Impact on malaria morbidity of a programme supplying insecticide treated nets in children aged under 2 years in Tanzania: community cross sectional study The impact of a targeted radio campaign to prevent STIs and HIV/AIDS in Mozambique. Physicians in private practice: reasons for being a social franchise member Randomize evaluations to improve health care delivery Elimination of Iron Deficiency Anemia and Soil Transmitted Helminth Infection: Evidence from a Fifty-four Month Iron-Folic Acid and De-worming Program Impact of the integration of water treatment and handwashing incentives with antenatal services on hygiene practices of pregnant women in Malawi. Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting. A large-scale intervention to introduce orange sweet potato in rural Mozambique increases vitamin A intakes among children and women. Impact of a mass media campaign on bed net use in Cameroon Measuring the Cost-Effectiveness of a National Health Communication Program in Rural Bangladesh Community-based prevention leads to an increase in condom use and a reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) and female sex workers (FSW): the Frontiers Prevention Project (FPP) evaluation results Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial. Evidence-based public health: not only whether it works, but how it can be made to work practicably at scale Red palm oil as a source of vitamin A for mothers and children: impact of a pilot project in Burkina Faso. A study to evaluate the acceptability, feasibility and impact of packaged interventions (“Diarrhea Pack”) for prevention and treatment of childhood diarrhea in rural Pakistan The Long-Term Impact of the MEMA kwa Vijana Adolescent Sexual and Reproductive Health Intervention: Effect of Dose and Time since Intervention Exposure Shame or subsidy revisited: social mobilization for sanitation in Orissa, India. Prevention of sexually transmitted infections in urban communities (Peru PREVEN): a multicomponent community-randomised controlled trial Distribution Systems of Insecticide-Treated Bed Nets for Malaria Control in Rural Burkina Faso: Cluster-Randomized Controlled Trial Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: results from a demand-side financing intervention A pragmatic intervention to promote condom use by female sex workers in Thailand. HIV Prevention Among Sex Workers in India Village-based AIDS prevention in a rural district in Uganda. A randomized community trial of enhanced family planning outreach in Rakai, Uganda. Scripted messages delivered by nurses and radio changed beliefs, attitudes, intentions, and behaviors regarding infant and young child feeding in Mexico. Community trial of insecticide-treated bed net use promotion in southern Ghana: the Net Use Intervention study Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China HIV prevention for migrants in transit: developing and testing TRAIN.
Abstract Objective : To assess the impact of a social marketing programme for distributing nets treated with insecticide on malarial parasitaemia and anaemia in very young children in an area of high malaria transmission . Design : Community cross sectional study . Annual , cross sectional data were collected at the beginning of the social marketing campaign ( 1997 ) and the subsequent two years . Net ownership and other risk and confounding factors were assessed with a question naire . Blood sample s were taken from the children to assess prevalence of parasitaemia and haemoglobin levels . Setting : 18 villages in the Kilombero and Ulanga districts of southwestern Tanzania . Participants : A r and om sample of children aged under 2 years . Main outcome measures : The presence of any parasitaemia in the peripheral blood sample and the presence of anaemia ( classified as a haemoglobin level of ≤80 g/l ) . Results : Ownership of nets increased rapidly ( treated or not treated nets : from 58 % to 83 % ; treated nets : from 10 % to 61 % ) . The mean haemoglobin level rose from 80 g/l to 89 g/l in the study children in the successive surveys . Overall , the prevalence of anaemia in the study population decreased from 49 % to 26 % in the two years studied . Treated nets had a protective efficacy of 62 % ( 95 % confidence interval 38 % to 77 % ) on the prevalence of parasitaemia and of 63 % ( 27 % to 82 % ) on anaemia . Conclusions : These results show that nets treated with insecticide have a substantial impact on morbidity when distributed in a public health setting In 1997 to 1998 , Population Services International ( PSI ) carried out a targeted radio campaign in Mozambique to promote behavior change for the prevention of sexually transmitted infections ( STIs ) and HIV/AIDS . To evaluate the coverage and impact of the campaign , PSI design ed and implemented a cross-sectional study using a two-stage r and om sample of " at-risk " individuals ; 754 individuals between the ages of 13 and 49 were interviewed . Over half ( 52.4 % ) heard the campaign and 45.5 % recalled one or more radio messages . However , recall of specific messages in specific risk groups was low . A multivariate model demonstrates that among those exposed to the radio campaign , 97.2 % reported intent to change their sexual behavior compared with 62.8 % of those not exposed to the campaign ( p < .001 ) . Among those who recalled campaign messages , 86.1 % attempted to change their behavior compared with 58 % of those who had no message recall ( p < .001 ) . Success in changing behavior is significantly higher among those with message recall ( 83.8 % ) than those without ( 56.8 % , p < .001 ) . This study illustrates the difficulties in using radio to target a specific group with a corresponding behavior change message . Although general recall of campaign messages was high per target group , the campaign did not succeed in ensuring exposure to the intended target group . The strategy of airing all of the spots simultaneously with different but similar messages result ed in one spot " stepping on " another . Despite the limitations in using radio to target , exposure to the radio campaign has contributed to individual intent to change sexual behavior Background Evidence is emerging on the cost-effectiveness , quality and health coverage of social franchises . But little is known about the motivations of providers to join or remain within a social franchise network , or the impact that franchise membership has on client volumes or revenue earnings . Methods ( i ) Uncontrolled facility based of a r and om sample of 230 franchise members to