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Small Grant: Nigeria | Microcredit, mHealth and breastfeeding promotion

October 27, 2014

Integrating microcredit, cell phone messaging, and breastfeeding promotion increased rates of early initiation and exclusive breastfeeding in Nigeria

Objectives

We tested the effect of an integrated microcredit, cell phone messaging, and breastfeeding promotion intervention on recommended breastfeeding practices in urban and rural areas of Bauchi State, Nigeria.

Design, setting, and participants

This was a cluster-randomized controlled trial comparing breastfeeding practices in women receiving microcredit plus breastfeeding promotion (intervention) versus microcredit alone (control).  Randomization occurred at the level of monthly microcredit meeting groups.  All pregnant clients within the randomized groups were recruited at baseline and interviewed again when their infants were > 6 months.

Interventions

Trained credit officers led monthly breastfeeding learning sessions during regular microcredit meetings for 10 months.  Text and voice messages were sent out weekly by the coordinating non-governmental organization to a cell phone provided to small groups of microcredit clients (5-6 women).  The small groups created one song or drama related to a cell phone message to present during the monthly meeting.

Outcome measures and analysis

The primary outcome was exclusive breastfeeding to 6 months.  Secondary outcomes included:  exclusive breastfeeding to 1 and 3 months, initiation of breastfeeding within one hour of delivery, and use of fluids other than breastmilk in the first three days of life.  Logistic regression models accounting for clustering were used to estimate the odds of performing behaviors in the intervention versus control group.

Results

Among the women who were interviewed during the final survey (n=390), those in the intervention group were significantly more likely than those in the control group to initiate breastfeeding within one hour of delivery (control: 48%, intervention: 70%) and to exclusively breastfeed their infants until 3 and 6 months of age (3 months – control: 58%, intervention: 71%; 6 months – control: 43%, intervention: 64%). Those in the intervention group were significantly less likely to give fluids other than breastmilk in the first three days of life (control: 29%, intervention: 14%).

Conclusions and implications

A face-to-face plus cell phone breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended breastfeeding practices.  This type of intervention could be scaled up in Nigeria, where local microcredit organizations already provide services to > 500,000 clients.

Publication

Flax VL, Negerie M, Ibrahim AU, Leatherman S, Daza EJ, Bentley ME. Integrating group coinseling, cell phone messaging, and participant-generated songs and dramas into a microcredit program increases Nigerian women’s adherence to international breastfeeding recommendations. Journal of Nutrition 2014  May 8, doi:10.3945/jn.113.190124  Download abstract.

Presentation

Linking microcredit, technology, and breastfeeding promotion in Bauchi State, Nigeria. Download file below.

Collaborating institutions

  • University of North Carolina at Chapel Hill (US) planned, coordinated, and oversaw data collection and analysis.
  • Partners for Development (Nigeria) coordinated and oversaw all project interventions in Nigeria, including sending out mass text and voice messages.
  • Gerewa Women Multipurpose Cooperative Society, Rahama Women’s Development Program, Women Development Association for Self-Sustainers, and Wurno Kowanaka Community Development Centre (Nigeria) conducted breastfeeding learning sessions during microcredit borrowers’ meetings.

Principal investigators

  • Margaret Bentley, PhD, Professor and Associate Dean for Global Health, University of North Carolina at Chapel Hill
  • Valerie Flax, PhD, Research Assistant Professor, University of North Carolina at Chapel Hill

Project directors

  • Mekebeb Negerie, DrPH, Deputy Country Program Director, Partners for Development
  • Alawiyatu Usman Ibrahim, Program Officer, Partners for Development

 

Resource Attachments:
http://aliveandthrive.org/wp-content/uploads/2014/10/Small-Grants-UNC-Nigeria-cell-phones.pdf (pdf)

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