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Cited by 152Global Maternal and Child HealthMaternal and Neonatal HealthcareReproductive Health and Contraception

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

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Bolam, A., Manandhar, D. S, Shrestha, P., Ellis, M., Costello, A. M d. L·1998·BMJ
DOI 10.1136/bmj.316.7134.805PMC PMC28481
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Abstract

Abstract 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

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  • Trials of promoting exclusive breastfeeding on food-borne infections have equivocal results.

    “Several trials have assessed the effect of promoting exclusive breastfeeding on food-borne infections, with equivocal results.28, 29”

    From Hygiene: new hopes, new horizons (2011) · cites this paper as [28]

    The Protocol says this randomised trial promoted exclusive breastfeeding, and the Abstract reports no significant difference in infant-feeding practices. But the Outcome measures section lists mothers’ knowledge of diarrhoea management, not infants’ food-borne infections; the trial therefore does not establish an equivocal effect on those infections. Page numbers are unavailable in our copy. (LLM, conf=0.86)

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  • Educational approaches to hygiene promotion have little supporting evidence of effectiveness in either developing or developed countries.

    “There is little proof that such educational approaches are effective, either in developing,73, 74 or developed countries.75”

    From Hygiene: new hopes, new horizons (2011) · cites this paper as [74]

    The ‘Evaluation of health education interventions’ section says that evaluations in developing countries were rare and often methodologically unsound, leaving little evidence of efficacy. That supports the sentence’s developing-country point, for which this paper is cited. The paper addresses postnatal infant-care and family-planning education, however, not hygiene promotion specifically; the developed-country point is attached to a different citation. (LLM, conf=0.82)

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Research works printed but not linked: 3

  1. [2]2. World Bank. Investing in health. The world development report. Oxford: Oxford University Press, 1993.
  2. [9]9. Parkin JM, Hey EN, Clowes JS. Rapid assessment of gestational age in the newborn infant. Arch Dis Child 1976;51:259.
  3. [16]16. American Public Health Association Work Group on Health Promotion/ Disease Prevention. Criteria for the development of health promotion and education programs. Am J Public Health 1987;77:89-92.

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Authors
Bolam, A., Manandhar, D. S., Shrestha, P., Ellis, M., & Costello, A. M. D. L.
Affiliations
Mother and Infant Research Activities (NP)
ORCID
Venue
BMJ
Publisher
BMJ
Published
1998-03-14
Volume
316
Issue
7134
Pages
805-811
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.316.7134.805
PMC
PMC28481
OpenAlex
W1986861495
Cited by
152
References
18
Citations by year
2025: 3 · 2024: 3 · 2023: 8 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 11 · 2018: 8 · 2017: 10 · 2016: 9 · 2015: 11 · 2014: 5 · 2013: 12 · 2012: 6
FWCI
3.28
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Department for International Development
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
infant care, family planning, postpartum contraception, exclusive breastfeeding, infant immunization, oral rehydration solution, infant diarrhea, infant pneumonia, maternal health knowledge, health behavior change, female health workers, Kathmandu
MeSH terms
Breast Feeding, Contraception Behavior, Family Planning Services, Female, Follow-Up Studies, Health Education, Humans, Immunization, Infant, Infant Care, Infant Nutritional Physiological Phenomena, Infant, Newborn, Male, Nepal, Nutritional Status, Perception, Pregnancy, Prenatal Care, Prognosis

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