Assessing the Effect of a Combined Malaria Prevention Education and Free Insecticide-Treated Bed Nets Program on Self-Reported Malaria Among Children in a Conflict-Affected Setting in Northern Uganda

This 16-page research report, published by RTI International Press, shares findings of a study to examine whether a concerted malaria prevention education effort is associated with reduced malaria disease burden among children under the age of 5 years residing in conflict-affected settings in Northern Uganda. The results from this survey show significantly lower rates of reported malaria among children under 5 years who were residing in an intervention camp where the distribution of insecticide treated nets (ITNs) was combined with a prevention education campaign, in contrast to a camp in which nets were distributed without education. This suggests that including enhanced malaria prevention education as an integral component of ITN distribution programmes could help promote the use of malaria prevention methods and help stem malaria infections.

Residents in two camps for internally displaced persons in the Lira District of Northern Uganda were given free ITNs, along with basic information on installation and use. In one camp, Ogur, health care workers, who were also camp residents, administered an intense malaria prevention education intervention for 6 months, using community meetings, household visits, and posters. The residents of Ogur camp also received assistance in hanging their ITNs as needed from the resident community health workers. In the other camp, Abia, no additional health education intervention was provided after the ITN distribution. After 6 months, a survey was conducted among a cross-section of respondents from each camp.

The proportion of households reporting malaria among children under 5 was significantly lower in the intervention arm (37.9% vs. 54.6%) as was the proportion reporting severe malaria in their households during the past 6 months (18.5% vs. 45.9%). A significantly higher proportion of respondents in the intervention arm reported current use of any effective malaria prevention methods (use of any bed net, insecticide sprays, or coils) in their household compared with respondents in the reference camp (73.8% vs. 59.6%). Factors significantly associated with lower risk of malaria included household reported use of effective malaria prevention methods, knowledge of challenges of bed nets, and respondents' perception of the extent of malaria in their community as "very bad."

This study indicates a significantly lower reported burden of self-reported U5 malaria in households with children under 5 in the treatment arm, where distribution of free nets was combined with health education, compared with households in the reference camp, who received free bed nets but no continued education after the instruction provided during the distribution process. In addition, respondents who knew of challenges in using ITNs reported lower household U5 malaria, perhaps an indication that knowledge of the challenges arose from more experience in using the nets and that in doing so, the respondents were also able to address the challenges faced and thereby benefit from the protection of the ITNs.

The report suggests that the magnitude of the difference in the effect of enhanced malaria prevention education on bed net use and reduced malaria disease burden, when compared to just having access to the methods with limited or no continuing education, could be even greater over time. The researchers also recommend that programmes engaged in the control and prevention of malaria, especially those using ITNs, consider providing enhanced health education as an integral component of their activities. We also recommend studies to examine the optimal intervals of follow-up education efforts after the distribution of nets.