For decades, social and behavior change communication (SBCC) has been used in malaria programs to positively influence behaviors around case management, malaria in pregnancy, insecticide-treated nets and indoor residual spraying. However, the evidence base for the impact of SBCC on malaria-related behavioral outcomes is still growing, especially with the recent introduction and scale-up of several malaria interventions and commodities.

To document and assess the evidence for malaria SBCC, HC3 conducted a critical review of the literature using a multiphase search and review process, involving abstract and full-article reviews of approximately 3,600 peer-reviewed articles and 1,700 grey literature documents. Each article was then scored on two indicators: the strength of the evidence presented in the article and the extent to which the SBCC activity used best practices during the design and implementation of the program.

The result is the Malaria SBCC Evidence Package, which includes a searchable online database, factsheets and infographics that compile and highlight key SBCC successes on malaria outcomes. The database below presents a collection of 80 articles describing interventions or studies that address malaria challenges through SBCC approaches. Some studies address the same intervention across multiple articles, while other studies evaluate multiple interventions in the same article.

Articles can be automatically filtered by checking boxes in the following categories (also listed below): Country, Malaria Technical Area, Type of Communication Intervention, Study Design and/or Audience Segmented. Unchecking the boxes or clicking the “clear filters” button will return the database to its original state. The database can also be filtered by searching keywords in the “search” box above the database. Database results can be printed, copied or converted into Excel/CSV files by clicking the appropriate buttons below.

Key findings from compiling the database have been highlighted in a series of infographics and factsheets on several malaria technical areas, including:

  • Case Management
  • Insecticide-treated Nets
  • Service Provider Behaviors

HC3 has created a report summarizing the findings of this literature review. It is available in both French and English.

