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Dako-Gyeke P, Hornuvo R, Glozah FN, Asampong E, Tabong PTN, Nwameme A, Chandi GM, Peprah NY, Gittelman D, Adongo PB. Pilot implementation of community health advocacy teams to improve the effectiveness of long-lasting insecticide net distribution through both campaigns and continuous channels in Ghana: a qualitative study of opportunities and barriers to implementation. Front Public Health 2023; 11:1133151. [PMID: 37583887 PMCID: PMC10423875 DOI: 10.3389/fpubh.2023.1133151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/07/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction In Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. It is known that the existence of effective and functional community-based groups could influence positive behaviours regarding health interventions promoted through health campaigns. However, there is no evidence of functional community-based groups that aim to improve the effectiveness of LLIN distribution campaigns by transitioning into primary healthcare delivery. This study aimed to explore the opportunities and barriers to the pilot implementation of co-created community health advocacy teams (CHATs) to improve the effectiveness of LLIN distribution through both campaigns and continuous channels in Ghana. Methods A qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13. Results CHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern. Conclusion The CHATs would be instrumental in promoting LLINs' use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important.
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Affiliation(s)
- Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Ruby Hornuvo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Franklin N. Glozah
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Asampong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Gloria. M. Chandi
- Ghana Health Service, Ga North Municipal Health Directorate, Accra, Ghana
| | | | - David Gittelman
- Health Campaign Effectiveness Coalition, Task Force for Global Health, Decatur, GA, United States
| | - Philip B. Adongo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
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Glozah F, Asampong E, Tabong PTN, Nwameme A, Hornuvo R, Chandi M, Peprah NY, Adongo P, Dako-Gyeke P. Creating interventions to transition long-lasting insecticide net distribution in Ghana. BMJ Open 2022; 12:e063121. [PMID: 35649610 PMCID: PMC9161095 DOI: 10.1136/bmjopen-2022-063121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Mass long-lasting insecticide net (LLIN) distribution campaigns are rolled out, as a part of the Ghana Malaria Strategic plan (2021-2025) which seeks to protect at least 80% of the population at risk with effective malaria prevention interventions. Although the mass LLIN distribution campaign indicates a comprehensive stakeholder engagement approach, it does not systematically transition into the basic primary healthcare structures within the Ghana Health Services. This paper presents the process and outcome of creating an innovative social intervention, which focuses on community mobilisation and capacity building of community health officers. METHODS This study employed a concurrent triangulation mixed methods approach conducted across six districts in Eastern and Volta regions, Ghana. Findings were synthesised, grouped and further distilled to guide the participatory cocreation workshops. Cocreation involved participatory learning in action technique which is a practical, adaptive research strategy which enabled diverse groups and individuals to learn, work and act together in a cooperative manner. RESULTS The results suggest the establishment of a Community Health Advocacy Team (CHAT). This would be necessary in efforts aimed at transitioning LLIN distribution campaign in communities. The role of the CHAT would be centred on key elements of community/social mobilisation and capacity building, all nested in a social and behaviour change communication strategies. CONCLUSION The research team is in the process of assessing the acceptability and feasibility of the CHAT intervention with all stakeholders in the various communities. Assessment of the effectiveness of the CHAT intervention would be done at a later time.
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Affiliation(s)
- Franklin Glozah
- Social and Behavioural Sciences, University of Ghana School of Public Health, Legon, Accra, Greater Accra, Ghana
| | - Emmanuel Asampong
- Social and Behavioural Sciences, University of Ghana School of Public Health, Legon, Accra, Greater Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Social and Behavioural Sciences, University of Ghana School of Public Health, Legon, Accra, Greater Accra, Ghana
| | - Adanna Nwameme
- Social and Behavioural Sciences, University of Ghana School of Public Health, Legon, Accra, Greater Accra, Ghana
| | - Ruby Hornuvo
- Social and Behavioural Sciences, University of Ghana School of Public Health, Legon, Accra, Greater Accra, Ghana
| | | | | | - Philip Adongo
- Social and Behavioural Sciences, University of Ghana School of Public Health, Legon, Accra, Greater Accra, Ghana
| | - Phyllis Dako-Gyeke
- Social and Behavioural Sciences, University of Ghana School of Public Health, Legon, Accra, Greater Accra, Ghana
