C-CHANGE
C-Channel:
Issue 29 | APRIL 2011
background gradient

Information to assist malaria communication

Of Interest…

C-Change manages the President's Malaria Initiative (PMI) Special Collection on C-Hub. The resource makes available PMI communication materials for both viewing and download. PMI technical and communication staff engaged in malaria prevention and control are encouraged to upload relevant materials to this PMI Special Collection, including related strategies, research, testing, and evaluation documents.
C-Hub

C-Channel 29 marks World Malaria Day, April 25, with six articles of interest to communication specialists and programmers working to prevent and control this endemic disease. The first article offers a valuable framework, easily integrated into the communication and M&E strategies, which can help malaria programs assess whether long-lasting insecticide-treated nets (ITNs) are being used and identify reasons for non-use. The next three articles report on current research on knowledge, attitudes, and practices relating to malaria and how these affect health-seeking behaviors in Swaziland, northwest Tanzania, and one district in Malawi. The last two articles outline a range of barriers to malaria control and treatment that must be addressed by communication programs.

C-Change worked with the government in Ethiopia's Oromia Region to launch a malaria prevention campaign that focuses on four small, doable actions by families and individuals working with community health workers. Model families display scorecards that indicate that they sleep under a net and give priority to pregnant women and children under 5, seek treatment at first sign of fever, adhere to treatment and do not share medication, and refrain from plastering after indoor spraying. For more information, see Where We Work/Ethiopia. To download the materials, please click here.

 

In this issue

A framework that programs can use to assess ITN use and non-use

1. Assessing bed net use and non-use after distribution
FULL TEXT

Research on malaria knowledge, attitudes, and practices (KAP)

2. KAP on malaria in Swaziland
FULL TEXT

3. KAP about malaria and its control in rural northwest Tanzania
FULL TEXT

4. Predictors of health-seeking behavior for febrile children under 5 in Mwanza-Neno District, Malawi
FULL TEXT

Barriers to malaria control and prevention

5. Barriers to prompt and effective malaria treatment among the poorest population in Kenya
FULL TEXT

6. Sleeping arrangement and house structure affect bed net use in villages along Lake Victoria
FULL TEXT


A framework that programs can use to assess ITN use and non-use

1. Assessing bed net use and non-use after long-lasting insecticidal net distribution: A simple framework to guide programmatic strategies

Authors: Vanden Eng J1; Thwing J1; Wolkon A1; Kulkarni M2; Manya A3; Erskine M4; Hightower A1; Slutsker L1
Institutions: 1 Centers for Disease Control and Prevention, USA; 2 Healthbridge, Canada; 3 Ministry of Health, Kenya; 4 International Federation of Red Cross and Red Crescent Societies, Geneva
Source: Malaria Journal 18 May 2010; 9:133. [Open Access]

ABSTRACT

BACKGROUND: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use.
METHODS: A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger.
RESULTS: The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations.
CONCLUSIONS: The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators.

To retrieve the full text of this article, click here. Access the journal website here.

Return To Top

Research on malaria knowledge, attitudes, and practices (KAP)

2. Community knowledge, attitudes and practices (KAP) on malaria in Swaziland: A country earmarked for malaria elimination

Authors: Hlongwana K1; Mabaso L1; Kunene S2; Govender D1; Maharaj R
Institutions: 1 South African Medical Research Council; 2 Department of Health, Swaziland
Source: Malaria Journal 19 Feb 2009; doi:10.1186/1475-2875-8-29. [Open Access]

