Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
RTI International, Research Triangle Park, NC, United States of America.
PLoS One. 2024 Apr 26;19(4):e0301695. doi: 10.1371/journal.pone.0301695. eCollection 2024.
Most health care providers in Lagos State, Nigeria are private and are not required to offer breastfeeding counseling to women. From May 2019-April 2020, Alive & Thrive implemented a multicomponent breastfeeding promotion intervention in private health facilities in Lagos that included training and support to implement the Baby-Friendly Hospital Initiative and provide breastfeeding counseling and support to pregnant women and lactating mothers in person and on WhatsApp. We conducted a mixed methods process evaluation in 10 intervention and 10 comparison private health facilities to examine the feasibility and acceptability of integrating the intervention into routine health services. We conducted in-depth interviews with 20 health facility owners/managers and providers, 179 structured observations of health providers during service provision to pregnant and lactating women and 179 exit interviews with pregnant and lactating women. The in-depth interviews were transcribed and analyzed thematically. The structured observations and exit interviews were summarized using descriptive and inferential statistics. The in-depth interviews indicated that almost all health facility owners/managers and providers at the intervention health facilities had generally positive experiences with the intervention. However, the health providers reported implementation barriers including increased workload, use of personal time for counseling on WhatsApp, and some mothers' lack of access to WhatsApp support groups. Observations suggested that more breastfeeding counseling occurred at intervention compared with comparison health facilities. Third trimester exit interviews showed that 86% of women in the intervention health facilities were very confident they could carry out the breastfeeding advice they received, compared to 47% in the comparison health facilities. Our research suggests that provision of breastfeeding counseling and support through private health facilities is feasible and acceptable, but service delivery challenges must be considered for successful scale-up.
在尼日利亚拉各斯州，大多数医疗服务提供者都是私营的，没有义务向妇女提供母乳喂养咨询。从 2019 年 5 月至 2020 年 4 月，Alive & Thrive 在拉各斯的私营医疗机构实施了一项多部分母乳喂养促进干预措施，包括培训和支持实施“爱婴医院倡议”，并亲自和通过 WhatsApp 向孕妇和哺乳期母亲提供母乳喂养咨询和支持。我们在 10 家干预和 10 家对照私营医疗设施中进行了一项混合方法过程评估，以研究将干预措施纳入常规卫生服务的可行性和可接受性。我们对 20 名医疗设施所有者/管理人员和提供者进行了深入访谈，对向孕妇和哺乳期妇女提供服务期间的 179 名卫生提供者进行了结构性观察，并对 179 名孕妇和哺乳期妇女进行了离职访谈。深入访谈的内容被转录并进行了主题分析。结构观察和离职访谈使用描述性和推断性统计进行了总结。深入访谈表明，干预医疗设施的几乎所有医疗设施所有者/管理人员和提供者对干预措施都有较为积极的体验。然而，卫生提供者报告了实施障碍，包括工作量增加、在 WhatsApp 上咨询时使用个人时间，以及一些母亲无法获得 WhatsApp 支持小组。观察结果表明，与对照医疗设施相比，干预医疗设施提供了更多的母乳喂养咨询。第三孕期离职访谈显示，干预医疗设施中 86%的女性非常有信心能够实施她们所接受的母乳喂养建议，而对照医疗设施中只有 47%的女性有信心。我们的研究表明，通过私营医疗设施提供母乳喂养咨询和支持是可行和可接受的，但必须考虑服务提供方面的挑战，以实现成功推广。
