A strategic analysis of health behaviour change initiatives in Africa.

BACKGROUND: Changed health behaviours can contribute significantly to improved health. Consequently, significant investments have been channelled towards health behaviour change initiatives in Africa. Health behaviour change initiatives that address social, economic and environmental levers for behaviour change can create more sustained impact. OBJECTIVES: Through a scoping study of the literature, we explored the literature on behaviour change initiatives in Africa, to assess their typologies. We explored whether the availability of initiatives reflected country demographic characteristics, namely life expectancy, gross domestic product (GDP), and population sizes. Finally, we assessed topical themes of interventions relative to frequent causes of mortality. METHODS: We used the Behaviour Change Wheel intervention categories to categorise each paper into a typology of initiatives. Using Pearson's correlation coefficient, we explored whether there was a correlation between the number of initiatives implemented in a country in the specified period, and socio-demographic indicators, namely, GDP per capita, total GDP, population size, and life expectancy. RESULTS: Almost 64% of African countries were represented in the identified initiatives. One in five initiatives was implemented in South Africa, while there was a dearth of literature from Central Africa and western parts of North Africa. There was a positive correlation between the number of initiatives and GDP per capita. Most initiatives focused on addressing sexually transmitted infections and were short-term trials and/or pilots. Most initiatives were downstream focused e.g. with education and training components, while upstream intervention types such as the use of incentives were under-explored. CONCLUSION: We call for more emphasis on initiatives that address contextual facilitators and barriers, integrate considerations for sustainable development, and consider intra-regional deprivation.

Developing an alcohol harm prevention research agenda in West Africa: a mixed methods approach.

Research on alcohol use and its associated harm is scarce in West Africa. To mitigate the knowledge gap and to build momentum for future research, we determined research priorities for alcohol prevention among stakeholders across nine countries in West Africa. We analyzed a cross-sectional survey conducted in the fall of 2020, distributed by the West African Alcohol Policy Alliance (WAAPA). Respondents represented members of the WAAPA, members of intra-country alliances on alcohol and other stakeholders reached by snowball sampling. Quantitative and qualitative survey measures, adapted from the WHO's readiness assessment for the prevention of child maltreatment or developed by the research team, assessed research priorities, awareness of alcohol-related harm, risk factors and data availability. We mapped the qualitative answers into general themes and conducted descriptive analysis on the quantitative responses. Participants outlined two general themes to focus on: (i) alcohol use among children and youth and (ii) the health-related impact of alcohol. The most commonly listed types of alcohol-related harms pertained to acute consequences, such as gender-based violence, injuries, traffic crashes and child maltreatment. Risk factors for alcohol-related harm included limited enforcement of alcohol policies, cheap alcohol, and limited knowledge. Strengthening the capacity for addressing these research priorities will be key in reducing alcohol-related harm in West Africa. The goal of these research priorities is to drive research that informs advocacy, programs and policy. In addition to research, an awareness campaign of the health effects of alcohol is urgently needed.

Formal and informal medicine retailers in Sub-Saharan Africa: a scoping review of research trends.

OBJECTIVES: In Sub-Saharan Africa (SSA), private medicine retailers have become the first entry point to health systems, irrespective of their level of accreditation. This review aims to map the main trends in research about formal and informal medicine retailers in SSA over the past 20 years. Such an overview offers a valuable resource to understand their role and develop inclusive interventions to improve accessibility to health care in line with people's health-seeking behaviours. This review followed the steps recommended by the Joanna Briggs Institute. Four electronic databases were searched and complemented by manual web researches. KEY FINDINGS: A total of 293 publications from 23 countries met our inclusion criteria, 79% of which relate to six countries. The number of publications has been growing since 2010. Medicine retailers are distributed among three professional groups based on their accreditation level. Most studies used quantitative methods. Three topics - service provision; knowledge, attitudes and practices; and the expanding role of medicine retailers in the health system - accounted for 67% of included studies. Most studies focus on a specific health condition, of which malaria (26%) and sexual/reproductive health (13%) are the most common. SUMMARY: This review reveals increasing interest in medicine retailers in SSA and increasing expectations as stakeholders within health systems. This review suggests that new research and interventions should focus on: moving beyond a disease-based approach; using qualitative methods; and understudied countries, rural areas and informal medicine retailers. A more dynamic, relational and interactive approach could help better understand the sector.

Exploring barriers and enablers for scaling up a community-based grain bank intervention for improved infant and young child feeding in Ethiopia: A qualitative process evaluation.

Child malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community-based intervention was designed to provide locally made complementary food for children 6-23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio-political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale-up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision-making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.

Community-based grain banks using local foods for improved infant and young child feeding in Ethiopia.

The first thousand days of a child's life are critical for ensuring adequate nutrition to enable optimal health, development and growth. Inadequate infant and young child feeding (IYCF) practices likely contribute to Ethiopia's concerning malnutrition situation. Development partners in four regions of Ethiopia implemented community production of complementary food with women's groups processing local grains and legumes at grain banks to improve availability, accessibility, dietary diversity and timely introduction of complementary foods. The objective of this study was to establish the acceptability, perceived impact, feasibility and required inputs to sustain local grain bank interventions to improve IYCF. A subsidized barter system was used by mothers in the rural communities, and flour was sold in the semi-urban context. Purposive sampling guided the qualitative study design and selection of project stakeholders. A total of 51 key informant interviews and 33 focus group discussions (n = 237) were conducted. The grain bank flour was valued for its perceived diverse local ingredients; while the project was perceived as creating labour savings for women. The grain bank flour offered the potential to contribute to improved IYCF; however, further dietary modification or fortification is needed to improve the micronutrient content. Dependence upon external inputs to subsidize the barter model and the reliance on volunteer labour from women's groups in the rural context are the greatest risks to sustainability. This intervention illustrates how integrated agricultural and health interventions leveraging local production can appeal to diverse stakeholders as an acceptable approach to improve IYCF.