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Process evaluation of a community based intervention to improve breast feeding and complementary feeding practices in rural Haryana, India



Process evaluation of a community based intervention to improve breast feeding and complementary feeding practices in rural Haryana, India



FASEB Journal 15(4): A255



A randomized intervention is underway in 8 rural communities (4 intervention and 4 control; population approximately 5000 each) to improve breast feeding and complementary feeding practices. The strategy evolved through formative research and with close involvement of the local government included development of locally relevant feeding messages, use of multiple channels for delivery to achieve high coverage and government partnership with local non-government organization (NGO) for community mobilization. Contacts selected were health care providers at primary health centres (PHC), private clinics and immunization sessions, village-based anganwadi workers at weighing sessions and home visits and traditional birth attendants (TBAs) at delivery. Women's core group meetings (MSS) with health workers, and neighbourhood meetings conducted by MSS members are also being used. Training for all involved hands on skills in nutritional counselling and in the use of communication material. Intervention impact will be assessed by feeding practices and anthropometry through two cross sectional surveys, and 3 monthly assessments in the post intervention newborn cohort (500 per group). In the mid study cross sectional survey of under two's 54% children were visited at home, 44% and 42% had attended weighing and immunization sessions respectively, 47% had visited PHCs and 65% private practitioners in the last 3 months. The proportion of interactions where mothers spontaneously recalled having received feeding advice was highest for home visits and weighing (80% each) followed by immunization (59%) and PHC (31%). Private practitioners had rarely (2%) counselled. 22% mothers had attended MSS meetings and 17% neighbourhood meetings. Of the TBA conducted deliveries occurring post intervention, 39% mothers were counselled. Key messages emerging are that it is possible to improve worker skills and motivation for counselling children in the community, however improved strategies need to be evolved to achieve the same for physicians including private practitioners. The government and NGO interaction works well and is an important contributory factor in sustaining home and community based activities.

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