assess self-reported motivations ; ( ii ) A 24 month prospect i ve cohort study of 3 cohorts of physicians who had been in the franchise for 4 years , 2 years and new members to track monthly case load and revenue generated . Results The most common reasons for joining the franchise were access to high quality and cheap drugs ( 96.1 % ) and feelings of social responsibility , ( 95.2 % ) . The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise , ( p<0.01 ) . These gains are sustained during the 3rd and 4th year of franchise membership , as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician ( p<0.01 ) . The net income of cohort 2009 increased significantly ( p=0.024 ) during their first two years in the franchise . The results for cohorts 2007 and 2005 also show a generalized trend in increasing income . Conclusions The findings show how franchise membership impacts the volume of franchise and non-franchised services . The increases in client volumes translated directly into increases in earnings among the franchise members , an unanticipated effect for providers who joined in order to better serve the poor . This finding has implication s for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor . The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern . As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practice s , attention should be given towards avoiding commercialization of services Administrative data and experimental design s lead the way The medical profession has long recognized the importance of r and omized evaluations ; such design s are commonly used to evaluate the safety and efficacy of medical innovations such as drugs and devices . Unfortunately , innovations in how health care is delivered ( e.g. , health insurance structures , interventions to encourage the use of appropriate care , and care coordination approaches ) are rarely evaluated using r and omization . We consider barriers to conducting r and omized trials in this setting and suggest ways for overcoming them . R and omized evaluations of fundamental issues in health care policy and delivery should be— and can be — closer to the norm than the exception Background Intermittent iron-folic acid supplementation and regular de-worming are effective initiatives to reduce anemia , iron deficiency , iron deficiency anemia , and soil transmitted helminth infections in women of reproductive age . However , few studies have assessed the long-term effectiveness of population -based interventions delivered in re source -constrained setting s. Methodology /Principal Findings The objectives were to evaluate the impact of weekly iron-folic acid supplementation and de-worming on mean hemoglobin and the prevalence of anaemia , iron deficiency , and soil transmitted helminth infection in a rural population of women in northern Vietnam and to identify predictive factors for hematological outcomes . A prospect i ve cohort design was used to evaluate a population -based supplementation and deworming program over 54 months . The 389 participants were enrolled just prior to commencement of the intervention . After 54 months 76 % ( 95 % CI [ 68 % , 84 % ] ) were taking the iron-folic acid supplement and 95 % ( 95 % CI [ 93 % , 98 % ] ) had taken the most recently distributed deworming treatment . Mean hemoglobin rose from 122 g/L ( 95 % CI [ 120 , 124 ] ) to 131 g/L ( 95 % CI [ 128 , 134 ] ) and anemia prevalence fell from 38 % ( 95 % CI [ 31 % , 45 % ] ) to 18 % ( 95 % CI [ 12 % , 23 % ] ) ; however , results differed significantly between ethnic groups . Iron deficiency fell from 23 % ( 95 % CI [ 17 % , 29 % ] ) to 8 % ( 95 % CI [ 4 % , 12 % ] ) , while the prevalence of iron deficiency anemia was reduced to 4 % ( 95 % CI [ 1 % , 7 % ] ) . The prevalence of hookworm infection was reduced from 76 % ( 95 % CI [ 68 % , 83 % ] ) to 11 % ( 95 % CI [ 5 % , 18 % ] ) . The level of moderate or heavy infestation of any soil-transmitted helminth was reduced to less than 1 % . Conclusions / Significance Population -based interventions can efficiently and effectively reduce anemia and practically eliminate iron deficiency anemia and moderate to heavy soil transmitted helminth infections , maintaining them below the level of public health concern Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea . We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers , sodium hypochlorite water treatment solution , soap , and educational messages . Program participants were more likely to know correct water treatment procedures ( 62 % versus 27 % , P < 0.0001 ) , chlorinate drinking water ( 61 % versus 1 % , P < 0.0001 ) , demonstrate correct h and washing practice s ( 68 % versus 22 % , P < 0.0001 ) , and purchase water treatment solution after free distribution ( 32 % versus 1 % , P < 0.0001 ) . Among participants , 72 % had at least three antenatal visits , 76 % delivered in a health facility , and 54 % had a postnatal check . This antenatal-clinic-based program is an effective new strategy for promoting water treatment and hygiene behaviors among pregnant women . Participants had high use of antenatal , delivery , and postnatal services , which could improve maternal and child health Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries . We evaluated the impact of household water treatment , latrines , shallow wells , and rainwater harvesting on  diarrhoea incidence in rural Kenyan children . We compared diarrhoea rates in 960 children aged < 5 years in 556 households in 12 r and omly selected intervention villages and six r and omly selected comparison villages during weekly home visits over an 8-week period . On multivariate analysis , chlorinating stored water  [ relative risk ( RR ) 0.44 , 95 % confidence interval ( CI ) 0.28 - 0.69 ] , latrine presence ( RR 0.71 , 95 % CI 0.54 - 0.92 ) , rainwater use ( RR 0.70 , 95 % CI 0.52 - 0.95 ) , and living in an intervention village ( RR 0.31 , 95 % CI 0.23 - 0.41 ) , were independently associated with lower diarrhoea risk . Diarrhoea risk was higher among shallow well users ( RR 1.78 , 95 % CI 1.12 - 2.83 ) . Chlorinating stored water , latrines  , and  rainwater use all decreased diarrhoea risk ; combined interventions may have increased health impact β-Carotene-rich orange sweet potato ( OSP ) has been shown to improve vitamin A status of infants and young children in controlled efficacy trials and in a small-scale effectiveness study with intensive exposure to project inputs . However , the potential of this important food crop to reduce the risk of vitamin A deficiency in deficient