Abstract
BackgroundMass distribution campaigns of insecticide-treated nets for malaria prevention are usually accompanied by intensive behaviour change communication (BCC) to encourage hanging and use of nets. However, data on the effectiveness of these communication efforts are scarce. In preparation for the next round of mass campaigns in Nigeria, a secondary analysis of existing data from post-campaign surveys was undertaken to investigate the influence of BCC on net hanging and use.MethodsSurveys were undertaken between 2009 and 2012 in ten states in Nigeria using standardized questionnaires. Two-stage cluster sampling was used to select households in each study site. Outcomes were defined as the effects of BCC message exposure and recall on knowledge, attitudes, perception as well as intentions and actual use. From the univariable analysis, potential confounders and explanatory variables were identified and key effects explored in multivariable linear or logistic regression models; terms in the models were kept if they had a marginal significance with p < 0.2. To quantify the effects from BCC, a treatment effect model was used with an inverse-probability weight regression adjustment.ResultsMore than half of the respondents (58.4 %; 95 % CI 56.0, 60.7) had heard a message about net use or hanging during or after the distribution campaign, with media cited as the most common source of information. Attitude towards net use was positively linked to the number of messages recalled and was overall better in the northern study sites. The number of messages recalled was also the strongest predictor of knowledge (p < 0.001). All BCC outcomes showed a significant increase in net use, which was strongest for the confidence to take action regarding nets with an overall effect of 17 %-point increase of net use comparing poor and excellent confidence levels. Intention to use every night increased net use by 15 %-points and discussing net use in the family by 8 % points. All these effects were statistically significant (p < 0.001).ConclusionsMultichannel BCC campaigns as well as other media were effective in contributing to an increase in net culture, hanging and use, particularly by vulnerable groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1463-7) contains supplementary material, which is available to authorized users.
Highlights
Mass distribution campaigns of insecticide-treated nets for malaria prevention are usually accompanied by intensive behaviour change communication (BCC) to encourage hanging and use of nets
Accessibility to insecticide-treated net (ITN) by all household members has been found to be the most important determinant of ITN use; in Papua New Guinea, it was found that 99.5 % of household members not using a net did not have access to one within the household [16], and a review of ITN use among children in 15 sub-Saharan African countries found intra-household access to ITNs to be the strongest and most consistent determinant of use among children [13]
The determinants of information exposure were explored in a multivariable logistic regression model (Table 2) and stratified by two outcomes: households that had any exposure to BCC messages, and households that could recall two or more messages
Summary
Mass distribution campaigns of insecticide-treated nets for malaria prevention are usually accompanied by intensive behaviour change communication (BCC) to encourage hanging and use of nets. Continual evidence has shown that despite increasing coverage and ownership of ITNs, net utilization is not synonymous with ownership [11] This gap between ITN ownership and use has been attributed to an inability or unwillingness to hang and/or use ITNs [6, 9, 12,13,14,15] or a failure of BCC programmes to convince people to use available nets [4]. It is essential to define the ‘use gap’ [17] and differentiate between ‘non-use’ due to insufficient numbers of, or unusable, ITN within the household, in which further distribution is required, and the behavioural failure to use an ITN even though it is available, indicating the need for BCC to encourage net use [10, 13, 16]
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