Behaviour Change Communication Strategies Research Articles

A Scoping Review of Existing Policy Instruments to Tackle Overweight and Obesity in India: Recommendations for a Social and Behaviour Change Communication Strategy

Background The Indian government is committed to address various manifestations of malnutrition, including overweight and obesity, inorder to improve individual health and well-being. The scoping review aims to map existing national policy instruments (programmes, schemes, regulations and guidelines) addressing overweight and obesity in India and analysing them for Social and Behaviour Change Communication (SBCC) strategies. Methods Systematic identification and selection of policy instruments using ‘Arksey and O’Malley’ framework was conducted from central government ministry websites, between March and June 2023. These instruments focused on nutrition and/or physical activity, targeting specific demographic groups like pregnant women, lactating mothers, children (0-5 years and 5-9 years), or adolescents (10-19 years); excluding those focusing on specific diseases like micronutrient deficiencies, wasting, and stunting. Based on search strategy six policy instruments were included and analysed for SBCC strategies. Results While many policy instruments incorporated SBCC plans; the ‘National Programme for Prevention of Non-Communicable Diseases (NP-NCD)’ stands out as a significant policy initiative specifically targeting the prevention of overweight and obesity within the broader context of Non-Communicable Diseases. It adopts a comprehensive approach addressing key drivers contributing to overweight/obesity across multiple levels of behavioural influence i.e., individual, interpersonal, community and organisation for health promotion. However, there’s need to strengthen SBCC strategies related to prevention and management of obesity, especially screening and counselling, to cover all age groups with a particular focus on adolescents and youth. SBCC strategies can also be incorporated into India’s Integrated Nutrition Support Programme (POSHAN 2.0) and/or Reproductive, Maternal, New-born, Child, Adolescent Health and Nutrition (RMNCAH+N) under the National Health Mission. Conclusion This paper underscores the necessity for comprehensive strategies to address multifaceted origin of overweight and obesity. The NP-NCD stands out as a noteworthy initiative, and there is considerable potential for other programmes to emulate it SBCC strategies to bolster their overall effectiveness. Note : *Policy instrument’s throughout the paper has been used to cover programmes, schemes, regulations and guidelines.

‘Counselling is not just providing information’: perceptions of caregivers and stakeholders on the design of nutrition and health counselling interventions for families with young children in rural Kenya

BackgroundGlobally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs.ObjectiveFor the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling.DesignWe employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo.SettingHealth and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya.ParticipantsWe interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya.ResultsNutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers.ConclusionThere is a disconnect between the caregivers’ preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.

Exploring health care providers’ engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study

BackgroundEngagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional’s engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis.PurposeThe purpose of this study was to explore the level of health care providers’ engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia.MethodsDescriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba’s parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity.ResultsTotal of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients’ causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis.ConclusionThe study explored five emergent themes: patient’s underlying causes, seeking support, perceived susceptibility, professionals’ incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.

IJCM_143A: Dietary changes during pregnancy: exploring the influencing factors as perceived by antenatal women and health care providers - a mixed methods study from a rural area in Dakshina Kannada district.

Background: Maternal nutrition impacts maternal-child health. Antenatal diet affects well-being and anaemia-related maternal mortality. Objectives: The objectives are to assess the dietary changes made by antenatal women, its association with socio demographic and clinical variables and to explore the factors influencing the dietary changes as perceived by the antenatal women and health care providers (Medical officer, ANMs and ASHA) Methodology: A mixed method study was conducted. The study involved interviewing antenatal women registered between October2020 to October 2021 in Kurnad PHC area and those who have completed their second trimester and in-depth interview of antenatal women and the health care providers (Medical officer, ANMs and ASHA) of Kurnad PHC in 2021 and two quarters of 2022. Results: Most participants were aged 26-30 (43.1%), mean age 27.41±4.838 years. 47.3% had high school education, 75.5% were unemployed, and 17.8% were self-employed. 77% were below the poverty line, 55.4% belonged to joint families, and 39.3% to nuclear families. 42% lived with husband’s family, 22% with maternal family. Co-morbidities were in 36%, anaemia in 87%, gestational diabetes in 51.85%, pregnancy-induced hypertension in 42.95%. Reasons were health improvement, healthy child, co-morbidities, and gastritis. Statistical significance existed between pregnancy dietary changes and socio- demographics, clinical variables. Factors influencing changes were health promotion, advice from family and providers, co-morbidity management, cravings, affordability, community-based services. Conclusion: Dietary changes were seen in more than half of the antenatal women. Behaviour change communication strategies and adequate support for decision making and availing nutritious food will facilitate appropriate dietary changes during pregnancy.

