Effects of a health educational intervention on malaria knowledge, motivation, and behavioural skills: a randomized controlled trial
Author(s): Ahmed Dahiru Balami1 , Salmiah Md Said1 , Nor Afiah Mohd Zulkefli1 , Norsa'adah Bachok2 and Bala Audu3
Malaria infection during pregnancy is associated with complications like anaemia [1-3], abortion [4, 5], stillbirth [6, 7] low birth weight [8, 9] and pre-term delivery . An estimated 25 million pregnancies are believed to occur annually, in malaria-endemic regions of sub-Saharan Africa . A higher risk of contracting malaria has also been reported among pregnant women [11, 12]. Sleeping under an insecticide-treated net (ITN) every night and receiving at least two doses of intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy (IPTp) have been proven to decrease the risk of malaria infection and its complications during pregnancy [13-16] and have been recommended by the World Health Organization (WHO), for all pregnant women in sub-Saharan Africa [10, 17]. However, the level of compliance with these recommended practices has been very poor, as only 18% of pregnant women in Nigeria were reported to sleep under any type of net, while only 23% of women who delivered within the last 2 years preceding the survey had received IPTp [18-25], many of which showed positive associations between these variables [21, 23, 26-29]. Some items of knowledge, motivation and self-efficacy for ITN use, had also been reported to predict ITN use itself , suggesting that improvements in these constructs is likely to improve compliance with ITN and IPTp.
A few health educational interventions have been studied among different groups, to determine their effectiveness in improving malaria knowledge and preventive practices among the target groups [31-35], most of which were not guided by a health theory. The information-motivation-behavioural skills model consists of three constructs, and was first proposed to help explain HIV preventive behaviours among students . Its first construct, information, refers to the requisite knowledge about the particular health behaviour ; motivation is the second construct, of which attitude is a component; while the third construct, behavioural skills, comprises of both the actual and perceived abilities to carry out the behaviour change . None of the previous health education interventions for malaria among pregnant women had targeted these three constructs as its outcome variable. This model, which suggests that information and motivation work through a mediator (behavioural skills), to cause a behaviour change has also been validated with diabetes self-care  and curb-cycle behaviour . It was therefore hypothesized that giving health education on malaria to pregnant women using a module developed based on the IMB model is likely to improve their knowledge, motivation and behavioural skills towards those preventive measures. The aim of this study was as such, to develop, implement, and assess the effects of a health educational intervention based on the IMB model on knowledge, motivation, and behavioural skills scores among pregnant women in a hospital in north-eastern Nigeria.
The study was conducted in Maiduguri, the Borno state capital of north-eastern Nigeria. Borno state lies between latitudes 10[degrees] 30' and 13[degrees] 50' north and longitudes 11.00[degrees] and 13[degrees]...