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FIELD ACTION REPORT
Open Access

Positive Influence of Behavior Change Communication on Knowledge, Attitudes, and Practices for Visceral Leishmaniasis/Kala-azar in India

Raghavan Srinivasan, Tanwir Ahmad, Vidya Raghavan, Manisha Kaushik and Ramakant Pathak
Global Health: Science and Practice March 2018, 6(1):192-209; https://doi.org/10.9745/GHSP-D-17-00087
Raghavan Srinivasan
aNew Concept Information Systems, New Delhi, India.
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  • For correspondence: raghavan.s@newconceptinfosys.com
Tanwir Ahmad
aNew Concept Information Systems, New Delhi, India.
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Vidya Raghavan
aNew Concept Information Systems, New Delhi, India.
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Manisha Kaushik
aNew Concept Information Systems, New Delhi, India.
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Ramakant Pathak
aNew Concept Information Systems, New Delhi, India.
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  • FIGURE
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    FIGURE

    Location of Project Districts in Bihar, Jharkhand, and West Bengal States of India, February 2016 to March 2017

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    TABLE 1.

    Situational Analysis According to Focal Areas of the BCC Intervention

    Focal AreasCurrent Situation/IssueBarriers/ChallengesComponents for BCC to AddressInterdependenciesa
    Knowledge and attitudes among communities and opinion leaders about causes, symptoms, and severity of VL
    • Unaware/not completely aware of the cause

    • Inability to differentiate between malaria and VL in terms of causes and causative vectors

    Insufficient/incorrect information about causative vector in transmission of VLKnowledge about causes of VL and differences between malaria and VLBuilding capacities of FLWs in IPC and effective use of BCC toolsb
    Not aware of all the symptoms and the modes of transmission of VLInsufficient/incorrect information about symptoms and modes of transmissionKnowledge about symptoms and modes of transmissionBuilding capacities of FLWs in IPC and effective use of BCC toolsb
    Awareness and perception that VL is severe and can be fatal if not diagnosed and cured on time
    • Late diagnosis due to lack of information about symptoms

    • Lack of identification of symptoms, leading to late diagnosis and delayed treatment

    Knowledge that delayed diagnosis leads to high transmission of parasite by vector, thereby increasing the case load within a householdBuilding capacities of FLWs in IPC and effective use of BCC toolsb
    Knowledge, attitudes, and practices among communities and opinion leaders about diagnosis and treatment of VL
    • Analysis of health-seeking behavior of community at the onset of fever reveals that most sought home remedies or visited the local healer (ojha)

    • Very few prefer going to government health facilities due to various service-delivery reasons

    • Community is not fully aware about the Rk39 test and about where it can be done

    • Lack of awareness about diagnosis and treatment and about where to go

    • Lack of timely diagnosis due to unavailability/inadequate quantity of Rk39

    • Lack of or poor access to government health facilities due to distance and transportation costs

    • Low credibility of public health service providers (including FLWs) and the perception/experience of people that there are no/insufficient medicines available at these health facilities

    • Low levels of motivation and knowledge among FLWs and other providers regarding diagnosis and treatment

    • Health-seeking behavior for early diagnosis and prompt treatment through public service delivery channels, emphasizing that it is of high quality and free of cost

    • Informing the community about the various services available and how they can be accessed

    • Increased credibility, confidence, and satisfaction among community on public health service delivery channels at the PHC and at Sadar district hospital

    • Increased credibility, trust, and confidence in FLWs, so the community feels motivated to seek help from them

    • Building capacities of FLWs in IPC and effective use of BCC toolsb

    • Ensuring sufficient stock of Rk39 diagnostic kits and AmBisome vials, as well as complete and appropriate treatment at Sadar district hospital

    • Advocating with policy makers regarding implementation of guidelines on incentives for patients and FLWs for treatment

    • Addressing ‘softer’ aspects like behavior and treatment toward patients by PHC/Sadar district hospital staff

    Knowledge, attitudes, and practices among communities and opinion leaders about prevention of VLLess knowledge on prevention measures of VL to prevent breeding of sand fly. Despite incomplete knowledge, VL perceived to be a preventable diseaseIncomplete knowledge on the methods of preventionKnowledge on preventive methods for Kala-azar (VL)Building capacities of frontline functionaries in IPC skill building and effective use of BCC toolsb
    • Limited knowledge of IRS as one method of prevention

    • Insufficient information provided to households well in advance of the date of the spray

    • Practices related to covering the entire house through IRS, including inside the house and cowsheds and in the surroundings and outside the house

    • IRS has not been done in the recent past in the village

    • Perceive the spray to affect the walls of the house and contaminate the food because of the bad smell and the stains it leaves behind

    • Spray workers taking bribes/food grains in exchange for spraying

    • IRS perceived to be ineffective in the long run

    • Allergy to the smell (causes headache, cough, etc.)

