Omrana Pasha, MD, MSPH¹, Mohammed Shafique², Ambreen Amama², Monique Sternin³, Abdul Bari, MBBS, MS², Mohammad Hashim, MBBS², and David R. Marsh, MD, MPH². (1) Women's and Children's Center, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, 404 248 0209, opasha@emory.edu, (2) Pakistan Afghanistan Field Office, Save the Children, PO Box 1952, Islamabad, Pakistan, (3) Consultant, 1 Bellis Ct, Cambridge, MA 02140

Introduction: Positive deviance (PD) is an approach for social and behavior change that rests on the observation that examples of healthy behavior occasionally occur despite generalized poor health. Identifying and interviewing PD individuals to discover the reasons for their behaviors can inform health interventions to improve practices among their neighbors. Methods: Save the Children/US pilot-tested a PD-informed behavior change project in two villages (total population 6000) in rural Pakistan. We compared baseline (July 2002; n=85) and endline (August 2003, three months after the intervention ceased; n=91) surveys of mothers pregnant in the preceding nine months. Results: During the post-intervention phase women more likely sought antenatal care (RR=1.3;95%CI 1.0-1.7), had 3 or more ANC visits (RR=1.6;95%CI 1.0-2.4), received tetanus toxoid (RR=4.9;95%CI 3.0-7.9), and saved money for possible delivery complications (RR=1.7;95%CI 1.1-2.4). While women continued to deliver at home, the birth attendant more likely washed her hands before delivery (RR=1.3;95%CI 1.1-1.6) and used a clean birth kit (RR=1.7;95%CI 1.2-2.5) and a clean blade to cut the cord (RR=18.3;95%CI 4.6-72.6). Immediate newborn care improved dramatically. The family was more likely to postpone bathing (RR=3.2;95%CI 2.1-5.0), to warm the infant (RR=2.6;95%CI 1.4-5.1), to give colostrum (RR=2.2;95%CI 1.6-3.1), and to withhold prelacteal feeds (RR=5.1;95%CI 2.8-9.4). Discussion: PD-informed intervention "worked" through mobilizing communities for behavior change, identifying pre-existing enablers of good behavior and real-life model "doers." Further confirmation of the success of this approach will be gained from an ongoing PD intervention-control trial. We believe this approach can inform larger-scale efforts for behavior change through mass media advocacy.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe the theoretical underpinings and practical application of a positive deviance (PD)-informed program.
• Recognize behaviors that lead to a high risk of neonatal death in rural areas of Pakistan.
• Identify behaviors that influence maternal and newborn outcomes which can be improved through PD-informed programming.

Keywords: Pakistan, Maternal and Child Health

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Save the Children, Federation Inc.
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Consultant