Background
What is behaviour change communication?
Evaluations of behaviour change communication
Artemisinin resistance in Cambodia
Knowledge, attitudes and practices of Cambodian households
The BCC strategy in the target areas
Purpose of this study
Methods
Description of the intervention
Intervention | Frequency | Duration | Messages | Delivery means |
---|---|---|---|---|
Community communication campaign | Two times per month | 3–4 h per session | Malaria caused by mosquito bites Wear long cloth from dusk to dawn Sleep under ITN every night even you visit forest Always check blood test before treatment Say no to fake drug, it can kill | Competition Game, quiz Community rally Banners Music Storytelling Role play |
Community media | Two times per month | 1–2 h per session | Cause of malaria Prevention of malaria Proper treatment Use of treated bed nets Care of patient with fever | Video spot Role plays Game, quiz Song CD/DVD |
Mobile broadcasting units (MBU) | Once a month (except for October due to heavy rain) | 2 ½ h per session | Malaria prevention Malaria treatment Malaria diagnosis | MBU staff use video equipment to screen movies (drama/novels) |
Listener viewer clubs | Once or twice a month | 1 h per session | Malaria prevention Malaria treatment Malaria diagnosis | LVC staff use video equipment to screen movies (drama/novels) |
IEC material: leaflets and banners | Once or twice a month | – | Malaria prevention Malaria treatment Malaria diagnosis | The leaflets are distributed during the LVC sessions and the banners will be located at the LVC post |
Community focus group discussions (FGD)-education | Twice a month | ½–1 h in each village | Cause of malaria Prevention of malaria Malaria caused by mosquito bites Wear long cloth from dusk to dawn Sleep under ITN every night even you visit forest Always check blood test before treatment | Big groups Small groups Door to door Face to face Poster Leaflets Flipchart |
Village malaria BCC meeting with village health volunteers (VHV) | Once a month | 1–2 h per session | Discussion on implementation issue and challenges | Groups discussion, report formats, practices on doing reports and field trip |
Organize community meeting | Once a month | 1–2 h per session | Sharing on implementation by village Refresh on lesion How to transfer the knowledge to target groups | Meeting, sharing experiences, knowledge refresher |
Study design
Sample size
Data collection
Data management and analysis
Ethical considerations
Results
Description of the sample
Background characteristic | iBCC N = 387 n (%) | niBCC N = 387 n (%) | Total N = 774 n (%) | Mc Nemar p value |
---|---|---|---|---|
Average age in years mean (range) | 40.9 (12–77) | 40.3 (14–80) | 40.3 (12–80) |
0.05*
|
Sex | ||||
