Behaviour Change Communication Strategies Research Articles

Between traditional remedies and pharmaceutical drugs: prevention and treatment of \u201cPalu\u201d in households in Benin, West Africa

BackgroundIn Benin, malaria clinical cases, including the larger popular entity called “Palu” are evoked when people get fever. “Palu” is often self-diagnosed and self-medicated at home. This study aimed to describe the use of herbal medicine, and/or pharmaceutical medicines for prevention and treatment of malaria at home and the factors associated with this usage.MethodsA cross-sectional survey was conducted in Benin in an urban and in a rural area in 2016. Around 600 households in each place were selected by using a random sampling of houses GPS coordinates of the families. The association between socio demographic characteristics and the use of herbal medicine was tested by using logistic regression models.ResultsIn Cotonou (urban), 43.64% of households reported using herbal or pharmaceutical medicine to prevent “Palu”, while they were 53.1% in Lobogo (rural). To treat “Palu” in Cotonou, 5.34% of households reported using herbal medicine exclusively, 33.70% pharmaceutical medicine exclusively and 60.96% reported using both. In Lobogo, 4% reported using herbal medicine exclusively, 6.78% pharmaceutical medicine exclusively and 89.22% reported using both. In Cotonou, the factors “age of respondent”, “participation to a traditional form of savings” and “low socioeconomic level of the household” were associated with the use of herbal medicine.ConclusionsThis study shows the strong use of herbal medicine to prevent “Palu” or even treat it, and in this case it is mostly associated with the use of pharmaceutical medicine. It also highlights the fact that malaria control and care seeking behaviour with herbal medicine remain closely linked to household low-income status but also to cultural behaviour. The interest of this study is mostly educational, with regards to community practices concerning “Palu”, and to the design of adapted behaviour change communication strategies. Finally, there is a need to take into account the traditional habits of populations in malaria control and define a rational and risk-free use of herbal medicine as WHO-recommended.

The Un Oeuf study: Design, methods and baseline data from a cluster randomised controlled trial to increase child egg consumption in Burkina Faso.

In many low‐income countries, such as Burkina Faso, rates of malnutrition are high among children. Research indicates that animal source foods may provide important elements to improve growth and development of young children, especially during periods of rapid development, such as the first 1,000 days of life. The Un Oeuf study is designed to test an innovative behaviour change communication strategy to increase egg consumption in children 6–24 months in Burkina Faso, thereby improving dietary diversity and nutritional outcomes. This 1‐year cluster randomised controlled trial tests whether the gifting of chickens by a community champion directly to a child, combined with a behaviour change package of integrated poultry management and human nutrition trainings, can significantly increase egg consumption among children under 2 years in rural communities where egg consumption is very low. The nutrition‐sensitive behaviour change package is designed to increase egg consumption through improving livestock production, women's empowerment and food security at the household level. This paper presents a detailed account of the study design and protocol for the Un Oeuf study, alongside a description of the study population. Baseline data show a study population with high rates of malnutrition (stunting 21.6%, wasting 10.8% and underweight 20.4%) and a very low rate of egg consumption—less than 10% among children. Although poultry production is quite common, egg consumption is low reportedly because of cultural norms, including widespread practice of allowing eggs to hatch and a lack of knowledge about the nutritional benefits of egg consumption.

Household factors associated with access to insecticide-treated nets and house modification in Bagamoyo and Ulanga districts, Tanzania

