The Healthy Baby Flipbook: piloting home-based counseling for refugee mothers to improve infant feeding and water, sanitation, and hygiene (WASH) practices

ABSTRACT

Problems in growth and undernutrition manifest in early infancy, with suboptimal breastfeeding and inadequate complementary feeding remaining strong risk factors for chronic undernutrition in infants. No published studies exist on educational interventions to improve infant feeding practices among refugees or displaced persons in low and middle-income (LMIC) settings. The objective of this study was to create and pilot educational materials for home-based counseling of refugee mothers along the Thailand–Myanmar border to improve appropriate infant feeding and water, sanitation, and hygiene (WASH) behaviors. Mothers of infants received counseling on appropriate infant feeding and WASH practices on a monthly basis for a total of six months from infant age three months until nine months. Educational materials were designed to feature a basic script for health workers and photos of locally available, appropriate foods. Of the 20 mothers participating in this pilot, infant feeding and WASH behaviors improved within 1 to 2 months of the first visit, including exclusive breastfeeding, minimum acceptable diet, and safe disposal of infant stool. This pilot demonstrates improvement in maternal infant feeding and WASH practices in a small set of refugee mothers, providing evidence for counseling measures to improve infant health in vulnerable populations.

Trial registration: ClinicalTrials.gov identifier: NCT00840502.

KEYWORDS:

• Infant nutritional physiological phenomena
• breastfeeding
• feeding behavior
• counseling
• vulnerable populations

Responsible Editor

Jennifer Stewart Williams, Umeå University, Sweden

Responsible Editor

Jennifer Stewart Williams, Umeå University, Sweden

Acknowledgments

We would like to acknowledge the pregnant women participating in this study. We would also like to thank the local health staff at the SMRU MLA clinic that helped support the logistics and implementation of this study.

Author contributions

All authors meet the International Committee of Medical Journal Editors requirements for authorship.

Disclosure statement

The authors report no conflicts of interest.

Ethics and consent

This investigation was part of a larger study (ClinicalTrials.gov Identifier: NCT00840502), and was approved by the University of Oxford (OxTREC (14–08)) and Mahidol University (TMEC 2008–028) Ethics Committees. The current study also received ethical approval by the University of Texas Medical Branch (Galveston, Texas) Institutional Review Board (14-0211). All institutions approved this study in accordance with the Declaration of Helsinki. In addition, the Tak Province Community Advisory Board (Tak, Thailand) based along the Thailand–Myanmar border also approved this study (TCAB-03.13).

Paper context

Suboptimal breastfeeding and complementary feeding remain strong risk factors for chronic infant malnutrition. No published studies exist on educational interventions to improve infant feeding practices among refugees or displaced persons in LMIC settings. This study created and piloted educational materials for counseling of refugee mothers along the Thailand–Myanmar border to improve infant feeding and water, sanitation, and hygiene practices. This pilot provides evidence of counseling measures to improve infant health in vulnerable populations.

Additional information

Funding

This research was supported by the Wellcome-Trust Major Overseas Programme in Southeast Asia under grant number: 106698/Z/14/Z. AH received personal funding from the Infectious Disease Society of America and through the Benjamin Kean Traveling Fellowship from the American Society of Tropical Medicine and Hygiene. The funders had no role in the study design, collection, analysis or interpretation of the data, the writing of the article, or in submission of the paper for publication. The views expressed in the paper are those of the authors and do not represent the positions of their respective institutions or that of the funding agencies.