market research for 7.1% chlorhexidine digluconate · page 3. research methodology ... first...
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Market research for 7.1% chlorhexidine digluconate
PATH
February 2015
Photo: PATH/Evelyn Hockstein
KENYA
Goals, Objectives, and Research Methodology
Page 2
Goals and objectives
Goals
• Support the development of effective introduction plans.
• Help manufacturers create business plans.
Objectives
• Segment the market and estimate demand by segment.
• Identify the priority market segments.
• Identify effective distribution and communication strategies to reach the priority market segments.
Page 3
Research methodology
• Research was Initiated in October 2014.• Employed both qualitative (in-depth
interviews and focus group discussions[FGDs]) and quantitative research (face-to-face household interviews using mobile phones).
• Samples for quantitative research were identified using snow-balling techniques (referrals).
• Survey areas (total 4 regions)• Nairobi (West and East areas) • Coast (Mombasa and Kwale* counties)• Central (Kiambu and Nyeri counties) • Rift Valley (Uasin Gishu and Kajiado counties)
*Kilifi county had been selected but was substituted with Kwale county after the
team faced challenges from the county government.
Page 4Page 4
Study population
Page 5
Quantitative research
82%18%
Recently delivered women Family members
n=738
• The number of family members interviewed became significantly lower than that of mothers because many family members were not home at the time of the survey.
n=134n=604
• Recently delivered women (RDW) = mothers with a child who is less than 3 years old.
• Approximately one half of mothers are women with a child who is less than 3 months old.
• Husbands and female relatives (mothers, mother-in-laws, and sister-in-laws of RDW)
Page 6
Quantitative research: characteristics of family members
6%
42%
21%
31%
Family members
Mothers-in-law
Husbands
Mothers
Other relatives(sister/sister-in-law)
n=134
Page 7
Quantitative research: characteristics of RDW
46%
54%
By urban/rural (n=604)
Urban Rural
26%
13%
9%
17%
12% 13% 12%
0%
10%
20%
30%
40%
50%
By county (n=604)
Page 8
Quantitative research: characteristics of RDW
63%
22%
14%
1%
By religion
Protestant Christian Catholic Christian
Muslim Others
Note: The middle-low household income level is represented by only 1% or 5 respondents. When results are analyzed by the household income level and shown in graphs using percentages in the following sections, the responses from mothers at the middle-low household income level are expressed as high percentages disproportionally to other household income levels. As a result, the responses from the middle-low household income level are excluded from graphs when results are analyzed by the household income level.
n=604 n=604
Page 9
39%
39%
18%
1%
4%
By income level
Lowest Low
Middle low Middle
Did not disclose
Qualitative research
Policymakers Interviewees National Coast Central Rift Valley Nairobi Total
County Director of Health 1 1 1 3Kenyan Pediatric Association/Chair 1 1Kenya Medical Association/Chair 1 1Total 2 1 0 1 1 5
Service ProvidersInterviewees National Coast Central Rift Valley Nairobi Total
Doctors 2 2 2 2 8Nurses/Midwives 4 4 4 4 16Community Health Workers (CHW) and Community Health Extension Workers (CHEW)
4 4 4 4 16
Traditional Birth Attendants (TBA) 4 4 4 4 16
Pharmacists from chemists and drug stores 4 4 4 4 16Total 0 18 18 18 18 72
FGDsParticipants National Coast Central Rift Valley Nairobi Total
# of FGDs (each group consists of 8 RDWs) 2 2 2 2 8
Page 10
Key finding: place of delivery
Page 11
Place of delivery (responses from RDW)
Total (n=604)
Page 12
17%
5%
14%62%
Home
Mission hospital/clinic
Private hospital/clinic
Government health facility
Place of delivery (responses from RDW)
25%
4% 7%
62%
1%
15%
3%
15%
67%
2%
14%
26%
57%
1%0%
20%
40%
60%
80%
100%By household income level
Lowest Low Middle low
n=576 (Those who disclosed. Excludes the middle household income.)n=604
Page 13
10% 7%
22%
60%
0%
24%
4%8%
63%
1%0%
20%
40%
60%
80%
100%
Urban Rural
By rural vs. urban
Factors influencing selection of place of delivery (responses from RDW)
Total (n=604). Multiple responses.
