1,180 households in 120 villages (treament and control)
Jed Friedman, World Bank
India’s National Vector Borne Disease Control Programme
In rural India, malaria infection causes about 11 percent of all deaths, and more than one million new cases are diagnosed annually. The east-central states, including including Odisha, where this study took place, account for 60 percent of cases in India as a whole. One of the challenges in particular is to ensure that pregnant women and young children use bed nets and seek treatment early when infected.
Researchers conducted a randomized experiment to evaluate the impact of complementary community-based interventions on malaria care-seeking and preventive behaviour in Odisha. Planning took place at the end of 2009 and the program was implemented throughout 2010. The program was a public-private-community partnership coordinated by the National Vector Borne Disease Control Programme, India’s strategy-setting board for malaria programs, and implemented by local non-government organizations with the participation of local community leaders and groups.
There were two complementary community-based interventions. One treatment group received the community mobilization portion alone, and the other treatment group received the community mobilization with special support (called supportive supervision) for community health workers, who are female volunteers picked by their communities. They do not have any formal healthcare training and usually only have a primary school education. The control group did not receive anything apart from the government’s regular community health worker program.
The community mobilization program had five main messages: people should seek treatment early when they have a fever, they should take medicines given if they test positive for malaria, they should finish the course of medicine, they should use bed nets at night when sleeping, and pregnant women and children should have preference if there are not enough bed nets. Community meetings, posters, street plays and home visits all were used to transmit these messages.
The special support for the community health workers included training and support visist conducted theough local non-governmental organizations and ensuring that the health workers had adequate supplies to test for malaria and treat those infected.
Both interventions increased use of bed nets. individuals in the treatment groups, especially women, were more likely to seek treatment when they had a fever, which can be a sign of infection with malaria. Both interventions also increased community health worker motivation and job satisfaction.
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