Behavior Change Communication Campaigns Research Articles

Introducing double fortified salt in social safety net programmes in Madhya Pradesh and Gujarat in India: Success factors, challengesand lessons learned.

Double fortified salt (DFS; with iron and iodine) was introduced in social safety net programmes (SSNPs) in Madhya Pradesh (MP) and Gujarat states in 2018. Nutrition International (NI) provided critical support for the intervention. An impact evaluation in MP found high DFS uptake, exceeding 90%. Conduct a process evaluation of the DFS programmes in MP and Gujarat states to identify success factors, challenges, and recommend considerations for scale-up. Twenty-eight qualitative interviews were conducted with NI staff, national and state level government officials, and DFS producers in 2022. Enablingenvironmental factors included national-level support for food fortification, consensus that anaemia was essential to address, and institutional trust in NI for technical assistance. In programme implementation, the primary challenges were reports of black specks in DFS and the darkening of food cooked with DFS. NI supported the government in improving handling practices, ensuring a regular and stable supply, introducing quality monitoring effortsand launching targeted behaviour change communication (BCC) campaigns regarding the value of DFS. Long-term implementation of the programmes is a weak point, as DFS production is more expensive than iodised salt, there is no existing market outside of institutional demand, and BCC must be long-term, high-quality, and requires resourcing for continued high uptake among SSNP beneficiaries. Strong government buy-in and technical support along the supply chain to address quality issues and beneficiary acceptance were key factors for the successful introduction of DFS. Comparative studies of DFS programmes should be conducted to improve confidence in the success factors that lead to high DFS uptake.

Relationship between home garden ownership and the consumption of fruits and vegetables.

This study assessed the extent to which access to home gardens associate with the frequency of fruit and vegetable (FV) consumption. The study was carried out in fifty rural communities in Northern Ghana where food insecurity and malnutrition including micronutrient deficiencies are prevalent. A community-based comparative analytical cross-sectional study. A sample of 847 randomly selected rural households. The proportion of households that consumed FV at least 3 d in a week was 45 %. Members in households who owned a home garden were 1·5 times more likely to consume FV at least 3 d in a week (adjusted OR (AOR) = 1·46 (95 % CI 1·06-2·0)), compared with their counterparts who had no home gardens. Furthermore, households in which mothers had a positive attitude towards FV consumption were 1·6 times more likely to consume FV (AOR = 1·63 (95 % CI 1·17-2·27)) compared with mothers who were less positive. Our results suggest that food and nutrition policy measures that promote home gardens can improve consumption of diversified diets including FV among vulnerable rural households in Northern Ghana. Additionally, households with lower income may benefit from nutrition behaviour change communication campaigns directed towards increasing a positive attitude to FV intake.

A good egg: An evaluation of a social and behavior change communication campaign to increase egg consumption among children in Rwanda.

Childhood malnutrition, which is endemic in rural areas of low-income countries, leads to a host of deleterious outcomes such as poor cognitive development, low educational attainment and lower lifetime wages. Promoting the consumption of eggs among young children has emerged as a promising strategy to combat childhood malnutrition, though pathways to scale remain unclear. In this paper, we evaluate the impact of a social and behaviour change communication (SBCC) campaign combined with a program in which rural families purchased chickens on credit (poultry + SBCC; n = 769) relative to an arm in which families only received the poultry intervention (poultry only; n = 750), using a difference-in-difference estimation strategy with propensity score matching. The SBCC consisted of radio messages, in-person training, text message reminders and posters. We found a relatively modest but statistically significant increase in the number of times per week respondents in the poultry + SBCC arm reported feeding eggs to children of 0.28 (p = 0.02) compared to the poultry-only arm. The increase in egg feeding, however, was more pronounced for boys (0.42, p < 0.01) than for girls (0.14, p = 0.26). In addition, the campaign increased egg feeding more for those who were already feeding eggs to children (0.63, p < 0.01) than those who were not engaging in those practices at baseline (0.26, p < 0.01). However, the difference in these differences was not statistically significant. Future campaigns should ensure higher saturation of messaging and include specific messaging around the importance of feeding girls as well as boys. Campaigns seeking to scale up egg feeding quickly could potentially target the easier-to-reach segment of caregivers who already occasionally feed eggs to children though these might not be the neediest group.

