Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam
Background Despite recommendations supporting optimal breastfeeding, the number of women practicing exclusive breastfeeding (EBF) remains low, and few interventions have demonstrated implementation and impact at scale. Alive & Thrive was implemented over a period of 6 y (2009–2014) and aimed to imp...
| Autores principales: | , , , , , , , , , , , , , , |
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| Formato: | Journal Article |
| Lenguaje: | Inglés |
| Publicado: |
Public Library of Science
2016
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| Materias: | |
| Acceso en línea: | https://hdl.handle.net/10568/147813 |
| _version_ | 1855515055095808000 |
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| author | Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Kennedy, Andrew Tran, Lan Mai Sanghvi, Tina Hajeebhoy, Nemat Baker, Jean Alayon, Silvia Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul |
| author_browse | Afsana, Kaosar Alayon, Silvia Baker, Jean Frongillo, Edward A. Hajeebhoy, Nemat Haque, Raisul Kennedy, Andrew Khaled, Adiba Menon, Purnima Nguyen, Phuong Hong Rawat, Rahul Ruel, Marie T. Saha, Kuntal K. Sanghvi, Tina Tran, Lan Mai |
| author_facet | Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Kennedy, Andrew Tran, Lan Mai Sanghvi, Tina Hajeebhoy, Nemat Baker, Jean Alayon, Silvia Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul |
| author_sort | Menon, Purnima |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background
Despite recommendations supporting optimal breastfeeding, the number of women practicing exclusive breastfeeding (EBF) remains low, and few interventions have demonstrated implementation and impact at scale. Alive & Thrive was implemented over a period of 6 y (2009–2014) and aimed to improve breastfeeding practices through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) intervention components delivered at scale in the context of policy advocacy (PA) in Bangladesh and Viet Nam. In Bangladesh, IPC was delivered through a large non-governmental health program; in Viet Nam, it was integrated into government health facilities. This study evaluated the population-level impact of intensified IPC, MM, CM, and PA (intensive) compared to standard nutrition counseling and less intensive MM, CM, and PA (non-intensive) on breastfeeding practices in these two countries.
Methods and Findings
A cluster-randomized evaluation design was employed in each country. For the evaluation sample, 20 sub-districts in Bangladesh and 40 communes in Viet Nam were randomized to either the intensive or the non-intensive group. Cross-sectional surveys (n ~ 500 children 0–5.9 mo old per group per country) were implemented at baseline (June 7–August 29, 2010, in Viet Nam; April 28–June 26, 2010, in Bangladesh) and endline (June 16–August 30, 2014, in Viet Nam; April 20–June 23, 2014, in Bangladesh). Difference-in-differences estimates (DDEs) of impact were calculated, adjusting for clustering. In Bangladesh, improvements were significantly greater in the intensive compared to the non-intensive group for the proportion of women who reported practicing EBF in the previous 24 h (DDE 36.2 percentage points [pp], 95% CI 21.0–51.5, p < 0.001; prevalence in intensive group rose from 48.5% to 87.6%) and engaging in early initiation of breastfeeding (EIBF) (16.7 pp, 95% CI 2.8–30.6, p = 0.021; 63.7% to 94.2%). In Viet Nam, EBF increases were greater in the intensive group (27.9 pp, 95% CI 17.7–38.1, p < 0.001; 18.9% to 57.8%); EIBF declined (60.0% to 53.2%) in the intensive group, but less than in the non-intensive group (57.4% to 40.6%; DDE 10.0 pp, 95% CI −1.3 to 21.4, p = 0.072). Our impact estimates may underestimate the full potential of such a multipronged intervention because the evaluation lacked a “pure control” area with no MM or national/provincial PA.
Conclusions
At-scale interventions combining intensive IPC with MM, CM, and PA had greater positive impacts on breastfeeding practices in Bangladesh and Viet Nam than standard counseling with less intensive MM, CM, and PA. To our knowledge, this study is the first to document implementation and impacts of breastfeeding promotion at scale using rigorous evaluation designs. Strategies to design and deliver similar programs could improve breastfeeding practices in other contexts.
