Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study

Altrena G Mukuria; Stephanie L Martin; Thaddeus Egondi; Allison Bingham; Faith M Thuita

doi:10.9745/GHSP-D-15-00197

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FIGURE 1.
Conceptual Model of Social Support Provided to Mothers Affecting Maternal, Infant, and Young Child Nutrition Practices
Cultural beliefs are mitigated by information and education on optimal nutrition practices. Provision of social support along with improved information and education of influencers (i.e., fathers and grandmothers) can impact maternal, infant, and young child feeding practices both indirectly by supporting mothers and directly by the influencers implementing optimal feeding practices themselves.
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FIGURE 2.
Study Timeline
Source: Thuita et al., 2015 ³¹
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A father in western Kenya feeds his child. Household members such as fathers and grandmothers often exert social influences on a mother’s adoption of optimal infant feeding practices.

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Grandmother Dialogue Groups

Father Dialogue Groups

Role of grandmothers in infant and young child feeding and maternal nutrition
Overview of maternal and infant and young child nutrition and the local health situation
Eating during pregnancy and breastfeeding
Early initiation of breastfeeding
Exclusive breastfeeding
Complementary feeding
Preparing food safely
Responsive feeding
What to do when a child falls ill
Mother‐to‐child transmission of HIV
Infant feeding and HIV
Supporting mothers with HIV and their families (including referrals and promoting health seeking)
Facilitation skills
Effective family communication
Infant feeding beliefs and myths

Understanding gender
Gender roles: behaviors and division of labor and child care in the home
Healthy and unhealthy relationships
Effective communication
Thinking about fatherhood
Family care
Poor child health “problem tree”
What your family eats
Understanding maternal and child nutrition
Supporting good infant feeding practices during the first 6 months of life
Complementary feeding
What to do when your child falls ill
Mother‐to‐child transmission of HIV
Infant feeding and HIV
Disclosure of HIV status (role plays)
Men, women, and caregiving
Men’s role in health promotion

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TABLE 1 Sample Sizes at Baseline and Endline, by Type of Participant

Study Areas	No. of Participants
	Mothers		Grandmothers		Fathers		Total
	Baseline	Endline	Baseline	Endline	Baseline	Endline	Baseline	Endline
Father intervention area (Kitagwa)	92	70	NA	NA	85	75	177	145
Grandmother intervention area (Viguru)	77	71	79	81	NA	NA	156	152
Comparison area (Mambai)	89	76	86	73	46	63	221	212
Total	258	217	165	154	131	138	554	509
Expected sample (69 participants/group)	207		138		138		483

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TABLE 2 Baseline Characteristics of Study Sample Mothers

	Father Intervention Area (Kitagwa) n = 92	Grandmother Intervention Area (Viguru) n = 77	Comparison Area (Mambai) n = 89	P Value
Age of mother, mean, years	27.2	27.5	26.5	.63
Sex of child is male, %	48.9	53.2	53.9	.77
Age of child, %
6 months	37.0	31.2	29.5	.27
7 months	15.2	18.2	22.7
8 months	26.1	16.9	15.9
9 months	21.7	33.8	31.8
Parity, %
1	25.0	15.6	33.0	.14
2–3	39.1	40.3	34.8
4+	35.9	44.2	32.9
Marital status, %
Married (ever)	100.0	88.2	78.7	.001
Single/never married	0.0	11.8	21.4	.001
Mother’s education, %
Primary completed	38.5	48.1	55.1	.001
Secondary completed	11.0	7.8	21.4	.001
Mother’s occupation, %
Subsistence farmer	34.8	46.1	30.6	.32
Homemaker (no outside work)	33.7	30.3	38.8
Outside work	31.5	23.7	30.6
Spouse’s age, mean, years	32.9	33.2	33.4	.57
Spouse’s education, %
Primary completed	31.3	47.1	48.6	.03
Secondary completed	21.7	16.2	27.1	.03
Spouse’s occupation, %
Subsistence farmer	18.7	30.9	16.9	.09
Employed	81.3	69.1	83.1	.09
Socioeconomic status, %
Lowest quartile	31.5	36.4	32.6	.83
Middle quartile	31.5	31.2	37.1
Highest quartile	37.0	32.5	30.3

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TABLE 3 Changes in Mothers’ Reported Infant Feeding Practices, by Intervention Area: Difference-in-Difference Analysis

	Father Intervention Area (Kitagwa)	Grandmother Intervention Area (Viguru)	Comparison Area (Mambai)	Father vs. Comparison Area			Grandmother vs. Comparison Area
	Father Intervention Area (Kitagwa)	Grandmother Intervention Area (Viguru)	Comparison Area (Mambai)	DiD	OR	P Value	DiD	OR	P Value
Adequate consistency of food consumed, No. (%)
Baseline	92 (32.2)	77 (30.3)	89 (31.4)
Endline	70 (68.1)	71 (88.7)	76 (45.8)	21.5	2.4	.06	44.0	9.8	.001
Minimum no. of meals provided in past 24 hours, No. (%)
Baseline	92 (71.7)	77 (77.9)	89 (64.0)
Endline	70 (70.0)	71 (77.5)	76 (64.5)	-2.2	1.3	.59	-0.9	1.5	.47
Dietary diversity (≥4 food groups), No. (%)
Baseline	92 (44.6)	77 (48.1)	89 (44.9)
Endline	70 (85.7)	71 (81.7)	76 (72.4)	13.6	2.3	.11	6.1	1.5	.42
Minimum acceptable diet, No. (%)
Baseline	92 (39.1)	77 (40.3)	89 (31.5)
Endline	70 (58.6)	71 (60.6)	76 (46.1)	4.9	1.2	.71	5.7	1.2	.66
Animal-source foods consumed on ≥3 days in past 7 days, No. (%)
Baseline	92 (9.8)	77 (14.3)	89 (11.2)
Endline	70 (41.4)	71 (42.3)	76 (11.8)	31.0	6.1	.005	27.4	4.1	.03

Abbreviations: DiD, difference-in-difference; OR, odds ratio.

