Browsing by Author "Wekesah, Frederick Murunga"

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    The challenges of breastfeeeding in poor urban areas in sub-Saharan Africa
    (African Sun Media, 2020) Kimani-Murage, Elizabeth Wambui; Wekesah, Frederick Murunga; Wanjohi, Milka; Nyamasege, Carolyn Kemunto; Mutoni, Sandrine; Macharia, Teresia
    Optimal breastfeeding has the potential to prevent more than 800 000 deaths in children younger than five years; 500 000 neonatal deaths; and 20 000 deaths in women every year. Despite these benefits, evidence from Sub-Saharan Africa shows that breastfeeding practices remain sub-optimal with only 25 per cent of children exclusively breastfed for the first six months, while six per cent of infants in these countries are never breastfed. For example, although the proportion of children who were exclusively breastfed in Kenya improved from 32 per cent in 2008 to 61 per cent in 2014, pockets of suboptimal breastfeeding practices are documented in urban slums. Exclusive breastfeeding in some of the urban slums in Kenya is as low as two per cent, with the age of introducing complementary foods being onemonth post-delivery, while about a third of children are not breastfed within one hour of delivery as recommended by the World Health Organization (WHO). Urban slums are faced by unique social and structural factors that hinder optimal breastfeeding including poverty and non-conducive livelihood opportunities, poor living conditions, food insecurity, poor professional and social support to breastfeeding mothers and knowledge deficit coupled with negative cultural beliefs and misconceptions about breastfeeding. This situation calls for macrolevel policies and interventions that consider the ecological setting. Promising interventions may include global initiatives such as the Baby-Friendly Hospital Initiative, the Baby-Friendly Community Initiative, Human Milk Banking and the Baby-Friendly Workplace Initiative. However, innovations in their implementation need to take consideration for the contextual complexities. This chapter explores breastfeeding practices, associated challenges and interventions that could promote breastfeeding in urban slums.
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    Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi : a cluster randomized controlled trial
    (BMC (part of Springer Nature), 2017) Kimani-Murage, Elizabeth W.; Griffiths, Paula L.; Wekesah, Frederick Murunga; Wanjohi, Milka; Muhia, Nelson; Muriuki, Peter; Egondi, Thaddaeus; Kyobutungi, Catherine; Ezeh, Alex C.; McGarvey, Stephen T.; Musoke, Rachel N.; Norris, Shane A.; Madise, Nyovani J.
    Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a homebased intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya. Methods: We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis. Results: A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4–59.9) in the intervention group and 54.6% (95% CI 50.0–59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0–2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0–4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0–6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718). Conclusions: EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.
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    Effectiveness of the baby-friendly community initiative in promoting exclusive breastfeeding among HIV negative and positive mothers : a randomized controlled trial in Koibatek Sub-County, Baringo, Kenya
    (BMC (part of Springer Nature), 2020-07-14) Samburu, Betty Mogesi; Young, Sera Lewise; Wekesah, Frederick Murunga; Wanjohi, Milkah Njeri; Kimiywe, Judith; Muriuki, Peter; Griffiths, Paula L.; McGarvey, Stephen T.; Madise, Nyovani Janet; Kimani-Murage, Elizabeth W.
    Background: Although the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya. Methods: A community-based cluster-randomized controlled trial was implemented from April 2015 to December 2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12 personalized home-based counselling sessions on infant feeding by trained community health volunteers from their first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings targeting influencers. The control group received standard health education at the facility and during monthly routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regression. Results: At 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm compared to the control arm (81.7% versus 42.2% p = 0.001). HIV positive mothers in the intervention arm had higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus 58.4%; p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the intervention arm than in the control (92.1% versus 60.7% p = 0.001). Among HIV positive mothers, such knowledge was high among both the intervention and control groups (96% versus 100%, p > 0.1). HIV negative and positive mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the control (84.5% versus 62.1%, p = 0.001) and (94.6% versus 53.8% to p = 0.001) respectively. Conclusions: BFCI interventions can complement facility-based interventions to improve exclusive and continued breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.