Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial.

Advancing gender equality and women's empowerment (GE/WE) may contribute to better child nutrition and development in low-resource settings. However, few empirical studies have generated evidence on GE/WE and examined the potential of engaging men to transform gender norms and power relations in the context of nutrition and parenting programs. We tested the independent and combined effects of engaging couples and bundling nutrition and parenting interventions on GE/WE in Mara, Tanzania. EFFECTS (ClinicalTrials.gov, NCT03759821) was a cluster-randomized 2 × 2 factorial trial plus control. Eighty village clusters were randomly assigned to one of five intervention conditions: standard of care, mothers nutrition, couples nutrition, mothers bundled nutrition and parenting, or couples bundled nutrition and parenting. Between October 2018-May 2019, 960 households were enrolled with children under 18 months of age residing with their mother and father. Community health workers (CHWs) delivered a bi-weekly 24-session hybrid peer group/home visit gender-transformative behavior change program to either mothers or couples. GE/WE outcomes were analyzed as intention-to-treat and included time use, gender attitudes, social support, couples' communication frequency and quality, decision-making power, intimate partner violence (IPV), and women's dietary diversity (WDD). Data were collected from 957 to 815 mothers and 913 and 733 fathers at baseline and endline, respectively. Engaging couples compared to mothers only significantly increased paternal and maternal gender-equitable attitudes, paternal time spent on domestic chores, and maternal decision-making power. Bundling increased maternal leisure time, decreased maternal exposure to any IPV, and increased WDD over 7 days. A combination of engaging couples and bundling was most effective for paternal gender attitudes, couples communication frequency, and WDD over 24 h and 7 days. Our findings generate novel evidence that CHWs can deliver bundled nutrition and parenting interventions to couples in low-resource community settings that advance GE/WE more than nutrition interventions targeting only women.

The syphilis elimination project: targeting the Hispanic community of Baltimore city.

OBJECTIVE: The objective of the Syphilis Elimination Project was to decrease the incidence of syphilis in the Hispanic community of Baltimore City through a culturally appropriate health initiative. DESIGN: Both qualitative and quantitative methods were used in the study design. Surveillance data were used to collect testing information. Comparisons at the start and end of the project measured change in individual knowledge about syphilis. Cross-sectional data from interviews with business owners and qualitative comments from outreach workers evaluated perception of program effectiveness. The local health department collected surveillance data. SAMPLE: A convenience sample of 63 Hispanic community members, 12 business owners/managers, and 8 outreach workers was utilized throughout the evaluation process. INTERVENTION: The project was a culturally appropriate approach to health promotion with street and business outreach. RESULTS: Post intervention there was a statistically significant increase in knowledge about syphilis within the Hispanic community and an increase in testing behaviors. CONCLUSIONS: The Syphilis Elimination Project was created in response to a marked increase in syphilis in Baltimore among the Hispanic population and a health disparity that existed within the city. It increased community members' knowledge of syphilis and positively influenced testing behaviors.