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ORIGINAL ARTICLE
Open Access

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 and Faith M Thuita
Global Health: Science and Practice March 2016, 4(1):55-72; https://doi.org/10.9745/GHSP-D-15-00197
Altrena G Mukuria
aUnited States Agency for International Development (USAID) Infant and Young Child Nutrition Project., Washington, DC, USA. Now with USAID Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project, Arlington, VA, USA
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Stephanie L Martin
bUSAID Infant and Young Child Nutrition Project, Washington, DC, USA. Now with Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA
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Thaddeus Egondi
cAfrican Population and Health Research Center, Nairobi, Kenya
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Allison Bingham
dPATH, Seattle, WA, USA
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Faith M Thuita
eUniversity of Nairobi, School of Public Health, Nairobi, Kenya
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Figures & Tables

Figures

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  • FIGURE 1.
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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

  • Figure3
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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.

Tables

  • Figures
  • Grandmother Dialogue GroupsFather 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

    • View popup
    TABLE 1 Sample Sizes at Baseline and Endline, by Type of Participant
    Study AreasNo. of Participants
    MothersGrandmothersFathersTotal
    BaselineEndlineBaselineEndlineBaselineEndlineBaselineEndline
    Father intervention area (Kitagwa)9270NANA8575177145
    Grandmother intervention area (Viguru)77717981NANA156152
    Comparison area (Mambai)897686734663221212
    Total 258 217 165 154 131 138 554 509
    Expected sample (69 participants/group)207138138483
    • View popup
    TABLE 2 Baseline Characteristics of Study Sample Mothers
    Father Intervention Area (Kitagwa) n = 92Grandmother Intervention Area (Viguru) n = 77Comparison Area (Mambai) n = 89P Value
    Age of mother, mean, years27.227.526.5.63
    Sex of child is male, %48.953.253.9.77
    Age of child, %
     6 months37.031.229.5.27
     7 months15.218.222.7
     8 months26.116.915.9
     9 months21.733.831.8
    Parity, %
     125.015.633.0.14
     2–339.140.334.8
     4+35.944.232.9
    Marital status, %
     Married (ever)100.088.278.7.001
     Single/never married0.011.821.4
    Mother’s education, %
     Primary completed38.548.155.1.001
     Secondary completed11.07.821.4
    Mother’s occupation, %
     Subsistence farmer34.846.130.6.32
     Homemaker (no outside work)33.730.338.8
     Outside work31.523.730.6
    Spouse’s age, mean, years32.933.233.4.57
    Spouse’s education, %
     Primary completed31.347.148.6.03
     Secondary completed21.716.227.1
    Spouse’s occupation, %
     Subsistence farmer18.730.916.9.09
     Employed81.369.183.1
    Socioeconomic status, %
     Lowest quartile31.536.432.6.83
     Middle quartile31.531.237.1
     Highest quartile37.032.530.3
    • View popup
    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 AreaGrandmother vs. Comparison Area
    DiDORP ValueDiDORP Value
    Adequate consistency of food consumed, No. (%)
     Baseline92 (32.2)77 (30.3)89 (31.4)
     Endline70 (68.1)71 (88.7)76 (45.8)21.52.4.0644.09.8.001
    Minimum no. of meals provided in past 24 hours, No. (%)
     Baseline92 (71.7)77 (77.9)89 (64.0)
     Endline70 (70.0)71 (77.5)76 (64.5)-2.21.3.59-0.91.5.47
    Dietary diversity (≥4 food groups), No. (%)
     Baseline92 (44.6)77 (48.1)89 (44.9)
     Endline70 (85.7)71 (81.7)76 (72.4)13.62.3.116.11.5.42
    Minimum acceptable diet, No. (%)
     Baseline92 (39.1)77 (40.3)89 (31.5)
     Endline70 (58.6)71 (60.6)76 (46.1)4.91.2.715.71.2.66
    Animal-source foods consumed on ≥3 days in past 7 days, No. (%)
     Baseline92 (9.8)77 (14.3)89 (11.2)
     Endline70 (41.4)71 (42.3)76 (11.8)31.06.1.00527.44.1.03
    • Abbreviations: DiD, difference-in-difference; OR, odds ratio.

