Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial

Trials

Nyovani J Madise⁴  Paula Griffiths²  Shane A Norris⁵  Rachel N Musoke³  Peterrock Muriuki¹  Milka Wanjohi¹  Frederick Wekesah¹  Alex C Ezeh¹  Catherine Kyobutungi¹  Elizabeth W Kimani-Murage¹ 

[1] African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya;Centre for Global Health and Human Development, Loughborough University, Loughborough, UK;Department of Paediatrics, University of Nairobi, Nairobi, Kenya;Centre for Global Health, Population, Poverty, and Policy University of Southampton, Southampton, UK;MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

关键词: Urban slums;    Sub-Saharan Africa;    Kenya;    Cluster randomised controlled trials;    Child nutrition;    Infant feeding practices;    Breastfeeding;   

Others  :  833656
DOI  :  10.1186/1745-6215-14-445

 received in 2013-05-15, accepted in 2013-12-09,  发布年份 2013

【 摘 要 】

Background

Nutrition in the first 1,000 days of life (during pregnancy and the first two years) is critical for child growth and survival. Poor maternal, infant and young child nutrition (MIYCN) practices are widely documented in Kenya, with potential detrimental effects on child growth and survival. This is particularly a problem in slums, where most urban residents live. For example, exclusive breastfeeding for the first six months is only about two per cent. Innovative strategies to reach slum residents are therefore needed. Strategies like the Baby Friendly Hospital Initiative have proven effective in some settings but their effectiveness in resource-limited settings, including slums where many women do not deliver in hospital, is questionable. We propose to test the effectiveness of a home-based intervention on infant feeding practices, nutrition and health outcomes of infants born in two slums in Nairobi, Kenya.

Methods/Design

The study, employing a cluster-randomised study design, will be conducted in two slums in Nairobi: Korogocho and Viwandani where 14 community units (defined by the Government’s health care system) will form the unit of randomization. A total of 780 pregnant women and their respective child will be recruited into the study. The mother-child pair will be followed up until the child is one year old. Recruitment will last approximately one year and three months from September 2012 to December 2013. The mothers will receive regular, personalised, home-based counselling by trained Community Health Workers on MIYCN. Regular assessment of knowledge, attitudes and practices on MIYCN will be done, coupled with assessments of nutritional status of the mother-child pairs and diarrhea morbidity for the children. Statistical methods will include analysis of covariance and multinomial logistic regression. Additionally, cost-effectiveness analysis will be done. The study is funded by the Wellcome Trust and will run from March 2012 to February 2015.

Discussion

Interventions aimed at promoting optimal breastfeeding and complementary feeding practices are considered to have high impact and could prevent a fifth of the under-five deaths in countries with high mortality rates. This study will inform policy and practice in Kenya and similar settings regarding delivery mechanisms for such high-impact interventions, particularly among urban poor populations.

