title: Development of behaviour change communication strategy for a vaccination-linked malaria control tool in southern Tanzania.
abstract: BACKGROUND
  Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyrimethamine and linked to the expanded programme on immunization (EPI) is a promising strategy for malaria control in young children. As evidence grows on the efficacy of IPTi as public health strategy, information is needed so that this novel control tool can be put into practice promptly, once a policy recommendation is made to implement it. This paper describes the development of a behaviour change communication strategy to support implementation of IPTi by the routine health services in southern Tanzania, in the context of a five-year research programme evaluating the community effectiveness of IPTi.
  
  
  METHODS
  Mixed methods including a rapid qualitative assessment and quantitative health facility survey were used to investigate communities' and providers' knowledge and practices relating to malaria, EPI, sulphadoxine-pyrimethamine and existing health posters. Results were applied to develop an appropriate behaviour change communication strategy for IPTi involving personal communication between mothers and health staff, supported by a brand name and two posters.
  
  
  RESULTS
  Malaria in young children was considered to be a nuisance because it causes sleepless nights. Vaccination services were well accepted and their use was considered the mother's responsibility. Babies were generally taken for vaccination despite complaints about fevers and swellings after the injections. Sulphadoxine-pyrimethamine was widely used for malaria treatment and intermittent preventive treatment of malaria in pregnancy, despite widespread rumours of adverse reactions based on hearsay and newspaper reports. Almost all health providers said that they or their spouse were ready to take SP in pregnancy (96%, 223/242). A brand name, key messages and images were developed and pre-tested as behaviour change communication materials. The posters contained public health messages, which explained the intervention itself, how and when children receive it and safety issues. Implementation of IPTi started in January 2005 and evaluation is ongoing.
  
  
  CONCLUSIONS
  Behaviour Change Communication (BCC) strategies for health interventions must be both culturally appropriate and technically sound. A mixed methods approach can facilitate an interactive process among relevant actors to develop a BCC strategy.
authors.affiliation: Ifakara Health Institute, P,O, Box 78373, Dar es Salaam, Tanzania. adiel.mushi@lshtm.ac.uk
authors.forename: Adiel K
authors.initials: AK
authors.lastname: Mushi
authors.forename: Joanna
authors.initials: J
authors.lastname: Schellenberg
authors.forename: Mwifadhi
authors.initials: M
authors.lastname: Mrisho
authors.forename: Fatuma
authors.initials: F
authors.lastname: Manzi
authors.forename: Conrad
authors.initials: C
authors.lastname: Mbuya
authors.forename: Haji
authors.initials: H
authors.lastname: Mponda
authors.forename: Hassan
authors.initials: H
authors.lastname: Mshinda
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso
authors.forename: Robert
authors.initials: R
authors.lastname: Pool
authors.forename: David
authors.initials: D
authors.lastname: Schellenberg
mesh_terms: D018890:Chemoprevention / Q000379:methods*; D003140:Communicable Disease Control / Q000379:methods*; D004338:Drug Combinations; D004493:Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D010361:Patients; D037841:Pregnant People; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D013636:Tanzania / Q000453:epidemiology; D014611:Vaccination
chemical_list: D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine