60 research outputs found

    Multiple behaviour change intervention for diarrhoea control in Lusaka, Zambia: a cluster randomised trial

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    Background Eff ective prevention and control of diarrhoea requires caregivers to comply with a suite of proven measures, including exclusive breastfeeding, handwashing with soap, correct use of oral rehydration salts, and zinc administration. We aimed to assess the eff ect of a novel behaviour change intervention using emotional drivers on caregiver practice of these behaviours. Methods We did a cluster randomised controlled trial in Lusaka Province, Zambia. A random sample of 16 health centres (clusters) were selected from a sampling frame of 81 health centres in three of four districts in Lusaka Province using a computerised random number generator. Each cluster was randomly assigned 1:1 to either the intervention— clinic events, community events, and radio messaging—or to a standard care control arm, both for 6 months. Primary outcomes were exclusive breastfeeding (self-report), handwashing with soap (observation), oral rehydration salt solution preparation (demonstration), and zinc use in diarrhoea treatment (self-report). We measured outcome behaviours at baseline before start of intervention and 4–6 weeks post-intervention through repeat cross-sectional surveys with mothers of an infant younger than 6 months and primary caregivers of a child younger than 5 years with recent diarrhoea. We compared outcomes on an intention-to-treat population between intervention and control groups adjusted for baseline behaviour. The study was registered with ClinicalTrials.gov, number NCT02081521. Findings Between Jan 20 and Feb 3, 2014, we recruited 306 mothers of an infant aged 0–5 months (156 intervention, 150 standard care) and 343 primary caregiver of a child aged 0–59 months with recent diarrhoea (176 intervention, 167 standard care) at baseline. Between Oct 20 to Nov 7, 2014, we recruited 401 mothers of an infant 0–5 months (234 intervention, 167 standard care) and 410 primary caregivers of a child 0–59 months with recent diarrhoea (257 intervention, 163 standard care) at endline. Intervention was associated with increased prevalence of self-reported exclusive breastfeeding of infants aged 0–5 months (adjusted diff erence 10·5%, 95% CI 0·9–19·9). Other primary outcomes were not aff ected by intervention. Cluster intervention exposure ranged from 11–81%, measured by participant self-report with verifi cation questions. Comparison of control and intervention clusters with coverage greater than 35% provided strong evidence of an intervention eff ect on oral rehydration salt solution preparation and breastfeeding outcomes. Interpretation The intervention may have improved exclusive breastfeeding (assessed by self-reporting), but intervention eff ects were diluted in clusters with low exposure. Complex caregiver practices can improve through interventions built around human motives, but these must be implemented more intensely

    Microfinance and loan officers' work experiences: perspectives from Zambia

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    This article studies the challenges faced by microfinance institutions in Zambia, whose remit it is to provide financial services to the poor. It focuses on loan officers – the agents of delivery on the ground. With reference to loan officers’ experiences and words, the paper examines how gender and education shape and structure their day-to-day encounters. The study finds that different social spaces – ’the office’ and ‘the field’ – and wider context explains the gendered, culturally complex and multidimensional nature of developmental work at grassroots level. Social expectations emerge as major pressure points more for female loan officers than their male counterparts, making them less suitable for microfinance work, which has traditionally targeted poor women

    Interrogating Microfinance Performance beyond Products, Clients and the Environment. Insights from the work of BRAC in Tanzania

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    The performance of microfinance organisations can depend upon many factors. Current research emphasizes factors pertaining to clients, products, or broader environments. But researchers have paid less attention to the workings and internal systems of microfinance organisations. We explore how variation in performance within an organisation can alter the consequences of loans and their popularity among clients and potential clients. We illustrate with data from BRAC in Tanzania, where the arrival and rapid expansion of BRAC’s microfinance programme provides an apposite case study
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