ABSTRACT

BACKGROUND: The potential contribution of knowledge, attitudes and practices (KAP) studies to malaria research and control has not received much attention in most southern African countries. This study investigated the local communities' understanding of malaria transmission, recognition of signs and symptoms, perceptions of cause, treatment-seeking patterns, preventive measures and practices in order to inform the country's proposed malaria elimination programme in Swaziland.
METHODS: A descriptive cross-sectional survey was undertaken in four Lubombo Spatial Development Initiative (LSDI) sentinel sites in Swaziland. These sentinel sites share borders with Mozambique. A structured questionnaire was administered to 320 randomly selected households. Only one adult person was interviewed per household. The interviewees were the heads of households and in the absence of the heads of households responsible adults above 18 years were interviewed.
RESULTS: A substantial number of research participants showed reasonable knowledge of malaria, including correct association between malaria and mosquito bites, its potential fatal consequences and correct treatment practices. Almost 90% (n = 320) of the respondents stated that they would seek treatment within 24 hours of onset of malaria symptoms, with health facilities as their first treatment option. Most people (78%) perceived clinics and vector control practices as central to treating and preventing malaria disease. Indoor residual spraying (IRS) coverage and bed net ownership were 87.2% and 38.8%, respectively. IRS coverage was in agreement with the World Health Organization's (WHO) recommendation of more than 80% within the targeted communities.
CONCLUSION: Despite fair knowledge of malaria in Swaziland, there is a need for improving the availability of information through the preferred community channels, such as tinkhundlas (districts), as well as professional health routes. This recommendation emerges along with the documented evidence suggesting that as the level transmission and disease decreases so does the perception about the importance of malaria control activities. Finally, given the relatively moderate ownership of bed net there is a need for future studies to evaluate the distribution of insecticide-treated nets (ITNs) compared with IRS.

To retrieve the full text of this article, click here.  Access the journal website here.

Return To Top

3. Knowledge, attitudes, and practices about malaria and its control in rural northwest Tanzania

Authors: Mazigo H1; Obasy E1; Mauka W1; Manyiri P2; Zinga M1; Kweka E2; Mnyone L 3; Heukelbach J 4,5
Institutions: 1 Weill Bugando University College of Health Sciences, Tanzania; 2 Tropical Pesticides Research Institute, Tanzania; 3 Sokoine University of Agriculture, Tanzania; 4 Federal University of Ceará, Brazil; 5 James Cook University, Australia
Source: Malaria Research and Treatment 5 Apr 2010; doi:10.4061/2010/794261. [Epub before print]

ABSTRACT

We assessed community knowledge, attitudes, and practices on malaria as well as acceptability to indoor residual spraying.
MATERIAL AND METHODS: A cross-sectional survey was done in a community in Geita district (northwest Tanzania). Household heads (n=366) were interviewed.
RESULTS: Knowledge on malaria transmission, prevention, and treatment was reasonable; 56% of respondents associated the disease with mosquito bites, with a significant difference between education level and knowledge on transmission (P<.001). Knowledge of mosquito breeding areas was also associated with education (illiterate: 22%; literate: 59% (P<.001). Bed nets were used by 236 (64.5%), and usage was significantly associated with education level (P<.01). The level of bed net ownership was 77.3%. Most respondents (86.3%) agreed with indoor residual spraying of insecticides. Health facilities were the first option for malaria treatment by 47.3%. Artemether-lumefantrine was the most common antimalarial therapy used.
CONCLUSIONS: Despite reasonable knowledge on malaria and its preventive measures, there is a need to improve availability of information through proper community channels. Special attention should be given to illiterate community members. High acceptance of indoor residual spraying and high level of bed net ownership should be taken as an advantage to improve malaria control.

To retrieve the full text of this article, click here. Access the journal website here.

Return To Top

4. Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi

Authors: Chibwana A1; Mathanga D1; Chinkhumba J1; Campbell C Jr2 
Institutions: 1 College of Medicine, University of Malawi; 2 CDC Malaria Malawi Programme
Source: Malaria Journal 24 Sep 2009; 8:219. [Epub before print; Open Access]

ABSTRACT

BACKGROUND: Prompt access to effective treatment for malaria is unacceptably low in Malawi. Less than 20% of children under the age of five with fever receive appropriate anti-malarial treatment within 24 hours of fever onset. This study assessed socio-cultural factors associated with delayed treatment of children with fever in Mwanza district, Malawi.
METHODOLOGY: It was a qualitative study using focus group discussions and key informant interviews.
RESULTS: A total of 151 caregivers and 46 health workers participated in the focus group discussions. The majority of caregivers were able to recognize fever and link it to malaria. Despite high knowledge of malaria, prompt treatment and health-seeking behaviour were poor, with the majority of children first being managed at home with treatment regimens other than effective anti-malarials. Traditional beliefs about causes of fever, unavailability of anti-malarial drugs within the community, barriers to accessing the formal health care system, and trust in traditional medicine were all associated with delays in seeking appropriate treatment for fever.
CONCLUSION: The study has demonstrated important social cultural factors that negatively influence for caregivers of children under five. To facilitate prompt and appropriate health-seeking behaviour, behavioral change messages must address the prevailing local beliefs about causes of fever and the socio-economic barriers to accessing health care.