BackgroundInsecticide-treated nets (ITNs) and house modifications are proven vector control tools, yet in most regions, full coverage has not been achieved. This study investigates household factors associated with access to ITNs and house modification in Tanzania.MethodsBaseline cross-sectional survey data from previous studies on spatial repellants and indoor residual spray evaluation was analysed from 6757 households in Bagamoyo (60 km north of Dar es Salaam) and 1241 households in Ulanga (a remote rural area in southeast Tanzania), respectively. Regression models were used to estimate the associations between the outcomes: population access to ITNs, access to ITN per sleeping spaces, window screens and closed eaves, and the covariates household size, age, gender, pregnancy, education, house size, house modification (window screens and closed eaves) and wealth.ResultsPopulation access to ITNs (households with one ITN per two people that stayed in the house the previous night of the survey) was 69% (n = 4663) and access to ITNs per sleeping spaces (households with enough ITNs to cover all sleeping spaces used the previous night of the survey) was 45% (n = 3010) in Bagamoyo, 3 years after the last mass campaign. These findings are both lower than the least 80% coverage target of the Tanzania National Malaria Strategic Plan (Tanzania NMSP). In Ulanga, population access to ITNs was 92% (n = 1143) and ITNs per sleeping spaces was 88% (n = 1093), 1 year after the last Universal Coverage Campaign (UCC). Increased household size was significantly associated with lower access to ITNs even shortly after UCC. House modification was common in both areas but influenced by wealth. In Bagamoyo, screened windows were more common than closed eaves (65% vs 13%), whereas in Ulanga more houses had closed eaves than window screens (55% vs 12%).ConclusionPopulation access to ITNs was substantially lower than the targets of the Tanzania NMSP after 3 years and lower among larger households after 1 year following ITN campaign. House modification was common in both areas, associated with wealth. Improved access to ITNs and window screens through subsidies and Behaviour Change Communication (BCC) strategies, especially among large and poor households and those headed by people with a low level of education, could maximize the uptake of a combination of these two interventions.

Perceived barriers and facilitators of healthy eating and physical activity: focus groups with children, parents and teachers in Mumbai, India

Background: Childhood offers a critical opportunity to inculcate healthy eating habits and promote adequate activity levels. Prior studies have assessed the factors that influence food choices and activity among children, however, these perspectives may vary considerably across communities, cultures and social environments. Knowledge regarding determinants of diet and activity related behaviors among children in India is lacking; understanding these influences will help to develop appropriate interventions. This qualitative study employed the tenets of the health belief model to identify barriers and facilitators of healthy eating and physical activity levels in children in Mumbai, India.Methods: Fourteen focus group discussions were conducted with children, parents and teachers, selected from three aided and three private schools in Mumbai. The transcripts were coded and analyzed using the scissor and sort method to derive common themes as per the protocol questions.Results: The discussions revealed four main themes, namely knowledge regarding non communicable diseases and physical activity guidelines, perceived susceptibility and severity of consequences of unhealthy behaviors, socio-environmental factors such as availability and accessibility of foods at school and home, facilities for sports and peer support and individual determinants that shape choices such as time, academic pressure, convenience and will power. Variety in canteen menus, ‘fun’ outdoor activities, daily screen time monitoring and parent role modeling emerged as key facilitators.Conclusions: The results reiterated a need to improve parents’ nutrition knowledge, enforce strict school food sale policies and generate interest and motivation among children through targeted behavior change communication strategies.

Predictors of relapse of acute malnutrition following exit from community-based management program in Amhara region, Northwest Ethiopia: An unmatched case-control study.

