IEC [information, education and communication] component of the Peru breastfeeding project, 1988-1990 : final report

AED used the findings from the research conducted earlier in the project to help develop: (1) a pocket reference on breastfeeding, which was distributed to all health workers during their training and later to health personnel in Bolivia, Ecuador, and Colombia, as well as to other agencies working in breastfeeding promotion in Latin America; (2) a flip chart for use by the hospitals" breastfeeding counselors, of which copies were placed in each intervention hospital; and (3) a poster-style calendar that was given to all mothers delivering at the two intervention hospitals (Cayetano Heredia and Dos de Mayo). The intervention notably improved health provider knowledge of appropriate infant feeding practices, particularly regarding the inappropriateness of giving water, other liquids, or bottles to young infants and the importance of encouraging exclusive breastfeeding through 6 months of age. However, this improved knowledge did not always translate into effective counseling of mothers. While a post-partum survey at 12 weeks revealed a relatively high prevalence (52%) of exclusive breastfeeding by mothers who delivered at Cayetano Heredia, the intervention hospital with the most complete and intensive intervention among both health providers and mothers, only 17% of mothers at the Dos de Mayo hospital and only 8% from the control hospital (Loayza) where still practicing exclusive breastfeeding. A 1992 follow-up evaluation conducted by AED in Cayetano Heredia and Dos de Mayo hospitals demonstrated that, while important changes had occurred in the two hospitals as a result of the intervention, both facilities continued to experience problems with inadequate knowledge of lactation management among health personnel and limitations on breastfeeding counseling of mothers. Personnel (particularly those not trained as part of the intervention) experienced difficulties with the use of the flip chart, and copies of the breastfeeding guide for health personnel developed by the project were no longer available for easy reference by new personnel. No take-home print materials with breastfeeding information were available for mothers. The evaluation concluded that conditions no longer existed in the two hospitals to facilitate consistent breastfeeding counseling of mothers. In sum, the Peru Breastfeeding Project proved to be an excellent example of the usefulness of the social marketing approach for identifying and refining messages tailored to modify specific breastfeeding-related behaviors that were found to be susceptible to influence. The 20-hour training course, supported by a thorough reference guide designed for hospital personnel, resulted in sharp improvements in health worker knowledge and attitudes that persisted long after the training activity itself. The overall effects of a one-time training activity in a facility are, however, limited due to staff turnover, indicating a need for both ongoing training of new personnel and refresher training. Most importantly, the project showed that increasing health workers" knowledge does not automatically translate into more effective application of that knowledge in educating and counseling mothers. The latter requires placing greater emphasis on training health workers in counseling skills, coupled with ongoing monitoring and supervision of how this training is put into practice on a daily basis.