To retrieve the full text of this article, click here. Access the journal website here.

Return To Top

Barriers to malaria control and prevention

5. Barriers to prompt and effective malaria treatment among the poorest population in Kenya

Authors: Chuma J1,2; Okungu V1; Molyneux C1,2
Institutions: 1 Kenya Medical Research Institute-Wellcome Trust Research Programme, Kenya; 2 Nuffield Department of Clinical Medicine, University of Oxford, UK
Source: Malaria Journal 27 May 2010; 9:144. [Open Access]

ABSTRACT

BACKGROUND: Prompt access to effective malaria treatment is central to the success of malaria control worldwide, but few fevers are treated with effective anti-malarials within 24 hours of symptoms onset. The last two decades saw an upsurge of initiatives to improve access to effective malaria treatment in many parts of sub-Saharan Africa. Evidence suggests that the poorest populations remain least likely to seek prompt and effective treatment, but the factors that prevent them from accessing interventions are not well understood. With plans under way to subsidize ACT heavily in Kenya and other parts of Africa, there is urgent need to identify policy actions to promote access among the poor. This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya.
METHODS: The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey (n=708 households); 24 focus group discussions; semi-structured interviews with health workers (n=34); and patient exit interviews (n=359).
RESULTS: Multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40 percent of individuals who self-treated using shop-bought drugs and 42 percent who visited a formal health facility reported not having enough money to pay for treatment, and having to adopt coping strategies including borrowing money and getting treatment on credit in order to access care. Other factors influencing affordability were seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organization of health care services, drug and staff shortages.
CONCLUSIONS: Ensuring that all individuals suffering from malaria have prompt access to effective treatment remains a challenge for resource constrained health systems. Policy actions to address the multiple barriers of access should be designed around access dimensions, and should include broad interventions to revitalize the public health care system. Unless additional efforts are directed towards addressing access barriers among the poor and vulnerable, malaria will remain a major cause of morbidity and mortality in sub-Saharan Africa.

To retrieve the full text of this article, click here. Access the journal website here.

Return To Top

6. Sleeping arrangement and house structure affect bed net use in villages along Lake Victoria

Authors: Iwashita H1; Dida G2; Futami K3; Sonye G4; Kaneko S3; Horio M3; Kawada H3; Maekawa Y3; Aoki Y1; Minakawa N3
Institutions: 1 Graduate School of International Health Development, Nagasaki University, Japan; 2 School of Public Health, Maseno University, Kenya; 3 Institute of Tropical Medicine and the Global Center of Excellence Program, Nagasaki University, Japan; 4 Springs of Hope, Kenya
Source: Malaria Journal 22 Jun 2010; 9:176. [Open Access]

ABSTRACT

BACKGROUND: Although insecticide-treated bed nets are effective tools, use often does not follow ownership. House structure and space arrangements may make the attempt to use bed nets difficult, especially for school age children. The objectives of this study were to explore whether an individual's sleeping arrangements and house structure affect bed net use in villages along Lake Victoria in western Kenya.
METHODS: Sleeping arrangements of residents were directly observed for use of a bed net, use of a bed, and location. House size, number and types of rooms, bed availability, and residents' ages were estimated. The family heads and mothers were asked about the reason for not using bed nets. Individual bed net use was examined against age and sleeping arrangement. Net use at the household level was examined against four variables: bed availability, bed net availability, house size, and number of rooms.
RESULTS: Bed net use by children between five and 15 years of age was lower than that among the other age classes. However, age was dropped from the final model, and sleeping arrangement was significantly associated with net use. Net use was significantly associated with bed availability, number of rooms and their interaction.
CONCLUSION: Net use was affected by sleeping arrangement and availability of suitable locations for hanging nets, in addition to net availability. Most residents had likely not realized that sleeping arrangement was a factor in net use. The ease of hanging a net is particularly important for children.

To retrieve the full text of this article, click here. Access the journal website here.

Return To Top


USAIDC-CHANGEFHi 360 Satellife Center for Health Information and Technology


This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of C-Change, and do not necessarily reflect the views of USAID or the United States Government.

To contact us, please send an email to c-channel@healthnet.org.
Additional information about the project is available at the website
www.c-changeprogram.org/