Trial registration

ISRCTN83692672

【 授权许可】

   
2013 Kimani-Murage et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bank W: Global Monitoring Report. Washington DC: World Bank; 2008.
• [2]United Nations Children’s Fund, World Health Organization, The World Bank: UNICEFWHO-World Bank Joint Child Malnutrition Estimates. New York: UNICEF; 2012. WHO, Geneva; The World Bank, Washington, DC; 2012
• [3]Murray CJ, Lopez AD: Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997, 349:1436-1442.
• [4]World Health Organization: World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: WHO; 2002.
• [5]Lanigan J, Singhal A: Early nutrition and long-term health: a practical approach. Proc Nutr Soc 2009, 1:8.
• [6]Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS: Maternal and Child Undernutrition Study G: Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008, 371:340-357.
• [7]Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B: Developmental potential in the first 5 years for children in developing countries. Lancet 2007, 369:60-70.
• [8]Oddy WH, Kendall GE, Blair E, De Klerk NH, Stanley FJ, Landau LI, Silburn S, Zubrick S: Breast feeding and cognitive development in childhood: a prospective birth cohort study. Paediatr Perinat Epidemiol 2003, 17:81-90.
• [9]WHO: Global strategy for infant and young child feeding. Geneva: WHO; 2003.
• [10]WHO: The optimal duration of exclusive breastfeeding. Report of an Expert Consultation. Geneva: WHO; 2002.
• [11]Kramer MS, Kakuma R: The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol 2004, 554:63-77.
• [12]Gareth J, Richard WS, Robert EB, Zulfiqar AB, Saul SM: How many child deaths can we prevent this year? Lancet 2003, 362:65-71.
• [13]Kenya National Bureau of Statistics (KNBS), ICF Macro: Kenya Demographic and Health Survey 2008–09. Calverton, Maryland: KNBS and ICF Macro; 2009.
• [14]CBS Kenya MoHMK, ORC Macro: Kenya Demographic and Health Survey 2003: Key Findings. Calverton, Maryland, USA: CBS, MOH and ORC Macro; 2004.
• [15]Pan American Health Organization (PAHO): Guiding principles for complementary feeding of the breastfed child. Washington DC: WHO; 2003.
• [16]World Health Organization: Guiding principles for feeding nonbreastfed children 6 to 24 months of age. Geneva: WHO; 2005.
• [17]Ministry of Public Health and Sanitation: National Strategy on Infant and Young Child Feeding Strategy 2007–2010. Nairobi: Ministry of Public Health and Sanitation, Kenya; 2007.
• [18]Montagu D, Yamey G, Visconti A, Harding A, Yoong J: Where Do Poor Women in Developing Countries Give Birth? A Multi-Country Analysis of Demographic and Health Survey Data. PLoS One 2011, 6:e17155.
• [19]UNHABITAT: Slums of the World. The Face of Urban Poverty in the New Millennium? Global Urban Observatory. Nairobi: UNHABITAT; 2003.
• [20]Fotso J-C, Ezeh A, Madise N, Ziraba A, Ogollah R: What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya. Matern Child Health J 2009, 13:130-137.
• [21]Essendi H, Mills S, Fotso JC: Barriers to formal emergency obstetric care services’ utilization. J Urban Health 2011, 88(Suppl 2):S356-S369.
• [22]Kimani-Murage E, Madise N, Fotso J-C, Kyobutungi C, Mutua K, Gitau T, Yatich N: Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya. BMC Public Health 2011, 11:396. BioMed Central Full Text
• [23]Abuya BA, Ciera J, Kimani-Murage E: Effect of mother’s education on child’s nutritional status in the slums of Nairobi. BMC Pediatr 2012, 12:80. BioMed Central Full Text
• [24]African Population and Health Research Center: Population and Health Dynamics in Nairobi Informal Settlements. Nairobi: APHRC; 2002.
• [25]Emina J, Beguy D, Zulu EM, Ezeh AC, Muindi K, Elung’ata P, Otsola JK, Ye Y: Monitoring of health and demographic outcomes in poor urban settlements: evidence from the Nairobi Urban Health and Demographic Surveillance System. J Urban Health 2011, 88(Suppl 2):S200-S218.
• [26]Campbell MK, Elbourne DR, Altman DG: CONSORT statement: extension to cluster randomised trials. BMJ 2004, 328:702-708.
• [27]Reading R, Harvey I, McLean M: Cluster randomised trials in maternal and child health: implications for power and sample size. Arch Dis Child 2000, 82:79-83.
• [28]Ndugwa RP, Kabiru CW, Cleland J, Beguy D, Egondi T, Zulu EM, Jessor R: Adolescent problem behavior in Nairobi’s informal settlements: applying problem behavior theory in sub-Saharan Africa. J Urban Health 2011, 88(Suppl 2):S298-S317.