Individual, Maternal, Household, and Community Level Variability in Determining Inequalities in Childhood Anaemia within Ethiopia: Four-Level Multilevel Analysis Approach

Background: Childhood anaemia is a major public health issue necessitating rapid attention due to its debilitating consequences on the child, family, and society. Previous studies have assessed the prevalence and contributing factors to childhood anaemia in many developing countries. Yet, little is known about the factors that contribute to childhood anaemia in Ethiopia. The study examined the factors associated with inequalities of childhood anaemia in Ethiopia. Methods: Data for the study were extracted from the 2016 Demographic and Health Survey of Ethiopia. A total of 7960 children were considered in the final study. Bivariate and multilevel ordinal logistic regression analyses were used to estimate determinants of inequalities of childhood anaemia status. Results: Overall, the prevalence of mild, moderate, and severe anaemia among the children were 24.5%, 28.4%, and 2.2%, respectively. The child’s age (in months), sex of the child, preceding birth interval (in months), mother’s educational level, antenatal care visit, wealth index of mothers, source of drinking water, type of toilet facility, place of residence, and region were significantly associated with childhood anaemia. The multilevel random coefficient model found that there is a variation of childhood anaemia among women (intra-cluster correlation [ICC] = 15.06%), households (ICC = 15.6%), and communities (ICC = 14.22%) in Ethiopia. Conclusions: This study showed that anaemia is common among Ethiopian children. Factors found to be associated with childhood anaemia were the sociodemographic characteristics of the child and their mothers. We recommend that existing programs and interventions to prevent and reduce childhood anaemia be strengthened. Moreover, a targeted intervention includes deworming, intensified year-round behavior change communication campaigns and testing using digital methods, and point-of-care treatment.

Prevalence, Trends, and Determinants of at Least Four Antenatal Visits in Malawi: Analyses of the Malawi Demographic and Health Surveys 1992–2016

This study aims to determine the prevalence, trends, and determinants of at least four antenatal visits in Malawi. The study used Demographic and Health Surveys from 1992 to 2016. The study population consisted of women who gave birth to at least one child within 60 months before the survey. Chi-square test and logistic regression analyses were used to establish the relationships between dependent and independent variables. The percentage of pregnant women who had at least four antenatal visits was 63.8% in 1992, 56.7% in 2000, 57.7% in 2004, 44.5% in 2010, and 50.6% in 2016. In 2016, the pregnant women less likely to have four or more antenatal visits were aged 15–19 years (OR = 0.51, 95% CI = 0.38–0.69), not using family planning (OR = 0.89, 95% CI = 0.80–0.98), not working (OR = 0.81, 95% CI = 0.76–0.88) and had no education (OR = 0.75, 95% CI = 0.65–0.87). Women residing in urban areas (OR = 1.28, 95% CI = 1.14–1.44), having 1–2 children ever born (OR = 1.30, 95% CI = 1.12–1.50), were more likely to have four or more antenatal visits. In 2010, women residing in the Northern Region (OR = 1.26, 95% CI = 1.05–1.52) were more likely to have four or more antenatal visits, whereas poor women (OR = 0.78, 95% CI = 0.69–0.88) were less likely. The study recommends that poor, uneducated, rural women with high parity should be encouraged to utilize antenatal care services through social and behavior change communication campaigns.

Are Participants in a Behavior Change Communication Campaign More Likely to Seek Care for Childhood Diarrhea? A Study of Caregivers of Children under 2 in Tanzania

Stunting remains a particular challenge in Sub-Saharan Africa. Despite encouraging declines in Tanzania over the past 25 years, one-third of Tanzanian children under the age of five years are stunted. Diarrhea remains one of the greatest causes of childhood stunting worldwide. Mass media has been used to improve the uptake of behaviors associated with reductions in diarrhea. This study evaluates the effectiveness of a mass media campaign in the Lake Zone region of Tanzania from 2015-2020 and positive changes in caregiver health-seeking behaviors related to diarrhea in children. Approximately 5000 households participated in a cross-sectional survey after a communications campaign. Exposure variables included hearing and seeing radio and TV spots and participating in a variety of interpersonal communication approaches. Study results indicated primary caregivers (mothers) exposed to media messages only (OR 1.66, CI 1.05 - 2.62), and to media messages and interpersonal communication (OR 2.51, CI 1.48 - 4.26), were more likely to seek advice or treatment for diarrhea from a health facility. Primary caregivers exposed to both media messages and interpersonal communication were more likely to give oral rehydration salts (OR 2.56, CI 1.72 - 3.79), zinc tablets/syrup (OR 1.74, CI 1.18 - 2.57), and homemade fluids (OR 2.02, CI 1.15 - 3.55) when their children had diarrhea. Male heads of household (fathers) exposure to mass media was not associated with care-seeking for diarrhea treatment.

