Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya

listen audio

Study Justification:
This study aimed to assess breastfeeding and infant feeding practices in urban slums in Nairobi, Kenya, with reference to World Health Organization (WHO) recommendations. The study was justified by the lack of evidence on breastfeeding and infant feeding practices in sub-Saharan Africa’s urban slums. The findings of this study would provide valuable information on adherence to WHO recommendations and identify factors influencing sub-optimal practices.
Highlights:
– The study found that almost all children (99%) in the slums had been breastfed at some point, but there were sub-optimal practices such as delayed initiation of breastfeeding and early introduction of other liquids.
– Exclusive breastfeeding for the first six months was rare, with only about 2% of infants exclusively breastfed for six months.
– Factors associated with sub-optimal practices included child’s sex, perceived size at birth, mother’s marital status, ethnicity, education level, family planning, health seeking behavior, and neighborhood.
Recommendations for Lay Reader and Policy Maker:
1. Interventions should focus on promoting adherence to WHO recommendations for breastfeeding and infant feeding practices.
2. Cultural practices, access to and utilization of healthcare facilities, child feeding education, and family planning should be addressed in interventions and further research.
3. Policy makers should prioritize improving the socio-economic conditions of urban slums, including housing, infrastructure, security, and employment opportunities.
4. Collaboration between healthcare providers, community leaders, and organizations working in the slums is essential for implementing effective interventions.
Key Role Players:
1. Healthcare providers: They play a crucial role in promoting and supporting breastfeeding and infant feeding practices. They should provide accurate information, counseling, and support to mothers.
2. Community leaders: They can help raise awareness, mobilize communities, and promote behavior change through community-based initiatives.
3. Non-governmental organizations (NGOs): NGOs working in the slums can provide resources, training, and support for breastfeeding and infant feeding programs.
4. Government agencies: Government agencies should develop and implement policies that support breastfeeding and infant feeding practices, including maternity leave policies and regulations on marketing of breastmilk substitutes.
Cost Items for Planning Recommendations:
1. Training and capacity building for healthcare providers and community leaders.
2. Development and dissemination of educational materials on breastfeeding and infant feeding.
3. Community outreach programs and awareness campaigns.
4. Improvement of healthcare facilities and services in the slums.
5. Research and monitoring to evaluate the effectiveness of interventions.
6. Collaboration and coordination between different stakeholders.
Please note that the cost items provided are general categories and not actual cost estimates. The actual cost will depend on the specific context and implementation strategies.

Background: The World Health Organisation (WHO) recommends exclusive breastfeeding during the first six months of life for optimal growth, development and health. Breastfeeding should continue up to two years or more and nutritionally adequate, safe, and appropriately-fed complementary foods should be introduced at the age of six months to meet the evolving needs of the growing infant. Little evidence exists on breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant feeding practices in Nairobi slums with reference to WHO recommendations. Methods. Data from a longitudinal study conducted in two Nairobi slums are used. The study used information on the first year of life of 4299 children born between September 2006 and January 2010. All women who gave birth during this period were interviewed on breastfeeding and complementary feeding practices at recruitment and this information was updated twice, at four-monthly intervals. Cox proportional hazard analysis was used to determine factors associated with cessation of breastfeeding in infancy and early introduction of complementary foods. Results: There was universal breastfeeding with almost all children (99%) having ever been breastfed. However, more than a third (37%) were not breastfed in the first hour following delivery, and 40% were given something to drink other than the mothers’ breast milk within 3 days after delivery. About 85% of infants were still breastfeeding by the end of the 11th month. Exclusive breastfeeding for the first six months was rare as only about 2% of infants were exclusively breastfed for six months. Factors associated with sub-optimal infant breastfeeding and feeding practices in these settings include child’s sex; perceived size at birth; mother’s marital status, ethnicity; education level; family planning (pregnancy desirability); health seeking behaviour (place of delivery) and; neighbourhood (slum of residence). Conclusions: The study indicates poor adherence to WHO recommendations for breastfeeding and infant feeding practices. Interventions and further research should pay attention to factors such as cultural practices, access to and utilization of health care facilities, child feeding education, and family planning. © 2011 Kimani-Murage et al; licensee BioMed Central Ltd.