    • Face difficulty while emptying the house prior to IRS (which is related to prior communication of the IRS dates)

    • Absence of male member in the house when spray workers arrive

    • Delay and continuous changes in dates of IRS

    • Complete knowledge about IRS and its intended benefits

    • Advantages of SP and the improvement over DDT

    • Key influencers and opinion leaders (ward members, Mukhiya, etc.) to play an active role in demanding complete spray

    • Building capacities of FLWs in IPC and effective use of BCC toolsb

    • Training of spray workers on technical and soft skills

    • Ensuring dates of IRS are communicated well in advance, and adhered to by the spray squad

    • Coordinating with other development partners like CARE

    Lack of basic awareness on maintaining cleanliness and keeping the surroundings clean as preventive methods for VLLimited knowledge of importance/benefits of keeping household, cowsheds, and surroundings clean and dryKnowledge and awareness of maintaining proper hygiene and cleanliness especially in damp areasBuilding capacities of FLWs in IPC and effective use of BCC toolsb
    Knowledge, attitudes, and practices among communities and opinion leaders about PKDL or relapse of kala-azar
    • Inadequate awareness about PKDL and importance of treatment among patients and their families

    • Lack of sufficient information that PKDL is a reservoir of infection, which would increase transmission and the case load

    • Delayed reporting of PKDL cases due to lack of knowledge

    Insufficient knowledge about PKDL among community membersKnowledge about PKDL and importance of getting it treated immediately
    • Building capacities of FLWs in IPC and effective use of BCC toolsb

    • Increasing awareness and motivation about PKDL among Medical Officer In-Charge

    • Abbreviations: BCC, behavior change communication; FLW, frontline health worker; IPC, interpersonal communication; IRS, indoor residual spraying; PHC, primary health center; PKDL, post-kala-azar dermal leishmaniasis; VL, visceral leishmaniasis.

    • ↵a Intervention focused primarily on BCC at the community level while recognizing that achieving the overall goal of VL elimination depends also on structural factors such as availability of timely and quality services.

    • ↵b The intervention used BCC facilitators to implement the BCC activities but also involved FLWs in the BCC activities; no formal communication capacity building of the FLWs, however, was done.

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    TABLE 2.

    Primary, Secondary, and Tertiary Audiences of BCC Activities

    LevelType of AudienceSpecific Audience
    Village/tola/community levelPrimary audience:
    Will be carrying out the intended action and therefore the prime target for BCC interventions
    • Patients and families in the endemic areas

    • Communities and clusters living in damp humid areas and near vegetation, especially certain vulnerable sections of the population (excluded communities and marginalized groups)

    • Workers in agricultural fields and in cowsheds

    • Pregnant women and families with children residing in the endemic areas

    Village/tola/community levelSecondary audience:
    Responsible for facilitating the desired action toward successful behavior change
    • Community-level key influencers and opinion leaders such as PRI members, religious leaders, SHGs/AGGs/youth groups, school teachers/headmasters

    • Children in middle and secondary schools

    Village/block levelSecondary audience:
    Responsible for facilitating the desired action toward successful behavior change
    • MoICs, frontline health workers (if any), and active SHG women

    District, state, and national levelTertiary audience:
    Responsible for providing an enabling environment for sustained behavior change
    • Policy makers and program managers

    • Abbreviations: AGG, adolescent girls' group; BCC, behavior change communication; MoIC, Medical Officer In-Charge; PRI, Panchayati Raj Institution; SHG, self-help group.

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    TABLE 3.

