Using Evidence to drive cholera behavior Change in Yemen
Summary:
Since the initial outbreak of Cholera in 2017, UNICEF intensified crosssectorial interventions which aim to promote prevention of Cholera, and to enable rapid response against the spread of the epidemic. As a result, Behaviour Indicator Monitoring Surveys (BIM) are utilized to verify the adoption of Cholera prevention practices by populations in high risk districts, which act as indicators to guide the implementation of appropriate C4D interventions in these areas to increase awareness and willingness of adoption of proper Cholera preventive practices. As requested by UNICEF, Prodigy Systems conducted the second round of the Behavior Indicator Monitoring in 95 out of the 98 Cholera high risk districts in 14 governorates in Yemen as 3 districts (Nahm, Salif, and Harf Sufyn) were inaccessible due to security and safety reasons. During this BIM, field monitors targeted households and food vendors in each district, in which indicators of risk perception about Cholera, handwashing, water treatment and storage, open defection and food safety were assessed through conducting structured interviews and producing observational data. A total of 10,196 households (HHs) and 1,108 food vendors (FV) were targeted during this monitoring exercise. The BIM covered adoptions of practices related to the 5 key Cholera prevention and response messages by the beneficiaries in HHs and FVs. As a result, findings mainly reflect Cholera preventive practices, as observed by field monitors (FM) and stated by beneficiaries; in addition to risk perception and knowledge acquired about Cholera.
Background/Objectives:
In the Yemen Cholera Integrated Response Plan 2017, C4D activities were included to scale-up the preventive and control response after the resurgence of Cholera cases in April 2017. As a result, the Cholera Behavior Indicator Monitoring was used to assess the behavior indicators that have been adopted by households in the 95 cholera hotspots, which have benefited from crosssectorial Cholera response activities since the start of the response. The task assumes that all populations of targeted districts were sensitized against Cholera and provided with 5 key messages on avoidance of the disease and measures to take if someone was infected.
Description of Intervention and/or Methods/Design:
Prodigy Systems worked jointly with UNICEF to develop the monitoring data collection tools used for this BIM exercise. The developed forms and questionnaires (translated to Arabic) were converted into electronic mobile data collection forms so all interviews were conducted electronically using a mobile data collection application ISurvey electronic data collection forms (PSS platform for mobile data collection) developed by Prodigy software developers. Two questionnaires were then used to assess adoption of Cholera key preventive practices at HHs and FVs in monitored districts. In terms of data collection, each of Prodigy field monitor had his/her own iPad with 3G data service to facilitate realtime data collection and entry from all interviews. All of the data was then compiled remotely from the monitors to the central database on our cloud server. To ensure quality of collected data, each completed interview had its own GPS coordinates and photos attached with the questionnaire data.
Results/Lessons Learned:
From these findings, results revealed that cholera prevention practices varied across many levels. As main practices were found to be adopted to a great extent, gaps were still found, which could affect monitored indicators and imply that further reinforcement in such gaps need to be instilled. For example, as 95% of HH respondents wash their hands, only 67% of them wash with water and soap, indicating that practicing handwashing with both water and soap needs to be reinforced through specific promotional activities. In terms of latrine use, 88% of HHs use latrines, but only 38% are connected to closed cesspits indicating the need to emphasize handwashing practices in areas with open cesspits or open defecation and WASH interventions. As open cesspits are acting as a hosting environment of Cholera. Additionally, 96% of HHs have drinking water, but less than 10% follow water treatment methods, highlighting an evident knowledge gap.
Discussion/Implications for the Field:
As shown through this study, BIMs can be an effective tool to assess the adoption of Cholera knowledge, attitudes and preventive practices by the communities targeted by the cholera awareness activities Through its application in Yemen, the data and insights received revealed that the focus on Cholera C4D strategies should include key quality practices and risk perceptions tailored to the areas with gaps found regarding adopting such practices. Because C4D delivers crosssectorial messages, further coordination with other sectors, especially WASH, is needed to improve the adoption of Cholera prevention by HHs and FVs.
