3.1 Descriptive analysis
Refer to Table 3 summary of the studies included.
Table 3
Summary of the included studies
Study
|
Study area
|
Target group
|
Actual group involved in the interventions
|
Strategy
|
Prevention behaviour
|
Monitoring and evaluation
|
Impact of the intervention
|
Russell, C.L. et al. 2015
|
Southeast Nigeria
|
Household
|
Enablers: Community health promoters, selected by their community leaders,
carried out the intervention at the household and community levels.
|
A community-based SBC intervention to increase the correct and consistent use of LLINs
SBC intervention activities
included: 1) monthly home visits by community health promoters; 2) mobilization of commu-
nity and religious leaders to support and promote malaria control interventions; and 3) organi-
zation of community events including net washing and mending days, workshops to build portable net hanging frames, and malaria-related performances and demonstrations.
|
Long lasting insecticide net
|
pre-intervention and post-intervention interviewer assisted questionnaire
|
The odds of net use increased among individuals who were exposed to tailored SBC in the context of a home visit or who received greater degrees of social support from friends
and family.
Findings suggest that LLIN use is significantly influenced by social support and exposure to a malaria-related SBC home visit.
|
Eskenazi et al. 2019
|
South Africa
|
|
Participa
nts were
adults
residing
in 16
villages
in the
Tulamela
region of
the
Vhembe
District
Municipa
l
-
ity of
Limpopo
Province
|
Use an entertaining skit, songs, and other folk media in the local language.
The objective is to
increase the
attendees’
knowledge of
precautions to take
prior to and after
spraying in order to
limit their insecticide
exposure resulting
from IRS.
|
Insecticide residual spray
|
The pre-
and post-performance questionnaires included questions
|
Attendees
improved in their knowledge about
precautions to
take prior to and
after spraying
Acceptance of
IRS was very
high both before
and after
the skit. However, a brief dramatic
presentation and
song performed by research study staf, who were not formally trained in the performing arts and wearing simple costumes, was an inexpensive method to increase over-
all knowledge about ways to prevent undue insecticide
exposure from IRS in communities such as those in Limpopo, South Africa.
|
Kebede, Y. et al. 2020
|
Ethiopia
|
A community based pre-post test study was conducted in five districts of the Jimma Zone
The data were collected in two phases (baseline, 2017) and (end-line, 2019) in five districts of
Jimma zone namely; Limmu-Kossa, Botor-Tolay, Gera, Shebe-Sombo, and Nono-Benja
|
engaged school aged students (5–8 grades) on participatory peer education within small groups, followed by exposing parents with malaria messages aimed to influencing ideation and preventive practices.
|
school based malaria SBCC
Objective is to evaluate school-based malaria
(SBCC) in terms of community message exposure, acceptance, knowledge, and practices.
poems, drama using mini media (facilitators use this media to teach students)
students use cards to influence their parents
|
Insecticide treated net
|
pre-intervention and post-intervention interviewer assisted questionnaire
The data were collected through face-to-face inter-
viewer-administered methods at the household level.
|
The school-based content intensity of
exposure had effects on comprehensive knowledge, message acceptance & ITN
utilization
|
Anderson et al. 2022
|
Vhembe District, Limpopo Province, South Africa.
|
Grade 3 (usually 10–11 years of age) primary school children
|
Engaged teachers & parent/guardians/caretakers as participants to support or focus the young learners
|
There are 4 groups for pre and post intervention: control, song only, drama only, song and drama
Objective is to increase knowledge about malaria
|
Malaria prevention behavior in general
|
pre-intervention and post-intervention interviewer-assisted questionnaire
|
song as intervention was the most effective learning intervention
A song that is easy to remember, repetitive and culturally appropriate will ensure the information is retained and able to be repeated.
The study concluded that a culturally and age-appropriate song can play a significant role in developing behavioural changes and spreading awareness against disease in a high-risk malaria region.
|
Research conducted by Russel, C. L. et al., looked at the determinants that influence net usage and the implications for programmatic interventions designed to increase the correct and consistent use of long-lasting insecticide treated nets (LLINs) [26]. The target group for the intervention program are all households in the selected clusters in Southeastern Nigeria. Community health promoters selected by their community leaders carried out the intervention at the household and community levels. The community health promoters acted as enablers in the intervention program. A community-based social behavior change (SBC) intervention was designed by The Carter Center and implemented through a partnership with the Ebonyi State Ministry of Health. The intervention involved various activities, including monthly home visits by community health promoters, organizing community events such as net washing and mending days, workshops, performances, and demonstrations related to malaria. They also mobilized the community and religious leaders to support and advocate malaria control interventions. Community health promoters assessed specific barriers to net use, hanging and care during monthly home visits. They used tailored messages and skills-building activities to address those barriers. Illustrated flip charts utilized during these visits to cover about the following: i) malaria transmission cycle, ii) the costs associated with malaria, iii) the importance of sleeping inside a net every night and in every season, iv) strategies for hanging bed nets over any sleeping space, v) the correct height for hanging nets, vi) the importance of mending all holes in bed nets, and vii) the appropriate way to wash a bed net. The training materials and job aids placed a strong emphasis on fostering social support for net use, based on the belief that social interactions are a major factor in how Nigerians utilize the net. The informational, emotional and instrumental support that people receive from social network members also contributed to the effectiveness of the message retention. The results show that the level of social support for net use received from family and friends and malaria-related home visits are significantly associated with LLINs use in the population. The relationship between net use and social support in this study points to a new direction for messages and activities employed in future SBC interventions. Tailored and interactive strategies such as home visits may be needed to aid households create new social norms around net use. The study suggested that some other forms of interpersonal communication may be more effective than mass communication campaigns aimed at raising awareness of malaria or highlighting specific behaviors. In this study, net use was the factor most significantly associated with self-reported exposure to SBC home visits.
