Contributions of health education and social mobilization in the implementation of a malaria control programme using long-lasting insecticidal nets.

Abstract

Background: Malaria is an infectious disease transmitted by mosquitoes of the genus Anopheles that represents a significant global health challenge, particularly in tropical and subtropical regions. In malaria-endemic areas, malaria control programmes have widely adopted long-lasting insecticidal nets (LLINs) and insecticide-treated nets (ITNs) as primary protection strategies against mosquito bites to interrupt transmission. To achieve maximum efficiency with these tools, proper community orientation through Health Education and Social Mobilization Strategies (HESMS) is necessary. This study aimed to assess the effects of these activities on the rates of diagnosis and treatment-seeking behaviour, and use of LLINs in the reduction of malaria cases among the local population.

Methods: From January 2010 to December 2012, intensive HESMS were implemented in 10 rural communities in Porto Velho, Rondônia, Brazil. These strategies included the mass distribution of 8,083 LLINs, training people, workshops and regular monitoring of proper washing and maintenance practices. The intervention took place in an area influenced by the Jirau Hydroelectric Power Plant.

Results: Training of local endemic agents facilitated an acceptance rate of 99.93% for LLINs usage. However, our data did not indicate any reduction in the looking for malaria diagnosis < 24 h after a symptom appear. Only Villages of Abunã and Imbaúba-Jirau reported malaria cases consistently. Monthly median cases during the pre-intervention period were, respectively, 24 (IQR: 5-61) and 7 (1 - 34) for Villages Abunã and Imbaúba-Jirau. Additionally, in these localities the proportion of patients who seek for treatment less than 24 h after the first symptom was, respectively, 65% (SD = 19%) and 61% (SD = 31%) for Villages Abunã and Imbaúba-Jirau. Most residents (92.13%) had sufficient LLINs available for all household members, with 57.41% reporting consistent use of mosquito nets on most nights and adherence to appropriate washing and drying practices, as directed.

Conclusion: Although ESMS actions were important for the community's acceptance of LLINs installation, they did not demonstrate a reduction in the demand for malaria diagnosis within 24 h after the onset of initial symptoms.