How a large-scale SBC program was able to improve womens dietary and healthcare-seeking behaviors in Tanzania
Summary:
The ASTUTE program in Tanzania uses radio campaigns, support groups, home visits using negotiation, positive deviance, and health facility counsel to improve womens diets and antenatal care-seeking. We documented the impact of an MCH program and explored how improvements in maternal health behaviors came about. We conducted a baseline and midline survey with data for 5,000 women with children < 2 years old. We used descriptive and multivariate analyses to test associations between program exposure, health behaviors, and their determinants. From baseline to midline, there were significant improvements in behaviors: 34% and 79% of women sought any antenatal care, respectively, and the percent of women receiving 4+ visits, purchasing iron tablets, eating more and diverse types of foods while pregnant rose by at least 10 percentage points. At midline, women were more likely to be visited by a CHW (19% vs. 2%) and hear project-specific radio broadcasts emphasizing nutrition and ANC (55% vs. 0%). Between baseline and midline, there was an improvement of at least 10 percentage points in womens attitude and decision-making, as well as support from husbands. However, at midline, women were less likely to participate in womens groups and to receive advice about maternal nutrition from health facility workers (88% versus 94%). Program planners and implementers may see even greater impact when they are able to increase program coverage. Our results also point to the importance of more equitable decision-making about womens healthcare and the role men can play in reducing womens workload.
Background/Objectives:
Womens diets and access to health services are critical to the well-being of mothers and children. While there are numerous examples of large-scale programs to improve both, not all MCH programs have a health impact. Those that do are often not rigorously documented, depriving program planners of information they need to bring about large-scale improvements in pregnancy-related behaviors. Our purpose is to document statistically significant differences in maternal health behaviors and explore how improvements in such behaviors came about.
Description of Intervention and/or Methods/Design:
ASTUTE is a 4.5-year nutrition program targeting 3.6 million women and children < 2 years old in northwestern Tanzania. ASTUTE strengthens government and primary caregivers capacity to improve practices related to nutrition, WASH, early childhood development, and womens workload. SBC interventions include large-scale radio and TV campaigns, support groups, home visits using negotiation for behavior change, and positive deviance/hearth. Strengthening counselling at health facilities has been an important component of ASTUTEs work. We examined ASTUTEs baseline (before programs began) and midline (three years later) data, collected from primary caregivers. Both the baseline and midline each included 5,000 women with children < 2 years old who were selected using two-stage cluster sampling. We used chi-squares, t-tests, and multivariate regression to test associations between program exposure, health behaviors, and their determinants.
Results/Lessons Learned:
From baseline to midline, there were large, significant improvements in behaviors: 34% and 79% of women sought any antenatal care, respectively, and the percent of women receiving 4+ visits, purchasing iron tablets, eating more and diverse types of foods while pregnant rose by at least 10 percentage points. The mechanism for such improvements is not clear though exposure to programs appears to be important. At midline, women were more likely to be visited by a CHW (19% vs. 2%), hear nutrition messages from CHWs (13% vs. 6%) and hear project-specific radio broadcasts emphasizing nutrition and ANC (55% vs. 0%) but less likely to participate in womens groups and to receive advice about maternal nutrition from health facility workers (88% versus 94%). Between baseline and midline, there was an improvement of at least 10% in womens attitude and decision-making, as well as support from husbands.
Discussion/Implications for the Field:
Documenting the impact of large-scale health programs is imperative. Understanding how such programs achieve impact is equally important. We have documented improvements in womens diets and healthcare-seeking behaviors stemming from a large-scale nutrition program, even though program exposure was not universal. Program planners and implementers should work to identify ways of increasing program exposure to bring about even greater change, though this may prove difficult in resource-limited settings. Our results also point to the importance of more equitable decision-making about womens healthcare and the role men can play in reducing womens workload.
