Introducing Insecticide-Treated Nets in the Kilombero Valley, Tanzania

Published in the Tropical Medicine and International Health journal, this article reviews a malaria prevention campaign in Tanzania promoting insecticide-treated mosquito nets (ITNs) from 1996-1999. The principal goal of the project was to formulate a tailored information, education, and communication (IEC) strategy that would address biomedical knowledge of malaria and malaria prevention within the context of local knowledge and practice. Although the study did not evaluate the specific impacts of social marketing activities, the authors argue that the sharp rise in ownership of ITNs in the period following the project can be attributed to the effectiveness of social marketing.



Evaluation/Research Methodologies:

There are two main methodological components. First, the project conduced a extensive formative study consisting of focus groups, in-depth interviews, and surveys of the study area population, to understand the local knowledge about febrile illness, local malaria prevention practices, and mosquito net ownership and use in households. Second, the findings from the formative research were used to develop an IEC strategy. The IEC strategy was designed in a manner to link ITN use with a number of key messages addressing mosquito- or malaria-related health hazards, safety of ITNs, proper way of using ITNs, among others. The IEC strategy adopted social marketing techniques, emphasising a brand name and logo, consumer orientation, and audience segmentation. In addition to the distribution of visual materials (such as leaflets), the project employed a variety of venues to market ITNs, including product launching parties, local drama groups, singing/dancing, roadside billboards, and soccer tournaments in order to conduct face-to-face marketing.

Key Findings/Impact:

The formative research phase of the project allowed the researchers to gain insights into local knowledge on febrile illness, local practices in malaria prevention and treatment, and ownership and use of mosquito nets in households. The authors found that the common local knowledge about the health conditions feared to be responsible for childhood deaths was not logically linked with mosquitoes (i.e., the cause of biological malaria). The local people indeed associated maleria (a local term) with mosquitoes, but from a biomedical point of view maleria is best defined as a form of mild malaria. Likewise, the common local preventive practices against malaria did not incorporate measures to avoid contacts with mosquitoes. Finally, more than half of the survey participants (52%) owned mosquito nets, although not treated ones. However, those who owned mosquito nets did so mainly to reduce the risk of maleria (a mild form of malaria). The use of mosquito nets was not associated with the prevention of more severe forms of malaria.

Citing several earlier studies that investigated the present Tanzanian ITN project, the authors report that the social marketing campaign of ITNs had positive impacts on the penetration of ITN and the health condition of the population. The household ownership of ITNs reached 50% in the period after the project, a sharp increase from an earlier figure, 10%. Perhaps the most valuable contribution of the present study is its methodological focus on the local knowledge. The local knowledge on febrile illness and the local practices in malaria prevention constituted the centerpiece of the communication strategy developed in the project. The strategy aimed at overcoming the gap between local beliefs in malaria and the biomedical knowledge of malaria. While the actual impact of the effort to incorporate local knowledge into the project design remains to be investigated, the present study offers a workable model of development communication method when dealing with knowledge and interpretation gaps between a target population and development organisations and staff.