, Kenya. Int Breastfeed J 15, 62 (2020). https://doi.org/10.1186/s13006-020-00299-4