Page 14
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Proximity of the facility/location
Affordable cost
Trust for the care provider
Availability of skilled health worker in case of emergency
Quality of service
Family preference
It was an emergency/unexpected labor pains
Tradition
Was refered to
Had complication/specialized on surgery i.e., cesarean delivery
Awareness and usage of delivery kits (responses from RDW)
15%
85%
Ever heard of a delivery kit
Yes No
14%
86%
Ever used a delivery kit
Yes No
n=90n=604
Page 15
Key finding: antenatal care (ANC)
Page 16
Page 17
90%
10%
Yes No
95%87%
0%
20%
40%
60%
80%
100%
Urban Rural
By rural vs. urban
82%
96% 97%
0%
20%
40%
60%
80%
100%
Lowest Low Middle low
By household income level
n=576 (Excludes the middle household income.)
Use of ANC (responses from RDW)
n=604
Where and from whom ANC was received (Responses from RDW)
6%
18%
1%
76%
42%
57%
1%
7%
25%
0%
67%
33%
66%
1%
5%
10%
1%
84%
50%
49%
1%
0% 20% 40% 60% 80% 100%
Mission hospital/clinic
Private hospital/clinic
Nursing/maternity/home
Government Health Facility
Doctors/clinical officer
Nurses/midwife
Mission hospital Health Worker
Wh
ere
Fro
m w
ho
m
By rural vs. urban
Rural Urban Total n=546
Page 18
Mission hospital health worker
Government health facility
Where and from whom ANC was received (Responses from RDW)
5%
17%
0%
78%
38%
61%
1%
12%
29%
0%
59%
48%
50%
2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Mission hospital/clinic
Private hospital/clinic
Nursing/maternity/home
Government Health Facility
Doctors/clinical officer
Nurses/midwife
Mission hospital Health Worker
Wh
ere
Fro
m w
ho
m
By household income level
Middle low Low Lowest
n=522 (Those who attended ANC and disclosed their household income. Excludes the middle income level.)
Page 19
Mission hospital health worker
Government health facility
Timing of first visit (responses from RDW)
36%
51%
13%0%
21%
68%
11%
0%
50%
100%
First trimester Secondtrimester
Thirdtrimester
Don’t know
By rural vs. urban
Urban Rural n=546
n=522 (Those who attended ANC and disclosed their income. Excludes the middle income level.)
21%
67%
10%1%
26%
58%
16%
48% 46%
7%
0%
50%
100%
First trimester Secondtrimester
Thirdtrimester
Don’t know
By household income level
Lowest Low Middle low
28%
60%
12%
1%
First trimester
Secnd trimester
n=546
Page 20
Second trimester
Timing of last visit (responses from RDW)
n=522 (Those who attended ANC and disclosed their household income. Excludes the middle income level.)
36%
51%
13%21%
68%
11%1%
0%
50%
100%
First trimester Secondtrimester
Thirdtrimester
Don’t know
By rural vs. urban
Urban Rural
21%
67%
10%1%
26%
58%
16%
48% 46%
7%
0%
50%
100%
First trimester Secondtrimester
Third trimester Don’t know
By household income
Lowest Low Middle low
28%
60%
12%
1%
First trimester Secnd trimester
Third trimester Don't know
n=546
n=546
Page 21
Second trimester
Key finding: current cord care practices
Page 22
Cord care substances applied immediately after cord cutting (responses from RDW)
35%
24%
34%
5%
Methylated spirit Nothing Don’t know Other
39%
19%
38%
2%
33%27%
30%
6%
0%
10%
20%
30%
40%
50%
Methylated spirit Nothing Don’t know Other
By rural vs. urban
Urban Rural
35%
26% 27%
8%
32%
22%
40%
5%
49%
12%
37%
1%0%
10%
20%
30%
40%
50%
Methylated spirit Nothing Don’t know Other
By household income level
Lowest Low Middle low
n=580
n=546
n=552 (Those who disclosed household income level. Excludes the middle income level.)
