Mr. Farhad Ali

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A QUALITATIVE ENQUIRY INTO ENABLERS AND BARRIERS TO BEHAVIOURS RELATED TO 7 POINT PLAN ON COMPREHENSIVE DIARRHEA CONTROL IN 4 DISTRICTS OF INDIA

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“A QUALITATIVE ENQUIRY INTO ENABLERS AND BARRIERS TO BEHAVIOURS RELATED TO 7 POINT PLAN ON COMPREHENSIVE DIARRHEA CONTROL IN 4 DISTRICTS OF INDIA ” FARHAD ALI SAVE THE CHILDREN, INDIA

A Qualitative Enquiry into Enablers and Barriers to Behaviours Related to 7 Point Plan on Comprehensive Diarrhea Control in 4 districts of India :

A Qualitative Enquiry into Enablers and Barriers to Behaviours Related to 7 Point Plan on Comprehensive Diarrhea Control in 4 districts of India Neeti Sharma, Farhad Ali, Arindam Ghatak , Prasann Thatte Save the Children, India  

Introduction:

Introduction Diarrhea is a second most common cause of death of children world-over. Most common cause of diarrhea is transmission of pathogen through oral-fecal mode. UNICEF/WHO 7 point plan which comprises treatment and prevention aspects of diarrhea has been a promising strategy for comprehensive diarrhea control. However Close to 50% children who fall sick to diarrhea do not get ORS and only around 9% get treatment with zinc in our settings.

Continues…..:

Continues….. In rural India, only 21% households have improved sanitation 67 % do not treat drinking water 47 % do not wash their hands after defecation . Save the Children undertook a qualitative study to learn the barriers and enablers related to exclusive breastfeeding, handwashing with soap, sanitation, ORS and zinc and childhood vaccination.

Key Objectives of the study:

Key Objectives of the study Understand how external factors influence specific behavioural practices around childhood diarrhea management- qualitative enquiry Investigate personal preferences and rationale behind people’s choice of specific diarrhea prevention and curative

Research Methodology Sampling strategy:

Research Methodology Sampling strategy

Sample Selection:

Sample Selection

Sampling FGDs:

Sampling FGDs State District Block Village/ GP Number of FGDs UP Balrampur Thulsipur MaharajGanj 1 Lal Bojhi 1 Shrawasti Gilaula Gujwala 1 Dikauli 1 Bahraich Payagpur Shiv Daha 1 Bhabiyawa 1 UK Udham Singh Nagar Sitarganj BaruawaBagh 2 TharuTisor 1

Sampling IDIs:

Sampling IDIs State District Block Village/ GP Number of IDIs UK Udham Singh Sitarganj Chaumhala 10 Rasoiyapur 10 UP Balrampur Thulsipur MahadeoGosai 10   Shrawasti Gilaula Raghunathpur 10 Pipri 10 Bahraich Payagpur Pakri Kalan 10

Key Findings :

Key Findings

Diarrhea Management by Caregivers :

Diarrhea Management by Caregivers

Immunization:

Immunization Knowledge (General)   Yes Knowledge (Diarrhea related)   No   Practice   Yes, not self-initiated   Enablers Barriers Timely support of ASHAs and AWWs in administration of vaccinations Knowledge dissemination by ASHAs Supply driven and not self initiated Few misconceptions around child falling ill because of immunizations indicating lack of knowledge on longer term benefits Inter-relations specifically with diarrhea are not established

Exclusive Breastfeeding:

Exclusive Breastfeeding Knowledge (General)   Yes Knowledge (Diarrhea related)   Mixed   Practice   Yes   Enablers Barriers Knowledge dissemination by ASHAs and doctors on breastfeeding practices Mothers were aware that they should continue to breastfeed the child even during diarrhea. Mixed perceptions on what to feed the child during an episode of diarrhea  

Hand Washing with Soap:

Hand Washing with Soap Knowledge (General)   Yes Knowledge (Diarrhea related)   Yes   Practice   Minimal   Enablers Barriers Awareness generation activities and campaigns. TV and ASHAs were cited as a source of information in Uttarakhand. Respondents are not motivated to follow the practice despite having knowledge of the same Doctors do not educate patients on important preventive steps Instances of soaps being expensive were cited ( Gujwala , UP)

Community Sanitation & Water Usage :

Community Sanitation & Water Usage Knowledge (General)   Yes Knowledge (Diarrhea related)   Yes   Practice   Minimal   Enablers Barriers Awareness generation activities and campaigns. TV and ASHAs were cited as a source of information. Access to private water taps in Uttarakhand.   Respondents were constrained by external environment factors. Surroundings areas of the house are unclean and maintaining cleanliness is a challenge. Monetary constraints in building of toilets. No community toilets in the village. Access water through Government hand pumps which are largely unclean. Lack of awareness on the importance of boiling and filtration of water at all times (not just during the time of diseases) Doctors do not provide information on prevention strategies at time of consultations .

ORS:

ORS Knowledge (Diarrhea related)   Yes   Practice   Yes   Enablers Barriers Awareness generation by ASHAs and Doctors who administer ORS in all cases of diarrhea   Respondents in UP were unaware of the exact terminology ORS packets are unavailable in local kirana shops, with respondents having to reach out to an ASHA or RMP in all instances. ASHAs, on the other hand, sourced their stock of medicines from local medical shops when their stock of medicines was limited  

Zinc:

Zinc Knowledge (Diarrhea related)   No   Practice   Yes (as prescribed by doctors/ ASHAs)   Enablers Barriers Recommendation by ASHA/Doctor Lack of awareness and knowledge on its use Perception that it does not provide relief  

Conclusion:

Conclusion Primary influencers were noted to be doctors and ASHAs; whereas, village heads, mothers – in –law, husbands, religious leaders, and elders were not found to influence decisions around child healthcare. Communication strategy on 7 point comprehensive diarrhea control should consider these findings.

Acknowledgement :

Acknowledgement Financial support from RB and technical support for save the children UK is duly acknowledged.

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