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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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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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“Several trials have assessed the effect of promoting exclusive breastfeeding on food-borne infections, with equivocal results.28, 29”
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“There is little proof that such educational approaches are effective, either in developing,73, 74 or developed countries.75”
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Metadata
- Authors
- Bolam, A., Manandhar, D. S., Shrestha, P., Ellis, M., & Costello, A. M. D. L.
- Affiliations
- Mother and Infant Research Activities (NP)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1998-03-14
- Volume
- 316
- Issue
- 7134
- Pages
- 805-811
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- 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
- bronze
- doi.org
- 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 › Medicine › Pediatrics, Perinatology and Child Health › 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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