a1 Division of Human Nutrition, University of Stellenbosch, Cape Town, South Africa
a2 Department of Foods, Nutrition & Dietetics, Kenyatta University, PO Box 43844 00100, Nairobi, Kenya
a3 Population Health, Health Systems and Innovation, Human Science Research Council, Cape Town, South Africa
a4 Department of Paediatrics, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
Objective To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya.
Design A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facility-based semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months.
Setting Kibera slum, Nairobi.
Subjects A total of 360 HIV-negative women, 34–36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group.
Results Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23·6 % in HBICG, 9·2 % in FBSICG and 5·6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk = 4·01; 95 % CI 2·30, 7·01; P = 0·001). There was no significant difference between EBF rates in FBSICG and CG.
Conclusions EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF.
(Received January 10 2012)
(Revised July 19 2012)
(Accepted August 17 2012)
(Online publication October 08 2012)