Page 23
Cord care substances applied at home (responses from RDW who applied something after cord cutting)
n=248 (Those who applied something.)
85%
93%
79% 81%87%
94%100%
0%
20%
40%
60%
80%
100%
Total Urban Rural Lowest Low Middlelow
Middle
Total Residence Household income
n=240 (Those who applied something and disclosed their household income. Excludes the middle income level.)
Page 24
Other cord care substances applied at home(responses from RDW who applied something after cord cutting)
11% 11%
24% 24%
8% 8%
14%
0%
10%
20%
30%
40%
50%
25% 25% 25% 26%
14% 14%
24% 24%
10%3%
10%
0%
10%
20%
30%
40%
50%
Iodine Don’t know
Nothing Saliva Ash BabyPowder
Other
Urban Rural
10%
45%
10%5%
10%15%
8%
50%
17% 16%
33% 33%
0%
10%
20%
30%
40%
50%
Don’t know Nothing Saliva Ash Baby Powder Other
Lowest Low income Middle low income Middle
n=37
Page 25
By rural vs. urban
By household income level
Baby powder
Baby powder
Frequency & duration of applying cord care substances (responses from RDW who applied something after cord cutting)
21%
34%
43%
2%
38%
59%
1%
2%
15%
44%
31%
6%
4%
38%
53%
3%
7%
0% 10% 20% 30% 40% 50% 60% 70%
Once a day
Twice a day
Thrice a day
Several times in a day
Alternate days
1-3 days
4-7 days
1-2 weeks
>2 weeks
Freq
uen
cy o
f ap
plic
atio
nD
ura
tio
n
Rural Urban Totaln=248 (Those who applied
something.)
Page 26
By rural vs. urban
Frequency & duration of applying cord care substances (responses from RDW who applied something after cord cutting )
40%
60%
60%
37%
1%
2%
26%
45%
22%
4%
4%
27%
61%
2%
10%
18%
35%
40%
4%
2%
12%
84%
4%
0% 20% 40% 60% 80% 100%
Once a day
Twice a day
Thrice a day
Several times in a day
Alternate days
1-3 days
4-7 days
1-2 weeks
>2 weeks
Freq
uen
cy o
f ap
plic
atio
nD
ura
tio
n
Middle low Low Lowest
By household income level
n=245 (Those who applied something and disclosed their household income.)
Page 27
Reasons for applying cord care substances (Responses from RDW)
70%
64%
33%31%
1% 1%
69%
62%
23%
18%
1%
71%
65%
41% 42%
1% 1%
0%
20%
40%
60%
80%
100%
To dryfaster
Tofacilitatehealing
To killgerms
Topreventinfection
Don'tknow
Nothing
Total Urban Rural
n=248 n=245 (Those who disclosed income. Excludes the middle income level.)
By rural vs. urban
Page 28
56%
71%
33%
38%
2% 2%
73% 72%
40%
35%
0% 0%
94%
34%
14%8%
0% 0%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
To dryfaster
Tofacilitatehealing
To killgerms
Topreventinfection
Don'tknow
Nothing
Lowest Low Middle low
By household income level
Factors influencing choice of cord care substances(responses from RDW who applied something after cord cutting)
n=248 (Those who applied something.)
28%
5%
4%
3%
6%
47%
3%
35%
2%
1%
2%
4%
51%
2%
22%
8%
7%
4%
7%
43%
4%
0% 10% 20% 30% 40% 50% 60%
Used in the family
Used in the village
Told by TBA
Told by CHW/CHEW
On the hospital list
Told by nurses/doctors
Available
Rural Urban Total
Page 29
Factors influencing choice of cord care substances(responses from RDW who applied something after cord cutting)
40%
8%
5%
3%
8%
27%
6%
28%
6%
6%
2%
4%
49%
1%
4%
4%
2%
84%
2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Used in the family
Used in the village
Told by TBA
Told by CHW/CHEW
On the hospital list
Told by nurses/doctors
Available
Middle low Low Lowest
n=245 (Those who applied something and disclosed their household income.)
