Tanzanian dance music blares from large speakers on

April 2010 • Number 25
Communication Impact: Rural communication
activities increase net use in Tanzania
Tanzanian dance music blares from large speakers on
a flatbed truck in a rural town. An audience gathers
in the village center as the roadshow begins. Dancers
start dancing to draw attention of people to come and
see what’s going on. After one song, the actors perform
skits about the dangers of not taking children with
fever quickly to the health center and the importance
of sleeping under long-lasting insecticidal nets (LLINs)
every night to prevent malaria. The MC explains why
pregnant women must also go to antenatal clinics to get
malaria prevention, and then announces a competition
to see who can retreat a net the fastest, following the
retreatment kit instructions. A video is projected on a
big screen as the sun sets, and the participants answer
quiz questions afterwards and get small prizes and flyers
with more information on malaria for correct answers.
These community roadshows and mobile video units are
contributing to improved use of long-lasting insecticide
treated nets (LLINs) in Tanzania.
Background
Hannah Koenker
Senior Program Officer
hkoenker@jhsph.edu
or
Marc Boulay
Senior Research Officer
mboulay@jhsph.edu
or
Arzum, Ciloglu
Senior Program Officer
aciloglu@jhsph.edu
Center for Communication Programs
based at the Johns Hopkins
Bloomberg School of Public Health
111 Market Place Suite 310
Baltimore, Maryland 21202, USA
Tel: (410) 659-6300
Fax: (410) 659-6266
Website: http://www.jhuccp.org
COMMIT integrates mass media and community-based
activities to increase individual’s perceptions of the threat
posed by malaria as well as their confidence in their
ability to take actions that effectively counter this threat.
Through these perceptions, the project aims to persuade
households to obtain and use ITNs.
Increasing perceived threat and
self-efficacy
The first activities to be rolled out under COMMIT
were the “mid-media” activities, which included the
roadshows and mobile video unit shows, implemented by
PSI. These began in 2008. The community mobilization
component with Community Change Agents (CCAs)
followed. The CCAs worked at the community level
engaging communities in group discussions, one on one
house visits, cultural shows and school activities. Initial
survey data were collected from Lindi and Mtwara,
the first two regions in 2009, one year following the
start of the community-based activities. In this survey,
individuals exposed to community-level activities had
greater perceptions of the threat of malaria and were
more confident in their ability to obtain and use ITNs
(Figure 1). Compared to the baseline survey in 2008
prior to implementation, overall perceptions of both
threat and confidence had increased.
Malaria causes an estimated 70,000 deaths in Tanzania
each year. While the use of insecticide-treated bed
nets (ITNs) can decrease the incidence of both
uncomplicated and severe malaria, in 2008, only 38
percent of households in Tanzania owned at least one
ITN and only 25 percent of children under five years
of age slept under an ITN the night before (Tanzania
Commission for AIDS, Dar es Salaam, Zanzibar AIDS
Commission, National Bureau of Statistics, Dar es
Salaam, Office of Chief Government Statistician,
Figure 1: Average scores on perceived threat and
Zanzibar and Macro International Inc. Calverton,
efficacy scales, by type of exposure in 2009
Maryland, USA, 2008).
The Communication and Malaria Initiative in
Tanzania (COMMIT) is a five year project funded
by USAID and the President’s Malaria Initiative
(PMI). CCP leads COMMIT in partnership with
Jhpiego, Population Services International (PSI),
the Research Triangle Institute (RTI), PMI and
the Tanzania Ministry of Health and National
Malaria Control Program (NMCP). The program
is implementing a comprehensive behavior
change and communication strategy for behavior
change and communication in the prevention
and case management of malaria in mainland
Tanzania. Specifically, COMMIT supports the
NMCP Communication Strategy objectives of (1)
influencing positive behavior change among target
audiences through a comprehensive approach,
(2) improving the flow of information to key
target audiences, and (3) advocacy to raise the
profile of malaria. The program conducts activities
Average proportion of
favorable responses
To learn more contact:
throughout the country with intensive community-based
interpersonal communication activities in 11 of the most
endemic regions in Tanzania.