    • View popup
    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 AreaGrandmother vs. Comparison Area
    DiDORP ValueDiDORP Value
    Mothers’ Reported Receipt of Social Support From Child’s Father or Grandmother
    No. of support actions received, median
     Baseline5.05.05.0
     Endline10.010.06.04.0––4.0––
    Any social support received, No. (%)
     Baseline92 (97.8)77 (94.8)89 (96.6)
     Endline70 (100.0)71 (100.0)76 (94.7)4.1––7.1––
    5+ social support actions received, No. (%)
     Baseline92 (65.2)77 (58.4)89 (66.3)
     Endline70 (97.1)71 (97.2)76 (72.4)25.813.6.00232.718.4.001
    Fathers’ Reported Provision of Social Support to Child’s Mother
    Any social support provided by fathers, No. (%)
     Baseline85 (88.2)NA46 (84.8)
     Endline75 (100.0)NA63 (90.5)6.1––NANANA
    5+ social support actions provided by fathers, No. (%)
     Baseline85 (63.5)NA46 (54.3)
     Endline75 (98.7)NA63 (52.4)37.146.0.001NANANA
    5+ physical support actions provided by fathers, No. (%)
     Baseline85 (18.8)NA46 (21.7)
     Endline75 (96.0)NA63 (44.4)54.535.9.001NANANA
    3+ material support actions provided by fathers, No. (%)
     Baseline85 (38.8)NA46 (45.7)
     Endline75 (96.0)NA63 (69.8)33.013.7.001NANANA
    Grandmothers’ Reported Provision of Social Support to Child’s Mother
    Any social support provided by grandmothers, No. (%)
     BaselineNA79 (86.1)86 (94.2)
     EndlineNA81 (97.5)73 (97.3)NANANA8.42.9.36
    5+ social support actions provided by grandmothers, No. (%)
     BaselineNA79 (60.8)86 (67.4)
     EndlineNA81 (90.1)73 (86.3)NANANA10.41.9.27
    5+ physical support actions provided by grandmothers, No. (%)
     BaselineNA79 (60.8)86 (67.4)
     EndlineNA81 (64.2)73 (38.4)NANANA36.64.4.002
    3+ material support actions provided by grandmothers, No. (%)
     BaselineNA79 (10.1)86 (23.3)
     EndlineNA81 (72.8)73 (57.5)NANANA28.45.3.003
    • 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.

    • View popup
    TABLE 5 Influence of Reported Social Support Received by Mothers on Infant Feeding Practices
    Min. No. of MealsMin. Dietary DiversityMin. Acceptable Diet
    OR (CI)P ValueORP ValueOR (CI)P Value
    No. of social support actions1.14 (1.00, 1.30).0471.07 (0.95, 1.21).241.06 (0.94, 1.20).32
    Study site; ref: comparison area (Mambai)
     Father intervention area (Kitagwa)2.94 (0.98, 8.83).0550.4 (0.14, 1.15).090.95 (0.33, 2.71).92
     Grandmother intervention area (Viguru)5.07 (1.56, 16.50).0070.38 (0.13, 1.13).081.00 (0.35, 2.90).99
    Support * Father intervention area0.85 (0.73, 1.00).0451.15 (0.98, 1.34).081.04 (0.90, 1.21).58
    Support * Grandmother intervention area0.82 (0.70, 0.97).021.19 (1.01, 1.40).041.06 (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.

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Global Health: Science and Practice: 4 (1)
Global Health: Science and Practice
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March 21, 2016
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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
Global Health: Science and Practice Mar 2016, 4 (1) 55-72; DOI: 10.9745/GHSP-D-15-00197

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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
Global Health: Science and Practice Mar 2016, 4 (1) 55-72; DOI: 10.9745/GHSP-D-15-00197
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