Background
Methods
Study setting
The school-based malaria SBCC approach
Study design and evaluation outcomes
Study population and sample
Quantitative method
Sampling procedure
Data collection tool and procedure
Measurements
Quantitative data analyses
Qualitative methods
Participants
Qualitative data collection and analysis
Qualitative data analysis
Results
Socio demographic characteristics
Categories | Frequency | Percentage (%) |
---|---|---|
Place of residence | ||
Urban | 61 | 15.2 |
Rural | 340 | 84.8 |
Sex | ||
Male | 242 | 60.3 |
Female | 159 | 39.7 |
Age of students | ||
10–14 | 144 | 35.9 |
15–19 | 229 | 57.1 |
20–24 | 28 | 7.0 |
Religion | ||
Muslim | 295 | 73.6 |
Orthodox | 72 | 18.0 |
Protestant | 34 | 8.5 |
Ethnicity | ||
Oromo | 344 | 85.8 |
Amhara | 31 | 7.7 |
Others | 26 | 6.4 |
Roles in class | ||
Class leader | 69 | 17.2 |
Vice leader | 57 | 14.2 |
Members | 275 | 68.6 |
Latest GPA | ||
Excellent | 48 | 12.0 |
Very good | 155 | 38.7 |
Satisfactory | 182 | 45.4 |
Fair | 16 | 4 |
Malaria knowledge and preventive behaviours
Variables | Frequency | Percentage |
---|---|---|
Frequency of school-based peer education | ||
Every weeks | 173 | 43.2 |
Every 2 weeks and above | 228 | 66.9 |
Specific topics of the PLEA-malaria | ||
About ITN use and care/handling | 174 | 43.4 |
About prompt care seeking for fever | 104 | 25.9 |
About anti-malarial drugs | 111 | 27.7 |
About environmental sanitation | 150 | 37.4 |
Malaria preventive behaviours | ||
Have at least one ITN in the house hold | ||
Yes | 364 | 90.8 |
No | 37 | 9.2 |
Number of ITN in household | ||
= 1 | 77 | 19.2 |
2–3 | 230 | 57.4 |
4+ | 94 | 23.4 |
ITN utilization | ||
Yes | 224 | 92.3 |
No | 140 | 34.9 |
Experienced fever in the last 2 weeks | ||
Yes | 33 | 8.2 |
No | 368 | 91.8 |
Sought care for the fever (n = 33) | ||
Yes | 32 | 7.7 |
No | 1 | 0.5 |
Prompt care seeking behaviours (n = 33) | ||
After 24 h | 14 | 3.5 |
Before 24 h | 19 | 4.7 |
Descriptive and Pearson correlation (r) parameters
Variables | 1 | 2 | 3 | 4 | 5 | 6 | 7 | |
---|---|---|---|---|---|---|---|---|
1 | Acceptability | – | ||||||
2 | Knowledge | 0.082 | – | |||||
3 | Attitude | − 0.035 | − 0.115* | - | ||||
4 | Perceived severity | 0.170** | 0.089 | 0.011 | − | |||
5 | Perceived susceptibility | − 0.134** | 0.060 | − 0.465** | − 0.261** | − | ||
6 | Team spirit | 0.302** | 0.098* | − 0.135** | 0.240** | − 0.085 | − | |
7 | Self-efficacy | 0.334** | 0.175** | − 0.088 | 0.299** | − 0.102* | 0.403** | - |
Number of items | 6 | 30 | 6 | 4 | 3 | 9 | 5 | |
Scale range | 30 | 0–30 | 6–30 | 4–20 | 3–15 | 9–45 | 5–25 | |
Mean score | 20.20 | 9.16 | 9.43 | 16.30 | 9.27 | 37.18 | 24.97 | |
Standard deviation | 3.86 | 3.42 | 4.34 | 2.30 | 3.22 | 5.33 | 3.29 |
Independent predictors of acceptability of the PLEA-malaria
Variables | Unstandardized coeffs. (β) | Standardized coeffs. (β) | 95% CI for β | p-value |
---|---|---|---|---|
Age in years | 0.449 | 0.264 | (0.266, 0.632) | 0.000 |
Gender | 0.545 | 0.069 | (− 0.131, 1.220) | 0.114 |
Grade level | 0.215 | 0.045 | (− 0.207, 0.637) | 0.318 |
GPA (latest semester) | 0.041 | 0.106 | (0.008, 0.074) | 0.015 |
Religion | − 0.466 | − 0.076 | (− 1.062, 0.130 | 0.125 |
Ethnicity | 0.378 | 0.053 | (− 0.325, 1.080) | 0.291 |
Frequency of parent student and communication | − 0.747 | − 0.149 | (− 1.201, − 0.293) | 0.001 |
Frequency of peer education | 1.801 | 0.232 | (1.087, 2.514) | 0.000 |
Parental readiness to malaria education | 1.420 | 0.184 | (0.711, 2.130) | 0.000 |
Number of ITN in the household | − 0.658 | − 0.111 | (− 1.182, − 0.135) | 0.014 |
ITN utilization | 0.529 | 0.066 | (− 0.196, 1.255) | 0.152 |
Self-efficacy on PLEA-malaria | 0.219 | 0.187 | (0.101, 0.336) | 0.000 |
Perceived severity of malaria | 0.025 | 0.019 | (− 0.097, 0.146) | 0.691 |
Perceived malaria risk | − 0.010 | − 0.009 | (− 0.138, 0.118) | 0.876 |
Peer education team spirit | 0.102 | 0.141 | (0.027, 0.177) | 0.008 |
Knowledge about malaria | − 0.045 | − 0.040 | (− 0.146, 0.056) | 0.382 |
Attitude towards malaria preventive measures | − 0.071 | − 0.079 | (− 0.160, 0.019) | 0.120 |
Summary of the qualitative results
Major themes | Sub-themes | Selected quotations |
---|---|---|
Facilitators to the implementation and adoption of the PLEA-malaria | ||