Page 30
Cord care practices
• No one single cord care is currently practiced.
• Policymakers are aware about use of chlorhexidine for umbilical cord care.
• Service providers are aware about the importance of maintaining hygienic practices. Majority of service providers said that keeping the cord clean and dry is important.
• Some health care providers use spirits and chlorhexidine while other said that they discourage use of spirits.
• Some service providers noted that they are not aware of the guidelines for cord care or that the guidelines are confusing.
• Require additional effort to raise awareness about proper cord care practices among service providers.
Page 31
Provision of currently used cord care substances
Page 32
Place to obtain cord care substances
n=248 (Those who applied something.)
n=245 (Those who applied something and disclosed their household income.)
n=248
Page 33
54%
27%
5% 4%10%
36%28%
8% 10%17%
0%10%20%30%40%50%60%
By rural vs. urban
Urban Rural
40%
21%
10% 10%
20%
47%
26%
7%4%
14%
42%46%
2% 4% 6%
0%
10%
20%
30%
40%
50%
By household income
Lowest Low Middle low
Total
44%
27%
7%
7%
15%
Chemists/pharmacies
Health care facility
Market/shop
Family member/friend
Other
Persons who obtained cord care substances
73%
11%
9%
6%
1%
Self Husband
Female relatives Other
None
82%
8% 6% 5% 0%
64%
14% 11% 8% 2%0%
20%
40%
60%
80%
100%
73% 11% 9% 6% 1%
Self Husband Femalerelatives
Other None
Urban Rural
76%
9% 7% 7%2%
62%
13% 14%9%
1%
86%
12%2%
0%
20%
40%
60%
80%
100%
73% 11% 9% 6% 1%
Self Husband Femalerelatives
Other None
Lowest Low Middle low
By household income level
n=248 (Those who applied something.)n=245.
n=248
Page 34
By rural vs. urban
Timing of obtaining cord care substances
51%38%
8%2%
Before delivery At delivery
After delivery Unknown
16%
33%
2%
Before delivery (not during ANC)
Before delivery, during ANC
Before delivery, at TBA home
n=248 (Those who applied something.)
Page 35
Timing of obtaining cord care
65%
32%
4%0%
40%45%
10%
4%
0%
20%
40%
60%
80%
100%
51% 38% 8% 2%
Beforedelivery
At delivery Afterdelivery
Unknown
Urban Rural
47%
40%
7% 6%
40%
48%
11%
0%
78%
18%
4%0%
0%
20%
40%
60%
80%
100%
51% 38% 8% 2%
Beforedelivery
At delivery After delivery Unknown
Lowest Low income Middle low income
n=248 n=245
By rural vs. urban By household income level
Page 36
Purchase of cord care substances
42%48%
38%
27%
45%
68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Tota
l
Urb
an
Ru
ral
Low
est
Low
Mid
dle
low
Mid
dle
Total Residence Household income
% purchasedcord care substances
n=248 n=245 (Those who disclosed income.)
106101
111
84
134
94
80
0
20
40
60
80
100
120
140
160
Total Urban Rural Lowest Low Middlelow
Middle
Total Residence Household income
Mean price paid
Average price of methylated spirit is KSH 130 for 100 ml
n=103 (Those who purchased.)
Page 37
Role of health care providers in obtaining cord care substances• Half of health care providers reported that spirits are given to
women for cord care at health care facilities free of charge.• Health care facilities make sure that spirits are given to women (CHEW,
Nairobi).
• Some health care facilities charge some amount of money for cord care and other items necessary when giving birth.
• They [health care facilities] will give you those items and charge you some amount of money (CHW, Kiambu).
• Some healthc are facilities provide cord care substances to women to encourage them to givebirth at health care facilities
• We like women to give birth hospitals. So, mothers are given a cord clamp to firmly hold the cord and surgical spirit to be applied after bathing babies (FGD, Kwale).
