Abstract:
Child Survival Interventions (CSI) have proven effective in reducing child morbidity and mortality in developing countries. Despite availability of cost-effective CSIs in Nigeria, mothers’ practice of CSIs is low and has been linked to under-five malnutrition. In Nigeria, there is limited published literature on the use of peer educators in increasing poorly educated mothers’ CSIs practice in rural communities. This study was designed to examine the effect of peer education on practice of CSIs among mothers in rural communities of Akinyele and Ido Local Government Areas (LGAs) in Ibadan.
The quasi-experimentalstudy involved a purposive selection of Akinyele and Ido LGAs. Nine rural communities (Akinyele-five and Ido-four) with primary health centres and at least 10km from LGA council were selected for the study. The four communities in Ido LGA were assigned to Experimental group (EG), while three and two communities in Akinyele LGA were assigned to Midwives Service Scheme group (MSSG) and Control group (CG), respectively. A total of 451 mother/child pair (MCP): 187 in EG, 215 in MSSG, and 49 in CG were purposively selected from the study groups. A pre-tested, interviewer-administered questionnaire was used to obtain information on demographic characteristics, practice of CSIs and anthropometry from mothers at baseline. A 17-point practice scale categorised as poor (0.0-4.89), fair (4.90-11.19) and good (11.20-17.00) was used to assess mothers’ CSIs practice. At intervention, 150, 135 and 95 consenting MCP in EG, MSSG and CG, respectively were recruited. In the EG, 8 mothers per community were selected and trained to provide mothers with information, skills, and support on breastfeeding exclusively (BE), oral-rehydration therapy (ORT) and immunisation. Weight and height/length of children were measured in the 1st, 6th, 9th and 12th month in MSSG and CG, and monthly in EG. Wasting, underweight and stunting were determined using WHO-Anthro. Data were analysed using descriptive statistics, Chi square test, paired t-test and ANOVA at p= 0.05.
Age of mothers/children was 27.0±5.9years/13.7±9.0 months, 27.3±6.6years/13.5±8.9monthsand 29.3±6.4years/14.2±8.7months in EG, MSSG and CG, respectively. Mothers’ CSIs practice scores were 7.6±3.1 in EG, 8.3±3.2 in MSSG, and 8.0±3.0 in CG at baseline. Proportion of mothers’ BE were 9.6% in EG, 17.2% in MSSG and 8.8% in CG. Mothers’ ORT use was 16.8% in EG, 28.4% in MSSG and 22.8% in CG. Children with complete vaccination by age were 49.7% in EG, 69.6% in MSSG and 54.4% in CG. Prevalence of wasting was 12.4%. Mothers’ practice score was significantly higher at post intervention (9.8±4.9) than at baseline in EG (7.6±3.1). Wasting prevalence significantly reduced by 99.1%, 70.1% and 86.2% (at 12th month) in EG, MSSG and CG, respectively. At the 6th month, percentage of mothers' BE was not significantly different between EG (35.3%) and MSSG (33.0%). Diarrhoea episodes decreased significantly in EG by 7.0% but increased in MSSG and CG by 46.0% and 34.0% respectively.
The use of peer educators in rural households in Ibadan increased the practice of exclusive breastfeeding, decreased episodes of diarrhoea and wasting.
