{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T22:41:01Z","timestamp":1781822461815,"version":"3.54.5"},"reference-count":32,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100007843","name":"Direktoratet for Utviklingssamarbeid","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100007843","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020171","name":"Foreign, Commonwealth and Development Office","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Human Reproduction Programme","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,5,21]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>There is limited evidence on effective health systems interventions for preventing female genital mutilation (FGM). This study tested a two-level intervention package at primary care applying person-centred communication (PCC) for FGM prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cluster randomised trial was conducted in 2020\u20132021 in 180 antenatal care (ANC) clinics in Guinea, Kenya and Somalia. At baseline, all clinics received guidance and materials on FGM prevention and care; at month 3, ANC providers at intervention sites received PCC training. Data were collected from clinic managers, ANC providers and clients at baseline, month 3 and month 6 on primary outcomes, including delivery of PCC counselling, utilisation of level one materials, health facility preparedness for FGM prevention and care services and secondary outcomes related to clients\u2019 and providers\u2019 knowledge and attitudes. Data were analysed using multilevel and single-level logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Providers in the intervention arm were more likely to deliver PCC for FGM prevention compared with those in the control arm, including inquiring about clients\u2019 FGM status (adjusted OR (AOR): 8.9, 95% CI: 6.9 to 11.5; p&lt;0.001) and FGM-related beliefs (AOR: 9.7, 95% CI: 7.5 to 12.5; p&lt;0.001) and discussing why (AOR: 9.2, 95% CI: 7.1 to 11.9; p&lt;0.001) or how (AOR: 7.7, 95% CI: 6.0 to 9.9; p&lt;0.001) FGM should be prevented. They were more confident in their FGM-related knowledge (AOR: 7.0, 95% CI: 1.5 to 32.3; p=0.012) and communication skills (AOR: 1.8; 95% CI: 1.0 to 3.2; p=0.035). Intervention clients were less supportive of FGM (AOR: 5.4, 95% CI: 2.4 to 12.4; p&lt;0.001) and had lower intentions of having their daughters undergo FGM (AOR: 0.3, 95% CI: 0.1 to 0.7; p=0.004) or seeking medicalised FGM (AOR: 0.2, 95% CI: 0.1 to 0.5; p&lt;0.001) compared with those in the control arm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first study to provide evidence of an effective FGM prevention intervention that can be delivered in primary care settings in high-prevalence countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration and date<\/jats:title><jats:p>PACTR201906696419769 (3 June 2019).<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-078771","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T16:31:05Z","timestamp":1720110665000},"page":"e078771","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Cluster randomised trial of a health system strengthening approach applying person-centred communication for the prevention of female genital mutilation in Guinea, Kenya and Somalia"],"prefix":"10.1136","volume":"14","author":[{"given":"Mamadou Dioulde","family":"Balde","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Muia","family":"Ndavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vernon","family":"Mochache","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Soumah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammary","family":"Esho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Munyao","family":"King\u2019oo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackline","family":"Kemboi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpha Oumar","family":"Sall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aissatou","family":"Diallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wisal","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khurshed","family":"Nosirov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soe Soe","family":"Thwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Petzold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna Abdi","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Diriye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1700-6774","authenticated-orcid":false,"given":"Christina","family":"Pallitto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"2024070409300718000_14.7.e078771.1","unstructured":"United Nations General Assembly . Intensifying global efforts for the elimination of female genital Mutilations: resolution \/ adopted by the United Nations General Assembly, A\/RES\/67\/146. 2013. Available: https:\/\/www.refworld.org\/docid\/51e67bc64.html [Accessed 4 May 2022]."},{"key":"2024070409300718000_14.7.e078771.2","unstructured":"World Health Assembly . WHA resolution 61.16. New York: United Nations, 2008. Available: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA61-REC1\/A61_REC1-en.pdf"},{"key":"2024070409300718000_14.7.e078771.3","unstructured":"UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO . Eliminating female genital mutilation: an interagency statement-OHCHR. Geneva: World Health Organization, 2008."},{"key":"2024070409300718000_14.7.e078771.4","unstructured":"World Health Organization . The World Health Report: 2000: health systems: improving performance. Geneva: World Health Organization, 2000. 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