Feasibility Trial : Intervention Design & Findings    Improving Handwashing with Soap and             Complementary Feedin...
Sumitro Roy Jean Baker      (Presenter)(Introduction)
Overview• Study timeline• Methodology• Intervention related findings from pre  assessment• Intervention• Results : TIPs• T...
Study timelinePre-assessment :       Designing of          Trials of Improved                       intervention:         ...
Population for study• Three pre-selected  rural districts                DINAJPUR• Representative                         ...
Selecting communities                   5 Upazilas                  1 Manikgonj           10 unions                   2 Di...
Selecting Villages                       70 villages                     (7 each union)                   50 villages- bas...
Intervention related findings from pre             assessment                              8
Qualitative Findings:• Child eats same family foods usually• Mothers take the decision regarding child food• Most responde...
• Lack of soap/soapy materials in a convenient place is a  perceived barrier• Participants ranked ‘Nurture’ as a best moti...
Factors Influencing HW Behavior10090                                                                                      ...
Summary of Intervention related findingsHandwashing                  Complementary feeding1. Barriers                  1. ...
Intervention
Behavioral Objectives• Handwashing with soap & water before food  preparation and feeding the child  – Maintaining handwas...
Handwashing        Food preparation              Feeding                          15
Content & messages Handwashing                Complementary feeding• Establish & maintain      • Age specific quantity  HW...
Materials used in InterventionReminderSticker                                          HW Job Aid           CF Job Aid    ...
Channels of communication & interventionPrimary audience          Secondary audienceMother : 6-24 m           Father & Gra...
• Setting of Handwashing  stations• Counseling & Demo of CF
• Village meeting & video  show• Mothers group meeting• Social Influential-  Orientation
Community level intervention• Establish handwashing station & reminder stickers• Each HH received four counseling visits b...
Mass media messages                Germ Ghost-HW                Diversity - CF
Intervention coverage• Intervention across all    • TIPs assessment (quali)  20 villages with total       done in 80 HH fr...
Steps of qualitative assessments                     Implement                    Interventions   Assessment 3            ...
Data collection during the 3 assessments                            Assessment   Assessment   Assessment                  ...
Data collection : Pre & post intervention                         Pre HH   Post HH                         survey    surve...
Results: TIPs                27
Coverage/Participation in Interventions*                                       Home visit                                 ...
Hand washing with soap before food        preparation & feeding child* (%)          100 100       98      100 100 100100  ...
Regular use & maintenance of HWS*                                                   (%)100                                ...
Quantity & Frequency of CF* (%)100                89      88 90                                              82 80        ...
Four varieties of CF* (%)100                88      90 90 80                                              74 70       67 6...
Mothers behavior on Handwashing in both        categories of villages (%)                                         86   89 ...
Exposure to the intervention                                                        Pre     Post                          ...
Outcome Variables Results                                                        Pre     Post                             ...
Mothers suggestions•   Continue all activities until all mothers get habituated•   Conduct inter-personal communication (I...
Timeline
Feasibility Trial: TimelineMass Media                     Mass Media                  Mass Media               Mass Media ...
Next steps: Timeline                                         Scale up intervention                                        ...
Acknowledgements•   Dr Stephan      Luby1     • Fosiul Nizame1•   Dr Leanne Unicomb1        • Debashish Biswas1•   Dr Nusr...