Page 38
Key finding: 7.1% chlorhexidine digluconate
Page 39
Preferred dosage form for 7.1% chlorhexidine digluconate
56%
44%
Liquid Gel
n=604
Page 40
Preferred dosage form
56% 56%44% 44%
0%
20%
40%
60%
80%
100%
Urban Rural
Liquid Gel
59%51%
62%
41%49%
38%
0%
20%
40%
60%
80%
100%
Lowest Low Middle low
Liquid Gel
63%
40%
71%
54%
37%
60%
29%
46%
0%
20%
40%
60%
80%
100%
Central Coast Nairobi Rift Valley
Liquid Geln=604
By region
By rural vs. urban
By household income
Page 41
Reasons for preference (multiple responses)
n=339
47%
22%
19%
6%
6%
0% 10% 20% 30% 40% 50%
Easy to apply
I don’t have to touch it to apply
Does not need the finger to apply
It dries faster/will keep the cord dry
Other
Reasons for preferring liquid
34%
32%
13%
5%
5%
13%
0% 10% 20% 30% 40% 50%
Feels good to the touch
Easy to apply
Its sticky
Smooth texture/soft
Lasts longer/does not dry faster
Other
Reasons for preferring gel
n=265
Page 42
Where to obtain the chlorhexidine product
55%
39%
3%
1%
1%
0% 10% 20% 30% 40% 50% 60% 70%
Pharmacies/chemists
Doctors/nurses at facilties
CHEW/CHW
ANC
TBA
65%
28%
2%
2%
2%
1%
0% 10% 20% 30% 40% 50% 60% 70%
Pharmacies/chemists
Doctors/nurses at facilties
CHEW/CHW
TBA
Market
Local shops
People who preferred liquid
People who preferred gel
n=339
n=265
Page 43
Timing of obtaining the chlorhexidine product
43%
57%
Before child birth After child birth
51%38%
8%
2%
Before delivery At delivery
After delivery Unknown
Timing of obtaining the current cord care substances
n=604
Page 44
Timing of obtaining the chlorhexidine product
Timing of obtaining the chlorhexidine product
Liquid Gel
43%46%
40%
57%54%
60%
0%
10%
20%
30%
40%
50%
60%
70%
Total Urban Rural
Before child birth After child birth
46%
55%
37%
54%
45%
63%
0%
10%
20%
30%
40%
50%
60%
70%
Total Urban Rural
Before child birth After child birth
n=265n=339
Page 45
Willingness to use the chlorhexidine product
n=265n=339
Page 46
94%
83%
0%
20%
40%
60%
80%
100%
Would use instead ofcurrent substances
Would still use gelchlorhexidine if
available
Willingness to use liquid
94%
76%
0%
20%
40%
60%
80%
100%
Would use instead ofcurrent substances
Would still use liquidchlorhexidine if
available
Willigness to use gel
Factors influencing decision to use the chlorhexidine product
66%
55%
18%
12%
8%
0% 10% 20% 30% 40% 50% 60% 70%
Doctor recommends
More effective
Locally available
Cheap
Other
45%
63%
19%
15%
13%
5%
0% 10% 20% 30% 40% 50% 60% 70%
Doctor recommends
More effective
Locally available
Cheap
Lasts longer
Other
People who preferred liquid chlorhexidine product
People who preferred gel chlorhexidine product
n=339
n=265
Page 47
Promotional avenues for the chlorhexidine product
79%
40%
37%
33%
27%
23%
10%
84%
34%
44%
37%
17%
20%
9%
74%
45%
31%
30%
35%
25%
13%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Health care providers at facilities
Radio
TV
One-on-one sessions
Community meetings
Posters/brochures
Other
Total Urban Rural
72%
40%
35%
31%
24%
12%
21%
81%
41%
50%
34%
11%
15%
20%
64%
39%
22%
28%
35%
11%
25%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Healthcare providers at facilities
Radio
TV
One-on-one sessions
Community meetings
Posters/brochures
OtherTotal Urban Rural n=265
n=339
People who preferred liquid chlorhexidine product
People who preferred gel chlorhexidine product
Page 48
Willingness to pay (KSH)
30 ml – Liquid (n=339)
49%43%
7%
43% 46%
11%
55%
40%
6%
0%
20%
40%
60%
80%
100%
<100 101-250 >251
Total Urban Rural
64%
31%
6%
52%43%
5%
19%
61%
19%
67%
33%
0%
20%
40%
60%
80%
100%
<100 101-250 >251
Lowest Low Middle low Middle
49%43%
8%
42%48%
10%
54%
39%
7%
0%
20%
40%
60%
80%
100%
<100 101-250 >251
Total Urban Rural
57%
31%
10%1%
54%43%
3% 1%
20%
71%
