Effectiveness of Communication for Behavioral Impact (COMBI) Strategy in Increasing Utilization Rate of Insecticide Treated Bed Nets (ITNs) - Blue Nile State, 2006

This report describes a study conducted in Sudan, at the household level, with the aim of promoting insecticide-treated bed net (ITN) usage using the Communication-for-Behavioural-Impact (COMBI) approach. As the author explains in the opening sections of the report, malaria is a major public health problem in Sudan - including in Blue Nile State, which is located in the southeast part of the country. While studies have shown that ITNs are an effective tool to control and prevent malaria, only 10% of Sudan's people own a bed net; the number who own an ITN is far less, and even fewer actually sleep under an ITN every night.

The study followed the quasi-experimental design. For the purpose of pre- and post-intervention surveys a sample of 73 households were chosen from Alaardaiba village (control) and 75 households from Shin Tashrab village (experimental) using random sampling technique. Structured questionnaires, observations, interviews, and focus group discussions were used for data collection. Baseline data were collected from the 2 villages in order to make a clear situation analysis; the following behavioural objectives emerged: to ensure that all ITNs in the village are erected by poles (Gana) before sunset daily from August 2005 to Oct 2005; to ensure that all children under age 5 sleep under ITNs, daily from 8 PM until the morning from August 2005 to Oct 2005; and to ensure that all pregnant women sleep under ITNs daily from 9 PM until 5 AM from August 2005 to Oct 2005.

A comprehensive health education and information, education, and communication (IEC) campaign was conducted in the experimental village according to the COMBI Strategy on the basis of the situation analysis findings. Per COMBI, the intervention consisted of: (i) administrative mobilisation/public relations/advocacy; (ii) community mobilisation; (iii) mass advertising (a photograph in the report of a billboard illustrating ITN use illustrates this); and (iv) personal selling/interpersonal communication (e.g., a photograph of a volunteer using a megaphone to call for ITN erection before sunset illustrates this).

In summary, the results showed that:

• Knowledge about malaria increased significantly in the experimental group, while there was no change in the control group.
• The acceptance and use of ITNs increased significantly in the experimental group: from 8% at baseline to 48% in the post-intervention survey.
• Time of erecting and holding ITN changed from at night to before sunset from 28% at baseline to 78.7% in the post survey in the experimental group, whereas the control group showed no change.
• The percentage of children under 5 years who used ITNs increased from 64% at baseline to 85.3% in the post survey, in the experimental group.
• The use of ITNs on daily basis and all round the year was found to be highly significant in the experimental group; no significant difference was found in the control group.
• There was a significant difference of households using their ITNs the night before the survey in the experimental group.
• The prevalence of malaria in the experimental village decreased from 29.3% at baseline to 24.3% at the post-intervention survey.

The report concludes with main findings, including: "We found that COMBI strategy made a significant difference, not only in the knowledge and beliefs, but also in behavioral patterns and life style changes which contributed a lot in increasing the utilization rate of ITNs in the population study....Early structuring of ITNs before sunset was due to the COMBI intervention." Amongst the recommendations are that: the COMBI strategy should be sustained in the country to dispel any misconceptions related to ITNs and to ensure that ITNs can fit 2 persons; "[a]ny new coverage of villages should be a accompanied by COMBI strategy as it proved efficiency in literature modification; and "[t]he COMBI strategy should be tested in other states in the Sudan to see if it brings the same results..."