Abstract:
BRAC Uganda provided mentors in 12 adolescent groups with megaphones and short health sensitization announcements as part of a community health sensitization program. BRAC instructed mentors to make daily announcements based on the script in their local language and during the afternoon or evening while walking around their village. All the participating villages are in Eastern Uganda, spread across 6 BRAC administrative units.
In order to facilitate evaluation of the program, BRAC randomized participation, assigning 24 villages to treatment or control status. Two rounds of surveys were conducted to measure program exposure, household characteristics, household knowledge of malaria prevention activities, and household bednet use and ownership. The response rate for the follow-up survey was 86%; much of the attrition was driven by a large building project in one of the treatment villages that displaced a number of survey respondents. While the treatment and control groups were well-balanced, the overall sample seems to be slightly wealthier than most inhabitants of Eastern Uganda. There was some contamination of control village respondents who lived near treatment villages and reported hearing the announcements.
This study measures the program’s effect on a variety of malaria prevention activities. While there was little evidence that the program caused wide-spread changes in household knowledge or practices, there were a few notable outcomes. The BRAC program shifted the distribution of nets owned, with households in treatment villages more likely to own two nets than one net. Though it was not possible to determine how these extra nets were acquired, findings suggest that the households in treatment villages may be slightly more likely to purchase nets than were households in control villages, though findings are not statistically significant. Households in treatment villages also seem more likely to report discussing bednets with their neighbors more often than households in control villages, though these finding are not statistically significant. Despite the changes in net ownership, however, there was no significant effect of the program on actual use of nets, even in high-risk populations. Households in treatment villages also did not show any greater knowledge of malaria prevention methods or use of other malaria prevention methods.
BRAC’s health sensitization program had limited success in changing household malaria prevention behaviors, though not the extent that was intended. If BRAC decides to continue with the program, staff should pay special attention to improving implementation through:
1. Greater involvement by ELA program staff at the branch and village level
2. Wider participation in the program
3. Improved training of survey staff
