Tropical Health Matters

Encouraging both health workers and their clients to use and accept malaria rapid diagnostic tests can be a challenge. Esther Kaggwa, Douglas Storey, John Baptist Bwanika, Angela Acosta, Ron Hess, Emily Katarikawe, Espilidon Tumukurate, Julian Atim, Daudi Ochieng and Matthew Lynch of the Johns Hopkins University School of Public Health Center for Communication Programs addressed the RDT issue at the American Society of Tropical Medicine and Hygiene 62nd Annual Meeting in Washington DC. Their work is summarized below.

For 2-3 decades, presumptive treatment of malaria was widely practiced. In 2011, only 26% of Ugandan children under 5 with fever in the past 2 weeks received a blood test for malaria.[1] The new WHO policy of parasite·based diagnosis and treatment requires a major change irl household’s case management behaviors.[2]

The “Power of Day One” is a behavior change communication campaign (BCC) promoting testing and treatment for malaria within 24 hours of fever onset for pregnant women and children under 5 in Uganda. It started in June 2011 and ran in six districts: Apac, Katakwi, Kumi, Ngora, Serere and Soroti. Activities included provision of subsidized RDTs, provider trainings, promotion of new services, billboards, community dialogues, home visits, radio spots, a phone hotline, and others.

Study respondents were selected using multi-stage random sampling that selected not more than 300 persons per district. This sub-analysis included 847 individuals in 3 campaign districts that participated in the survey (Apac, Kumi, and Soroti). Results were analyzed using propensity-score matching to create matched control and experimental groups since exposure to media could not be randomized. The effect of any exposure to Power of Day One and in combination with other malaria campaigns was assessed. Logistic regression controlling for age, gender, wealth index, marital status, education, and rural or urban residence measured the association between level of exposure to Power of Day One and testing for malaria among respondents who had family members with a fever in the past two weeks (n=296).

64% of respondents reported having seen or heard Power of Day One messages during the 12 months preceding the survey. Exposure was higher among respondents from urban areas (80%), those with more than secondary education (84%) and those from the highest wealth quintile (72%).1t was lowest among females aged 35-44 (53%) and respondents with a primary education (58%). 90% of those exposed to Power of Day One correctly recalled a specific message about testing and treatment for malaria within 24 hours.

49% of family members of respondents exposed to any malaria communication campaign that promoted Family members of respondents exposed to Power of Day 1 messages were 71% more likely to get blood drawn from a finger or heel for malaria testing when they had fever compared to those who were not exposed (p<0.001 ), primarily among women. Family members of respondents exposed to 2 or more communication channels were 1.3 times more likely to get tested for malaria than those not exposed.

Results indicate that communication can boost uptake of testing for malaria. Level of exposure was
also associated with behavior change. Further research on role of communication in promoting adherence to test results is needed.

The survey had some limitations in that the assessed testing behavior related to any family member with fever instead of just children under five. Households’ care-seeking behaviors for young children may differ from that for adults and other family members. Some of the observed effects may be due to other malaria programs, such as trainings on integrated community case management for community health workers which may have also taken place during the evaluation period.

This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responslbllity of the presenter and do not necessa rily reflect the views of USAID or the United States Government.

References

1. World Health Organization {WHO). 2012. T3:Test. Treat. Track Initiative, 24 Apri12012. Avallable: http://www.who.lnt/malarla/test_treat_tracklen/index.html. Accessed: 2012 July 5.
2. Uganda Bureau of Statistics {UBOS) and ICF International inc. 2012. Uganda Demographic and Health Survey 2011.Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc.

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