PLEA team building process and team experiences | Team formation process | We have already a functional team: The student circle is used to advance the academic performance of our students. The student circle consists of at least six individuals (three male and female each) with one leader and the secretary. So, all team leaders of the students’ circle were nominated for the current training [PLEA-malaria]. A school director, male The selection of leaders was based on academic performance while considering the gender mix. The students who have good academic performance or higher grade point average in the last semester will be nominated as leader and secretary of the student circle. Malaria focal teacher, male |
Quality of participation in PLEA | With student circle… we mean the team members should sit in circle while conducting the peer education or discussion on selected topics. the leader will initiate and present the issue. Then the team members participate and the discussion proceed usually in the form of question and answer. Female peer educator, grade 8 student While discussing about malaria among the circle, we all freely present our opinions. One student [the leader] would coordinate the discussion and we all follow him. Our group was eagerly to learn about health issue [malaria] and the process was participatory. Each member reacts to the discussion without any fear because we all are students and importantly friends. Male, peer educator, grade 6 student | |
Team spirit | During our discussion, we first prepare a topic discussion. We then establish consensus with respects to ideas. We trust each other and free to ask questions or share experiences. Our teacher was in charge of monitoring the process. Every day we conduct peer education at school, we also expected to deliver the information for our families when we are back home. Female, peer educator, grade 6 student We have got so many good experiences with working in circle or team. We have learned the effectiveness of working by team compared to working individually. The members have good respects for each other and the leader. We do often decide by consensus. Male, peer educator, grade 7 student | |
Outcome efficacy of the programme | Perceived benefits of the program: gain knowledge and skills on malaria | In our school…, I think students have got adequate knowledge on malaria. we have learned a lot of things. For instance, I myself have got enough knowledge on malaria and how to prevent it. I can also teach my parents about malaria and how to use the mosquito nets. Female, peer educator, grade 6 student Teachers acquired not only knowledge about malaria, but also skills needed to guide and implement the PLEA-malaria to sustain the practices A school director, male |
Perceived benefits of the programme: malaria prevention in community and schools | As to me I liked the programme. It has great contribution for malaria prevention and control in this area Since, our communities are uneducated about health issue, school students can learn and in-turn teaches their families at large. It would be good if the programme is expanded to reach all schools specially the rural one where many illiterate communities reside. Female, peer educator, grade 8 student The programme contributed a lot to malaria control in the community. Look, our ultimate goal was using students to reach parents, neighbours and school friends with malaria preventive information they have learned in school-based peer education. Each team member of student circle will have a home take assignment of teaching parents about malaria. They must report back the parental education activities to schools. There was also a close supervision by the health extension workers in the community. A school director, male | |
Presence of organization in the schools facilitated implementation of PLEA | School-based clubs and student circle | It was very easy for us to implement school-based malaria education activities [PLEA-malaria] since we have active clubs in our school including football club and school health club. We have conducted many school-based communication campaign activities and malaria information dissemination using these clubs. Similarly, regular peer education activities have been conducted in our school by student circle. A school director, female |
