Horii Naoko, Habi Oumarou, Dangana Alio, Maina Abdou, Alzouma Souleymane, Charbit Yves
Independent consultant in Behavior change communication, Maternal child health and nutrition, Paris, France.
Census mapping division, National Institute of Statistics, Niamey, Niger.
J Health Popul Nutr. 2016 Apr 21;35:12. doi: 10.1186/s41043-016-0048-y.
Early initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger.
A quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers.
The gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4-2.7; 1.3-3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9-1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4-2.9).
A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.
出生后尽早开始母乳喂养是一项关键的行为健康因素，已知可降低新生儿死亡风险。然而，很少有人口统计学研究考察基于社区的干预措施如何影响撒哈拉以南非洲社会经济贫困人群的产后母乳喂养情况。2011年进行了一项干预后评估，以衡量联合国儿童基金会主导的促进尼日尔农村儿童保健的行为改变沟通项目的效果。
一项定量调查基于对研究样本的两组（暴露组和未暴露组家庭）进行事后构建。样本包括年龄在15至49岁之间、至少有一个24个月以下经阴道分娩的孩子的妇女。采用双变量分析的率比和多变量逻辑回归进行统计分析。结果变量是出生后第一小时内开始母乳喂养。自变量包括其他行为结果变量、不同类型的沟通行动以及母亲的社会人口统计学和经济状况。
暴露组和未暴露组之间社会经济脆弱性的差距意味着，无法获得基本医疗服务和卫生设施的母亲可能被排除在沟通行动之外。与未进行洗手和使用传统厕所的母亲相比，进行洗手和使用传统厕所的母亲在出生后早期开始母乳喂养的可能性高出2.0倍（95%置信区间1.4 - 2.7；1.3 - 3.1）。社区志愿者的家访没有显著影响（调整后比值比1.2；95%置信区间0.9 - 1.5）。作为同伴积极参与纯母乳喂养推广的母亲在出生后第一小时内开始母乳喂养的可能性更大（调整后比值比2.0；95%置信区间1.4 - 2.9）。
将卫生习惯与最佳母乳喂养推广相结合的多部门方法有助于支持尽早开始母乳喂养。儿童保健的同伴推广提出了一种行为改变沟通策略模型，以应对社会经济差距。
