Effectiveness of a smartphone – based education intervention to improve breastfeeding and neonatal nutritional status: a randomised controlled trial

Exclusive breastfeeding is critically important during the first six months of an infant's life, offering numerous health benefits for both mothers and babies. A randomized controlled study was conducted involving a sample of 674 new mothers (224 in the control group and 450 in the intervention group) new mothers with their child aged under one month for a period of six months to evaluate the effectiveness of a breastfeeding smartphone-based educational intervention at Kenyatta National Hospital in Nairobi, Kenya. Participants were randomly assigned to the intervention group which received (mobile app-based education + routine care) and the control group (routine care). A total of 412 mother-infant dyads completed the study, representing 61.1% of the recruited participants in the study, with 206 in the intervention group and 206 in the control group. After six months, the following findings were observed; the intervention group showed a significant (p<0.01) improvement in breastfeeding knowledge, with a mean (±S.D.) score of 70.33% (±7.68), compared to 58.52% (±16.5) in the control group, resulting in a difference-in-difference of means (DID means = 3.53%, p<0.01). Attitudes toward breastfeeding improved significantly (p<0.01) in the intervention group, with a mean score of 73.58% (±6.79), compared to 47.75% (±9.96) in the control group, with a difference-in-difference of means (DID means = 1.60%, p<0.01). Practices significantly (p<0.01) improved, with the intervention group scoring 73.95% (± 2.66), while the control group scored 53.89% (±9.85), resulting in a difference-in-difference of means (DID means = 9.12%, p<0.01). At baseline, the mean (±S.D.) weight of infants was 2.82 kg (±0.87) and 2.98 kg (±0.62) in the control and intervention group respectively. Both groups experienced an increase in weight, with the control group averaging 7.36 kg (±0.91) and the intervention group averaging 7.82 kg (±0.94). Both groups had increased in height, with the control group measuring the mean (±S.D.) 67.42 cm (±2.43) and the intervention group measuring 67.95 cm (±2.87). There was significant (p<0.01) weight gain in intervention group infants (DID means = 0.28 kg, p<0.01) and length gain (DID means = 1.31 cm, p<0.01). Finally, the intervention group underweight reduced to 4.9%, stunting to 1.9%, and wasting to 4.4% resulting in statistical significant (p<0.01) reduction in malnutrition prevalence. The mobile app-based intervention significantly improved breastfeeding knowledge, attitudes, practices, and infant health, reducing malnutrition prevalence effectively. Hospital-based nutritionists should consider using mobile apps to monitor lactating mothers' exclusive breastfeeding adherence, while policymakers support their integration in post-natal care. Key words: Smartphone intervention, breastfeeding knowledge, attitude, practices, Infant nutritional status, Kenya