oa South African Journal of Clinical Nutrition - Impact of the special training of community health workers on breastfeeding counselling and support in KwaZulu-Natal
Objectives. To evaluate the impact of special training of community health workers (CHWs) on breastfeeding counselling and support.
Design. A cross-sectional, observational study.
Setting. The study was conducted in the area serviced by the Thukela District Child Survival Project, Bergville, KwaZulu-Natal.
Subjects. Mother-infant pairs (N = 95) visited by specially trained CHWs formed the intervention group and were compared with a control group of mother-infant pairs (N = 64) visited by normally trained CHWs. Both groups of CHWs had been trained in the integrated management of childhood illnesses (IMCI).
Outcome measures. To test for significant differences between the intervention and control groups in exclusive breastfeeding (EBF), feeding of colostrum, withholding of prelacteals, infant growth and diarrhoeal disease rates.
Results. EBF rates of 71.6% and 59.4% were found in the intervention and control groups respectively (p = 0.1). Both study groups showed higher rates of EBF compared with other areas in KwaZulu-Natal. The prevalence of feeding colostrum was 88.4% in the intervention and 92.2% in the control groups (p = 0.4). The prevalence of withholding prelacteals was 77% in the intervention and 86% in the control groups (p = 0.1). At the time of the interview, infants in both groups showed consistent growth (weight-for-age z-scores: intervention = 0.13, control = 0.18; p = 0.7). Diarrhoea prevalence did not differ significantly between study groups and varied from 7.5% (in the 7 days before interview, p = 0.1) to 16% (in the previous 3 months for infants ≥3 months, p = 0.5).
Conclusion. The special training did not have the anticipated impact on measured parameters. Training CHWs in IMCI was as effective as special training. If generally applied, the former may increase rates of EBF, improve infant growth and reduce the risk of diarrhoeal illness in South Africa.
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