A cross-sectional study on assessment of perceived threat to cervical cancer using health belief model among women in a slum area of Kolkata.

BACKGROUND:Despite the implementation of various cervical cancer preventive strategies by the Government of India, there is a scarcity of knowledge and consequent low utilization of cervical cancer screening services among women in India. This contributes to the burden of cervical cancer among Indian women. This study was conducted to assess perceived threat-regarding cervical cancer among women and to identify its explanatory factors in a slum area of Kolkata.MATERIALS AND METHODS:A cross-sectional study was conducted among 192 adult women from May to September 2019 in Kolkata. The multistage sampling technique was used using a structured schedule. Perceived threat to cervical cancer was measured using a composite score including perceived susceptibility and perceived severity constructs of the health belief model. Data were analyzed by descriptive statistics and multivariable logistic regression model using SPSS software version 16.RESULTS:Overall, 22.9% of the participants had satisfactory levels of perceived threat to cervical cancer. Statistically significant association was found between unsatisfactory levels of perceived threat with reproductive age group (adjusted odds ratio [AOR] = 3.01; P = 0.036), education level up to primary (AOR = 2.89; P = 0.026), and unsatisfactory knowledge (AOR = 2.94; P < 0.001) among respondents. The multivariable regression model was of good fit.CONCLUSION:The study population had very unsatisfactory levels of perceived threat to cervical cancer. Thus, to increase cervical cancer screening uptake among women, it is necessary to tailor robust behavior change communication campaigns to increase the perception of susceptibility and severity, thereby increasing the perception of threat of cervical cancer among women.

COVID-19 vaccine hesitancy among the adult population in Bangladesh: A nationwide cross-sectional survey.

Studies related to the COVID-19 vaccine hesitancy are scanty in Bangladesh, despite the growing necessity of understanding the population behavior related to vaccination. Thus, the present study was conducted to assess the prevalence of the COVID-19 vaccine hesitancy and its associated factors in Bangladesh to fill the knowledge gap. This study adopted a cross-sectional design to collect data from 1497 respondents using online (Google forms) and face-to-face interviews from eight administrative divisions of Bangladesh between 1-7 February 2021. We employed descriptive statistics and multiple logistic regression analysis. The prevalence of vaccine hesitancy was 46.2%. The Muslims (aOR = 1.80, p ≤ 0.01) and the respondents living in the city corporation areas (aOR = 2.14, p ≤0.001) had more hesitancy. There was significant variation in vaccine hesitancy by administrative divisions (geographic regions). Compared to the Sylhet division, the participants from Khulna (aOR = 1.31, p ≤0.001) had higher hesitancy. The vaccine hesitancy tended to decrease with increasing knowledge about the vaccine (aOR = 0.88, p≤0.001) and the vaccination process (aOR = 0.91, p ≤ 0.01). On the other hand, hesitancy increased with the increased negative attitudes towards the vaccine (aOR = 1.17, p≤0.001) and conspiracy beliefs towards the COVID-19 vaccine (aOR = 1.04, p≤0.01). The perceived benefits of COVID-19 vaccination (aOR = 0.85, p≤0.001) were negatively associated with hesitancy, while perceived barriers (aOR = 1.16, p ≤0.001) were positively associated. The participants were more hesitant to accept the vaccine from a specific country of origin (India, USA, Europe). Our findings warrant that a vigorous behavior change communication campaign should be designed and implemented to demystify negative public attitudes and conspiracy beliefs regarding the COVID-19 Vaccine in Bangladesh. The policymakers should also think about revisiting the policy of the online registration process to receive the COVID-19 vaccine, as online registration is a key structural barrier for many due to the persistent digital divide in the country. Finally, the government should consider the population's preference regarding vaccines' country of manufacture to reduce the COVID-19 vaccine hesitancy.

