Burden of Malaria / In children, malaria causes more morbidity (illness) and mortality in Bibiani District than any other disease. According to the Ghana Health Service, in 2008 nearly a third of all deaths in children under 5 were due to malaria. Malaria is one of, if not the greatest, health risk in Ghana.

Preventing Malaria / One of the best ways to prevent malaria is to sleep under an insecticide treated bednet. However, bednet usage rates are generally poor throughout sub-Saharan Africa. Barriers to using a bednet often include discomfort due to heat, inability to find a net to purchase, inability to afford a net purchase, and not knowing how to hang the net.

History of Program / Since 2006, GHEI has been providing insecticide treated bednets to the community free of charge. Following a similar distribution approach to the government and other organizations, GHEI at first provided bednets to the most at-risk groups of people, pregnant women and children under 5, and did not assist in hanging nets. Distribution and education were done at community-wide educational events. Despite providing bednets for free, GHEI soon observed the same trend being seen in similar projects throughout sub-Saharan Africa: that people often did not use the nets. GHEI needed a profound change in its approach to bednet distribution in order to achieve a meaningful impact on malaria prevention.

In 2007, GHEI shifted to the village of Sorano to work with the community to conduct a baseline study and learn how to create an intervention that might enable people to use the nets that we distribute. GHEI worked with community leaders to conduct focus groups and key informant interviews, and administer questionnaires based on the Malaria Indicator Survey from the World Health Organization. This study was IRB approved by the University of California, Los Angeles and Kwame Nkrumah University of Science and Technology and led to an intervention tailored specifically to the community and developed with the community.

Trained Community Health Workers (CHWs) were involved in every aspect of the intervention from planning, distribution, promotion and community support. During distribution, CHWs educated household members about malaria prevention and bed net use with a picture-based and culturally appropriate flipchart. They then hung free insecticide treated bednets to cover all sleeping areas, not just for those at greatest risk. Their role after distribution was to visit each household monthly to encourage use, mend nets and provide support and leadership to the community.

This unique four-part approach includes:

GHEI completed distribution in Sorano in 2008 and evaluations of bednet usage in 2009. The program was incredibly successful. After one year, bednet usage rates increased for individuals from 14% to 97%, for children under 5 years from 29% to 96% and for pregnant women from 50% to 100%. This was largely due to increased ownership of nets, but even in households that already owned nets, use dramatically improved from 29% to 97%.

Some Sorano community member comments about the program:

Malaria Intervention Continued