Endline Survey Research Articles

Assessment of the impact of integrated disease surveillance and response system on surveillance management at healthcare facilities in Pakistan.

Disease surveillance is very crucial especially in high vulnerability settings like Pakistan. However, surveillance and outbreak response management are still evolving in the country and research studies are needed to assess the existing system. To assess the impact of integrated disease surveillance and response system (IDSRS) implemented by the provincial government to strengthen infectious disease surveillance and reporting in 6 districts of Pakistan in 2016. A baseline cross-sectional assessment of health facilities and the healthcare workforce was conducted in 2016 to identify needs and gaps in public sector health facilities and the health system of 6 selected districts of Khyber Pakhtunkhwa Province, Pakistan. This was followed by a 2018 endline survey of the same facilities using the same variables. Overall, there was improvement in district management and facility level performance (χ2 (1, 314) = 21.19, P < 0.001, V = 0.26). District level management improved significantly in areas with relatively lower Gross Domestic Product (GDP)? χ2(1, 154) = 30.41, P <0.001, V = 0.44). Facilitation domain variables improved in the lower GDP districts (χ2 (1, 74) = 5.76, P = 0.016, V = 0.28) and showed counterintuitive deterioration (χ2 (1, 74) = 4.80, P = 0.028, V = 0.25) in relatively higher GDP areas. IDSRS is effective in improving surveillance and response systems, however, its effectiveness appears to depend on locale-specific economies and can be enhanced by modifying the implementation approach. Better empowerment of the local workforce can contribute to such improvement.

A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan-The Impact on Zero-Dose Children and Polio Coverage.

Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.

Effect of a Structured Integrated Obstetric Triage Model (SIOTEL) on Patient Waiting time in Maternity Units in Kiambu County – A Quasi Experimental Study

Background: Perinatal mortality and morbidity remains high in Kenya over the years, and this has been attributed to the Three Delays, the third focusing on access to care once the client is in the health facility. Structured frameworks for obstetric triage have been shown to improve perinatal outcomes across the globe. In Kenya, anecdotal evidence suggests that there is no formal framework for conducting obstetric triage in public facilities. This study sought to assess the effect of a Structured Integrated Obstetric Triage Model (SIOTEL) on patient waiting time in maternity units of Kiambu Referral Hospitals.&#x0D; Methods: A quasi experimental design was applied in the study. The intervention facility was Kiambu County Referral Hospital and control facility was Thika Level 5 Hospital. Study population included files of patients admitted in the labour wards. The intervention (SIOTEL) was a 3-scale modified Obstetric Triage Acuity Scale, a client assessment tool that was used to conduct obstetric triage. A baseline survey was conducted followed by development, validation and implementation of the tool, then an end line survey conducted to assess effect of the model on waiting time. Quantitative data was analyzed using STATA and presented in tables and graphs. T-statistic was used to test for significance of mean waiting time in the two facilities.&#x0D; Results: A total of 455 files were reviewed, 231 at baseline and 224 at endline survey. The mean client waiting time at baseline was 113.19 and 124.91 minutes in the intervention and control facilities respectively. At endline, the mean waiting time was 57.46 minutes in the intervention facility and 112.92 minutes in the control facility. Findings thus revealed a significant effect of the SIOTEL on client waiting time in the intervention facility (t-3.77;p value 0.00) compared to the control facility (t-0.78; p value 0.44)&#x0D; Conclusions and recommendations: The study concludes that implementation of structured models for obstetric triage contributes to reduction in client waiting time, and recommendations are made to adopt such models for triage in public facilities in Kenya

Home-Garden Production and Women Dietary Diversity: An Experience from Success of Micro-Intervention in Boru Meda Kebele, Ethiopia

