12,843 Malaria Communication Research, The Drum Beat 710, April 25 2016

The Drum BeatMalaria Communication Research – The Drum Beat 710
April 25 2016
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Today, April 25th, is World Malaria Day, a day to recognise and communicate about malaria control efforts around the globe. In light of the fact that, for half the world, every day of the year is a day to keep up the fight against malaria, the theme for 2016 is “End Malaria for Good”. Being that malaria is preventable and curable, many organisations are working to study the complex interactions involved, not only between parasites, mosquito vectors, and “hosts”, but between people as patients, parents, village health workers, clinical trialists, volunteers, donors, and governments.

Working with the ACT Consortium, a global research partnership seeking to answer key questions about the access, targeting, safety, and quality of artemisinin-based combination treatment (ACT), we have identified some of their relevant resources – for example, the Starter Kit – and resources from other organisations in support of your malaria-focused work. The emphasis of this Drum Beat is on how the ACT Consortium and others have used research to understand and shape the communication dynamics at the centre of the quest to #endmalaria for good.

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RESEARCH-BASED COMMUNICATION TOOLS
  • 1. Answering Key Questions on Malaria
    ACT Consortium Research from 2007 to 2015… and Future Directions
    This resource provides a lay person’s summary of 25 research studies in 10 countries in Africa and Asia conducted from 2007-2015 by the ACT Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. Work involved multidisciplinary teams and included formative research, cluster randomised trials, cohort and descriptive studies, impact evaluations, and economic and anthropological assessments. Based on this work, the booklet explores several questions, such as: What influences the uptake of rapid diagnostic tests (RDTs)? [Oct 2015]
  • 2. Malaria Diagnosis and Treatment: A Starter Kit to Develop Interventions in Endemic Countries
    Grounded in and emerging from ACT Consortium research, the Starter Kit is intended for people who are responsible for developing and delivering health education, communication, or training about malaria diagnosis and treatment in endemic countries. It has 5 resources which include training manuals, job aids, patient leaflets, and a card game that are designed to foster active engagement through facilitated learning, self-reflection tasks, participatory dramas, peer education, supervisory visits, tools for referral of patients or requisition of supplies, and distribution of posters and leaflets. [Apr 2016]
  • 3. ACT Consortium Guidance: Qualitative Methods for International Health Intervention Research
    by Clare I.R. Chandler, Joanna Reynolds, Jennifer J Palmer, and Eleanor Hutchinson
    Social scientists from the ACT Consortium released this compendium of guidance notes and templates to help international health researchers design, set up, run, analyse and monitor qualitative research in their studies. It is underpinned by the Consortium’s reflections on the theoretical challenges of applying a meaning-centred approach in a set of projects that were related in a devolved, multi-team approach. The document covers theory and practical advice on qualitative methods in 5 chapters. [Jan 2014]

* See also: ITN Access Indicator Snapshot [Video]

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EVALUATION STRATEGIES AND FRAMEWORKS
  • 4. Desk Review and Qualitative Assessment of Malaria Case Management Social and Behavior Change Communication Strategies in Four Countries: Ethiopia, Rwanda, Senegal and Zambia
    by Kamden Hoffmann, Nan Lewicky, and Michael Toso
    This Health Communication Capacity Collaborative (HC3) desk review was undertaken to better understand: (i) failure to use standard social and behaviour change communication (SBCC) malaria indicators in project design and evaluation and (ii) a lack of attention to service providers as the focus audience of SBCC interventions. The introduction describes a strategic SBCC approach: “a formative assessment, which identifies the important barriers and motivators to behavior change, followed by the design and implementation of a comprehensive set of interventions to support and encourage positive behaviors.” It then reviews impact indicators designed to look at the differences that a strategy might have made in the overall programme environment. Results are detailed by country and include descriptions of malaria operations plan studies and projects – along with several communication-related observations and recommendations. [May 2015]
  • 5. The Strategic Framework for Malaria Communication at the Country Level 2012–2017
    According to this Roll Back Malaria Partnership document, systematic communication to bring about sustained changes in social norms and behaviours is increasingly understood as integral to malaria control programmes. While there have been great successes, it is argued that there is now a need to focus on ensuring that evidence-based communication is positioned as a core component of global and national malaria control policy and is allocated the resources necessary to contribute to health impact. The document charts a framework for ensuring that communication is placed high on the agendas of malaria policy makers and national malaria control strategies in line with the Global Malaria Action Plan (GMAP).