population s will depend on the ability to distribute OSP vines and promote its household production and consumption on a large scale . In rural Mozambique , we conducted a r and omised , controlled effectiveness study of a large-scale intervention to promote household-level OSP production and consumption using integrated agricultural , dem and creation/behaviour change and marketing components . The following two intervention models were compared : a low-intensity ( 1 year ) and a high-intensity ( nearly 3 years ) training model . The primary nutrition outcomes were OSP and vitamin A intakes by children 6 - 35 months and 3 - 5·5 years of age , and women . The intervention result ed in significant net increases in OSP intakes ( model 1 : 46 , 48 and 97 g/d ) and vitamin A intakes ( model 1 : 263 , 254 and 492 μg retinol activity equivalents/d ) among the younger children , older children and women , respectively . OSP accounted for 47 - 60 % of all sweet potato consumed and , among reference children , provided 80 % of total vitamin A intakes . A similar magnitude of impact was observed for both models , suggesting that group-level trainings in nutrition and agriculture could be limited to the first project year without compromising impact . Introduction of OSP to rural , sweet potato-producing communities in Mozambique is an effective way to improve vitamin A intakes Background In 2011 , Cameroon and its health partners distributed over eight million free long-lasting insecticide treated nets ( LLINs ) in an effort to reduce the significant morbidity and mortality burden of malaria in the country . A national communications campaign was launched in July 2011 to ensure that as the nets were delivered , they would be used consistently to close a net use gap : only 51.6 % of adults and 63.4 % of their children in households with at least one net were sleeping under nets before the distribution . Even in households with at least one net for every two people , over 35 % of adults were not sleeping under a net . Malaria No More ( MNM ) adapted its signature NightWatch communications programme to fit within the coordinated “ KO Palu ” ( Knock Out Malaria ) national campaign . This study evaluates the impact of KO Palu NightWatch activities ( that is , the subset of KO Palu-br and ed communications that were funded by MNM ’s NightWatch program ) on bed net use . Methods Using national survey data collected at baseline ( in March/April 2011 , before the national LLIN distribution and KO Palu NightWatch launch ) and post-intervention ( March/April 2012 ) , this study evaluates the impact of exposure to KO Palu NightWatch activities on last-night net use by Cameroonian adults and their children under five . First , a plausible case for causality was established by comparing net use in 2011 and 2012 and measuring exposure to KO Palu NightWatch ; next , a propensity score matching ( PSM ) model was used to estimate the impact of exposure on net use by simulating a r and omized control trial ; finally , the model was tested for sensitivity to unmeasured factors . Results The PSM model estimated that among Cameroonians with at least one net in their household , exposure to KO Palu NightWatch activities was associated with a 6.6 percentage point increase in last-night net use among respondents ( 65.7 % vs 59.1 % , p < 0.05 ) and a 12.0 percentage point increase in last-night net use among respondents ’ children under five ( 79.6 % vs 67.6 % , p < 0.025 ) . Sensitivity analysis suggests only a very small risk of bias from omitted factors influencing exposure and net use . Conclusions Extrapolating the results of the PSM model to the population of Cameroonians with access to at least one mosquito net , this analysis estimates that approximately 298,000 adults and over 221,000 of their children under five slept under a bed net because of the knowledge , motivation , and /or timely reminder provided by KO Palu NightWatch activities . The programme cost less than $ 0.16 per adult reached , and less than $ 1.62 per additional person protected by a net . The results suggest a strong role for mass media communication interventions in support of investments in malaria control commodities such as LLINs In this article we examine the cost-effectiveness of the Smiling Sun multichannel media campaign , which was undertaken in Bangladesh from 2001 to 2003 and involved a nationally broadcast television serial drama supported by radio , television , newspaper , and billboard advertisements and local promotion activities . The goal was to encourage the use of a package of family health services at NGO ( nongovernmental organization ) Service Delivery Program ( NSDP ) providers . This analysis relates the costs of the Smiling Sun campaign at the national and local level to measures of change in the use of health services , namely , antenatal care and childhood immunizations . Effectiveness is measured using data from cross-sectional surveys conducted in 2001 and 2003 in NSDP catchment areas in rural Bangladesh . The statistical approach , bivariate probit estimation , controls for nonr and om exposure to the program 's media messages , advertisements , and signs . Using national-level data , we find that the Smiling Sun campaign was both effective and cost-effective , inducing higher levels of service utilization for only $ 0.05 per additional antenatal care ( ANC ) user and only $ 0.30 and $ 0.36 for each additional child vaccinated for measles and DPT3 , respectively . With respect to local promotion activities , the cost per attributable behavior change was considerably higher — nearly $ 8 per new ANC user , $ 37 per new DPT3 vaccination , and $ 32 per new measles vaccination Background India has an estimated 2.0 million to 3.1 million people living with HIV ; it has the highest number of HIV-positive people in Asia and ranks third in the world . The Frontiers Prevention Project ( FPP ) was implemented in 2002 to conduct targeted prevention intervention geared towards female sex workers ( FSW ) and men who have sex with men ( MSM ) in the state of And hra Pradesh ( AP ) . This paper reports the overall changes in behaviour and STI outcomes between 2003/4 and 2007 and also describes the changes attributed to the FPP . Methods The evaluation used two cross-sectional surveys among MSM and FSW at 24 sites in AP . Surveys were implemented using a similar methodology . Univariate analyses were conducted by comparing means : baseline vs. four-year follow-up and FPP vs. non-FPP . For both MSM and FSW , r and om and