ABSTRACT
Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Intervention (2012-2015; n=1110) and Comparison (2012-2014; n=487)], which followed mother-child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ(2) test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4-96.4), 84.3 (95% CI 40.7-174.6) and 3.9 (95% CI 1.8-8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.
Subject(s)
Breast Feeding/methods , Child Nutrition Disorders/prevention & control , Community Health Services , Counseling , Health Promotion , Nutritional Status , Adolescent , Adult , Breast Feeding/statistics & numerical data , Case-Control Studies , Child , Child Nutrition Disorders/epidemiology , Child, Preschool , Community Health Planning , Early Intervention, Educational , Female , Humans , Infant , Infant, Newborn , Kenya/epidemiology , Male , Middle Aged , Patient Education as Topic , Quality Improvement , Research Design , Socioeconomic Factors , Urban Population , Young AdultABSTRACT
PIP: Young people constitute a large and rapidly growing proportion of the population in most countries of Africa and in many parts of the world as a whole. These young people live in a rapidly changing world, faced with many pressures. Young people on the whole experience discomforting confusion, disquieting irritations and perplexities, and adjustment problems as a result of rapid social change. There is an increase in drug and alcohol use among youth leading to vandalism and disrespect toward their elders and authority. There also are teenage pregnancies and school dropouts. Illegal abortion is being practiced by many girls which sometime lead to premature death. Urbanization also has accentuated various kinds of evils and crimes. Modernization and western influences have helped to erode traditional Africa values. The family system has lost ground rapidly, and the indigenous systems of education have largely disappeared. The passing away of old Africa has contributed to laxity in morals. The current socioeconomic conditions in Africa block the progress of the Africa youth. Early marriages complicate matters for youth and increase the burdens of youth. Ignorance, illiteracy, and insufficient knowledge about fertility regulation methods all have helped to increase early childbearing. These are reinforced by African traditional values attached to childbearing. Furthermore, in traditional African society, the young people depended for guidance in behavior and personal relationships on some member of the family. This teaching was gradual and continued until the child was an adult. Today, the family has had to relinquish much of the responsibility of guiding youth on these concerns. Much of the task has been left to formal education and to chance. Problems relating to young people should be attacked at their roots. Such an effort should aim to inform, teach, educate, and orient youth so that they can face the reality of their sexual life. Family Life and Sex Education Programs can be developed for children and their parents. Such programs can inform young people realistically about the responsibilites of parenthood and the disadvantages of teenage parenthood compared to the advantages of postponing childbearing. For the parents to play their role effectively, they need to understand adolescence and be able to cope with problems related to it. Programs which aim at meeting the needs of young people should give an equal opportunity to women and men at all levels of responsibility. Some approaches to family life education are outlined.^ieng