* See also: Multisectoral Action Framework for Malaria

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Looking for more? See also:

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RESEARCH-BASED MALARIA COMMUNICATION AT THE COMMUNITY LEVEL
  • 6. Community Change Agents: “Doctors” of Malaria Information Mobilizing Communities to Action
    by Robert Ainslie
    This presentation examines the Communication and Malaria Initiative in Tanzania (COMMIT), a 5-year project launched in 2008 in an effort to change social norms and foster self-efficacy around malaria prevention, treatment, and control among communities and individuals in Tanzania. In addition to mass media (movies, radio, and print), health provider skills training, and advocacy, the behaviour change communication (BCC) project included over 1,200 community change agents (CCAs) responsible for mobilising and empowering communities in 11 out of 21 regions in Tanzania around consistent use of bednets (long-lasting insecticidal treated nets, or LLINs), intermittent preventive treatment for malaria in pregnancy (ITPp), under-5 case management, and indoor residual spraying (IRS). More than 10 million people were reached directly with malaria messages through home visits, group talks, school-based activities, and community-initiated events led by these CCAs. Community members resp! ected the CCAs and credited them with providing a deeper understanding of malaria. They were seen as important, trusted persons in their community, linked to the Tanzania Ministry of Health and National Malaria Control Programme (NMCP). [Feb 2016]
  • 7. Barriers to Expanded Malaria Diagnosis and Treatment: A Focus on Barriers which May Be Addressed through Advocacy, Communication, and Training Interventions
    by Scott Wittet
    This MalariaCare partnership report documents barriers to improved case management services for malaria and other febrile (fever-causing) illnesses in order to address barriers through policy adjustments and behaviour change interventions among decision-makers, health care providers, the community, and patients and caregivers. The findings of their May-September 2013 study suggest priority areas including: As providers internalise this new way of working – mobilising communities and patients to demand diagnosis and appropriate treatment of febrile illness and empowering patients to comply with treatment protocols – they will need to pass on accurate and relevant information to patients and caregivers. [May 2014]
  • 8. Use of Rapid Diagnostic Tests to Improve Malaria Treatment in the Community in Uganda
    In this ACT Consortium study in Uganda, based on the belief that community health workers (CHWs) can help patients in remote locations access prompt treatment for malaria, including ACT, community medicine distributors (CMDs) received training to use malaria RDTs and learned how to prescribe ACTs to treat malaria, how to recognise signs of other infections in children, and when to refer patients. The training was based on adult learning principles and used small group interactive processes: role play and a series of materials to simulate communication with the patient/caregiver for reaching a treatment decision. The study found that trained CHWs can use RDTs and comply with results, and that caretakers are willing for their child to be tested by CHWs before receiving treatment. Over 85% of CHWs in both transmission sites complied with the results of the RDTs, reducing overprescription of ACTs.
  • 9. Factors Likely to Affect Community Acceptance of a Malaria Vaccine in Two Districts of Ghana: A Qualitative Study
    by Arantza Meñaca, Harry Tagbor, Rose Adjei, Constance Bart-Plange, Yvette Collymore, Antoinette Ba-Nguz, Kelsey Mertes, and Allison Bingham
    As part of the effort to inform local and national decision-making in preparation for possible malaria vaccine introduction, this qualitative study explores community-level factors that could affect vaccine acceptance in Ghana and provides recommendations for a health communication strategy. The study identified a number of factors that could facilitate the introduction of a licensed malaria vaccine, including “the highly accepted and well-established routines of the CWCs, the high value placed on vaccination by communities despite their limited knowledge of vaccines, and the shared understanding that malaria prevention requires a comprehensive approach. The finding that communities appeared to be open to using a combination of methods to fight diseases suggests that a partially efficacious malaria vaccine could be part of a tool kit of malaria control strategies. The study has also confirmed the existence of an active and flexible national health communication structur! e and processes that allow for dissemination and local coordination of messages and activities.” [Oct 2014]