The study by Eskenazi et al. focused on the importance of indoor residual spraying (IRS) for malaria control and ways to prevent insecticide exposure [5]. A dramatic presentation and song were developed by study personnel and performed by lay performers in the Vhembe District of Limpopo in South Africa. The educational intervention program was conceptualized within the framework of the Health Belief Model. The program consisted of a skit followed by a song in the local language. The skit was developed at University of California Berkeley (D.I.L.). Then, feedback was elicited from the field office staff of approximately 10 individuals. The updated skit was then performed to patients and staff at the local hospital, as well as to drama students at the University of Pretoria. The skit was then revised based on this feedback. The song was developed by the field office staff based on the information in the skit. The skit and song were performed by Venda Health Examination of Mothers, Babies and their Environment (VHEMBE) study staff in costume as mosquitos and identified several precautions to be taken before and after spraying. The presentation was staged in villages that had been sprayed for malaria. Each participant was handed pre- and post-performance questionnaires. Before the drama and song began, the participants were asked to complete the pre-performance questionnaire. After the drama and song were performed, the participants were asked to complete the post-performance questionnaire. Results showed acceptance of IRS was very high both before and after the skit. However, a brief dramatic presentation and song performed by research study staff, who were not formally trained in the performing arts and wearing simple costumes, was an inexpensive method to increase overall knowledge about ways to prevent undue insecticide exposure from IRS in the communities.
Kebede, Y. et al., used school-based social and behavior change communication (SBCC) in the malaria intervention in five districts of the Jimma Zone, Ethiopia [27]. This involved engaging students in primary schools on participatory peer education within small groups, followed by exposing parents to malaria messages aimed at influencing ideation and preventive practices. The students were trained by natural science teachers and acted as peer educators, delivering messages about the cause, manifestations, prevention measures, and roles of students in malaria prevention. The intervention also included the formation of anti-malaria clubs and the use of peer education guiding flipcharts. Results showed the intensity of exposure to school-based content had effects on comprehensive knowledge, message acceptance, and insecticide-treated nets (ITNs) utilization. The study recommends the inclusion of school based SBCC in the national malaria control programs.
The study by Anderson et al. aimed to compare and assess three teaching intervention strategies to assist young children, specifically grade 3 (typically 10–11 years old) primary school learners about malaria [28]. In Phase 1, the interventions included a culturally and age-appropriate song, a drama piece, a combination of song and drama, and a control group that received no intervention. Phase 2 focused on validating the most effective intervention method identified in Phase 1, which was the song. Amongst all the four interventions groups, the group that received only the song showed statistical significance. The interventions were implemented in selected primary schools, and pre-intervention and post-intervention questionnaires were used to assess the knowledge growth of the children. The findings revealed a ‘ripple effect’ where knowledge conveyed to the children was later passed on to parents and therefore resulted in an increase of knowledge among family members. This is significant as the parents’ group for the song scored a statistical significance. The parents mentioned that they heard the song at home and demonstrated knowledge growth based on just hearing the children singing at home.
3.2 Thematic analysis
Table 4 below summarizes the themes identified in the studies.