Discussion             41
Sumitro roy  design and findings hq- edited version
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Sumitro roy design and findings hq- edited version

  1. 1. Feasibility Trial : Intervention Design & Findings Improving Handwashing with Soap and Complementary Feeding Brownbag , May 30, 2012 FHI360 SUMITRO ROY Deputy Country Director, A&T Bangladesh May 30, 2012
  2. 2. Sumitro Roy Jean Baker (Presenter)(Introduction)
  3. 3. Overview• Study timeline• Methodology• Intervention related findings from pre assessment• Intervention• Results : TIPs• Timeline• Acknowledgement 3
  4. 4. Study timelinePre-assessment : Designing of Trials of Improved intervention: Practices (TIPs) To inform integrated Handwashing intervention into Infant and development Young Child  Feeding  Qualitative Qualitative Quantitative Quantitative Dec 2010 to March to Sept 2011 to Feb 2011 June 2011 Jan 2012 4
  5. 5. Population for study• Three pre-selected rural districts DINAJPUR• Representative MANIKGONJ CHITTAGONG sample from these districts• Sampling method used for qualitative & quantitative study 5
  6. 6. Selecting communities 5 Upazilas 1 Manikgonj 10 unions 2 Dinajpur (2 each upazila)3 districts 2 Chittagong Exclude -A&T upazilas -<10 villages 6
  7. 7. Selecting Villages 70 villages (7 each union) 50 villages- baseline 10 unions 15 villages-(2 each upazila) structure obs. 20 villages Intervention (TIPs) 7
  8. 8. Intervention related findings from pre assessment 8
  9. 9. Qualitative Findings:• Child eats same family foods usually• Mothers take the decision regarding child food• Most respondents relate the child food contamination with the dust/dirt• A good portion of people have handwashing knowledge, but this did not translate into practice• Observed data showed that caregivers occasionally wash their hands before preparing food or feeding a child but with water only 9
  10. 10. • Lack of soap/soapy materials in a convenient place is a perceived barrier• Participants ranked ‘Nurture’ as a best motivator and ‘Disgust’ as a second best motivator to wash hands with soap• Community prefers visual actions like drama, video projection to promote hygiene behavior• According community, along with doctors, community leaders could also be effective agents to promote positive behavior change 10
  11. 11. Factors Influencing HW Behavior10090 Soap / 8280 HW Product70 Social pressure 66 63605040 3530 Belief in benefits & risks20 1510 0 0 HW with soap prevents HW with soap prevents Family support needed Others don’t practice Convenience Soap NOT costly Diarrhea Cough & Cold soap/soapy water N= 350 ICDDRB-A&T, Baseline
  12. 12. Summary of Intervention related findingsHandwashing Complementary feeding1. Barriers 1. Barriers• Convenience • Knowledge• Perception about illness – Quantity• Social pressure – Frequency – Diversity (animal food)2. Source of information • Convenience3. Decision makers 2. Source of information 3. Decision makers 12
  13. 13. Intervention
  14. 14. Behavioral Objectives• Handwashing with soap & water before food preparation and feeding the child – Maintaining handwashing station- Soap & water near to food preparation & child feeding area• Complementary feeding : Correct quantity & frequency• Complementary feeding: Four varieties including one animal food daily 14
  15. 15. Handwashing Food preparation Feeding 15
  16. 16. Content & messages Handwashing Complementary feeding• Establish & maintain • Age specific quantity HW station and frequency• Washing hand with • Diversity – 4 varieties soap before food including one animal preparation of child by food daily mother/caregiver • Use of family food• Washing of child hands • Continue breast feeding with soap before self feeding 16
  17. 17. Materials used in InterventionReminderSticker HW Job Aid CF Job Aid 17
  18. 18. Channels of communication & interventionPrimary audience Secondary audienceMother : 6-24 m Father & Grandparents• Setting up of HW • Mass media-TV & radio station • Village Meetings with video• Mass media-TV & radio show• HH visit Community leaders• Mothers Group • CHWs, Religious leaders, Meetings • V.Doctors, School teachers• Video show at village • Union chairman & member meeting 18
  19. 19. • Setting of Handwashing stations• Counseling & Demo of CF
  20. 20. • Village meeting & video show• Mothers group meeting• Social Influential- Orientation
  21. 21. Community level intervention• Establish handwashing station & reminder stickers• Each HH received four counseling visits by trained Community volunteers/Community health workers• Mobile phone stickers at every target HH• Three village meetings for target audience with video show• Monthly mothers group meetings• Half day orientation of village doctors, imams, school teachers & union leaders on Handwashing & complementary feeding 21
  22. 22. Mass media messages Germ Ghost-HW Diversity - CF