Trial registration
ClinicalTrials.gov NCT01678716 (Bangladesh) and NCT01676623 (Viet Nam) |
| format | Journal Article |
| id | CGSpace147813 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2016 |
| publishDateRange | 2016 |
| publishDateSort | 2016 |
| publisher | Public Library of Science |
| publisherStr | Public Library of Science |
| record_format | dspace |
| spelling | CGSpace1478132025-04-03T21:30:00Z Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Kennedy, Andrew Tran, Lan Mai Sanghvi, Tina Hajeebhoy, Nemat Baker, Jean Alayon, Silvia Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul health mass media nutrition child feeding infant feeding children experimental design breastfeeding Background Despite recommendations supporting optimal breastfeeding, the number of women practicing exclusive breastfeeding (EBF) remains low, and few interventions have demonstrated implementation and impact at scale. Alive & Thrive was implemented over a period of 6 y (2009–2014) and aimed to improve breastfeeding practices through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) intervention components delivered at scale in the context of policy advocacy (PA) in Bangladesh and Viet Nam. In Bangladesh, IPC was delivered through a large non-governmental health program; in Viet Nam, it was integrated into government health facilities. This study evaluated the population-level impact of intensified IPC, MM, CM, and PA (intensive) compared to standard nutrition counseling and less intensive MM, CM, and PA (non-intensive) on breastfeeding practices in these two countries. Methods and Findings A cluster-randomized evaluation design was employed in each country. For the evaluation sample, 20 sub-districts in Bangladesh and 40 communes in Viet Nam were randomized to either the intensive or the non-intensive group. Cross-sectional surveys (n ~ 500 children 0–5.9 mo old per group per country) were implemented at baseline (June 7–August 29, 2010, in Viet Nam; April 28–June 26, 2010, in Bangladesh) and endline (June 16–August 30, 2014, in Viet Nam; April 20–June 23, 2014, in Bangladesh). Difference-in-differences estimates (DDEs) of impact were calculated, adjusting for clustering. In Bangladesh, improvements were significantly greater in the intensive compared to the non-intensive group for the proportion of women who reported practicing EBF in the previous 24 h (DDE 36.2 percentage points [pp], 95% CI 21.0–51.5, p < 0.001; prevalence in intensive group rose from 48.5% to 87.6%) and engaging in early initiation of breastfeeding (EIBF) (16.7 pp, 95% CI 2.8–30.6, p = 0.021; 63.7% to 94.2%). In Viet Nam, EBF increases were greater in the intensive group (27.9 pp, 95% CI 17.7–38.1, p < 0.001; 18.9% to 57.8%); EIBF declined (60.0% to 53.2%) in the intensive group, but less than in the non-intensive group (57.4% to 40.6%; DDE 10.0 pp, 95% CI −1.3 to 21.4, p = 0.072). Our impact estimates may underestimate the full potential of such a multipronged intervention because the evaluation lacked a “pure control” area with no MM or national/provincial PA. Conclusions At-scale interventions combining intensive IPC with MM, CM, and PA had greater positive impacts on breastfeeding practices in Bangladesh and Viet Nam than standard counseling with less intensive MM, CM, and PA. To our knowledge, this study is the first to document implementation and impacts of breastfeeding promotion at scale using rigorous evaluation designs. Strategies to design and deliver similar programs could improve breastfeeding practices in other contexts. Trial registration ClinicalTrials.gov NCT01678716 (Bangladesh) and NCT01676623 (Viet Nam) 2016-11-03 2024-06-21T09:23:21Z 2024-06-21T09:23:21Z Journal Article https://hdl.handle.net/10568/147813 en Open Access Public Library of Science Menon, Purnima; Nguyen, Phuong Hong; Saha, Kuntal K.; Khaled, Adiba; Kennedy, Andrew; Tran, Lan Mai; Sanghvi, Tina; Hajeebhoy, Nemat; Baker, Jean; Alayon, Silvia; Afsana, Kaosar; Haque, Raisul; Frongillo, Edward A.; Ruel, Marie T.; and Rawat, Rahul. 2016. Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam. PLoS Med 13(10): e1002159. https://doi.org/10.1371/journal.pmed.1002159 |
| spellingShingle | health mass media nutrition child feeding infant feeding children experimental design breastfeeding Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Kennedy, Andrew Tran, Lan Mai Sanghvi, Tina Hajeebhoy, Nemat Baker, Jean Alayon, Silvia Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam |
| title | Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam |
| title_full | Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam |
| title_fullStr | Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam |
| title_full_unstemmed | Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam |
| title_short | Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam |
| title_sort | impacts on breastfeeding practices of at scale strategies that combine intensive interpersonal counseling mass media and community mobilization results of cluster randomized program evaluations in bangladesh and viet nam |
| topic | health mass media nutrition child feeding infant feeding children experimental design breastfeeding |
| url | https://hdl.handle.net/10568/147813 |
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