Attitude towards COVID 19 vaccines and vaccine hesitancy in urban and rural communities in Tamil Nadu, India \u2013 a community based survey

BackgroundEffective and safe COVID 19 vaccines have been approved for emergency use since the end of 2020 and countries are actively vaccinating their people. Nevertheless, hesitancy towards the vaccines exist globally.ObjectivesWe conducted this study to understand the attitudes towards COVID 19 vaccines and hesitancy to accept it among urban and rural communities in Tamil Nadu, India.MethodsWe conducted a community based cross sectional study in urban and rural communities among 564 persons who had not been vaccinated yet, selected through multistage random sampling. The vaccine attitude scale (VAX) was used to measure attitudes towards the vaccines and their acceptance of the vaccine was captured by responses to a direct question.ResultsMore than 50% of the respondents had positive attitudes towards the COVID 19 vaccines. Based on their attitudes, they were segmented into four clusters, first with preference for natural immunity compared to vaccines and low concern regarding adverse effects. Second with high level of trust in vaccines and low mistrust. The third cluster members had high level of concern regarding the adverse effects and low levels of mistrust in vaccines and the fourth had high trust in vaccines and low preference for natural immunity. Older individuals with higher education and occupation were more likely to belong to cluster four with high trust in the vaccines. Younger individuals, women, rural residents, belonging to low income labourer class were highly mistrusting of the vaccines. The prevalence of vaccine hesitancy was 40.7% (95% CI – 36.67 - 44.73%), while 19.5% (95% CI = 16.23 - 22.77%) of the respondents were vaccine deniers. While vaccine acceptance was greatest in cluster 1, it was least in cluster 3.ConclusionsVaccine hesitancy was high in urban and rural Tamil Nadu. The population could be effectively segmented into groups based on their attitudes and this understanding can be used to develop targeted behaviour change communication campaigns.

The role of ideation on the effect of an SBC intervention on consistent bed net use among caregivers of children under 5\u2009years in Nigeria: a multilevel mediation analysis

BackgroundMalaria remains a significant public health challenge in Nigeria. Consistent bed net use (sleeping under a treated net every night) has been identified as a key malaria prevention behavior. This paper explores the relationship between mass media social and behavior change interventions, psychosocial factors, and consistent bed net use.MethodsData is from the endline survey of a USAID-funded social and behavior change communication campaign conducted from 2012 to 2017 across five states in Nigeria. The outcome measure was consistent bed net use, and the mediator variable was a composite measure called ideation from a set of psychosocial factors believed to influence bed net use. The independent variable was recall of malaria specific media messages. Multilevel mediation analysis explored if recall of malaria specific media messages had any effect on bed net related ideation and if this ideation had any effect on consistent net use.ResultsRespondents included in this study were on average aged 31 years, mostly married or cohabiting (97.5%) and female 75%. Four in 10 (39.7%) respondents were able to recall malaria specific messages. Respondents with low, moderate and high recall were 23, 32 and 80% more likely to have a higher ideational score in the emotional domain compared to those not able to recall. Respondents were more likely to have higher ideational scores in the cognitive domain if they had low (AOR = 1.26, 95% CI 1.15–1.38), moderate (AOR = 1.16, 95% CI 1.00–1.34) or high recall (AOR = 1.55, 95% CI 1.16–2.06), respectively compared to those with no recall. Similarly, respondents with low (AOR = 1.03, 95% CI .99–1.08), moderate (AOR = 1.15, 95% CI 1.08–1.23) and high (AOR = 1.15, 95% CI 1.01–1.30) recall were more likely to have a higher ideational score in the social domain compared to those with no recall. After adjusting for recall of media messages and other potential covariates, all three ideational domains also had a significant positive effect on consistent bed net use. For every unit increase in ideational score, the likelihood of reporting consistent bed net use increased by 5 to 10%. There was a significant indirect effect of recalling malaria specific messages on consistent bed net use through each of the ideational domains.ConclusionAccess to a bed net is a critical first step in the process of bed net utilization. However, psychosocial factors e.g., emotional, cognitive, and social domains of ideation also play a major role in bed net use. Mass media SBC interventions could potentially influence bed net related ideation and consequently improve net use behavior. Future Social and behavior change interventions should employ approaches that improve these domains of ideation within their audiences in order to increase bed net utilization.

Knowledge, Attitudes, and Practices Regarding Coronavirus Disease Among Patients Visiting Eye Hospitals of Province Number 2, Nepal.