IJCM_351A: A study on Internet use and its association with psychopathology of Sleep among: students at a Government Medical college in Koppal, Karnataka

Background: Internet addiction has become a very common disorder because of which youngsters are wasting a lot of time, becoming irritable and depressed and having poor academic/ work performance and are becoming victims of social isolation. College students have easy access to internet and so there is high chance of higher prevalence of Internet addiction among them. By studying the association of internet usage and its impact on sleep we can set boundaries for early warning signs of underlying psychopathology at the earliest. Objective: The Objectives of the study were: 1) To estimate the prevalence of Internet addiction among medical students in the study setting, 2) To estimate the prevalence of psychopathology in sleep pattern among medical students in the study setting, and 3) To determine the impact of Internet addiction on psychopathology in sleep pattern among them. Methodology: : A cross sectional study was conducted among medical students at a Government Medical college, Koppal, Karnataka for a duration of 3 months from June 2023 to August 2023. Data collection was done using a pretested and semi structured questionnaire (shared through Google form) consisting of questionnaires of Internet addiction test (IAT) to assess Internet use and Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep among them along with socio demographic and other relevant details. Statistical analysis was done using WHO Epi info software version 3.5.4. Results: The prevalence of Internet addiction among medical students was 286 (57.2%) and was found to be mild, moderate and severe in 214 (42.8%), 68 (13.6%) and 4 (0.8%) of students respectively. Quality of sleep was disturbed in 270 (54%) of students according to PSQI. The study found significant association between Internet addiction among medical students and quality of sleep among them Conclusion: Need for Behavior change communication strategies to reduce unnecessary use of Internet.

PREVALENCE OF NON-COMMUNICABLE DISEASE RISK FACTOR AMONG THE ADULT POPULATION OF BHARATPUR METROPOLITAN CITY, CHITWAN, NEPAL

Background: Non-communicable diseases (NCDs) are the leading causes of disease burden worldwide. The data from Nepal indicated 6% increase in the deaths caused by non-communicable diseases from 2014 to 2018. The nationwide STEPS survey of non-communicable disease risk factor, 2019 showed high prevalence of risk factors, posing a greater threat for the NCD epidemic in future in the country. Thus, this study aims to find out the prevalence of non-communicable disease risk factors among the adult population of Bharatpur Metropolitan City in Chitwan, Nepal. Methods: A descriptive, community-based cross-sectional study was conducted among 310 respondents residing in Bharatpur Metropolitan. Four wards were selected purposively and convenient sampling was used to select the sample. A semi-structured questionnaire based on WHO NCD STEPS instrument adapted to the local context, was used to collect the data. A descriptive analysis was carried out to analyze the data. Results: The prevalence of current smoking, alcohol consumption, low intake of vegetables and fruits, raised salt intake and low physical activity was found to be 18.1%, 38.7%, 94.6%, 80% and 66.5% respectively. Regarding metabolic risk factors, the prevalence of ever-raised blood pressure, blood sugar and cholesterol was 50%, 28.4% and 17.4% respectively. Conclusions: The study revealed a high prevalence of behavioral and metabolic risk factor which varied in the age group of 40-60 years. The findings call for population specific policy and interventions and focused actions for the behavior modification through primary prevention module and behavior change communication strategy.

Utilization of HIV Pre-exposure Prophylaxis and Associated Factors Among Female Sex Workers in Bahir Dar City, North-West Ethiopia, Cross-sectional Study, 2022.

