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Development of behaviour change communication strategy for a vaccination-linked malaria control tool in southern Tanzania

Adiel K Mushi12, Joanna Schellenberg23*, Mwifadhi Mrisho2, Fatuma Manzi2, Conrad Mbuya2, Haji Mponda2, Hassan Mshinda2, Marcel Tanner4, Pedro Alonso5, Robert Pool35 and David Schellenberg23

Author Affiliations

1 National Institute for Medical Research-Amani Centre, P.O. Box 81, Muheza Tanzania

2 Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania

3 London School of Hygiene and Tropical Medicine, London, UK

4 Swiss Tropical Institute, Basle, Switzerland

5 Barcelona Centre for International Health Research (CRESIB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

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Malaria Journal 2008, 7:191  doi:10.1186/1475-2875-7-191

Published: 29 September 2008



Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyrimethamine and linked to the expanded programme on immunization (EPI) is a promising strategy for malaria control in young children. As evidence grows on the efficacy of IPTi as public health strategy, information is needed so that this novel control tool can be put into practice promptly, once a policy recommendation is made to implement it. This paper describes the development of a behaviour change communication strategy to support implementation of IPTi by the routine health services in southern Tanzania, in the context of a five-year research programme evaluating the community effectiveness of IPTi.


Mixed methods including a rapid qualitative assessment and quantitative health facility survey were used to investigate communities' and providers' knowledge and practices relating to malaria, EPI, sulphadoxine-pyrimethamine and existing health posters. Results were applied to develop an appropriate behaviour change communication strategy for IPTi involving personal communication between mothers and health staff, supported by a brand name and two posters.


Malaria in young children was considered to be a nuisance because it causes sleepless nights. Vaccination services were well accepted and their use was considered the mother's responsibility. Babies were generally taken for vaccination despite complaints about fevers and swellings after the injections. Sulphadoxine-pyrimethamine was widely used for malaria treatment and intermittent preventive treatment of malaria in pregnancy, despite widespread rumours of adverse reactions based on hearsay and newspaper reports. Almost all health providers said that they or their spouse were ready to take SP in pregnancy (96%, 223/242). A brand name, key messages and images were developed and pre-tested as behaviour change communication materials. The posters contained public health messages, which explained the intervention itself, how and when children receive it and safety issues. Implementation of IPTi started in January 2005 and evaluation is ongoing.


Behaviour Change Communication (BCC) strategies for health interventions must be both culturally appropriate and technically sound. A mixed methods approach can facilitate an interactive process among relevant actors to develop a BCC strategy.