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Family networks and infant health promotion: a mixed-methods evaluation from a cluster randomised controlled trial in rural Malawi

Scott, M; Malde, B; King, C; Phiri, T; Chapota, H; Kainja, E; Banda, F; (2018) Family networks and infant health promotion: a mixed-methods evaluation from a cluster randomised controlled trial in rural Malawi. BMJ Open , 8 (6) , Article e019380. 10.1136/bmjopen-2017-019380. Green open access

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Abstract

OBJECTIVE: Parents may rely on information provided by extended family members when making decisions concerning the health of their children. We evaluate whether extended family members affected the success of an information intervention promoting infant health. METHODS: This is a secondary, sequential mixed-methods study based on a cluster randomised controlled trial of a peer-led home-education intervention conducted in Mchinji District, Malawi. We used linear multivariate regression to test whether the intervention impact on child height-for-age z-scores (HAZ) was influenced by extended family members. 12 of 24 clusters were assigned to the intervention, in which all pregnant women and new mothers were eligible to receive 5 home visits from a trained peer counsellor to discuss infant care and nutrition. We conducted focus group discussions with mothers, grandmothers and peer counsellors, and key-informant interviews with husbands, chiefs and community health workers to better understand the roles of extended family members in infant feeding. RESULTS: Exposure to the intervention increased child HAZ scores by 0.296 SD (95% CI 0.116 to 0.484). However, this effect is smaller in the presence of paternal grandmothers. Compared with an effect size of 0.441 to 0.467 SD (95% CI -0.344 to 1.050) if neither grandmother is alive, the effect size was 0.235 (95% CI -0.493 to 0.039) to 0.253 (95% CI -0.529 to 0.029) SD lower if the paternal grandmother was alive. There was no evidence of an effect of parents' siblings. Maternal grandmothers did not affect intervention impact, but were associated with a lower HAZ score in the control group. Qualitative analysis suggested that grandmothers, who act as secondary caregivers and provide resources for infants, were slower to dismiss traditionally held practices and adopt intervention messages. CONCLUSION: The results indicate that the intervention impacts are diminished by paternal grandmothers. Intervention success could be increased by integrating senior women.

Type: Article
Title: Family networks and infant health promotion: a mixed-methods evaluation from a cluster randomised controlled trial in rural Malawi
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2017-019380
Publisher version: http://doi.org/10.1136/bmjopen-2017-019380
Language: English
Additional information: Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: child health, extended family, health promotion, nutrition, sub-saharan africa
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > UCL SLASH
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of SandHS > Dept of Economics
URI: https://discovery.ucl.ac.uk/id/eprint/10050337
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