This study aimed to assess the utilization of HIV pre-exposure prophylaxis and associated factors among commercial female sex workers in Bahir Dar City, Northwest Ethiopia, in 2022. An institution-based cross-sectional study was conducted in Bahir Dar City from November 1 to 30, 2022. The random sampling technique was used to select 396 commercial female sex workers. Kobo Collector was used to gather the data, which was then exported to STATA 14 for analysis. In bivariate regression analysis, all variables with a P-value of <0.2 were entered into multivariable logistic regression. Multivariable logistic regression variables with P-values ≤0.05 at a 95% confidence interval were declared to be significantly linked with the utilization of HIV pre-exposure prophylaxis. In this study, 183 (46.2%) (95%CI: 41.33-51.16) of respondents utilized HIV pre-exposure prophylaxis. Educational status: secondary and above (AOR: 2.18, 95%CI: 1.05-4.53). Age of sex workers 26-36 (AOR: 0.20, 95%CI: 0.17-0.84); experience of sex work 3-5 years (AOR: 0.25, 95%CI: 0.24-0.83); and having good knowledge (AOR: 4.98, 95%CI: 3.90-10.65) were significantly associated with the utilization of HIV pre-exposure prophylaxis. In this study, HIV pre-exposure prophylaxis was not widely used by commercial female sex workers. Therefore, social and behavioral change communication strategies focus on creating awareness and building knowledge on HIV pre-exposure prophylaxis utilization.

Public Health Behavior Change Communication Strategies in Accelerating the Reduction of Stunting in North Minahasa Regency

Communication Strategy for Community Health Behavior Change in Accelerating Stunting Reduction in North Minahasa Regency, through aspects (1) Announcing: socialization and counseling to pregnant women and parents who have children under 5 years old through lectures, presentations and questions and answers. (2) Motivating: Pay attention to nutritional intake, Conduct regular health checks for pregnant women and toddlers, Overcome the problem of children having difficulty eating by providing variants in food, Maintain environmental sanitation, provide education to pregnant and lactating women in the "Hope of the Lover of the Heart" program, Carry out complete vaccination of babies born as recommended. (3) Educating: Education on proper and nutritious eating patterns with the "Fill the Plate" program in a Canteen. Parenting education Education risks the threat of infectious diseases if not using sanitation and clean water. (4) Information Dissemination (Informing): Directly by means of socialization with verbal communication, also using paflet media, posters and videos. (5) Supporting decision making: Supported by the PPKB Office, Health Office, Social Service, PMD, Food Office, Disdukcapil, Private Sector, TP-PKK, TNI. Communication Strategy for Public Health Behavior Change in Accelerating Stunting Reduction contributes to increasing public knowledge and sustainable social strengthening through efforts to accelerate stunting reduction.

Communication for Social and Behaviour Change: A Case Study of Puppetry Animation in Kenya.

The COVID-19 pandemic has claimed over six million lives worldwide (Ritchie, 2022). In Kenya, more than three hundred thousand lives have been lost (Ministry of Health, 2022). Prevention has been the main focus. This has necessitated behaviour change. The government, non-governmental organisations, and private agencies set out to find Social and Behaviour Change Communication (SBCC) strategies at the start of the pandemic. Different strategies received different types of feedback. One strategy that has been proven time and time again to be effective in mass communication and education while entertaining is puppetry. It was, however, only partially utilised. This research sought to explore communication for social and behaviour change communication and how it was applied to curb the spread of COVID 19 using a case study of puppetry in Kenya. It attempted to answer the following questions: What types of puppets were used in Kenya for social and behaviour change communication? Which advocacy messages were communicated for social and behaviour change using puppetry? How was puppetry used for social mobilisation for social and behaviour change communication? What factors hindered puppetry's use for social and behaviour change communication? The theoretical base of this research was informed by the health belief model, which provides a framework for designing messaging that targets perceived barriers, benefits, self-efficacy, and threats; the social learning theory, which explains how behaviour is learned through observation; and the social marketing theory, which provides a framework for how behaviour change messages are designed using marketing principles. This study used a qualitative research design. It analysed past studies to give a framework and then used interviews and observation to collect current data by observation and key informant interviews for thematic analysis. The population chosen for this study was all the puppet shows created, digitally recorded, and aired for SBCC to communicate behaviour change as a prevention measure against COVID-19. For this research, the Dr Pamoja show was purposely chosen as the sample as it met all the criteria for this study. Coding was used for thematic analysis of the collected puppetry video samples from the Dr Pamoja show produced by Project hand up to communicate SBCC against COVID-19. The codes were derived using the deductive approach, and the show analysed both the latent and the semantic. The gaps in the data were informed by Key informants, including the Dr Pamoja show’s director, an AMREF representative, sixteen (16) puppeteers, a community leader, a health representative, and ten (10) parents. After collecting and analysing the data, findings showed that the main types of puppets used are glove puppets, and puppetry remains an effective tool for social and behavioural change communication in Kenya. It was found to be efficient in communicating advocacy messages through influence, persuasion, and social marketing, and also in social mobilisation at both the community level and national level by promoting health messaging that is personalised, normative, and identity-relevant and relies on people’s connections and sense of accountability. The data also showed that episodes translated to Kiswahili and Kikuyu were more popular than the other languages. It is, however, faced with social challenges such as perception, motivation, cultural, psychological, and production challenges such as financing. The study recommends better utilisation of puppetry for SBCC and incorporation of puppetry in communication by the government, non-governmental organisations, and mainstream media. It further recommends that further research be conducted on memory retention of new behaviours learned from puppetry, gender issues in puppetry, and the use of puppetry in other areas such as therapy, play, and education.

