Malaria-Related Psychosocial Factors, Past Antenatal Care-Seeking Behaviors, and Future Antenatal Care-Seeking Intentions by Maternal Age in Malawi and Democratic Republic of the Congo

Young women in sub-Saharan Africa are a group at increased risk for malaria in pregnancy. Early antenatal care (ANC) seeking makes it more likely that women will receive the recommended doses of intermittent preventive treatment of malaria in pregnancy. This study used data from national Malaria Behavior Surveys conducted in Malawi and the Democratic Republic of the Congo (DRC) in 2021 to explore the association between intention to attend ANC in the first trimester for a future pregnancy (early ANC intention) and psychosocial factors among women aged 15-49 years. Eight psychosocial factors related to ANC and based on the ideation model were included, including knowledge, attitudes, and self-efficacy. The study used multivariable logistic regression models controlling for demographic characteristics to evaluate associations between early ANC intention and the individual ideational factors and the composite measure. Analysis included 2,148 women aged 15-49 years (Malawi: 827, DRC: 1,321). Antenatal care ideation was lower among young (aged 15-20 years) than among older (aged 21-49 years) women in Malawi. Young mothers with higher ANC ideation were more likely to intend to attend ANC early in their next pregnancy in both countries. Specific ideational factors associated with intention to attend ANC early varied by country and included positive attitudes, knowledge of ANC, and positive self-efficacy. In Malawi and the DRC, youth-friendly social and behavior change interventions to increase ANC-related ideation could increase future early ANC attendance among young women to improve malaria and birth outcomes.

The role of ideation on the effect of an SBC intervention on consistent bed net use among caregivers of children under 5 years in Nigeria: a multilevel mediation analysis

Background

Malaria remains a significant public health challenge in Nigeria. Consistent bed net use (sleeping under a treated net every night) has been identified as a key malaria prevention behavior. This paper explores the relationship between mass media social and behavior change interventions, psychosocial factors, and consistent bed net use.

Methods

Data is from the endline survey of a USAID-funded social and behavior change communication campaign conducted from 2012 to 2017 across five states in Nigeria. The outcome measure was consistent bed net use, and the mediator variable was a composite measure called ideation from a set of psychosocial factors believed to influence bed net use. The independent variable was recall of malaria specific media messages. Multilevel mediation analysis explored if recall of malaria specific media messages had any effect on bed net related ideation and if this ideation had any effect on consistent net use.

Results

Respondents included in this study were on average aged 31 years, mostly married or cohabiting (97.5%) and female 75%. Four in 10 (39.7%) respondents were able to recall malaria specific messages. Respondents with low, moderate and high recall were 23, 32 and 80% more likely to have a higher ideational score in the emotional domain compared to those not able to recall. Respondents were more likely to have higher ideational scores in the cognitive domain if they had low (AOR = 1.26, 95% CI 1.15–1.38), moderate (AOR = 1.16, 95% CI 1.00–1.34) or high recall (AOR = 1.55, 95% CI 1.16–2.06), respectively compared to those with no recall. Similarly, respondents with low (AOR = 1.03, 95% CI .99–1.08), moderate (AOR = 1.15, 95% CI 1.08–1.23) and high (AOR = 1.15, 95% CI 1.01–1.30) recall were more likely to have a higher ideational score in the social domain compared to those with no recall. After adjusting for recall of media messages and other potential covariates, all three ideational domains also had a significant positive effect on consistent bed net use. For every unit increase in ideational score, the likelihood of reporting consistent bed net use increased by 5 to 10%. There was a significant indirect effect of recalling malaria specific messages on consistent bed net use through each of the ideational domains.

Conclusion

Access to a bed net is a critical first step in the process of bed net utilization. However, psychosocial factors e.g., emotional, cognitive, and social domains of ideation also play a major role in bed net use. Mass media SBC interventions could potentially influence bed net related ideation and consequently improve net use behavior. Future Social and behavior change interventions should employ approaches that improve these domains of ideation within their audiences in order to increase bed net utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11709-5.

Factors associated with caregivers' consistency of use of bed nets in Nigeria: a multilevel multinomial analysis of survey data

Background

Malaria remains endemic in Nigeria despite programmes and policies put in place toward malaria elimination. Long-lasting insecticidal nets have been documented to offer protection from malaria by preventing mosquito bites. While many studies have examined the factors associated with the use of bed nets in Nigeria and across Africa, little information is available on the factors associated with consistency of use of bed nets.

Methods

The data for this study were derived from a household survey conducted in three states in Nigeria (Akwa Ibom, Kebbi and Nasarawa) between July and September 2015 by the Health Communication Capacity Collaborative, a 5-year cooperative agreement supported by the United States Agency for International Development and the US President’s Malaria initiative and led by the Johns Hopkins Center for Communication Programs. The analysis was limited to a total of 3884 men and women selected from 2863 households with at least one bed net. Multilevel multinomial logistic regression was used to assess the factors associated with consistency of use of bed nets.

Results

The findings revealed 43.2% of the respondents use bed nets every night, while 38.4% use bed nets most nights. The factors associated with using a bed net every night rather than rarely or never using a bed net included sociodemographic and household variables (age, gender, religion, household size, net density, and household wealth), ideational variables (perceptions about severity, susceptibility, self-efficacy to use nets, and response-efficacy of bed net; awareness of place of purchase; willingness to pay for bed nets; attitudes towards net use; and descriptive norm about nets), and state of residence. The three study states differ significantly in terms of most of the independent variables included in the estimated model.