Background: In order to combat malnutrition and micronutrient deficiencies, Nutrition Sensitive Agriculture (NSA) gives nutrient-dense foods, dietary diversity, and food fortification the highest priority. This micro-intervention project's goal is to increase home-gardening system's contribution to raising women's dietary diversity score (WDDS) by diversifying family farming practices. Methods: In Ethiopia's Boru-Meda Kebele, The authors applied the intervention to 40 specifically chosen female beneficiaries between the ages of 15 and 49. FAO's standardized questionnaire was used as a tool to conduct an initial and end-line dietary diversity survey by giving careful consideration to cultural and religious elements. The qualitative information was also gathered using case studies, key informant interviews, and focus group discussions. Results: The local population's diet was dominated by staple cereal crops, and women were less knowledgeable about home gardening and diverse diets. Before intervention, the average number of food groups produced and consumed was 2.63±1.00 and 3.68±1.16 respectively. The intervention enhanced the WDDS to 6.13±0.76, and the production diversity to 5.63±0.90. The intervention changed the community's consumption and production patterns, especially among women. Conclusion: Home-garden agriculture helps to increase WDDS. As a result, development partners must concentrate on farming system diversification by increasing the accessibility of vegetable seeds and educating local farmers about the contribution of diversified vegetable production and consumption. Strengthening the cooperation among stakeholders and maintaining monitoring of activities should also be given due emphasis.

Good School Toolkit-Secondary Schools to prevent violence against students: protocol for a pilot cluster randomised controlled trial

IntroductionNo whole-school interventions which seek to reduce physical, sexual and emotional violence from peers, intimate partners and teachers have been trialled with adolescents. Here, we report a protocol for a...

Effect of Nurse-Led PMTCT Health Education on HIV Disclosure among HIV-Positive Women in Mombasa County: A quasi-experimental study

Background: This study investigated the impact of nurse-led PMTCT (Prevention of Mother-toChild Transmission) health education on enhancing HIV status disclosure among HIVpositive women in Mombasa County, Kenya. HIV status disclosure is crucial for the prevention of mother-to-child transmission and the overall well-being of affected individuals and their families.&#x0D; Methods: A quasi-experimental design was employed, with participants divided into an intervention group of 107 receiving nurse-led PMTCT health education and a control group of 107 receiving standard care. Demographic information, knowledge, attitudes, and practices related to HIV status disclosure were collected at baseline and post-intervention phases. Descriptive statistics were computed and a chi-square test was used to compare the level of self-disclosure of HIV status to sexual partners across the groups. Difference in differences (DID) analysis was used to evaluate the effectiveness of the intervention. Results: The study initially found that at baseline, 60.4% of HIV-positive women in the control group did not disclose their status to sexual partners, compared to 55.4% in the intervention group. However, there was no significant difference between the two groups at this stage. In the end-line survey, the control group had 64% non-disclosure, while the intervention group showed a significant improvement, with only 20% not disclosing. Chi-square analysis revealed a substantial difference (p &lt; 0.001) in disclosure rates between the intervention and control groups. Additionally, a Difference-in-Differences (DID) analysis indicated a significant improvement in self-disclosure (23.1% net intervention effect, p &lt; 0.0001). Overall, the nurse-led health education intervention notably increased HIV status disclosure among HIV-positive women in selected Mombasa County health facilities.&#x0D; Conclusion: Nurse-led PMTCT education enhances HIV disclosure in Mombasa County, improving PMTCT outcomes and curbing mother-to-child transmission. Tailored interventions are vital in addressing HIV challenges in diverse contexts.

Red Ribbon Club inculcation of positive deviance approach to promote blood donation among undergraduate medical college students

