ABSTRACTS: Oral Presentation Abstracts
Introduction: The promotion of improved nutrition for young children and women through educational and training activities are the principal goals of LINKAGES/Madagascar project, which has been operational in Madagascar since 1999. LINKAGES trains health workers and community volunteers. Community volunteers carry out most of the activities through their work as liaisons between health centers and communities. The objective of the current study was to evaluate the effectiveness of the project, particularly regarding breastfeeding practices.
Methods: Rapid assessment procedures, developed by UNICEF and WHO that incorporated both quantitative and qualitative measurements were adopted. For the quantitative portion of the study, the sampling frame was based on commune, village, and household units. Each commune was purposefully chosen, where there was evidence that the approach had been embraced. The selection of villages and households within each commune were done using the proportional-population cluster sampling method. Interview questions focused on key messages as well as breastfeeding and maternal nutrition practices. The study was conducted in 9 health districts, where LINKAGES had been assisting the Ministry of health and in one control health district. The program and control districts were well matched of demographic, economic, health, and cultural characteristics. However, intensive promotion of breastfeeding and appropriate feeding of young child has not occurred in the control district.The qualitative portion of the study consisted of semi-structured interviews and focus group discussions with the health workers, volunteers and mothers.
Results: After three intensive years, our evaluation showed that:
- 76% of infants were breastfed within the first hour after birth in the program districts compared to 35% in the control district,
- 75% of infants were exclusively breastfed in the intervention districts as opposed to 40% in the control district,
- 85% of infants were breastfed 10 or more times a day in the intervention districts compared to 65% in the control district.
However, there were no differences between program and control districts regarding maternal nutrition.
Conclusion: Breastfeeding practices were greatly improved during the intervention period. But there is a need to reinforce maternal nutrition by promoting iron and vitamin A supplementation, as well as the use of enriched foods like iodised salt. Community volunteers are the cornerstones of the community approach in a behavior change strategy, because they provide mothers with more nutrition information than they received before from the health centers alone. The improved breastfeeding practices would suggest that this shift in information source has had a positive effect.