10%
50% 50%
0%
20%
40%
60%
80%
100%
<100 101-250 251-500 >501
Lowest Low Middle low Middle
33 g – Gel (n=265)
Page 49
Willingness to pay (KSH): purchased vs. obtained for free
25%
67%
3% 5%
66%
28%
3% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
<100 101-250 251-500 >500
Purchased (n=61) Did not purchase (n=92)
50%48%
2%
63%
25%
12%
0%
10%
20%
30%
40%
50%
60%
70%
<100 101-250 251-500
Purchased (n=44) Did not purchase (n=51)
30 ml – Liquid 33 g – Gel
Page 50
Key finding: effects of cord care substances
currently used
Page 51
Preferred dosage form for 7.1% chlorhexidine digluconate
52
62%
46%
38%
54%
0%
10%
20%
30%
40%
50%
60%
70%
Respondents who applied mehylated spirits(n=205)
Respondents who applied nothing (n=137)
Liquid Gel
Where to obtain the chlorhexidine product
Page 53
49%
46%
2%
1%
0%
0%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Pharmacits/chemists
Doctors/nurses at facilities
CHEW/CHW
TBA
Market
Local shops
Respondents who applied methylated spirits
71%
20%
3%
3%
2%
1%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Pharmacits/chemists
Doctors/nurses at facilities
CHEW/CHW
TBA
Market
Local shops
Respondents who applied nothing
When to obtain the chlorhexidine product
Page 54
0% 10% 20% 30% 40% 50% 60% 70%
After childbirth
Before childbirth
Respondents who applied methylated spirits
0% 10% 20% 30% 40% 50% 60% 70%
After childbirth
Before childbirth
Respondents who applied nothing
Factors influencing decision to use the chlorhexidine product
69%
48%
16%
7%
8%
5%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Doctors' recommendation
More effective
Local availablity
Price (inexpensive)
Last longer
Other
Respondents who applied methylated spirits
40%
67%
28%
20%
9%
3%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Doctors' recommendation
More effective
Local availablity
Price (inexpensive)
Last longer
Other
Respondents who applied nothing
Page 55
Lasts longer
Lasts longer
Doctor’s recommendation
Doctor’s recommendation
Willingness to pay for chlorhexidine product (KSH)
Larger volume of the chlorhexidine product
Applied methylated spirits
Applied nothing
Mean 148 155
Mode 100 100
Median 120 110
Range 30-600 0-2000
Page 56
Segmentation
Page 57
Segmentation factors
Residence and household income level affect where women give birth.
• The majority of respondents gave birth at government health care facilities regardless of the location of their residence and household income level. However:
• Giving birth at home is more common for respondents who live in rural areas and/or whose household incomes are at the lowest level.
• Affordability and proximity to their residences were the two most significant factors mentioned by respondents as their reason for choosing the location to give birth.
Page 58
Segmentation factors
Residence and household income level affect where and from whom women receive ANC.
• The majority of respondents receive ANC at government health care facilities regardless of the location of their residence and household income level. However:
• About one quarter of respondents who live in urban areas received ANC at private hospitals/clinics.
• 30% of respondents with middle-low income received ANC at private facilities.
• Respondents with the lowest and lower household income levels receive ANC more frequently from nurses/midwives than from doctors/clinical officers.
Page 59
Segmentation factors
Prevailing cord care practice affected a few factors:Applied methylated spirits Applied nothing
Preferred dosage form
Liquid is more preferred. Gel is more preferred.
Place to obtain the chlorhexidine product
Pharmacists/chemists are preferred by the majority of respondents.
