PT - JOURNAL ARTICLE AU - Balde, Mamadou Dioulde AU - Ndavi, Patrick Muia AU - Mochache, Vernon AU - Soumah, Anne-Marie AU - Esho, Tammary AU - King’oo, James Munyao AU - Kemboi, Jackline AU - Sall, Alpha Oumar AU - Diallo, Aissatou AU - Ahmed, Wisal AU - Stein, Karin AU - Nosirov, Khurshed AU - Thwin, Soe Soe AU - Petzold, Max AU - Ahmed, Muna Abdi AU - Diriye, Ahmed AU - Pallitto, Christina TI - 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 AID - 10.1136/bmjopen-2023-078771 DP - 2024 Jul 01 TA - BMJ Open PG - e078771 VI - 14 IP - 7 4099 - http://bmjopen.bmj.com/content/14/7/e078771.short 4100 - http://bmjopen.bmj.com/content/14/7/e078771.full SO - BMJ Open2024 Jul 01; 14 AB - Introduction 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.Methods A cluster randomised trial was conducted in 2020–2021 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’ and providers’ knowledge and attitudes. Data were analysed using multilevel and single-level logistic regression models.Results 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’ FGM status (adjusted OR (AOR): 8.9, 95% CI: 6.9 to 11.5; p<0.001) and FGM-related beliefs (AOR: 9.7, 95% CI: 7.5 to 12.5; p<0.001) and discussing why (AOR: 9.2, 95% CI: 7.1 to 11.9; p<0.001) or how (AOR: 7.7, 95% CI: 6.0 to 9.9; p<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<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<0.001) compared with those in the control arm.Conclusion 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.Trial registration and date PACTR201906696419769 (3 June 2019).Data are available upon reasonable request. De-identified data set will be retained in the WHO HRP electronic archival system. Any use of the de-identified analytic data set for secondary research purposes will be governed by the WHO data use regulation. Request for data dictionary and for data set may be sent to pallittoc@who.int.