Effectiveness of social and behavioral change communication intervention to promote the use of 7.1% chlorhexidine for umbilical cord care in hard-to-reach rural Bangladesh: A mixed method study.

BACKGROUND: Developing countries account for 99.0% of the 2.7 million neonatal deaths occurring worldwide each year. Umbilical cord infection contributes greatly to this predicament, but evidence shows that 7.1% chlorhexidine solution (CHX) can substantially reduce the risk of infection. To address this challenge, this study aimed to determine the effect of a social and behavioral change communication (SBCC) intervention on promoting the use of WHO recommended CHX as well as on improving the knowledge, attitude, and practices of rural communities regarding umbilical cord care in hard-to-reach areas of Bangladesh. METHODS: A pretest-posttest quasi-experimental study was conducted in two unions of Jamalpur district during 2017-2019 among 748 pregnant women in their third trimester. The SBCC intervention was implemented through town-hall meetings (n = 3), community meetings (n = 30), and door-to-door meetings (n = 22 223) in Dangdhora union, which served as the intervention group, while Hativanga union was kept as a real-time comparator group. Qualitative data were collected from a total of 200 respondents, where 100 participants were chosen from both intervention and control groups. Statistical analysis was carried out in R and outcomes with P values less than 0.05 at 95% confidence intervals (CIs) were presented. RESULTS: Following SBCC intervention, significant (P < 0.001) improvements were observed in the intervention group with regards to the primary objective: CHX use increased from 1.07% to 57.80%, while CHX use decreased from 1.6% to 0.0% in the control group. Meaningful improvements were also observed in relation to knowledge (29.0% to 43.0%), attitude (53.0% to 90.0%), and practices (25.0% to 70.0%) of rural communities regarding cord care. Marked improvements were also observed in the intervention group related to understanding causes of cord infections; importance of cord cleanliness; use of antiseptic and other preventive measures; care-seeking behavior; and ensuring hygienic childbirth. CONCLUSIONS: This pioneer study revealed that SBCC interventions led to an increase in CHX use and improved the knowledge, attitude and practices of Bangladeshi communities regarding cord care and cord infection. This indicates that SBCC intervention is indeed an effective and feasible method for reducing infant mortality rates in hard-to-reach populations and achieving SDG goal 3.2.

Social dynamics of short term variability in key measures of household and community wellbeing in Bangladesh.

High-frequency social data collection may facilitate improved recall, more inclusive reporting, and improved capture of intra-period variability. Although there are examples of small studies collecting particular variables at high frequency in the social science literature, to date there have been no significant efforts to collect a wide range of variables with high frequency. We have implemented the first such effort with a smartphone-based data collection approach, systematically varying the frequency of survey task and recall period, allowing the analysis of the relative merit of high-frequency data collection for different key variables in household surveys. This study of 480 farmers from northwestern Bangladesh over approximately one year of continuous data on key measures of household and community wellbeing could be particularly useful for the design and evaluation of development interventions and policies. While the data discussed here provide a snapshot of what is possible, we also highlight their strength for providing opportunities for interdisciplinary research in the household agricultural production, practices, seasonal hunger, etc., in a low-income agrarian society.

Assessing recall bias and measurement error in high-frequency social data collection for human-environment research.

A major impediment to understanding human-environment interactions is that data on social systems are not collected in a way that is easily comparable to natural systems data. While many environmental variables are collected with high frequency, gridded in time and space, social data is typically conducted irregularly, in waves that are far apart in time. These efforts typically engage respondents for hours at a time, and suffer from decay in participants' ability to recall their experiences over long periods of time. Systematic use of mobile and smartphones has the potential to transcend these challenges, with a critical first step being an evaluation of where survey respondents experience the greatest recall decay. We present results from, to our knowledge, the first systematic evaluation of recall bias in components of a household survey, using the Open Data Kit (ODK) platform on Android smartphones. We tasked approximately 500 farmers in rural Bangladesh with responding regularly to components of a large household survey, randomizing the frequency of each task to be received weekly, monthly, or seasonally. We find respondents' recall of consumption and experience (such as sick days) to suffer much more greatly than their recall of the use of their households' time for labor and farm activities. Further, we demonstrate a feasible and cost-effective means of engaging respondents in rural areas to create and maintain a true socio-economic "baseline" to mirror similar efforts in the natural sciences.

Real-Time Social Data Collection in Rural Bangladesh via a 'Microtasks for Micropayments' Platform on Android Smartphones.

The advent of cheap smartphones in rural areas across the globe presents an opportunity to change the mode with which researchers engage hard-to-reach populations. In particular, smartphones allow researchers to connect with respondents more frequently than standard household surveys, opening a new window into important short-term variability in key measures of household and community wellbeing. In this paper, we present early results from a pilot study in rural Bangladesh using a 'microtasks for micropayments' model to collect a range of community and household living standards data using Android smartphones. We find that more frequent task repetition with shorter recall periods leads to more inclusive reporting, improved capture of intra-seasonal variability, and earlier signals of events such as illness. Payments in the form of mobile talk time and data provide a positive development externality in the form of expanded access to mobile internet and social networks. Taken to scale, programs such as this have potential to transform data collection in rural areas, providing near-real-time windows into the development of markets, the spread of illnesses, or the diffusion of ideas and innovations.