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IMPACT OF MALARIA COMMUNICATION INTERVENTIONS
  • 10. Basic or Enhanced Clinician Training to Improve Adherence to Malaria Treatment Guidelines: A Cluster-Randomised Trial in Two Areas of Cameroon
    by Wilfred F Mbacham, Lindsay Mangham-Jefferies, Bonnie Cundill, Olivia A Achonduh, Clare I.R. Chandler, Joel N Ambebila, Armand Nkwescheu, Dorothy Forsah-Achu, Victor Ndiforchu, Odile Tchekountouo, Mbuh Akindeh-Nji, Pierre Ongolo-Zogo, and Virginia Wiseman
    Interactive training programmes for health workers could reduce overdiagnosis of malaria by half and help prevent valuable drugs from being wasted on patients who do not have the disease, according to this research report. Carried out in Cameroon by the ACT Consortium, the research was conducted in response to calls from governments to provide evidence that helps to change the behaviour of clinicians, who often treat patients based on their signs and symptoms without testing their blood for the presence of malaria parasites. The enhanced training package lasted 3 days and was designed to change prescribing practices by giving health workers not only training to diagnose and treat malaria but the confidence to put what they learn into practice and to communicate more effectively with patients about why they are tested and that fever is not always caused by malaria. The results showed that those undertaking the comprehensive programme were much less likely to overuse antimala! rials. Inappropriate use of antimalarial drugs after a negative test was reduced from 84% in the control group to 52% in the basic-training group and to 31% in the enhanced-training group. [Apr 2014]
  • 11. Prescriber and Patient-Oriented Behavioural Interventions to Improve Use of Malaria Rapid Diagnostic Tests in Tanzania: Facility-Based Cluster Randomised Trial
    by Bonnie Cundill, Hilda Mbakilwa, Clare I.R. Chandler, George Mtove, Frank Mtei, Annie Willetts, Emily Foster, Florida Muro, Rahim Mwinyishehe, Renata Mandike, Raimos Olomi, Christopher JM Whitty, and Hugh Reyburn
    Noting that the reasons for overprescription (and neglect of non-malaria causes of fever) depend on prescriber perceptions including of patient expectations, researchers from the ACT Consortium carried out the Targeting Artemisinin Combination Trial (TACT), which was guided by formative mixed-methods research that took an evidence-based approach to a design comprising 5 key stages. Small group training with SMS was associated with an incremental and sustained improvement in prescriber adherence to RDT results and reducing over-prescribing of antimalarials to close to zero. [May 2015]
  • 12. Evaluating the Impact of a Public Health Centre Intervention on Management of Malaria and Health Outcomes of Children in Uganda: Results from the PRIME & PROCESS Studies
    by Sarah Staedke
    Findings from ACT Consortium’s formative research in Tororo district, Uganda were considered in the context of literature reviews on previous interventions as well as theory of behaviour change and adult learning, and were discussed with stakeholders in Uganda. The researchers then designed an intervention which aimed to attract patients to seek care and to improve the quality of care delivered at public health centres. Some participants in the intervention took part in workshops on patient-centred services (PCS) designed to strengthen providers’ relationships with patients, colleagues, and the community by reorienting the care-seeking experience towards patients’ aspirations for good quality care. The evaluation found that, overall, use of RDTs was much higher in patients attending intervention health centres (52% intervention vs 7% standard care). However, RDT appeared to have little impact on the use of the ACT drug artemether-lumefantrine (AL), and there were no improvem! ents in health outcomes of community children. To improve quality of health care within the public sector, infrastructure and wider systems and political issues must be addressed. [Jul 2014]
  • 13. Evaluation of the Behaviour Change Communication and Community Mobilization Activities in Myanmar Artemisinin Resistance Containment Zones
    by Myat Htut Nyunt, Khin Myo Aye, Myat Phone Kyaw, Khin Thet Wai, Tin Oo, Aye Than, Htet Wai Oo, Hnin Phyu Phway, Soe Soe Han, Thurein Htun, and Kyaw Kyaw San
