Community based intervention on infant's feeding practices among - PowerPoint PPT Presentation

Community based intervention on infant's feeding practices among mothers in four villages in Bethlehem governorate Jerusalem-Palestine 1433-2012 Nutrition specialist: Hana Rabadi Nuha El –Sharif, PhD

Effective care for newborns and infants are important for their survival, growth and development. Effective care includes : } Caring behaviors such as hygienic cord care , skin care and thermal care. } Feeding practices . } Prevention and care for illnesses

Studies revealed that infant and young child feeding practices are associated with : } Malnutrition (ex: obesity in adult life and increasing risks of metabolic complications). } Future chronic health conditions( NCD ’ s) such as diabetes and some types of childhood cancer. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008

A conducted research ( desk review and qualitative assessment) on infant and young child feeding revealed the following : Poor infant feeding practices among mothers . } The need for strengthening household level behaviors among } women in relevance to child nutrition issues through implementing the timely targeted counseling intervention (TTC) method. World Vision, landscape report 2010 —

} To assess mothers' knowledge and practices regarding infants feeding practices } To evaluate the effectiveness of TTC in changing these practices in the targeted four villages in Bethlehem governorate.

Designed to enable messages to be appropriately Timed : neither too early, lest they be forgotten, nor too late } for the behavior to be practiced, and appropriately Targeted: to those who would practice these behaviors, and } to those who would influence the decision to adopt these behaviors. communicated in a secure environment that encourages } open discussion with a skilled and knowledgeable provider

Study sample : } All newborns in the four targeted villages from Bethlehem Governorate ( Nahalin, Wadi Rahhal , Marah Rabah and Wadi Al Ness ) during the months of March, April 2011 were identified. } The total numbers of newborns during the mentioned months were 118. 66 mothers were identified as intervention group, and 52 were identified as comparison group

} This is an intervention study (experimental research, were we have intervention group and comparison group) . } This study focuses on the direct outreach of community health workers to the households of the identified mothers that were selected as part of the intervention group. This study is divided into four stages: } First stage: The preparatory stage and selection of field workers } Second stage: The assessment stage } Third stage: The implementation stage } fourth stage: The evaluation stage

} Identifying the community health workers, 7 community health workers were identified in collaboration with village stirring committees and village councils. } Developing health workers tool kit. } Training of community health workers § 32 hours on capacity building activities . § 8 hours follow up training with a focus on growth monitoring. § 32 training hours on data collection (baseline and end line data). § 8 hours on using the job aids.

} Selecting household beneficiaries } Setting community worker's home visits schedule according to the identified targets.

} Baseline data was collected from both the both the intervention group and the comparison group. } Baseline data were collected by filling a structured multi-item questionnaire according to the study objectives. } Data was cleaned, entered and analyzed using the statistical software package SPSS version 17.

} Conduct the household visits , and deliver the messages on timely basis . } Each CHW was assigned a number of households, they visited the target household a minimum of 2 times per month and a maximum of 4 times as required by the case . } Supervision and coordination team meetings took place once every two weeks. } Plans and forms were reviewed to assure work quality. } field monitoring visits were conducted.

} After the intervention CHW ’ s collected endline data from both the comparison group and the intervention group. } Data was cleaned, entered and analyzed using the statistical software package SPSS version 17 . } Comparison was made within and between the 2 groups before and after the intervention.

} Characteristics of the study population. } The univariate and the multivariate analysis .

} variables for both groups such as ;mother ’ s age ,infants gender ,father ’ s level of education, mother ’ s level of education, mother ’ s working ,mother ’ s profession, father ’ s working ,father ’ s profession and the number of live births were analyzed. No significant differences in the socio demographic characteristics between the intervention compared to the comparison group were identified.

1.Breastfeeding practices : initiation of breastfeeding , exclusive breastfeeding , duration of breastfeeding and the use of bottle feeding . 2.Complementary feeding practices : timely introduction of meals and minimum meal diversity . For both groups variables within each subsection before and after the intervention were analyzed.

Intervention group comparison group 83.3% 69.7% 68.7% 56.1% 51.9% 46.2% 46.2% 27.3% 21.2% 21.2% 9.6% 5.8% exclusive no bottle feeding Breastfeeding exclusive no bottle feeding Breastfeeding above breastfeeding above 1 year breastfeeding 1 year Before After

Intervention group comparison group 66.7% 38.5% 23.1% 22.7% 19.6% 16.7% 15.4% 13.5% Introduction of food at 6 Min meal diversity Introduction of food at 6 Min meal diversity months months Before After

Breastfeeding practices Sig. AO 95% C.I.for AOR R lower upper Exclusive breastfeeding .000 29 8.01 108 Duration of breastfeeding above .045 2.9 1.03 8.41 a year Complementary feeding practices Introduction of food at 6 months .000 83 17.2 405

} Implementing Timed and Targeted Counseling for a whole year, proved to be very effective. Significant progress was achieved. No major changes among the comparison group were identified. } In regards to breastfeeding practices mothers in the intervention group were 29.5 times more likely to exclusively breastfeed their babies, they were also 3 times more likely to extend breastfeeding above one year. } Complementary feeding practices were also improved among mothers in the intervention group, they were 83.6 times more likely to introduce food at six months.

The study showed : } Non –compliance with the international guidelines and recommendations regarding new born care among mothers in the targeted villages. } The effectiveness of community level approach “ timed and targeted counseling “ ,in contributing to the change in mother ’ s knowledge and behavior. } The intervention effectiveness was reflected on the babies health in general . } The effect on the Community Health workers (CHWs), as there was a positive effect on their personalities, where they became recognized and respected members in their communities.

At the household level: } Due to context similarities in most of the oPt localities, the TTC is recommended to be used at the household level as one of the effective methods to scale-up positive MCHN practices and prevent the common malpractices in other areas. } Improve the social support systems at the household level since it ’ s also a barrier to optimal newborn care.

At the community level: } Assist the community to have an emergency plan, especially for cases that need urgent response. } Improve partnership between the health facility and the communities they serve. } It ’ s recommended to combine the TTC with other community level models/approaches.

At the national level: } Activate and enhance the role of CHW ’ s . } Improve partnership and cross sectoral collaboration between the government and the different organizations to address the underlying causes of the health problem in our communities. } Initiate baby friendly hospitals. } Improve outreach health events especially in villages that do not have access to health services within their communities.