Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial

Background: Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya. Methods: The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government's Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health. Discussion: Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aimed at promoting optimal breastfeeding and other infant feeding practices. The intervention, if proved feasible and effective, will inform policy and practice in Kenya and similar settings, particularly regarding implementation of the baby friendly community initiative. Trial registration:ISRCTN03467700 ; Date of Registration: 24 September 201

Experiences of incorporating support for early childhood development into the Baby Friendly Community Initiative in rural Kenya

Over 66 per cent of children in sub-Saharan Africa remain affected by poor developmental outcomes, exacerbating early inequalities. UNICEF and WHO evolved the Care for Child Development package (CCD) as a community-based initiative to support caregivers to develop stronger relationships with young children and support nurturing care. The Baby Friendly Community Initiative (BFCI) is a global WHO strategy to promote optimal maternal, infant and young child nutrition at the community level. This paper provides insights into the feasibility and lessons learned from rural Kenya in providing CCD training and supporting its implementation alongside the BFCI. Findings from qualitative interviews with caregivers and implementers of the BFCI revealed that training community health volunteers on CCD, enabled them to deliver CCD messages alongside those of the BFCI during counselling sessions. However, a more integrated approach to training as well as practical training opportunities, refresher training and provision of materials that facilitate the programme will enable further support for nurturing care in Kenya

Effect of a baby-friendly workplace support intervention on exclusive breastfeeding in Kenya

Exclusive breastfeeding (EBF) during the first 6 months of life is crucial for optimizing child growth, development and survival, as well as the mother's wellbeing. Mother's employment may hinder optimal breastfeeding, especially in the first 6 months. We assessed the effectiveness of a baby-friendly workplace support intervention on EBF in Kenya. This pre-post intervention study was conducted between 2016 and 2018 on an agricultural farm in Kericho County. The intervention targeted pregnant/breastfeeding women residing on the farm and consisted of workplace support policies and programme interventions including providing breastfeeding flexi-time and breaks for breastfeeding mothers; day-care centres (crèches) for babies near the workplace and lactation centres with facilities for breast milk expression and storage at the crèches; creating awareness on available workplace support for breastfeeding policies; and home-based nutritional counselling for pregnant and breastfeeding women. EBF was measured through 24-h recall. The effect of the intervention on EBF was estimated using propensity score weighting. The study included 270 and 146 mother–child dyads in the nontreated (preintervention) group and treated (intervention) group, respectively. The prevalence of EBF was higher in the treated group (80.8%) than in the nontreated group (20.2%); corresponding to a fourfold increased probability of EBF [risk ratio (RR) 3.90; 95% confidence interval (CI) 2.95–5.15]. The effect of the intervention was stronger among children aged 3–5 months (RR 8.13; 95% CI 4.23–15.64) than among those aged <3 months (RR 2.79; 95% CI 2.09–3.73). The baby-friendly workplace support intervention promoted EBF especially beyond 3 months in this setting