• [29]Chan YH: Randomised controlled trials (RCTs)–sample size: the magic number? Singapore Med J 2003, 44:172-174.
• [30]Haider R, Ashworth A, Kabir I, Huttly S: Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000, 356:1643-1647.
• [31]Fotso JC, Madise N, Baschieri A, Cleland J, Zulu E, Mutua MK, Essendi H: Child growth in urban deprived settings: does household poverty status matter? At which stage of child development? Health Place 2012, 18:375-384.
• [32]World Health Organization: Infant and Young Child Feeding Counselling: An Integrated Course. Geneva: WHO Document Production Services; 2006.
• [33]Black MM, Aboud FE: Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr 2011, 141:490-494.
• [34]Engle PL, Bentley M, Pelto G: The role of care in nutrition programmes: current research and a research agenda. Proc Nutr Soc 2000, 59:25-35.
• [35]Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M, Maternal and Child Undernutrition Study Group: What works? Interventions for maternal and child undernutrition and survival. Lancet 2008, 371:417-440.
• [36]Lohman TG, Roche AF, Martorell R: Anthropometric standardization reference manual. Abridgedth edition. Champaign, IL: Human Kinetics Books; 1991.
• [37]WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006, 450:76-85.
• [38]WHO Working Group: Use and interpretation of anthropometric indicators of nutritional status. Bull World Health Organ 1986, 64:929-941.
• [39]Prameela KK, Vijaya LR: The importance of breastfeeding in rotaviral diarrhoeas. Malaysian journal of nutrition 2012, 18:103-111.
• [40]Twisk J, Proper K: Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up. J Clin Epidemiol 2004, 57:223-228.
• [41]Sainani KL: Making sense of intention-to-treat. PM R 2010, 2:209-213.
• [42]Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost effectiveness in health and medicine. New York: Oxford University Press; 1996.
• [43]Strauss AL, Corbin JM: Basics of qualitative research: grounded theory procedures and techniques Newbury Park. California: Sage Publications; 1990.
• [44]Ryan GW, Bernard HR: Techniques to identify themes. Field Methods 2003, 15:85-109.
• [45]Aksu H, Kucuk M, Duzgun G: The effect of postnatal breastfeeding education/support offered at home 3 days after delivery on breastfeeding duration and knowledge: a randomized trial. J Matern Fetal Neonatal Med 2011, 24:354-361.
• [46]Wangalwa G, Cudjoe B, Wamalwa D, Machira Y, Ofware P, Ndirangu M, Ilako F: Effectiveness of Kenya’s Community Health Strategy in delivering community-based maternal and newborn health care in Busia County, Kenya: non-randomized pre-test post test study. Pan African Med J 2012, 13:12.
• [47]Chung M, Raman G, Trikalinos T, Lau J, Ip S: Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2008, 149:565-582.
• [48]Sikorski J, Renfrew MJ, Pindoria S, Wade A: Support for breastfeeding mothers: a systematic review. Paediatr Perinat Epidemiol 2003, 17:407-417.
• [49]Martens PJ: What do Kramer’s Baby-Friendly Hospital Initiative PROBIT Studies tell us? A review of a decade of research. J Hum Lact 2012, 28:335-342.
• [50]Saadeh RJ: The Baby-Friendly Hospital Initiative 20 years on: facts, progress, and the way forward. J Hum Lact 2012, 28:272-275.
• [51]Merten S, Dratva J, Ackermann-Liebrich U: Do baby-friendly hospitals influence breastfeeding duration on a national level? Pediatrics 2005, 116:e702-708.
• [52]Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Collet JP, Vanilovich I, Mezen I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E, PROBIT Study Group (Promotion of Breastfeeding Intervention Trial): Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001, 285:413-420.
• [53]Coutinho SB, De Lira PI, De Carvalho LM, Ashworth A: Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Lancet 2005, 366:1094-1100.
• [54]Guise JM, Palda V, Westhoff C, Chan BK, Helfand M, Lieu TA, Force USPST: The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Services Task Force. Ann Family Med 2003, 1:70-78.
• [55]Bhutta AZ, Lassi ZS, Pariyo G, Huicho L: Global experience of community health workers for delivery of health related Millennium Development Goals: a systematic review, country case studies and recommendation for integration into national health systems. Geneva: World Health Organization: Global Health Workforce Alliance; 2010.
• [56]Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, Walker DG, Bhutta Z: Achieving child survival goals: potential contribution of community health workers. Lancet 2007, 369:2121-2131.