Table 4 Themes identified in included studies
![](data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAvQAAAC2CAYAAAC20xlYAAAgAElEQVR4Ae2b65Ecu9Ft6coJ2qHf9EEe0AAZwV/HDMoMRdALRdCWubF5vyVuJlH9nmZ190LEHFQBiXwsZAE5I+rDm00CEpCABCQgAQlIQAISeFgCHx7Wcx2XgAQkIAEJSEACEpCABN4s6E0CCUhAAhKQgAQkIAEJPDABC/oH3jxdl4AEJCABCUhAAhKQwG8F/YcPH978kYE5YA6YA+aAOWAOmAPmgDmwzxyYv8L8VtBPAd8lIAEJSEACEpCABCQggf0SsKDf797omQQkIAEJSEACEpCABI4SsKA/ikgBCUhAAhKQgAQkIAEJ7JfAVQX9f//737e//vrrl59//OMfv0X773//+y0/17Z//etfbyv91+p1vQQg8OnTp6P/H5KvX78ifrCPXP7t4ffv33/Iffz48e3z588H1zzC5Ixr7z5nT9+jffny5e3bt2/vofoqnfPfu8bPZ2/5xhJ3f5vvte/PzvI949vrN5OYVzl0CoucAa/wjZ3C4hSZfJd+m6eQOl/m4oL+P//5z49CfhbqKbpT5NMo+qcc8+f0FvTn0FL2FgRSJNzqsLagv8WOnKcje5c9vHXLJR69eyroiXX6FD9f7QKFxa33XX2XE9jjN9PRXFrQ3/KOaH+e9dmC/v129uKb7p///OdbCuxVS0H/999//5iyoF8RcuxRCNzysLagv/+uv1dht7fi5JA/lxYq99+t21l8r32/nYevp+lQju6BxqXfyS3viD1weG8fLOjfj/BVBX2K+kONYp5/loN8ep5Zn18A+i/7Geev/RnPP7Xpv9D3MzrSR45fJnrcZwlcQuDYYZ35/un/yX/+05RVQZ+xXt8+Zj1rIpPnrZa5FDE5LNHHX2XbRmS6ccmyJn0utm7EgQzFUsutZFrH1jM66Vtn1jCefsYfPzI2baMDP9EROVozyXw3mNDP9XN8D/+MKj6w3x0Lz/E5P92IK/1ki77JMOszx9q2yT5MPnlnjnXtR2xPhnlvn7IuOnrfek32HJnpc9bFz/YV+6zhffbT7+juFn8yFt3EtrIz/Y5M+x+dLRNd0xYxYgff0nebenouOjPPWnRFd+Z4j8xsHWPk+M4ix57Towff5viMfdr6E+/wxef4kDjy3kzbd+JM38yOxRuWzTvP0UteoLd1wuSY7ujJDz7j79y/2JwNuzOeyEU+Ole503rmfHR1ix/5sd2ewK+kz9BPAZ5iO4X7VqOo739yc0pBPwt27PFv6PknP+lpjB3yB1l7CZxCIIfR6uDL2jnHQZYDN413Lr4chhyurO+DLXaiE3nW95ofihf/4fDOmrQ+9Kc/vCPDe9bFVh/A+IBPrFn52Xomm+kyl2ezbdvMd+w9H33waoZ5DgsaMrynz3yvmTIdI+uQmRw6ZmT/RJ+Y4uMp7RS2sG7+2dPeV/Rgl1xp/uGcNc178s9720kMeW892IY3e0S+4wvv7Bc88I39yzhjyMyeeWxmvuPPe3zMGHbxAybIdPww6Zgng634Wi9MsL2yNTnw3v4QQ/sT3f0e+d4P2MATf7OOhq0p0zyR3UPP3jVPGOMzcU6Z3peVzNxfcgC9iT+8Y6/3ZnI/RTd62seM9f6hB/vE3nuOHvaG/Tzk38yLrJ0x5L11oN/+egI/v74LdPVf0Pkr/Pzr+CUFPWu6WI97KeYp6HmPD7T5SwDj9hK4lEAO2D6s0cPhxnt6DkXk5+HWh/pqfXS0DOs5dNvWfM66eUjG9z6gsyZjHPSrg3XajF7iwSYHPRd1+4wMeniffXRk3apF79Z87wcM8SO6uKgYQwY7+MU84x0nOuCETLND5pS9Yf179s3lmJ1T2LLHrSv5MvcsY5FNg20zgX/zzljryTM6sDd9THxTpm1Hf+8PdtGXfjJa5X/Lr/wiRuQiEz3d4idj5EnHj6/Eg86Wib6OeTLLPOvS9/vUEx+zPg0uLRM/YqvbKobe18g2f+LEF3T1niAz9SD7p3v2pWPoPcC/jjtjkYFv3jPP/rOG2OGe+exLt9U+TJ9O0b3Sk3UZnw1/Mjf9iWzHtsqdGVd0TDtz3SqG6ZfvlxH49Su+TMePVSm0Ker7r/YU5+f8hT6y0THbLNjzy8Ms8OcvFFOH7xI4h0AfaFvrONQi2/JcuByafdhtHWo5/DhY5/ot+xlv3ci1L4fGMsehSwyJicskz93ary2ZrXH0bF0wzK/iyVwui6xNw2fWpGcvYD5len2v63F0zLjDhst+S6Z13vN5tddb9k9hGx7kIXpWOdtjnResmfwzPsdW/kz7q/g6h8g39mfaiN3e47z3fuIvPfpmDszxLd87RyfH2Fityzj641t+4nNax/pjoGSJecaHXI9vcZk+Zg1jWcMzOtP3+Nb30Iy3ZFrnn3yGPTzjS/xPnN3mXkyZjrnX9Xh0kCPI9D4xlj7s8aF1tEyP994hk/WRyc+qxUbWzdY+oaNl2NOwmy1rsZkemVXsc63vlxFY7+5lun6s4p+98Jfz9yzosZWe59izSeBWBHIQcZhOnX1Y5RLgQkA+Y32Q9aG5dahlLZfnXD/t93vrZnzle49xGBNH/Mdm5ognz92QyfzUgS76yK7ayt+W25o/9YLB53kJhTu+zR7uxIQO/Io8e7slg+y9+y1eKz+2ZJttnuGBjlXO9ljnBWsm/4zPsZU/036zR3fbJlfJt2kja9o/ntE1e/Z35gjv2Dnm+4wDO/E9c7ToQTc5lndkVnayNjL4Ep3omH3Wp624rHzssTxPff0evfB6pG/mB5D6z8yhTCVO9gPRzrspg47m08/omjqiJ5wzPht7f6ru3rvWxR7hDzkRGWy0fJ7bp1XuoJN957vCRnSwLv6nrWL/MeF/riZw84I+HvW/kb+moJ/F+fwLfWzlL/T5q/z8a/3VZFQggY0DPWBWhyYHLoc2hxsHWR+aW4da653rYzfrOCzTRz6tdf8Y2PA9a/BvtQabOaCJJ2PdkMn8PNBb7tDzynbLb803Ny6KXjf9mTK9vtf189TBXLPbkkH23n1fvCvbnVensG159K3Y9VjnBWsm/4zPsZU/036zR3fbnrk6bbAmeuLnMV6n7u8x3+NHZGaL7/Eh7ZCvyLR86yKejDWPlunnla3JOvI91s+tq5+3ePW+bcm0nj/5PHMovrT/+DY5t8xKB+u6nzoyF84Zny35k307Vfc5+4W9VR7Hj/ZzlTtzT5sFcbAu/k+dyNjfhsBFBf2qSG93UnjzF/qM55/PHPsnN5Hnn9ls6U/x3v/EJrop5Cns2w+fJXAtgdUBFZ190GGDwy0HWNoscPrQ5JBjLX3LzPXIrPpex/zK9x7rZ9bgV2JJW+nNhZG1HNArPbBAD/rpj106W/NtC1/RmX7ahSEyqzWZ6/2cOljbtrlct+Jjzb36Q/4wl9jTTmG7kmlGxNVjsCYvIrPiPcdWORa9Gac1e8baNjHGhzR8QZY+cWVd9CHL3OxXNmdurHxvdsg3k9iJ7siltTw+EA8yYdY8Iodu4phc0dWcVjIr+z0GyxlDy+BL+m7NkJimTMv/yWf8g2d8af/xrXlmLPsSrrRVTkzdU0fWhmfsdWMdzE7R3fvSuuZzy/Vzy3X8q9zpfcfX5hddxJX5tFXsbdPnywn8mj1n6Mlf4VOA55+6dFv905dZ0KcIzxh/gWcNBX30dYGfd9bMgp7iv/W1Pz5L4BoCfaC1Hg43DqnMRbbl50U4D+PI5nCjTZ1zPXKrfuqOTPvCmh6L7ayjcThHhgsEH3hvGWLHb2SiL3o7NmzQc/hnLa1tMZ/LgMbFwDt2eU+Pf/iCzpaZ3JFhzdTB2maHf6xB5k/28Eg8NPzsfWbsENvM9ZroW13EPQbH6KfhE+/p59jcV/S0/WaPrrZNTMSODmTp2dvoO9bws/d45nXem2N0TnZzTfyOfdbh67TTMsQXn2iZzw8xZzzv0U+buomJ+fTT39VYYsgPDY7Y5r1jiGz8wWdimDLo/NM9/hHT9B//Ou8yFi7EmHeYt56saX5TR9ZlH8KLvED3aj8P6V7tZ2y3nuhuW8TetvEnsmmr3Jn7Pu3AIrZiI20V+48J/3M1geOn2gET/J9XU0zzMwvuLKc47zl+Ici6PFOwtznWIZP31oFsxlbjzNtL4FICfSFNHTmYMs9PDreMcXBzmHGQZbwPzOjLGOvTd5vre24+r3RHX180WTPH2jb207ef+IEs78QVvYwh0+unr/2OPH3rxF/m4Mr6Uy6Y1tEsJve2Oy8p7MWP1sH+p99Lw3eYTZ/bz5aZbLN/cyxxzlh7jBxolqs9Wo31fsT2tL+Ko23HZmTiA434es8yl/EZB2tmT0zomnkdv+fY9D06Z3xzXdZgI33sMoZPxIgcHDvmaSuyx/Zj5e9qLMywnT65RiPveixzkWv+6DiVP/rv0cO3eU7/40d8b//Zh8jS4JGx/LT8SkfGYB7ZrXWRO6YbPfhC3zkY/ZGbDbvpI9+NOHsMX9h3GKInOhgjDya/1ufzdQR+ZuB1ev7o6hTz+YXAJgEJSEACEjhEIMVGF22HZN9rLoUOBc6lNiiUKKYu1eO