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Impact of reduced in-home secondhand smoke exposure on low birthweight prevalence and neonate health

PI: Yayi Suryo Prabandari, Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University
USG-Supported Partner: Donald Bailey, Research Triangle Institute (RTI) International
Project dates: February 2015- January 2018

Project Overview:
Indonesia has made strides towards improving many public health and development indicators, but the rates of low birth weight (LBW) births, neonatal morbidity, and mortality remain higher than other countries in the region. International evidence has clearly implicated secondhand smoke (SHS) exposure as a primary preventable risk factor for LBW and neonatal morbidity; indeed, the evidence has been deemed sufficient to implicate SHS exposure as an independent cause of LBW. While smoking rates among women in Indonesia are relatively low, the percentage of men who smoke is among the highest in the world, and a majority of these males smoke within the home. Efforts to reduce LBW births and improve neonatal health must address male smoking in the home. The proposed study, the first of its kind in Indonesia, aims to demonstrate the potential impact of an innovative, multi-component intervention designed to impact pregnant women who live in households where a male smokes. Community and household intervention will directly target male smokers. Specifically, we propose a quasi-experimental, intervention/control study in two geographically distinct but demographically similar areas. The intervention area will receive three separate but interrelated intervention components: a Smoke-Free Home media campaign aimed at educating the broad public about the dangers of SHS during pregnancy and the benefits to child health by restricting smoking in homes; Smoke-Free Home community promotion leading to a community-level declaration of commitment to Smoke-Free Homes; and Smoke-Free Home family education leading to household-level Smoke-Free Home contracts. Results of this study will demonstrate the potential impact of this intervention to reduce SHS exposure in the home, reduce rates of LBW births, and improve neonatal health outcomes. If effective, the intervention could be efficiently scaled up throughout Indonesia with the potential to significantly improve neonatal health outcomes. 

PH 2-1 2016 Q1 photo 1PH 2-1 2016 Q1 photo 2
Media testing. (photo courtesy of PI Yayi Suryo Prabandari)
Study socialization and introduction at the district level. (photo courtesy of PI Yayi Suryo Prabandari)

Summary of Recent Activities:

In the last three months (January to March 2016), the team has accomplished several activities including: finishing training plan and materials in January; finishing our media intervention materials, training our field team in the site in February; and in March, launched the project to all stakeholders in both study areas. Meanwhile, the second proposal to the IRB has been submitted, finishing questionnaire’ translation and health media try out, as well as developing the computer-assisted personal interviewing (CAPI) system. 

A training plan consisting of five trainings with different target audiences is being implemented. The team has finished in preparing all training outlines, objectives and sessions, as continuation of our previous training preparation. The trainings were planned for field coordinators and supervisors, data collector, midwifes, primary health care doctors and health promotion officers, as well as health cadres and local leaders. Training started in February, one field coordinator and four supervisors participated in the field team training. All participants were actively involved in the questionnaire and health media testing and gave feedback, particularly in fitting the diction of questionnaire questions with local context. Our research partner from RTI, Eric Crankshaw, also participated in the field team training and the testing of health promotion media and questionnaires.

The questionnaires and health promotion materials have been finalized after they were tested in Bahasa. As a result, we were able to submit our second study phase proposal in the beginning of March.

As soon as the final versions of the questionnaires were ready, we have sent them to the CAPI system team. We collaborate with graduate program of public health IT team. We discussed a few times with the IT team, and by the end of March, one of questionnaire has been ready to be tested. In the third week of March, the research team launched the study in the North Lombok district.

PEER Health Cycle 2 Recipients