Pharmacists/chemists and health care facilities (provided by doctors and nurses) are almost equally preferred by respondents.
Timing of obtaining the chlorhexidine product
Only a slightly larger number of respondents preferred obtaining the chlorhexidine product after giving birth.
The larger number of the respondents preferred obtaining the chlorhexidine product after giving birth.
Factors influencingdecisions to use the chlorhexidine product
Doctor’s recommendation most significantly affected their decision to use the product.
Effectiveness of the product most significantly affected their decision to use the product.
Page 60
Segmentation and priority segments
Mothers(577)
Rural(295)
Lowest(148)
Apply(45)
Not apply(38)
Don’t know(43)
Low(113)
Apply(36)
Not apply(27)
Don’t know(41)
Middle low(33)
Apply(19)
Not apply(5)
Don’t know(8)
Middle(1)
Apply(0)
Not apply(1)
Don’t know(0)
Urban(262)
Lowest(76)
Apply(34)
Not apply(20)
Don’t know(18)
Low(117)
Apply(37)
Not apply(23)
Don’t know(51)
Middle low(66)
Apply(30)
Not apply(7)
Don’t know(29)
Middle(3)
Apply(1)
Not apply(1)
Don’t know(1)
Ru
ral v
s.
Urb
an
Inco
me
leve
lSu
bst
ance
th
ey
use
= Priority Segments
Page 61
Segmentation summary: general characteristics
• Government facilities are predominantly used as places to receive ANC and give birth.
• Women have significant trust in health care professionals.
• Health care professionals influence women’s decision to use the cord care substances.
• Women want to receive product information from health care providers.
• Chemists and pharmacies are generally preferred places to obtain the chlorhexidine product.
• Women generally prefer obtaining the chlorhexidine product after giving birth.
Page 62
Segmentation summary: different characteristics
• Women who live in rural areas:
• Give birth at home (second to the government facilities).
• Prefer obtaining the chlorhexidine product after giving birth.
• Mentioned radio and community meetings as effective venues for promoting use of the chlorhexidine product.
• Women who live in urban areas:
• Use private health care facilities for ANC and giving birth (second to the government health care facilities).
• Prefer obtaining the chlorhexidine product before giving birth.
• Mentioned TV as promotional venue more often than women in rural areas.
Page 63
Segmentation summary: different characteristics
• Women who said methylated spirits are applied to their babies' cord:
• Liquid is more preferred.
• Health care facilities and chemists/pharmacies are almost equally preferred as places to obtain the chlorhexidine product.
• Doctor’s recommendation is the most significant factor that influences their decision to use the chlorhexidine product.
• Women who said that nothing was applied to the cord or they don’t know what was applied:
• Gel is more preferred.
• Chemists/pharmacies are strongly preferred as a place to obtain the chlorhexidine product.
• Effectiveness of the chlorhexidine product is the most significant factor that would influence their decision to use the product.
Page 64
Recommendations
Page 65
Recommendation: primary target and dosage form
• Primarily target is expectant mothers since they obtain the cord care substances themselves.
• Target expectant mothers at the lowest and lower household income levels in rural areas. Also target expectant mothers at the middle-low household income level in urban areas.
• Decide on the form of the chlorhexidine product. Factors to consider:
• Which form is preferred by primary target users?
• Which form results in a larger production quantity (demand)? A larger production quantity/demand could results in lower pricing.
• Which form could provide a competitive advantage to Kenyan manufacturers? A stronger local industry could lead to economic benefits and sustainable supply.
Page 66
Recommendation: communication
• Raise awareness about the latest cord care guideline among health care professionals.
• Focus on government facilities to educate expectant mothers on use of the chlorhexidine product. ANC is a good venue to increase awareness about the product.
• Utilize health care professionals to convey messages to expectant mothers as they are the most trusted source of information.
• Utilize mass media effectively to expand the number of users.
• Focus on effectiveness of the chlorhexidine product to effectively capture the segment of users who applied nothing to the cord.
Page 67
Recommendation: distribution
• Sell the chlorhexidine product at chemists/pharmacies.
