BMJ 1998;316:805-811 ( 14 March )

Papers

The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial

Alison Bolam, research fellow, ^a Dharma S Manandhar, consultant paediatrician, ^b Purna Shrestha, research assistant, ^b Matthew Ellis, research fellow, ^a Anthony M de L Costello, reader in international child health. ^a

^a Centre for International Child Health, Institute of Child Health, London WC1N 1EH, ^b Mother and Infant Research Activities (MIRA), Maternity Hospital, Kathmandu, c/o GPO Box 921, Kathmandu, Nepal

Correspondence to: Dr Costello a.costello{at}ich.ucl.ac.uk

Objectives: To evaluate impact of postnatal health education for mothers on infant care and postnatal family planning practices in Nepal.
Design: Randomised controlled trial with community follow up at 3 and 6 months post partum by interview. Initial household survey of study areas to identify all pregnant women to facilitate follow up.
Setting: Main maternity hospital in Kathmandu, Nepal. Follow up in urban Kathmandu and a periurban area southwest of the city.
Subjects: 540 mothers randomly allocated to one of four groups: health education immediately after birth and three months later (group A), at birth only (group B), at three months only (group C), or none (group D).
Interventions: Structured baseline household questionnaire; 20 minute, one to one health education at birth and three months later.
Main outcome measures: Duration of exclusive breast feeding, appropriate immunisation of infant, knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea, knowledge of infant signs suggesting pneumonia, uptake of postnatal family planning.
Results: Mothers in groups A and B (received health education at birth) were slightly more likely to use contraception at six months after birth compared with mothers in groups C and D (no health education at birth) (odds ratio 1.62, 95% confidence interval 1.06 to 2.5). There were no other significant differences between groups with regards to infant feeding, infant care, or immunisation.
Conclusions: Our findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding, care, or immunisation, although uptake of family planning may be slightly enhanced.

Key messages Health education is widely promoted in primary care, but there have been few rigorous evaluations of its impact, especially in developing countries A randomised controlled trial of postnatal individual health education for mothers given by trained female health workers showed no significant impact on maternal knowledge and practices of child care or on infant health outcomes, but there was a small improvement in uptake of family planning at six months after birth The efficacy of health education interventions that rely solely on giving people information to bring about a change in health behaviour is unproved; interventions should be evaluated before being implemented on a large scale Alternative strategies for health promotion in developing countries such as interactions within families, peer groups, or communities may be more effective but are costly and difficult to implement on a large scale

---

© BMJ 1998
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Postnatal health education in Nepal

Craig Stangroom and Alistair Appleby
BMJ 1998 317: 477. [Extract] [Full Text]

Education, loss, and diagnostic acumen
BMJ 1998 316: 0. [Full Text] [PDF]

Postnatal health education in Nepal has little impact
BMJ 1998 316: 0. [Full Text]

This article has been cited by other articles:

• Judah, G., Aunger, R., Schmidt, W.-P., Michie, S., Granger, S., Curtis, V. (2009). Experimental Pretesting of Hand-Washing Interventions in a Natural Setting. AJPH 99: S405-S411 [Abstract] [Full text]  
• Mullany, B. C., Becker, S, Hindin, M. (2007). The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial. Health Educ Res 22: 166-176 [Abstract] [Full text]  
• Bhutta, Z. A., Darmstadt, G. L., Hasan, B. S., Haws, R. A. (2005). Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence. Pediatrics 115: 519-617 [Abstract] [Full text]  
• de Oliveira, M. I. C., Camacho, L. A. B., Tedstone, A. E. (2001). Extending Breastfeeding Duration Through Primary Care: A Systematic Review of Prenatal and Postnatal Interventions. J Hum Lact 17: 326-343 [Abstract]  
• Fortuin, J. N. (1998). Equity in health. Global Health Promotion 5: 13-17 [Abstract]  
• Stangroom, C., Appleby, A., Thompson, B E L, Furber, A., Bolam, A., Ellis, M., Costello, A. M d. L, Manandhar, D. S, Shrestha, P. (1998). Postnatal health education in Nepal. BMJ 317: 477-477 [Full text]  
• Yach, D., Jensen, M. S., Norris, A., Evans, T. (1998). Promoting Equity in Health. Global Health Promotion 5: 7-13 [Abstract]  

Online poll

Find out more >>