Impact of a Mass Media Campaign on Bed Net Use in Cameroon

This Malaria journal article discusses the impact of a national communications campaign in Cameroon (July 2011 - March 2012) to accompany the distribution of free long-lasting insecticide treated nets (LLINs) in an effort to reduce the morbidity and mortality burden of malaria in the country. Drawing on behaviour change communication (BCC) principles, the mass media campaign was designed to ensure that, as the nets were delivered, they would be used consistently.

Noting that only 51.6% of adults and 63.4% of their children in households with at least one net were sleeping under nets before the distribution, Malaria No More (MNM), in collaboration with partners, adapted its NightWatch communications programme to fit within the "KO Palu" (Knock Out Malaria) national campaign. This study evaluates the impact of KO Palu NightWatch activities on bed net use.

"The core conceptual model for NightWatch hypothesises that communication contributes to malaria-control behaviours, such as net use, in two ways: supporting individual action (by imparting knowledge, influencing attitudes, and providing consistent and motivational reminders) and shaping social norms." Activities included:

• KO Palu anthem, an original song and music video featuring "educational lyrics about malaria control, performed by popular Cameroonian artists". The anthem was released at a NightWatch press conference in July 2011 and featured at the August 2011 KO Palu Campaign launch event. According to organisers, the song spread to a spectrum of local radio and television stations and "was heard throughout Yaoundé's popular bars and clubs." There was also music video (see below), as well as CDs for sale on street corners (without being produced by MNM).
• Four KO Palu NightWatch public service announcements (PSAs), which were released in August 2011 and aired on CRTV, Equinox TV, Canal 2 International, and Spectrum TV, as well as 16 radio stations. The PSAs featured singer Lady Ponce delivering a message in French and NBA player Luc Mbah a Moute in English.
• KO Palu NightWatch SMS (text messaging), which involved net-use reminders that began in August 2011, and a second round began in February/March 2012; the SMS featured one of three key messages in either English or French.
• Other activities: For example, approximately 100 billboards were erected featuring KO Palu celebrity spokespeople, posted around high-traffic areas throughout Cameroon in early 2012. The KO Palu Campaign has also produced hand-out materials such as 2012 calendars and sponsored events in Yaoundé and Douala to celebrate World Malaria Day in April 2012.

"During the study period (March 2011 to March 2012), the KO Palu NightWatch activities were the primary mass media communications about malaria in Cameroon....This analysis focuses only on the KO Palu NightWatch activities conducted by MNM, and may underestimate the full impact of the KO Palu brand if those considered 'not exposed' did actually benefit from other partners' communication activities under the unified brand."

In short, the results are as follows: "National surveys of Cameroon in 2011 and 2012 found evidence of significant increases in last-night use of mosquito nets among adults and children under five, even when comparing usage only among individuals with at least one net at home. Using the 2012 dataset to identify drivers of this increased net use, this analysis shows a significant impact from Malaria No More’s KO Palu NightWatch activities, even after controlling for other factors. A propensity score-matching model using individuals with at least one net at home, which simulated a control group against which to compare the behaviour of individuals exposed to KO Palu NightWatch, found that exposure increased adults’ net use by 6.6 percentage points (from 59.1% among controls to 65.7% among those exposed) and increased their children's net use by 12.0 percentage points (from 67.6% among controls to 79.6% among those exposed). This translates into over 500,000 individuals that used a mosquito net to protect themselves from malaria as a result of the KO Palu NightWatch, at a cost of less than $1.62 per person protected."

More specifically, the study found that KO Palu NightWatch mass media activities were nearly ubiquitous in Cameroon, though some populations such as rural residents were less likely to recall the campaign activities. The KO Palu Anthem was the most widely recognised element of the campaign. "The lower reach of specific television and radio PSAs is likely due more to the stepwise fashion they were rolled out at two points in the study period (with some time off-air) than to their resonance with the audience....[I]t is likely that many children would also see or hear what their parents are watching on television or listening to on the radio. In addition, 14% of respondents who were exposed to KO Palu NightWatch activities said that they frequently discuss malaria communications with friends or family members, creating an unmeasured indirect audience."

"The findings suggest an important role for mass media behaviour change communications in ensuring that available bed nets are used appropriately to prevent malaria. For malaria control programmes seeking to ensure that their investments in bed nets do not go to waste, the findings offer a possible route to close the gap between net access and net use."