BackgroundCommunity-based management of acute malnutrition (CMAM) is an effective program to manage children with acute malnutrition, including both severe and moderate acute malnutrition. However, little is known about continued child nutritional status after discharge from community based management of acute malnutrition programs in Ethiopia.ObjectiveThe study aimed to identify factors associated with relapse of acute malnutrition among children 6–59 months after been discharged recovered from community based management program in South Gondar Zone, Northwest Ethiopia.MethodsA case-control study was conducted in three districts of South Gondar Zone by tracing children age 6–59 months who were reported as recovered from the community based management program. Sample size calculated for the first objective of assessing prevalence of severe acute malnutrition among children following discharge as recovery using Epi- Info version 7.1.3.3 StatCalc taking 95% CL, 17.8% post discharge relapse (Ashraf H, et al. (2012), 3% margin of error, design effect of 2 and adding 5% non-response rate was the largest sample size and used to this study.Children with Mid Upper Arm Circumference (MUAC) <12.5cm constituted cases and children with > = 12.5cm served as controls. Data were collected from 10 November 2017 to 30 January 2018 using a survey questionnaire and families were asked to bring children to a health facility for anthropometric measurements, following which data were entered and analyzed. Bivariate and multivariable logistic regression models were utilized to measure association between the risk factors and acute malnutrition.ResultsOverall, 1,273 participants were interviewed. The mean age in months of children was 23.1 (±9.1 SD) for cases and 23.1 (±8.9 SD) for controls. About 40% of the cases and 50% of the controls were female children. The factors associated with acute malnutrition were: male children (AOR = 1.84, 95% CI: 1.42–2.39), living in a food insecure household (AOR = 1.67, 95% CI:1.15–2.44), non-receipt of Vitamin A supplement (AOR = 1.76, 95% CI: 1.28–2.41), prelacteal feeding (AOR = 2.81 (95%CI, 1.57–5.05), distance to water source more than 15 walk (AOR = 1.88, 95% CI:1.32–2.71), less frequent self-reported hand washing (AOR = 1.35, 95% CI:1.05–1.75), mother not having consumed extra food during this pregnancy/lactation (AOR = 1.36, 95% CI: 1.03–1.78), and respondent age above 30 years (AOR = 1.43, 95% CI:1.10–1.87).ConclusionThe key factors contributing to relapse of acute malnutrition were related to childcare and feeding practices. Social and behavior change communication strategies targeting families at risk of undernutrition, along with improved food security and integrated programming are recommended to prevent relapse of acute malnutrition.

Behavioral Communication Strategies for Global Epidemics: An Innovative Model for Public Health Education and Humanitarian Response.

In response to a number of growing global health challenges, New York University and UNICEF designed a Behavioral Communication Strategies for Global Epidemics course that brings together United Nations professionals, government staff, and MPH (Master of Public Health) students to design innovative social behavior change communication (SBCC) strategies that address disease outbreaks and humanitarian challenges around the world. Applying a systems approach, participants in the course work on interdisciplinary teams to design strategies, develop skills, and engage in global learning. At the culmination of the course, all teams present strategies to UNICEF country offices for implementation. This innovative model for disease outbreak, public health education, and humanitarian response provides professionals with an opportunity to develop a wide range of competencies, including systems thinking, behavior change, and human-centered design and equips them with the necessary tools to develop more novel approaches to SBCC. As the number of outbreaks and humanitarian challenges increase each year, this format for learning can serve as a model for how professionals can effectively address these complex crises.

Do women justify the violence they face? Intimate partner violence among married women

Introduction: Intimate partner violence (IPV) is a significant public health problem with harmful consequences for affected individuals. We report the prevalence of physical and sexual violence and justification of this violence by ever-married women. Methodology: We conducted this cross-sectional study on 500 women in an urban area of a metropolitan city of North India. We used a validated questionnaire to estimate the prevalence and forms of IPV and proportion of women who justify the violence they face. We used logistic regression to determine the association of violence with certain sociodemographic factors. We also studied the association of justification of violence with these sociodemographic factors. Results: Ninety-one (18.2%) women had “ever” experienced physical violence. Alcohol consumption by the husband, initial place of residence, and controlling behavior by the husband were significantly associated with physical violence. Fifty two (10.4%) had “ever” experienced sexual violence. Higher education status of the women, justification of violence by the women, controlling behaviour and alcohol consumption by the husbands was significantly associated with sexual violence. Women who had faced any one form of violence (physical or sexual) were at higher risk of facing the other form as well. One hundred and eight two women (36.2%) justified violence by husbands. Women who faced controlling behavior, experienced sexual violence, were poorly educated, or were married for more than 10 years were more likely to justify any form of IPV they faced. Conclusion: Alcohol consumption, controlling behavior, and justification of violence are important behavioral predictors for physical or sexual violence. We recommend behavioral change communication strategies targeted at male partners and also the families to curb the menace of IPV.