The study was carried out in two urban slums of Nairobi Kenya (Korogocho and Viwandani) where the African Population and Health Research Center (APHRC) runs a health and demographic surveillance system; the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). The two slum areas are densely populated (63,318 and 52,583 inhabitants per square km, respectively), and are characterized by poor housing, lack of basic infrastructure, violence, insecurity, high unemployment rates, and poor health indicators [14,15,17]. The socio-economic status of the two slums differs slightly: Viwandani has relatively higher levels of education and employment as being located in the industrial area, it attracts migrant workers. On the other hand, the population of Korogocho is more stable since on average, residents in the area have lived the area for a longer period than Viwandani residents. Approximately two thirds of married men live with their spouses in Korogocho, compared with half in Viwandani. The NUHDSS involves a systematic recording (every four months) of vital demographic events including births, deaths and migrations occurring among residents of all households in the NUHDSS area, since 2003. Other data that are collected regularly include household assets, morbidity, and highest educational attainment. This paper is based on data from a maternal and child health component of a broader longitudinal study entitled “Urbanization, Poverty and Health Dynamics in sub-Saharan Africa” that was nested within the NUHDSS. The study started in February 2007 and ended in December 2010. All women who gave birth since September 2006 and their children were enrolled in the study and were followed up every four months to obtain data including self-reported health status, breastfeeding, complementary feeding practices, vaccination and health care. Data on socio-economic status was extracted from the NUHDSS database and linked to the study participants through their household identifier. The data presented in this paper were collected at baseline and during the first two updates, four months apart, for each child recruited between February 2007 and May 2009. Therefore, the follow-up period for each child was on average nine months and the average age of the children at the second update was 15 months. However, we restrict our analyses to the first year of life for all 4,299 children who were enrolled in the study. Table ​Table11 presents the sample size for the children involved in the study and the data collection dates. Six cohorts of children enrolled during the study period are included. Sample Size, Nairobi informal settlements, Kenya * Censored Note: The total number of children enrolled across all six panels is 4299 The two dependent variables are cessation of breastfeeding and introduction of complementary foods (liquids and solids). Cessation of breastfeeding is a time-dependent variable indicating the age when breastfeeding was stopped. Introduction of complementary foods is also a time-dependent variable indicating the age at which complementary foods (either liquids or solids other than breastmilk) were introduced. Children who entered the study after the events (breastfeeding cessation or initiation of complementary foods) had occurred had their information updated retrospectively. About 1% of children were never breastfed and were excluded from survival analysis. Children who did not have their information updated due to loss to follow-up were excluded from the study. The independent variables were: the child’s sex; the mother’s age (< 25 years, 25-34 years, 35+ years); the marital status of the mother (in union i.e. currently married or living with someone; previously in union; and never married/in union); the ethnicity of the mother (Kikuyu, Luhya, Luo, Kamba, and other tribes); the highest level of education (none, primary, secondary or higher); and parity (1, 2, 3+); pregnancy desirability of the index child (wanted at the time of conception, wanted later and never wanted,); the place of delivery (health facility, home or traditional birth attendant [TBA]); the mother's perception of the child's size at birth (normal, smaller than normal, larger than normal); the socio-economic status of the household; and the slum of residence (Viwandani or Korogocho). The household socioeconomic status was defined using the household monthly expenditure per capita, taking a child to be the equivalent of half an adult. The expenditure data used was obtained from the poverty component of the Urbanization, Poverty and Health Dynamics study, and was collected in the same year as the data for the dependent variables above. This variable was recoded as tertiles of "poorest", "middle" and "least poor". The survival analysis of the duration of breastfeeding and the time to introduction of complementary foods is presented using Kaplan-Meier survival curves. Cox regression analysis was performed to determine factors associated with breastfeeding cessation during infancy and early introduction of complementary foods. Some independent variables had missing values, mainly maternal level variables such as the mother's age, ethnicity, the highest level of education; and the household's socio-economic status. A missing category was created in the multivariate analysis to keep all cases in the analysis (though results for missing category are not shown). In all cases, except the household expenditure variable, the number of cases with missing information was less than 10%. About one-third of the participants were missing data on household expenditure, therefore imputation using a linear interpolation computation procedure was used. A p-value of less than 0.05 was used as the cut-off for statistical significance. The Urbanization, Poverty and Health Dynamics study was approved by the Ethical Review Board of the Kenya Medical Research Institute (KEMRI). The field workers were trained in research ethics and obtained informed consent from all respondents. The NUHDSS has also been approved by KEMRI's Ethical Review Board. Verbal consent is routinely obtained from all the NUHDSS respondents.

N/A

Based on the information provided, here are some potential recommendations for innovations to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and reminders about breastfeeding and complementary feeding practices. These apps can also track the child’s growth and development, provide access to educational resources, and connect mothers with healthcare professionals for guidance and support.

2. Community Health Workers: Train and deploy community health workers in urban slums to provide education and counseling on breastfeeding and infant feeding practices. These workers can conduct home visits, organize support groups, and serve as a bridge between the community and healthcare facilities.

3. Telemedicine: Establish telemedicine services to provide remote consultations and support for breastfeeding and infant feeding practices. This can help overcome barriers to accessing healthcare facilities in urban slums and provide timely guidance to mothers.

