Engaging fathers and grandmothers to improve maternal and child dietary practices: Planning a community-based study in western Kenya

Fathers and grandmothers are key family influencers who have an impact on maternal and child health. This paper describes the planning, design, and implementation of a four-phased evaluation study on the impact of engaging fathers or grandmothers in improving diets of mothers and feeding practices of infants and young children in a rural setting in western Kenya. The study used a quasi-experimental, non-equivalent comparison group design with pre- and post-test observations. It tested the hypothesis that families participating in activities to engage fathers or grandmothers have better knowledge and adopt better practices related to maternal nutrition and complementary feeding than families for which nutrition messages are targeted only to mothers. Information generated from previous formative research was used to design culturally relevant interventions for fathers and grandmothers. Interventions included separate but parallel peer education dialogue groups with fathers and grandmothers. They were held twice a month, and family bazaars and special fathers’ days at local clinics were held once per month. The study team selected the dialogue-based group methodology, including promotion of social support actions, because it engages participants to actively discuss new information and experiences providing social support rather than passively receive information. Community health extension workers and Ministry of Health nutritionists provided supportive supervision and monitoring of the dialogue group activities. Father and grandmother interventions were implemented in two separate sub-locations of Kenya’s former Western Province, and the program effects were compared to findings in a population with a similar socioeconomic background living in a similar sub-location in the same province. An examination of the study implementation methodology provides useful insights into practical issues that need to be addressed in programs seeking to engage key household influencers of maternal nutrition and infant and young child feeding behaviours. Results showed that the dialogue group methodology, formative research to inform intervention design, use of the existing Ministry of Health community health unit structure to provide critical support supervision, and actions that motivated peer mentors were key factors for successful implementation of the study intervention.Keywords: Maternal nutrition, infant feeding, complementary feeding, grandmother, father, design, formative researc

Lessons from implementing mass drug administration for soil transmitted helminths among pre-school aged children during school based deworming program at the Kenyan coast

Abstract Background The 2012 London declaration which committed to “sustaining, expanding and extending drug access programmes to ensure the necessary supply of drugs and other interventions to help control soil-transmitted helminths (STH) by 2020” has seen many countries in Africa roll out mass drug administration (MDA) especially among school age children. In Kenya, however, during the National school-based deworming exercise, pre-school aged children (PSAC) have to access treatment at primary schools as the pre-school teachers are not trained to carry out deworming. With studies being conducted on the effectiveness of MDAs, the experiences of key education stakeholders which could improve the programme by giving best practices, and challenges experienced have not been documented. Methods This was a cross-sectional qualitative study using Focus group discussions (FGDs) and Key informant interviews (KIIs). It was conducted in 4 sub-counties with high STH prevalence at the Kenyan coast (Matuga, Malindi, Lunga Lunga and Msambweni) to understand best practices for implementing MDA among PSAC.FGDs categorized by gender were conducted among local community members, whereas KIIs involved pre-school teachers, primary school teachers, community health extension workers (CHEWs) and opinion leaders. Participants were purposefully selected with the saturation model determining the number of interviews and focus groups. Voice data collected was transcribed verbatim then coded and analyzed using ATLAS.Ti version 6. Results Majority of the primary school teachers and CHEWs reported that they were satisfied with the method of mobilization used and the training tools. This was however not echoed by the pre-school teachers, parents and chiefs who complained of being left out of the process. Best practices mentioned included timely drug delivery, support from pre-school teachers, and management of side effects. Overcrowding during the drug administration day, complexity of the forms (for instance the ‘S form’) and long distance between schools were mentioned as challenges. Conclusion There is need to utilize better sensitization methods to include the local administration as well as the parents for better uptake of the drugs. Extending deworming training to pre-school teachers will enhance the national deworming programme