fixed-effects logit regression models at the site level were estimated for condom use with last partner , syphilis sero-positivity and HSV 2 sero-positivity . In addition , for FSW we estimated models for condom use with regular partner , and for MSM we estimated models for condom use with last female partner . Results Among MSM , fixed-effects analysis revealed that FPP was positively correlated with the probability of condom use with last female sexual partner and negatively correlated with the individual probability of sero-positivity to syphilis and HSV 2 . Among FSW , the FPP intervention was significantly correlated with increased condom use with regular partners and with lower probability of STI sero-positivity . Discussion Important changes in behaviours related to an increase in prevention activities translated to reductions in STI sero-prevalence in AP , India . In contrast with non-FPP sites , the FPP sites experienced an intense community approach as part of the FPP intervention , and the general increase in condom use and its effect on STI sero-prevalence reflected the efficacy of these intense prevention activities focused on key population s in AP OBJECTIVE To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate , symptom duration , and treatment outcome of smear-positive tuberculosis ( TB ) . METHODS We r and omly allocated 32 rural communities to intervention or control groups . In intervention communities , health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum sample s for sputum microscopy from symptomatic TB suspects . In addition , trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings . Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility . In control communities , cases were detected through passive case-finding among symptomatic suspects reporting to health facilities . Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospect ively enrolled . FINDINGS In the 1-year study period , 159 and 221 cases of smear-positive TB were detected in the intervention and control groups , respectively . Case-notification rates in all age groups were 124.6/10(5 ) and 98.1/10(5 ) person-years , respectively ( P = 0.12 ) . The corresponding rates in adults older than 14 years were 207/10(5 ) and 158/10(5 ) person-years , respectively ( P = 0.09 ) . The proportion of patients with > 3 months ' symptom duration was 41 % in the intervention group compared with 63 % in the control group ( P<0.001 ) . Pre-treatment symptom duration in the intervention group fell by 55 - 60 % compared with 3 - 20 % in the control group . In the intervention and control groups , 81 % and 75 % , respectively of patients successfully completed treatment ( P = 0.12 ) . CONCLUSION The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting . Both groups had comparable treatment outcomes Because public health must operate at scale in widely diverse , complex situations , r and omized controlled trials ( RCTs ) have limited utility for public health . Other method ologies are needed . A key conceptual backbone is a detailed “ theory of change ” to apply appropriate evidence for each operational component . Synthesizing patterns of findings across multiple method ologies provides key insights . Programs operating successfully across a variety of setting s can provide some of the best evidence . Challenges include judging the quality of such evidence and assisting programs to apply it . WHO and others should shift emphasis from RCTs to more relevant evidence when assessing public health issues . Because public health must operate at scale in widely diverse , complex situations , r and omized controlled trials ( RCTs ) have limited utility for public health . Other method ologies are needed . A key conceptual backbone is a detailed “ theory of change ” to apply appropriate evidence for each operational component . Synthesizing patterns of findings across multiple method ologies provides key insights . Programs operating successfully across a variety of setting s can provide some of the best evidence . Challenges include judging the quality of such evidence and assisting programs to apply it . WHO and others should shift emphasis from RCTs to more relevant evidence when assessing public health issues OBJECTIVE To demonstrate the effectiveness of the commercial introduction of red palm oil ( RPO ) as a source of vitamin A ( VA ) for mothers and children in a non-consuming area , as a dietary diversification strategy . DESIGN A pre-post intervention design ( no control area ) was used to assess changes in  VA intake and status over a 24-month pilot project . SETTING AND SUBJECTS The pilot project involved  RPO promotion in 10 villages and an urban area in east- central Burkina Faso , targeting approximately 10 000 women and children aged < 5 years . A r and om sample of 210 mother-child ( 12 - 36-months-old ) pairs was selected in seven out of the 11 pilot sites for the evaluation . RESULTS After 24 months , RPO was reportedly consumed by nearly 45 % of mothers and children in the previous week . VA intake increased from 235+/-23 microg retinol activity equivalents ( RAE ) to 655+/-144 microg RAE in mothers ( 41 to 120 % of safe intake level ) , and from 164+/-14 microg RAE to 514+/-77 microg RAE in children ( 36 to 97 % ) . Rates of serum retinol < 0.70 micromol l(-1 ) decreased from 61.8+/-8.0 % to 28.2+/-11.0 % in mothers , and from 84.5+/-6.4 % to 66.9+/-11.2 % in children . Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake . CONCLUSIONS Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites . While it is promising as part of a national strategy , additional public health and food-based measures are needed to control VA malnutrition , which remained high in the RPO project area Background Diarrhea remains one of the leading public health issues in developing countries and is a major contributor in morbidity and mortality in children under five years of age . Interventions such as ORS , Zinc , water purification and improved hygiene and sanitation can significantly reduce the diarrhea burden but their coverage remains low and has not been tested as packaged intervention before . This study attempts to evaluate the package of evidence based interventions in a “ Diarrhea Pack ” through first level health care providers at domiciliary level in community based setting s. This study sought to evaluate the acceptability , feasibility and impact of diarrhea Pack on diarrhea burden . Methods A cluster r and omized design was used to evaluate the objectives of the project a union council was considered