The Role of Community Health Volunteers in Infant and Child Nutrition

August 5, 2014

A healthy nation is a wealthy nation’ this quote emphasizes the critical role that health and well being plays in a country’s human and economic growth and development.  Optimal nutrition in childhood is linked to optimal health, physical and intellectual development as well as productivity. Poor child nutrition on the other hand precipitates ill health, impaired intellectual development and poor productivity which run over generations (Black et al., 2008; Victora et al., 2008)

Poor child nutrition practices are prevalent in the country, only 32% of women practice exclusive breast feeding and over 60% are started on complementary feeding before six months (Kenya National Bureau of Statistics (KNBS) and ICF Macro, 2010). Lack of knowledge on optimal child nutrition and inadequate support for mothers to practice optimal IYCN are some of the major reasons for poor child nutrition practices. Close to 50% of women in the country do not deliver in health facility where information and support on infant and young child feeding is offered; majority of those who deliver in health facilities do not go back for consequent follow-ups, creating a gap in the continuum of care (Kenya National Bureau of Statistics (KNBS) and ICF Macro, 2010). This gap in service delivery between community and health facilities contributes to knowledge deficit and lack of optimal support for optimal infant feeding practices, resulting in to poor child nutrition practices.

The use of community health volunteers (CHVs) to promote infant and young child feeding practices at community level has been shown to improve IYCN practices (Haider, Ashworth, Kabir, & Huttly, 2000; Nankunda et al., 2006). In Kenya, though the community strategy is being implemented, the effectiveness of using CHVs to promote IYCN is still at pilot level. Currently, the African Population and Health Research Center (APHRC) in collaboration with the Human Nutrition and Dietetics Unit of the Ministry of Health, Kenya is implementing a Pilot study on the effectiveness of CHVs in promotion of IYCN in urban slums. In this study, community health volunteers walk the journey of child feeding with mothers from pregnancy through to the age of one year and beyond. During pregnancy, they regularly visit mothers and counsel them on the importance and preparation of balanced and nutritious meals; refer and follow-up pregnant women to ensure that they attend ante natal clinics as recommended, they also provide messages on the importance of hospital delivery, immediate initiation and exclusive breastfeeding for six months.

After delivery, CHVs counsel and provide support for mothers to practice exclusive breastfeeding including support for proper position, attachment, expressing breast milk for mothers who are separated from their babies for long and optimal complementary feeding from six months. Follow-up and support for optimal child feeding, continued breastfeeding for at least two years and growth monitoring continue until the child is one year and beyond. In cases where mothers experience challenges with child feeding, the CHVs refer them to health facilities for further assessment and follow-up. They also follow-up the mother and child pairs for other health services including immunization, family planning services and growth monitoring.  An evaluation of this study reveals that CHVs are highly appreciated in the community and considered as ‘village doctors’ and as important sources of IYCN information and support.

In the past I used to think that for you to eat a balanced diet you must have a lot of money, but she (CHV) has taught me that with the little that I have I can still go to the market and buy something that I can afford and still manage to eat a balanced die (IDI with pregnant woman – korogocho;

Previously, with my other children, I dint know how to take care of children because we used to start introducing foods to children one month after birth, but since she ( CHW) came and started advising me I haven’t given this one any food since I gave birth to her. It is just breastfeeding only (IDI with breastfeeding woman- Viwandani)

The work of a CHV however is not without challenges. Some of the challenges include deep-seated social cultural and religious beliefs and inadequate training on IYCN for some CHVs. Further, poverty in some areas is a challenge for CHVs as they are forced to dip into their own pockets in support of needy mothers in spite of their meager income.

We entered that house and there was nothing…, this mother has completely nothing to eat, my colleague will tell you what I did, I took her child to go buy some charcoal, sugar with my own money; it is because we took flour from my house, the child knew my house so she went with porridge flour. After one week, the mother sent her child again having a bigger problem, at times we volunteer completely because if we stop, there is nothing we will be doing. There are others where we have get into our own pockets to help ( CHW viwandani)

The community health volunteers play an important role in promoting child health and nutrition.  Adequate training and provision of materials, equipments and allowances is important to ensure their optimal performance as a strategy to improve maternal and child nutrition practices. Given the challenges they face in their work, incentives are critical for their continued engagement. Additionally, they also need psychosocial support to enable them to adequately deal with vulnerable cases.


Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M., . . . Child Undernutrition Study, G. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. Lancet, 371(9608), 243-260. doi: 10.1016/s0140-6736(07)61690-0

Haider, R., Ashworth, A., Kabir, I., & Huttly, S. R. (2000). Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial [see commments]. Lancet, 356(9242), 1643-1647.

Kenya National Bureau of Statistics (KNBS) and ICF Macro. (2010). Kenya Demographic and Health Survey 2008-09. Calverton, Maryland:KNBS and ICF Macro

Nankunda, J., Tumwine, J. K., Soltvedt, A., Semiyaga, N., Ndeezi, G., & Tylleskar, T. (2006). Community based peer counsellors for support of exclusive breastfeeding: experiences from rural Uganda. Int Breastfeed J, 1, 19. doi: 10.1186/1746-4358-1-19

Victora, C. G., Adair, L., Fall, C., Hallal, P. C., Martorell, R., Richter, L., . . . Child Undernutrition Study, G. (2008). Maternal and child undernutrition: consequences for adult health and human capital. Lancet, 371(9609), 340-357. doi: 10.1016/s0140-6736(07)61692-4