title: Eliminating Plasmodium falciparum in Hainan, China: a study on the use of behavioural change communication intervention to promote malaria prevention in mountain worker populations.
abstract: BACKGROUND
  In the island of Hainan, the great majority of malaria cases occur in mountain worker populations. Using the behavioral change communication (BCC) strategy, an interventional study was conducted to promote mountain worker malaria prevention at a test site. This study found the methods and measures that are suitable for malaria prevention among mountain worker populations.
  
  
  METHODS
  During the Plasmodium falciparum elimination stage in Hainan, a representative sampling method was used to establish testing and control sites in areas of Hainan that were both affected by malaria and had a relatively high density of mountain workers. Two different methods were used: a BCC strategy and a conventional strategy as a control. Before and after the intervention, house visits, core group discussions, and structural surveys were utilized to collect qualitative and quantitative data regarding mountain worker populations (including knowledge, attitudes, and practices [KAPs]; infection status; and serological data), and these data from the testing and control areas were compared to evaluate the effectiveness of BCC strategies in the prevention of malaria.
  
  
  RESULTS
  In the BCC malaria prevention strategy testing areas, the accuracy rates of malaria-related KAP were significantly improved among mountain worker populations. The accuracy rates in the 3 aspects of malaria-related KAP increased from 37.73%, 37.00%, and 43.04% to 89.01%, 91.53%, and 92.25%, respectively. The changes in all 3 aspects of KAP were statistically significant (p < 0.01). In the control sites, the changes in the indices were not as marked as in the testing areas, and the change was not statistically significant (p > 0.05). Furthermore, in the testing areas, both the percentage testing positive in the serum malaria indirect fluorescent antibody test (IFAT) and the number of people inflicted decreased more significantly than in the control sites (p < 0.01).
  
  
  CONCLUSIONS
  The use of the BCC strategy significantly improved the ability of mountain workers in Hainan to avoid malarial infection. Educational and promotional materials and measures were developed and selected in the process, and hands-on experience was gained that will help achieve the goal of total malaria elimination in Hainan.
authors.forename: Chang-hua
authors.initials: CH
authors.lastname: He
authors.forename: Xi-min
authors.initials: XM
authors.lastname: Hu
authors.forename: Guang-ze
authors.initials: GZ
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.forename: Ding-wei
authors.initials: DW
authors.lastname: Sun
authors.forename: Yu-chun
authors.initials: YC
authors.lastname: Li
authors.forename: Chun-xiang
authors.initials: CX
authors.lastname: Chen
authors.affiliation: Hainan Provincial Center for Disease Control and Prevention, No,44, Haifu Road, 570203 Haikou, Hainan province, China. djwei22@sohu.com.
authors.forename: Jian-wei
authors.initials: JW
authors.lastname: Du
authors.forename: Shan-qing
authors.initials: SQ
authors.lastname: Wang
mesh_terms: D000382:Agricultural Workers' Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D000818:Animals; D000852:Anopheles / Q000469:parasitology; D000953:Antigens, Protozoan / Q000097:blood; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D003020:Clothing; D016250:Compact Disks; D019353:Endemic Diseases / Q000517:prevention & control*; D019084:Fluorescent Antibody Technique, Indirect; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D007303:Insect Vectors / Q000469:parasitology; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D020407:Internet; D062312:Islands; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D009032:Mosquito Control / Q000379:methods*; D016273:Occupational Exposure; D010963:Plasmodium falciparum / Q000276:immunology; D015995:Prevalence; D012424:Rural Population; D013664:Teaching Materials
chemical_list: D000953:Antigens, Protozoan; D000962:Antimalarials; D007306:Insecticides