literature review of malaria bcc evaluations september 21, 2012 angela acosta & karen kirk
TRANSCRIPT
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.