Differentiated effects of sources of malaria messages on mosquito bed net use among women of reproductive age in Uganda: a propensity score matched analysis.

introductionMalaria remains a significant public health challenge, particularly in high-burden settings such as Uganda. Social and Behaviour Change Communication (SBCC) interventions play a vital role in influencing knowledge, attitudes, and practices related to malaria prevention. However, despite the widespread promotion of mosquito bed net (MBN) use, there is limited evidence on the comparative effectiveness of different media platforms in encouraging their adoption. This study estimated the effect of exposure to malaria messages from different media platforms on MBN use among women of reproductive age in Uganda using propensity score-matched analysis.

methodsWe conducted a secondary analysis of nationally representative data from the 2018-2019 Uganda Malaria Indicator Survey (UMIS), restricted to 3488 women aged 15-49 years who reported exposure to at least one malaria message. The primary outcome was MBN use, and the key exposures were nine distinct SBCC platforms. One-to-one nearest neighbour propensity score matching was applied, adjusting for key socio-demographic characteristics including age, education level, household wealth index, place of residence, and region. Propensity score matching analysis (PSMA) was applied to estimate the average treatment effect on the treated (ATT) for each platform, with ATT chosen to quantify effects among women who were actually exposed to malaria-related messages, adjusting for relevant observed covariates. Data analysis was done in Stata V14.0.

resultsOf the 3488 women included in the study, 73.2% reported using MBN the previous night before the survey. Propensity score matched analysis revealed that exposure to malaria messages through community health workers (ATT = 0.322, 95% CI 0.111, 0.533), community events (ATT = 0.296, 95% CI 0.085, 0.507), and social mobilization (ATT = 0.185, 95% CI 0.008, 0.362) significantly increased MBN use. Other effective channels included social media, radio, interpersonal communication, and billboards. Television exposure (ATT = 0.051; 95% CI  - 0.062, 0.164) and exposure from other unspecified sources were not significantly associated with MBN use.

conclusionAmong women exposed to malaria messages, exposure through community health workers and community events showed the strongest associations MBN use, followed by exposure through social mobilisation and other SBCC platforms. Exposure through television was not significantly associated with MBN use, suggesting that community-based and interpersonal communication channels may be more strongly associated with MBN utilisation than some mass media platforms.