The present study aims to explore knowledge, attitudes, and practices regarding COVID-19 and level of satisfaction with efforts to halt the further spread of the disease among patients visiting eye hospitals in province number 2, Nepal. All eligible patients (n = 1112) presenting during the study period were interviewed using a validated semistructured questionnaire. The level of awareness was significantly associated with educational attainment and district of residence. Different myths and misconceptions regarding COVID-19 were prevalent. Preventive practices against the pandemic were observed by less than 50% of the participants and it varied significantly by education and the district of residence. Health education and behavior change communication (BCC) campaigns are necessary in the eye hospitals in province 2 to improve the knowledge level, address prevailing negative attitudes, and promote preventive measures against the COVID-19 pandemic. Studies in eye hospitals in other provinces in Nepal are required.

Socio-biological determinants of contraceptive practice in a district of West Bengal, India: An appraisal

Background:Contraceptive practice is said to be associated with socio-economic status, education &amp; many other factors prevailed in the areas. Population stabilization and reduction of population growth are the basic aims behind contraceptive practices. Objectives: To assess current status of contraceptive practice among eligible couples &amp; determine its social correlates. Material &amp; Methods: A community based cross- sectional study was carried out in Paschim Midnapur district of West Bengal in 2009. Multistage random sampling method was followed. Total 16 areas were selected for study purpose and from each area 125 married women were interviewed to cover 2000 eligible couples. Results: 67.4% contraceptive prevalence rate and 62.6% couple protection rate were observed in the study with a finding that contraceptive use directly proportional with literacy status and social class. The contribution of tubectomy was highest (61.9%) in couple protection. Area wise variation (46% to 76%) in couple protection rate also detected. Conclusion: Strengthening of Behavior change Communication Campaign needed for awareness generation in promotion of spacing methods.

Salt and Health: Public Awareness, Attitudes and Practices in Sri Lanka to Inform a Behavior Change Communication Campaign to Reduce Dietary Salt

Background: Sri Lankan citizens consume almost double the recommended daily amount of salt. Objective of this study was to assess the knowledge, attitudes and practices related to health effects of dietary salt among adults and adolescents in Sri Lanka to inform a national behavior change communication campaign. Methods: We conducted a descriptive household survey among adults (n=1016) and adolescents (n=505) in 10 districts. An, interviewer administered questionnaire was used for data collection. The approximate amount of dietary salt intake of the individuals was estimated based on household purchases. Findings: The recommended salt limit was identified by 40% of the population. Majority, adults (90.8%) and adolescents (86.1%) knew the adverse health effects of high salt intake. Although household monthly purchase of salt indicated consumption is much higher than recommended, 48.3% of adults and 45.9% of adolescents believed that they consume ’just the right’ amount. Discretionary salt added to home cooking was a major contributor to intake, with approximately half (50%) adding salt when cooking rice, the staple. For health-related information most preferred (adults - 72%, adolescents – 69%) media is television. Interpretation: The study identified gaps as well strengths in knowledge, attitudes and practices of Sri Lankans related to salt and health and recommends that the communication campaign include specific messaging to address gaps and leveraging on strengths. The survey identified adult females to be a key target group for the campaign and television is recommended as the mode of delivery.

Health Belief Model of Persistent Dengue Transmission in Klaten, Indonesia.

Objectives: In this study, we aimed to assess health beliefs, barriers, and motivations of individuals that will be useful in formulating the appropriate social and behavior change communication (SBCC) campaigns regarding dengue vector control. Methods: We conducted this qualitative study among adult residents of Gergunung and Kajen villages in Klaten, Indonesia. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) using interview an interview guide. We had audio-recorded interviews transcribed and coded. The analysis focused on general perspectives and practices of behaviors in the attempt of vector control. Results: We recruited 188 participants from 2 villages for the study. Our study revealed knowledge deficits among the villagers. Barriers include incorrect perceptions on disease severity, perceived mosquito breeding places, improper practice on mosquito source reduction, and perceived toxicity of the insecticides. Households tend to weigh the benefits of performing vector control versus perceived benefits. Conclusions: By using the Health Belief Model, a future SBCC campaign should address changing beliefs that DHF is a serious disease, increasing knowledge about mos- quito source reduction and insecticide use, and promoting benefits of performing dengue vector control.

