Suchergebnisse

Recognizing the need for evidence to inform public health officials and health care workers in the U.S. government and low- and middle-income country governments on efficient, effective behavior change policies, strategies, and programs for child health and development, the U.S. government convened the Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change. This article summarizes the background and methods for the acquisition and evaluation of the evidence used to the achieve the goals of the summit that is reviewed in other articles in this special issue of the Journal of Health Communication. The process began by identifying focal questions intended to inform the U.S. and low- and middle-income governments about behavior change interventions that accelerate reductions in under-5 mortality and optimize healthy and protective child development to 5 years of age. Experts were selected representing the research and program communities, academia, relevant nongovernmental organizations, and government agencies and assembled into evidence review teams. This was followed by the systematic gathering of relevant peer-reviewed literature that would inform the focal questions. Members of the evidence review teams were invited to add relevant articles not identified in the initial literature review to complete the bibliographies. Details of the search processes and methods used for screening and quality reviews are described. The evidence review teams were asked to comply with a specific evaluation framework for recommendations on practice and policy on the basis of both expert opinion and the quality of the data reviewed.

OBJECTIVES: UNICEF's Community Infant and Young Child Feeding (C-IYCF) Counselling Package (the Package), was launched by in 2010 to equip community workers for IYCF promotion. Though the Package was in use in at least 68 countries at the end of 2014, no formal evaluation of the Package had been conducted. In response, we evaluated the impact of the Package, when implemented at scale, on priority IYCF practices in Nigeria. METHODS: In collaboration with the Kaduna State Ministry of Health, two local government areas (LGA) (one intervention and one comparison) were selected. Intervention planning and implementation followed guidance provided in the Package. The Package was implemented in every ward of the intervention LGA for 18 months. It involved training 78 health workers and 238 community volunteers, community sensitization and mobilization events, support group meetings, home visits, review meetings, and supportive supervision. A baseline survey of mothers of children under two was conducted in early 2015 and the endline 2 years later in both LGAs. Survey instruments included modules on household characteristics and socioeconomic status, women's agency, as well as breastfeeding knowledge, attitudes, and practices. RESULTS: In the intervention LGA, the rate of early initiation of breastfeeding had increased by 10.4 percentage points more than in the comparison LGA, even after controlling for child, mother and household level covariates (P < 0.001). Similarly, the net adjusted change in the exclusive breastfeeding rate was 10.8 percentage points in favor of the intervention LGA (P < 0.01). No significant changes were observed on other IYCF practices CONCLUSIONS: The Package was effective at improving early breastfeeding initiation and exclusive breastfeeding. Other IYCF practices that are more sensitive to economic downturns and food prices may require a more sustained multi-sectoral investment with greater saturation. Additional research studying the impact of the Package, when implemented at scale in ...