IMPROVING MOTHERS’ PRACTICE OF CHILD SURVIVAL STRATEGIES THROUGH BEHAVIOUR CHANGE COMMUNICATION IN DELTA STATE, NIGERIA

Abstract

Under-five mortality remains high in Nigeria and this could be attributed to low practice of Child Survival Strategies (CSS) by mothers. Behaviour Change Communication (BCC) strategies have been shown to favourably improve child survival practice. The health talk normally used for antenatal education does not seem to be effective. This study was conducted to assess the effect of Behaviour Change Communication on mothers’ practice of CSS in Delta State, Nigeria. This quasi-experimental study involved a three-stage simple random sampling technique to select one rural Local Government Area (LGA) from three Senatorial Districts, two communities (one experimental; one control) per LGA and one primary health centre for each community where 40 mother-child pairs were recruited. A pretested, semi-structured, interviewer-administered questionnaire was used to collect information on socio-demographic, Knowledge, Attitude and Practice (KAP) of CSS. Using a 45-point scale, knowledge was categorized into poor (0-14), fair (15-30) and good (31+); 27-point scale was used to categorize attitude into negative (0-7) and positive (8-27) and 15-point scale was used to categorize practice into poor (0-4), fair (5-10) and good (11-15). WHO/UNICEF Guide for Community Resource Persons and Social Cognitive Theory were adapted to develop interventions to address identified gaps from KAP of CSS. One BCC intervention each: drama, audiovisual or talks were implemented weekly for three months per experimental community. Anthropometric data of children was assessed using standard procedure and analysed using WHO Anthro software. Data were analysed using descriptive statistics and association between BCC strategies and KAP of CSS was determined using chi-square and paired t test at α 0.05. Mothers’ age was 27.8±5.6 years, 22.1% had tertiary education and 38.3% earned <N10,000 monthly.Children’s age ranged from 0-15 months, 64.7% were 0-6 months and 49.2% were females. Knowledge increased from 15.8% to 21.6%, positive attitude from 65.5% to 76.1% and good CSS practice from 43.5% to 51.8% in experimental group after intervention. Mean knowledg score was significantly higher in the experimental group (25.7±8.7) compared to the control group (11.9±7.9); (t=-12.370, p<0.05). The mean practice score was also significantly (t= -3.690, p<0.05) higher in the experimental group compared to the control group. Respondents who received drama, talk and audiovisual treatment had 26.7%, 23.1% and 14.3% (X2 =4.53; p=0.33) good knowledge respectively. Respondents in audiovisual strategy group had higher positive attitude (90.6%) compared to those in talks (82.7%) and drama (55.6) which was significantly different (X2 = 6.29; p<0.05). There was no significant difference (F=1.103, sig = 0.335) in practice based on BCC method. The proportion of mothers who intended to breastfeed for 24 months was significantly different (X2 = 16.28; p<0.05) at endline. All mothers took their children for growth monitoring post intervention compared to baseline (72.3%) in experimental group; (X2 =48.99; p<0.05). Use of social cognitive theory in designing the behaviour change communication intervention improved knowledge, attitude and practice of child survival strategies among mothers in Delta State. The strategy should be adopted in the design and implementation of appropriate child survival education programs targeting mothers in Nigeria.