as a cluster for analysis , a total of eight clusters , four in intervention and four in control were included in the study . We conducted a baseline survey in all clusters followed by the delivery of diarrhea Pack in intervention clusters through community health workers at domiciliary level and through sales promoters to health care providers and pharmacies . Four quarterly surveillance rounds were conducted to evaluate the impact of diarrhea pack in all clusters by an independent team of Field workers . Results Both the intervention and control clusters were similar at the baseline but as the study progress we found a significant increase in uptake of ORS and Zinc  along with the reduction in antibiotic use , diarrhea burden and hospitalization in intervention clusters when compared with the control clusters . We found that the Diarrhea Pack was well accepted with all of its components in the community . Conclusion The intervention was well accepted and had a productive impact on the uptake of ORS and zinc and reduction in the use of antibiotics . It is feasible to deliver interventions such as diarrhea pack through community health workers in community setting s. The intervention has the potential to be scaled up at national level Background Despite recent decreases in HIV incidence in many sub-Saharan African countries , there is little evidence that specific behavioural interventions have led to a reduction in HIV among young people . Further and wider-scale decreases in HIV require better underst and ing of when behaviour change occurs and why . The MEMA kwa Vijana adolescent sexual and reproductive health intervention has been implemented in rural Mwanza , Tanzania since 1999 . A long-term evaluation in 2007/8 found that the intervention improved knowledge , attitudes to sex and some reported risk behaviours , but not HIV or HSV2 prevalence . The aim of this paper was to assess the differential impact of the intervention according to gender , age , marital status , number of years of exposure and time since last exposure to the intervention . Methods In 2007 , a cross-sectional survey was conducted in the 20 trial communities among 13,814 young people ( 15–30 yrs ) who had attended intervention or comparison schools between 1999 and 2002 . Outcomes for which the intervention had an impact in 2001 or 2007 were included in this subgroup analysis . Data were analysed using cluster-level methods for stratified cluster-r and omised trials , using interaction tests to determine if intervention impact differed by subgroup . Results Taking into account multiplicity of testing , concurrence with a priori hypotheses and consistency within the results no strong effect-modifiers emerged . Impact on pregnancy knowledge and reported attitudes to sex increased with years of exposure to high- quality intervention . Conclusions The desirable long-term impact of the MEMA kwa Vijana intervention did not vary greatly according to the subgroups examined . This suggests that the intervention can have an impact on a broad cross-section of young people in rural Mwanza . Trial registration Clinical Trials.gov OBJECTIVE To determine the effectiveness of a sanitation campaign that combines ' shaming ' ( i.e. emotional motivators ) with subsidies for poor households in rural Orissa , an Indian state with a disproportionately high share of India 's child mortality . METHODS Using a cluster-r and omized design , we selected 20 treatment and 20 control villages in the coastal district of Bhadrak , rural Orissa , for a total sample of 1050 households . We collected sanitation and health data before and after a community-led sanitation project , and we used a difference-in-difference estimator to determine the extent to which the campaign influenced the number of households building and using a latrine . FINDINGS Latrine ownership did not increase in control villages , but in treatment villages it rose from 6 % to 32 % in the overall sample , from 5 % to 36 % in households below the poverty line ( eligible for a government subsidy ) and from 7 % to 26 % in households above the poverty line ( not eligible for a government subsidy ) . CONCLUSION Subsidies can overcome serious budget constraints but are not necessary to spur action , for shaming can be very effective by harnessing the power of social pressure and peer monitoring . Through a combination of shaming and subsidies , social marketing can improve sanitation worldwide Summary Background Previous community-r and omised trials of interventions to control sexually transmitted infections ( STIs ) have involved rural setting s , were rarely multicomponent , and had varying results . We aim ed to assess the effect of a multicomponent intervention on curable STIs in urban young adults and female sex workers ( FSWs ) . Methods In this community-r and omised trial , baseline STI screening was done between August , and November , 2002 , in r and om household sample s of young adults ( aged 18–29 years ) and in FSWs in Peruvian cities with more than 50 000 inhabitants . Geographically separate cities were selected , matched into pairs , and r and omly allocated to intervention or control groups with an S-PLUS program . Follow-up surveys of r and om sample s were done after 2 years and 3 years . The intervention comprised four modalities : strengthened STI syndromic management by pharmacy workers and clinicians ; mobile-team outreach to FSWs for STI screening and pathogen-specific treatment ; periodic presumptive treatment of FSWs for trichomoniasis ; and condom promotion for FSWs and the general population . Individuals in control cities received st and ard care . The composite primary endpoint was infection of young adults with Chlamydia trachomatis , Trichomonas vaginalis , or Neisseria gonorrhoeae , or syphilis seroreactivity . Laboratory workers and the data analyst were masked , but fieldworkers , the Peruvian study team , and participants in the outcome surveys were not . All analyses were done by intention to treat . This trial is registered , IS RCT N43722548 . Findings We did baseline surveys of 15 261 young adults in 24 Peruvian cities . Of those , 20 geographically separate cities were matched into pairs , in each of which one city was assigned to intervention and the other to st and ard of care . In the 2006 follow-up survey , data for the composite primary outcome were available for 12 930 young adults . We report a non-significant reduction in prevalence of STIs in young adults , adjusted for baseline prevalence , in intervention cities compared with