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Using Participatory Action Research to Create Community-based Campaigns to Reduce the Risk of Malaria, Dengue, and Other ILIs. November 2011. Presenter Disclosures. Tula Michaelides
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Using Participatory Action Research to Create Community-based Campaigns to Reduce the Risk of Malaria, Dengue, and Other ILIs November 2011
Presenter Disclosures • Tula Michaelides • The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: • No relationships to disclose
Overview • Participatory Action Research (PAR) in two cross-border areas (Lao-Thailand and Lao-Vietnam) • Communication campaigns created to prevent AI, dengue, malaria, and other influenza-like illnesses (ILIs)
PAR Locations • Savannakhet • Hub of commerce, comm, and movement of people between Thailand and Vietnam. • Road No. 9 lays east-west from the provincial capital to the Vietnamese border town of Lao Bao. • Mukdahan • People and cars can cross the Mekong river between Savannakhet and Thailand's Mukdahan.
Objectives • To assess daily life, including livelihood, culture and traditional practices that affect health • To determine communication behaviors and practices related to how they seek health care • To look at communication behaviors and prevention practices toward infectious diseases To use this data to develop communication strategies and materials
PAR Preparation • 2 Districts: Nong & Sepone for Viet Nam Border • 2 Districts: Kayson & Songkhon for Thai Border • 4 Villages: Thasano, Thadeua, Dansavanh, Danvilay • Discussion with the Public Health Department • Touching base with district health office • Making arrangements with Village Leaders • PAR Team: • AED Consultant: 1 • PPHO: 1 • DPHO: 1 • Village Facilitators: 2
PAR Activity on Thailand Side • Four (4) villages (Moo 1, 10, 12 and 16) in Kam Pa Lai Sub-district, Muang District, Mukdahan province were selected for the PAR activity. • Villages located about 25 kilometers from Thai-Laos Bridge, 40 kilometers from Mukdahan city. • Villages comprised of 623 households, 2,444 population people; nearly half was female. • Most are farmers (rice, cassava, rubber trees) and temporary employees.
PAR Preparation PAR Training of Master Trainers, and Training for Facilitators • Public health officers from Mukdahan and Savannakhet province • Local authorities and village health volunteers (VHVs) from Kam Pa Lai Sub-district, Muang District, Mukdahan province
Research Questions • What is the main health problem in the village? • How serious is the disease in the village? • How do people recognize the symptoms? • How do people seek treatment ? • What are gender roles regarding care? • How does the bridge affect their lives? • How do villagers prefer to receive information? What means and channels have they used often? • What actions do they take to protect themselves from influenza-like diseases? • What actions would they consider to protect their village from influenza-like diseases?
Data Collection:Participatory Action Research (PAR) • Village Mapping • Transect walk - Observation • Individual interviews • 2 FGDs (10 men & 10 women): • Daily Activities Profile • Seasonal Calendar • Bean Quantification • Chapatti Pie • Ranking Table • Flowchart • Force Field Analysis
Research Tool Village Mapping • Show infrastructure, • What is important to them in the village and the surroundings • Boundaries of the village with the next village
Research Tool Transect walk Tosee villagers’ behaviors and available resources in the village (not included in the mapping)
Research Tool Daily Activities Profile Daily activities showed village livelihood (number of activities during the day). Showed that women’s workload included ‘productive’ work and household work, while men concentrated on ‘productive’ work and social events.
Research Tool Seasonal Calendar • Showed different events during the year • Each event could indicate the cause of disease emergence in the village • Indicate duration of disease
Research Tool Bean Quantification Was used to rank importance of diseases to them village
Research Tool Chapatti Pie • Was used to show % of workload by gender with regard to home care • Was used to show % of people traveling across border by gender
Research Tool Flow chart Was used to describe phases of treatment seeking
Research Tool Preferred Ranking Was used to prioritize communication channels used in the village
Research Tool Force Field Analysis • Used to help the village members think of what could be done in the village to protect the village from disease • Used to discuss and define a key actions to undertake in the future.
Findings How do people recognize symptoms? • High fever, body pain, headache with nasal congestion (runny nose) are symptoms of common colds. • If they do not experience a nasal problem, they do not know which disease it is. They will go to the hospital and have blood tests to determine the exact disease.