    This study aimed to evaluate the effectiveness of the BCC and community mobilisation activities carried out under the rubric of the fifth objective of the Myanmar Artemisinin Resistance Containment (MARC) programme zones in Myanmar. The researchers conclude that there is “improvement of the behaviour change in the MARC areas comparing with the previous findings”. They recommend: Promote training on BCC among basic health staff and malaria volunteers; carry out supervision and monitoring on BCC activities by health staff; encourage multi-channel BBC activities; aim to conduct BCC activities at convenient times for the intended audience; and conduct operational research on the effect of BCC activities by using uniform study design in different tiers in MARC before and after the activities. [Dec 2015]
  • 14. Using SBCC to Create Demand for Mosquito Nets in the Private Sector: The Case of the Malaria Control Culture Project in Uganda
    by Daudi Ochieng
    The Malaria Consortium created a SBCC project in Uganda using mass LLIN distribution as an entry point to create a culture of sleeping under an LLIN every night and to promote other malaria control key behaviours through: mass media, in particular, radio; person-to-person dialogues through drug shops; and mobilisations and information, education, and communication (IEC) materials at health facilities. Results of the evaluation revolve around: frequency of sleeping under nets (up from 89% in year one to 96% in year two); willingness to buy a net (74% in year one, 79% in year two); reported actions after exposure to campaigns, including, for example: encouraging others to sleep under nets, buying a net, and talking to others about using nets; and increase in LLIN sales from 2,535 to 3,200. [Feb 2016]
  • 15. Wazazi Nipendeni – Love Me, Parents
    by Waziri Nyoni, Jennifer Orkis, and Robert Ainslie
    This Health COMpass SBCC Spotlight describes the process and strategy of the Wazazi Nipendeni campaign in Tanzania, a malaria-in-pregnancy campaign using a mix of mass media, community, and interpersonal communication channels that was expanded to include several key safe motherhood behaviours. It details each specific phase in the research-based endeavour, including the “evaluate and evolve” phase, during which it was found, for instance, that exposure to the campaign was a significant predictor of number of ANC visits, HIV testing, individual birth planning, delivery at a health facility, knowledge of malaria in pregnancy, receipt of sulfadoxine-pyrimethamine (SP), number of doses of SP received, and net use. One suggestion going forward: Institute a system to capture health facility data from partners before, during, and after the campaign in order to determine if campaign implementation is associated with an increase in uptake of services and intended health ou! tcomes. [Jan 2015]
  • 16. Engaging School Children as Change Agent to Create a Malaria Control Culture: A Case Study of the Malaria Control Culture Project in Uganda
    by Dr. Julian Atim
    The project employs three strategies in primary schools. First, nets are distributed to pupils in class one and class four consistently every year. Secondly, the schools were tasked to compose an anthem about malaria control which they sing at the school assembly every morning. In this way, children are preaching malaria control behaviours to themselves and to the communities when they go back home. This anthem is also played on radio every day. Thirdly, a SBCC campaign running alongside the schools’ intervention encourages children to sleep under mosquito nets. The number of nets distributed through schools that had been used the previous night increased from 78.8 % in year one to 91.6 % in year two. The proportion of those nets used by the children themselves, as opposed to any other member of the household, also increased by 2.8% across the two years. [Feb 2016]
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This issue of The Drum Beat was written by Kier Olsen DeVries.
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The Drum Beat is the email and web network of The Communication Initiative Partnership.

Full list of the CI Partners:
ANDI, BBC Media Action, Bernard van Leer Foundation, Breakthrough, Citurna TV, Fundación Imaginario, Fundación Nuevo Periodismo Iberoamericano (FNPI), Heartlines,Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Maternal and Child Survival Program (MCSP), MISA, Open Society Foundations,Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS, UNICEF, Universidad de los Andes,USAID, World Health Organization (WHO), W.K. Kellogg Foundation

The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.

Chair of the Partners Group: Garth Japhet, Founder, Soul City garth@heartlines.org.za

Executive Director: Warren Feek wfeek@comminit.com

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The Editor of The Drum Beat is Kier Olsen DeVries.
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Please send additional project, evaluation, strategic thinking, and materials information on communication for development at any time. Send to drumbeat@comminit.com

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