Abstract
Decisions made at the household level, for example, to seek antenatal care or breastfeed, can have a direct impact on the health of mothers and newborns. The SMART Community-based Initiatives program in Egypt worked with community development associations to encourage better household decision-making by training community health workers to disseminate information and encourage healthy practices during home visits, group sessions, and community activities with pregnant women, mothers of young children, and their families. A quasi-experimental design was used to evaluate the program, with household surveys conducted before and after the intervention in intervention and comparison areas. Survey questions asked about women’s knowledge and behaviors related to maternal and newborn care and child nutrition and, at the endline, exposure to SMART activities. Exposure to program activities was high in intervention areas of Upper Egypt: 91% of respondents reported receiving home visits and 84% attended group sessions. In Lower Egypt, these figures were 58% and 48%, respectively. Knowledge of danger signs related to pregnancy, delivery, and newborn illness increased significantly more in intervention than comparison areas in both regions (with one exception in Lower Egypt), after controlling for child’s age and woman’s education; this pattern also occurred for two of five behaviors (antenatal care visits and consumption of iron-folate tablets). Findings suggest that there may have been a significant dose-response relationship between exposure to SMART activities and certain knowledge and behavioral indicators, especially in Upper Egypt. The findings demonstrate the ability of civil society organizations with minimal health programming experience to increase knowledge and promote healthy behaviors among pregnant women and new mothers. The SMART approach offers a promising strategy to fill gaps in health education and counseling and strengthen community support for behavior change.
Highlights
Pregnant women and young children in Egypt face persistent health challenges
The SMART Community-based Initiatives program in Egypt worked with community development associations to encourage better household decision-making by training community health workers to disseminate information and encourage healthy practices during home visits, group sessions, and community activities with pregnant women, mothers of young children, and their families
The findings suggest that knowledge of danger signs and certain behaviors may have increased with the intensity of respondents’ exposure to SMART activities, especially in Upper Egypt (Table 6)
Summary
Pregnant women and young children in Egypt face persistent health challenges. Neonatal mortality has been declining more slowly than under-five mortality [1]and accounts for 52% of all under-five deaths in Egypt [2]. The inability to recognize danger signs and assess the seriousness of illness can lead to lifethreatening delays by mothers in seeking health care for themselves and their newborns [6,7]. A 2013 cross-sectional study in Mansoura, Egypt found that 58% of newborns were given liquids other than breast milk before starting to breastfeed; the most frequent reasons were tradition and advice from mothers and mothers-in-law [8]. A multivariate analysis found that the risk of malnutrition among children age 6–23 months was independently associated with five factors; not being exclusively breastfed increased the risk five times, and late initiation of breastfeeding, reluctance to seek medical advice during illness, and not attending health or nutrition education sessions each doubled the risk [9]
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