• Ensure that the chlorhexidine product is available at chemists/pharmacies or nearby government health are facilities, leveraging manufacturers’ existing distribution channels.
• Don’t need to constrain distribution of the product to limited geographical areas (e.g., rural areas, areas with high neonatal mortality rate) since manufacturers have wide distribution channels.
• Focus communication and distribution effort to rural areas having a lower socioeconomic profile (i.e., hard-to-reach areas) in collaboration with implementing partners.
• Price the chlorhexidine product at or lower than 100 KSH for a multiple-application bottle/tube in order to capture a greater number of segments.
Page 68
Thank you.
Page 69
Photo: PATH/Evelyn Hockstein
Support for this project is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the HealthTech Cooperative Agreement # AID-OAA-A-11-00051. The contents are the responsibility of PATH and do not necessarily reflect the views of USAID or the US Government.
Back up slides
Page 70
Overall impression of liquid and gel
Advantages Disadvantages
Liquid • Can apply it using cotton wool. • Can easily apply without touching the
cord; therefore, germs will not be introduced and infection will be minimized.
• Texture is light. Not smooth. Rough.Waterish. Cold.
• Does not dry as quickly as gel. • Cannot feel it [the product] after drying
(unlike gel).
Gel • Texture is soft and smooth. • Dry the cord easily but not too quickly.• The cord will dry yet it will remain soft
and moisturized. • Would not spill over; therefore, it is
easier to manage.• Stays for a longer time [than liquid] and
it can prevent the cord from germs for a longer time [than liquid].
• Have to touch the cord to apply.• Sticky, and the clothes may stick to the
cord.
Page 71
Who assisted with childbirths (RDW)
Total (n=604)
Page 72
45%41%
9%
2% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Doctor Nurse /midwife TBA No one Familymember/relatives
Women who live in rural areas
Lowest income Lower
Place for ANC • Government facilities
Place for givingbirth
• Government facilities
Factors influencingdecision to use chlorhexidine
• Doctor’s recommendation, effectiveness of the product, and local availability are important.
• Effectiveness of the product is particularly important for women who currently apply nothing or don’t know what was applied.
Place to obtain chlorhexidine
• Chemists and pharmacies• Health care facilities (women who said methylated spirits were applied to
their babies).
Time point to obtainchlorhexidine
• After giving birth
Promotional venue • Health care professions at health care facilities• Radio and community meetings (women who said methylated spirits were
applied to their babies).• TV (women in the lower household income group).
Page 73
Women who live in urban areas
Lowest income Lower income Middle-low income
Place for ANC • Government facilities • Government facilities• Private facilities are used by the majority of women who
did not know what was applied to the cord.
Place for giving birth
• Government facilities • Government facilities• Private facilities are used by the fairly large number of
women who did not know what was applied to the cord.
Factors influencingdecision to use chlorhexidine
• Doctor’s recommendation, effectiveness of the product, and local availability are important.
• Effectiveness of the product is particularly important for women who currently apply nothing.
Place to obtain chlorhexidine
• Chemists and pharmacies. • Healthcare facilities (women who said methylated spirits were applied to their babies).
Time point to obtainchlorhexidine
• After giving birth • Before giving birth
Promotionalvenue
• Health care professionals at health care facilities. • Mass media such as TV and radio are mentioned more often by women who live in urban
areas than women living in rural areas.
Page 74
Sources of information on ANC and child care issues
n=604 (multiple response)
Page 75
84%
45%
40%
40%
36%
25%
14%
5%
4%
4%
4%
7%
90%
50%
41%
32%
43%
22%
3%
3%
3%
4%
6%
12%
78%
40%
38%
47%
31%
27%
23%
7%
5%
4%
2%
6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Doctor/clinical officer/nurse/midwife (during ANC)
Mother-in-law/female relatives
Friends
Radio
TV
Doctor/clinical officer/nurse/midwife (not during ANC)
TBA
Wife of religious head/women in the delivery center
Trade groups (chamas)
Marketplace
Internet
Others
Total Urban Rural