title: Community-directed educational intervention for malaria elimination in Bhutan: quasi-experimental study in malaria endemic areas of Sarpang district.
abstract: BACKGROUND
  As per the World Malaria Report 2011, there was a 17% reduction in morbidity and 26% reduction in mortality in 2010, compared to 2000. In Bhutan, there were only 194 malaria cases in 2011 as compared to 5,935 cases in 2000. As the country moves towards an elimination phase, educating the community and empowering them on malaria prevention and control is imperative. Hence, this study was conducted to elucidate the effectiveness of the community-directed educational intervention on malaria prevention and control in malaria-endemic areas of Sarpang district, Bhutan.
  
  
  METHODS
  This quasi-experimental study design was conducted using both qualitative and quantitative data collection methods. In-depth interviews and focus group discussions were carried out in addition to household survey using a structured questionnaire conducted before and after the intervention. Intervention was conducted using community action groups, who were provided with training and which then developed action plans for implementation of interventions within their communities.
  
  
  RESULTS
  The study resulted in a significant improvement in knowledge and attitude in intervention as compared to control during the post-intervention survey (p < 0.001). The practice score was higher in the control group both during pre- and post-intervention, however, the mean ( ±sd) score of practice in intervention group increased from 6.84 ± 1.26 in pre-intervention to 8.35 ± 1.14 in post-intervention (p < 0.001), where as it decreased from 9.19 ± 1.78 to 9.10 ± 1.98 in the control group (p = 0. 68). When comparing pre- and post- in the intervention group, there was significant improvement during post-intervention in knowledge, attitude and practice (p < 0.001).
  
  
  CONCLUSIONS
  The findings from this study corroborate that community-directed interventions can be utilized as an effective means for improving knowledge, attitude and practice in the malaria-endemic areas of Bhutan. Further studies are needed to see the long-term effect and sustainability of such interventions.
authors.affiliation: Ministry of Health, Thimphu, Bhutan. tobgayla2000@yahoo.com
authors.forename: Tashi
authors.initials: T
authors.lastname: Tobgay
authors.forename: Deki
authors.initials: D
authors.lastname: Pem
authors.forename: Ugyen
authors.initials: U
authors.lastname: Dophu
authors.forename: Shyam P
authors.initials: SP
authors.lastname: Dumre
authors.forename: Kesara
authors.initials: K
authors.lastname: Na-Bangchang
authors.forename: Cristina E
authors.initials: CE
authors.lastname: Torres
mesh_terms: D000328:Adult; D000818:Animals; D001631:Bhutan / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D006266:Health Education / Q000379:methods* / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires