TY - JOUR
T1 - Formative research for the development of baby water, sanitation, and hygiene interventions for young children in the Democratic Republic of the Congo (REDUCE program)
AU - Kuhl, Jennifer
AU - Bisimwa, Lucien
AU - Thomas, Elizabeth D.
AU - Williams, Camille
AU - Ntakirutimana, Joseph
AU - Coglianese, Nicole
AU - Bauler, Sarah
AU - Francois, Ruthly
AU - Sanvura, Presence
AU - Bisimwa, Jean Claude
AU - Mirindi, Patrick
AU - George, Christine Marie
N1 - Funding Information:
This research was made possible by the support of the American People through the United States Agency for International Development (USAID). This material is based in part upon work supported by the USAID Office of Food for Peace, under a Development Food Security Activity (DFSA), led by Food for the Hungry in South Kivu region of DRC. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of partner organizations or the U.S. Government. A special thank you to Phil Moses and Amagana Togo at Food for the Hungry for their support, and Precious Sancho, Kyla Gregoire, and Nicole Van Abel at the USAID Office of Food for Peace. We also thank the study participants and the following Research Supervisors and Assistants who were crucial to the successful implementation of this study: Alves Namunesha, Willy Mapendano, Eric-Yves Iragi, Pascal Tezangi, Blessing Muderhwa, Manu Kabiyo, Fraterne Luhiriri, Wivine Ntumba, Julienne Rushago, Pacifique Kitumaini, Freddy Endelea, Claudia Bazilerhe, Jean Claude Lunye Lunye, Adolophine F. Rugusha, Gisele N. Kasanzike, Brigitte Munyerenkana, Jessy T. Mukulikire, Dieudonné Cibinda, Jean Basimage, and Siloé Barhuze.
Funding Information:
This study received financial support from the United States Agency for International Development. The funder had a role in the design of the study, and the provided feedback on the manuscript before submission.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Research exploring the unique exposure pathways to fecal pathogens for young children and innovative water, sanitation, and hygiene (WASH) interventions for susceptible pediatric populations is needed to reduce the burden of diarrheal diseases and stunting globally. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to 1) identify exposure pathways to fecal pathogens that are significant contributors to morbidity for young children in South Kivu, Democratic Republic of the Congo, and 2) develop and evaluate scalable interventions that reduce fecal contamination and exposure from these pathways. The formative research portion of the project sought to identify feasible and acceptable WASH interventions to modify behaviors found to be associated with diarrheal disease and impaired growth in our REDUCE cohort study. Methods: Ninety-one semi-structured interviews, 6 focus group discussions, and a pilot study of 102 households were conducted during 24 months of formative research. Thirty-one interviews and six focus group discussions were conducted with caregivers, community health workers, and village leaders to explore existing WASH practices and to identify barriers and facilitators to WASH behaviors. Findings were organized using the Integrated Behavioral Model for Water, Sanitation and Hygiene to facilitate interpretation and identify determinants to Baby WASH behaviors in this setting. Care Group modules and enabling technology were developed based on exploratory findings and then revised during a two-part, iterative pilot study. Sixty interviews were conducted with participants in a pilot study of the REDUCE Baby WASH Care Group modules to learn about their experiences with the intervention. Results: Six REDUCE Baby WASH Care Group modules were developed based on formative research findings and covered the following topics: 1) living with animals; 2) child mouthing of fomites and feces; 3) composting animal feces; 4) child feces disposal; 5) handwashing with soap; and 6) water treatment. Conclusion: This study took a theory-driven and evidence-based approach to formative research and the development of the REDUCE Baby WASH Care Group modules. Intervention design focused on interrupting the exposure routes for infants and young children to fecal pathogens in the environment and promoting low-cost, low-burden Baby WASH behavioral recommendations and enabling technology. These developed REDUCE Baby WASH Care Group modules are currently being rolled out to over 1,000,000 beneficiaries in Democratic Republic of the Congo.
AB - Background: Research exploring the unique exposure pathways to fecal pathogens for young children and innovative water, sanitation, and hygiene (WASH) interventions for susceptible pediatric populations is needed to reduce the burden of diarrheal diseases and stunting globally. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to 1) identify exposure pathways to fecal pathogens that are significant contributors to morbidity for young children in South Kivu, Democratic Republic of the Congo, and 2) develop and evaluate scalable interventions that reduce fecal contamination and exposure from these pathways. The formative research portion of the project sought to identify feasible and acceptable WASH interventions to modify behaviors found to be associated with diarrheal disease and impaired growth in our REDUCE cohort study. Methods: Ninety-one semi-structured interviews, 6 focus group discussions, and a pilot study of 102 households were conducted during 24 months of formative research. Thirty-one interviews and six focus group discussions were conducted with caregivers, community health workers, and village leaders to explore existing WASH practices and to identify barriers and facilitators to WASH behaviors. Findings were organized using the Integrated Behavioral Model for Water, Sanitation and Hygiene to facilitate interpretation and identify determinants to Baby WASH behaviors in this setting. Care Group modules and enabling technology were developed based on exploratory findings and then revised during a two-part, iterative pilot study. Sixty interviews were conducted with participants in a pilot study of the REDUCE Baby WASH Care Group modules to learn about their experiences with the intervention. Results: Six REDUCE Baby WASH Care Group modules were developed based on formative research findings and covered the following topics: 1) living with animals; 2) child mouthing of fomites and feces; 3) composting animal feces; 4) child feces disposal; 5) handwashing with soap; and 6) water treatment. Conclusion: This study took a theory-driven and evidence-based approach to formative research and the development of the REDUCE Baby WASH Care Group modules. Intervention design focused on interrupting the exposure routes for infants and young children to fecal pathogens in the environment and promoting low-cost, low-burden Baby WASH behavioral recommendations and enabling technology. These developed REDUCE Baby WASH Care Group modules are currently being rolled out to over 1,000,000 beneficiaries in Democratic Republic of the Congo.
KW - Care groups
KW - Democratic Republic of the Congo
KW - Infants
KW - Qualitative methods
KW - Water, sanitation, and hygiene
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U2 - 10.1186/s12889-021-10246-5
DO - 10.1186/s12889-021-10246-5
M3 - Article
C2 - 33648466
AN - SCOPUS:85101811532
SN - 1471-2458
VL - 21
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 427
ER -