title: Engagement of the community, traditional leaders, and public health system in the design and implementation of a large community-based, cluster-randomized trial of umbilical cord care in Zambia.
abstract: Conducting research in areas with diverse cultures requires attention to community sensitization and involvement. The process of community engagement is described for a large community-based, cluster-randomized, controlled trial comparing daily 4% chlorhexidine umbilical cord wash to dry cord care for neonatal mortality prevention in Southern Province, Zambia. Study preparations required baseline formative ethnographic research, substantial community sensitization, and engagement with three levels of stakeholders, each necessitating different strategies. Cluster-specific birth notification systems developed with traditional leadership and community members using community-selected data collectors resulted in a post-natal home visit within 48 hours of birth in 96% of births. Of 39,679 pregnant women enrolled (93% of the target of 42,570), only 3.7% were lost to follow-up or withdrew antenatally; 0.2% live-born neonates were lost by day 28 of follow-up. Conducting this trial in close collaboration with traditional, administrative, political, and community stakeholders facilitated excellent study participation, despite structural and sociocultural challenges.
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Davidson H
authors: DH
authors: Hamer
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Julie M
authors: JM
authors: Herlihy
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Kebby
authors: K
authors: Musokotwane
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Bowen
authors: B
authors: Banda
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Chipo
authors: C
authors: Mpamba
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Boyd
authors: B
authors: Mwangelwa
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Portipher
authors: P
authors: Pilingana
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Donald M
authors: DM
authors: Thea
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Jonathon L
authors: JL
authors: Simon
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Kojo
authors: K
authors: Yeboah-Antwi
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia.
authors: Caroline
authors: C
authors: Grogan
authors: Center for Global Health Development, Boston University, Boston, Massachusetts; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts; Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia; Zambia Chlorhexidine Application Trial Field Office, Zambia Center for Applied Health Research and Development (ZCAHRD), Choma, Zambia; Southern Province Medical Office, Choma, Zambia ksemrau@ariadnelabs.org.
authors: Katherine E A
authors: KE
authors: Semrau
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003256:Community Participation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D049590:Postpartum Period; D011247:Pregnancy; D011635:Public Health Administration; D014470:Umbilical Cord; D015024:Zambia / Q000453:epidemiology
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
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