Title: Using an intervention mapping approach in planning, implementation and evaluation of a community-led project towards malaria elimination in the Eastern Province of Rwanda
Chantal Marie Ingabire, Emmanuel Hakizimana Fredrick Kateera, Alexis Rulisa, Bart van den Borne, Ingmar Nieuwold, Claude Mambo Muvunyi, Constantianus JM Koenraadt, Michelle Van Vugt, Leon Mutesa, Jane Alaii
Malaria remains a major public health problem worldwide. The World Health Organization estimates about 3.2 million people to be at risk of malaria worldwide and in 2015, 89% of malaria cases and 91% of malaria deaths of the global malaria burden were located in sub Saharan Africa. Malaria elimination requires strategies that target the parasite, the vector and most importantly the human host, hence the community participation is a key factor. We describe the development, implementation and evaluation of an integrated community-based malaria elimination project (MEPR) in Ruhuha sector, Bugesera district, Eastern province of Rwanda using an intervention mapping (IM) approach. MEPR consisted of four components: Behavioural sciences, biomedical sciences, medical entomology and health economics
IM is defined as a systematic approach used in the development of health promotion program. Informed by theory, IM guides strategies for change that are linked to behavioral and environmental factors related to health outcomes. IM involves six steps; (1) a needs assessment, (2) design of a matrix of proximal program objectives, (3) selection of theory-based intervention methods and practical applications (4) design of the program, (5) adoption and implementation plans, and (6) program evaluation. The needs assessment in the current program included Open Space discussions, a stakeholder analysis, household and entomological surveys to inform systematic development of targeted project interventions for behavioural and environmental changes. Two project components were subsequently implemented, namely the establishment of community malaria action teams (CMATs) in mid-2014 as platforms to deliver malaria preventive messages at village level, and implementation of a mosquito larval source control program that used biological substances in neighboring marshlands and other water bodies for a duration of six months (January- July 2015). Both programs were followed by a process and outcome evaluation to inform future scale up
Step 1: Needs assessment
Step 2: Synthesis of determinants and defining change objectives
Step 3: Theoretical methods, practical applications and parameters for use
Step 4: Design of program components and materials
Two program components were deemed important:
Step 5: Program adoption, implementation and maintenance
In addition to identification of stakeholders to be engaged, the project recommended activities to be performed for adoption, implementation and maintenance of the project components:
Step 6 Process and outcome evaluation
A follow up household survey conducted in December 2014 indicated:
An end line qualitative study conducted in October 2015 highlighted:
This community-based program demonstrated the feasibility and effectiveness of active community participation in malaria control activities, which largely contributed to community empowerment and reduction of presumed malaria in the area. Further studies should explore how gains may be sustained for malaria pre-elimination.
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