PRESENTED BY WANI KUMBA LAHAI SEPTEMBER 2016 SENEGAL Rapid Assessment of Barriers to Treated bed net use/IPT uptake & Early treatment SEEKING BEHAVIOUR with ACTs in sierra Leone PRESENTED BY WANI KUMBA LAHAI SEPTEMBER 2016 SENEGAL

Background Malaria is a significant public health concern in Sierra Leone contributing to high U5 mortality rate. To improve maternal and child health is one of the priorities in Sierra Leone. The misuse of ITNs/LLINs and late health care seeking practice is among the major challenges. Free Health Care Initiative was launched in 2010 for pregnant women and children under-five years. Findings used to inform Government and NGOs in the development of an effective SBCC strategy. Study was conducted by the Catholic Relief Services. 

RATIONALE FOR BA Even though knowledge on the prevention and treatment of malaria is high (91%), however, malaria prevention and treatment behaviours appear not to be changing at the hoped-for pace. Awareness of pregnant women as high risk group is low.  Aim: To examine why recommended malaria prevention and treatment behaviours in Sierra Leone are adopted reluctantly - or not at all - by individuals in selected communities, in order to improve the evidence base for behaviour change communication interventions, including campaigns.  Objectives: To explore barriers to; Treated bed net use by pregnant women. Treated bed net use by children under 5. seeking treatment for children under 5 within 24 hours of developing a fever. IPTp uptake among pregnant women attending ANC.

Study sites DOERS NON-DOERS TOTAL Kambia 2 16 Koinadugu - 14   DOERS NON-DOERS TOTAL Net-use by U5 Net-use by pregnant women IPTp uptake Treatment with ACT within 24 hours for U5 Kambia 2 16 Koinadugu - 14 Western Rural Western Urban 8 6 62

Methodology A barrier analysis was conducted using a FGD of doers and non doers in 4 districts. Purposive sampling method was used to select study areas and target audience. A total of 62 FGDs were conducted. Target audience: women of child bearing age (15-49years), pregnant women and women with under-five children. Approach: Perceived Susceptibility, Severity, Social Acceptability, Action Efficacy, Self-efficacy, Perception of Divine Will, Cues for Action, Positive & Negative Attributes.

BARRIERS TO TREATED BEDNET USE Net efficacy Perceived being caged and dislike for ITNs/LLINs Heat and inhibits sleep. Skin reaction-effect of the chemical Size of the net Sleeping places/Lack of ownership

BARRIERS TO IPT uptake by pregnant women Distance, transport costs and medical fees? Cultural/traditional influence. Low decision making power of women. Clinic stockouts Unpleasant attitude of nurses and long waiting time in clinics Forget appointment dates with competing demands (such as housework).

BARRIERS TO early treatment seeking for acts Perceived malaria to be less serious Perceived traditional medicines were more important Cultural influence Opportunity Cost. Distance. Attitude of nurses. Perception of children dislike the ACT, weakens children or make them vomit.

CONCLUSION The Study revealed multiple and interrelated barriers to the four behaviours which are rooted in traditional and belief systems of the community low awareness. Health programmes can be used in addressing the barriers by focusing on the determinants that were found to be a problem (barrier) or a positive attributes of the action to better promote the behaviour. Key behaviour change messages developed and used to support activities in the program.

Identify systems to help ANC attendees keep appointment, Recommendations Consider engaging religious leaders in advocacy on bed net use for children under five. IEC/BCC messages delivered in an integrated way be women’s groups, inter-Religious councils, Faith-based ambassadors etc. Adapt health promotion messages to emphasize the need for multi-faceted approach to malaria prevention. Target sensitization campaigns at community members in order to improve the quality of advice given within a community context. Strengthen training of health workers in FHCI and Interpersonal Communication skills. Identify systems to help ANC attendees keep appointment,  

Malaria treatment is free for everybody in all government health facilities   Pregnant women must visit the clinic to receive three doses of SP free