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Cycle 1

Feasibility and effectiveness of the baby friendly community initiative (BFCI) in Kenya: A pilot community trial in a rural setting.

Principal Investigator: Judith Kimiywe, Kenyatta University
NIH-Supported Collaborator: Stephen McGarvey, Brown University
Title of NIH Award: Diabetes Care in American Samoa

Project Overview
Nutrition in the first 1000 days of life is critical for child growth, wellbeing and survival. There is evidence that undernutrition is associated with more than half of child deaths due to its influence on morbidity. Interventions promoting optimal maternal infant and young child nutrition (MIYCN) could prevent a fifth of under five deaths. Poor MIYCN practices are widely documented in Kenya, like in other developing countries, with potential detrimental effects on child growth, health and survival. The Division of Nutrition (DON), Kenya, developed a national strategy to promote optimal MIYCN practices in 2007, actualized mainly through the baby-friendly hospital initiative (BFHI) in maternity wards. However, since only two in five women deliver in health facilities, majority of women lack this support and MIYCN practices are greatly influenced by traditional beliefs and practices. Hence the impact of BFHI is minimal. Recognizing the need to reach women at the community level, The DON is therefore considering implementing the Baby Friendly Community Initiative (BFCI), which employs the principles of BFHI at the community level. Hard evidence on the effectiveness of BFCI and how it works best in the Kenyan context are needed to create the political buy in, budgetary allocation and effective implementation at the national level. This study aims to pilot implementation of BFCI to determine its feasibility and effectiveness with regards to maternal and child nutrition and health status in a rural setting in Kenya. The study will be conducted in East Pokot, a semi-arid rural district with poor health access in North Rift region of Kenya. The study will combine both qualitative and quantitative methods to answer the research questions. A formative study using participatory action research will be conducted. Then, a quasiexperimental study with both qualitative and quantitative data collection will be conducted. Data on MIYCN practices, nutritional status and health of the children will be collected on cohorts of mother-child pairs in both intervention and control arms through baseline and end-line cross-sectional surveys. The study will generate sound scientific evidence on the feasibility and effectiveness of implementing BFCI on maternal, infant and young child nutrition and health outcomes. This will inform effective and efficient scale-up of the BFCI in Kenya.

PH 1-120 Kenya 2015 photo1PH 1-120 Kenya 2015 photo2PH 1-120 Kenya 2015 photo3
Seated  above are some of the support group breast feeding mothers who acquired skilled deliveries at Solian Health facility displaying their tokens (white baby shawls). Behind the mothers is the BFCI team.
Breast feeding messages displayed on the wall at the breast feeding corner at Kituno Clinic.
Seated above on the left is the Toniok CU work force and seated on the right are members of the supervision team –BFCI team leader, (Pamela) Nutritionist from MOH-HQ (Betty) SCMOH (Dr. Yator)and the SCCSFP (Mr.Ng’otie)

Summary of Recent Activities:

By March 2016, 798 pregnant women had been recruited into the study; 47 of them were however lost to follow up due do reasons such as the death of their newborns, miscarriage and movement (migration from study area). Of the recruited pregnant women, 388 women have delivered and follow-up (intervention and prospective data collection) is ongoing. The research team conducted a mid-line qualitative data collection in February 2016. This evaluation study incorporated the women who are beneficiaries of the intervention, their family members, health care workers, Community Health Extension Workers - CHEWs, the sub County Health Management team (SCHMT) and the Community Health Volunteers (CHVs). Data is being transcribed and the report will be ready in due course. Intervention activities are ongoing including: targeted home visits; establishment of mother support groups; mentorship and supervision by the SCHMT; educating mothers on the BFCI content during the MSG meetings and documentation; conducting education sessions for the mothers at MCH; conducting community gatherings involving other influencers; community mobilization through chiefs Barazas; monthly meetings for BFCI to report BFCI activities; training-Regular on job training for CHVs and HCW; and income Generation Activities for CHVs. Some team members participated in three different workshops organized by MOH to discuss the process of developing a BFCI implementation guidelines and BFCI training package. This is to enable the budgeting by the government for scaling-up the BFCI in the next financial year starting in July 2016. The PI was invited to attend and present at the AAAS (American Association for the Advancement of Science) Annual Meeting and NAS PEER Grantees meeting in Washington, DC, USA. The PEER project has achieved success in translating research into policy implications. The government has decided to take up BFCI as one of the flagship projects for improving maternal and child nutrition in Kenya. MOH is working with the team to provide technical guidance as they await the outcomes of the study.

Health Cycle 1 Recipients