A cross-sectional study on prevalence and determinants of anemia among women of reproductive age in a rural community of West Bengal.

Context:Anemia is a serious public health concern especially in women of reproductive age (WRA) as it causes a high burden of morbidity and mortality and persists through intergenerational cycle. As most of the risk factors are preventable, a thorough understanding of its risk factors is necessary to design better interventions.Aims:Current study aimed to estimate the burden of anemia as well as explore determinants of various grades of anemia among WRA in a rural area.Settings and Design:A community-based cross-sectional study was conducted among non-pregnant, non-lactating women of reproductive age in rural field practice area of All India Institute of Hygiene and Public Health.Methods and Materials:House to house visit was conducted for interviewing with pre-designed pre-tested questionnaire along with blood hemoglobin and anthropometric measurement.Statistical Analysis Used:Descriptive statistics and test of significance like multinomial logistic regression and Kruskal-Wallis test (with post-hoc) were used.Results:Majority (70.8%) of participants were anemic. Proportion of mild, moderate, and severe anemia were 24.16%, 37.5%, and 9.16%, respectively. Different levels of anemia were significantly associated with higher age, lower education, poor iron-rich food intake, lack of dietary diversity, and adiposity. Significantly low hemoglobin level in both underweight and obesity was noticed suggesting U shaped relationship between BMI and anemia.Conclusion:Periodic screening for anemia among WRA especially in both extremes of malnutrition, i.e., undernutrition and obesity should be considered at the policy level. Year-round behaviour change communication campaigns must be carried out for the promotion of necessary food groups in diet.

Knowledge and Practices regarding commonly occurring mosquito borne diseases among people of urban and rural areas of Rajkot District, Gujarat

Background: People’s knowledge and awareness towards the disease can help in the formation of the design of Behaviour Change Communication campaigns to influence acceptance and use of any control measures. Aims: To study the knowledge and practices regarding commonly occurring mosquito borne diseases among people of urban and rural areas of Rajkot District. Material and Methods: Multistage sampling method was used. Total 432 households, 216 each from urban and rural areas, were studied. Selection of areas was based on Annual Parasite Incidence. Six areas from urban and six talukas form rural areas were studied. Data were collected using a pretested semi structured questionnaire during the high transmission season (July 2011 to October 2011) of mosquito borne diseases. Data were entered in Microsoft Excel and analysis was done using Epi Info 6. Results: 87.96%respondents knew that mosquito transmits malaria.75.93% respondents did not know how dengue is transmitted. Fever (95.60%) and chills (71.06%) were the most common malaria symptoms told by respondents. 85.65%respondents were not knowing about dengue symptoms. 48.84% told joint pain as chikunguniya symptom. 90.05% respondents associated water collection to mosquito breeding place. 90.51% respondents knew that mosquito borne diseases can be prevented by using personal protective measures. 23.84% of the respondents did not use anything for prevention against mosquito bites. Conclusion: Knowledge regarding malaria was found satisfactory but knowledge regarding other mosquito borne diseases was unsatisfactory. Knowledge regarding prevention of mosquito borne disease was good and majority of the households were using preventive measures against mosquito bites.

Assessment of menstrual hygiene among adolescent girls of East Delhi: A community-based cross-sectional research from an urban resettlement colony

Introduction: Even though menstruation is a normal physiological process, menstrual hygiene is a most neglected issue with many myths and social stigmas being associated with it. Due to unhygienic menstrual practices, young girls are vulnerable to reproductive tract infections and pelvic inflammatory diseases and other complications. Therefore, the objective of this study was to assess the knowledge, attitude, and practices of menstrual hygiene among adolescent girls. Material and Methods: This is a descriptive cross-sectional study conducted in an urban resettlement colony of Kalyanpuri, East Delhi. One hundred and five adolescent girls participated in the study. The mean age of the participants was 14.18 ± 2.13 years. Predesigned and pretested semi-structured questionnaire was used. Institutional Ethical clearance was obtained. Results: In this study, out of 105 girls, only 35.2% girls had knowledge about menstruation before they experienced menarche. Only 56.2% girls were aware that menstruation is a normal physiological process. Overall knowledge level about menstrual hygiene was unsatisfactory. Only 31.4% of girls were using sanitary pads during menstruation, 59.25% of the respondents had good practices. About 12.4% girls had positive attitude toward menstrual hygiene. Conclusion: Although practices on menstrual hygiene management among adolescents were fairly satisfactory, knowledge and attitude still need to improve. Findings indicate the need of behavior change communication campaigns along with frequent reinforcement of school health education programs.

