Thèse de Socio-démographie soutenue le 12 novembre 2015 par Naoko HORII sous la direction de Yves CHARBIT à l’université Paris Descartes.
Contact : Naoko.Horii chez gmail.com
This research aims to evaluate the effects of a behavior change communication program promoting early initiation of breastfeeding within the first hour of birth among the most vulnerable mothers in rural Niger. The main objectives are to identify the social determinants of initial breastfeeding and to examine the typology of integrated communication strategies for the socio-economically vulnerable group of populations. Behavioral child health outcomes have become an important research subject in Demography. However, few studies have examined breastfeeding during the postpartum period in Sub-Saharan Africa (SSA). Very few demographic approaches were applied to evaluate neonatal care by looking into socio-economic inequity in SSA. This thesis quantifies predominantly qualitative information characterizing behavioral studies in breastfeeding among the most deprived population.
This is a secondary analysis of cross-sectional quantitative studies conducted in Niger at different points of time based on a literature review of previous studies conducted in Sub-Saharan Africa. The cross-sectional surveys include : the 2006 Niger Demographic Health Survey (DHS), the 2012 Niger DHS and the post-intervention survey (PIS) conducted in 2011 to evaluate a communication program promoting family and community based child health care in 4 regions of Niger. To constitute a study population for each dataset, the same exclusion criteria were applied to include women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. The PIS study population, drawn from the original survey with stratified random sampling, was divided into two strata, the intervention and control groups according to exposure to the communication program. Statistical analysis tools were the chi-square test and multivariate logistic regression. Independent variables include behavior change activities, socio-demographic and economic status of mothers, health seeking behavior and hygiene practices.
Postpartum breastfeeding is impaired by income poverty in Niger. Regardless of socio-economic vulnerability, hygiene practice increases the chance of early initiation of breastfeeding. Multivariate analysis with the 2011 PIS shows that hand washing and use of a traditional latrine increases by 2.4 (95%CI : 76 ; 220) and by 2.3 (95%CI : 51 ; 248) respectively the odds of early initiation of breastfeeding. Government health workers, midwives, play a key role determining mothers’ postpartum breastfeeding. Antenatal care (ANC) provided by midwives increases the chance of early breastfeeding that increases by 52% (95%CI : 14, 103) compared to ANC provided by other health professionals among the most deprived group of populations. The PIS does not provide any information to evaluate the role of traditional birth attendants in neonatal care. An inter-sectorial approach addressing multiple dimensions of maternal and child health significantly increases by 6.9 odds (95%CI : 374, 900) early initiation of breastfeeding compared to those who are not reached by the whole integrated KFP promotion. Home visits by community volunteers are not significant (IC 95% : -10 ; 54). Involvement of mothers as a peer promoting exclusive breastfeeding significantly reduces the risk of delayed initiation of breastfeeding by 2.0 odds (IC 95% : 39 ; 189). However, the number of exposures to different types of communication strategies does not influence positively early breastfeeding.
The impact of community volunteers and health workers is limited with regard to early breastfeeding among the most deprived group of mothers. The model of behavior change communication with participatory peer promotion and a multi-sectorial approach combining optimal hygiene promotion suggests a response to socio-economic disparity.
Breastfeeding, Determinants, Behavior change, Neonatal care, Vulnerability
Afrique sub-saharienne, Niger