Title

Rapid Assessment of Barriers to Treated Bednet use by Pregnant Women and Children Under-Five, IPTp2 uptake by Pregnant Women, Seeking Early Treatment with ACT for Children Under-five developing Fever within 24 hours in Western Area, Kambia, Koinadugu Districts of Sierra Leone

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 will be used to inform Government and NGOs in the development of an effective SBCC strategy. Study was conducted by Catholic Relief Services.

Program Intervention

Aim of Study: To identify barriers, opportunities and determinants to treated bednet use by pregnant women and children under-five , IPTp2 uptake by pregnant women, seeking early treatment wth ACT for children under five developing fever within 24 hours at community level in the study areas in order to improve evidence-based for an effective SBCC strategy in Sierra Leone

Results

Method •A barrier anlaysis was conducted using a focused group discussion of doers and non doers in Kambia, Koinadugu, Western Area communities. •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. Results Major barriers for bednet use among Pregnant women •Hot and unable to sleep. •Pereceived being caged and dislike for ITNs/LLINs Major barriers for treated bednet use among children under-five •Hot and child sweats and cries a lot •Dislike for ITNs/LLINs Major barriers for IPTp uptake among Pregnant women •Distance, transport costs and medical fees. •Cultural/traditional influnece. •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). Major barriers for seeking treatment with ACT for febrile children within 24 hours •Perceived malaria to be less serious •Perceived traditional medicines were more important •Cultural influence •Opportunity Cost. •Distance. •Attitude of nurses. •Perception children dislike the ACT, weaken children or make them vomit.

Discussion

Conclusions Study revealed multiple and interrelated barriers to the four behaviours which are rooted in traditional and belief systems of the community low awareness. The health programmes can be used in addressing the barriers. Recommendations 1.Improve distribution chains to reduce SP/Fansidar stockouts. 2.Adapt health promotion messages to emphasize the need for multi-faceted approach to malaria prevention. 3.Target sensitization campaigns at community members in order to improve the quality of advice given within a community context. 4.Strengthen training of health workers in FHCI and Interpersonal Communication skills. 5.Identify systems to help ANC attendees keep appointment,