3. Overview
• Study timeline
• Methodology
• Intervention related findings from pre
assessment
• Intervention
• Results : TIPs
• Timeline
• Acknowledgement
3
4. Study timeline
Pre-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. Population for study
• Three pre-selected
rural districts DINAJPUR
• Representative
MANIKGONJ
CHITTAGONG
sample from these
districts
• Sampling method
used for qualitative
& quantitative
study
5
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. • 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. Factors Influencing HW Behavior
100
90
Soap / 82
80 HW Product
70
Social pressure 66
63
60
50
40
35
30
Belief in benefits & risks
20
15
10
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. Summary of Intervention related findings
Handwashing Complementary feeding
1. Barriers 1. Barriers
• Convenience • Knowledge
• Perception about illness – Quantity
• Social pressure – Frequency
– Diversity (animal food)
2. Source of information
• Convenience
3. Decision makers
2. Source of information
3. Decision makers
12
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
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. Materials used in Intervention
Reminder
Sticker
HW Job Aid
CF Job Aid 17
18. Channels of communication & intervention
Primary audience Secondary audience
Mother : 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. • Setting of Handwashing
stations
• Counseling & Demo of CF
20. • Village meeting & video
show
• Mothers group meeting
• Social Influential-
Orientation
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
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. 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. Data collection during the 3 assessments
Assessment Assessment Assessment
1 2 3
Informal discussion with 74 78 76
mothers
Unstructured observation 20 20 20
Video observation - - 12
GD: Family elders 4 4 4
GD: Influential villagers 4 4 4
25
26. Data collection : Pre & post intervention
Pre HH Post HH
survey survey
HH Survey (Randomly 454 444
sampled each time)
26
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. Hand washing with soap before food
preparation & feeding child* (%)
100 100 98 100 100 100
100
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. 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. 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. 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. 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. Exposure to the intervention
Pre Post
N=454 N=444
Indicators % %
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. Outcome Variables Results
Pre Post
N=454 N=444
Indicators % %
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. 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
38. Feasibility Trial: Timeline
Mass Media Mass Media Mass Media Mass Media
campaign campaign campaign campaign
TV (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. Next steps: Timeline
Scale up intervention
in nutrition program
2013
Launch of MMC
HW linked to CF
July/Aug
2012
Community level
implementation through
nutrition 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. 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 Gates
1= ICDDRB Foundation
2= Alive & Thrive
• USAID 40
