Environmental Health
Responses to environmental health problems should address the
individual, household, community, and policy levels and respond
to the local situation. The Manoff Group approach integrates
activities in community mobilization, Behavior-Centered Programming,SM
and social change. We have worked on a range of environmental
health issues: prevention of diarrheal disease through hygiene
promotion; promotion of appropriate behavior to decrease the
effects of indoor and outdoor air pollution; and support for
community management of water systems. In Ecuador in the early
1970s, the Manoff Group used radio and print materials in a
pioneering program to improve hygiene behaviors for diarrheal
disease prevention.
Through the Environmental Health Project (EHP), we assisted hygiene projects in the Dominican Republic, Nicaragua, and Peru that measured significant improvements in many hygiene practices and diarrhea prevalence. We incorporated our experiences in a manual on using a behavioral approach to hygiene improvement, published by PAHO. In Zlatna, Romania, we lead an effort that decreased children's blood lead levels by one-third through cleaning up children's play areas and promoting protective home practices. We worked with the Medical Research Council in South Africa to design and carry out TIPs that indicated the feasibility of various practices to reduce indoor air pollution and/or children's exposure to indoor smoke. We are currently extending such experiences through the Hygiene Improvement Project (HIP).
Romania: Reducing Child Lead Poisoning
In the mid-1990s, The Manoff Group participated in an activity of the USAID-funded
Environmental Health Project to address extremely serious
air pollution and child lead-poisoning problems in Zlatna,
Romania, home of a large copper smelter and refinery. With
local partners, we organized in-depth formative research including
focus group discussions with eight- to ten-year-olds and developed
community participation and communication activities. The
community cleaned up children's play areas and embraced many
actions at home that reduced lead exposure. These actions
resulted in a reduction of children's blood-lead levels by
more than 30%. In less than two years, the population's knowledge
of how to avoid exposure increased from 17% to 78%. A significant
portion of families adopted new behaviors to protect themselves
and their families from environmental lead: washing hands
before meals and before entering the house, cutting fingernails
three or more times per week and washing toys.
South Africa: Formative Research on Reducing Child Exposure to Indoor Air Pollution
Indoor air pollution is linked to Acute Lower Respiratory Infection (ALRI) in children less than five years of age and accounts for a significant proportion of death and illness in developing countries. A team from the Medical Research Council (MRC) of South Africa with support from the CHANGE project (the Manoff Group was a key partner) used formative research to identify behaviors that could reduce indoor air pollution.
The "identification" phase of the research found that two of the most commonly used interventions—changing to less polluting fuels or repairing or replacing stoves—were not economically feasible for these mostly low-income families.
The "trials" phase used the TIPs (Trials of Improved Practices) methodology, a formative research method that involves asking families to try selected behaviors and identify the factors that helped them maintain the positive behaviors or the barriers to practicing them. The results of the trials showed that two of the four behaviors tested—reducing the amount of time young children spent close to a cooking fire and reducing the burning time of solid fuel—were feasible for most of the families that tried them. Most of these families said they were willing to continue practicing these behaviors in the future because they had noticed improvements in their child's health and/or that their house was cleaner. This two-phase process of screening and evaluating behaviors was effective to learn what to recommend to reduce indoor air pollution.
Phase I Study: The Identification of Behavioural Intervention Opportunities to Reduce Child Exposure to Indoor Air Pollution in Rural South Africa
Phase II Study: Testing Behaviors To Reduce Child Exposure To Indoor Air Pollution In Rural South Africa
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