market research for 7.1% chlorhexidine digluconate · page 3. research methodology ... first...

Market research for 7.1% chlorhexidine digluconate

PATH

February 2015

Photo: PATH/Evelyn Hockstein

KENYA

Goals, Objectives, and Research Methodology

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.

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 4

Study population

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)

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

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)

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

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

Key finding: place of delivery

Place of delivery (responses from RDW)

Total (n=604)

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

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.

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

Key finding: antenatal care (ANC)

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%


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%



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

Mission hospital health worker


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%



Nursing/maternity/home

Government Health Facility

Doctors/clinical officer

Nurses/midwife

Mission hospital Health Worker

Wh

ere

Fro

m w

ho

m


Middle low Low Lowest

n=522 (Those who attended ANC and disclosed their household income. Excludes the middle income level.)

Mission hospital health worker


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%


Thirdtrimester

Don’t know



28%

60%

12%

1%

First trimester

Secnd trimester

n=546

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%


Thirdtrimester

Don’t know

By rural vs. urban

Urban Rural

21%

67%

10%1%

26%

58%

16%

48% 46%

7%

0%

50%

100%


Third trimester Don’t know

By household income


28%

60%

12%

1%

First trimester Secnd trimester

Third trimester Don't know

n=546

n=546

Second trimester

Key finding: current cord care practices

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%


By rural vs. urban

Urban Rural

35%

26% 27%

8%

32%

22%

40%

5%

49%

12%

37%

1%0%

10%

20%

30%

40%

50%




n=580

n=546

n=552 (Those who disclosed household income level. Excludes the middle income level.)

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.)

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

By rural vs. urban


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.)

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



n=245 (Those who applied something and disclosed their household income.)

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

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



Factors influencing choice of cord care substances(responses from RDW who applied something after cord cutting)


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

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



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.

Provision of currently used cord care substances

Place to obtain cord care substances



n=248

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


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



n=248 (Those who applied something.)n=245.

n=248

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


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

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


% 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


Mean price paid

Average price of methylated spirit is KSH 130 for 100 ml

n=103 (Those who purchased.)

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).

Key finding: 7.1% chlorhexidine digluconate

Preferred dosage form for 7.1% chlorhexidine digluconate

56%

44%

Liquid Gel

n=604

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%


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

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

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

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



Liquid Gel

43%46%

40%

57%54%

60%

0%

10%

20%

30%

40%

50%

60%

70%

Total Urban Rural


46%

55%

37%

54%

45%

63%

0%

10%

20%

30%

40%

50%

60%

70%

Total Urban Rural


n=265n=339

Willingness to use the chlorhexidine product

n=265n=339

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

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

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)

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

Key finding: effects of cord care substances

currently used

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

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

0% 10% 20% 30% 40% 50% 60% 70%

After childbirth

Before childbirth


0% 10% 20% 30% 40% 50% 60% 70%

After childbirth

Before childbirth


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


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


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

Segmentation

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.


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.


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.


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.

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

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.

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.

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.

Recommendations

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.

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.

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.

Thank you.

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

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.

Who assisted with childbirths (RDW)

Total (n=604)

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).

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.

Sources of information on ANC and child care issues

n=604 (multiple response)

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

market research for 7.1% chlorhexidine digluconate · page 3. research methodology ... first...

Documents