Intention to Donate Kidney and Associated Factors Among Students in Bahir Dar University: Application of Theory of Planned Behavior.

Kidney donation is the donation of a kidney from a living or dead person to another living person who requires transplantation. The scarcity of kidneys is a great public health concern worldwide, owing to an increase in end-stage renal failure. There is no sufficient evidence regarding the intention to donate kidneys in Ethiopia. To assess the intention to donate kidneys and its associated factors among Bahir Dar University students in Ethiopia in 2023 by the application of theory of planned behavior. This institution-based cross-sectional study was conducted from March 7 to April 5, 2023. A multistage sampling technique was used to select 630 participants. Self-administered structured questionnaires were used to collect data. Data were entered into Epi-data version 4.6, and exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Bivariate and multivariate linear regression analyses were performed. Findings with a p-value <0.05 at the 95% confidence interval were considered statistically significant and interpreted by the unstandardized beta (ß) coefficient. The mean score of intention to donate the kidney was 12.9 ± 4.1 standard deviation. Direct attitude (B = 0.341, 95% CI = 0.265, 0.416), direct subjective norm (B = 0.088, 95% CI = 0.010, 0.167), direct perceived behavioral control (B = 0.353, 95% CI 0.251, 0.455), knowledge (B = 0.417, 95% CI 0.251, 0.583), and previous experience of blood donation (B = 0.915, 95% CI 0.321, 1.510) were factors associated with intention to kidney donation. The mean score of intention to donate kidneys was 12.9 ± 4.1 SD. Direct attitude, direct subjective norm, direct perceived behavioral control, experience with blood donation, and knowledge of participants were significant factors for the intention to donate kidneys. Therefore, social and behavioral change communication strategies should address these factors in order to increase kidney donation.

Conducting formative research during a pandemic threat to inform the development of an obesity prevention social and behaviour change communication strategy in Tonga.

The global epidemic of obesity is overtaking many parts of the world with the Pacific Islands at particular risk. Tonga population surveys identify significant increases in overweight and obesity with Social and Behaviour Change Communication (SBCC) offering opportunities for curbing the rise in non-communicable diseases. Formative research was conducted during the Covid-19 pandemic to assess stakeholder and program beneficiary needs and wants toward an obesity prevention SBCC strategy in Tonga. Semi-structured interviews with 17 key informants and 18 focus group discussions (N = 168) were conducted in Tongatapu. Data analysis was conducted on Nvivo 2020 qualitative software with desk research of secondary data supporting in-field findings. Potential barriers to behavioural compliance included social/cultural norms, poor attitudes; low motivation and capability; and vulnerabilities of gender and other social determinants. Opportunities included the Tongan collective mindset and the desire for greater social interaction and fun. Strong political will to affect change was apparent with the need to consider targeting to youth, social mobilisation of communities through empowering messaging, and an integrated range of activities. Co-design in the formative research process was able to be fostered via online communication processes to overcome the challenges of Covid-19 travel restrictions. The innovative approach provided a number of learnings including identification of national and regional priorities and improved efficiencies in SBCC planning, implementation and evaluation. SO WHAT?: Formative research adopting co-design approaches with stakeholders and program beneficiaries can provide optimal engagement and ownership in the SBCC strategy including insights into messaging approaches.

Intake of ultra-processed food, dietary diversity and the risk of nutritional inadequacy among adults in India.

