SBCC coordinator Rejoice Misozi Kankhande at a community dialogue session, talking about how to use mosquito nets treated with insecticide ©World Vision Malawi

Although mosquito nets offer effective protection against malaria, they are under-used in Malawi. BACKUP Health and World Vision Malawi demonstrate a holistic approach to bringing about change.

Malaria is one of the most widespread diseases in Malawi. Mosquito nets treated with insecticide, also called Long-lasting insecticidal nets (LLINs), are a simple and effective means of preventing infection. Working with the Global Fund and its partners, Malawi has already made significant headway with the distribution of nets. For effective protection against malaria, not only should nets be easily available, but should also be consistently used. A joint project with World Vision Malawi, funded by BACKUP Health and which ran until 2020, was dedicated to removing obstacles to the use of mosquito nets with the help of social and behaviour change communication measures. The results are impressive.

Every year, many people fall ill with malaria in Malawi

Some six million people in Malawi contract malaria each year. This equates to almost one in three of the country’s 20 million inhabitants every 12 months. In fact, malaria is the most common disease and leading cause of death among pregnant women and children under the age of five. The particular challenge lies not only in the disease being dangerous for those who catch it, but in the enormous socio-economic impact it has on family finances and the state budget in the form of lost working hours, school absences and the expenses incurred for preventive measures and treatment.

In spite of this, some people are hesitant to use the available insecticide-treated mosquito nets

A simple, yet effective means of preventing infection with the mosquito-borne disease is to sleep under a mosquito net coated with insecticide. The use of these nets has been linked to a reduction in the number of people infected with malaria through mosquito bites, fewer deaths from the disease, and a drop in child mortality rates. Studies have shown that the use of mosquito nets have the potential to reduce the total number of malarial infections by 40 percent.

World Vision Malawi and the Malawian Government are working with the Global Fund to Fight AIDS, Tuberculosis and Malaria as part of the National Malaria Control Programme in order to provide as many people as possible access to the nets so that they can protect themselves against malaria. In 2018, a study found that over 82 percent of Malawian households had the nets as a result. In addition to this basic necessity, there is another aspect that is important for effective prevention, namely consistent use of the nets. However, a number of factors, such as not knowing how to install the square nets, feeling that heat accumulates under the mesh at night and even the myth that the nets cause bed bugs, are hindering their use.

Health workers are learning to pinpoint the reasons for this

The joint project Strengthening Health Systems for Disease Prevention through Social and Behaviour Change Communication (SBCC) tasked itself with identifying and removing the barriers to the use of mosquito nets in order to promote consistent utilisation. The SBCC project, which ran from January 2019 to March 2020, was a partnership between BACKUP Health (a project of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH) and World Vision Malawi, one of the main recipients of the Global Fund in Malawi.

At the heart of the programme was the training of health workers in social and behaviour change communication methods. They received instruction in how to identify individual barriers to using mosquito nets and develop their own strategies for effecting behavioural change. Training was delivered to over 1,300 individuals from school, community and health institutions in three pilot regions. Over 220,100 households were reached in total through the measures in the three pilot districts Mangochi, Dowa and Rumphi.

‘Malaria is a very important topic for me’

Rejoice Misozi Kankhande supported the measure for World Vision Malawi. She had already been working at the organisation since the end of 2011 and served during the project term as SBCC Coordinator in Dowa, one of the pilot districts. ‘Malaria is a very important topic for me,’ says Rejoice. ‘Children under five years of age in Malawi are the most vulnerable group and they are susceptible to malaria. As a mother and someone working in the health sector, I consider malaria a real public health issue that requires attention and investment if we are to save the lives of those at risk.” Rejoice coordinated all activities in conjunction with SBCC in Dowa. These included developing the strategy and materials for training and communication, and delivering training herself. She was also responsible for coordinating the deployment of health workers at community level and oversaw the collection of data for analysing the project initiatives.

Communication is central

As part of the project, health workers and volunteers sought to engage directly with families through numerous home visits and community dialogues in which they explained in detail how to use the mosquito nets and addressed concerns and other questions about malaria prevention. With primary school children also playing a key role, school campaigns and malaria clubs were used to educate them about the topic in a way they could understand. Activities included songs, poems and drama performances.

Health professional Rejoice’s experience with direct dialogue has been extremely positive: ‘The women were able to tell their stories [in the community dialogue sessions] on how they were dealing with malaria and also the barriers which affect them to use mosquito nets for malaria prevention. I also shared my knowledge on best practices, and in doing so, we shared our experience in good conversations and we were learning from each other. So people could understand why it is important to use nets, but I also learned a lot about the barriers which affect the community members to follow malaria prevention measures.”

The dialogues reach and resonate with many people

Many other training participants who conducted situation analyses in their work and adapted their communication strategies accordingly resonate with the project’s approach and want to use these skills to increase the effectiveness of their work going forward. The changing trend within the population is an even more compelling testament to the success of the project. A survey found that 89 percent of individuals reached with the social and behaviour change communication measures had slept under a mosquito net the previous night. This is a significant outcome; in fact, it far exceeds the target set by the National Malaria Communication Strategy of seeing 80 per cent of the Malawian population sleep under mosquito nets.

Despite this success, Rejoice knows that there is still a long way to go to eradicate malaria in Malawi. It is primarily the thought of children that spurs her on: “People are really suffering, but sometimes they do not have the broad knowledge about how to prevent the disease. So my motivation to keep going is to help that children are no longer suffering from the disease. So that they are able to go to school, to continue with their education. Malaria, if not treated, has a high possibility of contributing to irreversible health conditions in children which can affect them for a long time. This is a big challenge for Malawi.”

Alexandra Teitge and Christina Heese
April 2022