The Ife South Breastfeeding project: Training community health extension workers to promote and manage breastfeeding in rural communities
Intro: Reported are the results of a project to promote exclusive breastfeeding in rural communities through the training of community health extension workers in rural Nigeria.
Methods and Results: A workshop for the trainers was organized for health workers in the study area; subsequently, these trainers ran district-level training workshops. In the study area perinatal facilities, early initiation of breastfeeding has increased compared with those in the control area (P < 0.001). Also, the trained health workers had significantly better knowledge about breastfeeding than their untrained colleagues in both the study (P < 0.001) and control areas (P < 0.001), and more often recommended timely initiation and exclusive breastfeeding than the controls (P < 0.001). A multivariate analysis showed that the training programme and the study area were the only significant variables that were predictors of breastfeeding knowledge (P < 0.001). Appropriate education of health extension workers can therefore contribute significantly to the promotion of breastfeeding in rural communities. The strategy of training community health extension workers in rural Nigeria to promote exclusive breast feeding was evaluated in a survey of 66 trained primary health care workers in the Ife South Breast Feeding Project area and 56 primary health care workers in seven non-intervention districts. Although breast feeding is widespread in Ife South, understanding of the importance of early initiation of breast feeding, use of colostrum, and prolonged exclusive breast feeding was deficient. Focus group discussions before the training revealed no differences in the breast feeding knowledge of health workers from the intervention and control areas. A workshop for trainers in the study area was followed by district-level workshops led by these trainers. Initiation of breast feeding within 30 minutes of delivery was reported for 32% of deliveries in the intervention area compared with only 6% in the control group. Trained workers had better knowledge of and attitudes toward breast feeding than controls and were significantly more likely to recommend exclusive breast feeding for 4-6 months. Multivariate analysis of breast feeding knowledge scores showed that location in the study area and participation in training were the only variables that contributed significantly to improve overall scores.
Conclusion: In rural Nigeria, where over 75% of mothers have contact with primary health care workers, incorporation of breast feeding training into the primary health care system is recommended.