The impact of information, education and communication (IEC) strategies in malaria prevention and control during pregnancy in Africa.

Background: Malaria continues to pose a complex public health problem amongst pregnant women in Africa (Schantz-Dunn & Nour 2009; Antwi 2010), accounting for over 90% of the global malaria burden (WHO 2002; Morel et al. 2005; Schantz-Dunn & Nour 2009). However, little is known about the impact of information, education and communication (IEC) strategies in malaria prevention and control among pregnant women in Africa. Aims and Objectives: The study sought to identify: evidence of impact of IEC strategies; feasibility, appropriateness, meaningfulness and effectiveness of the IEC strategies; challenges; best practices and key lessons to inform governments, policymakers, health partners, the academic community, directors, managers of health, frontline health professionals and health educators at institutional and community levels. Moreover, the study aimed to develop a theoretical framework to enhance the understanding of issues related to implementation of IEC strategies. Methods: A mixed method approach was adopted. This consisted of a systematic review of evidence within the African context and an evaluation methodology involving a contextually based survey of Ethiopia, Ghana, Nigeria and Tanzania. The systematic review involved a structured search of relevant databases and websites, and hand search strategies. Three sets of evidence were identified and aggregated using a narrative synthesis approach. A survey questionnaire reflecting the outcomes of the review was sent to health professionals and lay persons in the countries under study. Primary data were analysed using SPSS Version 15.0. Non-parametric tests and sensitivity analyses were conducted to assess the nature of opinions among respondents within and across countries. Findings: 3,440 studies were identified during the systematic review. Out of this number, 57 met the inclusion criteria. Following critical appraisal, 50 studies met the criteria for methodological quality. Ten IEC strategies were identified. These were: Staff training and orientation Advocacy Community mass education campaigns House-to-house sensitisation Health education in health units Visiting places of worship Womens group meetings Integrated health education campaigns Symbolism versus message delivery Audience segmentation versus information delivery. The survey reveals a high level of awareness of IEC strategies among respondents in the African countries studied. The evidence of impact reported by respondents supported the findings of the systematic review. However, there were some differences, and some concerns still remain regarding the extent of impact. The study suggests that using an IEC strategy implementation equation could enhance the understanding of issues related to implementation of IEC strategies. Implications of the findings are outlined, including implications for professional practice in relation to IEC programme implementation, most especially among nurses and midwives. IEC roles and responsibilities of key actors are also proposed. Conclusions: Despite the challenges of adopting a mixed method approach, the study highlights an important relationship between evidence and practice. This approach also helped to ensure that a comprehensive multiperspective view of IEC strategies was achieved. In designing and implementing IEC programmes, clients must be involved in order to encourage community ownership and programme sustainability. Attitudinal change and commitment is required by all stakeholders in order to achieve and maintain impact on malaria in pregnancy. Finally, while recognising the essence of feasibility, appropriateness and meaningfulness of a given strategy, it is worth noting that the key message from this study is that no one single strategy on its own appears ideal. Therefore, there is the need to pay equal attention to both institutional and community-based strategies. Doing one thing alone will not work; more evidence of impact is required to know what works and in what context.