Findings Serious disease in the village
Findings What are gender roles regarding care? Mother’s responsibilities are heavier than father’s, particularly at 2-3 days of at-home care. Bringing the sick child to the health center is mostly done by women. If their children are not better, then the man helps in seeking treatment at the hospital in the district or cross border area
Findings Preferred channel to receive health information
Findings Key actions to protect against ILIs • There are no actions they would consider to protect their village from influenza-like diseases • Villagers believe common colds are caused by seasons changing • Exercise, rest, and eating warm and healthy foods are considered by Lao Lum as ways to protect themselves from common colds
Findings How does the border affect their lives?Nong and Sepon-Viet Nam border Positive • Good transportation and communication - increasing numbers of traders, visitors • Increase demand of food supply, village women can sell their agriculture and other products like bamboo shoots and herbals • Men are employed in tree farms, and hired as carry boys and transporters via motorbike Negative • People come to Lao side for jobs • Access to guest houses, restaurants, nightclubs/karaoke, etc. leads to sex services and gambling • Traffic jams and accidents • Water pollution and garbage problems • Drunks fighting each other or with wives • Loss of agricultural land to private concessioners who run tree farms
Findings: How does the bridge affect their lives?Kaysone and Songkhone-Thailand Positive • Have more confidence crossing the border into Thailand legally (rather than via boat) • Livelihoods are better because their sons and daughters who work on the Thai side send money to their family • Increased number of merchants Negative • They feel unhappy; miss and think of their children who work in Thailand, where there are risks of disease and risks to security • Divorces due to drugs and card playing • One case of dengue was reported; the person works in Thailand
Cross-Border Findings Advantages of new bridge • More travelling between the 2 countries (Laos and Thailand) • Better economic situation and public transportation between the countries • More travelling business between the countries • During harvest period, more Laotians visit their relatives in Thailand and/ or work as temporary employees in Mukdahan (will get about 120 – 150 Baht per day) • Increased number of marriages between Thais and Laotians
Cross-Border Findings Disadvantages of the new bridge • Drugs • Gambling • Increased number of traffic accidents • More criminal issues • Increased prices of land in Mukdahan
Key Findings: Male Problem Identification Issues/ Problem Identification: MALES
Key Findings: Female Problem Identification Issues/ Problem Identification: FEMALES
Key Findings: Dengue Symptoms Cause and Recognition of Symptoms:Dengue Fever
Key Findings: Dengue Home Care Treatment/ Home Care: Dengue Fever • Mild forms observe symptoms (monitor to see if it will become severe or not) tepid sponge to cool fever give medication (e.g., paracetamol bought from grocery shops) in the meantime, use bed nets during day and night • Severe forms seek treatments from health center (if not yet recovered) will go to district hospital (health officers will admit the patient and test blood to check for dengue) if more serious condition, the patient will be referred to provincial/regional hospitals
Key Findings: Male Comm. Channels Communication Channels: MALES
Key Findings: Female Comm. Channels Communication Channels: FEMALES
Key Findings: Dengue Prevention Practices to prevent dengue prior to an outbreak • Clean out any containers that contain water • Use bed nets during day and night to protect against mosquito bites • Use fish to eat larvae Practices to prevent dengue during an outbreak • Report suspected cases to VHVs and/or local authorities immediately • Spray and fog households that are infected • Clean households and village environment • Using salts and larvae in water containers
Key Findings: Impact of Disease • Lack of income • Fear and cause of worry • More expenses for treatment and health care • Absence from work to take care of ill family members • Spend more money to purchase fuel for spraying and fogging in their households and community
Conclusions from PARs • People’s health seeking behavior was low; health was not a large concern in the family. • People underestimated the risk of ILIs. • Households rarely chose public health services as a first response to illness. They preferred to buy drugs over the counter or to consult the village health volunteer (or private practitioner if available). • Capacity of health facilities and health care providers at the village level was very weak.
What Did We Do With This Information? • Cross- border districts and villages were given priority for community-level communication and social mobilization activities. • Goal: Mobilize full community participation, cooperation and involvement so that would be responsible for their own health care and create an enduring movement for hygiene and prevention that would render everyone capable of resolving his/her own health problems. • Use VHVs and village health officers to provide health education and deliver messages. • Relationships between villagers and health staff should be improved • Strengthen capacity of community leaders and credible sources of information through interpersonal communication using job aids and other materials
What Did We Do With This Information? Trainings in Lao villages in LuangPrabang • Community leaders including health and veterinary volunteers, district livestock officers, primary school teachers, district health staff , Lao Women’s Union representatives • Using communication materials (AI flip chart, AI booklet, AI TV update video, dengue poster, booklet & pocket-size guide) • Group work and discussions using adult learning techniques • Communication planning exercises – engaging community leaders using case scenarios to identify local resources and solutions to protect their communities • Role play and demonstrations -- to illustrate community leaders’ roles in mobilizing community members to protect village from H5N1 and dengue
