Poster Topical Area: Community and Public Health Nutrition

Location: Auditorium

Poster Board Number: 85

P06-064 - Early initiation and exclusivity of breastfeeding in rural Zimbabwe: impact of a breastfeeding intervention delivered by village health workers

Monday, Jun 11
8:00 AM – 3:00 PM

Objective Suboptimal breastfeeding contributes to >800,000 global child deaths annually. Optimal breastfeeding includes early initiation (EI) and exclusive breastfeeding (EBF) for the first 6 months. We tested the hypothesis that an intervention targeting context-specific barriers to EI and EBF and delivered at infant ages when the information is most relevant will achieve higher EI and EBF rates compared to those of women participating in the concurrently conducted 2015 Zimbabwe Demographic Health Survey (Z-DHS).

Methods We designed an intervention that addressed cultural and time-specific barriers to EI and EBF. We implemented the intervention within the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in two rural Zimbabwean districts. Intervention modules were delivered at four perinatal time points by government-employed Village Health Workers. We compared EI and EBF rates among women who received the SHINE intervention with women in the 2015 Z-DHS.

Results In cross-sectional analyses EI rates were 86.6% and 64.3% in the SHINE and Z-DHS samples, respectively; absolute difference (95% CI) = 22.4% (17.5, 27.3). EBF rates were similarly high (>80%) in both surveys during the first month of life; during 1<2, 2<3 mo, 3<4 mo, 4<5 mo, and 5<6 mo EBF rates were, respectively, 85%, 90%, 90%, 84%, and 75% in SHINE, and 71%, 65%, 35%, 26%, 25% in Z-DHS; absolute difference (95% CI) = 50.2% (34.7, 65.7) at 5<6 mo. Cesarean delivery, mother's belief that intimate partner violence was sometimes justifiable, and having a male infant negatively modified the effects of the intervention.

Conclusions EI and EBF rates among women receiving the SHINE intervention are among the highest reported in the literature. Concurrently addressing gender norms will be critical to make further progress. Formative studies to identify context and infant age-specific barriers to EI and EBF may inform improvement of breastfeeding practices elsewhere. Important work remains to scale up this intervention beyond a research setting.

Funding Source: The Bill and Melinda Gates Foundation (OPP1021542 and OPP1143707); the United Kingdom Department for International Development (DFID/UKAID); Wellcome Trust (093768/Z/10/Z and 108065/Z/15/Z); Swiss Agency for Development and Cooperation.

CoAuthors: Mduduzi Mbuya – GAIN Health; Cynthia Matare, PhD – Cornell University; Naume Tavengwa – Zvitambo Institute for Maternal and Child Health Research; Bernard Chasekwa – Zvitambo Institute for Maternal and Child Health Research; Robert Ntozini – Zvitambo Institute for Maternal and Child Health Research; Florence Majo – Zvitambo Institute for Maternal and Child Health Research; Ancikaria Chigumira – Zimbabwe Ministry of Health and Childcare; Cynthia Chasokela – ZImbabwe Ministry of Health and Childcare; Andrew Prendergast – Queen Mary University of London; Lawrence Moulton – Johns Hopkins Bloomberg School of Public Health; Rebecca Stoltzfus – Cornell University; Laura Smith – University at Buffalo

Jean H. Humphrey

Johns Hopkins Bloomberg School of Public Health
Harare, Harare, Zimbabwe