Literature review of malaria BCC evaluations

September 21, 2012

Angela Acosta & Karen Kirk

Introduction

What limits us from having a strong body of evidence on the effectiveness of BCC for malaria?

One way to look at this may be by asking: How well do we tell our story?

Objectives

1. Inventory how the literature is distributed across five key malaria behaviors

2. Identify trends in evaluation methods used

3. Identify trends in outcomes reported

4. Identify trends in types of BCC activities evaluated

Methods

• Databases such as PubMed, Google Scholar, Embase, PschyInfo, Scopus, BioMed Central and Communication Initiative

• Review of articles’ references to identify additional candidates

• Searches conducted April-June 2012• Selected characteristics entered into tables

and quantified

Methods• Inclusion criteria: 5 key behaviors (net use, IPTp

uptake, IRS acceptance, parasite-based diagnosis, and prompt and appropriate treatment with ACTs); a BCC intervention using community mobilization or mass media was used; evaluation of the BCC intervention; peer-reviewed publication up to June 2012

• Exclusion criteria: targeted retail drug sellers or providers,* pricing, or product development.

*addressed in another recent lit review

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Figure 1. Distribution of published studies on BCC for selected malaria-related behaviors, N=9

Key behaviors for preventing or treating malaria

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Results for Objective 1: Inventory how the literature is distributed across these interventions

*One paper double counted b/c it addressed net use and diagnosis

Cohort or multiple follow-ups

Control group, or level of exposure

Pre-post data

Random assignment to intervention

Random assignment for assessment

Follow up rate of >80%

Comparison groups equivalent in socio-demographics

Comparison groups equivalent on outcome measure at baseline

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Figure 2. Design and Reporting Characteristics, N=9

Results for Objective 2: Identify trends in evaluation characteristics

Table 1. Types of outcomes reported

StudyTopic Outcomes measured

Exposure Knowledge Attitude Behavior Disease

Deribew et. al., 2012 LLIN

Rickard et. al, 2011 LLIN

Ssengozi and Makumbi, 2010 LLIN

Ayi et. al., 2010 LLIN

Widmar et. al., 2009 LLIN

El-sheikh, 2007 LLIN

Okabayashi et. al., 2006 LLIN/PDx

Gies et. al., 2009 IPTp

Fatungase et. al., 2012 ACT

Results for Objective 3: Identify trends in outcomes reported

Intervention design characteristics

• None made specific reference to a framework, model or theory

• Three conducted formative research• Two conducted materials testing. Another two were

school programs that resulted in flexible teacher and child-led development of communication products.

• One mentioned a branded, strategic health communication approach (COMBI).

Results for Objective 3: Identify trends in types of BCC activities reported

Implementation characteristics

• A mix of channels were used, usually group sessions combined with posters or a guide (N=6); other mixes involved different types of community mobilization activities (N=3 and 2 of these had large school communication components).

• Frequency of group session was either just one visit total or monthly. With few exceptions, frequency or number of community mobilization activities were often unmentioned.

• Scale of implementation was limited: 5 programs took place in only one village; the others took place from 11-18 villages to one ward or district.

• Duration varied from 1-day to 2 years.

DiscussionLimitations: very narrow range of behaviors, did not

include grey literature

Key Findings:• Few published studies assess effect of BCC for current

malaria interventions• Mass media and larger-scale community mobilization

activities were not found• Authors suggest BCC contributes to improvements in

KAP/B and disease…• But…many limitations in terms of evaluation rigor and

reporting of intervention.

Recommendations: • Publishers and authors alike may benefit from

guidelines on what constitutes “good” BCC evaluation and reporting

• Potential candidates for inclusion in an OR agenda could be interventions that used mass media

References• Ayi I, Nonaka D, Adjovu J, Hanafusa S, Jimba M, Bosompem K et al. (2010). School based participatory health

education for malaria control in Ghana: engaging children as health messengers. Malaria Journal 9:98.• Bertrand J, O’Reilly K, Denison J, Anhang R, Sweat M. (2006) Systematic review of the effectiveness of mass

communication programs to change HIV/AIDS related behaviors in developing countries. Health Education Research 21; 4: 567-597.

• Deribew A, Birhanu Z, Sena L, Dejene T, Reda A, Sudhakar M et al. (2012). The effect of household heads training about the use of treated bed nets o the burden of malaria and anemia in under-five children: a cluster randomized trial in Ethiopia. Malaria Journal. 11:8.

• Elsheik, I. (2006). Effectiveness of Communication for Behavioral Impact (COMBI) strategy in increasing utilization rate of Insect icide Treated bed Nets (ITNs) – Blue Nile State, 2006. Sudanese Journal of Public Health. 2;2: 103.

• Gies S, Coulibaly S O, Ky C, Ouattara F T, Brabin B J and D'Alessandro U. (2009). Community-based promotion campaign to improve uptake of intermittent preventative antimalarial treatment in pregnancy in Burkina Faso. American Journal of Tropical Medicine and Hygiene. 80;3:460-469.

• Fatungase K, Amoran O, Alausa K. (2012). The effect of health education intervention on home management of malaria among caregivers of children aged under 5 years in Ogun State, Nigeria. European Journal of Medical Research

• Okabayashi H, Thongthien P, Singhasvanon P, Waikagul J, Looareesuwan S, et. al. (2006). Keys to success for a school-based malaria control program in primary schools in Thailand. Parasitology International 55;121-126.

• Rickard D, Dudovitz R, Wong M, Jen H, Osborn R, Fernandez H, et al. (2010). Closing the gap between insecticide treated net ownership and use for the prevention of malaria. Johns Hopkins University Press. Summer 2011 5.2: 124-134.

• Ssengonzi R and Makumbi F. (2010). Malaria among children in conflict-affected setting in Northern Uganda. RTI Press. April.

• Widmar M, Nagel C, Ho D, Benziger, Hennig N. (2009). Determining and addressing obstacles to the effective use of long-lasting insecticide-impregnated nets in rural Tanzania. Mal Journ 8:315: 1-23.

Thank you!