A community-based study: Prevalence of diabetes mellitus and its complications in rural population of Moradabad district, Uttar Pradesh, India

Background: In last two-decade prevalence of Diabetes Mellitus in India is increasing at higher rate and currently India is the Diabetic Capital of the World. Reliable and informative epidemiological evidence is vital to quantify impacts and predictors of disease and to facilitate formulation of prevention and control strategies. In North India particularly Uttar Pradesh the area specific data regarding diabetes mellitus is scarce. Objectives: Prevalence of Type-II Diabetes Mellitus and its associated risk factors in rural population of the Moradabad district. Materials and Methods: A Cross-sectional, community-based study was conducted from October 2016 to October 2017 among adults in the age group of 30 year and above residing in Moradabad rural area. A two-stage stratified random sampling technique was adopted to achieve the desired sample size. In first stage, one ward was randomly selected from each group and in second stage; one village was selected randomly from each of the two wards. Result: The prevalence of Diabetes Mellitus was found to be 10.7%, it was 17.8% among males and 14.8% among females. 4.6% were newly diagnosed while the remaining 6.1% were known diabetics. In the present study statistically, significant association is observed between prevalence of diabetes mellitus with age, socioeconomic class, BMI. A significant correlation was found between diabetic retinopathy and diabetic nephropathy. Conclusion: There is a need for continuous screening program and lifestyle modifications to timely detect and intervene in the pathogenesis of diabetes mellitus. Behaviour change communication strategy should take a vital role in improving lifestyle of the community as most of these risk factors are modifiable.

Are Corneal Patients Accepting the Transplantation? The Cases of University of Gondar, Tertiary Eye Care and Training Center, Ethiopia.

Background For so long, corneal diseases have been known as one of the leading causes to blindness in the global. This blindness might be due to failure to accept the corneal transplantation. Therefore, this study aimed to determine the prevalence and the root challenges for corneal transplantation acceptance at the University of Gondar tertiary eye care and training center, Ethiopia. Methods An institution-based cross-sectional study was conducted among patients who had an indication for corneal transplantation at the University of Gondar tertiary eye care and training center since January 1, 2017, up to October 30, 2018. A structured questionnaire was used to collect the data and entered into Epi-Info 7 software and analyzed using SPSS version 20. Simple logistic regression was used to identify the associated factors of corneal transplantation acceptance. Associations between outcome and exposure variables were expressed by the adjusted odds ratio with a 95% confidence interval and p value <0.05. Result A total of 116 patients with a mean age of 51 (±21) years participated in the study. The overall acceptance level of corneal transplantation was only 38.8% (95% CI: 29.93, 47.66). Patients with poor knowledge [AOR = 2.41; 95% CI: 1.90, 6.48] and an unfavorable attitude [AOR = 6.33; 95% CI: 2.42, 16.54] were significantly associated with the acceptance of corneal transplantation. Conclusion The study revealed that the corneal transplantation acceptance level was very low. Hence, the government and other concerned stakeholders should give due emphasis to the awareness creation and behavior change communication strategies to increase the acceptance level of corneal transplantation.

Translating Evidence-Based Program Recommendations into Action: The Design, Testing, and Scaling Up of the Behavior Change Strategy EsIAN in Mexico

The Integrated Strategy for Attention to Nutrition (EsIAN in Spanish) is a national strategy within Mexico's conditional cash transfer program (initially Progresa, then Oportunidades, then Prospera, CCT-POP) designed to strengthen the health and nutrition component, address the nutrition transition, and improve the health and nutritional status of its beneficiaries, through 3 main components: 1) procurement of functioning equipment to primary health care (PHC) units; 2) providing free micronutrient supplements to beneficiary women and children; 3) implementing a behavior change communication (BCC) strategy and a training system for PHC providers (PHCPs). We aim to describe the iterative process and evidence-based approach used to design and roll-out the EsIAN at scale, by focusing on the BCC component. The BCC strategy was developed by following an iterative process through the following phases: situational analysis, formative research and design of the BCC strategy (using the socioecological framework and the social marketing approach), large-scale feasibility study, redesign, and national scale-up. The review and formative research revealed several barriers and issues that limited program coverage, utilization, and acceptance. These included misconceptions about pregnancy and infant feeding, nonalignment of practices with international recommendations, and lack of knowledge on nutrition and related topics, among others. These results were used to identify priority behaviors and elaborate key messages for mothers/caregivers and providers to develop the BCC strategy. The feasibility study resulted in significant improvements in PHCPs' knowledge, counseling (breastfeeding, and supplement use and consumption), and caregivers' complementary feeding behaviors, and highlighted several design and delivery aspects that needed strengthening. Based on these findings, the BCC strategy was adapted prior to a national scale-up. The theory-based iterative approach resulted in the identification of specific actions to target, and approaches to do so, as part of the design and roll-out of the BCC strategy at scale.

