Implementing a Novel Facility-Community Intervention for Strengthening Integration of Infant Nutrition and Family Planning in Mara and Kagera, Tanzania

Chelsea M. Cooper, Mary Drake, Justine A. Kavle, Joyce Nyoni, Ruth Lemwayi, Lemmy Mabuga, Anne Pfitzer, Mary Makungu, Elizabeth Massawe and John George
Additional contact information
Chelsea M. Cooper: USAID’s Maternal and Child Survival Program/Jhpiego, Washington, DC 20036, USA
Mary Drake: Jhpiego, Baltimore, MD 21231, USA
Justine A. Kavle: Kavle Consulting, LLC, Washington, DC 20001, USA
Joyce Nyoni: Institute of Social Work, University of Dar es Salaam, Dar es Salaam, Tanzania
Ruth Lemwayi: Jhpiego, Dar es Salaam, Tanzania
Lemmy Mabuga: USAID’s Maternal and Child Survival Program/Jhpiego, Dar es Salaam, Tanzania
Anne Pfitzer: USAID’s Maternal and Child Survival Program/Jhpiego, Washington, DC 20036, USA
Mary Makungu: Government of Tanzania, Musoma, Mara Region, Tanzania
Elizabeth Massawe: Bukoba Referral Hospital, Government of Tanzania, Bukoba, Kagera Region, Tanzania
John George: UNICEF, Dar es Salaam, Tanzania

IJERPH, 2021, vol. 18, issue 8, 1-21

Abstract: Tanzania has high fertility, low contraceptive prevalence and low exclusive breastfeeding (EBF). The Lake Zone, including Mara and Kagera regions, leads the country in total fertility; use of the lactational amenorrhea method (LAM) is negligible. This pre-/post-study explored the effects of a multi-level facility and community intervention (service delivery support, community engagement, media and LAM tracking) to integrate maternal and infant nutrition and postpartum family planning (FP) within existing health contacts. Mixed methods were used, including service statistics, exit interviews, patient-tracking tools for community health workers, client self-tracking tools, supervision data, focus group discussions and in-depth interviews. Results are presented using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) implementation science framework. The intervention reached primarily the second and fourth wealth quintiles, increased FP and EBF at six weeks postpartum. LAM was very acceptable, provided an entry point for FP conversations and for addressing misconceptions, and reinforced EBF practices. Partners felt encouraged to support spousal nutrition, breastfeeding and FP. Higher adoption in Kagera may be influenced by performance-based financing. The intervention was implemented with generally high fidelity. Maintenance data reflected stakeholder interest in continuing the intervention. A multi-level facility and community intervention was feasible to implement and likely contributed to improved EBF practices and FP uptake, including LAM use.

Keywords: exclusive breastfeeding; family planning; postpartum family planning; lactational amenorrhea method; maternal infant nutrition; service integration; community health; male engagement; implementation science (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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