    Mapping of Key Audiences to Communication Objectives, BCC Activities, and BCC Tools

    LevelAudienceCommunication ObjectivesDescription of BCC ActivityBCC Materials/Tools
    Village/tola/community levelPrimary audience:
    • Patients and families in the endemic areas

    • Communities and clusters living in damp humid areas and near vegetation

    • Workers in agricultural fields and in cowsheds

    • Pregnant women and families with children residing in the endemic areas

    • Increase awareness about VL and PKDL causes, symptoms, and mode of transmission

    • Ensure timely identification and reporting of fever and PKDL cases to avoid delays in diagnosis and treatment (which increases chances of transmission and case load)

    • Ensure IRS within complete household (including cowsheds, cracks, holes)

    • Maintain cleanliness and hygiene within household and surroundings and keep them dry

    • Increase in awareness regarding:

      • Location and accessibility of the nearest PHC and Sadar district hospital

      • Duration, costs, side effects regarding treatment

      • Provision of incentives for treatment

    • Group communication sessions using the VL film

    • IPC using the flip-book

    • IPC activities such as simple and participatory games, which can be carried out without any specific BCC tool

    • Miking during IRS (only in Bihar)

    • Munadi (drum beating) during IRS (only in Jharkhand)

    • VL film

    • Flip-book

    • Posters and stickers displayed at the PHC and Sadar district hospital

    • Display posters on rickshaws, tempo, and other vehicles plying in rural areas

    • SMS alerts

    Village/block levelSecondary audience:
    Frontline health workers at village level; MoIC and KTS at the block level
    • Ensure timely diagnosis and treatment of Kala-azar patients

    • Ensure active case finding and identification during Kala-azar fortnights and passive case finding during home visits (both Kala-azar and PKDL)

    • Increase community awareness on causes, symptoms, diagnosis, treatment and prevention of Kala-azar and PKDL

    • Provide identification and motivation of patients and their families for seeking timely diagnosis and treatment for fever and PKDL (through IPC and counselling during home visits)

    • Provide information about incentives/other entitlements for Kala-azar patients

    • Ensuring active participation of FLWs in group communication sessions using the Kala-azar film (to ensure continuity and sustainability)

    • IPC using the flip-book

    • Interactions/meetings using FAQ booklet

    • Capacity building on IPC and communication skills

    • VL film for GC sessions

    • Flip-book for IPC sessions

    • FAQ booklet

    • Module on IPC and effective communication

    • SMS alerts

    Village/tola/community levelSecondary audience:
    Opinion leaders, PRI/Gram Sabha members, religious leaders, SHGs/AGGs/youth groups, school teachers and headmasters
    • Increase awareness about VL and PKDL causes, symptoms, and mode of transmission

    • Timely reporting of fever and PKDL cases

    • Ensuring IRS of complete village in each and every household (including cowsheds)

    • Mobilize and motivate the community to timely report PKDL cases

    • Mobilize and motivate the community to access and demand various services

    • Provide information and assist patients in getting incentives after treatment

    • Provide support during active case finding in Kala-azar fortnights

    • Ensuring active participation in group communication sessions using the VL film

    • IPC using the flip-book

    • Interactions/meetings using FAQ booklet;

    • Screenings of VL film at the school

    • Miking during IRS (only in Bihar)

    • Munadi (drum beating) during IRS (only in Jharkhand)

    • VL film

    • Flip-book

    • FAQ booklet

    • Posters and stickers distributed to the community, the PHC, and Sadar district hospital

    • Display posters on rickshaws, tempo, and other vehicles plying in rural areas

    • SMS alerts

    Village/block levelSecondary audience:
    Private practitioners/traditional healers
    • Ensure timely diagnosis and treatment of VL patients

    • Informing the patients about causes, symptoms, diagnosis, treatment, and prevention of VL and PKDL

    • Provide information about diagnosis and treatment processes as well as procedures for referral to Sadar district hospital

    • Ensure proper recording and reporting of cases

    • Inform the patients about the nearest accessible and functional health facility

    Sensitization workshops
    • FAQ booklet

    • Posters and stickers for display and distribution in clinics, hospitals

    • SMS alerts

    • Workshop kit

    District, state, and national levelTertiary audience:
    Policy makers and program managers
    • Provision of quality and timely resources (human, equipment, and finances)

    • Provision of timely and regular supply of diagnostic kits and medicines

    • Ensure proper planning and implementation to ensure complete coverage through IRS

    • Devise a plan for capacity building of health care service providers and spray staff on technical and soft skills to enhance their motivation and awareness levels

    • Coordinate with other departments to ensure concerted efforts toward elimination

    • Ensure periodic review of the VL elimination program by senior officials at state and district levels

    Advocacy by KalaCORE with supportAdvocacy
    • Abbreviations: AGG, adolescent girls' groups; BCC, behavior change communication; FAQ, frequently asked questions; IPC, interpersonal communication; IRS, indoor residual spraying; KTS, Kala-azar Technical Supervisor; MoIC, Medical Officer In-Charge; PHC, primary health center; PKDL, post-kala-azar dermal leishmaniasis; PRI, Panchayati Raj Institution; SHG, self-help group; VL, visceral leishmaniasis.

