Background
Method
Study area and target population
Procedure
Data analysis
Ethical aspects
Results
Location of study village | Faith-based groups represented | Percentage of participants |
---|---|---|
North Tanna
| Christian denominations (5)* | 82% |
Kastom (incl. John Frum) | 14% | |
Unspecified | 4% | |
Middle Bush
| Christian denominations (6)* | 54% |
Kastom (incl. John Frum) | 23% | |
Other (Baha'i, independent religion) | 23% | |
South Tanna
| Christian denominations (4)* | 100% |
Location of study village | Level of education | Percentage of men | Percentage of women | Percentage of youth |
---|---|---|---|---|
North Tanna
| None | - | 45.5 | Not available |
Primary | 66.7 | 54.5 | Not available | |
Secondary | 33.3 | - | Not available | |
Middle Bush
| None | 44.4 | 53.8 | - |
Primary | 44.4 | 15.4 | 39.5 | |
Secondary | 11.1 | 30.8 | 60.5 | |
South Tanna
| None | 14.3 | 27.3 | - |
Primary | 85.7 | 63.6 | 27.3 | |
Secondary | - | 9.1 | 72.7 | |
Over all study villages
| None | 22.7 | 42.9 | - |
Primary | 63.6 | 42.9 | 37.0 | |
Secondary | 13.7 | 14.2 | 63.0 |
Location of study village | Types of prevention practices reported | Frequency & motivation for bed net use | Influences on preventative health behaviours | Community suggestions for participation in malaria elimination |
---|---|---|---|---|
North Tanna
| Use of bed nets Clean home/personal hygiene Protective clothing Tidy village/source Insect spray | Some reported seasonal use others reported year round use (varies at household & individual levels) Motivation to nets for both mosquito nuisance and protection from malaria Net rarely used when travelling | Health officers most influential (VHW, nurse) Church leaders, chiefs & Village elders Teachers Mothers most influential on health behaviours of children Risk perception Acceptability and Practical issues | Take advice of village leaders Set example for others Tidy village/source reducton activities Use bed nets Mosquito spray and coils Use fire/smoke for protection outside Improve roads to Lenakel/ closer clinics for treatment |
Middle Bush
| Use of bed nets Clean home Tidy village/source reduction Drinking clean water Blanket for protection when sleeping during travel | Mostly seasonal use of bed nets Primary motivation is mosquito nuiscance Net rarely used when travelling | Doctors & health officers Cheif & church leaders Teachers Household heads influence family practices Mothers influence health practices of children Risk perception Acceptability and practical issues | Village leaders to spread messages Leaders to set example for others Tidy village/source reduction activities Use bed nets Improve access to early and effective treatment |
South Tanna
| Use of bed nets Clean home/personal hygiene Tidy village/source reduction Fire/smoke as repellent Blanket for protection when travelling | Some reported seasonal use others year round use (varies at household & individual levels) Motivation to use nets for both mosquito nuiscance and protection from malaria Net rarely used when travelling | Health officers Church leaders, chief and village elders Household heads influence family Mothers influence health practices of children Risk perception Acceptability and practical issues | Village leaders to encourage participation Tidy village/source reduction activities Use bed nets Support IRS |
Homogeneity/
Heterogeneity of
responses
|
Homogeneity in types of
protection methods
used across the 3 villages
|
Heterogeneity between
the Middle Bush village
and other 2 villages due
to absence of malaria
|
Homogeneity in
influences on health
behaviours across the
3 villages
|
Homogeneity in ideas for
participation in malaria
prevention across the
3 villages
|
Methods of malaria prevention used
Bed net coverage
Bed net acceptability and barriers to consistent use
Maintenance of bed nets
Influences on preventative health behaviours
North Tanna village | Middle Bush village | South Tanna village | |
---|---|---|---|
Men
(Adult health & disease priorities) | Not available | Back ache Cold/flu Stomach ache Arthritis Ulcers | High blood pressure Stroke Malaria Cancer Back ache Leprosy |
Women
(Adult health and disease priorities | Prolapsed uterus Malaria Back ache TB Head ache | Prolapsed uterus Cancer TB Back ache Long periods | Head ache Chest pain Malaria Long periods Back ache Diarrhoea |
Youth
(Adult health & disease priotities) | Not available | Cancer TB High blood pressure Malaria Ulcers | Malaria High blood pressure Diabetes |
Children
(Health & disease priorities based on consolidated listing/ranking activities by men, women & youth during PLA workshops) | Malaria Headache Asthma Measles Fever | Diarrhoea Fever Ulcers Scabies Cough | Malaria Fever Diarrhoea |
Avenues for receiving health information
Discussion
Proposed interventions | Attempting individual behaviour change | Attempting modification of social norms |
---|---|---|
Engaging and augmenting social mechanisms | × | |
Engaging communities by: | ||
Integrating malaria interventions with activities addressing other community health and disease priorities | × | |
Obtaining multisectoral involvement | × | |
Providing feedback to communities of progress towards elimination | × | |
Communication strategy (targeted messages) | ||
Increasing knowledge of malaria | × | |
Modifying malaria risk perception | × | × |
Modifying perceptions and misconceptions of LLINs | × | × |
Modifying patterns of bed net use (and conveying importance of high community coverage) | × | × |
Promoting LLIN maintenance | × | × |
Addressing gender specific or lifestyle related exposure to mosquitoes/malaria | × | |
Addressing issue of limited LLIN use while travelling | × | × |
Communication strategy (channels of communication) | × | × |
Storytelling, community meetings, workshops, school curriculum, community theatre, music, special events, personal selling, mass media, promotional materials and peer-led education |
Strategies to address barriers to community participation in malaria prevention practices in Tafea Province
1. Engaging and augmenting social mechanisms
2. Engaging communities and maintaining motivation for participation
3. Communication strategy
Messages
Avenues for message delivery
A model for sustaining community participation for malaria elimination
-
New technologies or implementation options for existing interventions (e.g. models for larviciding/source reduction activities, IRS implementation, LLIN distribution) could be trialled and modified as required at sentinel site communities prior to large scale application in order to maximize intervention success and reduce relative costs.
-
Sentinel sites can provide valuable in-depth, real-time feedback to provincial malaria staff and policy makers, allowing the programme to remain responsive to changes in community perception, misconceptions, priorities, concerns and practices. Such rapid and responsive actions will go a long way to preventing community disharmony arising from unattended concerns and misconceptions that would negatively impact participation in the elimination programme.
-
They provide an avenue for constructive dialogue and the exchange of views and perspectives between communities and policy makers and demonstrate programme commitment to genuine community participation.
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Sentinel sites would provide a continuous interface for the exchange of 'exogenous' and 'indigenous' knowledge and communication [28].
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If significant concerns are raised in sentinel site communities, further investigations can be carried out in other communities to investigate these issues in more depth.
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Through the PLA approach, sentinel site communities would benefit from further enhancement of social capital, the development of 'critical consciousness' and contribute to a sense of community ownership, which will assist with maintaining motivation for malaria elimination in the context of disappearing disease.