Abstract submitted by:
Nana Azia Garbrah-Aidoo - UNICEF
Since the initial outbreak of Cholera in 2017, UNICEF intensified crosssectorial interventions which aim to promote prevention of Cholera, and to enable rapid response against the spread of the epidemic. As a result, Behaviour Indicator Monitoring Surveys (BIM) are utilized to verify the adoption of Cholera prevention practices by populations in high risk districts, which act as indicators to guide the implementation of appropriate C4D interventions in these areas to increase awareness and willingness of adoption of proper Cholera preventive practices. As requested by UNICEF, Prodigy Systems conducted the second round of the Behavior Indicator Monitoring in 95 out of the 98 Cholera high risk districts in 14 governorates in Yemen as 3 districts (Nahm, Salif, and Harf Sufyn) were inaccessible due to security and safety reasons. During this BIM, field monitors targeted households and food vendors in each district, in which indicators of risk perception about Cholera, handwashing, water treatment and storage, open defection and food safety were assessed through conducting structured interviews and producing observational data. A total of 10,196 households (HHs) and 1,108 food vendors (FV) were targeted during this monitoring exercise. The BIM covered adoptions of practices related to the 5 key Cholera prevention and response messages by the beneficiaries in HHs and FVs. As a result, findings mainly reflect Cholera preventive practices, as observed by field monitors (FM) and stated by beneficiaries; in addition to risk perception and knowledge acquired about Cholera.
Background/Objectives:
In the Yemen Cholera Integrated Response Plan 2017, C4D activities were included to scale-up the preventive and control response after the resurgence of Cholera cases in April 2017. As a result, the Cholera Behavior Indicator Monitoring was used to assess the behavior indicators that have been adopted by households in the 95 cholera hotspots, which have benefited from crosssectorial Cholera response activities since the start of the response. The task assumes that all populations of targeted districts were sensitized against Cholera and provided with 5 key messages on avoidance of the disease and measures to take if someone was infected.
Description of Intervention and/or Methods/Design:
Prodigy Systems worked jointly with UNICEF to develop the monitoring data collection tools used for this BIM exercise. The developed forms and questionnaires (translated to Arabic) were converted into electronic mobile data collection forms so all interviews were conducted electronically using a mobile data collection application ISurvey electronic data collection forms (PSS platform for mobile data collection) developed by Prodigy software developers. Two questionnaires were then used to assess adoption of Cholera key preventive practices at HHs and FVs in monitored districts. In terms of data collection, each of Prodigy field monitor had his/her own iPad with 3G data service to facilitate realtime data collection and entry from all interviews. All of the data was then compiled remotely from the monitors to the central database on our cloud server. To ensure quality of collected data, each completed interview had its own GPS coordinates and photos attached with the questionnaire data.
Results/Lessons Learned:
From these findings, results revealed that cholera prevention practices varied across many levels. As main practices were found to be adopted to a great extent, gaps were still found, which could affect monitored indicators and imply that further reinforcement in such gaps need to be instilled. For example, as 95% of HH respondents wash their hands, only 67% of them wash with water and soap, indicating that practicing handwashing with both water and soap needs to be reinforced through specific promotional activities. In terms of latrine use, 88% of HHs use latrines, but only 38% are connected to closed cesspits indicating the need to emphasize handwashing practices in areas with open cesspits or open defecation and WASH interventions. As open cesspits are acting as a hosting environment of Cholera. Additionally, 96% of HHs have drinking water, but less than 10% follow water treatment methods, highlighting an evident knowledge gap.
Discussion/Implications for the Field:
As shown through this study, BIMs can be an effective tool to assess the adoption of Cholera knowledge, attitudes and preventive practices by the communities targeted by the cholera awareness activities Through its application in Yemen, the data and insights received revealed that the focus on Cholera C4D strategies should include key quality practices and risk perceptions tailored to the areas with gaps found regarding adopting such practices. Because C4D delivers crosssectorial messages, further coordination with other sectors, especially WASH, is needed to improve the adoption of Cholera prevention by HHs and FVs.
Abstract submitted by:
Nana Azia Garbrah-Aidoo - UNICEF
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: ©UNICEF Yemen/2019/Moohialdin Fuad