Interpersonal approaches are the most heavily researched and one of the oldest forms of health intervention. They involve interpersonal communication (IPC, also known as face-to-face interaction), between health promoters, educators, communicators, service providers and clients. These approaches can occur in a health facility, the home, or elsewhere and among small groups, such as with a family, or one-on-one. The advantage of interpersonal approaches is that they can tailor information to a client’s needs. They can be simulated through many different channels, including media campaigns or other forms of technology, such as the delivery of personalized SMS (Storey, 2011).
1.1 Background of the Study
Exclusive breastfeeding means giving a baby no other food or drink not even water but mother’s milk. Medicines, vitamin and mineral drops essential for the newborn can be given. Expressed‐ mother’s milk is also permitted. Improved breastfeeding practices can contribute significantly to the achievement of the Millennium Development Goals. An estimated 1.3 million (Jones G et al., 2003) to 1.45 million (Lauer et al., 2006) childhood deaths in developing countries are attributed to suboptimal breastfeeding practices. Initiation of breastfeeding within the first hour of birth, exclusive breastfeeding for the first six months, and continued breastfeeding to two years and beyond are optimal practices based on scientific evidence of their health impact. The inclusion of breastfeeding promotion and support in various programmatic frameworks is supported by evidence presented in the Lancet series on child survival, neonatal survival, and child development along with the Disease Control Priorities Project’s recognition of the importance of better child feeding practices in reducing the burden of disease.
The Millennium Development Goals (MDGs) were a universal initiative aimed to accelerate poverty reduction and develop social conditions in the emerging regions of the universe. Goals 4, 5 along with 6 addressed health directly (maternal and child health, and the major disease problems of HIV and AIDS, malaria and tuberculosis) and aimed to lessen the burden of preventable illness plus premature death in developing nations (Murage, 2014). From the year 2000, much growth has been made in decreasing maternal and child mortality, access to treatment for target diseases, and decrease in transmission of malaria and HIV. Just above half of the populace in sub-Saharan Africa has access to clean water, while about 40 percent have access to enhanced sanitation. These advances are, nonetheless, dwarfed by the sheer scale of the challenges that face health systems inside Africa. Health continues to be underfunded (per capita expenditure remains relatively below the WHO endorsed minimum of US$40 yearly, and only six nations have achieved the 15 per cent target of national budgetary provision to health with regards to the Abuja declaration); health facilities are understaffed (typically one doctor for over 30,000 people compared to one for 450 in developed countries); health infrastructure is dilapidated, poorly maintained and supplied, and woefully managed. This is the backdrop against which millions of Africans continue to suffer and die from infectious diseases that are comparatively simple to avert or treat. Africa remains the continent with the lowest levels of per capita investment in health and the weakest health systems. According to Murage et.al, (2014), this is not always as a result of poverty, but fairly management of public affairs remains greatly wanting and wastes billions of Africa’s resources. On average Africans live the shortest lives, and costs of ill health and premature death costs the continent billions of dollars (Murage, 2014).
According to a research done by Otieno (2012), it found that women have special needs during pregnancy and after pregnancy that include social, physical, emotional, financial and psychological support (Otieno, 2012). Although there are many cultural variations of how these systems of support manifest during pregnancy and after pregnancy, research indicates that those close to a woman often have influence through interpersonal communication. Women rely heavily on the community health workers, spouses, family, and close friends. These social connections are known to influence health behaviors taken up during and after the pregnancy, such as smoking cessation and dietary changes. As part of the Baby-friendly Community Initiative in Cambodia, teams are created to promote and support breastfeeding. The team is made up of two village health support group volunteers (one man and one woman per village), a traditional birth attendant (TBA), the village chief, and two mothers. The criteria for selection of the “model mothers” are positive breastfeeding experience, literacy, respect in the community, communication skills, and motivation to participate. The TBA plays an important role because the majority (79 percent) of deliveries in Cambodia takes place at home, and TBAs assist in 55 percent of them. The TBAs continue to provide care to mothers and babies for several months after delivery (UNICEF, 2012).
Randomized controlled trials of community-based breastfeeding counseling by health providers and community-based workers and peer counselors show that community strategies to improve breastfeeding practices can be effective for a relatively small intervention group (Bhandari et al., 2003). Interpersonal communication skills entail the knowledge and skills that enable health workers to help mothers/caregivers optimally feed their infants and young children and take care of their own nutritional needs.
The main provider of community-based activities, including breastfeeding support, is the multi-purpose community health worker. A resurgence of interest in this cadre of workers is partly the result of decentralization of health systems, continued lack of access to health services, and a focus on broad-scale coverage (UNICEF, 2012). Though pregnancy and the mother-baby entity have long been viewed as existing solely in the female realm, research has consistently found that community health workers are noted as the one of the greatest source of support for a pregnant woman. Interpersonal communication between pregnant and breastfeeding women and the community health workers is said to be truly influential.
In the programmes reviewed, implementation of community-based breastfeeding activities was often through multi-purpose community health workers and other volunteers responsible for promoting nutrition and health interventions. Various names are used to describe these workers, but in this paper they will all be referred to as community health workers. Opportunities for breastfeeding promotion and support include home visits, growth monitoring and promotion sessions, meetings of local groups, immunization days, community events such as local festivals, and informal encounters. Homes, clinics, markets, schools, houses of worship, workplaces, and outdoor gathering places can serve as venues for CHW activities. Recognizing that community health workers must address many health topics and reach a sizable area, some programmes have trained members of the community to focus on a more limited number of topics and fewer households. In Madagascar, women were chosen from existing women’s associations and groups to become community nutrition promoters. In three regions of Ethiopia, community members were trained to support the work of the government’s health extension workers. They relate to 30–50 households while the health extension worker is responsible for around 500 households. In India, community members known as change agents received training to support outreach activities of auxiliary nurse midwives and staff of government childcare centers (Bhandari et al., 2003). In Kenya, with regards to Kenya Demographic and Health Survey 2008-2009, 32% of children under the age of six months are exclusively breastfed, improving from only 13% in 2003 (Murage, 2014). In Korogocho slums, exclusive breastfeeding for the first six months is rare as only about 2% of infants were exclusively breastfed for six months.