This study assessed diet diversity and consumption of ultra-processed foods and explored its impact on macronutrient intake and risk of micronutrient inadequacy. Cross-sectional, non-probability snowball sampling. Nutrient intake was assessed using 24-h dietary recall method and diet diversity through FAO-diet diversity score (DDS). Mann-Whitney U test was used to assess differences in risk of inadequacy across gender. Spearman's rank correlation assessed associations between energy contributed by ultra-processed food and risk of nutrient inadequacy. A total of 589 adults (20-40 years) belonging to upper-middle and high-income groups. The average individual DDS was 4·4 ± 0·6. Most of the participants (>80 %) had intakes less than national recommendations of pulses/eggs/flesh foods, milk/milk products, fruits, vegetables and nuts. Ultra-processed foods contributed to 17 % of total energy intake, 12 % of protein, 17 % of carbohydrate, 29 % of added sugar, 20 % of total fat and 33 % of Na intake. The average risk of nutrient inadequacies for Zn (98 % v. 75 %), folate (67 % v. 22 %) and niacin (83 % v. 44 %) was higher among males than females (P < 0·001). The average risk of nutrient inadequacies for Fe (58 % v. 7 %), vitamin B6 (95 % v. 90 %) and vitamin A (68 % v. 44 %) was higher among females than males (P < 0·001). There was a positive correlation between energy contributed by ultra-processed food and risk of niacin (ρ = 0·136, P = 0·001) and folate (ρ = 0·089, P = 0·049) inadequacy. Reformulating ultra-processed food to reduce fat, sugar and salt and increase micronutrients and behaviour change communication strategies that promote dietary diversity will improve micronutrient adequacy and diet quality.

The quality of Indian diets: A comparison of two indices to predict risk of dietary inadequacies linked to non-communicable diseases

Nutritional inadequacies lead to various health problems among Indians. Improvements in diets can be addressed when different aspects of diet quality are known. The primary objective of the study was to assess diet quality of Indian adults belonging to the high-income group. The study also wanted to compare the suitability of two diet quality indices for use in the Indian scenario. A cross sectional study design with non-probability purposive sampling was used to collect data from 589 adults (20-40 years) in Delhi, India. Nutrient intake was assessed using the 24- hour dietary recall method. Two internationally recognized diet quality indices - Diet Quality Index- International Score (DQI-I) and the Global Diet Quality Score (GDQS) were selected to measure diet quality. 78% of the participants had poor diet quality using the DQI-I; the average score was 56.4 ± 5.6. The average DQI-I component scores for variety, adequacy, moderation and overall balance were 13.1±2.6, 27.5±2.2, 15.3±2.9, 0.43±0.9 respectively. Females were more likely (OR=2.07, 95% C.I.: 1.26 – 3.401) to have DQI-I scores in the lowest quartile (p=0.04). 88% had a moderate risk of nutritional inadequacy while 11% were at a high risk of nutritional inadequacy on the basis of their GDQS scores, the average of which was 16.9±2.1. There was a positive association between GDQS and DQI- I scores (ρ =0.316, p&lt;0.001). The GDQS is better for assessing nutrient adequacy with healthy and unhealthy food consumption being compared. On the other hand, DQI-I gives a composite score combining the nutrient and food group intake and observes variety, adequacy, moderation and overall balance. Behaviour change communication strategies that encourage healthier food selection and promote dietary diversity may help improve nutritional quality of diets in Indian populations such as this one.

The impact and implementation of an mHealth intervention to improve infant and young child feeding in Senegal: IIMAANJE protocol for a cluster randomized control trial.

Behavior change communication (BCC) strategies have the potential to improve infant feeding and nutrition outcomes among infants and young children in low- and middle-income countries. More recently, there has been a shift toward the adoption of mHealth interventions-the use of mobile phones to transmit health-related information or direct care-to promote recommended BCC strategies among the caregivers of infants and young children. In Senegal, most infants and young children are not fed according to recommended practices leading to a high prevalence of undernutrition and micronutrient deficiencies. The aims of this cluster randomized control trial, using an effectiveness-implementation (type 1) hybrid design, were to: (1) determine the impact of an mHealth IYCF intervention on IYCF practices and nutrition outcomes; and (2) examine the implementation, costs, and opportunities for scaling up the mHealth messaging intervention. The trial was conducted in three regions in Senegal (Thies, Fatick, Diourbel) with 488 mother, father and children (6-23 months) triads. The intervention included 8 scripted messages, that underwent cognitive testing prior to the intervention implementation, and 8 unscripted messages from positive deviants. One voice message and one text message were sent each week to members of our experimental group for a 16-week period. The impact of the intervention was assessed through a household survey, 24-h dietary recall, and hemoglobin measurements before and after the intervention implementation. The primary outcomes were minimal acceptable diet (MAD) and anemia. We also included a total of 54 participants in nine focus groups held with mothers and fathers and semi-structured interviews with Badienou Gox (i.e., community health workers) (n = 6) and national partners and program implementers (n = 6) to examine the intervention implementation process. The study was registered prior to data collection on Clinicaltrials.gov (Identifier: NCT05374837).