Male | 104 (26.2) | 146 (40.1) | 250 (39.0) |
0.003**
|
Female | 283 (73.8) | 241 (59.9) | 524 (61.0) | |
Ethnic group | ||||
Khmer | 382 (98.6) | 387 (100) | 769 (99.9) |
0.0001***
|
Cham | 4 (1.1) | 0 (–) | 4 (0.1) | |
Vietnamese | 1 (0.3) | 0 (–) | 1 (0.0) | |
Live in a house that owns | ||||
a radio | 122 (31.2) | 118 (30.3) | 240 (30.3) | 0.87 |
a television | 209 (55.0) | 152 (40.5) | 361 (41.6) | 0.10 |
Province | ||||
Battambang | 52 (4.8) | 232 (79.1) | 284 (73.3) |
0.0001***
|
Pailin | 156 (40.8) | 26 (1.9) | 182 (5.0) | |
Kampong Speu | 179 (54.3) | 129 (19.0) | 308 (21.8) | |
Anyone from household travelled in past 6 months | 209 (53.9) | 206 (52.8) | 415 (52.9) | 0.80 |
Marital status | ||||
Single-never married | 14 (3.9) | 18 (5.4) | 32 (5.3) | 0.11 |
Married | 312 (83.3) | 333 (84.5) | 654 (84.4) | |
Widowed | 44 (10.8) | 35 (9.8) | 79 (9.9) | |
Divorced/separated | 7 (1.9) | 1 (0.3) | 8 (0.5) | |
Married but not living together | 1 (0.1) | 0 (–) | 1 (0.0) | |
Occupation | ||||
Agricultural labourer | 8 (2.2) | 20 (6.4) | 28 (6.1) | 0.73 |
Seller | 26 (7.3) | 23 (6.3) | 49 (6.4) | |
Fisherman | 0 (–) | 1 (0.1) | 1 (0.1) | |
Forestry worker (logging) | 0 (–) | 3 (1.0) | 3 (0.9) | |
Farmer | 324 (82.1) | 311 (78.6) | 635 (78.9) | |
Housewife | 12 (3.3) | 15 (4.1) | 27 (4.0) | |
Government staff | 8 (2.4) | 5 (1.2) | 13 (1.3) | |
Other | 9 (2.6) | 9 (2.2) | 18 (2.3) | |
Level of education | ||||
Never attended school | 92 (23.6) | 85 (19.4) | 177 (19.7) | 0.19 |
1–3 years | 99 (25.4) | 105 (28.4) | 204 (28.2) | |
3 years or more | 192 (49.8) | 194 (51.4) | 386 (51.3) | |
University level | 3 (0.9) | 3 (0.8) | 6 (0.8) | |
Don’t know | 1 (0.3) | 0 (–) | 1 (0.0) |
Level of knowledge
Indicator | iBCC N = 387 | niBCC N = 387 | Mc Nemar p value | ||
---|---|---|---|---|---|
% | 95 % CI | % | 95 % CI | ||
Sign knowledge | |||||
Fever | 91.5 | 87.4–94.4 | 93.5 | 89.8–96.0 | 0.38 |
Chill | 89.7 | 85.4–92.8 | 89.3 | 83.9–93.1 | 0.90 |
Know fever + chill | 85.8 | 80.7–89.7 | 87.5 | 82.1–91.5 | 0.59 |
Transmission knowledge | |||||
Malaria transmitted by mosquito | 96.9 | 94.4–98.4 | 97.2 | 94.6–98.6 | 0.83 |
Staying/sleeping in forest | 39.7 | 29.5–50.8 | 30.7 | 23.7–38.7 | 0.17 |
Staying sleeping in farm | 7.1 | 4.0–12.3 | 5.1 | 2.8–9.0 | 0.40 |
Prevention knowledge | |||||
Avoid mosquito bite | 69.3 | 61.4–76.2 | 58.4 | 48.1–68.1 | 0.08 |
Sleep under an ITN | 80.4 | 73.6–85.8 | 84.8 | 80.1–88.6 | 0.23 |
Stay out of forest | 17.3 | 12.3–23.6 | 12.7 | 8.9–17.7 | 0.19 |
Reaction in case of malaria suspicion | |||||
Stay home and wait for fever to go away | 34.9 | 19.1–54.9 | 34.8 | 21.0–51.7 | 0.99 |
Seek advice from VMW/VMW | 62.9 | 52.8–72.1 | 65.2 | 53.1–75.6 | 0.76 |
Seek advice from public health facility | 15.5 | 8.1–27.5 | 21.0 | 12.2–33.6 | 0.44 |
