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      Strategic roles for behaviour change communication in a changing malaria landscape

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          Abstract

          Strong evidence suggests that quality strategic behaviour change communication (BCC) can improve malaria prevention and treatment behaviours. As progress is made towards malaria elimination, BCC becomes an even more important tool. BCC can be used 1) to reach populations who remain at risk as transmission dynamics change (e.g. mobile populations), 2) to facilitate identification of people with asymptomatic infections and their compliance with treatment, 3) to inform communities of the optimal timing of malaria control interventions, and 4) to explain changing diagnostic concerns (e.g. increasing false negatives as parasite density and multiplicity of infections fall) and treatment guidelines. The purpose of this commentary is to highlight the benefits and value for money that BCC brings to all aspects of malaria control, and to discuss areas of operations research needed as transmission dynamics change.

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          The changing epidemiology of malaria elimination: new strategies for new challenges.

          Chris Cotter, Hugh Sturrock, Michelle S Hsiang … (2013)
          Malaria-eliminating countries achieved remarkable success in reducing their malaria burdens between 2000 and 2010. As a result, the epidemiology of malaria in these settings has become more complex. Malaria is increasingly imported, caused by Plasmodium vivax in settings outside sub-Saharan Africa, and clustered in small geographical areas or clustered demographically into subpopulations, which are often predominantly adult men, with shared social, behavioural, and geographical risk characteristics. The shift in the populations most at risk of malaria raises important questions for malaria-eliminating countries, since traditional control interventions are likely to be less effective. Approaches to elimination need to be aligned with these changes through the development and adoption of novel strategies and methods. Knowledge of the changing epidemiological trends of malaria in the eliminating countries will ensure improved targeting of interventions to continue to shrink the malaria map. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Changes in the burden of malaria in sub-Saharan Africa.

            Wendy Prudhomme O'Meara, Judith Mangeni, Rick Steketee … (2010)
            The burden of malaria in countries in sub-Saharan Africa has declined with scaling up of prevention, diagnosis, and treatment. To assess the contribution of specific malaria interventions and other general factors in bringing about these changes, we reviewed studies that have reported recent changes in the incidence or prevalence of malaria in sub-Saharan Africa. Malaria control in southern Africa (South Africa, Mozambique, and Swaziland) began in the 1980s and has shown substantial, lasting declines linked to scale-up of specific interventions. In The Horn of Africa, Ethiopia and Eritrea have also experienced substantial decreases in the burden of malaria linked to the introduction of malaria control measures. Substantial increases in funding for malaria control and the procurement and distribution of effective means for prevention and treatment are associated with falls in malaria burden. In central Africa, little progress has been documented, possibly because of publication bias. In some countries a decline in malaria incidence began several years before scale-up of malaria control. In other countries, the change from a failing drug (chloroquine) to a more effective drug (sulphadoxine plus pyrimethamine or an artemisinin combination) led to immediate improvements; in others malaria reduction seemed to be associated with the scale-up of insecticide-treated bednets and indoor residual spraying. 2010 Elsevier Ltd. All rights reserved.
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              Assessment of insecticide-treated bednet use among children and pregnant women across 15 countries using standardized national surveys.

              Thomas P Eisele, Megan Littrell, Joseph Keating … (2009)
              Impact of insecticide-treated bednets (ITNs) on preventing malaria may be minimized if they are not used by vulnerable populations. Among ITN-owning households from 15 standardized national surveys from 2003 to 2006, we identify factors associated with ITN use among children younger than 5 years of age and make comparisons of ITN use among children and pregnant women across countries. Within ITN-owning households, many children and pregnant women are still not using them. Between-country analysis with linear regression showed child ITN use increases as intra-household access to ITNs increases (P = 0.020, R2 = 0.404), after controlling for season and survey year. Results from within-country logistic regression analyses were consistent with between-country analysis showing intra-household access to ITNs is the strongest and most consistent determinant of use among children. The gaps in ITN use and possession will likely persist in the absence of achieving a ratio of no more than two people per ITN.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Malar J
                Journal ID (iso-abbrev): Malar. J
                Title: Malaria Journal
                Publisher: BioMed Central
                ISSN (Electronic): 1475-2875
                Publication date Collection: 2014
                Publication date (Electronic): 2 January 2014
                Volume: 13
                Page: 1
                Affiliations
                [1 ]Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place Suite 310, Baltimore, MD 21202, USA
                [2 ]Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, Louisiana 70112, USA
                [3 ]United States Agency for International Development, Washington, District of Columbia, USA
                [4 ]Roll Back Malaria Partnership, Geneva, Switzerland
                Article
                Publisher ID: 1475-2875-13-1
                DOI: 10.1186/1475-2875-13-1
                PMC ID: 3882285
                PubMed ID: 24383426
                SO-VID: 3067ada6-df7e-4b67-810f-4fd1240069e2
                Copyright © Copyright © 2014 Koenker et al.; licensee BioMed Central Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 July 2013
                Date accepted : 16 December 2013
                Categories
                Subject: Commentary

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: elimination,behaviour change communication,malaria
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: elimination, behaviour change communication, malaria

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