Designing messages for fluorosis mitigation behavior change: Role of message framing and perceived risk

This article describes the research to develop message for fluorosis behavior change communication campaign. Using a posttest only with control experiment the study investigates the impact of perceived risk associated with advocated behavior (RISK-AB) and perceived risk associated with existing behavior (RISK-EB) on the effectiveness of framed fluorosis messages. Findings suggest that positive-frame is more appropriate when RISK-AB is high and RISK-EB is low or RISK-AB is low and RISK-EB is high or both RISK-AB and RISK-EB are low. And negative-frame is more persuasive when both RISK-AB and RISK-EB are high. Marketing implications are discussed.

Determinants of choice of skilled antenatal care service providers in Ghana: analysis of demographic and health survey

BackgroundThe International Safe Motherhood initiative provides a focus for programmes and research to improve maternal health in low – income countries. Antenatal care is one of the key pillars of the initiative. This study sought to examine the association between background characteristics and choice of skilled providers of antenatal care services in Ghana.MethodsThe study used data from the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to analyse the data.ResultsResults show that the proportion of women who received antenatal care (ANC) services from skilled providers improved over the period. Also, women with secondary education (OR = 1.42, CI = 1.07–1.88), richest wealth status (OR = 5.10, CI = 2.28–11.85) were more likely to utilise antenatal care services from skilled providers. Whereas women from rural areas (OR = 0.55, CI = 0.41–0.74), with four births or more (OR = 0.55, CI = 0.36–0.85) and from the northern ethnic group were less likely to utilise antenatal care services from skilled providers.ConclusionChoice of skilled providers of antenatal care services were predicted by some predisposing factors including education, ethnicity, and ecological zone. Also enabling factors such as wealth status, residence and the need for care factor, parity predicted choice of skilled providers of antenatal care services. Women with secondary or higher education, those within richer and richest wealth status, those from forest zone are more likely to utilise the services of skilled providers during their antenatal care visits. Whereas women from rural areas, those with four births or more and those with the northern ethnic group were more likely to utilise ANC service from unskilled providers. The Ghana Health Service and Ministry of Health should encourage women in rural areas to utilise antenatal care services from skilled providers through social and behaviour change communication campaigns.

Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo.

Unmet need for family planning in the conflict-affected area of eastern Democratic Republic of the Congo (DRC) has been reported to be as high as 38%, and women in such conflict settings are often the most at risk for maternal mortality. The International Rescue Committee implements the Family Planning and Post-Abortion Care in Emergencies program in 3 provinces of eastern DRC to provide women and couples access to family planning, including long-acting reversible contraceptives (LARCs). This article presents routine program data from June 2011 through December 2013 from 2 health zones as well as results from a qualitative assessment of family planning clients and of male and female non-users, conducted in 2013. It then describes how these findings were used to make program adjustments to improve access to family planning services and client informed choice and assesses the effects of the program design changes on family planning uptake and method mix using routine program data from January 2014 through December 2016. Between 2011 and 2013, 8,985 clients adopted family planning, with an average 14 clients adopting a method per facility, per month. The method mix remained stable during this period, with implants dominating at 48%. Barriers to uptake identified from the qualitative research were both supply- and demand-related, including misconceptions about certain modern contraceptive methods on the part of providers, users, and other community members. The program implemented several program changes based on the assessment findings, including clinical coaching and supportive supervision to improve provider skills and attitudes, introduction of immediate postpartum insertion of the intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS), and behavior change communication campaigns to raise awareness about family planning. After these program changes, the mean number of clients adopting modern family planning per facility, per month increased from 14 to 37 and the percentage of family planning adopters choosing LARCs increased from 50% to 66%. While implants continued to be the most dominant method, reaching 60% of the method mix in 2016, the percentage of clients adopting IUDs increased each year, from 3% in 2014 to 13% in 2016. In total, 39,399 clients started family planning methods during the post-program design change period (2014-2016). Our experience in eastern DRC demonstrates that women and their partners affected by conflict want family planning, and that it is feasible to deliver the full range of modern contraceptive methods when programs are adapted and sensitive to the local context.