scholarly journals Use of Community-based Interventions to Promote Family Planning Use Among Pastoralist Women in Ethiopia: Cluster Randomized Controlled Trial

2020 ◽  
Author(s):  
Mussie Alemayehu ◽  
Araya Abrha Medhanyie ◽  
Elizabeth Reed ◽  
Afework Mulugeta Bezabih

Abstract Background- Afar region is one of the pastoralists dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) with 5.4%. Lack of awareness, husband objection, and religious influence was the reasons attributed to low CPR in the region. As objective we assessed the effect of a community-based interventions for promoting FP use among pastoralist communities of Afar region state, Ethiopia.MethodsThe design was parallel, cluster randomized controlled trial (CRT) recruiting married women. It had three arms: 1) women’s education on FP, 2) male involvement in FP education and 3) control with one to one ratio. A total of 33 kebeles (lowest administrative structure) were randomized and allocated. Women’s FP education and male involvement in FP education were the interventions. It was implemented using 1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group) 2) Video-assisted message on FP, and 3) Assisting the faema leader using health workers. The intervention was given for a total of 9 months. FP use and intentions were measured as outcome variables based on woman’s perspectives. Cluster level summaries considering a cluster effect analysis was performed. The result was presented with adjusted risks and 95% CI. A p-value < 0.05 was used to declare statistically significant.ResultsThere was a positive change in the proportion of married women who use FP in the women’s FP education arm, absolute risk (AR) of 0.13(95% CI,0.08,0.17) and male involvement arm with AR of 0.29 (95% CI, 0.23,0.34) as compared to the control arm. In the control arm, the proportion of FP use was 4.3%, whereas it was 17.5% with women who receive FP education and 34% in the male involvement arm. Furthermore, the proportion of married women who had high intention to use FP was high in arms of women’s FP education and male involvement with AR = 3.4(95% CI: 2.48,4.91) and AR = 2.1 (95% CI: 1.5,2.95), respectively as compared with the control arm.ConclusionThe community-based interventions brings a significant change in increasing FP users and intention to use FP.Trial registration : NCT03450564

2021 ◽  
Author(s):  
Mussie Alemayehu ◽  
Araya Abrha Medhanyie ◽  
Elizabeth Reed ◽  
Afework Mulugeta Bezabih

Abstract Background: - Afar region is one of the pastoralists dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) with 5.4%. Lack of awareness, husband objection, and religious influence was the reasons attributed to low CPR in the region. As objective we assessed the effect of a community-based interventions for promoting FP use among pastoralist communities of Afar region state, Ethiopia.Methods: The design was parallel, cluster randomized controlled trial (CRT) recruiting married women. It had three arms: 1) women’s education on FP, 2) male involvement in FP education and 3) control with one to one ratio. A total of 33 kebeles (lowest administrative structure) were randomized and allocated. Women’s FP education and male involvement in FP education were the interventions. It was implemented using 1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group) 2) Video-assisted message on FP, and 3) Assisting the faema leader using health workers. The intervention was given for a total of 9 months. FP use and intentions were measured as outcome variables based on woman’s perspectives. Cluster level summaries considering a cluster effect analysis was performed. The result was presented with adjusted risks and 95% CI. A p-value <0.05 was used to declare statistically significant.Results: There was a positive change in the proportion of married women who use FP in the women’s FP education arm, absolute risk (AR) of 0.13(95% CI,0.08,0.17) and male involvement arm with AR of 0.29 (95% CI, 0.23,0.34) as compared to the control arm. In the control arm, the proportion of FP use was 4.3%, whereas it was 17.5% with women who receive FP education and 34% in the male involvement arm. Furthermore, the proportion of married women who had high intention to use FP was high in arms of women’s FP education and male involvement with AR=3.4(95% CI: 2.48,4.91) and AR=2.1 (95% CI: 1.5,2.95), respectively as compared with the control arm. Conclusion: The present study highlighted the effctienesswomen’s education on FP and male involvement in FP education brings a significant change in increasing the number of women who use FP and intention. Using the community-led support groups in the pastoralist community appears to be effective in increasing the number of women FP users and intention to use.Trial registration: NCT03450564


Author(s):  
Mussie Alemayehu ◽  
Araya Abrha Medhanyie ◽  
Elizabeth Reed ◽  
Afework Mulugeta Bezabih

AbstractObjectiveWe assessed the effect of a community-based intervention for promoting FP use and intention among pastoralist communities of Afar region state, Ethiopia.MethodsThe design was parallel, cluster randomized controlled trial (CRT) recruiting married women. It had three arms: 1) women’s FP education, 2) male involvement and 3) control with one to one ratio. A total of 33 kebeles were randomized and allocated. Data were collected through an open data kit. Women’s FP education and male involvement in FP service were the interventions. It was implemented with the assistance of a faema leader using a separate group meeting for males and women and disseminates video recorded messages on FP. The intervention was given for a total of 9 months. FP use and intentions were measured. Cluster level summaries considering a cluster effect analysis was performed. The result was presented with adjusted risks and 95% CI. A p-value < 0.05 was used to declare statistically significant.ResultsThere was a positive change in the proportion of married women who use FP in the women’s FP education arm, absolute risk (AR) of 0.13(95% CI,0.08,0.17) and male involvement arm with AR of 0.29 (95% CI, 0.23,0.34) as compared to the control arm. In the control arm, the proportion of FP use was 4.3%, whereas it was 17.5% with women who receive FP education and 34% in the male involvement arm. Furthermore, the proportion of married women who had high intention to use FP was high in arms of women’s FP education and male involvement with AR = 3.4(95% CI: 2.48,4.91) and AR = 2.1 (95% CI: 1.5,2.95), respectively as compared with the control arm.ConclusionThe community-based intervention (male involvement and women’s education about FP use) brings a significant change in increasing FP users and promotes the intention to use FP.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mussie Alemayehu ◽  
Araya Abrha Medhanyie ◽  
Elizabeth Reed ◽  
Afework Mulugeta Bezabih

