Are Participants in a Behavior Change Communication Campaign More Likely to Seek Care for Childhood Diarrhea? A Study of Caregivers of Children under 2 in Tanzania

Stunting remains a particular challenge in Sub-Saharan Africa. Despite encouraging declines in Tanzania over the past 25 years, one-third of Tanzanian children under the age of five years are stunted. Diarrhea remains one of the greatest causes of childhood stunting worldwide. Mass media has been used to improve the uptake of behaviors associated with reductions in diarrhea. This study evaluates the effectiveness of a mass media campaign in the Lake Zone region of Tanzania from 2015-2020 and positive changes in caregiver health-seeking behaviors related to diarrhea in children. Approximately 5000 households participated in a cross-sectional survey after a communications campaign. Exposure variables included hearing and seeing radio and TV spots and participating in a variety of interpersonal communication approaches. Study results indicated primary caregivers (mothers) exposed to media messages only (OR 1.66, CI 1.05 - 2.62), and to media messages and interpersonal communication (OR 2.51, CI 1.48 - 4.26), were more likely to seek advice or treatment for diarrhea from a health facility. Primary caregivers exposed to both media messages and interpersonal communication were more likely to give oral rehydration salts (OR 2.56, CI 1.72 - 3.79), zinc tablets/syrup (OR 1.74, CI 1.18 - 2.57), and homemade fluids (OR 2.02, CI 1.15 - 3.55) when their children had diarrhea. Male heads of household (fathers) exposure to mass media was not associated with care-seeking for diarrhea treatment.

Stunting-Related Knowledge: Exploring Sources of and Factors Associated with Accessing Stunting-Related Knowledge among Mothers in Rural Indonesia

Background: Stunting in young children continues to be a major concern in developing country settings, including middle income countries like Indonesia. Early intervention is critical to prevent increased morbidity and mortality, lower cognitive functioning, and diminished productivity in adulthood. Mothers may benefit from knowledge and information related to stunting causes and effects. Indonesia has readily adopted a variety of platforms, which are now being used to disseminate health information. The purpose of this study was to address two related research questions: 1) What are the primary sources of Indonesian mothers’ stunting-related knowledge? 2) What factors are associated with using these various platforms to access stunting-related information? Method: Mothers (n = 745) responded to questions about demographics and the source of stunting knowledge, which included hospitals, the Internet, midwives, posyandu (community health posts), and puskesmas (public health centers). Multivariate logistic regression was used to identify factors associated with mothers’ reported use of the three most common sources to acquire information about stunting, including posyandu, puskesmas and the Internet. Results: Eighty percent of mothers in this study sample used posyandu, 31.7% puskesmas, and 16.9% used the Internet as a source for stunting-related knowledge. For the three most common sources, factors associated with each included not accessing the other sources. Conclusions: Indonesian mothers are using a variety of platforms and services to acquire information about stunting. These sources are different one from another and each may be an important resource for disseminating health information, especially outside of urban centers. Results from this study may help to identify characteristics of Indonesian mothers who could benefit from acquiring stunting-related information in these formats. Each of these sources of information appears to be utilized by different groups of mothers. This is an important finding as it suggests that each may continue to be a resource for mothers that might not otherwise access stunting information. The Indonesian health system in rural settings has a history of support for posyandu and puskesmas. Moving forward, the Internet may also be used to improve outcomes for children of mothers that do not access information through these more traditional means.

Addressing Communications Campaign Development Challenges to Reduce Stunting in Indonesia

One in four children under 5 years of age in the developing world are stunted (chronically malnourished). Reducing stunting can be a challenge, especially in populous countries where families are dispersed, as is the case in Indonesia. This paper describes how one government project (Indonesia’s National Nutrition Communication Campaign [NNCC]) delivered effective behavior change communications interventions that reached 40 million people. This paper focuses on four challenges that nutrition campaigns often face and provides useful lessons for similar campaigns, based on the experience of NNCC, which include the following: 1) Fully engaging stakeholders at all levels in campaign design and implementation ensured broad-based support for stunting reduction efforts;2) Pro-actively involving journalists in nutrition campaigns improved public opinion about stunting and positively influenced decision-making in policy formulation;3) Use of humorous public service announcements with limited technical information was effective in engaging priority populations;and 4) Social media (YouTube ads, web advertorials, Facebook pages, Twitter, Instagram) extended the campaign’s reach and reinforced messaging from other sources. Based on NNCC’s experience, specific recommendations are provided.