Correlates of Social Behavior Change Communication on Care-seeking Behaviors for Children with Fever: An Analysis of Malaria Household Survey Data from Liberia

"Social and behavior change communication campaigns that aim to promote desired care-seeking behaviors should be compelling enough for their audiences to remember[,] as caregiver recall of messages is positively associated with positive care-seeking behaviors."

The prevalence of prompt artemisinin-based combination therapy (ACT) among children in Liberia was stagnant for several years before this study took place in 2014. This paper investigates the correlates of 2 malaria case management outcomes: (i) a female caregiver taking a febrile child to a health facility, and (ii) prompt treatment with ACT. The authors were specifically interested in caregiver exposure to the "Healthy Baby, Happy Mother" social and behaviour change communication (SBCC) campaign, which disseminated 4 key messages about how a caregiver should respond if her child developed fever.

To help reduce the health toll caused by malaria, the Ministry of Health (MOH) and the JSI Research and Training Institute, Jhpiego, Management Sciences for Health, and the Johns Hopkins Center for Communication Programs collaborated to implement the Rebuilding Basic Health Services (RBHS) project from 2010 to 2014, with the financial support of the United States Agency for International Development (USAID). In partnership with the National Malaria Control Programme and the National Health Promotion Division of the MOH, in October 2010, the RBHS project developed early case management materials and audio messages as part of "Healthy Baby, Happy Mother". Campaign materials included 5 radio spots promoting 4 key case management messages that were aired 7,776 times on 2 national radio stations and on eight community-based radio stations. In addition, approximately 30,000 posters and 50,000 brochures were distributed to health facilities, general community health volunteers (gCHVs), and schools. The brochure specified that ACT was a "new" medicine in Liberia that treated malaria; the poster focused on home fever management.

The data analysed in this manuscript came from a 2014 cross-sectional household survey implemented to inform malaria prevention and treatment programmes in Liberia. Analysis was limited to 607 female caregiver and child pairs in which the child had experienced fever within the 2 weeks prior to data collection.

Most commonly (71.5%), caregivers reported hearing or seeing the phrase "Healthy Baby, Happy Mother" in the 6 months before their interview and having seen a malaria prevention or treatment message. The most common channels through which women were exposed to the campaign were the radio (59.4%) and healthcare workers (57.8%), a category that included both facility-based health workers and gCHVs.

The full model with all potential correlates indicated that listening to the radio at least once a week (odds ratio (OR) 1.99, 95% confidence interval (CI) 1.359, 2.929) was associated with increased odds of prompt ACT treatment. It also showed that recalling one or more campaign messages was significantly and positively correlated with increased odds of a caregiver's child receiving ACT the same or next day as fever alone (OR 3.62, 95% CI 1.398, 9.372) or in combination (OR 2.11, 95% CI 1.090, 4.131) with hearing or seeing any malaria prevention or treatment message in the past year.

Caregiver recall of the campaign was not associated with care-seeking during the 2 weeks before interview, but prompt care-seeking likely preceded prompt receipt of ACT, since most ACT came from health facilities. Unmeasured community-level factors, such as a community's distance from health facility, accounted for 19.0% of the variation in the odds that a caregiver's child was brought to a health facility.

The researchers stress that "Communication programs that generate demand for health-facility services will be most effective when coupled with interventions that address structural barriers to treatment of child malaria."