Discussion
pneumonia, diarrhea, ARI, discolored, bitter, and emitting a foul odor., infectious disease
DISEASE, INFECTIOUS DISEASE, EVENT, PNEUMONIA
This study was conducted as part of the formative phase of the CoMIC trial, which provided insight into community preferences, allowing the design of trial interventions in accordance with the needs of the community.The community residing in rural TMK belongs to a low socioeconomic background with limited access to basic amenities of life. The study highlights different perceptions that community members have regarding the importance of breastfeeding, timely and adequate complementary feeding, immunization and the use of ORS and other prescribed medicines. It is important to note that people belonging to low SES face many issues, most importantly earning a living, as most are daily wagers. Their focus towards survival leaves them with little or no energy to prioritize healthcare. Preventive measures are often ignored, and care is only sought in the event of disease or emergency. This explains why populations with low SES have comparatively poor health outcomes, especially women and children.In this study, issues related to WASH, childhood illnesses, IYCF, and vaccination coverage were reported by the community. There was consistency between the data presented in our study and findings from reported research. In TMK, water quality is not suitable for drinking or domestic use. Most people reported water in their area to be discolored, bitter, and emitting a foul odor. This corroborates with findings from a WHO report which suggested that approximately 70% of households are still drinking bacterially contaminated water [Issues related to WASH, coupled with low EBF and vaccine coverage increases the risk of contracting diarrhea and pneumonia. Pakistan has the third highest under-5 mortality burden for diarrhea and ARI [We also found EBF practices were minimal. This corroborates evidence that in Pakistan only 4 out of every 10 babies were exclusively breastfed [Finally, our results showed that most people are interested in forming groups that use collective action to improve behaviors in society. Community mobilization programs and non-cash incentives such as construction of toilets and latrines, installation of hand pumps, and distribution of soaps were suggested to improve behaviors and health practices. This aligns with the evidence synthesis by Gilmore et al. which suggested that well-implemented and contextually-appropriate community engagement strategies can help prevent and control infectious disease outbreaks and epidemics [Community engagement is a strategy that enables key stakeholders to take collective action towards a common goal. It has gained attraction as a strategy for addressing multifaceted problems [Findings derived from this formative research were used to design the CoMIC trial, in which the intervention involved collective community-based conditional non-cash incentives. The eligibility to receive incentives was based on a composite indicator comprising of the following outcomes: age-appropriate fully immunized children, ORS use for diarrhea, and sanitation index. As advised by the results of this study, the incentives were based on need assessment and prioritization by the community themselves and were given only upon achieving improvement in the outcomes. The findings of this study were discussed with the local community and used to design the intervention in the CoMIC trial [