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Impact of a behaviour change intervention on long-lasting insecticidal net care and repair behaviour and net condition in Nasarawa State, Nigeria.

Koenker H, Kilian A, Hunter G, Acosta A, Scandurra L, Fagbemi B, Onyefunafoa EO, Fotheringham M, Lynch M - Malar. J. (2015)

Bottom Line: All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN).Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA. hkoenker@jhu.edu.

ABSTRACT

Background: While some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net.

Methods: The study used an intervention-control design with before-after assessment through repeated cross-sectional household surveys with two-stage cluster sampling following Nasarawa State's December 2010 mass campaign. All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN). Baseline, midline, and endline surveys occurred at one-year intervals, in March 2012, March 2013, and April 2014, respectively. Outcome measures were the proportion of confirmed campaign nets with observed repairs, and the proportion in serviceable condition, measured with proportionate hole index (pHI) and according to WHO guidelines.

Results: For all respondents, exposure to BCC messages was strongly correlated with increased positive attitude towards care and repair, and increases in attitude were positively correlated with observed net repairs, and with the proportion of nets in serviceable condition. In a multivariate regression model, positive care and repair attitude (OR 6.17 p = 0.001) and level of exposure (1 source: OR 4.00 p = 0.000; 3 sources: OR 9.34 p = 0.000) remained the most significant predictors of net condition, controlling for background and environmental factors. Nets that were tied up had 2.70 higher odds of being in serviceable condition (p = 0.001), while repairs made to nets were not sufficient to improve their pHI category. Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.

Conclusion: Exposure to multiple channels of a comprehensive BCC intervention was associated with improved attitude scores, and with improved net condition at endline. It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan. Care and repair messages are easily incorporated into existing malaria BCC platforms, and will help contribute to improved net condition, providing, in principle, more protection from malaria.

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Related in: MedlinePlus

Plot of proportion of nets surviving at endline (3.3 years after distribution) by exposure to the BCC intervention against standard decay curves. Decay curves are labelled according to where each curve hits the 50% line (dotted red line), e.g. the green curve crosses the median at 3 years since distribution, and is therefore the curve for a 3-year net.
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Fig10: Plot of proportion of nets surviving at endline (3.3 years after distribution) by exposure to the BCC intervention against standard decay curves. Decay curves are labelled according to where each curve hits the 50% line (dotted red line), e.g. the green curve crosses the median at 3 years since distribution, and is therefore the curve for a 3-year net.

Mentions: Three years after LLIN distribution, significantly higher proportions of nets survived among households with a net care and repair attitude score greater than zero (45.3%) as compared to households with attitude scores of zero or less (15.4%), shown in Table 6. Similarly, when attitude scores were further broken down into categories, a trend towards dose–response was observed, although this was not statistically significant (Table 6 middle section). When dichotomized by recall of messages, 30.9% of nets in households with no exposure to the care and repair campaign survived to endline, compared to 50.1% of nets for exposed households. Net survival was then plotted against hypothetical survival curves of defined median and median net lifespan estimated in households with positive and negative attitude (Figure 9). This indicated an approximately 1.0 year difference in median net lifespan for nets in households with positive attitudes, giving a two-year estimated median lifespan for nets in households with negative attitude toward care and repair, and a three-year estimated lifespan for those in households with a positive attitude. The estimated median lifespan difference was slightly less but still statistically significant for exposed vs unexposed households, where a difference of approximately 0.7 years was observed (Figure 10). This translates into a nine-month longer estimated lifespan for nets in households exposed to the campaign.Table 6


Impact of a behaviour change intervention on long-lasting insecticidal net care and repair behaviour and net condition in Nasarawa State, Nigeria.

Koenker H, Kilian A, Hunter G, Acosta A, Scandurra L, Fagbemi B, Onyefunafoa EO, Fotheringham M, Lynch M - Malar. J. (2015)

Plot of proportion of nets surviving at endline (3.3 years after distribution) by exposure to the BCC intervention against standard decay curves. Decay curves are labelled according to where each curve hits the 50% line (dotted red line), e.g. the green curve crosses the median at 3 years since distribution, and is therefore the curve for a 3-year net.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4308907&req=5

Fig10: Plot of proportion of nets surviving at endline (3.3 years after distribution) by exposure to the BCC intervention against standard decay curves. Decay curves are labelled according to where each curve hits the 50% line (dotted red line), e.g. the green curve crosses the median at 3 years since distribution, and is therefore the curve for a 3-year net.
Mentions: Three years after LLIN distribution, significantly higher proportions of nets survived among households with a net care and repair attitude score greater than zero (45.3%) as compared to households with attitude scores of zero or less (15.4%), shown in Table 6. Similarly, when attitude scores were further broken down into categories, a trend towards dose–response was observed, although this was not statistically significant (Table 6 middle section). When dichotomized by recall of messages, 30.9% of nets in households with no exposure to the care and repair campaign survived to endline, compared to 50.1% of nets for exposed households. Net survival was then plotted against hypothetical survival curves of defined median and median net lifespan estimated in households with positive and negative attitude (Figure 9). This indicated an approximately 1.0 year difference in median net lifespan for nets in households with positive attitudes, giving a two-year estimated median lifespan for nets in households with negative attitude toward care and repair, and a three-year estimated lifespan for those in households with a positive attitude. The estimated median lifespan difference was slightly less but still statistically significant for exposed vs unexposed households, where a difference of approximately 0.7 years was observed (Figure 10). This translates into a nine-month longer estimated lifespan for nets in households exposed to the campaign.Table 6

Bottom Line: All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN).Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA. hkoenker@jhu.edu.

ABSTRACT

Background: While some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net.

Methods: The study used an intervention-control design with before-after assessment through repeated cross-sectional household surveys with two-stage cluster sampling following Nasarawa State's December 2010 mass campaign. All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN). Baseline, midline, and endline surveys occurred at one-year intervals, in March 2012, March 2013, and April 2014, respectively. Outcome measures were the proportion of confirmed campaign nets with observed repairs, and the proportion in serviceable condition, measured with proportionate hole index (pHI) and according to WHO guidelines.

Results: For all respondents, exposure to BCC messages was strongly correlated with increased positive attitude towards care and repair, and increases in attitude were positively correlated with observed net repairs, and with the proportion of nets in serviceable condition. In a multivariate regression model, positive care and repair attitude (OR 6.17 p = 0.001) and level of exposure (1 source: OR 4.00 p = 0.000; 3 sources: OR 9.34 p = 0.000) remained the most significant predictors of net condition, controlling for background and environmental factors. Nets that were tied up had 2.70 higher odds of being in serviceable condition (p = 0.001), while repairs made to nets were not sufficient to improve their pHI category. Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.

Conclusion: Exposure to multiple channels of a comprehensive BCC intervention was associated with improved attitude scores, and with improved net condition at endline. It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan. Care and repair messages are easily incorporated into existing malaria BCC platforms, and will help contribute to improved net condition, providing, in principle, more protection from malaria.

Show MeSH
Related in: MedlinePlus