BackgroundEarly initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger.MethodsA quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15–49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers.ResultsThe gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4–2.7; 1.3–3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9–1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4–2.9).ConclusionsA multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.

StudyDesign, Setting, Participants, and Intervention: The Healthy Outcomes for Teens (HOT) Project is an interactive website for middle-school students with 7 modules, including 6 videos for observational learning. A duplicate site was created replacing videos with narratives. Students (n¼41), recruited from 6th-8th grade Physical Education classes, were divided into 2 groups, video-first and narration-first. Students viewed one site first, and then switched to view the other site in a cross-over design. Focus groups followed each website viewing by one week and were recorded, transcribed, and analyzed by thematic analysis. Outcome, Measures and Analysis: Recall and comprehension of 6 videos and 6 narratives. Results: The video-first group provided more details of the scenarios, and more accurately comprehended the intended messages compared to the narrative-first group. Students felt the scenarios were believable and should remain on the website. A small group of students agreed that the choices modeled needed to be more challenging, while another small fraction agreed the scenarios should be longer. Preference for watching videos did not differ by gender; however, gender may have influenced which scenarios were most remembered by boys and girls. Conclusions and Implications: Embedded videos could augment the educational process and could be a way to improve long-term retention of nutrition information in adolescents.