3 research outputs found
Multiple behaviour change intervention for diarrhoea control in Lusaka, Zambia: a cluster randomised trial
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
Exploring community participation in project design: application of the community conversation approach to improve maternal and newborn health in Zambia
Abstract Background The United Nations Development Programme (UNDP) has adopted an approach entitled Community Conversation (CC) to improve community engagement in addressing health challenges. CCs are based on Paulo Freire’s transformative communication approach, in which communities pose problems and critically examine their everyday life experiences through discussion. We adopted this approach to engage communities in maternal and newborn health discussions in three rural districts of Zambia, with the aim of developing community-generated interventions. Methods Sixty (60) CCs were held in three target districts, covering a total of 20 health facilities. Communities were purposively selected in each district to capture a range of rural and peri-urban areas at varying distances from health facilities. Conversations were held four times in each community between May and September 2014. All conversations were digitally recorded and later transcribed. NVivo version 10 was used for data analysis. Results and Discussion The major barriers to accessing maternal health services included geography, limited infrastructure, lack of knowledge, shortage of human resources and essential commodities, and insufficient involvement of male partners. From the demand side, a lack of information and misconceptions, and, from the supply side, inadequately trained health workers with poor attitudes, negatively affected access to maternal health services in target districts either directly or indirectly. At least 17 of 20 communities suggested solutions to these challenges, including targeted community sensitisation on the importance of safe motherhood, family planning and prevention of teenage pregnancy. Community members and key stakeholders committed time and resources to address these challenges with minimal external support. Conclusion We successfully applied the CC approach to explore maternal health challenges in three rural districts of Zambia. CCs functioned as an advocacy platform to facilitate direct engagement with key decision makers within the community and to align priorities while incorporating community views. There was a general lack of knowledge about safe motherhood and family planning in all three districts. However, other problems were unique to health facilities, demonstrating the need for tailored interventions