BackgroundBlood is an essential part of human life and blood donation has become a necessity that every society must take into consideration. Health care professionals have a major responsibility in raising community awareness on blood donation. ObjectiveThis study aims to find out the knowledge and attitude of undergraduate medical students on blood donation and to determine the effectiveness of positive deviance (PD) approach. MethodologyThis institutional based cross-sectional study was conducted as a part of World AIDS Days celebration by Red Ribbon club among 414 undergraduate students using convenient sampling technique. A baseline and endline survey were conducted using a pre-structured validated questionnaire. To address the knowledge gap PD approach was used for the students who had voluntarily donated blood, volunteered in providing health education, and shared their experience to their peers. Ethical principals were adhered. ResultsThe mean age of the students was 20.4 ± 1.2 years. Most respondents had moderate knowledge on blood donation and positivity attitude towards the same. The key finding of our study is that about 45 students (10.9%) have donated blood till now. As a result of PD training session more than half of them volunteered to donate blood in the future. ConclusionThis study shows that awareness about blood donation were minimal among the medical students with misconceptions. After PD approach, the willingness was increased from 10% to 66%. Thus, PD approach builds capacity and leadership in volunteers is considered as the best approach for behavior change among their own peers.

Impact of market-based home fortification with micronutrient powder on childhood anemia in Bangladesh: a modified stepped wedge design.

Anemia poses a significant public health problem, affecting 1.6 billion people and contributing to the loss of 68.4 million disability-adjusted life years. We assessed the impact of a market-based home fortification program with micronutrient powder (MNP) called Pushtikona-5 implemented by Bangladesh Rural Advancement Committee (BRAC) on the prevalence of anemia among children aged 6-59 months in Bangladesh. We used a modified stepped wedged design and conducted three baseline, two midline, and three endline surveys to evaluate the Pushtikona-5 program implemented through three BRAC program platforms. We interviewed children's caregivers, and collected finger-prick blood samples from children to measure hemoglobin concentration. We also collected data on coverage of Pushtikona-5 and infant and young child feeding (IYCF) practices. We performed bivariate and multivariable analysis and calculated adjusted risk ratios (ARRs) to assess the effect of program outcomes. A total of 16,936 households were surveyed. The prevalence of anemia was 46.6% at baseline, dropping to 32.1% at midline and 31.2% at endline. These represented adjusted relative reductions of 34% at midline (RR 0.66, 95%CI 0.62 to 0.71, value of p <0.001) and 32% at endline (RR 0.68, 95%CI 0.64 to 0.71, value of p <0.001) relative to baseline. Regarding MNP coverage, at baseline, 43.5% of caregivers surveyed had heard about MNP; 24.3% of children had ever consumed food with MNP, and only 1.8% had consumed three or more sachets in the 7 days preceding the survey. These increased to 63.0, 36.9, and 4.6%, respectively, at midline and 90.6, 68.9, and 11.5%, respectively, at endline. These results show evidence of a reduction in the prevalence of anemia and an improvement in coverage. This study provides important evidence of the feasibility and potential for impact of linking market-based MNP distribution with IYCF promotion through community level health workers.

Family responsive care mediating the home visiting effects on left-behind children's early development in rural China.

The early development of left-behind children requires great concern and improvement. Yet, current interventions for left-behind children are mainly focussed on children older than 3. This study aims to assess the effectiveness of a home visiting programme on family responsive care and early development of rural left-behind children and examine whether family responsive care mediates the effects of intervention on child development. A quasi-experimental study design was utilized in this study. A stratified clustered sampling was employed to choose villages in programme towns into intervention group. A control village was matched with every intervention village. All of the left-behind children and their caregivers meeting the inclusion criteria in the chosen villages were enrolled in the survey. The outcomes included child development, caregiver's early stimulation, parent-child communication, and learning materials. Baseline assessments were conducted in 2018, and endline assessments were conducted in 2020. In the endline survey, we enrolled 608 children with 258 in the intervention group and 350 in the control group. Left-behind children in the intervention group were less likely to have development delay compared with the control group (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.36, 0.96). Migrant parents of children in the intervention group showed higher proportion of expressing emotional support to their children when communicating (OR = 1.69, 95% CI: 1.05, 2.72). Children who received home visits more than once per 2months had lower level of suspected development delay than children in the control group (OR = 0.34, 95% CI: 0.18, 0.68). Caregiver's early stimulation and migrant parents' emotional support to left-behind children mediated the intervention dose and left-behind children's development. Caregiver's early stimulation mediates the intervention and child's development. The findings suggest a promising future for scaling similar early childhood development interventions for left-behind children in rural settings.