Get a test | 0.3 | 0.0–2.0 | 0.1 | 0.0–1.2 | 0.69 |
Appropriate source for test and treatmenta
| |||||
Appropriate source for testa
| 90.4 | 81.8–95.2 | 91.1 | 84.7–95.0 | 0.87 |
Appropriate source for treatmenta
| 88.5 | 78.7–94.1 | 91.5 | 85.6–95.1 | 0.47 |
Appropriate source for test AND treatmenta
| 88.0 | 78.1–93.7 | 90.3 | 84.1–94.2 | 0.59 |
Knowledge of treatment duration | |||||
Less than 3 days | 0.4 | 0.1–1.7 | 0.3 | 0.0–2.4 | 0.08 |
3 days | 58.6 | 50.1–66.6 | 57.8 | 48.1–67.0 | |
More than 3 days | 16.6 | 11.9–22.7 | 8.8 | 5.7–13.4 | |
Don’t know | 24.4 | 16.2–35.1 | 33.1 | 25.6–41.6 | |
Ever heard of resistance of malaria drugs | 63.9 | 54.8–72.1 | 54.6 | 46.7–62.2 | 0.11 |
Home practices and behaviours
Indicator | iBCC N = 387 | niBCC N = 387 | Mc Nemar p value | ||
---|---|---|---|---|---|
% | 95 % CI | % | 95 % CI | ||
Ever discussed about malaria | 51.7 | 42.5–60.9 | 35.8 | 27.7–44.9 | 0.02 |
Household with any insecticidal net | 55.8 | 33.2–76.2 | 94.6 | 85.1–98.1 | <0.01** |
ITN use in household last night among ITN owning households | N = 208 | N = 368 | |||
Nobody used an ITN | 5.9 | 2.4–13.8 | 3.4 | 1.2–9.5 | 0.33 |
Some people used an ITN | 9.6 | 4.6–18.9 | 5.7 | 3.7–8.6 | |
All people used an ITN | 84.5 | 70.2–92.7 | 90.9 | 85.7–94.4 | |
ITN use frequency the past week | N = 208 | N = 368 | |||
Did not use at all | 1.9 | 0.6–5.4 | 5.2 | 2.5–10.4 | 0.21 |
1–3 nights | 2.9 | 1.2–7.0 | 2.3 | 1.2–4.5 | |
4–6 nights | 93.0 | 85.8–96.7 | 91.7 | 86.0–95.2 | |
Every night | 2.2 | 0.8–6.0 | 0.8 | 0.2–2.7 |
Health seeking behaviour of reported fever cases
Indicator | iBCC N = 387 | niBCC N = 387 | Mc Nemar p value | ||
---|---|---|---|---|---|
% | 95 % CI | % | 95 % CI | ||
Household with any reported fever case in past month | 31.4 | 23.7–40.4 | 26.0 | 19.0–34.6 | 0.34 |
Sought any advice or treatment | N = 123 | N = 97 | |||
94.1 | 89.3–96.9 | 93.8 | 87.3–97.1 | 0.91 | |
When sought advice or treatment | N = 115 | N = 90 | |||
Same day | 32.4 | 22.7–43.9 | 13.4 | 8.1–21.3 |
<0.01**
|
1 day later | 44.7 | 34.8–55.0 | 46.0 | 35.4–56.9 | |
2 days later | 20.1 | 13.2–29.4 | 32.0 | 22.7– 3.1 | |
3 days or more later | 2.8 | 0.6–11.7 | 8.6 | 5.3–13.7 | |
Sought treatment within 24 h | 77.1 | 68.5–83.9 | 59.4 | 48.3–69.6 |
<0.01**
|
Had any test for malaria | N = 115 | N = 90 | |||
40.8 | 26.9–56.4 | 50.5 | 37.9–63.1 | 0.33 | |
Test type | N = 47 | N = 43 | |||
RDT/dipstick | 54.0 | 37.0–70.1 | 48.2 | 34.7–61.9 | |
Blood slide/microscopy | 34.4 | 16.9–57.6 | 38.0 | 23.5–54.9 | 0.88 |
Don’t know | 11.5 | 4.9–24.8 | 13.8 | 3.8–39.3 | |
Test result | N = 47 | N = 43 | |||
Positive | 27.9 | 12.8–50.3 | 24.5 | 8.4–53.5 | 0.82 |
Negative | 72.1 | 49.7–87.2 | 75.5 | 46.5–91.6 |