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    TABLE 4.

    Estimated Reach of BCC Activities in Bihar and Jharkhand, India, February 2016 to March 2017

    BCC ActivitiesNo. of ActivitiesNo. of Contacts Madea
    Group communication sessions24,572982,880
    VL film screenings3,090185,400
    Interaction with frontline health workers through FAQ booklet and with KI using leaflet64,48464,484
    IPC sessions through flip-book74,452595,616
    Posters (on treatment, IRS, PKDL)91,228456,140
    Wall stickers (on treatment and PKDL)215,6971,078,485
    TOTAL3,363,005
    • Abbreviations: BCC, behavior change communication; FAQ, frequently asked questions; IPC, interpersonal communication; IRS, indoor residual spraying; PKDL, post-kala-azar dermal leishmaniasis; VL, visceral leishmaniasis.

    • ↵a These do not necessarily represent unique contacts because there may have been overlap in the people exposed to different BCC activities.

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    TABLE 5.

    Demographic Characteristics of Households Included in the Survey, Bihar and Jharkhand States of India, 2016

    VariablesBiharJharkhandTotal
    Control (n=250)Intervention (n=500)Control (n=100)Intervention (n=200)Control (N=350)Intervention (N=700)
    Population of villagesa112,522394,49712,59037,516125,112432,013
    Total no. of householdsa24,43163,9442471762026,90271,564
    Distance to nearest PHC, mean (km)11.09.014.312.611.910.1
    Average no. of family members in the surveyed households10.19.56.05.68.98.4
    Caste group, %
    General12.813.40.00.59.19.7
    Other Backward Caste42.043.610.013.032.934.9
    Scheduled Caste31.227.29.03.524.920.4
    Scheduled Tribe6.48.278.082.026.929.3
    Mahadalitb6.85.81.00.05.14.1
    Not disclosed0.81.82.01.01.11.6
    Religious affiliation, %
    Hindu85.283.837.041.571.471.7
    Muslim13.615.00.00.59.710.9
    Christian0.80.435.033.510.69.9
    Sikh0.00.00.00.00.00.0
    Jain0.00.00.00.00.00.0
    Buddhist0.00.01.00.00.30.0
    Sarna0.00.627.023.57.77.1
    Not disclosed0.40.20.01.00.30.4
    Major occupation, %
    Agriculture32.431.395.087.550.347.4
    Labor44.844.11.02.532.332.2
    Service5.65.22.02.04.64.3
    Business10.011.21.02.07.48.6
    Other7.28.21.06.05.47.6
    Income category, %
    Below the poverty level74.070.690.086.578.675.1
    Above the poverty level22.025.49.012.518.321.7
    Don't know4.04.01.01.03.13.1
    • Abbreviation: PHC, primary health center.

    • ↵a Data from government IRS microplan.

    • ↵b Lowest Scheduled Caste subcategory.

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    TABLE 6.

    Exposure to the VL Messages Among Intervention and Control Households, Bihar and Jharkhand States of India, 2016

    Intervention (%) (N=700)Control (%) (N=350)OR95% CIP Value
    Have heard/seen anything about VL in the last 12 months?68.721.18.4(4.41, 15.90)<.001
    Where did you hear/see anything about VL?a
    Radio0.30.70.3(0.01, 8.20).50
    TV6.41.36.3(0.75, 53.48).09
    Newspaper0.50.71.0(0.06, 16.21)1.00
    Poster10.50.912.2(1.55, 96.68).02
    Health meeting at PHC0.20.41.0(0.02, 50.89)1.00
    Community meeting2.90.47.2(0.37, 141.53).19
    Religious place/religious leaders0.30.01.0(0.02, 50.89)1.00
    Community leaders0.00.11.0(0.02, 50.89)1.00
    Friends/neighbor1.91.42.0(0.18, 22.65).57
    Miking/drum beating6.54.41.5(0.42, 5.60).52
    ASHA, ANM, AWW, or other health staff3.52.11.5(0.25, 9.27).65
    Door-to-door meeting5.70.013.8(0.77, 248.81).07
    Other0.00.41.0(0.02, 50.89)1.00
    BCC project activities24.50.367.9(4.02, 113.00)<.001
    Don't know/not heard or seen36.887.00.1(0.04, 0.18)<.001
    Did you get prior information about IRS of your house?b
    Yes66.930.34.7(2.61, 8.61)<.001
    No25.351.40.3(0.18, 0.58)<.001
    Don't know7.918.30.4(0.16, 0.96).04
    • Abbreviations: ANM, auxillary nurse-midwife; ASHA, Accredited Social Health Activist; AWW, Agaanwadi Worker; BCC, behavior change communication; CI, confidence interval; OR, odds ratio; PHC, primary health center; PKDL, post-Kala-azar dermal leishmaniasis; VL, visceral leishmaniasis.

