Evaluation of the behaviour change communication and community mobilization activities in Myanmar artemisinin resistance containment zones

Malaria Journal Nyunt et al. Malar J (2015) 14:522 DOI 10.1186/s12936-015-1047-y Open Access RESEARCH Evaluation of the behaviour change communication and community mobilization activities in Myanmar artemisinin resistance containment zones Myat Htut Nyunt*, Khin Myo Aye, Myat Phone Kyaw, Khin Thet Wai, Tin Oo, Aye Than, Htet Wai Oo, Hnin Phyu Phway, Soe Soe Han, Thurein Htun and Kyaw Kyaw San Abstract Background: Behaviour change communication (BCC) can improve malaria prevention and treatment behaviour. As a one of the activities under Myanmar Artemisinin Resistance Containment (MARC) programme, BCC have been conducting. This study aimed to evaluate the effectiveness of the behaviour change communication and community mobilization activities in MARC zones in Myanmar. Methods: A cross sectional descriptive survey was conducted in randomly selected 16 townships in Tier I and II areas of MARC zones by quantitative and qualitative approaches. Results: In 832 households resided by 4664 people, there were 3797 bed nets. Around 54 % were untreated while 45.6 % were insecticide-treated nets (ITN) and 36.2 % were long-lasting insecticide-treated nets (LLINs). Proportion of households with at least one ITN was 625 (75.12 %), proportion of households with at least one ITN for every two peoples was 487 (58.53 %), and proportion of existing ITNs used in previous night was 1225 (70.65 %) respectively. Nearly 23 % of households had old nets while 52 % had new and unused extra bed nets reflecting the adequacy. Interestingly, 38 % could not mention the benefit of the use of ITN/LLINs. Although 88.2 % knew the disease “malaria”, 11.9 % could not be able to mention the symptoms. More than 80 % provided correct responses that mosquito bite can cause malaria while only 36.9 % could mention the blood test for malaria diagnosis. Only 36.6 % received malaria information within previous year but nearly 15 % could not recognize it. Mostly, 80 % of fever episodes were treated at rural health centers (38.24 %) followed by drug shops (17.65 %) and private clinics (16.18 %) respectively. Conclusions: Efforts should focus on correcting misconceptions about malaria transmission, prevention and universal use of ITN/LLINs. Although BCC activities have been documented, it is still necessary to intensify community mobilization through all accessible multiple channels in MARC areas. Keywords: Malaria, Behaviour change communication, Community mobilization, Myanmar Background Artemisinin-based combination therapy (ACT) is recognized as the most effective pharmacological treatments *Correspondence: Department of Medical Research, Yangon, Republic of the Union of Myanmar of Plasmodium falciparum infection [1]. However, an reduced susceptibility of P. falciparum to artemisinin was reported at the Thai–Cambodian border in 2007 [2] and in southern Myanmar in 2011 [3, 4]. Therefore, a multifaceted containment programme has been launched, including early diagnosis and appropriate treatment, decreasing drug pressure, optimizing vector control, targeting the mobile population, strengthening management © 2015 Nyunt et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Nyunt et al. Malar J (2015) 14:522 and surveillance systems, and operational research [5]. To guide implementation, malaria endemic countries should consider the following three classifications: Tier I areas for which there is credible evidence of artemisinin resistance; Tier II areas with significant inflows of people from tier I areas, including those immediately bordering tier I; Tier III areas with no evidence of artemisinin resistance and limited contact with tier I areas [4]. In Myanmar, the Myanmar Artemisinin Resistance Containment programme (MARC) has been conducted by the tier approach since 2011 [5]. The fifth objective of the MARC strategy mentions as “to support containment/elimination of artemisinin tolerant parasites through comprehensive behaviour change communication (BCC), community mobilization and advocacy” [5]. BCC is defined as any intervention with individuals or communities to develop communication strategies to promote positive behaviours appropriate to their settings to provide a supportive environment enabling people to initiate and sustain the desired behaviours, such as sleeping under insecticide-treated bed nets (ITN) [6]. There is evidence that effective BCC programmes can increase a range of positive health behaviours in a target population [7, 8]. BCC has a significant effect on utilization of ITN for prevention of malaria [9]. Page 2 of 9 In Myanmar, regional artemisinin initiatives (RAI) have been implemented and it covered the drug resistance falciparum malaria among mobile and migrant population, distribution of ITN, investigation of all falciparum cases in low endemic areas, comprehensive response package to all falciparum cases, administration of the direct observed treatment, quality assurance and control of diagnosis and treatment of malaria. However, provision of the diagnosis, treatment and preventive tools are not enough to combat the disease without proper information to change their risk behaviour by conjunction with all interventions to increase the knowledge and practice of the target population. Therefore, mass media, community networks and interpersonal approached have been used to deliver the BCC activities in all target townships in Tier I and II areas of MARC. IEC materials, such as pamphlets, posters, bill boards, have been distributed (Fig. 1). All of the basic health staff and malaria volunteer were trained for interpersonal communication and health talk to promote the BCC in target population. Mass media including radio talk, television short stories and video have been developed after conducting the containment efforts [5, 6]. Although BCC activities and community mobilization activities have been ongoing in MARC zones, there may be many possible factors and barriers to a successful programme (Fig. 2). In this study, the effectiveness of Fig. 1 IEC materials distributed in study sites. Various IEC (information, education and communication) materials were distributed for BCC (behaviour change communication) in target population. a Posters applied in local grocery shop, b Pamphlet, c Video disk (VCD), d Billboard showing the cause of malaria and prevention methods Nyunt et al. Malar J (2015) 14:522 Page 3 of 9 Fig. 2 Conceptual frame work. Many factors of t (...truncated)