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Madumla EP, Moore SJ, Moore J, Mbuba E, Mbeyela EM, Kibondo UA, C S, Mmbaga, Kobe D, Baraka J, Msellemu D, Swai JK, Mboma ZM, Odufuwa OG. "In starvation, a bone can also be meat": a mixed methods evaluation of factors associated with discarding of long-lasting insecticidal nets in Bagamoyo, Tanzania. Malar J 2022; 21:101. [PMID: 35331242 PMCID: PMC8944021 DOI: 10.1186/s12936-022-04126-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Between 2000 and 2019, more than 1.8 billion long-lasting insecticidal nets (LLINs) were distributed in Africa. While the insecticidal durability of LLINs is around 3 years, nets are commonly discarded 2 years post distribution. This study investigated the factors associated with the decision of users to discard LLINs. METHODS A mixed-method sequential explanatory approach using a structured questionnaire followed by focus group discussions (FGDs) to collect information on experiences, views, reasons, how and when LLINs are discarded. Out of 6,526 households that responded to the questionnaire of LLINs durability trial, 160 households were randomly selected from the households in four villages in Bagamoyo Tanzania for FGDs but only 155 households participated in the FGDs. Five of the household representatives couldn't participate due to unexpected circumstances. A total of sixteen FGDs each comprising of 8-10 adults were conducted; older women (40-60 years), older men (40-60 years), younger women (18-39 years), younger men (18-39 years). During the FGDs, participants visually inspected seven samples of LLINs that were "too-torn" based on Proportionate Hole Index recommended by the World Health Organization (WHO) guidelines on LLIN testing, the nets were brought to the discussion and participants had to determine if such LLINs were to be kept or discarded. The study assessed responses from the same participants that attended FGD and also responded to the structured questionnaire, 117 participants fulfilled the criteria, thus data from only 117 participants are analysed in this study. RESULTS In FGDs, integrity of LLIN influenced the decision to discard or keep a net. Those of older age, women, and householders with lower income were more likely to classify a WHO "too-torn" net as "good". The common methods used to discard LLINs were burning and burying. The findings were seen in the quantitative analysis. For every additional hole, the odds of discarding a WHO "too-torn" LLIN increased [OR = 1.05 (95%CI (1.04-1.07)), p < 0.001]. Younger age group [OR = 4.97 (95%CI (3.25-7.32)), p < 0.001], male-headed households [OR = 6.85 (95%CI (4.44 -10.59)), p < 0.001], and wealthy households [OR = 3.88 (95%CI (2.33-6.46)), p < 0.001] were more likely to discard LLINs. CONCLUSION Integrity of LLIN was the main determinant for discarding or keeping LLINs and the decision to discard the net is associated with socioeconomic status of the household, and the age and gender of respondents. WHO "too torn" nets are encouraged to be used instead of none until replacement, and disposal of nets should be based on recommendation.
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Affiliation(s)
- Edith P Madumla
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania.
- Nelson Mandela African Institution of Science and Technology, Tengeru, Arusha, Tanzania.
| | - Sarah J Moore
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Nelson Mandela African Institution of Science and Technology, Tengeru, Arusha, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Jason Moore
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
| | - Emmanuel Mbuba
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Edgar M Mbeyela
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Ummi A Kibondo
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | | | - Mmbaga
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Dickson Kobe
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Jitihada Baraka
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Daniel Msellemu
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- University of Basel, St. Petersplatz 1, CH-4002, Basel, Switzerland
| | - Johnson K Swai
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Zawadi M Mboma
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Olukayode G Odufuwa
- Vector Control Product Testing Unit, Environmental Health and Ecological Science Department, Ifakara Health Institute, Bagamoyo, Tanzania
- Vector Biology Unit, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Opoku R, Amoah PA, Nyamekye KA. Examining the incentives and disincentives in the maintenance of Insecticide-Treated Nets among householders in Ghana. Int J Health Plann Manage 2021; 36:2263-2276. [PMID: 34363240 DOI: 10.1002/hpm.3294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study explored the factors that affect the incentive to care for Insecticide-Treated Nets (ITNs) among householders in the Shai-Osudoku District of Ghana. METHODS The study employed a descriptive qualitative design. Four in-depth interviews (IDIs) and four focus group discussions (FGDs) were conducted to gather the data from 38 participants. A thematic technique was used to analyse the data. FINDINGS Householders were aware of the importance and use of ITNs. The factors underlying the motivation of householders to care for ITNs included their need to stay healthy; inadequate funds to acquire new ITNs and pay for healthcare cost; and their knowledge of the use and efficacy of ITNs. It was also found that obtaining the nets at no cost; limited time available to mend the ITNs; and limited knowledge on how to mend the ITNs disincentivised householders from effectively caring for the nets. CONCLUSIONS There is a need to rethink current ITN intervention programmes in ways that will improve the contents of public education messages and strengthen monitoring frameworks to ensure that householders take optimum care of their nets.
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Affiliation(s)
- Robert Opoku
- PMI VectorLink Project, Population Services International (PSI), Accra, Ghana
| | - Padmore Adusei Amoah
- School of Graduate Studies, Asia Pacific Institute of Ageing Studies, Institute of Policy Studies, Lingnan University, Tuen Mun, Hong Kong
| | - Kingsley Atta Nyamekye
- Department of Geographical Sciences and Planning- School of Geo-Sciences, University of Energy and Natural Resources, Sunyani, Ghana
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