Risk factor assessment for clinical malaria among forest-goers in a pre-elimination setting in Phu Yen Province, Vietnam

BackgroundThe transition from malaria control to elimination requires understanding and targeting interventions among high-risk populations. In Vietnam, forest-goers are often difficult to test, treat and follow-up for malaria because they are highly mobile. If undiagnosed, forest-goers can maintain parasite reservoirs and contribute to ongoing malaria transmission.MethodsA case–control study was conducted to identify malaria risk factors associated with forest-goers in three communes in Phu Yen Province, Vietnam. Cases (n = 81) were residents from the study area diagnosed with malaria and known to frequent forest areas. Controls (n = 94) were randomly selected forest-going residents from within the study area with no identified malaria infection. Participants were interviewed face-to-face using a standard questionnaire to identify malaria risk factors. Logistic regression was used to calculate odds ratios (ORs) and 95% CI for risk factors after adjusting for socio-demographic characteristics.ResultsAmong the cases, malaria infection varied by species: 66.7% were positive for Plasmodium falciparum, 29.6% for Plasmodium vivax, and 3.7% were diagnosed as mixed infection. Cases were less likely than controls to use treated nets (aOR = 0.31; 95% CI 0.12–0.80), work after dark (aOR = 2.93; 95% CI 1.35, 6.34), bath in a stream after dark (aOR = 2.44; 95% CI 1.02–5.88), and collect water after dark (aOR = 1.99; 95% CI 1.02–3.90).ConclusionsAs Vietnam moves toward malaria elimination, these findings can inform behaviour change communication and malaria prevention strategies, incorporating the risk of after-dark and water-related activities, in this priority and difficult-to-access population group.

Suboptimal infant and young child feeding practices in rural Boucle du Mouhoun, Burkina Faso: Findings from a cross-sectional population-based survey.

In Burkina Faso in 2016, 27% and 8% of children under-5 were estimated to suffer from stunting and wasting respectively. Here, we report on infant and young child feeding (IYCF) practices in rural areas of the Boucle du Mouhoun region. A cross-sectional population-based survey was performed in 2017 in a representative sample of mothers of children aged 6 to 23 months. IYCF practices were assessed using 24-hour dietary recall. Logistic regression was used to identify predictors of IYCF practices. All analyses accounted for sampling stratification by child's age group and for data clustering. According to mothers' reports, 60% (95%CI 55, 65%) of children received the minimum meal frequency, but only 18% (95%CI 15, 22%) and 13% (95%CI 10, 16%) benefited from the minimum dietary diversity and the minimum acceptable diet respectively. Only 16% (95%CI 13, 20%) of mothers reported increasing breastfeeding or liquids and continued feeding during an episode of child illness. Knowledge of timely introduction of complementary foods and recommended feeding practices during an illness were low. Despite positive attitudes towards the introduction of key food groups, mother's perceived self-efficacy to provide children with these food groups every day was relatively low. Our findings highlight the need for interventions to improve mothers' knowledge and practices in relation to IYCF in the Boucle du Mouhoun region. Behaviour change communication strategies have the potential to improve IYCF indicators but should be tailored to the local context. The high attendance of health facilities for preventive well-baby consultations represents an opportunity for contact with caretakers that should be exploited for promotion and child growth monitoring.

