Potential effectiveness of community health strategy to promote exclusive breastfeeding in urban poor settings in Nairobi, Kenya: a quasi-experimental study

Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies (Pre-intervention [2007-2011; n=5824], Intervention [2012-2015; n=1110] and Comparison [2012-2014; n=487]) which followed mother-child pairs longitudinally to establish EBF rates from 0-6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0-6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a Chi square test and logistic regression. At six months, the prevalence of EBF was 2% in the Pre-intervention group compared to 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (p<0.05). After adjusting for baseline characteristics, the Odds Ratio for EBF from birth to six months was 66.9 (95% CI 45.4 to 96.4), 84.3 (95% CI 40.7 to 174.6), and 3.9 (95% CI 1.8 to 8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared to the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting exclusive breastfeeding in urban poor settings where health care access is limited.