    • ↵a Respondents were asked open-ended questions and their first response was recorded.

    • ↵b Refers to information through miking on the day of or before the IRS spray to announce arrival of the spray team. In intervention villages, miking was conducted by the BCC project, whereas in control villages it was conducted by the government.

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    TABLE 7.

    IRS Refusal Rates During the Second Spray Round Among Intervention and Control Households, by District and Block, Bihar and Jharkhand States of India, 2016

    DistrictBlock% IRS RefusalORa95% CIP Value
    InterventionControl
    Bihar6.2020.900.24(0.09, 0.62)<.001
    ArariaForbesganj5.6351.390.06(0.02, 0.15)<.001
    GopalganjBaruali3.1615.080.18(0.05, 0.63).01
    KatiharKadwa3.684.620.79(0.21, 3.04).73
    MuzaffarpurParoo11.9616.650.67(0.30, 1.48).32
    PurniaKaswa5.181.672.58(0.49, 13.62).26
    SamastipurSarairanjan12.7226.110.43(0.20, 0.89).02
    SaranDariyapur, Garkha9.0832.840.20(0.09, 0.45)<.001
    SitamarhiDumra5.6337.790.10(0.04, 0.26)<.001
    SiwanBarhariya3.9612.440.31(0.10, 0.98).05
    VaishaliMahua1.4410.120.09(0.01, 0.72).02
    Jharkhand12.2033.400.28(0.13, 0.58)<.001
    DumkaRamgarh1.1834.720.02(0.00, 0.14)<.001
    GoddaSundarpahari18.7644.730.29(0.15, 0.54)<.001
    PakurLittipara19.0725.070.70(0.36, 1.38).31
    SahibganjBorio9.8229.090.27(0.12, 0.60)<.001
    Total (Bihar and Jharkhand)7.9524.450.27(0.11, 0.62)<.001
    • Abbreviations: CI, confidence interval; OR, odds ratio; IRS, indoor residual spraying.

    • ↵a OR estimated based on assumption that the percentage of households that accepted IRS in the intervention areas would have refused IRS had they not been exposed to the BCC intervention. For example, in Araria district, 5.63% of households exposed to BCC activities still refused IRS. Therefore, we assume that 94.37% of households would have refused IRS if they had not been exposed to the BCC intervention, keeping aside confounders and outliers.

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    TABLE 8.

    Knowledge, Attitudes, and Practicesa Related to Prevention of VL Among Intervention and Control Households, Bihar and Jharkhand States of India, 2016

