In Uganda, service communication was used to improve net durability. The activities – designed by a group of health workers, school teachers, district leaders, and SBCC experts - included mass media, community mobilization, and clinic posters. The evaluation showed that the intervention resulted in improved knowledge and attitudes towards care and repair, which impacted positively on net condition.
Source: Impact of a behaviour change communication programme on net durability in eastern Uganda
Results below from a facility-based cluster randomized trial in Tanzania found that a communication intervention was associated with improved prescriber adherence to rapid diagnostic test results, and reduced over-prescription of antimalarials to almost zero. Communication activities included interactive small group workshops, feedback and motivational SMS to providers, and patient leaflets and clinic posters in the facilities. Each of the activities led to incremental improvements in over-prescription of antimalarials. Provider behavior was changed through this combination of communication interventions.
The table below shows the results of the communication intervention.
Effect of Interventions on Antimalarial Prescribing, RDT Use and Antibiotic Prescribing
| Outcome | Arm | Number of Patients | Prevalence Number (%) | Crude RDa (95% CI) | Adjusted RDb (95% CI) | P-value |
|---|---|---|---|---|---|---|
| Patients with fever treated with rAM | Control | 9,231 | 2180 (24%) | 0 | 0 | |
| HW | 9,752 | 1700 (17%) | 0.07 (0.004, 0.13) | 0.03 (–0.04, 0.10) | 0.44 | |
| HWP | 7,887 | 1,304 (16%) | 0.07 (0.01, 0.14) | 0.05 (–0.002, 0.10) | 0.06 | |
| Patients with no fever treated with rAM | Control | 4,863 | 82 (2%) | 0 | 0 | |
| HW | 6,062 | 193 (3%) | –0.003 (–0.02, 0.01) | 0.002 (–0.01, 0.01) | 0.52 | |
| HWP | 5,984 | 40 (1%) | 0.01 (–0.01, 0.03) | 0.002 (–0.01, 0.01) | 0.73 | |
| RDT Uptake | ||||||
| Patients with fever tested with RDT | Control | 9,297 | 4960 (53%) | 0 | 0 | |
| HW | 9,825 | 5374 (55%) | –0.04 (–0.15, 0.07) | –0.04 (–0.20, 0.10) | 0.57 | |
| HWP | 7,963 | 5153 (65%) | –0.12 (–0.21, –0.03) | –0.02 (–0.13, 0.09) | 0.72 | |
| RDT eligible (fever and no obvious alternate diagnosis) not tested | Control | 8,241 | 3697 (45%) | 0 | 0 | |
| HW | 9,064 | 4000 (44%) | 0.04 (–0.07, 0.15) | 0.06 (–0.11, 0.23) | 0.44 | |
| HWP | 7,292 | 2459 (34%) | 0.12 (0.04, 0.21) | 0.18 (0.05, 0.32) | 0.01 | |
| RDT ineligible (no fever) tested | Control | 4,874 | 587 (12%) | 0 | 0 | |
| HW | 6,083 | 955 (16%) | –0.01 (–0.07, 0.04) | 0.01 (–0.06, 0.07) | 0.86 | |
| HWP | 6,000 | 518 (9%) | 0.02 (–0.05, 0.09) | 0.02 (–0.04, 0.09) | 0.43 | |
| Presumptive Treatment | ||||||
| RDT eligible treated presumptively for malaria | Control | 8,241 | 471 (6%) | 0 | 0 | |
| HW | 9,064 | 374 (4%) | 0.02 (–0.01, 0.05) | 0.01 (–0.02, 0.04) | 0.40 | |
| HWP | 7,292 | 256 (4%) | 0.02 (–0.003, 0.05) | 0.02 (–0.004, 0.05) | 0.09 | |
| RDT ineligible treated presumptively for malaria | Control | 4,874 | 42 (1%) | 0 | 0 | |
| HW | 6,083 | 47 (1%) | 0.004 (–0.001, 0.01) | 0.003 (–0.001, 0.01) | 0.15 | |
| HWP | 6,000 | 12 (0.2%) | 0.007 (0.003, 0.01) | 0.004 (–0.0001, 0.01) | 0.05 | |
| Adherence to RDT negative | ||||||
| RDT negative receiving AM | Control | 4,015 | 762 (19%) | 0 | 0 | |
| HW | 4,539 | 250 (6%) | 0.14 (0.08, 0.20) | 0.10 (0.03, 0.17) | 0.01 | |
| HWP | 4,330 | 189 (4%) | 0.15 (0.09, 0.21) | 0.10 (0.04, 0.16) | 0.002 | |
| RDT negative receiving AM (among those with fever) | Control | 3,488 | 723 (21%) | 0 | 0 | |
| HW | 3,793 | 235 (6%) | 0.16 (0.08, 0.23) | 0.11 (0.03, 0.19) | 0.01 | |
| HWP | 3,897 | 177 (5%) | 0.21 (0.04, 0.17) | 0.12 (0.05, 0.19) | 0.002 | |
| RDT negative receiving AM (among those with no fever) | Control | 527 | 39 (7%) | 0 | 0 | |
| HW | 746 | 15 (2%) | 0.05 (–0.01, 0.10) | 0.03 (0.01, 0.05) | 0.004 | |
| HWP | 433 | 12 (3%) | 0.04 (–0.01, 0.10) | - | - |
Source: Cundill et al. BMC Medicine (2015) 13:118.
For additional malaria-related evidence on the impact of integrating SBCC and health services, see the following resources:
- The Impact of BCC on the Use of Insecticide Treated Nets: A Secondary Analysis of Ten Post-Campaign Surveys from Nigeria
- Malaria Evidence Database (coming soon)