Michaud-Létourneau Isabelle, Gayard Marion, Wassef Jacqueline, Likhite Nathalie, Tharaney Manisha, Cissé Aita Sarr, Le Dain Anne-Sophie, Laillou Arnaud, Zafimanjaka Maurice Gerald, Kiburente Médiatrice, Bambara Estelle, Kim Sunny S, Menon Purnima
Society for Implementation Science in Nutrition, Washington DC, USA.
Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Québec, Canada.
Curr Dev Nutr. 2023 Aug 19;7(9):101988. doi: 10.1016/j.cdnut.2023.101988. eCollection 2023 Sep.
The practice of giving water before 6 mo of age is the biggest barrier to exclusive breastfeeding in West and Central Africa. To address this challenge, a regional initiative, "Stronger with Breastmilk Only" (SWBO), was rolled out at country level in several countries of the region.
We examined the implementation process of the SWBO initiative and the contribution of its advocacy component to a more supportive environment for breastfeeding policies and programs.
This study was based on 2 assessments at the national level carried out in 5 countries (Burkina Faso, Chad, Democratic Republic of the Congo, Senegal, and Sierra Leone) using qualitative methods. We combined 2 evaluative approaches (contribution analysis and outcome harvesting) and applied 2 theoretical lenses (Breastfeeding Gear Model and Consolidated Framework for Implementation Research) to examine the implementation process and the enabling environment for breastfeeding. Data sources included ∼300 documents related to the initiative and 43 key informant interviews collected between early 2021 and mid-2022.
First, we show how a broad initiative composed of a set of combined interventions targeting multiple levels of determinants of breastfeeding was set up and implemented. All countries went through a similar pattern of activities for the implementation process. Second, we illustrate that the initiative was able to foster an enabling environment for breastfeeding. Progress was achieved notably on legislation and policies, coordination, funding, training and program delivery, and research and evaluation. Third, through a detailed contribution story of the case of Burkina Faso, we illustrate more precisely how the initiative, specifically its advocacy component, contributed to this progress.
This study shed light on how an initiative combining a set of interventions to address determinants of breastfeeding at multiple levels can be implemented regionally and contributes to fostering an enabling environment for breastfeeding at scale.
在西非和中非，6个月龄前喂水的做法是实现纯母乳喂养的最大障碍。为应对这一挑战，一项名为“仅靠母乳更健康”（SWBO）的区域倡议在该地区的几个国家层面展开。
我们研究了SWBO倡议的实施过程及其宣传部分对营造更有利于母乳喂养政策和项目的环境的贡献。
本研究基于对布基纳法索、乍得、刚果民主共和国、塞内加尔和塞拉利昂这5个国家在国家层面进行的2次评估，采用定性方法。我们结合了2种评估方法（贡献分析和成果收集），并应用2种理论视角（母乳喂养工具模型和实施研究综合框架）来研究母乳喂养的实施过程和有利环境。数据来源包括2021年初至2022年年中收集的约300份与该倡议相关的文件和43次关键信息访谈。
首先，我们展示了一项由一系列针对母乳喂养多个决定因素层面的联合干预措施组成的广泛倡议是如何建立和实施的。所有国家在实施过程中都经历了类似的活动模式。其次，我们说明该倡议能够营造有利于母乳喂养的环境。在立法和政策、协调、资金、培训和项目实施以及研究和评估方面都取得了显著进展。第三，通过布基纳法索案例的详细贡献情况，我们更精确地说明了该倡议，特别是其宣传部分，是如何促成这一进展的。
本研究揭示了一项结合一系列干预措施以解决母乳喂养多个层面决定因素的倡议如何在区域层面实施，并有助于大规模营造有利于母乳喂养的环境。