Early Postnatal Care Service Utilization and Associated Factors among Mothers who Gave Birth in the Last One Year Preceding the Survey in Sidama Zone Malga District, Southern Ethiopia

BACKGROUND: Early Post-natal care service utilization is extremely low and stagnant over the decade ofperiod in Ethiopia. Ethiopian Demographic and Health Survey 2016 reported that only 17% early post-natal careservice utilization occurred despite the fact that, maternal mortality is high in the first 24 to 48 hours after delivery.OBJECTIVE: The aim of this study was to assess early postnatal care service utilization and associated factorsamong mothers who gave birth in the last one year, in Sidama Zone Malga Woreda, Southern Ethiopia.METHOD: A community based quantitative supplemented by a qualitative cross-sectional study was conductedfrom September 15, 2017 to October 15, 2017 in Sidama Zone, Malga district among 395 mothers who gave birth inthe last one year. Mothers were selected by Simple random sampling technique. Quantitative data was collected bysemi structured questionnaires and coded, cleaned, entered into EPI info version 3 and exported to SPSS version 20for analysis. In binary logistic regression, variables with P value less than 0.25 were taken into multivariable logisticregression analysis and then, variables with p value &lt; 0.05 at the final model were considered statistically significantpredictors of the outcome variable. Qualitative data was collected by focus group discussions, and Individual Indepthinterview and then thematic analysis were used to interpret the results.RESULTS: In this study, 22.5% of mothers utilized early postnatal care. Women who had experience of earlypostnatal care utilization has two times (AOR: 2.11, 95% CI: 1.11, 4.00), those who delivered at health facility werefour times, (AOR: 4.10, 95% CI : 1.76, 9.57), those mothers who decide by themselves about early post-natal careutilization nearly four times (AOR: 3.84, 95% CI: 1.88, 7.82 ) , mothers who traveled on foot for less than two hourswere four times (AOR: 4.24, 95% CI: 1.82, 9.91), mother who had four antenatal care follow up were nearly fourtimes (AOR: 3.94, 95% CI: 1.18, 13.23) and educated mothers were seven times (AOR: 7.04, 95% CI: 2.42, 20.49)more likely to utilize early postnatal care service than their counterparts.CONCLUSION: The study revealed that, early postnatal care services in the district are low. Maternal education,place of delivery, decision making power of the mother, time taken to reach to health facility, antenatal care followup, previous early postnatal care utilization and experience of the mother were independent predictors of early postnatalcare service utilization. Therefore, Social and behavioral change communication strategies and continuum ofcommunity based care should have to strengthened.KEY WORDS: Early Post-natal care, utilization, Barrier, Associated factor, Malga district

Experimental evidence on post-program effects and spillovers from an agriculture-nutrition program

Integrated agricultural-nutrition programs are often implemented under the premise that program effects are durable and spillover. This paper estimates one year post-program effects, three-year aggregate program effects and spillover effects using treated and untreated household cohorts. Two treatment interventions implemented agricultural interventions with behavior change communication strategies varying implementers using either village health committees or older female leaders. In the post-program period, program effects deteriorated relative to program period impacts documented in Olney et al. (2015), but the three-year agricultural, nutrition knowledge, health care practices and severe anemia impacts remained statistically significant. Despite the non-rival nature of nutrition education and promoted production techniques, there is little evidence of agricultural technology or health knowledge spillovers to non-treated households within treatment communities. Spillover effects measured for appropriate treatment of diarrhea (10 pp increase in giving rehydration salts rather than traditional medicine), wasting (20 pp lower probability of wasting) and children’s anemia status (7 pp reduction in severe anemia) significantly improve in later cohorts. The aggregate program effects and spillovers are generally robust to multiple hypothesis testing.