control cities ( relative risk 0·84 , 95 % CI 0·69–1·02 ; p=0·096 ) . In subgroup analyses , significant reductions were noted in intervention cities in young adult women and FSWs . Interpretation Syndromic management of STIs , mobile-team outreach to FSWs , presumptive treatment for trichomoniasis in FSWs , and condom promotion might reduce the composite prevalence of any of the four curable STIs investigated in this trial . Funding Wellcome Trust and Burroughs Wellcome Fund , National Institutes of Health , Center for AIDS Research , CIPRA , and USAID-Peru Background Insecticide-impregnated bed nets ( ITNs ) have been shown to be a highly effective tool against malaria in the endemic regions of sub-Saharan Africa ( SSA ) . There are however different opinions about the role of ITN social marketing and ITN free distribution in the roll-out of ITN programmes . The objective of this study was to evaluate the effects of free ITN distribution through antenatal care services in addition to an ITN social marketing programme in an area typical for rural SSA . Methods A cluster-r and omised controlled ITN trial took place in the whole Kossi Province in north-western Burkina Faso , an area highly endemic for malaria . Twelve clusters were assigned to long-term ITN ( Serena br and ) social marketing plus free ITN ( Serena br and ) distribution to all pregnant women attending governmental antenatal care services ( group A ) , and 13 clusters to ITN social marketing only  ( group B ) . The intervention took place during the rainy season of 2006 and thereafter . The trial was evaluated through a representative household survey at baseline and after one year . Serena ITN household ownership was the primary outcome measure . Findings A total of 1052 households were visited at baseline in February 2006 and 1050 at follow-up in February 2007 . Overall Serena ITN household ownership increased from 16 % to 28 % over the study period , with a significantly higher increase in group A ( 13 % to 35 % ) than in group B ( 18 % to 23 % ) ( p<0.001 ) . Interpretation The free distribution of ITNs to pregnant women through governmental antenatal care services in addition to ITN social marketing substantially improved ITN household ownership in rural Burkina Faso . Trial registration Controlled-Trials.com IS RCT Background Dem and -side financing projects are now being implemented in many developing countries , yet evidence showing that they reach the poor is scanty . Methods A  maternal health voucher scheme provided voucher-paid services in Jhang , a predominantly rural district of Pakistan , during 2010 . A pre-test/post-test quasi-experimental design was used to assess the changes in the proportion of facility-based deliveries and related maternal health services among the poor . Household interviews were conducted with r and omly selected women in the intervention and control union councils , before and after the intervention . A strong outreach model was used . Voucher promoters were given basic training in identification of poor women using the Poverty Scorecard for Pakistan , in the types of problems women could face during delivery , and in the promotion of antenatal care ( ANC ) , institutional delivery and postnatal care ( PNC ) . Voucher booklets valued at Rs . 4,000 ( $ 48 ) , including three ANC visits , a PNC visit , an institutional delivery , and a postnatal family planning visit , were sold for Rs . 100 ( $ 1.2 ) to low-income women targeted by project outreach workers . Women suffering from complications were referred to emergency obstetric care services . Analysis was conducted at the bivariate and the multivariate levels . At the multivariate level , logistic regression analysis was conducted to determine whether the increase in institutional delivery was greater among poor women ( defined for this study as women in the fourth or fifth quintiles ) relative to non-poor women ( defined for this study as women in the first quintile ) in the intervention union councils compared to the control union councils . Results Bivariate analysis showed significant increases in the institutional delivery rate among women in the fourth or fifth wealth quintiles in the intervention union councils but no significant changes in this indicator among women in the same wealth quintiles in the control union councils . Multivariate analysis showed that the increase in institutional delivery among poor women relative to non-poor women was significantly greater in the intervention compared to the control union councils . Conclusions Dem and -side financing projects using vouchers can be an effective way of reducing inequities in institutional delivery An overview is presented of a multifaceted intervention to promote consistent condom use by female commercial sex workers in Thail and , in the context of the government 's 100 % condom use policy for preventing spread of human immunodeficiency virus ( HIV ) infection . The project is described with reference to a succession of stages including pre-programme needs assessment , intervention design , implementation and evaluation . The key elements of the intervention were video scenarios and discussion s coordinated by health personnel , and video-depicted open-ended narratives aim ed at helping sex workers to explore their personal and work-related dilemmas and concerns . A core objective was to enhance sex workers ' self-esteem and perceived future with a view to strengthening their motivation to take preventive action against HIV infection . The intervention was evaluated using a combination of qualitative ( process evaluation ) and quantitative ( outcome ) methods . The outcome evaluation was undertaken using a pretest , post-test intervention and control group quasi-experimental design . There were significant increases in consistent condom use among the intervention groups but not among the controls . Pragmatic stability is advocated for the Thai sex industry and recommendations are offered for good quality HIV prevention activities Summary : To test the efficacy of a sustainable community-level HIV intervention  among sex workers , the Sonagachi Project was replicated , including community organizing and advocacy , peer education , condom social marketing , and establishment of a health clinic .  