4. Peer Support Programs: Implement peer support programs where experienced mothers who have successfully practiced optimal breastfeeding and complementary feeding can provide guidance and support to new mothers. These programs can be facilitated through community centers or online platforms.

5. Improved Access to Healthcare Facilities: Enhance the availability and accessibility of healthcare facilities in urban slums, ensuring that they are equipped to provide comprehensive maternal and child health services. This includes providing breastfeeding support, counseling, and access to affordable and nutritious complementary foods.

6. Targeted Education and Awareness Campaigns: Develop culturally sensitive and targeted education and awareness campaigns to promote the importance of breastfeeding and optimal infant feeding practices. These campaigns can utilize various media channels, community events, and partnerships with local organizations.

7. Integration of Maternal and Child Health Services: Integrate maternal and child health services within existing healthcare facilities in urban slums. This can ensure that mothers receive comprehensive care and support throughout the continuum of pregnancy, childbirth, and postpartum.

8. Strengthening Health Systems: Invest in strengthening health systems in urban slums, including training healthcare providers on breastfeeding and infant feeding practices, improving infrastructure and equipment, and ensuring the availability of essential supplies and medications.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the target population.
AI Innovations Description
Based on the information provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Implement community-based breastfeeding and infant feeding education programs: Develop and implement educational programs that focus on promoting exclusive breastfeeding for the first six months of life and appropriate complementary feeding practices. These programs should be tailored to the specific cultural practices and needs of the urban slum communities in Nairobi, Kenya. The programs can be delivered through community health workers, local clinics, and community centers to ensure widespread access and reach.

2. Strengthen access to and utilization of healthcare facilities: Improve access to healthcare facilities for pregnant women and new mothers in urban slums. This can be achieved by increasing the number of healthcare facilities in these areas, improving the quality of services provided, and addressing barriers such as cost and transportation. Additionally, promote the use of skilled birth attendants and discourage home births or reliance on traditional birth attendants.

3. Integrate family planning services with maternal health services: Incorporate family planning services into maternal health programs to address the issue of unintended pregnancies. This can help women better plan their pregnancies and ensure adequate spacing between births, which is important for the health of both the mother and the child.

4. Address socio-economic factors: Address the socio-economic factors that contribute to sub-optimal breastfeeding and infant feeding practices. This can be done through interventions that aim to improve the overall living conditions in urban slums, such as providing access to clean water and sanitation facilities, improving housing conditions, and creating economic opportunities for residents.

5. Conduct further research: Conduct further research to better understand the specific factors influencing breastfeeding and infant feeding practices in urban slums in sub-Saharan Africa. This research can help inform the development and implementation of targeted interventions and policies to improve maternal and child health outcomes in these communities.

By implementing these recommendations, it is possible to improve access to maternal health and promote optimal breastfeeding and infant feeding practices in urban slums, ultimately leading to better health outcomes for mothers and children.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement community-based programs to educate women and their families about the importance of exclusive breastfeeding for the first six months and the introduction of complementary foods at the appropriate time. This can be done through health education sessions, workshops, and outreach programs.

2. Improve access to healthcare facilities: Enhance the availability and accessibility of healthcare facilities in urban slums. This can include establishing more health clinics or mobile health units in these areas, ensuring they are well-equipped to provide maternal and child health services.

3. Strengthen support systems: Develop support systems for breastfeeding mothers, such as lactation counseling services and peer support groups. These can provide guidance, encouragement, and practical tips to help mothers overcome challenges and continue breastfeeding.

4. Address cultural practices: Take into account cultural practices and beliefs that may influence breastfeeding and infant feeding practices. Work with community leaders and traditional birth attendants to promote and support optimal breastfeeding and complementary feeding practices.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that reflect improved access to maternal health, such as the percentage of women exclusively breastfeeding for the first six months, the percentage of women receiving prenatal and postnatal care, or the percentage of women delivering in healthcare facilities.

2. Collect baseline data: Gather data on the current status of these indicators in the target population. This can be done through surveys, interviews, or existing data sources.

3. Implement interventions: Introduce the recommended interventions in the target population. This could involve implementing health education programs, improving healthcare infrastructure, and establishing support systems.

4. Monitor and evaluate: Continuously monitor the implementation of the interventions and collect data on the indicators. This can be done through regular surveys, interviews, or monitoring systems.

5. Analyze the data: Analyze the collected data to assess the impact of the interventions on the selected indicators. This can involve comparing the baseline data with the post-intervention data to determine any changes or improvements.

6. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the interventions in improving access to maternal health. Identify any gaps or areas for improvement and make recommendations for future interventions or adjustments to the existing ones.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions for further interventions.

Partilhar isto:
Facebook
Twitter
LinkedIn
WhatsApp
Email