Likelihood of Breast Screening Uptake among Reproductive-aged Women in Ethiopia: A Baseline Survey for Randomized Controlled Trial

Breast cancer is the most devastating public health problem affecting women in developed and developing world. Therefore, this study was aimed to assess the likelihood of taking breast self-examination as a breast screening behavior among reproductive age women. A community based cross-sectional study was conducted on 810 reproductive-age women. Intervieweradministered questionnaires were used to collect data. Study participants were selected using systematic sampling method. Data were analyzed using SPSS version 24.0. The likelihood of performing breast self-examination was 54.3%. However, the comprehensive knowledge of the participants was 11.5%. As independent predictors, perceived severity of breast cancer [AOR (95%CI) = 2.05 (1.03 to 1.07)] and self-efficacy [AOR (95%CI) = 2.97(0.36-0.99)] were positively associated with the likelihood of performing breast self-examination whereas districts [AOR (95%CI) = 0.58 (0.37 to 0.91)] and place of residence [AOR (95%CI) = 0.69 (0.51 to 0.93)] were negatively associated with the likelihood of performing breast selfexamination. The HBM Model explained 64.2% of the variance in this study. Although the likelihood of performing breast selfexamination was relatively good, the comprehensive knowledge of the women was very low. Therefore, breast cancer screening education must address knowledge and socio-cultural factors that influence breast screening through awareness creation using appropriate behavioral change communication strategies.

A Social and Behavior Change Communication Framework for Addressing Delays to Appropriate TB Care and Treatment

Social and behavior change (SBC) communication strategies and interventions have been used to successfully promote positive health behaviors and health outcomes, yet there is little evidence in the published literature on SBC frameworks for tuberculosis (TB) care and treatment

Reproductive, Maternal, Newborn, Child and Adolescent Health and related Behaviour Change Communication strategies in Bangladesh, Nepal and India: A narrative review

AimThe review was conducted to collate the evidence on the current status of “Reproductive, Maternal, Newborn, Child and Adolescent Health” (RMNCAH) and related Behaviour Change Communication (BCC) interventions in RMNCAH in South Asia, particularly Bangladesh, Nepal and India. MethodsLiterature search was conducted on multiple databases and websites in March 2019. The search was limited to English language publications. The data on health indicators for the eight South Asian countries are compared in the review. This review narratively summarises the key RMNCAH and related BCC initiatives undertaken in Bangladesh, Nepal and India. ResultsThe South Asian countries have achieved significant progress in socio-economic indicators related to health aligned with the Millennium Development Goals but face a number of challenges. There has been a significant development in financial incentives, programmes and policies framed for improving indicators of maternal and child health. Various RMNCAH initiatives which impact positively on maternal and child health indicators were identified. ConclusionBangladesh, Nepal and India have made substantial improvement in maternal and child health indicators but at a slower pace than other countries of South Asia, in relation to which consistent disparities still exist. There are a number of BCC initiatives targeting RMNCAH. The improvement in RMNCAH indicators can be attributed to multiple initiatives wherein the contribution of BCC is relevant, because of their wide community outreach and effectiveness among all age-groups.

Rapid Assessment Procedures Formative Research Approach Used to Design a Mobile-technology Enhanced Social and Behavior Change Communication Nutrition Strategy in Nigeria (P16-053-19)

Objectives1To design of a tailored social and behavior change communication (SBCC) strategy to improve program coverage and key nutrition behaviors of internally displaced persons (IDP) in northeast Nigeria,2To determine preferred and appropriate ways of integrating one- and two-way mobile communication tools into SBCC activities,3To demonstrate application of the Rapid Assessment Procedures (RAP) formative research approach in a humanitarian context with severe insecurity. MethodsA RAP approach and was conducted over 4 weeks in August, 2018. It included multiple qualitative methods and various participant types for triangulation. In-depth interviews (IDI), open-ended interviews and focus group discussions (FGD) were conducted among mothers and fathers of children under 5 years, local community leaders and health workers. Semi-structured interviews were conducted among professionals (nutrition and technology experts) with contextual programming knowledge. Interviews and FGD were digitally recorded in Hausa or Kanuri before translation and transcription into English. Textual data were managed in NVivo software, where salient themes pertinent to the research questions were identified. ResultsA total of 29 IDI, 12 FGD and 10 semi-structured interviews were conducted among diverse stakeholders. An SBCC strategy was designed with preferred communication channels, defined audience segments and tailored messages using emic terms in local languages. Primary caregivers, typically female in this context, were identified as the primary audience. Community health workers, local leaders (e.g., imams) and husbands were identified as secondary audiences who influence the primary caregivers’ nutrition behaviors. Interpersonal (care groups), media (radio) and mobile technologies (interactive voice response calls; SMS; chatbots in low-cost websites) emerged as preferred and viable communication channels. Salient terms and phrases were applied to standard biomedical nutrition messages about breastfeeding and complementary feeding. ConclusionsA RAP approach offers a viable formative research model in humanitarian contexts where security challenges might not allow for desired lengthy, in-depth formative work typical of high-quality SBCC strategy design. Funding SourcesWorld Food Program, Korea International Cooperation Agency (KOICA). Supporting Tables, Images and/or Graphs▪