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TABLE 4 Changes in Reported Social Support, by Intervention Area: Difference-in-Difference Analysis

	Father Intervention Area (Kitagwa)	Grandmother Intervention Area (Viguru)	Comparison Area (Mambai)	Father vs. Comparison Area			Grandmother vs. Comparison Area
	Father Intervention Area (Kitagwa)	Grandmother Intervention Area (Viguru)	Comparison Area (Mambai)	DiD	OR	P Value	DiD	OR	P Value
Mothers’ Reported Receipt of Social Support From Child’s Father or Grandmother
No. of support actions received, median
Baseline	5.0	5.0	5.0
Endline	10.0	10.0	6.0	4.0	–	–	4.0	–	–
Any social support received, No. (%)
Baseline	92 (97.8)	77 (94.8)	89 (96.6)
Endline	70 (100.0)	71 (100.0)	76 (94.7)	4.1	–	–	7.1	–	–
5+ social support actions received, No. (%)
Baseline	92 (65.2)	77 (58.4)	89 (66.3)
Endline	70 (97.1)	71 (97.2)	76 (72.4)	25.8	13.6	.002	32.7	18.4	.001
Fathers’ Reported Provision of Social Support to Child’s Mother
Any social support provided by fathers, No. (%)
Baseline	85 (88.2)	NA	46 (84.8)
Endline	75 (100.0)	NA	63 (90.5)	6.1	–	–	NA	NA	NA
5+ social support actions provided by fathers, No. (%)
Baseline	85 (63.5)	NA	46 (54.3)
Endline	75 (98.7)	NA	63 (52.4)	37.1	46.0	.001	NA	NA	NA
5+ physical support actions provided by fathers, No. (%)
Baseline	85 (18.8)	NA	46 (21.7)
Endline	75 (96.0)	NA	63 (44.4)	54.5	35.9	.001	NA	NA	NA
3+ material support actions provided by fathers, No. (%)
Baseline	85 (38.8)	NA	46 (45.7)
Endline	75 (96.0)	NA	63 (69.8)	33.0	13.7	.001	NA	NA	NA
Grandmothers’ Reported Provision of Social Support to Child’s Mother
Any social support provided by grandmothers, No. (%)
Baseline	NA	79 (86.1)	86 (94.2)
Endline	NA	81 (97.5)	73 (97.3)	NA	NA	NA	8.4	2.9	.36
5+ social support actions provided by grandmothers, No. (%)
Baseline	NA	79 (60.8)	86 (67.4)
Endline	NA	81 (90.1)	73 (86.3)	NA	NA	NA	10.4	1.9	.27
5+ physical support actions provided by grandmothers, No. (%)
Baseline	NA	79 (60.8)	86 (67.4)
Endline	NA	81 (64.2)	73 (38.4)	NA	NA	NA	36.6	4.4	.002
3+ material support actions provided by grandmothers, No. (%)
Baseline	NA	79 (10.1)	86 (23.3)
Endline	NA	81 (72.8)	73 (57.5)	NA	NA	NA	28.4	5.3	.003

Abbreviations: DiD, difference-in-difference; OR, odds ratio.
(–): No values reported either because the indicator is reported in terms of median or because there is 100% response; in either case, logistic regression cannot be fitted.

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TABLE 5 Influence of Reported Social Support Received by Mothers on Infant Feeding Practices

	Min. No. of Meals		Min. Dietary Diversity		Min. Acceptable Diet
	OR (CI)	P Value	OR	P Value	OR (CI)	P Value
No. of social support actions	1.14 (1.00, 1.30)	.047	1.07 (0.95, 1.21)	.24	1.06 (0.94, 1.20)	.32
Study site; ref: comparison area (Mambai)
Father intervention area (Kitagwa)	2.94 (0.98, 8.83)	.055	0.4 (0.14, 1.15)	.09	0.95 (0.33, 2.71)	.92
Grandmother intervention area (Viguru)	5.07 (1.56, 16.50)	.007	0.38 (0.13, 1.13)	.08	1.00 (0.35, 2.90)	.99
Support * Father intervention area	0.85 (0.73, 1.00)	.045	1.15 (0.98, 1.34)	.08	1.04 (0.90, 1.21)	.58
Support * Grandmother intervention area	0.82 (0.70, 0.97)	.02	1.19 (1.01, 1.40)	.04	1.06 (0.91, 1.23)	.48

Abbreviation: OR, odds ratio.The first row (number of social support actions) indicates the effect of increasing social support in all 3 study groups on the selected infant feeding practices. The second row (study site) compares the effect on infant feeding practices of the father intervention area vs. the comparison area and the grandmother intervention area vs. the comparison area, without specifically taking into account social support. The last set of rows (support * father intervention area; support * grandmother intervention area) takes into account the interaction effects of both intervention area and social support on infant feeding practices.