Self-reported uptake of STI testing services among adolescents and young people aged 15-24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia.

There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.

Social Awareness for Women’s Health: An Endline Study in Gazaria, Munshiganj, Bangladesh

Background: The “Social Awareness for Women’s Health: Gazaria Pilot” project aimed to address menstrual health awareness and distribute free sanitary napkins in the Gazaria region. This endline survey evaluates the project’s impact on menstrual health practices, knowledge, and socio-cultural barriers among women and girls. Objective: Baseline data highlighted critical challenges, including limited awareness about menstrual hygiene, widespread use of non-hygienic materials such as old cloths, and significant emotional distress associated with menstruation. Access to reliable menstrual health information was predominantly through informal channels, with cultural taboos further exacerbating the menstrual health crisis. Methodology: A mixed-methods approach was employed, combining quantitative surveys and qualitative interviews to gather data from community members participating in the Gazaria Pilot project. Surveys were conducted to assess changes in health behaviors and attitudes, while interviews provided insights into community perceptions and experiences with project interventions. Findings: Following the project’s implementation, there was a notable improvement in menstrual hygiene practices. The use of disposable sanitary napkins increased from 5.99% at baseline to 15.36% at endline, reflecting enhanced access and acceptance of sanitary products. Additionally, knowledge about the risks of unclean menstrual practices and the benefits of personal hygiene saw significant gains, with awareness rising from 55.5% to 72.66% and from 62.0% to 75.78%, respectively. Menstruation has decreased emotional reactions, promoting mental well-being, but challenges persist like reliance on old cloths, lack of medical advice, and socio-cultural taboos affecting health behaviors. Conclusion: The project emphasizes the need for community-based interventions and sustained engagement to improve menstrual health outcomes in Gazaria, highlighting the need for ongoing efforts.

Development and Assessment of a Six-Item Index to Gauge Motivation to Receive COVID-19 Vaccination.

This study examined the factors influencing vaccine uptake using the Fogg Behavioral Model (FBM) and validated a multi-dimensional index for measuring a key construct in the FBM, motivation, using Confirmatory Factor Analysis (CFA) and Cronbach's alpha. The research was conducted in Yopougon Est, Côte d'Ivoire, and Kinshasa, Democratic Republic of Congo. We aimed to develop a motivation index for COVID-19 vaccination uptake informed by the FBM. The motivation index was developed and refined using interviews and cognitive testing, and then used in baseline and endline surveys to measure the motivation to uptake COVID-19 vaccination among 2173 respondents. The index was simplified to six items validated using Confirmatory Factor Analysis (CFA) and demonstrated strong internal reliability with Cronbach's alphas of 0.89 for the baseline and 0.77 for the endline. The study's findings indicate that this motivation index is a valid tool for measuring motivation to receive COVID-19 vaccination, with potential applications in other vaccination campaigns. However, further testing in diverse settings is needed to enhance generalizability, including in rural areas. This research provides valuable insights for designing effective behavior change interventions to increase COVID-19 vaccination rates.

Impact of a community-based primary healthcare programme on childhood diphtheria-tetanus-pertussis (DPT3) immunisation coverage in rural northern Ghana