Quality diets for better health: Integrated orange‐fleshed sweetpotato intervention improved dietary practice in southern Ethiopia

AbstractPoor diet quality for women and children under 2 years of age is the major public health problem in developing countries claiming lives of millions of children and mothers. Nutrition‐sensitive, climate smart orange‐fleshed sweetpotato (OFSP) [Ipomoea batatas (L.) Lam] intervention has been proved to be an effective approach to ensure enhanced diet quality and reduce the health burden faced by women and children. The objective of this study is to contribute to evidence generation effort by assessing the effectiveness of the introduction of vitamin A‐rich, OFSP cultivars alongside social and behavior change communication strategy and agronomic practice in improving diet quality. Cluster‐randomized control trial design was implemented on cross‐sectional data collected from project beneficiary and control households in 2017 (n = 1451) and 2019 (n = 2065). Quasi‐experimental double difference analysis is used to measure the impact of the intervention on key nutrition outcome indicators. Nutrition‐sensitive climate smart agriculture focused on OFSP cultivars with integrated nutrition behavioral change social communication and agronomic training presented significant potential to improved food security, dietary diversity, and frequency of vitamin A food‐rich intake among the rural population of southern Ethiopia. Thus, it is concluded that enhanced investment in nutrition dense agricultural commodities such as orange fleshed‐sweetpotatoes with appropriate training on both nutrition and agronomic can be effective and cheaper means to address the diet quality problem.

Key Lessons From a Systematic Behavior Change Communication Process Used in a Pneumonia Prevention Program in Five African Countries.

A systematic behavior change communication (BCC) process was designed to enable local partners to effectively conduct formative research and develop a comprehensive BCC strategy, as part of a pneumonia prevention and control program implemented from 2017 to 2021 by the Red Cross Red Crescent in Ethiopia, Ivory Coast, Mali, Sudan, and Zambia. Qualitative content analysis was used to identify, categorize, and summarize key results, lessons, and recommendations related to the BCC process from country evaluation data. Key elements to success of a locally implemented BCC process include: (1) through simple formative research, understanding household decision-making dynamics for timely health seeking and coexistence of modern and traditional medicine; (2) explicitly analyze motivators for uptake of protective behaviors, with strong and deliberate community participation to validate and tailor BCC messages and channels; (3) ensuring that the challenges to access basic services, such as water and sanitation facilities, are adequately addressed as critical enabling factors for behavior change. Other implications include a need for innovative solutions to physical and economic barriers in areas where large distances, lack of transportation, or cost hinder caregivers seeking care for sick children. Community health programs that apply a BCC process through local partners can be effective in achieving behavioral outcomes. Participatory planning and involvement of the community in iterative rounds of validation improved the relevance, appropriateness, and impact. Further research is needed to determine the effectiveness of different communication methods and sustained impact on health outcomes.

Nutritional Quality of Diets of Adults (20-40 Years) in Delhi, India

Rise in prevalence of diet related non communicable diseases can be prevented by following balanced and healthy diets. The study aimed to assess adequacy of nutrient and food group intakes along with frequency of consumption of foods High in Fat, Sugar and Salt (HFSS). The study was a cross-sectional study with non-probability purposive sampling method. A total of 589 adults (20-40 years) were selected from housing colonies from four geographical zones of city. Dietary intake was assessed using 24-hour dietary recall method. Frequency and amount of foods consumed was recorded using a semi quantitative Food Frequency Questionnaire (FFQ). The differences in food groups and nutrient intakes across socio-demographic groups were assessed using Independent sample t-test and Mann-Whitney U test. Statistical significance was assumed at 5% level (p&lt;0.05). Most participants had nutrient intakes lower than the EAR for calcium (97%), zinc (98%), riboflavin (100%), niacin (68%), vitamin B6 (96%) and vitamin A (60%). All participants had lower intakes of pulses, green leafy vegetables, other vegetables, fruits, milk and milk products, oilseed and nuts when compared to the recommended intakes. HFSS foods-sweet plain biscuits (46%), fried namkeen (37%), roasted namkeen (30%), non-carbonated drinks (29%) and deep-fried foods (25%) were eaten regularly by more than one fourth of participants. Participants occasionally consumed pizzas (60%), chat (54%), dosa (50%) and burgers (48%). Therefore, reducing the share of foods high in fat, sugar and salt and enabling healthier selection of food groups through behaviour change communication strategies will ensure adequate nutrient intakes.

