Alive & Thrive
Alive & Thrive impact evaluation in Burkina Faso (2015-2018)
The project was an impact evaluation of the Alive & Thrive (A&T) initiative in Burkina Faso, funded by the Bill & Melinda Gates Foundation and the governments of Canada and Ireland and managed by FHI 360.
A team from the Maternal Health Group (MHG) involving Prof Veronique Filippi, Dr Jenny Cresswell, Dr Sophie Sarrassat, and Professor Simon Cousens in collaboration with Dr Hama Diallo and Dr Rasmane Ganaba and their teams in two research institutions in Burkina Faso, Centre MURAZ, and AFRICSanté, performed the impact evaluation of the A&T initiative to improve infant feeding practices, specifically increasing rates of exclusive breastfeeding in Burkina Faso.
A&T implemented a community-based intervention package, which had three components: community mobilization, training of health workers and interpersonal communication activities in health facilities and at home. The community-based intervention took place between December 2015 and July 2017 and was implemented in Boucle du Mouhoun, a region selected in consultation with the Ministry of Health of Burkina Faso.
To conduct a cluster randomised trial in the region of Boucle du Mouhoun to determine the impact of A&T’s programme on the prevalence of exclusive breastfeeding (EBF) among infants up to six months, and other outcomes of interest in infants up to twelve months;
To conduct a complementary qualitative study to document (i) the implementation of Alive & Thrive activities at regional and local levels, activities conducted by other agencies, and the ways in which women receive information on breastfeeding in the intervention and control areas; and (ii) the social determinants of breastfeeding;
To conduct a validation study in a sub-sample of mothers and infants up to six months comparing mother’s self-reported exclusive breastfeeding practice to a reliable biochemical method (the dose to the mother deuterium oxide turnover technique).
After 20 months of community mobilization and interpersonal communication, the intervention appeared effective in improving the knowledge, attitudes and practices of EBF reported by mothers.
At baseline, only one-third of children aged 0 to 5 months in both arms of the study were exclusively breastfed during the previous 24 hours according to their mothers’ dietary recall. At endline, the prevalence of EBF increased in both arms of the RCT. It was 51% in the control arm compared to 93% in the intervention arm, leading to an absolute risk difference of 42% in favor of the intervention. Secondary outcomes show similar patterns.
Results of the validation study conducted between baseline and endline suggested the existence of a courtesy bias in women’s responses, which was more pronounced among women in the intervention arm. There is therefore a possibility that the improvement in knowledge may not have immediately translated into a change in practices.
Visit the Alive & Thrive website to learn more.