wdt_ID Citation Year Intervention Description Results Summary Country Malaria Area Communication Intervention Study Design Audience Segmentation
1 Ainslie, R. (2016). Community Change Agents: “Doctors” of Malaria Information. Johns Hopkins Center for Communication Programs. Powerpoint presentation. 2016 The COMMIT project in Tanzania promoted malaria prevention behaviors through community mobilization, mass-media, movies and print. The program also used health provider skills strengthening and advocacy meetings with community change agents. Project activities included community-led activities, group talks, programs for children and one-on-one discussions among community members. When comparing baseline to endline surveys in a pre-post study, awareness of the community change agents ranged from 21% to 52% among the four project villages. Between 19% and 36% of the community members surveyed had attended an event with a community change agent in the previous year. Community change agents were found to be more effective in changing attitudes around the effectiveness of nets compared to media and community events. Tanzania LLIN/ITN Community engagement, Interpersonal communication, Mass media, Print media, Provider training Pre- and post-assessment Community mobilizers
2 C-Change Ethiopia Final Report. Washington DC.FHI 360 2013 C-Change Ethiopia developed a comprehensive communication strategy centered on the socio-ecological model, using a multi-faceted operational framework to maximize the effectiveness of the program. Malaria prevention and control activities began with message harmonization and training of healthcare workers. SBCC messaging was delivered through mass-media (radio), IPC and community mobilization activities. C-Change carried out several school-based activities focused on 5-to-8-year-olds. Comparing baseline and endline Malaria Indicator Surveys in the program areas, C-Change program areas demonstrated an increase in the percentage of pregnant women (31% versus 15%), children under 5 (50% versus 17%) and household members (34% versus 23%) who slept under an ITN the previous night. Additionally, a higher proportion of households were sprayed at endline, compared to baseline (58% versus 39%). Ethiopia LLIN/ITN, IRS Mass media, Interpersonal communication, Community engagement Pre- and post-assessment Households, Pregnant women, Children
3 Amegnikou, DE (2015) ARM3’s Behavior Communication Strategy on the Prevention and Management of Malaria in Pregnant Women and Children Under-5. PMI, USAID. 2015 ARM3’s SBCC program in Benin was designed to improve the uptake of IPTp, the use of LLINs amongst children under five and pregnant women, and the case management of malaria in children under 5. The program made use of mass-media (radio, television, music), as well as flyers, posters, banners, pamphlets and T-shirts. Community mobilization activities using caravans and community theatre and involving local leaders, associations, women’s groups and CHWs were carried out to support media efforts to prevent malaria in the community. More women in the intervention group (87%) slept under a LLIN the night before the survey, compared to the control group (76%) (p<0.05). There was no statistically significant difference in the percentage of women receiving ANC who were given a second dose of IPTp under direct observation in the intervention group. Exposure to campaign messaging was significantly associated with uptake of two or more doses of IPTp (66% versus 42% [p<0.01]) and use of LLINs among women with at least one child under five (94% versus 82%). Exposure to campaign messaging also improved malaria-related knowledge. Benin LLIN/ITN, Malaria in Pregnancy, Case management Mass media, Print media, Interpersonal communication, Community engagement Post-assessment only with control group Pregnant women, Caregivers of children under 5
4 Bennett, A., Smith, S. J., Yambasu, S., Jambai, A., Alemu, W., Kabano, A., & Eisele, T. P. (2012). Household possession and use of insecticide-treated mosquito nets in Sierra Leone 6 months after a national mass-distribution campaign. PLoS One, 7(5), e37927. 2012 The NMCP Sierra Leone implemented a one-week national integrated maternal and child health campaign, involving an LLIN mass distribution combined with IPC and community mobilization, in an effort to achieve 100% household possession (defined as one net for every two people in a house). Through the program, volunteers distributed vouchers, which could be redeemed at community distribution points, and returned at a later point to model proper net hanging and use. Malaria information was also shared at community and religious gatherings and a one-day health fair. The NMCP used a post-campaign, randomized and nationally-representative household survey to assess the influence of the campaign on household LLIN possession and utilization. Findings revealed that household heads who had heard malaria messaging had correct knowledge of malaria transmission, and where at least one ITN was hanging, were more likely to have slept under an ITN. Respondents were also 1.4 times more likely to sleep under a net the previous night if they had heard a malaria message within the past 12 months. Sierra Leone LLIN/ITN Interpersonal communication, Community engagement Post-assessment only Households
5 Ahmed, S. M., Hossain, M. S., & Kabir, M. (2014). Conventional or IPC: which works best in disseminating malaria information in an endemic rural Bangladeshi community?. PLoS One, 9(3), e90711. 2014 The program introduced by BRAC, an indigenous development NGO in Bangladesh, has introduced IEC activities alongside its other preventative and curative measures, such as ITN distribution and presumptive case management activities. IEC materials included posters, leaflets, billboards and radio television spots; health workers used flip charts during home visits. Baseline and follow-up surveys were conducted approximately five years later via in person interviews that followed a semi-structured questionnaire, to assess how different communication media can facilitate changes in informed malaria-related decision-making. The intervention was associated with increasing knowledge in symptom recognition and the importance of bed nets. Interpersonal communication with community health workers/relatives/neighbors/friends was found to be more effective in improving knowledge and practice than conventional print and audio-visual media. Referring to audiovisual media and CHWs for malaria knowledge decreased from 15% to 8% and from 48% to 38%, respectively. Bangladesh Case management, LLIN/ITN Community engagement, Interpersonal communication, Print media Pre- and post-assessment Households
