Parker Warren, Pennas Thaddeus, Kommwa Innocent
Independent Consultant, Cape Town, South Africa.
FHI360, Washington D.C., USA.
Malawi Med J. 2018 Jun;30(2):99-102. doi: 10.4314/mmj.v30i2.9.
Communication to address priority health challenges typically draws on epidemiological research in conjunction with referencing global and country strategies. While community-level perspectives on health challenges typically align with national priorities, nuances and barriers that constrain health response may be less well known. To deepen understanding of the relation between situational aspects of health and ways of making meaning, community insights into health priorities were explored.
Action Media, an established participatory research methodology for informing health communication design and strategy, was undertaken with parents of children under 5 in Balaka District, Malawi.
Participants identified malaria as a priority concern in their community. While it was reported that there was strong commitment to consistent use of long lasting insecticide treated nets, there was frustration that malaria incidence remained high. It was observed that risk of exposure to mosquito bites was increased as a result of chores and other activities that extended into the early evenings prior to retiring to bed under a bed net. Bed bug infestations were said to be a common and ongoing concern. Some community members alleviated discomfort by abandoning their beds and sleeping outside without adequate protection while others boiled their bed nets to remove bed bugs. Accessing distant health facilities when ill with malaria was difficult for adults and children. Participants identified the need for effective strategies to address these concerns including accessing mosquito repellant, eradicating bed bugs, treating malaria locally and collaborating in malaria control activities.
Meeting targets for malaria prevention requires consideration of contextual factors that undermine effective malaria prevention in affected communities. Such factors are not immediately apparent through epidemiological data. Regularly assessing contextual challenges in high malaria incidence areas provides opportunities to understand gaps, to refine intervention strategies and to inform communication programming.
应对优先健康挑战的沟通通常借鉴流行病学研究，并参考全球和国家战略。虽然社区层面对于健康挑战的看法通常与国家优先事项一致，但限制健康应对措施的细微差别和障碍可能鲜为人知。为了加深对健康状况与意义构建方式之间关系的理解，我们探索了社区对健康优先事项的见解。
在马拉维巴拉卡区，针对5岁以下儿童的家长开展了行动媒体研究，这是一种既定的参与式研究方法，用于为健康沟通设计和战略提供信息。
参与者将疟疾确定为其社区优先关注的问题。虽然据报告人们坚定致力于持续使用长效驱虫蚊帐，但疟疾发病率居高不下令人沮丧。据观察，由于家务和其他活动会持续到傍晚时分才在蚊帐下睡觉，接触蚊虫叮咬的风险增加。臭虫侵扰据说很常见且一直令人担忧。一些社区成员通过不睡床而睡在户外且没有足够防护措施来缓解不适，而另一些人则煮蚊帐以清除臭虫。患疟疾时，成人和儿童前往远处的医疗机构都很困难。参与者确定需要有效的策略来解决这些问题，包括获取驱蚊剂、根除臭虫、在当地治疗疟疾以及在疟疾控制活动中开展协作。
要实现疟疾预防目标，需要考虑那些破坏受影响社区有效疟疾预防的背景因素。这些因素通过流行病学数据并非立即显而易见。定期评估疟疾高发地区的背景挑战，为了解差距、完善干预策略和为沟通规划提供信息提供了机会。