Schools priority, support and follow up | school and teachers support | Effective teaching and learning activities to enable the students would be only possible if the students and the teachers are healthy enough. Maintaining health of the students and the teachers is the first thing we should worry for before education. School director, male Students are attending schools for their own mission and teachers are there to teach them. Teachers can bring the students together creating an opportunity for us to approach them and transmit any health message need for the larger community. In this way, we can easily reach the whole community without more challenges. A HEW, female |
Nature of the programme (school-based SBCC) | Participation of frontline stakeholders | The programme approach was so holistic. It involved everyone including frontline community providers from health, education and teachers. We had regular meeting with these people to discuss about performances, achievement and gaps. Head, districts education office, male |
Participation of parents | Parents were not familiar with the programme as they have been reached by their school children. We had been also making a frequent visit to household to monitor the students message delivery practices and parents adoption of the advices. A HEW, female | |
Multiple strategies (training, PLEA, campaigns) | We have a lot of approaches to implement this malaria programme. First we conduct PE every two weeks. Students are guided to learn from each other and they will be instructed to reach their parents and neighbours with malaria messages. We have frequent school level campaigns to delivery persuasive malaria information. school director, male | |
Presence of community-based structures/systems | Connection between HEWs and schools | As part of health extension packages, malaria prevention education and community behavior change intervention is one of the activities of the HEWs. Malaria prevention campaigns sometimes target schools to reach the rural community using students. So, I believe it would be easy to integrate this programme with routine tasks so that students will be supported. A director of health department |
Barriers to implementation and adoption of the PLEA-malaria | ||
PE team building process and team experiences | PE members motivation | The fellow peers were skeptical especially at the early phase of the PE programme, though the problem was resolved gradually by continuous efforts made by the supervisors. 14 years old and grade 7 students |
Low threat appraisal and response efficacy | Low threat appraisal for malaria | Malaria has seriously affected this community some years ago. Nowadays, it’s getting low. Although, people have some level of fear about this disease, their concerns are getting low and low. The same thing true for our students. Look, previously, the school-dropout due to malaria was high. Now, this number is considerably reduced. But, everyone need to be vigilant. school director, male |
Low self-efficacy | Some peer educators feel they are not fit to teach or provide health education on malaria. Thus, in collaboration with people from health offices, we have to provide up to data information on malaria to improve their confidence. We have also guided the students use the information and malaria messages outlined in flip charts distributed for schools. A school teacher, male | |
Planning and implementation of PLEA activities | Inappropriate PLEA schedules | Most often students are forced to sit for PE after quite tiresome class. We all get tired after class, right? Some students do not pay due attention to the discussion. This often led to inadequate discussions. A male peer educator, grade 8 |
lack of uniformity of PE schedule | In order to balance the time allotted for academic class and for PE activities, we have planned to run the PE every two weeks of Friday. A school teacher, female | |
Organization and coordination gaps: fail to harmonize and align roles between schools and health offices | Roles confusion | Sometimes we get confused about who should do what? Although, the programme was situated in the schools, the question about who should take the lead role was a big challenge. Some health offices received no reports about the programme performance. The schools were also not committed to finding out possible solutions. A health worker, male |
Teachers priority and staff turnover | In connection with inadequate training [all school teachers didn’t receive basic training on the programme], they felt they are not appropriate to participate in the programme to guide students in PE activities. the problem arised from the turning over the trained teachers and lack of continuous training and capacity building efforts. A HEW, female |