Abstract
BackgroundThe use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts.MethodsSampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use.ResultsIn all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative).ConclusionThis research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control.
Highlights
The use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria
Study setting This study is based on analysis of household survey data collected in Madagascar, Mali, and Nigeria between 2014 and 2015 by the Johns Hopkins Center for Communication Programs (CCP), under the United States Agency for International Development (USAID)-funded Health Communication Capacity Collaborative (HC3) project and with the support of the President’s Malaria Initiative (PMI)
Results indicate that a more diverse set of ideational factors play a role in household bed net use in Madagascar compared to Mali or Nigeria, and that the strongest ideational predictors of bed net use vary from one country to another, efficacy-related variables appear to be important in all three settings
Summary
The use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. The standard Roll Back Malaria indicator of population access to ITN refers to the proportion of individuals that could use a net within a household, assuming one net covers two people. An additional standard indicator is the proportion of households that own enough ITNs to achieve the World Health Organization’s universal coverage recommendation of one ITN for every two people [4, 8, 9, 11]. In the few countries where access and use are not strongly correlated, and among groups of people with access who do not use ITNs, social and behavior change communication (SBCC) campaigns offer the most feasible means of closing the ITN access/use gap [10, 12]
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