title: Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study.
abstract: BACKGROUND
  Malaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas.
  
  
  METHODS
  A randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages.
  
  
  RESULTS
  The knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2= 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72-5.72)], (η2= 0.64). The average of mothers' knowledge about malaria was increased by 64 % (η2= 0.64), the use of LLINs was increased by 79 % (η2= 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages.
  
  
  CONCLUSIONS
  These results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs.
authors.affiliation: Faculty of Medicine, Gezira University, Wadmadni, Sudan. yousifm_34@hotmail.com.
authors.forename: Yousif Mohammed
authors.initials: YM
authors.lastname: Elmosaad
authors.affiliation: Faculty of Medicine, Gezira University, Wadmadni, Sudan.
authors.forename: Magda
authors.initials: M
authors.lastname: Elhadi
authors.affiliation: College of Public Health & Health Informatics, Qassim University, Bukayriah, Qassim, Saudi Arabia.
authors.forename: Asif
authors.initials: A
authors.lastname: Khan
authors.affiliation: Federal Ministry of Health, Khartoum, Sudan.
authors.forename: Elfatih Mohamed
authors.initials: EM
authors.lastname: Malik
authors.affiliation: College of Public Health & Health Informatics, Qassim University, Bukayriah, Qassim, Saudi Arabia.|James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
authors.forename: Ilias
authors.initials: I
authors.lastname: Mahmud
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D002675:Child, Preschool; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control* / Q000523:psychology*; D009035:Mothers; D012424:Rural Population; D013397:Sudan
keywords: Communication for behavioural impact; Long-lasting insecticidal nets; Malaria; Mothers of under-five children; North Sudan and utilization