We propose a controlled intervention trial in the peri-urban area Bandim of the capital Bissau. Bandim is the site of a population based surveillance initiated in 1978, and from 1987 a longitudinal diarrhoea study. The proposed intervention study is mainly based on the findings of these projects. The intervention suggested include a standardised health education message concerning improved diarrhoea case management, and improved lactation and feeding practices. The health education is combined with an improved access to ORS-packages within the health system. The project has been divided into two components: one concerning intervention on breast-feeding and weaning, and one by improving case management. The present proposal concerns mainly the latter project, but in reality they will be carried out as one study.
The study is designed as a prospective community study, including active surveillance for diarrhoeal diseases during 3 years. The study population is devided into clusters which are randomized into an intervention group and a control group each comprising of approximately 500 children below 3 years of age. In addition a third group of children in an adjacent quarter Belem forms a second control group, allowing to control forflow of information from the intervention group to the control group in Bandim. Before the intervention, a pilot study has been carried out, in which knowledge, attitudes and practices regarding breast-feeding, weaning and case-management were elucidated by the use of rapid ethnographic methods (e.g. focus groups). At the same time a preintervention morbidity survey Was initiated.
The actual intervention consists of an educational message formulated on the basis of the findings from the existing data and the Dre-intervention phase. The message contains simple-and-easy-to-remember facts on aDDr0- priate infant feeding and diarrhoeal case-manaaement in the household. The message is passed on to the mothers at antenatal controls and immunization visits at the local health centre in the first year of life of the child by trained health workers.