  23. 23. Intervention coverage• Intervention across all • TIPs assessment (quali) 20 villages with total done in 80 HH from 4 834 HH of 6-24 m villages Hardware & children software• Pre & Post HH survey • 40 HH given HW stations & done across 20 villages; 40 HH encouraged to randomly sampled 454 arrange their own & 444 HH respectively 23
  24. 24. Steps of qualitative assessments Implement Interventions Assessment 3 Assessment 1 Day 83 Day 20 Program Design Implement Implement Interventions Interventions Assessment 2 Day 58 24
  25. 25. Data collection during the 3 assessments Assessment Assessment Assessment 1 2 3Informal discussion with 74 78 76mothersUnstructured observation 20 20 20Video observation - - 12GD: Family elders 4 4 4GD: Influential villagers 4 4 4 25
  26. 26. Data collection : Pre & post intervention Pre HH Post HH survey survey HH Survey (Randomly 454 444 sampled each time) 26
  27. 27. Results: TIPs 27
  28. 28. Coverage/Participation in Interventions* Home visit 100 Installation of HWS Intervention activities 98 HW stickers 97 Village meeting 87 TV ads 50 Mothers Group Meeting 47 0 20 40 60 80 100 120 % of mothers* Reported by mothers during assessment # 3 28
  29. 29. Hand washing with soap before food preparation & feeding child* (%) 100 100 98 100 100 100100 78 75 80 60 60 56 38 40 29 20 0 Understand risk & Has tried Currently practicing Intend to adopt & benefits (of those who have tried) continue (of those currently practicing) Assessment-1 Assessment-2 Asseessment-3* Reported by mothers 29
  30. 30. Regular use & maintenance of HWS* (%)100 96 98 91 90 85 80 73 72 65 60 54 50 40 37 20 16 0 Understand risk & Has tried Currently practicing Intend to adopt & benefits (of those who have tried) continue (of those currently practicing) Assessment-1 Assessment-2 Assessment-3* Reported by mothers 30
  31. 31. Quantity & Frequency of CF* (%)100 89 88 90 82 80 78 70 67 64 60 50 44 43 42 40 38 31 30 20 18 10 0 Understand risk & Has tried Currently practicing Intend to adopt & benefits (of those who have tried) continue (of those currently practicing) Assessment-1 Assessment-2 Assessment-3* Reported by mothers 31
  32. 32. Four varieties of CF* (%)100 88 90 90 80 74 70 67 60 57 50 42 40 33 30 27 19 20 15 10 7 5 0 Understand risk & Has tried Currently practicing Intend to adopt & benefits continue Assessment-1 Assessment-2 Assessment-3* Reported by mothers 32
  33. 33. Mothers behavior on Handwashing in both categories of villages (%) 86 89 100 80 90 71 71 63 80 70 53 60 50 28 40 30 20 10 0 Hardware Software Hardware Software Ass-1 Ass-3 Regular use & maintenance of HWS HWWS before food preparation & feeding 33
  34. 34. Exposure to the intervention Pre Post N=454 N=444Indicators % % Health worker home visit 17 98* Attended mothers’ group meeting - 67 Attended video show in the community - 68 Recalled TV message 26 34* Handwashing station with soap is near cooking/feeding area - 65 * Statistically significant 34
  35. 35. Outcome Variables Results Pre Post N=454 N=444Indicators % % Handwashing Perception that illness is caused by not handwashing with soap 14 75* Handwashing with soap at both key times 12 79* Acceptable complementary feeding Perception about correct quantity 59 93* Practice of acceptable complementary feeding 32 61* * Statistically significant 35
  36. 36. Mothers suggestions• Continue all activities until all mothers get habituated• Conduct inter-personal communication (IPC) with other members of the household, including the male members• Arrange more quiz session and prize giving in group meetings• Involve students in this intervention• Arrange video show in public places such as school field or local markets (bazaars)• Provide HWS to all households• Provide nutritious food to the children free of cost 36
  37. 37. Timeline
  38. 38. Feasibility Trial: TimelineMass Media Mass Media Mass Media Mass Media campaign campaign campaign campaignTV (BF, CF) TV (BF, CF) TV (BF, CF) TV (BF, CF, HW)Qualitative and quantitative Intervention Trial HW+CF assessment 2010 A-1 A-2 A-3 0D 20th D 58th D 83th D Trial Trial April 19 start date assessment end date Oct 2011 qualitative Dec 2011 Pre HH Survey Post HH Survey
  39. 39. Next steps: Timeline Scale up intervention in nutrition program 2013 Launch of MMC HW linked to CF July/Aug 2012Community levelimplementation throughnutrition program June/July 2012 Community level implementation National workshop through water Scale up July 2012 , sanitation & intervention in hygiene program water, sanitation & July/Aug 2012 hygiene program Core group meeting 2013 April 30 National April 19 Dissemination
  40. 40. Acknowledgements• Dr Stephan Luby1 • Fosiul Nizame1• Dr Leanne Unicomb1 • Debashish Biswas1• Dr Nusrat Najnin1 • Aasma Afroz1• Gazi Salahuddin1 • Dorothy Southern1• Probir Kumar Ghosh1 • Sumitro Roy A&T2• Field Research Officers • Dr Tina Sanghvi A&T2 and Assistants (N=14)1 • Val Curtis/Robert Aunger, LSHTM • Bill and Melinda Gates1= ICDDRB Foundation2= Alive & Thrive • USAID 40
  41. 41. Discussion 41

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