title: Evaluation of intensified behaviour change communication strategies in an artemisinin resistance setting.
abstract: BACKGROUND
  In Cambodia, behaviour change communication (BCC) represents an integral component of malaria efforts aimed at fighting artemisinin resistant parasites and achieving elimination. The multi-pronged BCC interventions include interpersonal communication through village health volunteers (VHVs) and village malaria workers (VMWs), broadcasting malaria prevention, diagnosis and treatment messages via TV, radio and mobile broadcasting units (MBUs), distributing information education and communication (IEC) materials and introducing mobile malaria workers (MMWs) in endemic villages.
  
  
  METHODS
  This was a cross sectional household survey using a stratified multi-stage cluster sampling approach, conducted in December 2012. A stratified multi-stage cluster sampling approach was used; 30 villages were selected (15 in each stratum) and a total of 774 households were interviewed. This survey aimed to assess the potential added effect of 'intense' BCC interventions in three Western provinces. Conducted 2 years after start of these efforts, 'non-intense' BCC (niBBC) interventions (e.g., radio or TV) were compared to "intense" BCC (iBBC) implemented through a set of interpersonal communication strategies such as VMWs, VHVs, mobile broadcasting units and listener viewer clubs.
  
  
  RESULTS
  In both groups, the knowledge of the mode of malaria transmission was high (96.9 vs 97.2 %; p = 0.83), as well as of fever as a symptom (91.5 vs 93.5 %; p = 0.38). Knowledge of local risk factors, such as staying in the forest (39.7 vs 30.7 %; p = 0.17) or the farm (7.1 vs 5.1 %; p = 0.40) was low in both groups. Few respondents in either group knew that they must get tested if they suspected malaria (0.3 vs 0.1; p = 0.69). However, iBBC increased the discussions about malaria in the family (51.7 vs 35.8 %; p = 0.002) and reported prompt access to treatment in case of fever (77.1 vs 59.4 %; p < 0.01).
  
  
  CONCLUSIONS
  The use of iBCC supported positive improvements in both attitudes and behaviours among the population with regard to malaria compared to mass media (niBCC) only. The significantly increase in people seeking treatment for fever in iBCC villages supports Objective Five of the Strategic Plan in the Cambodia Malaria Elimination Action Framework (2016-2020). Therefore, this study provides evidence for the planning and implementation of future BCC interventions to achieve the elimination of artemisinin resistant Plasmodium falciparum malaria.
authors.affiliation: Malaria Consortium Cambodia, Phnom Penh Office, House #91, St. 95, Boeung Trabek, Chamcar Morn, Phnom Penh, Cambodia.|Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.|Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Canavati
authors.affiliation: Malaria Consortium International, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Celine Zegers
authors.initials: CZ
authors.lastname: de Beyl
authors.affiliation: The National Center For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner street 92, Trapaing Svay village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia.
authors.forename: Po
authors.initials: P
authors.lastname: Ly
authors.affiliation: Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavidhi Road, Bangkok, 10400, Thailand. m.shafique@malariaconsortium.org.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Shafique
authors.affiliation: The National Center For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner street 92, Trapaing Svay village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia.
authors.forename: Thavrin
authors.initials: T
authors.lastname: Boukheng
authors.affiliation: Malaria Consortium Cambodia, Phnom Penh Office, House #91, St. 95, Boeung Trabek, Chamcar Morn, Phnom Penh, Cambodia.
authors.forename: Chandary
authors.initials: C
authors.lastname: Rang
authors.affiliation: The University of Queensland, School of Public Health, Herston, QLD, 4006, Australia.|College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4006, Australia.|Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4006, Australia.
authors.forename: Maxine Anne
authors.initials: MA
authors.lastname: Whittaker
authors.affiliation: Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavidhi Road, Bangkok, 10400, Thailand.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Roca-Feltrer
authors.affiliation: Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavidhi Road, Bangkok, 10400, Thailand.
authors.forename: David
authors.initials: D
authors.lastname: Sintasath
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000494:pharmacology*; D037621:Artemisinins / Q000494:pharmacology*; D002160:Cambodia; D002648:Child; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D016778:Malaria, Falciparum / Q000469:parasitology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000187:drug effects*; D012423:Rural Health; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin
keywords: Artemisinin resistance; Behaviour change communication strategy; Cambodia; Health-seeking behaviour; Interpersonal communication; Malaria elimination