Abstract
BackgroundInterventions to reduce malaria burden are effective if communities use them appropriately and consistently. Several tools have been suggested to promote uptake and use of malaria control interventions. Community workshops on malaria, using the ‘Health Animator’ approach, are a potential behaviour change strategy for malaria control. The strategy aims to influence a change in mind-set of vulnerable populations to encourage self-reliance, using community volunteers known as Health Animators. The aim of the paper is to describe the process of implementing community workshops on malaria by Health Animators to improve uptake and use of malaria control interventions in rural Malawi.MethodsThis is a descriptive study reporting feasibility, acceptability, appropriateness and fidelity of using Health Animator-led community workshops for malaria control. Quantitative data were collected from self-reporting and researcher evaluation forms. Qualitative assessments were done with Health Animators, using three focus groups (October–December 2015) and seven in-depth interviews (October 2016–February 2017).ResultsSeventy seven health Animators were trained from 62 villages. A total of 2704 workshops were conducted, with consistent attendance from January 2015 to June 2017, representing 10–17% of the population. Attendance was affected by social responsibilities and activities, relationship of the village leaders and their community and involvement of Community Health Workers. Active discussion and participation were reported as main strengths of the workshops. Health Animators personally benefited from the mind-set change and were proactive peer influencers in the community. Although the information was comprehended and accepted, availability of adequate health services was a challenge for maintenance of behaviour change.ConclusionCommunity workshops on malaria are a potential tool for influencing a positive change in behaviour towards malaria, and applicable for other health problems in rural African communities. Social structures of influence and power dynamics affect community response. There is need for systematic monitoring of community workshops to ensure implementation fidelity and strengthening health systems to ensure sustainability of health behaviour change.
Highlights
Interventions to reduce malaria burden are effective if communities use them appropriately and consistently
The 2014 Malawi Malaria Indicator Survey (MMIS) reported that only 52% of the population used insecticide-treated bed nets (ITN) the previous night, ownership of at least one ITN per household had increased from 58% in 2010 to 70% in 2014 [6]
This paper evaluates the implementation of community workshops on malaria to improve use of malaria interventions in a rural setting
Summary
Interventions to reduce malaria burden are effective if communities use them appropriately and consistently. The aim of the paper is to describe the process of implementing community workshops on malaria by Health Animators to improve uptake and use of malaria control interventions in rural Malawi. A combination of poor health systems, limited access to malaria prevention, diagnosis and treatment services, poverty, and low levels of education, hinder efforts to reduce malaria in most rural African communities [3, 4]. The 2014 MMIS reported that only 52% of the population used ITNs the previous night, ownership of at least one ITN per household had increased from 58% in 2010 to 70% in 2014 [6] These low rates of uptake undermine the effectiveness of the interventions, and highlight the need to address factors hindering behavioural changes consistent with malaria prevention
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