BackgroundChild healthcare services such as diphtheria-tetanus-pertussis (DPT3) vaccination are known to reduce childhood mortality and morbidity. However, inequalities in access to these services in developing countries continue to constrain global efforts aimed at improving child health. This study examines the impact and equity effect of a community-based primary healthcare programme known as the Ghana Essential Health Intervention Programme (GEHIP) on improving the uptake of childhood DPT3 immunisation coverage in a remote rural region of Ghana.MethodsUsing baseline and end-line household survey data collected from mothers, the effect of GEHIP’s community-based healthcare programme on DPT3 immunisation coverage is evaluated using difference-in-differences multivariate logistic regression models. Household wealth index and maternal educational attainment were used as equity measures.ResultsAt end-line, both intervention and comparison districts recorded increases in DPT3 immunisation coverage although intervention districts had a relatively higher coverage than comparison districts (90% versus 88%). While children resident in intervention areas had slightly higher rates than children resident in comparison areas, regression results show that this difference was not statistically significant (DiD = 0.038, p-value = 0.102). There were also no significant equity disparities in the coverage of DPT3 vaccination for both household wealth index and maternal educational attainment.ConclusionDPT3 vaccination coverage in both study arms met the global vaccine action plan targets. However, because estimated effects are not significantly higher among treatment area children than among comparison districts counterparts, no equity/inequity effects of the community-based healthcare programme on DPT 3 coverage is evident.

Maternal and child health indicators in primary healthcare facilities: Findings in a health systems quasi-experimental study in western Kenya.

Maternal and infant mortality are higher in low-income than in high-income countries due to weak health systems. The objective of this study was to improve access, utilization and quality of Maternal and Child Health care through a predesigned Enhanced Health Care System (EHC) that embodies the World Health Organization (WHO) pillars of the health system. This study was conducted in two dispensaries in the Counties of Busia and Bungoma in Kenya as intervention sites and in four control clusters in Kakamega, Uasin Gishu, Trans Nzoia and Elgeyo Marakwet Counties. The study population was pregnant women and their children delivered over the study period in the intervention and control clusters.A quasi-experimental study design was used to conduct the study between 2015 and 2020 to compare the outcomes of the implementation of the EHC using the Find Link Treat and Retain (FLTR) strategy in one cluster, community owned initiatives in the other cluster and four control clusters at baseline and at the end of the study. A baseline survey was conducted in year one and an end line survey in the fifth year. Continuous data collection on maternal and childhood health indicators was done in all the six clusters and comparison made at the end of the study between the clusters. We found a 26%, 10.3% and 0.8% increase in antenatal care (ANC) attendance in the intervention clusters of Obekai, Kabula and control clusters respectively. There was a 28.2%, 5.8% and 17.0% increase in attendance of 4+ ANC clinics of Obekai, Kabula and control clusters respectively. There was a 24% and 13% increase in Obekai and Kabula respectively in contraceptive use and a 2% decrease in contraceptive use in the control locations. There was a 38.2%, 25.6% and 34.7% increase in facility deliveries over the study period in Obekai, Kabula and control clusters respectively. There was a marked increase in immunization coverage in the intervention clusters of Obekai and Kabula compared to a significant decrease in control clusters for BCG, polio, pentavalent and measles. In conclusion, use of the health systems approach in health care provision provides a holistic improvement in access and utilization of health services and in the improvement of health indicators.We do recommend that a systems approach be used in health services delivery to improve access, utilization and quality of health care provision at community and primary care levels.

Impact of food hygiene and safety training on knowledge, attitude, and practices of food hygiene and safety practices among food handlers in boarding schools of Embu County, Kenya

Background: The reduction of foodborne illnesses depends on the adoption and evaluation of effective food handling procedures in the food service industry. The purpose of the study was to evaluate the impact of food hygiene and safety training on the knowledge, attitudes, and practices of food handlers in boarding schools in Embu County, Kenya. Methods: A longitudinal nonequivalent quasi-experimental survey design was utilized. A sample size of 198 study respondents was generated, Magnani formula was used. Multistage sampling was applied to select the study participants. STATA version 17 was employed for data analysis. Results: The knowledge score changed from 71% at baseline to 90% at the end line compared to the control arm which did not significantly change. Attitude score changed from 71% at baseline to 89% at endline compared to the control arm which did not significantly change (64% to 63%). This corresponds to a DID change of 19 percent increase in the attitudes scores (p&lt;0.001). Lastly, practices score changed from 63% at baseline to 93% at endline. This corresponded to a 34 percentage point increase in the practice scores (p&lt;0.001). Conclusions: Overall, Knowledge, attitude and practices were low at baseline than at the endline survey. Statistically, the study revealed that knowledge, attitude, and practices were associated with adherence to food safety and hygiene standards. The Government through the Ministries of health and education should consider training of food handlers on food safety and hygiene for improved knowledge, attitude, and practices.

