Effect of a Community Based Social Marketing Strategy on the Uptake of Clean Delivery Kits in Peri-Urban Communities of Karachi, Pakistan

Abstract

\n Background: Neonatal and maternal mortality is high in Pakistan. More than half of all deliveries take place at homes by unskilled birth attendants and unhygienic practices are common. The objective of our study was to determine the effect of a community based strategy of social marketing promoting clean delivery kits on the uptake of clean delivery kits for use in home deliveries in peri-urban communities of Karachi, Pakistan. Methods: Following a baseline survey of women who delivered in previous three months as a reference group, end line survey was conducted of women who delivered post intervention to assess need, use and availability of clean delivery kits. Availability of these kits was ensured at accessible stores in these communities. Quantitative component comprised of the baseline and post intervention surveys while qualitative information was sought from focus group discussions. Binary logistic regression was used to analyze quantitative data and ground theory to analyze qualitative data.Results: 603 women were surveyed in the baseline survey and 568 women in the end-line survey. The proportion of women using CDKs in home deliveries increased from 9.3% in the baseline survey to 23.8% (p=<0.05) after the social marketing intervention in the end-line survey. 40% of women reported non-use of kits due to inability to pay for it. However, focus group discussions revealed that many women thought that the kits should be free or should be included in the amount charged by birth attendants. After adjusting for other variables, age of the woman and education of the husband were found significantly associated with use of clean delivery kits in home deliveries. Conclusions: Social marketing strategy targeting pregnant women and their family members can play a significant role in improving use of clean delivery kits in home deliveries. However, many women expect that the cost of the kit to be included in charges paid to birth attendants. A combined approach targeting both pregnant women as well as traditional birth attendants may improve clean delivery kit use to higher levels and be sustainable in the long-run.