In Jos, an initiative is using behavioural change communication to fight malaria

By Johnstone Kpilaakaa

Bulus Weng* resides in Jenta Mangoro, a suburb of Jos metropolis in North Central Nigeria laden with several inadequacies including poor sanitation due to the poor waste disposal system in the communities with an estimated population of 30,000 residents. Houses are structured in clusters in the hill-dominated community.

Weng has had to struggle with malaria severally, even though it is a common sickness in Africa (accounting for 60% of outpatient visits to hospitals in Nigeria), the stagnant and polluted water in Jenta provides more room for mosquitoes to breed and attack the residents of this community. “Before now, I slept without a mosquito net,” Weng said. “After we had a community sensitisation on the importance of using these nets to curb malaria, I became very intentional about it.”

In 2019, Block Malaria Africa Initiative, a non-governmental organization held an outreach tagged: “Operation Keep Jenta Mangoro Clean and Free From Mosquitoes”, the one-day event featured sanitation, health talks and distribution of free mosquito nets. Weng was one of the 371 beneficiaries of the programme.

Data from UNICEF show that every two minutes, a child under five dies of malaria; the highest prevalence being in Sub-Saharan Africa. Nigeria accounted for 26.7% of malaria cases and 31.8% of the total deaths globally in 2020. The number of cases increased from 60.37 million in 2019 to 64.46 million representing a 6.8% increase. The number of deaths also increased from 187,437 in 2019 to 199,689 in 2020, a 6.5% increase within the period.

In its efforts to curb malaria in the country, Block Malaria Africa Initiative employs behavioural change communication (BCC). This is the strategic use of communication to promote positive health outcomes, based on proven theories and behaviour change models. BCC uses a systematic process, beginning with formative research and behaviour analysis, followed by communication planning, implementation, monitoring, and evaluation. Audiences are carefully segmented, messages and materials are pre-tested, and both mass media and interpersonal channels are used to achieve defined behavioural objectives.

“The fight against malaria comes with a lot of work at the individual level,” Ngwoke Ifeanyi, the Founder of the Health Promotion Initiative in Nigeria and a medical laboratory scientist said. “We’re dealing with a parasite vector, the mosquitoes that have predictable patterns and environmental preferences. When people change their behaviour to environmental sanitation like waste disposal in drainages and clearing bushes, we’ll have fewer breeding sites and less vector population around.”

After the Block Malaria Africa Initiative intervention in the Jenta Mangoro in 2019, the community leaders instituted routine sanitation in the community to ensure that the refuse and sewages are properly disposed of. “We saw the need to take responsibility to avoid the prevalence of malaria and other related infections in the community,” said Andy Wumanna, a member of the Jenta Youth Council.

Fighting malaria from a music concert

In 2017, Odinaka Kingsley Obeta attended a World Malaria Day event hosted by the Association of Medical Laboratory Scientists of Nigeria (AMLSN), Plateau state chapter. However, AMLSN was not going to hold the event in 2018 when Obeta enquired if he could volunteer.

Within three days, Obeta who was an undergraduate at the time collaborated with his friends and a medical student association to host a music concert and radio shows to educate the residents of Agwan Rukuba, a community in Jos North and other communities about the dangers of malaria and how it can be prevented—100 free mosquito nets were also distributed to vulnerable people, including pregnant women and nursing mothers.

To ensure sustainability, the Block Malaria Africa Initiative team (then Jos Block Malaria) became more strategic. “We made proper arrangements ahead of World Malaria Day in 2019,” he said. Obeta’s joint effort with his team (wholly made of young volunteers) has garnered recognition within Nigeria and internationally. He was recently appointed as a youth advisor to the African Leaders Malaria Alliance (ALMA) and has also been recognised by the Malaria No More UK as an ambassador.

Accurate data on prevalence is important in ensuring the fight against malaria. After two outreaches in the Jenta community, Obeta carried out his clinical research on prevalence to ascertain the impact of the malaria awareness programmes, and the result was 13.8% prevalence. “We deduced that the behavioural change communication we implemented and how well the community implemented the solution also contributed to the reduced prevalence,” he said.

As a policy, Block Malaria Africa Initiative conducts environmental sanitation assessments before commencing an outreach. This enables them to ascertain the impact of their intervention on each community they visit.

Challenges: “Funding and government support”

“After our project in Jenta we needed to evacuate the waste that we gathered out of the community for proper disposal. Even though we reached out to the Plateau Environmental Protection and Sanitation Agency (PEPSA), it took eight days after the intervention before the government authorities responded, after relentless advocacy via the media,” Obeta said.

Although PEPSA later came over to the Jenta community to dispose of the waste, a prompt response would have yielded more fruits. “People are willing to change their behaviour to achieve positive health outcomes, but when they are challenged—especially from the government, it’s difficult to convince them,” he added.

Obeta said that “due to the paucity of funds, we are unable to provide beneficiaries with adequate healthcare as we intend, such as mosquito nets and waste management facilities that will enable these individuals to sustain the behavioural change.” Beyond Jenta, the Block Malaria Project has recruited volunteers in Taraba, Ebonyi, and Cross River States for the rollout of its forthcoming interventions.

According to Obeta, “communities need to build resilience to the disease through a joint effort. Hence, we have been engaging with community leaders to educate them so that they can pass on to their subjects and the need to build good relationships with government agencies responsible for health and sanitation.”

“This story has been supported by Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, solutionsjournalism.org”