Community Consultation on Child Health Practices in Timor-Leste

"Community Consultation on Child Health Practices in Timor-Leste" provides results from a 2007 consultation conducted by the Timor-Leste Integrated Maternal and Child Health Care Project (TAIS), jointly implemented by United States Agency for International Development (USAID)/BASICS and USAID/IMMUNIZATIONbasics, to learn more about key preventive and care-seeking health practices related to child health. The community exercise consisted of focus group discussions in five districts on the context of behaviour change, such as the range of household tasks that mothers perform and their level of independence. This was followed by in-depth interviews and trials of improved practices (TIPs) in thirteen communities. In the TIPs, mothers were asked to try out new, improved practices for a trial period, after which interviewers returned to seek feedback on what people did, as well as the benefits they perceived and difficulties they encountered during the trial period.

The following are communication-related next steps towards the desired behavioural changes in maternal practices that were among those analysed in the TIPS study:

• Make a birth plan - Encourage leaders and existing groups in communities to develop a general plan for emergency transportation and contact points for obstetrical and other emergencies.
  
• Make at least four antenatal visits - Promote several antenatal visits, with an emphasis on an early visit as soon as the woman knows she is pregnant; in communities with poor access to a facility, provide occasional prenatal care via outreach; and train providers to counsel on iron tablet compliance, nutrition, and danger signs; to treat women with respect; and to keep more complete records (e.g. of tetanus toxoid vaccinations).
  
• Breastfeed exclusively for six months - Behaviour Change Communication (BCC) should focus on the meaning and importance of exclusive breastfeeding, and train community promoters to identify breastfeeding problems and to know when to refer the mother to a clinic - as in the Mother Support Group model, in which mothers meet together to support each other in successful breastfeeding.
  
• Ensure adequate iron intake for mother and young children - Community-based promoters and groups should promote antenatal counselling (ANC) and iron, and health professionals should be trained to counsel on iron tablet adherence.
  
• Minimise the exposure of babies and young children to smoke - BCC should address the dangers of exposing newborns to excessive smoke, particularly from cooking fires, and traditional leaders/grandmothers should be consulted to learn if there are acceptable alternative ways to keep the mother and newborn safe and warm.
  
• Bring children to immunisation service delivery points at the ages in the national schedule - Organising community tracking systems to remind and motivate families when a vaccination is due; training health staff to improve their counselling on immunisation; and increasing the amount and reliability of outreach sessions.