6 Zurovac, D., Githinji, S., Memusi, D., Kigen, S., Machini, B., Muturi, A., ... & Nyandigisi, A. (2014). Major improvements in the quality of malaria case-management under the “test and treat” policy in Kenya. PLoS One, 9(3), e92782. 2014 The ‘‘test and treat’’ policy for malaria was extended in Kenya to include a ‘‘track’’ component, to ensure that routine information systems capture and reliably report commodity stocks, and providers test all suspected cases and provide appropriate treatment. Between 2010 and 2013, the key activities relevant for the implementation of test and treat policy at public health facilities included procurement and distribution of antimalarial medicines and RDTs, development and distribution of new case management guidelines/job aids for health workers, three rounds of national in-service trainings for front-line health workers and strengthening of supervisory and malaria microscopic capacities. The study design included six cross-sectional health facility surveys in public facilities measuring levels and trends in national indicators. With respect to the seven dispensing and counseling tasks, the comparison between baseline and the last survey showed significant improvements for the following three tasks: weighing of patients (52% versus 64%; p=0.039), administration of the first AL dose at the facility (32% versus 52%; p=0.013) and provision of advice that all doses should be completed (80% versus 90%;). Kenya Case management Interpersonal communication, Provider training Pre- and post-assessment Providers/Prescribers
7 Raifman, J. R., Lanthorn, H. E., Rokicki, S., & Fink, G. (2014). The impact of text message reminders on adherence to antimalarial treatment in northern Ghana: a randomized trial. PLoS One, 9(10), e109032. 2014 An SBCC program developed an SMS system to improve malaria treatment adherence in Ghana by providing reminders to individuals who received ACTs from stationary ACT distributors (e.g., hospitals, clinics and pharmacies). Flyers advertising the service were posted on site, and those who signed up received either simple SMS message reminders or a simple reminder paired with additional information the importance of completing the pill regimen. Patients in this study were automatically assigned to either no message, a simple message reminder or a message reminder with an additional statement about the importance of taking all pills administered. Logistic regression was used to ascertain the association the impact of messages on treatment completion. Receiving any message was associated with an increased odds of adherence (OR: 1.45, 95%). Ghana Case management mHealth Randomized control trial Malaria Tested/Treated/Patients
8 Kilian, A., Balayo, C., Feldman, M., Koenker, H., Lokko, K., Ashton, R. A., ... & Boulay, M. (2015). The effect of single or repeated home visits on the hanging and use of insecticide-treated mosquito nets following a mass distribution campaign-a cluster randomized, controlled trial. PLoS One, 10(3), e0119078. 2015 An SBCC activity, implemented in Uganda, used IPC to target community members. One arm received one hang-up visit, and the other arm received two visits at four and seven months after the campaign. The control group was only exposed to messages during the campaign. During visits, village health teams assisted hanging nets and educated about net use. The project used a two-stage cluster-RCT and cross-sectional surveys to assess the influence of SBCC on net hanging and use. Findings revealed that the proportion of the population using an ITN the previous night was similar among the intervention and control groups – ranging between 64 to 68% (95% CI 60.8, 67.2). The proportion of households with all campaign nets hanging increased from 56% to 73% at endline (p<0.0005). The study concluded that the initial mass-media campaign activities were adequate to induce high levels of ITN use. Uganda LLIN/ITN Interpersonal communication Cluster randomized control trial Households
9 Lal, S., Ndyomugenyi, R., Alexander, N. D., Lagarde, M., Paintain, L., Magnussen, P., ... & Clarke, S. E. (2015). Health facility utilization changes during the introduction of community case management of malaria in South Western Uganda: an interrupted time series approach. PLoS One, 10(9), e0137448. 2015 An SBCC program, implemented in Uganda, used CHW trainings and IPC to promote RDT use and improve malaria testing and treatment. The program built off of an existing CHW network and included messages about using RDT to diagnose malaria. All CHWs were trained on how to examine the febrile children, take their history and record basic patient details on treatment registers, recognize children with severe malaria and refer them to the nearest public health center. The 31 villages in the mRDT arm received additional training in malaria diagnosis using mRDTs and to only prescribe ACTs after a positive test result. The program used a cross-sectional study and outpatient department visit data collected one year before and 20 months during the intervention to determine the influence of SBCC activities for CHWs on malaria behaviors. Findings revealed that overall health center utilization decreased by 63% compared to the pre-intervention period and the health centers saw 32 fewer overall visits per month compared to the pre-intervention period. Malaria visits also declined shortly after the intervention began. There were 27 fewer visits per month during the intervention-period compared with the pre-intervention period (p<0.05). Declines in overall and malaria visits were sustained for the entire intervention-period. Uganda Case management Interpersonal communication, Provider training Pre- and post-assessment Providers/Prescribers, Households
10 Russell, C. L., Sallau, A., Emukah, E., Graves, P. M., Noland, G. S., Ngondi, J. M., ... & Richards, F. O. (2015). Determinants of bednet use in Southeast Nigeria following mass distribution of LLINs: implications for social behavior change interventions. PLoS One, 10(10), e0139447. 2015 A statewide mass distribution of LLINs along with community-based messaging was implemented in Nigeria to increase correct and consistent ITN use, especially among pregnant women and children under five. Community health promoters carried out monthly home visits to address barriers to net use and educate community members on the importance of sleeping under a net. Health promoters also mobilized community and religious leaders to support malaria prevention and organized community events demonstrating net installation and care. The program used a post-test study to assess the importance of IPC and social support for the adoption of net use. Exposure to malaria messages from home visits (OR =17.11; 95%) and social support from friends and family were associated with increased odds of net use. Nigeria LLIN/ITN Interpersonal communication, Community engagement Post-assessment only Households