    Intervention(%) (N=700)Control(%) (N=350)OR95% CIP Value
    KNOWLEDGEb
    What causes VL?
    Insects3.64.90.8(0.21, 3.04).73
    Mosquitos20.363.10.1(0.08, 0.28)<.001
    Sand fly68.47.428.2(11.76, 67.77)<.001
    Other3.31.71.5(0.25, 9.27).65
    Don't know4.322.90.1(0.05, 0.42)<.001
    Is VL contagious and spread by touching?
    Yes21.023.40.9(0.46, 1.74).73
    No66.744.62.5(1.41, 4.40)<.001
    Don't know12.332.00.3(0.14, 0.60)<.001
    What are the symptoms of VL?
    Fever >2 weeks25.410.53.0(1.36, 6.64).01
    Loss of appetite15.57.12.5(0.99, 6.45).05
    Enlargement of spleen14.85.52.8(1.03, 7.45).04
    Weakness and anemia11.44.23.0(0.91, 9.66).07
    Don't know29.468.10.2(0.11, 0.35)<.001
    Do you know IRS prevents VL?
    Yes82.341.76.3(3.29, 12.01)<.001
    No7.419.70.3(0.12, 0.75).01
    Don't know10.338.30.2(0.08, 0.39)<.001
    What is effective treatment of VL?
    Local/traditional treatment6.412.60.4(0.15, 1.17).10
    Malarial medicine8.114.60.5(0.19, 1.22).13
    1-day medicine that is given in government hospital64.713.112.4(6.09, 25.36)<.001
    No need for medicine0.60.03.0(0.12, 75.28).50
    Other1.67.70.2(0.05, 1.13).07
    Don't know18.452.00.2(0.11, 0.39)<.001
    Do you know that complete treatment of VL is available?
    Yes88.362.04.5(2.17, 9.29)<.001
    No3.914.00.3(0.08, 0.81).02
    Don't know7.924.00.3(0.12, 0.65)<.001
    Do you know that complete treatment of VL is free?
    Yes81.039.16.7(3.51, 12.66)<.001
    No6.926.90.2(0.08, 0.49)<.001
    Don't know12.034.00.3(0.13, 0.55)<.001
    When to treat a patient with VL?
    Immediately38.020.32.5(1.31, 4.63).01
    Within 1 week11.35.71.9(0.68, 5.46).21
    Within 2 weeks22.66.04.7(1.81, 12.07)<.001
    When the patient has a fever10.412.60.7(0.31, 1.78).51
    Other1.73.40.7(0.11, 4.04).65
    Don't know16.051.40.2(0.09, 0.36)<.001
    ATTITUDES
    To whom do you advise patients with VL symptoms to go for diagnosis and treatment?
    PHC77.039.45.2(2.83, 9.69)<.001
    Private doctor7.327.10.2(0.08, 0.49)<.001
    RMP/Quack1.16.30.1(0.01, 1.04).05
    Traditional healer0.40.31.0(0.02, 50.89)1.00
    Other1.32.30.5(0.04, 5.55).57
    Don't know12.924.60.4(0.21, 0.94).03
    Will you motivate/help community members to accept IRS?
    Yes78.644.64.6(2.47, 8.56)<.001
    No14.931.10.4(0.19, 0.79).01
    Don't know6.624.30.2(0.09, 0.58)<.001
    Will you help community members to identify suspected cases of VL?
    Yes72.330.95.7(3.11, 10.52)<.001
    No18.444.30.3(0.15, 0.53)<.001
    Don't know9.124.90.3(0.13, 0.67)<.001
    PRACTICES
    Did you allow spraying of SP last timec in your house?
    Yes, all rooms77.354.62.7(1.49, 5.04)<.001
    Yes, partially16.327.40.5(0.26, 1.03).06
    No1.14.00.2(0.03, 2.21).21
    My house was locked1.92.90.7(0.11, 4.04).65
    Unaware about day of IRS3.411.10.3(0.06, 0.93).04
    • Abbreviations: ANM, auxillary nurse-midwife; ASHA, Accredited Social Health Activist; AWW, Anganwadi Worker; CI, confidence interval; OR, odds ratio; PHC, primary health center; PKDL, post-Kala-azar dermal leishmaniasis; RMP, registered medical practitioner; SP, synthetic pyrethroid; VL, visceral leishmaniasis.

    • ↵a Respondents were asked open-ended questions and their first response was recorded.

    • ↵b Correct answers are shown in italics.

    • ↵c Refers to the first IRS round.

Additional Files

  • Figures
  • Tables
  • Supplemental material

    Files in this Data Supplement:

    • Download Supplement 1 - Mapping of Communication Channels to BCC Activities, Materials, and Audiences
    • Download Supplement 2 - Implementation Plan for BCC Intervention in Bihar, India
    • Download Supplement 3 - Organogram of the Bihar and Jharkhand Project Teams
    • Download Supplement 4 - Instructions for Field Implementation
    • Download Supplement 5 - Project Management Information System
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Global Health: Science and Practice: 6 (1)
Global Health: Science and Practice
Vol. 6, No. 1
March 21, 2018
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Positive Influence of Behavior Change Communication on Knowledge, Attitudes, and Practices for Visceral Leishmaniasis/Kala-azar in India
Raghavan Srinivasan, Tanwir Ahmad, Vidya Raghavan, Manisha Kaushik, Ramakant Pathak
Global Health: Science and Practice Mar 2018, 6 (1) 192-209; DOI: 10.9745/GHSP-D-17-00087

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Positive Influence of Behavior Change Communication on Knowledge, Attitudes, and Practices for Visceral Leishmaniasis/Kala-azar in India
Raghavan Srinivasan, Tanwir Ahmad, Vidya Raghavan, Manisha Kaushik, Ramakant Pathak
Global Health: Science and Practice Mar 2018, 6 (1) 192-209; DOI: 10.9745/GHSP-D-17-00087
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