Conclusions

The study recommends that efforts designed to promote consistent use of bed nets should be state-specific and include strategies targeting ideational variables. Furthermore, given the significance of unmeasured heterogeneity at the cluster level, strategies to engage and mobilize the community, such as community dialogue, home visits and engaging community leadership, are relevant.

"Protect Your Loved Ones From Fataki": Discouraging Cross-Generational Sex in Tanzania

The Fataki campaign aired in Tanzania via radio from 2008 to 2011 to address cross-generational sex, a major driver of HIV in the region. The campaign sought to incite social disapproval of men who engage in such relationships, generate dialogue around the issue, and encourage community interventions in these relationships through social learning. Using qualitative methods, we explored campaign reactions, use of the term Fataki to describe men in relationships with much younger women, and the nature of discussions spurred by the campaign. We conducted focus group discussions and individual interviews in Iringa and Pwani regions with young women, older men, and community leaders. Results showed that the Fataki term was widely used and had negative connotations reflecting social disapproval of men who participate in such relationships. Dialogue spurred by the campaign, primarily directed toward young women, focused on reasons for avoiding these relationships. We conclude with suggestions for relevant future interventions.

Multi-country comparison of delivery strategies for mass campaigns to achieve universal coverage with insecticide-treated nets: what works best?

Background

The use of insecticide-treated nets (ITNs) is widely recognized as one of the main interventions to prevent malaria. High ITN coverage is needed to reduce transmission. Mass distribution campaigns are the fastest way to rapidly scale up ITN coverage. However, the best strategy to distribute ITNs to ensure household coverage targets are met is still under debate. This paper presents results from 14 post-campaign surveys in five African countries to assess whether the campaign strategy used had any effect on distribution outcome.

Methods

Data from 13,901 households and 14 campaigns from Ghana, Nigeria, Senegal, South Sudan and Uganda, were obtained through representative cross-sectional questionnaire surveys, conducted three to 16 months after ITN distribution. All evaluations used a multi-stage sampling approach and similar methods for data collection. Key outcomes examined were the proportion of households having received a net from the campaign and the proportion of households with one net for every two people.

Results

Household registration rates proved to be the most important determinant of a household receiving any net from the campaign (adjusted odds ratio [OR] 74.8; 95 % confidence interval [CI]: 55.3–101.1) or had enough ITNs for all household members (adjusted OR 19.1; 95 % CI: 55.34–101.05). Factors that positively influenced registration were larger household size (adjusted OR 1.7; 95 % CI: 1.5–2.1) and families with children under five (adjusted OR 1.4; 95 % CI: 1.2–1.6). Urban residence was negatively associated with receipt of a net from the campaign (adjusted OR 0.73; 95 % CI: 0.58–0.92). Registration was equitable in most campaigns except for Uganda and South Sudan, where the poorest wealth quintiles were less likely to have been reached. After adjusting for other factors, delivery strategy (house-to-house vs. fixed point) and distribution approach (integrated versus stand-alone) did not show a systematic impact on registration or owning any ITN. Campaigns that used a universal coverage allocation strategy were more effective in increasing the proportion of households with enough ITNs than campaigns that used a fixed number of ITNs. Registering based on counting usual sleeping spaces resulted in higher levels of households with one net per two people among those receiving any campaign net (adjusted OR 1.6; 95 % CI: 1.07–2.48) than campaigns that registered based on the number of household members.

Conclusion

All of the campaigns, irrespective of strategy, successfully increased ownership of at least one ITN. Delivery method and distribution approach were not associated with receipt of at least one ITN from the campaign. Rather, the key determining factor for receipt of at least one ITN from the campaign was a successful registration process, which depends on the ability of community volunteers to reach households during the exercise. Universal coverage campaigns, especially those that used a sleeping space allocation strategy, were more effective in increasing the proportion of households with enough ITNs. Maximizing registration completeness and using a universal coverage allocation strategy are therefore likely to improve campaign outcomes.

"They just whisper in their hearts that he's doing a bad thing": a qualitative study of Tanzanian perceptions of cross-generational sex

HIV prevalence among young Tanzanian women is twice that of men, and risk doubles if a partner is ten or more years older. Cross-generational sex (CGS) is typified by transactions, economic asymmetries, power differentials, and inconsistent condom use. By investigating perceptions of CGS in families, schools, and communities, this study explored the role each plays in addressing or condoning CGS and where interventions are needed. Qualitative data were collected in Tanzania's Iringa and Pwani regions after a campaign to reduce CGS. Community leaders suggested key informants and provided household lists used to randomly select participants. Individual interviews were conducted with 20 women (M age = 20.7, SD = 3.1, range = 15 to 26) and 20 men (M age = 37.1, SD = 7.3, range = 30 to 56), focus groups with 15 women (M age = 20.4, SD = 2.9, range = 17 to 25) and 26 men (M age = 39.2, SD = 7.9, range = 30 to 55), and key informant focus groups with 10 women (M age = 47.6, SD = 10, range = 37 to 70) and 16 men (M age = 55.5, SD = 9.5, range = 37 to 67). CGS was viewed as detrimental to girls' education and a financial loss to parents, but barriers, including reluctance to approach parents and older men, prevented community action. Interventions may involve community leaders transcending restrictions on confronting older men and promoting communication between teachers, communities, parents, and young women regarding CGS.