Abstract submitted by:
Kirk A Dearden - IMA World Health
Generose Mulokozi - IMA World Health
Joseph Mugyabuso - IMA World Health
Benesta Masau - IMA World Health
Kerry Ann Dobies
The ASTUTE program in Tanzania uses radio campaigns, support groups, home visits using negotiation, positive deviance, and health facility counsel to improve womens diets and antenatal care-seeking. We documented the impact of an MCH program and explored how improvements in maternal health behaviors came about. We conducted a baseline and midline survey with data for 5,000 women with children < 2 years old. We used descriptive and multivariate analyses to test associations between program exposure, health behaviors, and their determinants. From baseline to midline, there were significant improvements in behaviors: 34% and 79% of women sought any antenatal care, respectively, and the percent of women receiving 4+ visits, purchasing iron tablets, eating more and diverse types of foods while pregnant rose by at least 10 percentage points. At midline, women were more likely to be visited by a CHW (19% vs. 2%) and hear project-specific radio broadcasts emphasizing nutrition and ANC (55% vs. 0%). Between baseline and midline, there was an improvement of at least 10 percentage points in womens attitude and decision-making, as well as support from husbands. However, at midline, women were less likely to participate in womens groups and to receive advice about maternal nutrition from health facility workers (88% versus 94%). Program planners and implementers may see even greater impact when they are able to increase program coverage. Our results also point to the importance of more equitable decision-making about womens healthcare and the role men can play in reducing womens workload.
Background/Objectives:
Womens diets and access to health services are critical to the well-being of mothers and children. While there are numerous examples of large-scale programs to improve both, not all MCH programs have a health impact. Those that do are often not rigorously documented, depriving program planners of information they need to bring about large-scale improvements in pregnancy-related behaviors. Our purpose is to document statistically significant differences in maternal health behaviors and explore how improvements in such behaviors came about.
Description of Intervention and/or Methods/Design:
ASTUTE is a 4.5-year nutrition program targeting 3.6 million women and children < 2 years old in northwestern Tanzania. ASTUTE strengthens government and primary caregivers capacity to improve practices related to nutrition, WASH, early childhood development, and womens workload. SBC interventions include large-scale radio and TV campaigns, support groups, home visits using negotiation for behavior change, and positive deviance/hearth. Strengthening counselling at health facilities has been an important component of ASTUTEs work. We examined ASTUTEs baseline (before programs began) and midline (three years later) data, collected from primary caregivers. Both the baseline and midline each included 5,000 women with children < 2 years old who were selected using two-stage cluster sampling. We used chi-squares, t-tests, and multivariate regression to test associations between program exposure, health behaviors, and their determinants.
Results/Lessons Learned:
From baseline to midline, there were large, significant improvements in behaviors: 34% and 79% of women sought any antenatal care, respectively, and the percent of women receiving 4+ visits, purchasing iron tablets, eating more and diverse types of foods while pregnant rose by at least 10 percentage points. The mechanism for such improvements is not clear though exposure to programs appears to be important. At midline, women were more likely to be visited by a CHW (19% vs. 2%), hear nutrition messages from CHWs (13% vs. 6%) and hear project-specific radio broadcasts emphasizing nutrition and ANC (55% vs. 0%) but less likely to participate in womens groups and to receive advice about maternal nutrition from health facility workers (88% versus 94%). Between baseline and midline, there was an improvement of at least 10% in womens attitude and decision-making, as well as support from husbands.
Discussion/Implications for the Field:
Documenting the impact of large-scale health programs is imperative. Understanding how such programs achieve impact is equally important. We have documented improvements in womens diets and healthcare-seeking behaviors stemming from a large-scale nutrition program, even though program exposure was not universal. Program planners and implementers should work to identify ways of increasing program exposure to bring about even greater change, though this may prove difficult in resource-limited settings. Our results also point to the importance of more equitable decision-making about womens healthcare and the role men can play in reducing womens workload.
Abstract submitted by:
Kirk A Dearden - IMA World Health
Generose Mulokozi - IMA World Health
Joseph Mugyabuso - IMA World Health
Benesta Masau - IMA World Health
Kerry Ann Dobies
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: IMA World Health