Sex workers were r and omly selected in 2 small urban communities in northeastern India ( n = 100 each ) and assessed every 5–6 months over 15 months ( 85 % retention ) . Overall condom use increased significantly in the intervention community ( 39 % ) compared with the control community ( 11 % ) , and the proportion of consistent condom users increased 25 % in the intervention community compared with a 16 % decrease in the control community . This study supports the efficacy of the Sonagachi model intervention in increasing condom use and maintaining low HIV prevalence among sex workers OBJECTIVE To design , implement and evaluate a  village-based AIDS prevention programme  in a rural district in north-western Ug and a. A baseline KAP survey of the general population was carried out to design a district-wide information campaign and condom promotion programme . Eighteen months later the impact achieved was measured through a second KAP survey , using the same methodology . METHODS Anonymous structured interviews were conducted in March 1991 and October 1992 with 1486 and 1744 r and omly selected individuals age 15 - 49 , respectively . RESULTS At 18 months , 60 % of respondents had participated in an information session in the past year ( 47 % women , 71 % men ) and 42 % had received a pamphlet about AIDS ( 26 % women , 58 % men ) . Knowledge about AIDS , high initially ( 94 % ) , reached 98 % . More respondents knew that the incubation period is longer than one year ( from 29 % to 40 % ) , and were willing to take care of a PWA ( from 60 % to 77 % ) . Knowledge about condoms increased from 26 to 63 % in women and 57 to 91 % in men . Ever use of condoms among persons having engaged in casual sex in the past year increased from 6 to 33 % in women , and 27 to 48 % in men . Fifty per cent of condom users criticized lack of regular access to condoms . CONCLUSIONS This is the first documented example of the impact a village-based AIDS prevention programme can achieve in a rural African community . Critical areas to be improved were identified , such as : women must be given better access to information , more attention must be paid to explain the asymptomatic state of HIV infection in appropriate terms , and condom social marketing must be developed A r and omized community trial of a family planning outreach program  was conducted in Rakai District , Ug and a. Five communities received st and ard services ; six intervention communities  received additional family planning information , counseling , and contraceptive methods from government service providers and community-based volunteer agents using social marketing and other strategies . Condom use was promoted in all of the communities . The community-based family planning outreach program was implemented in two phases--1999 - 2000 ( early ) and 2001(late)-- and its impact was evaluated by means of population surveys in 2002 - 03 . At follow-up , hormonal contraceptive prevalence was 23 percent in the intervention communities , compared with 20 percent in the control communities . The differential was greater in the early-intervention communities than the late-intervention communities . Pregnancy rates at follow-up were 15 percent in the control and 13 percent in the intervention communities . No differentials in condom use were found between study arms . Family planning outreach via social marketing can significantly increase hormonal contraceptive use and decrease pregnancy rates , but the impact of this outreach program was modest Scalable interventions are needed to improve infant and young child feeding ( IYCF ) . We evaluated whether an IYCF nutrition communication strategy using radio and nurses changed beliefs , attitudes , social norms , intentions , and behaviors related to breastfeeding ( BF ) , dietary diversity , and food consistency .  Women with children 6 - 24 mo were r and omly selected from 6 semi-urban , low-income communities in the Mexican state of Morelos ( intervention , n = 266 ) and from 3 comparable communities in Puebla ( control , n = 201 ) .  Nurses delivered only once 5 scripted messages : BF , food consistency , flesh-food and vegetable consumption , and feed again if food was rejected ; these same messages aired 7 times each day on 3 radio stations for 21 d. The control communities were not exposed to scripted messages via nurse and radio . We used a pre-/post-test design to evaluate changes in beliefs , attitudes , norms , and intentions as well as change in behavior with 7-d food frequency questions . Mixed models were used to examine intervention-control differences in pre-/post changes . Coverage was 87 % for the nurse component and 34 % for radio . Beliefs , attitudes , and intention , but not social norms , about IYCF significantly improved in the intervention communities compared with control . Significant pre-/post changes in the intervention communities compared with control were reported for BF frequency ( 3.7 ± 0.6 times/d ) , and consumption of vegetables ( 0.6 ± 0.2 d ) and beef ( 0.2 ± 0.1 d ) and thicker consistency of chicken ( 0.6 ± 0.2 d ) and vegetable broths ( 0.8 ± 0.4 d ) . This study provides evidence that a targeted communication strategy using a scalable model significantly improves IYCF ABSTRACT Insecticide-treated nets ( ITNs ) reduce malaria transmission and related morbidity and child mortality ; however , incorrect and inconsistent use limits their protective factors . This community trial titled the Net Use Intervention study sought to bridge the gap between ITN ownership and use in southern ( coastal ) Ghana and to determine the best mix of communication tools to affect behavior of ITN owners to consistent use while maintaining optimal internal and external validity . This two-group , non-r and omized experiment evaluated a multichannel , multisector intervention process over the course of 8 weeks . A longitudinal cohort was scientifically sample d from six intervention and six control communities for both baseline and posttest surveys . The posttest survey showed no change in knowledge of ITNs in the intervention or control . In terms of use the previous night , there was a strong and statistically significant intervention effect ( OR = 1.67 ; p < .05 ) within the intervention communities . The overall increase in ITN coverage was approximately one person per night per every two households . The promotion efforts succeeded well beyond the planners ’ expectations , not only promoting usage but also dramatically increasing dem and for new ITNs Objective : The impact of a multicomponent intervention programme on the  sexual health of adolescents was assessed in rural Tanzania . Design : A community-r and omized trial . Methods : Twenty communities were r and omly allocated to receive either a specially design ed programme of interventions ( intervention