Diversifying Effective Malaria Elimination Approaches: School Based SBCC Modifies Communitys Malaria Messages Exposure, Processing and Practices in Ethiopia

Summary:

Background: Community empowerment is a landmark to meet ambitious plans of eliminating malaria by 2030 in Ethiopia. This study was aimed to evaluate effectiveness of school based Malaria SBCC.Methods: Pre-posttest cross-sectional study was conducted in five districts of Jimma Zone, Ethiopia. 762 households were sampled. The intervention (2017-2019) engaged students from primary schools on participatory material assisted peer education followed by exposing parents with essential malaria messages. Effect sizes (ES) for exposure, perceptions, message acceptance and practices were computed [P-value < 5%] from baseline and endline surveys. Results: The study revealed sharp rise (ES=65.7%, pv=0.00) in exposure to malaria messages [9.4% to 75.1%]. School specific exposure has grown to 57.8%, (ES=44.5%). Comprehensive knowledge about malaria was increased to 39.1% (ES=14.8%). 74.0% identified mosquito bite as cause for malaria (ES=20.8%). Slight reduction in risk perception (3.3%) and attitude (3.8%) and rise in self-efficacy (8.5%) were observed. Communitys message acceptance in favor of malaria danger control was significantly enlarged to 84.2% (ES=10%) i.e. growth in rationality for decision making towards uptake of preventive practices. Consistently, long lasting insecticide treated nets (LLINs) usage was improved to 63.0% (ES=25.8%). Giving priority to use LLIN grew by 16% (under-five) and 25% (pregnant women). Significant improvements were observed on treatment seeking (ES=16.3%), early treatment (ES=15.5%) for fever. Proper care-IRS was 71.8% (ES=61%). No significant change was observed on drug adherence. Implications: School based malaria SBCC effectively advances community behaviors; should be expanded and involved in national malaria elimination strategy.

Background/Objectives

Ethiopia has shown incredible successes pertaining to malaria morbidity, mortality and control. Currently, community empowerment and ownership is a landmark to meet ambitions of eliminating malaria by 2030. To evaluate school based malaria Social Behavior Change Communication (SBCC) in terms of communitys message exposure, knowledge, perceived risk and efficacy, and preventive practices.

Description Of Intervention And/or Methods/Design

A pre-posttest repeated cross-sectional study was conducted in five districts of Jimma Zone, Ethiopia. 762 households were sampled the surveys each. The intervention ( 2 years) engaged students from primary schools on IEC material assisted participatory peer education within small groups followed by exposing parents with essential messages aimed to influence ideation and preventive practices about malaria. The data were analyzed using SPSS version 20.0. Proportion/mean differences were computed to compare both surveys on exposure, knowledge, perceptions, message acceptance and practices at P-value < 5%. Message acceptance was psychological index measuring how messages were processed and evaluated by exposed community members, computed from difference between perceived response efficacy of malaria preventive actions and risk perceptions. Positive score indicated that exposed people were processing messages in favor of uptake of preventive actions while the negative score was measure of reluctance.

Results/Lessons Learned

Results: The repeated surveys revealed sharp rise (ES=65.7%, pv=0.00) in exposure to malaria messages from 9.4% to 75.1%. School specific exposure has grown to 57.8%, (ES=44.5%, pv=0.00). Comprehensive knowledge about malaria was increased to 39.1% (ES=14.8%, Pv=0.00). 74.0% households identified mosquito bite as cause for malaria; improved by 20.8% (pv < 0.05). High attitude (93%), perceived severity (84%), self-efficacy (77%) and low risk perception (49%) were observed at endline. Nonetheless, slight reduction in risk perception (3.3%) and attitude (3.8%) and higher rise in self-efficacy (8.5%) were observed (PV < 0.05). Communitys message acceptance in favor of malaria danger control was significantly enlarged to 84.2% (ES=10%) i.e. growth in psychological readiness towards uptake of preventive practices. For example, long lasting insecticide treated nets (LLINs) usage was 63.0% (ES=25.8%, pv=0.00). Giving priority to use LLIN grew by 16% (under-five) and 25% (pregnant women) (pv < 0.05). Significant improvements were observed on treatment

Discussion/Implications For The Field

School based malaria SBCC was effective strategy to expose to messages, modify its acceptance and advance behaviors towards malaria elimination. Use of school community should be expanded, well involved in national malaria elimination strategy. It should also be package in school based health programs currently under trial in Ethiopia.

Abstract submitted by: 

Yohannes  Kebede - Jimma university

Zewdie  Birhanu

Sudhakar Morankar

Guda Alemayehu

Lakew Abebe