Father Engagement in Improving Infant and Young Child Feeding (IYCF) Practices: Evidence from a Clustered Randomized Controlled Trial in Ethiopia (P11-112-19)

ObjectivesWe identified lack of knowledge and lack of paternal support as barriers to improved IYCF practices in Ethiopia, the focus of this study. Behavior change communication (BCC) strategies are often used to improve knowledge, but BCC programs commonly target only mothers. The objective of this study is to assess the impact of both paternal and maternal BCC program on complementary feeding practices compared to maternal BCC program alone. MethodsThis study is a community-based, clustered randomized controlled trial conducted in Ejere district, Ethiopia. We randomly selected three rural kebeles (ward) and three urban kebeles within the Ejere district. 63 garees (villages) were identified and randomly assigned within selected kebeles into treatment and control groups: T1, maternal BCC only; T2, both maternal BCC and paternal BCC; and C, control. The maternal BCC program and paternal BCC program consisted of weekly one-hour long group sessions for the duration of 16 and 12 weeks, respectively. Both BCC program included messages on improved IYCF practices. In addition, paternal BCC program included messages on gender roles. ResultsFather’s IYCF knowledge increased by 0.31SD when BCC was provided to mothers and by 0.62SD when provided to both mothers and fathers. Although we see spillover of knowledge from BCC from BCC-attending mothers to their partners in maternal BCC group, we see paternal BCC additionally increase father’s knowledge by 0.36SD. The provision of both maternal and paternal BCC group improves child dietary diversity score (CDDS) by 0.64 food groups and increases the likelihood they meet minimum diet diversity by 18 percentage points. However, the additional impact of paternal BCC on child diets is not statistically significant at the 5% level. We see no differential impact on child anthropometry. ConclusionsNutrition BCC program that targets both fathers and mothers have greater impact on father’s knowledge, compared to nutrition BCC program that targets mothers only. However, additional knowledge gain has limited impact on IYCF practices. Funding SourcesAfrica Future Foundation. Supporting Tables, Images and/or Graphs▪▪▪▪

Socio-cultural determinants of open defecation in rural households of Perambalur district, Tamil Nadu

Background: In many areas of the world, including India, open defecation still remains the predominant norm and poses one of the biggest threats to the health of the people particularly in rural areas.Objectives were to study the prevalence and socio-cultural determinants of open defecation in rural area of Perambalur district.Methods: The present cross-sectional was done in a three randomly selected villages falling under rural field practice area of Department of Community Medicine of Dhanalakshmi Srinivasan Medical College and Hospital in Perambalur district (Tamil Nadu). Data was collected on 330 houses using pre-tested interview schedule developed using SBM-G questionnaire/schedule for ODF verification for household surveys which was modified for present study. Statistical analysis was done using Epi Info version 7 software.Results: Most (89.1%) of the study participants were above 30 years of age. Majority of respondents (39.4%) were illiterate. Prevalence of open defecation was 78.8%. Only 70 (21.2%) houses were using household sanitary latrines. Various reasons reported for open defecation were unawareness about availability of public latrine (41.5%), inadequate water (15.3%), insufficient space for latrine construction (16.9%), inadequate money (10%), considering open defecation better (16.6%) and caste based discrimination (0.4%). The study found sex, education and occupation of head of family to be significantly associated with open defecation.Conclusions: This study highlights the need for implementation well planned behavior change communication strategy to stop the menace of open defecation.