Breastfeeding Interpersonal Communication, Mobile Phone Support, and Mass Media Messaging Increase Exclusive Breastfeeding at 6 and 24 Weeks Among Clients of Private Health Facilities in Lagos, Nigeria

https://doi.org/10.1093/jn/nxab450Get rights and content
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Abstract

Background

Although most health facilities in urban Nigeria are privately owned, interventions to promote optimal breastfeeding practices in private facilities have not previously been implemented.

Objectives

We tested the impact of a breastfeeding promotion intervention on early initiation of breastfeeding and exclusive breastfeeding among clients of private facilities in Lagos, Nigeria.

Methods

The intervention included training for health-care providers on the Baby-Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging. We used logistic regression models adjusted for clustering to measure intervention impact in a cohort of women (n = 1200) at 10 intervention and 10 comparison facilities interviewed during their third trimester and at 6 and 24 weeks postpartum.

Results

The intervention significantly increased the percentage of infants who were exclusively breastfed at 6 weeks (83% intervention; 76% comparison; P = 0.02) and 24 weeks (66% intervention; 52% comparison; P < 0.001), but had no impact on early initiation of breastfeeding (35% intervention; 33% comparison; P = 0.65). Among infants who were exclusively breastfed at 6 weeks, the odds of continued exclusive breastfeeding at 24 weeks were higher in the intervention arm than in the comparison arm (OR, 1.6; 95% CI: 1.2-2.1). Infants had increased odds of being exclusively breastfed at 6 weeks if their mothers discussed breastfeeding with a private health provider (OR, 2.3; 95% CI: 1.5-3.4), received text or WhatsApp messages about breastfeeding (OR, 1.7; 95% CI: 1.0-2.7), or heard breastfeeding radio spots (OR, 4.2; 95% CI: 1.2-14.7). Infants had increased odds of exclusive breastfeeding at 24 weeks if their mothers participated in a WhatsApp breastfeeding support group (OR, 1.5; 95% CI: 1.0-2.2).

Conclusions

A breastfeeding intervention in private health facilities in Lagos increased exclusive breastfeeding. Implementation of breastfeeding interventions in private facilities could extend the reach of breastfeeding promotion programs in urban Nigeria. This trial was registered at clinicaltrials.gov as NCT04835051.

Key words

breastfeeding
health workers
mHealth
interpersonal communication
behavior change communication

Abbreviations

BCC
behavior change communication
BFHI
Baby-Friendly Hospital Initiative
IYCF
infant and young child feeding
LMICs
low- and middle-income countries
pp
percentage point

Cited by (0)

This research was funded by the Alive & Thrive initiative, managed by FHI Solutions, and currently funded by the Bill and Melinda Gates Foundation (OPP 1135932, INV-029432), Irish Aid, the Tanoto Foundation, UNICEF, and the World Bank.

Author disclosures: UR-O and SB are employed by Alive & Thrive. OA is employed by the Equitable Health Access Initiative.

Alive & Thrive and Equitable Health Access Initiative were involved in the design, implementation, and monitoring of the intervention, but not in data collection or analysis for this study. All other authors report no conflicts of interest.

Supplemental Tables 1 and 2 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/.