Abstract Background Afar region is one of the pastoralist dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) of 5.4%. Lack of awareness of contraceptive use, husband objection and religious barriers are attributed to low CPR in the region. This study assessed the effect of community-based interventions for promoting family planning (FP) use among pastoralist communities in Ethiopia. Methods The study design was a three-arm, parallel, clustered randomized controlled trial (CRT). The three study arms were: (1) male involvement in family planning (FP) education; (2) women’s education on FP; and (3) control. A total of 33 clusters were randomized and allocated with a one-to-one ratio. Intervention components included (1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group); (2) video-assisted message on FP; and (3) assisting the faema leader using health workers and health extension workers (HEWs). The intervention was given for a total of nine months. FP use and intentions were measured as outcome variables. In addition, a cluster-level summary considering a cluster effect analysis was performed. The result was presented with t.test, adjusted risks and its 95% confidence interval (CI). Results The proportion of FP use among the arms was 34% in the male involvement in FP education, 17.5% in women’s education on FP and 4.3% in the control. There was a positive change in the proportion of FP use in the male involvement in FP education and women’s education on FP arms with absolute risk (AR) of 0.29 (95% CI, 0.23,0.34) and 0.13 (95% CI,0.08,0.17), respectively, as compared to the control arm. Similarly, married women in the male involvement in FP education and women’s education on FP arms had 3.4 (2.48, 4.91) and 2.1 (1.50, 2.95) higher intention to use FP, respectively, as compared with the control arm. Conclusion The present study suggests that in such male-dominated pastoralist communities with more considerable religious barriers, the community-based health education mainly targeting males appears to be a promising strategy for improving FP use and intention to use FP. Trial registration ClinicalTrials.gov, NCT03450564, March, 2018.


Author(s):  
Cláudia Fançony ◽  
Ânia Soares ◽  
João Lavinha ◽  
Henrique Barros ◽  
Miguel Brito

Angola reports one of the highest infant mortality rates in the world, and anemia represents one of its important causes. Recent studies, in under-five children from the Bengo province of Angola, described high prevalence’s, suggesting malaria, undernutrition and urogenital schistosomiasis as important contributors for the occurrence and spatial variations of anemia. Educational community-based interventions, either in Nutrition and Water, Sanitation, Hygiene and Malaria are recommended to correct anemia. Herein, we designed a cluster-randomized controlled trial to study the efficacy of two educational-plus-therapeutic interventions in the reduction of anemia: one in nutrition and the other in WASH/Malaria. Socioeconomic, nutritional, anthropometric, parasitological and biochemical data will be collected from all willing-to-participate children, aging under four and resident in the Health Research Center of Angola study area. Considering the multifactorial causes of this condition, determining the efficacy of both interventions might help documenting weaknesses and opportunities for planning integrated strategies to reduce anemia.


2020 ◽  
Author(s):  
Stephen Hodgins ◽  
Binamra Rajbhandari ◽  
Deepak Joshi ◽  
Bharat Ban ◽  
Subarna Khatry ◽  
...  

Abstract Background: Most newborn deaths occur among those of low birthweight (LBWt), due to prematurity &/or impaired fetal growth. Simple practices can mitigate this risk. In low-income country settings where many births occur at home, strategies are needed that empower mothers to determine if their babies are higher risk and take protective measures. Earlier studies suggest that foot-length may be a good proxy for birthweight. An earlier Nepal study found a 6.9cm cut-off performed relatively well, differentiating normal from low birthweight.Methods: Community-based, cluster-randomized controlled trial. Objective: to determine whether family-administered screening, with targeted messages improves care practices known to mitigate LBWt risks. Participants: pregnant women participating in a parent trial in rural Nepal. Women were given a 6.9cm card to assess whether the baby’s foot is small; if so, to call number on the card for advice. Follow-up visits were made over 2 weeks following the birth, assessing for: reported skin-to-skin thermal care, and care-seeking outside the home; restricting to low birthweight (using 2 cutoffs: 2,500g and 2,000g). Randomization: 17 clusters intervention, 17 control. The study also documented steps along the presumed causal chain from intervention through behavioral impact.Results: 2,022 into intervention, 2,432 into control. Intervention arm: 519 with birthweight <2,500g (vs. 663 among controls), of which 503 were available for analysis (vs. 649 among controls). No significant difference on care-seeking; for those <2,500g RR 1.13 (95%CI: 0.97-1.131). More of those in the intervention arm reported skin-to-skin thermal care than among controls; for those <2,500g RR 2.50 (95%CI: 2.01-3.1). Process measures suggest this apparent effect cannot be attributed to the intervention; the card performed poorly as a proxy for LBWt, misclassifying 84.5% of those <2,000 as normal.Conclusions: Although the trial found an apparent effect on one key behavioral outcome, this cannot be attributed to the intervention; most likely it was a result of pure chance. Other approaches are needed for identifying at-risk babies in such settings, and targeting them for appropriate care messaging.Trial registration : clinicaltrials.gov identifier: NCT02802332, registered 16 June 2016, https://clinicaltrials.gov/ct2/show/NCT02802332


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