Effects of Behaviour Change Communication on Knowledge and Prevention of Malaria Among Women in Ghana.

Behaviour change communication (BCC) remains a central component of the interventions used in the fight against malaria in Ghana. However, there is limited evidence of its effectiveness. This study evaluated the effects of BCC strategies on knowledge (symptoms, causes and prevention) and overall knowledge of malaria among Ghanaian women aged 15-49years. The propensity score matching (PSM) approach and logistic regression were used to analyse data from the 2016 edition of the Malaria Indicator Survey (MIS). Women who participated in community-level education or heard/saw media messages on malaria, or both, had significantly more knowledge of the disease than women who lacked access to any of these mediums of communication. The effect of these strategies on women's overall knowledge of malaria is about 2% to 4% and is higher on their knowledge of the symptoms (3% to 6%) and prevention (2% to 4%) than the causes (2%). The combined effects of both mediums of communication are relatively higher than the effect of either of them as a single medium of communication. Further analysis showed that improved knowledge of the disease is associated with higher preventive measures taken by women for themselves and for their children. The results are more significant in rural and poor households than in urban and non-poor households. These findings underscore the need for the Ministry of Health and its partner institutions to adopt an innovative approach which combines the two strategies in intensively educating Ghanaians, and women in particular, on the symptoms and prevention of malaria, giving due cognisance to households' socioeconomic status and geographical location.

Prevalence of Exclusive Breastfeeding and Associated Factors among Mothers in Karongi District, Rwanda

BackgroundExclusive breastfeeding is crucial for an infant’s growth and development. In Rwanda, 47% of rural children and 27% of urban children are stunted which could be linked to poor exclusive breastfeeding. Thus, this study was carried out to assess prevalence of exclusive breastfeeding and associated factors in Karongi district of Rwanda.MethodA cross-sectional design was used involving 261 mothers with infants of 6 to 9 months selected systematically with an interval two as they came to the health facilities. The data were collected using structured questionnaire. The factors independently associated with exclusive breastfeeding were determined using multivariable logistic regression analysis.ResultsThe prevalence of exclusive breastfeeding was 87.1%. Married mothers (AOR= 3.15; 95%CI = 1.07 – 9.28), protestant mothers (AOR= 0.15; 95%CI = 0.03 – 0.69), attending prenatal care (AOR= 19.87; 95%CI = 3.00 – 131.68), receiving postnatal care (AOR = 3.07; 95%CI = 1.31 – 7.21) and receiving breastfeeding counseling (AOR= 3.16; 95%CI = 1.03 – 9.69) were identified as independent factors associated with exclusively breastfeeding.ConclusionThe prevalence of exclusive breastfeeding was high but with various healthcare service associated factors. Therefore awareness and appropriate behavior change communication strategies on exclusive breastfeeding should be encouraged during prenatal and postpartum care for optimum practice.Rwanda J Med Health Sci 2023;6(2):123-134

Pilot implementation of community health advocacy teams to improve the effectiveness of long-lasting insecticide net distribution through both campaigns and continuous channels in Ghana: a qualitative study of opportunities and barriers to implementation.

In Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. It is known that the existence of effective and functional community-based groups could influence positive behaviours regarding health interventions promoted through health campaigns. However, there is no evidence of functional community-based groups that aim to improve the effectiveness of LLIN distribution campaigns by transitioning into primary healthcare delivery. This study aimed to explore the opportunities and barriers to the pilot implementation of co-created community health advocacy teams (CHATs) to improve the effectiveness of LLIN distribution through both campaigns and continuous channels in Ghana. A qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13. CHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern. The CHATs would be instrumental in promoting LLINs' use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important.