Alive & Thrive Nigeria Breastfeeding Promotion in Urban Private Facilities Study
Condition: Breastfeeding
Study type: Interventional

Summary: 
      The purpose of this study was to evaluate the effect of a breastfeeding promotion
      intervention on breastfeeding intentions, early initiation of breastfeeding, and exclusive
      breastfeeding among clients in private health facilities in Lagos, Nigeria.
    

Detailed description: 
      This was a longitudinal cohort study designed to evaluate and measure the implementation
      processes of a breastfeeding counseling and support intervention offered to pregnant and
      postpartum women in private health facilities in Lagos State, Nigeria. This study was
      conducted as part of the Alive & Thrive Nigeria program, implemented by FHI 360 and partners.
      RTI led the design, implementation, and analysis for the study, with Datametrics Associates
      Ltd. serving as the data collection partner in Nigeria. The study took place in 20 private
      health facilities. Ten facilities were assigned to intervention and 10 to comparison based on
      their location within the existing intervention and comparison local government areas (LGAs)
      for our overall impact evaluation of the Alive & Thrive program in Nigeria (NCT02975063). To
      be included in the study, facilities had to provide maternity and pediatric services, such as
      antenatal care, postnatal care, and immunizations, and be registered with the Association of
      General and Private Medical Practitioners of Nigeria and the Health Facility Monitoring and
      Accreditation Agency. To ensure that the investigators would achieve their sample size,
      selected facilities with a monthly average of ≥40 antenatal clients and ≥20 deliveries over 3
      months. All eligible women attending antenatal care on the days of data collection were
      invited to participate until the target enrollment at each facility was achieved. The
      investigators collected survey data from a cohort of 1,200 women (600 per study arm) during
      the third trimester of pregnancy and when their child was 6 weeks and 24 weeks. The purpose
      of the surveys were to obtain data on the women's breastfeeding intentions (third trimester)
      and practices (6 weeks and 24 weeks), their breastfeeding knowledge and attitudes, and their
      exposure to the intervention. To measure implementation outcomes, the investigators conducted
      180 observations of client-provider interactions among a subset of women enrolled in the
      study and then completed a short exit interview with the women immediately after their
      facility visit. In addition, the investigators conducted qualitative interviews with 20
      health providers and facility managers/owners in the intervention facilities at the end of
      the intervention to learn about the facilitators and barriers to implementation.
    

Intervention name(s): Breastfeeding promotion
Intervention type(s): Behavioral
Intervention description(s): The intervention included training of health workers in private health facilities to provide in-person breastfeeding counseling to pregnant women and women with a child <6 months during clinic visits. The health workers also offered a mobile phone support component for appointment reminders, breastfeeding SMS and WhatsApp messages, WhatsApp breastfeeding support groups, informational materials (posters and foldable pocket-sized cards), and family engagement activities. Breastfeeding-related mass media through television and radio spots was available state-wide, including to women in intervention and comparison facilities.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Exclusive breastfeeding; Early initiation of breastfeeding