Early Initiation and Exclusivity of Breastfeeding in Rural Zimbabwe: Impact of a Breastfeeding Intervention Delivered by Village Health Workers. Issue 4 (28th February 2019)

• Record Type: Journal Article
• Authors: Mbuya, Mduduzi N N; Matare, Cynthia R; Tavengwa, Naume V; Chasekwa, Bernard; Ntozini, Robert; Majo, Florence D; Chigumira, Ancikaria; Chasokela, Cynthia M Z; Prendergast, Andrew J; Moulton, Lawrence H; Stoltzfus, Rebecca J; Humphrey, Jean H
• Is Part Of: Current developments in nutrition. Volume 3:Issue 4(2019)
• Publication Date: 2019-02-28
• Subjects: exclusive breastfeeding -- early breastfeeding initiation -- infants -- breast milk -- Zimbabwe -- village health workers; Nutrition -- Periodicals; Nutritional Physiological Phenomena; Nutrition; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 612.3
• DOI: 10.1093/cdn/nzy092
• Languages: English
• ISSNs: 2475-2991

Abstract

ABSTRACT: Background: Suboptimal breastfeeding contributes to >800, 000 global child deaths annually. Optimal breastfeeding includes early initiation (EI) and exclusive breastfeeding (EBF) for the first 6 mo. Objectives: We tested the hypothesis that an intervention targeting context and infant age-specific barriers to EI and EBF will achieve a higher EI and EBF prevalence than those of women participating in the concurrently conducted 2015 Zimbabwe Demographic Health Survey (Z-DHS). Methods: We designed an intervention to promote EI and EBF, and implemented it within the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Intervention modules were delivered at 4 perinatal time points by government-employed village health workers. We compared EI and EBF prevalence among SHINE women who provided outcomes at 1 mo ( n = 2442) and 3 mo ( n = 2728), with women in the 2015 Z-DHS. Results: In cross-sectional analyses EI prevalence was 86.6% and 64.3% in the SHINE and Z-DHS samples, respectively; absolute difference (95% CI) = 22.4% (17.5%, 27.3%). EBF prevalence was similarly high (>80%) in both surveys during the first month of life; during 1 to <2 mo, 2 to <3 mo, 3 to <4 mo, 4 to <5 mo, and 5 to <6 mo, EBF prevalence was, respectively, 85%, 90%, 90%, 84%, and 75% in SHINE, and 71%, 65%, 35%, 26%, and 25% in Z-DHS; absolute difference (95% CI) = 50.2% (34.7%, 65.7%) at 5 to <6 mo. Cesarean delivery, mother's belief that intimate partner violence was sometimes justifiable, and having a male infant negatively modified the effects of the intervention. Conclusions: The SHINE intervention achieved a high prevalence of EI and EBF. Concurrently addressing gender norms will be critical to make further progress. Formative studies to identify context- and infant age-specific barriers to EI and EBF may inform improvement of breastfeeding practices elsewhere. Important work remains to scale up this intervention beyond a research setting. SHINE was registered at www.clinicaltrials.gov as NCT01824940.