By Estelle Sidze, Associate Research Scientist, APHRC via Conversation Africa About 21 pregnant women die every day in Kenya due to complications from childbirth. That’s equivalent to two 10-seater commuter micro minibuses, known...
The Center has documented shockingly high levels of childhood malnutrition among poor urban populations, largely driven by poor feeding practices in the first year of life. We have also generated evidence on how to improve feeding
practices for infants, specifically by promoting breastfeeding at household, community and workplace levels, as well as in health facilities. We must go deeper, however, to improve understanding of the contextual and relevant
influences on mothers regarding child nutrition, especially in the first 1,000 days of life, and how to promote and sustain good breastfeeding practices.
The Center has also initiated research to develop and test models of service delivery for maternal, newborn and child health within urban slum populations. These models have not yet been tested at scale and their utility in other marginalized communities is unknown. The overarching goal of this Unit is to understand the social and physical determinants of maternal health and child survival and potential to thrive, in order to develop effective intervention strategies for their promotion as part of the global push for improved maternal and child health outcomes. Three programmatic areas will define this agenda:
The signature issue for this Unit will be breastfeeding optimization. Situated within a broader Maternal, Infant and Young Child Nutrition research agenda, this program aims to understand multiple influences of, and strategies to optimize, early nutrition, including but not limited to the magnitude of visible and hidden maternal and child malnutrition, and the impacts of preconception nutrition and nutrition during the first 1,000 days of life on long-term health and human capital trajectories. The program will continue its work on developing and assessing interventions to optimize nutrition, specifically breastfeeding. At the macro level, the program will aim to characterize the nutrition transition in the African context and its influence on maternal and child nutrition and health.
The second program of work will be Early Childhood Development (ECD), to understand and promote contextual strategies to optimize early childhood development and understand the factors, interactions and pathways that
shape child health, development and early learning.
The Unit will also contribute to broader Maternal, Newborn and Child Health issues by monitoring MNCH health outcomes and influences in different contexts, including obstacles to access for MNCH services for vulnerable populations.
Kenya has a high burden of neonatal deaths (22/1,000 live births) and an estimated 39,000 infants die every year.
Evidence shows that optimal breastfeeding (BF) is among the most powerful interventions for reducing infant mortality. Some babies, however, lack access to their mother’s milk because of suboptimal BF practices or because the mother is sick, unavailable, or dead.
When BF is not an option, the World Health Organization recommends donated human milk (DHM) as a lifesaving alternative, particularly for vulnerable infants, and has called for global scale-up of Human Milk Banks (HMBs) to increase access to DHM. Nevertheless, none of the sub-Saharan African countries including Kenya are yet to implement the global best practice of providing safe DHM from HMBs for children who cannot access their mother’s own milk.
APHRC conducted a formative assessment in 2016 on the potential acceptability of donor human milk and feasibility of establishing HMBs. It found potential feasibility, acceptability and need for donor human milk. The next phase of implementation research aims at assessing the operational feasibility of establishing a Mother-Baby Friendly Initiative Plus program that includes a HMB, Kangaroo Mother Care, and breastfeeding promotion in Kenya. The study will also evaluate the potential effectiveness of an integrated MBFI+ model in improving neonatal health and nutrition outcomes and the actual cost of implementing the MBFI+ model. Evidence generated from this study will be instrumental in informing the scale-up strategies for MBFI+ including HMBs in Kenya and other similar settings of sub-Saharan Africa, as an important strategy to reverse the high neonatal and infant deaths in the country and improve child health and nutrition outcomes in general.
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