Assessing acceptability and effectiveness of a pleasure-oriented sexual and reproductive health chatbot in Kenya: an exploratory mixed-methods study

Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. We aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot. We used an exploratory mixed-methods study design. Between November 2021 and January 2022, participants completed a self-administered online questionnaire before and after chatbot engagement. In-depth phone interviews were conducted among a select group of participants after their initial chatbot engagement. Quantitative data were analysed using paired analyses and interviews were analysed using thematic content analysis. Of 301 baseline participants, 38% (115/301) completed the endline survey, with no measured baseline differences between participants who did and did not complete the endline survey. In-depth interviews were conducted among 41 participants. We observed higher satisfaction at endline vs. baseline on reported ability to exercise sexual rights (P ≤ 0.01), confidence discussing contraception (P ≤ 0.02) and sexual feelings/needs (P ≤ 0.001) with their sexual partner(s). Qualitative interviews indicated that most participants valued the chatbot as a confidential and free-of-judgment source of trustworthy “on-demand” SRHR information. Participants reported improvements in sex-positive communication with partners and safer sex practices due to new learnings from the chatbot. We observed increases in SRHR empowerment among young Kenyans after engagement with the chatbot. Integrating sexual pleasure into traditional SRHR content delivered through digital tools is a promising strategy to advance positive SRHR attitudes and practices among youth.

Farmers’ innovativeness and positive affirmation as main drivers of adoption of soil fertility management practices – evidence across sites in Africa

ABSTRACT Purpose Declining soil fertility is worrying in sub-Saharan Africa. Various technologies serve to mitigate or rebuild soil fertility, but uptake by farmers, especially smallholders, is low. The study addresses this adoption problem in a novel way, assessing empirically many factors from various domains (economic, socio-demographic, individual, institutional, networks and information sources) to identify what drives adoption. Design/Methodology/Approach The panel study used data from baseline and endline surveys with 1870 smallholders in Ghana, Kenya, Mali, and Zambia. Quantitative data were analysed simultaneously via logistic regression, complemented by qualitative interviews. The study demonstrates the advantage of panel studies, as they can measure changes in practice or in farmers’ attitudes. Findings Individual factors, for example innovativeness, perception about soil fertility and correct knowledge, have the biggest influence on adoption. Socio-demographic and economic factors, by contrast, play hardly any role, as do individual information sources. Practical implications Future research should focus on in-depth studies of individual factors, e.g. innovativeness and knowledge, and on the information environment of farmers. Communication efforts must primarily target innovative farmers, ensure high quality, address competing messages, and communicate through many different channels. Theoretical implications The importance of ‘intrinsic’ factors that have previously been overlooked in adoption studies in SSA becomes clear. Originality/Value The study is one of very few that empirically assesses a wide range of independent variables to identify the drivers of adoption. It reports not only significance but also effect sizes.

Testing the Effectiveness of a Community-Based Peer Support Intervention to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Zimbabwe

ObjectivesSocial isolation and stigma contribute to poor mental health outcomes. Adolescent mothers in Zimbabwe often experience isolation and stigma, lacking social support and resources to navigate motherhood. The study tested the effectiveness of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe.MethodsCommunity health workers (n = 12) and peer educators (n = 12) in the intervention arm were recruited and trained on co-facilitating peer support groups. Adolescent mothers aged 15–18 years from two low-income high-density communities in Harare were recruited, using a quasi-experimental design. The intervention arm (n = 104) participated in the peer support groups and both arms completed sociodemographic, base-, mid-, and end-line surveys (control arm n = 79). Peer support groups (12 groups with 6–12 participants in each) met in-person twice a month and completed 12 sessions from May to August 2019 addressing participant-identified topics such as income generation and depression. WhatsApp Messenger was used for training and implementation support. Key community stakeholders discussed project progress and recommendations to improve adolescent mothers’ health. Data were analyzed using Stata 15.ResultsThe intervention arm reported lower depressive symptoms and common mental disorders and higher overall, family, friends, and significant-other support, compared to control. The intervention arm felt more engaged with peers, knew who and where to turn to for help, and had coping, parenting and communication strategies to manage life challenges.Conclusions for PracticeThe intervention mitigated social isolation and stigma and thereby improved mental health and social support among adolescent mothers in Harare.Trial Registration This trial is registered at Clinical Trials.gov, NCT05213182 https://clinicaltrials.gov/ct2/show/NCT05213182.

Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers’ schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi: the PROMOTE Project pilot randomized controlled trial protocol

IntroductionGirls’ and women’s health as well as social and economic wellbeing are often negatively impacted by early childbearing. In many parts of Africa, adolescent girls who get pregnant often drop out of school, resulting in widening gender inequalities in schooling and economic participation. Few interventions have focused on education and economic empowerment of adolescent mothers in the region. We aim to conduct a pilot randomized controlled trial in Blantyre (Malawi) and Ouagadougou (Burkina Faso) to examine the acceptability and feasibility of three interventions in improving educational and health outcomes among adolescent mothers and to estimate the effect and cost-effectiveness of the three interventions in facilitating (re)entry into school or vocational training. We will also test the effect of the interventions on their sexual and reproductive health (SRH) and mental health.InterventionsThe three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training, subsidized childcare, and life skills training offered through adolescent mothers’ clubs. The life skills training will cover nurturing childcare, SRH, mental health, and financial literacy. Community health workers will facilitate the clubs. Each intervention will be implemented for 12 months.MethodsWe will conduct a baseline survey among adolescent mothers aged 10–19 years (N = 270, per site) enrolled following a household listing in select enumeration areas in each site. Adolescent mothers will be interviewed using a structured survey adapted from a previous survey on the lived experiences of pregnant and parenting adolescents in the two sites. Following the baseline survey, adolescent mothers will be individually randomly assigned to one of three study arms: arm one (adolescent mothers’ clubs only); arm two (adolescent mothers’ clubs + subsidized childcare), and arm three (adolescent mothers’ clubs + subsidized childcare + cash transfer). At endline, we will re-administer the structured survey and assess the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training attendance during the intervention period. We will also compare baseline and endline measures of SRH and mental health outcomes. Between the baseline and endline survey, we will conduct a process evaluation to examine the acceptability and feasibility of the interventions and to track the implementation of the interventions.DiscussionOur research will generate evidence that provides insights on interventions that can enable adolescent mothers to continue their education, as well as improve their SRH and mental health. We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings.Trial registration number AEARCTR-0009115, May 15, 2022.

ThIRST: Targeted IRrigation Support Tool for sustainable coffee production

The Central Highlands of Vietnam is an important Robusta coffee growing region. However, the region is facing climate change impacts from rising temperatures and irregular rainfall, while Vietnamese coffee farmers predominantly rely on irrigation from heavily depleted aquifers. To continue productive and sustainable growth, this system requires an innovative approach to meet this hydrological challenge. Here we propose a user-friendly tool, which aims to support coffee farmers’ irrigation decisions, through the Targeted Irrigation Support Tool or ThIRST. ThIRST combines seasonal forecasts, on-farm metrics, and farmer’s expertise. The research comprises baseline (n = 400) and endline (n = 237) surveys of coffee farmers in Đắk Lắk and Lâm Đồng Provinces. Through the surveys, farmers’ irrigation needs and the applicability of the tool are evaluated. Despite low smartphone usage for farming advisory, the results show the tool allows coffee farmers to continually achieve water-use efficiency and adapt to climate variability. Involving farmers in the design, production and evaluation of climate services can improve the trust and uptake of agro-advisories and the way this information is communicated.