For effective health interventions of any type, the more you know about your audience and how precisely it relates to the problem, the more likely your materials will be focussed on the problem. In Baluchestan, we decided early on that as the problem was diarrhoeal mortality (with CMR ~200/000), we would target mothers. We wanted to obtain data on the characteristics of mothers who lost their children to diarrhoea because we reasoned that if the majority of child deaths were of infants or children under-5 born to women under the age of 21, say, then this would have defined our audience as very young mothers. Sadly, such data were not available. Census data had been manipulated and were considered unreliable.

For Baluchestan it was an established fact that the literacy rate for adult women in the province was less than 1%; thus written materials were discarded at the outset. There are two major groups in the province – Pukhtoon and Baluch. However, this masks the fact that Quetta, the capital, lies on a trade crossroad and thus five languages were routinely spoken – Urdu, Pushto, Baluch, Sindhi and Pharsi/Dari. However, the majority of the target audience were thought to be young Pukhtoon or Baluch women. Virtually all the target audience were conservative Muslims and some would not use the left hand for touching food at all because traditionally, the left hand is used to ablute the anus following defecation. In this area, people are washers, not wipers (i.e. they ablute with water).

Iodine deficiency disease is not noted in the province though it is prevalent further north in Chitral. Vaccination uptake rates were very modest and as vaccines were sometimes stored in fridges that didn’t work, effective coverage was assumed to be very low. Thus measles was considered to be a serious risk – with the attendant diarrhoea which often follows the disease, some 30 days later. Both chronic and acute malnutrition was widespread with levels well above the country average.