Effect of Behavior Change Communication on the Incidence of Pneumonia in Under Five Children: A Cluster Randomized Controlled Trial.

Background Improving health education of the mother by providing community-based interventions is known to help control pneumonia. Objectives To determine the effect of behavior change communication (BCC) activities for mothers in reducing the incidence of childhood pneumonia. Design Open-label cluster randomized controlled trial. Setting Urban slums and villages in two districs of Maharashtra. Participants/cluster Under-five children and their mothers from households in the randomly selected 16 clusters out of total 45 clusters, stratified into Pune and Sangli districts and further into rural and urban areas before randomization. Intervention Three forms of BCC activities were imparted, viz., interactive sessions of education using pictorial mothers' booklet, screening of a audio-visual film, and virtual hand wash demonstration and use of flashcard. Routine care under the National health program was provided by the Accredited Social Health Activists (ASHA) workers in both the arms. Outcome The primary outcome was pneumonia as per the IMNCI criteria assessed during fortnightly visits of the ASHA/anganwadi workers to the houses of under-five children, who received at least one follow-up visit in a period of one year. Results The incidence of pneumonia in 1993 and 1987 under-five children in the intervention and control arm was 0.80 and 0.48 episodes per child per year, respectively (P=0.03). Conclusions BCC for mothers is not sufficient to reduce the incidence of childhood pneumonia.