Hunter, Erin

School of Public Health



Bangladesh - Formative research on behavior change to improve child development outcomes

Children living in poverty do not achieve their developmental potential. Intense focused interventions that encourage mothers to be sensitive and respond to their young children improve child cognitive development. Other interventions, including improved nutrition, reducing environmental fecal contamination, and reduced lead exposure may provide additive or synergistic benefit to child health and cognitive development, but the current evidence on the benefit of combined interventions is weak. This intern placement is on a project in collaboration with the International Center for Diarrheal Disease Research, Bangladesh (icddr,b) exploring how to best integrate WASH+Nutrition+Child Stimulation interventions for eventual scale-up in rural underserved areas, while maintaining effectiveness.  All interventions are behavior change interventions to be implemented at the household and community level through community health workers. The task at hand is how to design evidence-based state of the art interventions of high feasibility and acceptability, as well as how to best integrate them in a single package, in order to achieve behavior change and the resulting positive health outcomes.  Formative and qualitative research, process evaluation and survey research play key roles in the project, as does iterative training, mentoring and supervision of community health workers.

Global Health PI/Mentor: Elli Leontsini

Bangladeshi schoolgirls face myriad challenges in managing their menstrual hygiene while at school. A large percentage of schools across the country lack adequate sanitation facilities, making it difficult or impossible to change menstrual absorbents at school. Furthermore, menstruation is a highly taboo topic and teachers often choose to skip the chapter on puberty in the physical education textbooks—thus leaving many students uninformed and unprepared for menarche. Unsupportive school environments lead many girls to remain at home during their days of heaviest menstrual flow, so that they can change their absorbents as required. Girls who do attend school during their periods often face difficulties fully participating and concentrating in class due to anxiety over potentially staining their uniforms and school benches.


Left: Body Changes. Right: Role Play

The Environmental Interventions Unit at icddr,b in Dhaka Bangladesh is conducting a pilot intervention study in effort to identify low-cost ways of creating more girl-friendly school environments where girls may be empowered to continue attending class during their periods. During my GHEFP, I worked alongside the icddr,b study team to support the launch of the pilot intervention. As a Certified Health Education Specialist, I was able to contribute to the development of the intervention curriculum, which is being taught to Class 5-10 students by schoolteachers in 4 schools (2 urban, 2 rural). The curriculum addresses physical and mental changes experienced by both girls and boys during puberty, and also incorporates activities to strengthen life skills such as problem solving. Girls are given the opportunity to strengthen their self-efficacy in managing their menstruation by participating in a variety of activities--such as tracking a menstrual cycle on a calendar and role-plays where they practice asking for an emergency pad from the school janitor.


Left: School Launch. Right: Teacher Training

In addition to creating the Teacher’s Manual for the pilot curriculum, I assisted in facilitating two teachers’ trainings where the pilot schools’ teachers were brought together and trained in providing the class sessions. I also participated in the orientation programs at the pilot schools during which the intervention was officially launched, and girls were provided menstrual hygiene management materials and instructed on how to appropriately use them.

Having worked primarily in qualitative research previously, I was keen to gain additional experience in survey research during my GHEFP. I was fortunate to have had the opportunity to participate in the refining of the study’s baseline survey and provided support for the training of the data collectors and piloting of the survey before implementation. Although I have lived and worked in Bangladesh previously, this was the first time I have worked extensively on adolescent health in the school environment. Collaborating with school principals and teachers and feeding off of the energy and enthusiasm of students was rewarding and a tremendous learning opportunity—which has prepared me well as I embark now on my dissertation research within the same population.

Study Team


Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

April 2020



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