The intervention focuses on exclusive breastfeeding by promoting behavioural change of some harmful cultural practices and beliefs such as discarding colostrums, giving of prelacteral feeds and delay in initiation of breastfeeding.
72 peer counselors, locally selected by traditional leaders were trained to implement this intervention in rural communities of Mchinji district, Malawi. In Malawi breastfeeding has always been there, but rarely has exclusive breastfeeding been practiced due to cultural beliefs.
These counsellors also promote safe motherhood key care practices; identification of danger signs for the pregnant woman or postnatal mother and appropriate; birth preparedness, skilled birth attendance, family planning and timely referral for health care.
A key component of the intervention is that it is closely integrated with the District Health Office in Mchinji. The counsellors are supervised by government Health Surveillance Assistants (HSAs), for sustainability.
Methods
The role of the counselors is to identify pregnant women in their communities and make home visits at five key points:
- during pregnancy and after birth
- once in the third trimester
- the first week after birth (within the first three days)
- one month after birth; three months after birth
- five months after birth.
Where possible the woman’s partner is included in these counseling sessions.
During these visits the counsellors provide support and counseling on different range of health issues including: exclusive breastfeeding; family planning, prevention of mother-to-child transmission of HIV (PMTCT); complementary feeding after six months.
The counsellors also provide support for women with breast problems and raised awareness on key danger signs in pregnancy, postnatal and the need for appropriate and timely health care seeking.
Successes
Maimwana peer counsellors are recognised in the community, people invite them to their households for counseling, including men.
The counsellors reach out to the remotest areas where health workers fail to reach; complementing Ministry of Health efforts. They are trusted by community health workers and the community, and they also use them in other health activities like growth monitoring.
Most of the women are now accessing health care services:
- antenatal
- facility deliveries,
- postnatal
- family planning
- under five clinics
- PMTCT uptake has also increased
Health facilities receive referrals from Maimwana volunteers as awareness has been brought to the community. Most communities are seeking health care early following awareness by the peer counsellors.
This intervention has also promoted behaviour change in most of the men regarding birth preparedness and other reproductive health issues, as they join their partners during the counselling sessions. In most areas where the counselors are working there are fewer breast problems.
Lessons
The intervention has a direct impact on the people and the mothers of the rural community, thereby saving lives of mothers and infants in Mchinji.
Exclusively breastfeed children do not get sick as frequently; they grow more healthily, and they are more protected from most childhood infections like diarrhoea and pneumonia.
It is easy to change harmful cultural beliefs by using people from the same community who share the same belief; as they build trust in them.
Women learn better when counselled individually by peers and in their own environment.