Perceived threat Perceived efficacy
Not Exposed
Exposed to roadshow
or video
Controlling for Age, Education, Number of Household
Possessions, Currently works for money, Malaria Knowledge
Scale, and Use of Media
Center for Communication Programs
Witte’s Expanded Parallel Process Model (Witte,
1992) posits that individuals with high perception
of threat as well as high confidence will be more
likely to take action to counter the threat than will
individuals with high perception of threat and low
confidence. Individuals who perceive low threat do
not process the message any further.
Consistent with theoretical predictions, perceived
threat was positively associated with ITN use
among individuals with high confidence and
negatively associated with ITN use among
individuals with low confidence (Figure 2). We see
that low-efficacy households use nets less as their
perceived threat of malaria increases – they are
stymied by the threat and unable to act. For the
high-efficacy households, their net use increases as
their perception of the threat increases, but only
up to a certain point. Beyond step 5 on the threat
scale, net use falls off, which may indicate that
the threat messages may be too fear-inducing, and
could be dialed back.
Reaching our audience
Since 2008, COMMIT has directly reached
more than 3 million people through a variety of
community mobilization and outreach activities.
This includes discussions and group meetings with
Community Change Agents, Mobile Video Unit
shows and Road Shows. All activities are focused
on the main malaria messages of sleeping under
ITNs, malaria in Pregnancy and under-five case
management.
Since the 2009 survey, more than 1,000 villagebased respected community members have been
trained as community change agents (CCAs).
CCAs organize and conduct interpersonal
communication and facilitate educational events
with community members, focusing on the
importance of using ITNs, proper treatmentseeking behavior, prevention of malaria during
pregnancy, and preparing communities to accept
indoor residual spraying (IRS).
COMMIT, together with the National Malaria
Control Program established a Journalist Against
Figure 2: High efficacy and low efficacy
households’ net use
80
60
Low efficacy
High efficacy
40
20
0
2
Next steps for assessing impact
To measure the impact of these mass media and
village-level communication activities, a second
survey will be fielded in 2010, one year following
previous survey. It will assess the combined effects
of mass media and community-based activities
on perceptions and use of ITNs, and offer further
lessons in message development and channel
selection for other malaria prevention programs.
Works Cited
Tanzania Commission for AIDS (TACAIDS),
Zanzibar AIDS Commission (ZAC), National.
(2008). Tanzania HIV/AIDS and Malaria Indicator
Survey 2007-08. Dar es Salaam, Tanzania:
TACAIDS, ZAC, NBS, OCGS, and Macro
International Inc.
100
1
In 2010, Tanzania launched the Malaria
Haikubaliki Campaign in coordination with
implementing partners CCP, PSI, Malaria No
More and Voices Tanzania. The campaign launch
concert featured the President of Tanzania,
Jakaya Kikwete, several national music stars, and
highlighted the work of the Community Change
Agents. COMMIT’s Malaria Haikubaliki radio
campaign in 2010 will feature 16 serial PSAs and
16 “2 Minutes of Wisdom” spots that use well
respected national figures to share their stories
about malaria and offer sage advice.
3
5
6
Perceived threat of malaria (1=Low, 6=High)
Controlling for age, education, socio-economic
status, malaria knowledge, receipt of voucher, and
exposure to general media, the team found that
households that were exposed to the roadshows were
more than twice as likely to have all of their children
under five sleeping under an ITN (Figure 3).
Malaria Network with a core group of print, TV,
and radio journalists working together to ensure
malarial is on the national and local agenda.
The network will work to disseminate correct
information on malaria prevention, as well as to act
as a watchdog on the implementation of malaria
programs in Tanzania.
Figure 3: Percent of households in which all children under 5 slept under a bednet the
previous night, by exposure
Witte, K. (1992). Putting the fear back into fear
appeals: The extended parallel process model.
Communication Monograph , 59, 329-349.
COMMUNICATION
Summarizes research and programmatic
findings from the Center for Communication
Programs at the Johns Hopkins University
School of Public Health.
JHUCCP leads the COMMIT project,
with partners Population Services
International, JHPIEGO and a number
of local Tanzanian NGOs.
COMMIT is supported by the President’s
Malaria Initiative through the United States
Agency for International Development, the
Centers for Disease Control and Prevention,
and the Department of Health and
Human Services.
Not Exposed
Exposed to Roadshow or Video
Center for Communication Programs
Communication Makes the Difference!
April 2010, Number 25