group ) or st and ard activities ( comparison group ) . The intervention had four components : community activities ; teacher-led , peer-assisted sexual health education in years 5–7 of primary school ; training and supervision of health workers to provide ‘ youth-friendly ’ sexual health services ; and peer condom social marketing . Impacts on HIV incidence , herpes simplex virus 2 ( HSV2 ) and other sexual health outcomes were evaluated over approximately 3 years in 9645 adolescents recruited in late 1998 before entering years 5 , 6 or 7 of primary school . Results : The intervention had a significant impact on knowledge and reported attitudes , reported sexually transmitted infection symptoms , and several behavioural outcomes . Only five HIV seroconversions occurred in boys , whereas in girls the adjusted rate ratio ( intervention versus comparison ) was 0.75 [ 95 % confidence interval ( CI ) 0.34 , 1.66 ] . Overall HSV2 prevalences at follow-up were 11.9 % in male and 21.1 % in female participants , with adjusted prevalence ratios of 0.92 ( CI 0.69 , 1.22 ) and 1.05 ( CI 0.83 , 1.32 ) , respectively . There was no consistent beneficial or adverse impact on other biological outcomes . The beneficial impact on knowledge and reported attitudes was confirmed by results of a school examination in a separate group of students in mid-2002 . Conclusion : The intervention substantially improved knowledge , reported attitudes and some reported sexual behaviours , especially in boys , but had no consistent impact on biological outcomes within the 3-year trial period Objectives : To assess whether individual clinic-based counselling as a supplement to peer education for male and female condom promotion leads to greater use of protection and lower STI prevalence among sex workers in Madagascar already exposed to intensive male condom promotion . Methods : In two public dispensaries in Madagascar , a total of 901 sex workers were r and omly allocated between two alternative male and female condom promotion interventions : peer education only , or peer education supplemented with individual clinic-based counselling . Participants were followed for 12 months . Every 2 months they made clinic visits , where they were interviewed on condom use . Peer educators counselled all participants on condom use as they accompanied their assigned participants to study visits . Participants assigned to receive the supplemental intervention were counselled by a trained clinician following study interviews . Participants were tested and treated for chlamydia , gonorrhoea and trichomoniasis every 6 months . We used logistic regression to assess whether the more intensive intervention was associated with reduced STI prevalence . Use of protection with clients and non-paying partners was assessed by study arm , site , and visit . Results : There was no statistically significant association between study arm and aggregated STI prevalence . No substantial differences in levels of reported protection were noted between study groups . Conclusions : This study found little evidence for gains from more thorough clinical counselling on male and female condom use . These findings suggest that less clinical ly intensive interventions such as peer education could be suitable for male and female condom promotion in population s already exposed to barrier method promotion Objective : To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users ( IDU ) in China . Design : Two-armed , prospect i ve , community-r and omized prevention trial . Setting : Four counties/townships in Guangxi and Guangdong provinces ; one r and omized to intervention the other to control in each province . Participants : Injecting drug users : 823 ( 443 intervention , 382 control ) at baseline and 852 ( 415 intervention , 407 control ) at the second cross-sectional survey 12 months later . Intervention : A needle social marketing programme , including promotion of safe injection norms and increased access to clean needles over a 12 month period . Main outcome measures : Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities . Results : Needle sharing behaviours were similar in the two groups at baseline ( 68.4 vs. 67.8 % ) , and dropped significantly to 35.3 % in the intervention community and remained relatively stable in the control community ( 62.3 % ; P < 0.001 ) . In a subset of cohort of new injectors , the incidence of HCV was significant lower in intervention than in control in both provinces ( P < 0.001 , P = 0.014 ) and overall ( P < 0.001 ) but HIV was only significantly lower in intervention in Guangdong ( P = 0.011 ) . Conclusion : Needle social marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be exp and ed This study was a pilot investigation of the feasibility , acceptability , and effects of TRAIN ( Transit to Russia AIDS Intervention with Newcomers ) a three-session HIV preventive intervention for Tajik male labor migrants performed in transit . Sixty adult Tajik male labor migrants on the 5-day train ride from Dushanbe to Moscow were r and omly assigned to either the intervention or a control condition . Each initially completed an in-person survey then another 3 days later ( immediately postintervention ) , and participated in a cell phone survey three months later . All participants came to all intervention sessions , were satisfied with the program , and completed all post assessment s. In comparison with the controls , the TRAIN group reported significant increases in condom use with sex workers and non-sex workers , condom knowledge , worry about HIV/AIDS , talking with persons about HIV/AIDS , talking with wife about HIV/AIDS , community activities , and religious activities . HIV/AIDS prevention performed in transit is feasible , accceptable , and potentially efficacious in diminishing HIV risk behaviors in labor migrants
Social marketing is a commonly used strategy in global health .
Social marketing programmes may sell subsidized products through commercial sector outlets , distribute appropriately priced products , deliver health services through social franchises and promote behaviours not dependent upon a product or service .
We aim ed to review evidence of the effectiveness of social marketing in low- and middle-income countries , focusing on major areas of investment in global health : HIV , reproductive health , child survival , malaria and tuberculosis .
Global health investments are needed to ( i ) fill evidence gaps , ( ii ) strengthen evaluation rigour and ( iii ) exp and effective social marketing approaches