6fRDYKsT34Z1ePAKBhy/o+V8JHgG2PkpAAhKQwJ8jkCJ6/uXxPb3JLw75BaKL7tVfOo/5kGIverr5l86m8fjPFvSPv4d/OoJfT4g/7c0Z9vvfzs9/x3+GGkUlIAEJSODJCfBPA1IU5y/b92wU8LHNzyX2+59iRE/ebc9DwIL+efbyT0XysAX9nwKmXQlIQAISkIAEJCABCeyJgAX9nnZDXyQgAQlIQAISkIAEJHAmAQv6M4EpLgEJSEACEpCABCQggT0RsKDf027oiwQkIAEJSEACEpCABM4kYEF/JjDFJSABCUhAAhKQgAQksCcCFvR72g19kYAEJCABCUhAAhKQwJkELOjPBKa4BCQgAQlIQAISkIAE9kTAgn5Pu6EvEpCABCQgAQlIQAISOJOABf2ZwBSXgAQkIAEJSEACEpDAnghY0O9pN/RFAhKQgAQkIAEJSEACZxKwoD8TmOISkIAEJCABCUhAAhLYEwEL+j3thr5IQAISkIAEJCABCUjgTAIW9GcCU1wCEpCABCQgAQlIQAJ7ImBBv6fd0BcJSEACOybwr3/96+0f//jHXTz85z//eRc7x4z85z//efvrr7/e0tsk8KwE8r3d+pv797///ZYfWs6OnCG29yFgQf8+XNUqAQlI4OkI3Kugv5edUzbIgv4USspI4FcC//3vf3/8ItwF/a8Svt2agAX9rYmqTwISkMCTErhXoX0vO6dskwX9KZSUkcCvBCzof+VxjzcL+ntQ1oYEJCCBOxLIX8Xyz0T6p83nf1pP0ZwfZFb/lGbOn1Joc5Gjd/7P+Csd+Ju1bTM6UlBTVP/999//85d4VvLM0Sc2/EkfPbNNmdhMW9mODv/yOAk+1/vMq5kzc5586Zwhd8i95MwcS87TkoOxk2+GNXw/nZ/tS54j2w0b+BRfowdZdPeazGOL8bwjm37mfM/1/NYZkBjiS7fWkflunAvEgyxxtazPb28W9GaBBCQggSciwCXYhUIu5r4suai7MMhl2ZdtnnsNxUCPTWxcvK132p56o2P6PGXQG13dIhe/acj1hR9/I0dDpouTGTuxhiHybafn0Wv/PARmzpID5AzfDxHPed47Z8jV/n6mncxlDXZaT57T+FZ4JxfxJT3rkMF2fwex1d9Tnvt9zk+78bO/8zlPUU8s8Ss68YF53jOPn8SCzqyjTRnG7S3ozQEJSEACT0WgL00C49KnyJ+FROQiw8XJZUtBgJ7MI8NY97MoyBy6uNhzIU8dXNz4N2UoUNCx0osfWUthMvUik2IkcmmwYa77+LOyHZkuvHqNz49NgP2euZ+oOh/mfOcsOjpfycVexxjE8l2Qu4x1rvYYulf5i31sxbfo6TZt97fLHN9jr8vYymbGYyNzabzjZ8YSH99d82r9rQM/iKP19livf+Vn/0L/yrtv7BKQwFMT4CLPJZkfLui+vAGQi5hCm4uUOfqtS5j5vowZSx97hy5y7OHftDMLlOhkTds5NE6BAYv2ZxZRrXNlO/NbsfZanx+PwFZeEcmqmM0ceZI84zk9Db3keMbnWBe8rFvlWY+t/Jn25/fUtrHTZ0KfBcxv9djiu8raNL63xEjr+PqZ+fTxle9x8sk8epttr3/lZwv6V959Y5eABJ6OAJcgF2wC5NKnmOjLGwDI5B0dzNGvCgPm0neh0eOx1wU0vzgggz38m3YoGvoSx1/inD26Yos5io2848+KBX6lX9nOeHSgr+V9fmwC5NVWFFvz5EnyjufO15nj0T/HVkXuKs96bOXPtD+/p5Xt/g5W8pNHfOAncSTu9ov3zNE6vn5mPn1sx5e0ySdjK70/hP2P/4beHJCABCTwTAT6UiUuLv1chml9eU+ZvK8u0owfu+hXtrOuL++VjmlvyswCJTqJKc9bbUsmfsZG2opF61vZzvxWrL3W58cjsJUzRLI13zm8ypmeR9cc6+8EmVWe9djKn2l/fk/RPW33d7CSx5/0q3kK7fiTxnvs0Dq+fmY+ffsxfcz8Sm+vf+Vn/0L/yrtv7BKQwFMR2LrscgGnCMh8Wl+aAOjCYEtPLuH8bLWV3qlrVQxgG//y3nZmgRL7q7GMoyvPK1v4k7kp/2Ng/GfLThdVY4mvD0xga78JaWu+c20lsypO59iqyF3lWY91vuMjeuNHWvs2Zfjm+ttlPXOsoW9Zxog5/tDiZ3TROr6VT5Hr2FZ+8P22XvS/em9B/+oZYPwSkMBTEcilmQuXxqWYi5ILenUhz8IgF27W0JjvQps5+tWlHlu9Bn8oNrig27/Y6jXoZQ32ort9RBdFxbSVddGbNYmPNt+xl/U8T9tZgx302D8HgZmziapzZOYdOZJ8SeO9c4Zc5BuM3BxLbnZeYnfmWecetrDNmshgf1U8T9uJKT+0+NLv/W3Fn+jvWPLefuFH+9Xxoa/jzXN00KaPGWdd60X+1XsL+lfPAOOXgASeigAXHhdsLlHGKAzm5R0AXNINgws2urJmVRi0fJ6xhf0uCpBtvfFvXtytI3MULRQo6EnfumJzXvSrecZaT/zA5/TY2rIdGXi2Hp+fgwA5Qk7MvZ7z5EuiX+XMzPHIzbEueKG4yrM5xreLr9N+fI3ubtP26kzIGDrT97c152IzY20HRoxtxYcN5PBz+phxzob2BflX7y3oXz0DjF8CEpCABCQgAQlI4KEJWNA/9PbpvAQkIAEJSEACEpDAqxOwoH/1DDB+CUhAAhKQgAQkIIGHJmBB/9Dbp/MSkIAEJCABCUhAAq9OwIL+1TPA+CUgAQlIQAISkIAEHpqABf1Db5/OS0ACEpCABCQgAQm8OgEL+lfPAOOXgAQkIAEJSEACEnhoAhb0D719Oi8BCUhAAhKQgAQk8OoELOhfPQOMXwISkIAEJCABCUjgoQlY0D/09um8BCQgAQlIQAISkMCrE7Cgf/UMMH4JSEACEpCABCQggYcmYEH/0Nun8xKQgAQkIAEJSEACr07gt4L+w4cPb/7IwBwwB8wBc8AcMAfMAXPAHNhnDsxfYH4r6KeA7xKQgAQkIAEJSEACEpDAfglY0O93b/RMAhKQgAQkIAEJSEACRwlY0B9FpIAEJCABCUhAAhKQgAT2S+Digv7Tp0+b/9b+48ePu4z48+fPb+1b/l3Yly9fLvJ1xp/3Yy22YvMe7fv372+J95r27du3H/6mP6eFcf+bu69fv/62HBbIxd+tFtkVX/xDB/3K3pZuxyUggX0S4Hue51ifHYfOjX1GpVcSeD8C+R74bvKddMt3xFyP+/w8BC6uLlNgrYqsoEnSbM39SXS3KOgpIufHkngT96HGRXRI5lZzKarnRXiubmI9p6CP3d57dHSRneew4jKe7+0nc62T+cz1L2iM20tAAo9PgG8/ZwVn0KGC5fEjNgIJXE+AOqPvWO7hjOW7sj0ngcMV6IGYU2Ctiqws4SCmYDug5q5Ttyjo80HMYp4gjhXRfGjIv2d/zJdTbHMIcJkeW4P83Pdw71yJb5Nh5ucvIHkP7/z0evzI/FzDnL0EJPD4BPLd5/vnF/f5/vgRGoEEbk8g30vfm/P99hbVuAcC71LQU9hRCK4KfP7S0r8tknQUcT0XWMfm0cn6WQSm+IsOWuRmYcncqieO1VzGEi8xr2RuWdCji1ib1eS08oWxKds85j6y5ty+ubNHk1Ps9t4QX+Syj3Mv40PkO+5z/VJeAhLYNwHOi5xzfVbN82PfUeidBO5LgLt7fjf5nmzPS+BdCnoKX5JnvgcnBzUF2Sza5ppj8+jrgnSu6cIyPpxb0Gf9qrA8NT0oUk+V35JDD3yJHZZZl8sv/h5qU4ZDAD28X3t5xg7c0Inv+Md+89793Efm5mGV92t9Rbe9BCSwDwKcd/m+83PsXNuH13ohgT9LIN8J30z6ro3+rGdafy8C71LQJ3ko4OI4xVoXcbMITdG3SjjWHJtP8kamGzYo8qbMuUm+VVi2zUPPXEyHZE6ZW/kd3R1/ng9dfKs9ie3oZh3FN/xO8W3KYAcdvLOvyDPOe/cr7viGr5FHB7Zah88SkMDjEsh5lrMpPzYJSOA0AnwzXRuctlKpRyRw8emYIotkmX0XWYFCodVFHMV25tKyJnq2Eu/YfNatfiHo8eho/bG3WrO1kavCckt2NX6Lgp5CtlnG1hxPnHMfVj5ljL1gH1mHzksLZPSiL7ZWudDjKx/P4X6O7MqWYxKQwL4IcA5xPnFn7MtLvZHAvghw1/LdXHqP7ysqvTlE4KqCPsVTtxSRSZ7ZSKwuQin2+nBGjgSc+g/Ns2bVU1Cmv6agn+tnnMfeb1HQTwYzXj7aUwp69is6+MUmz/DiIkXnsfh6nv2de4jOzoWsI67WwfM5RXri6D1Gh70EJPCYBPqc4rx7zEj0WgL3I8C3Qu+9eD/2f8rS79X3iZ5sFVlJnpk4FGtdxFHwZW7VWENxOWXmfOxSlE5Z3mdBfsoa1qbHZo/1M/MdZ8/fsqDfsoG97MEWu8hs+RImrKP4PregZ90s5mOXfZ86DxXiW7lGrN0f0tNyPktAAvsnwDmVc4mzo8+o/UeghxK4P4Hc4flO5neT78n2vARuXtBT1HbiMNZFKEVf5rbasUKu5/u59SWh8eXagj56Uyijr+0wFz+2WtbFn2sal9rkNhnHDwrzlb3JIjLoZh17NIvvlT7GWIMOxrtfMTzk72pvibf15vmQninruwQksF8CnEd9hvPdZ+ycc2m/UeqZBG5LgDs43wh1ArVHxroOu61ltf1pAhdXl6sii2BSzPWBy8HchXCKuk64PHcRONccmyeJ2wZ+tF+xS4vOlmf8UI+d9jXyxHPoY+GjOqT/lDnialuTz7HClouxL0ViIDZibZlj/sWP2D7U4ID/832u3cq1aeuYnqnXdwlIYL8E8t3nG+8zO95uje83Ej2TwP0IcI/Pe3hr/H6eaem9CbxLQR+ncxDnh6KNApJxikV+g+w1yKRA68Y4/ZyPLebSz4sghWqPRQYd+HNq8dp28jw/nvgdWxTHeafgnGt7PTId9+oZOXQRB7LNmz1gjp5fDNCRNYxFZjLBJutnzzz6Zt/yU3bLx6wJ2xXfzHFIYatt+CwBCTwmgT6/5pnc5/w89x4zWr2WwG0I9L0671Tu89yVXXfdxrJa9kDg4oJ+D87f2od8DPPyuLUN9UlAAhKQgAQkIAEJSOCWBCzoi2b+Cjx/q61pHyUgAQlIQAISkIAEJLA7Ahb0/7clKeT7n8fsbqd0SAISkIAEJCABCUhAAgsCFvQLKA5JQAISkIAEJCABCUjgUQhY0D/KTumnBCQgAQlIQAISkIAEFgQs6BdQHJKABCQgAQlIQAISkMCjELCgf5Sd0k8JSEACEpCABCQgAQksCFjQL6A4JAEJSEACEpCABCQggUchYEH/KDulnxKQgAQkIAEJSEACElgQsKBfQHFIAhKQgAQkIAEJSEACj0LAgv5Rdko/JSABCUhAAhKQgAQksCBgQb+A4pAEJCABCUhAAhKQgAQehYAF/aPslH5KQAISkIAEJCABCUhgQeC3gv7Dhw9v/sjAHDAHzAFzwBwwB8wBc8Ac2GcOzJr+t4J+CvguAQlIQAISkIAEJCABCeyXgAX9fvdGzyQgAQlIQAISkIAEJHCUgAX9UUQKSEACEpCABCQgAQlIYL8ELi7oP378ePDf2n/58uWkqCOXf5/1CO3Tp09v+bm2Xavj+/fvP5h9/fr1LFdit/8t3GqPorNlvn37tmkjssmDVWtbWzKrdY5JQAISCIGcPZxF86zjfPFsMVck8CuBvsPn/U3ddm0N8qtF3/ZC4OJKOonx+fPnq+N4pIL+6mDf3n78QnDtx3RJQR+bffmho4t6LlAOgfne8TPXOpnnsuX91faYuO0lIIHrCOSOoahH06GCBRl7CbwyAe7gvp+5h/M95f63PR8BC/o772k+tPxc0yjG51+ttnQiT6GOXD7w/uDj1/wlLe/T3z4Yen30UuhPW9GRdTYJSEAC5xCgoOdsmu/n6FJWAq9AgDs/30ru3fn+CgxeMca7FPQp5jiESTBgUxzynh7ZJCGNsfSziIyOjPVfbiLX66NnzkeGRiHadnimEE0cs7hlPf20wdrMTw7TP3SsZLnMMsfHeWpB33r7ebJPvFMn8bCO9/TxabUXzZV1sXWMHbL2EpCABCDAmZNzJecN5zLz9hKQwO8EuN/7u5n39e+rHHlkAj8r2jOjSGJ0kbm1fBZ9FM78BZekY32SbxZ+GWtbUyc6el2eO3m5FLqInjL4QB87sU2LfNtgnB4bxJbxrI9/tGM6IjdlKODRw3vsXdNiB0bobN+jm/1qbtic+5Bx9gIZ+oxjizF7CUhAAqcQyFmVs5Sfa8++U2wqI4FHJ5A7l28m/bzfHz0+/f+VwM9q9dfxo28zUTpp8kzLQdzFOOMUiF0ARmfku/V8j8cGh7cQpHkAABSGSURBVDoy6IzcLESje/qxWoeNVXEe36Z/yKdf2UAPcsd04Pf88JoNxTfxo/ucHjvo4H3aZbzZYmdV0G/JJ+7EYJOABCRwLgHOvJz7h87gc/UqL4FnJsB9nO9m1j/PHPerxvaz8j6TwKp4XamgaO4iv+WYj76VTA7vVSL2ODpaL4m8VYjGFj9ThssjervF5tZlwprY7TbHD+nodTzjY3pso5NiHNlz+taXdfCa/jMem7OtCvrIZC+7eOeXmh6bunyXgAQksEWAM57zcHUeba11XAKvSiB3NN9MettzE7h4h1OcrQrtFS6KQhKrCzsO6oxlfupknLXdU+Cio21jkwKVopL1kWXdvBxiE92t81Axjj30z57i+5AObEWG9fBon64t6KM7+rqhE17MEddklPn4NvWwLuMdQ1hvybLGXgISkMAkwNnEeZJ+dT7Pdb5L4JUJcHf3d0M98cpcnjn2uxT0DZAk40CmqI4MRXcXlSkCjyVh68AWdtCVpI5cN9Z1sUox3XI8Zw6/GaOf9hif/SEdkYVB+5TxcMA2Fxy/JEwbW++s2yqsw2jqxJ+VzkMF/ZSP78f2ca7xXQISkEDOjpxNObc4Z1dnlaQkIIGfBPK95DvJ98M9nndqop+SPj0LgbsX9AHXhSBFNUCTfF1wtiwy6SNDgTh1ZJ6DPz2F7CxWsz4JTvGMnq2Ej2/52WrRFR3d2o+Mx+YhHfjQOvLMh5nnrXjmmn5nzSHbmYMpaw/5m7neq6yZ8aIn/k/+zNlLQAISWBFYFSI5d3Ke5McmAQn8ToA6It8I9U3u97zPO/v31Y48KoGLT8QuqA8FH7lZRCapKBxJPHRQeFIY84585FhDovKOjvSzsJx+9EURPcgfKjoTx4ylbeJHdNGm3cRxSMfKj8iHGetgcshX7NPHj/wcajDB//k+1yaWlc4Zc/xeyU19vktAAhJoAjn3+r5gbmuceXsJvCoB6oN8I9RRYbE1/qqcnjHuqwp6DtVVT/EZaCnmWmZVnDfczEeewjJzvT7P3Sike4zCGB2dzFkfnxjLemxOO3nH38TUcbU9nimC0cNa5vEr8/jGHD3xoCPvjMVn/Kagx2bGV4159M2+103ZLR9jJ7FtFeq958eYrXx2TAISeG0CfSZPEn1OHTqj5jrfJfDsBHLf5o5f3c3UEZnve//ZmbxKfL9Wxq8StXFKQAISkIAEJCABCUjgSQhY0D/JRhqGBCQgAQlIQAISkMBrErCgf819N2oJSEACEpCABCQggSchYEH/JBtpGBKQgAQkIAEJSEACr0nAgv41992oJSABCUhAAhKQgASehIAF/ZNspGFIQAISkIAEJCABCbwmAQv619x3o5aABCQgAQlIQAISeBICFvRPspGGIQEJSEACEpCABCTwmgQs6F9z341aAhKQgAQkIAEJSOBJCFjQP8lGGoYEJCABCUhAAhKQwGsSsKB/zX03aglIQAISkIAEJCCBJyFgQf8kG2kYEpCABCQgAQlIQAKvScCC/jX33aglIAEJSEACEpCABJ6EwG8F/YcPH978kYE5YA6YA+aAOWAOmAPmgDmwzxyYv4f8VtBPAd8lIAEJSEACEpCABCQggf0SsKDf797omQQkIAEJSEACEpCABI4SsKA/ikgBCUhAAhKQgAQkIAEJ7JfAxQX9x48f3z5//ryMjH9v9fXr1+X8HIye6HuP9uXLlx//n4Bb6f7+/fsPfYf8zVwY3Lp9+vTpapWH9m1LOQzZ15UfcEEma2bLOubTr2SSMy3z7du3qcb3Cwn0Pma/usF865tuWZ8l8N4EtvLxUA6/t0/ql8CeCfQdPO/WnOt8U3uOQd+uI3Bx1blVGF6SNI9U0Ad3iszEOT+azHHhzILpum36qfdaPVv7tqV3FU90zKJ+8pjvkc86GodPM4QrRfx8Z6395QSyB9mb3j8P+8t5uvJ9CPQv9pwHnBnzbHkfD9QqgccjwH2db4QahHs0Y6f+kfXxItfjELhpQZ+Eyc+57dEK+sRHEcRHkzEunC5Sz2WxJc+HujV/6vi5BX3kZzwcEMSe+S7W4wsXcp7hwsWMr3Ndisxw7Zb3Lj57zufzCbB3HO7z/XyNrpDA+xDId5885WyZ7+9jVa0SeGwC+V7y3XBvzvfHjk7vDxE4v/r+P21Jki6+SJotY0kwfiLbLXrQtyUT+S4+Itf20Ufhix7emU/PGDKX/taa9Xw00ZvnGVvbPfR8KLZz/J2y0x84H/Ll2By+pk9L3HMvtor41o2vjIXn3Iv+xQA5++sIZK/I/eTDzOPrtLtaArchwBmS/CRP88y5cxsrapHAcxHgfp7fDX+Ae65ojaYJ3KSg57Btxf2cxOqCL89ZQ6PAOFQck6Rd8EVH650FIsVg7NOQIbm5NFovssf69glbl1w2rQebx2JDrnti67Hoaa5Tb8ue+owdGEZnxmYL90Nc+xcg9mHygw22pg3fLyOQvekf+V7G0VXvS4Czhlzt8/59LatdAo9LgJqK72Z1Pz9udHq+ReBnpbslsTFOYZiiLEnTRWMv4UDusTxnDcUeydcyFHjIRP+0MYu91oku/OM9MjO58554Lmn4Do9LdJwS2xbHtreKDf+Qu8ZPdMRO9NJWdjOXcfYPWXr2jnne03dj3IKzqVz/HO7Zn629u96CGiRwGwI5s8jV22hUiwSenwDfzKW1zfMTer4IryroSRiKzVkoB1eK1S7+QNjjmc/7bF18xhbFX8sxvlX44VvWbMlsjbedQ89wOCRzaI4YpkyPdxxTbvUenviVntZMGTunR2+vif7V3rf/LZ/nzPWeswfpuzFuQd9Urn9mH7MPHvjX81TD+xDg+0+eHjpP3se6WiXwmAT6Dzb5bua9+phR6fUxAj8rvWOSYz5FQBKFQou/BM/EQY4DuXsKumMFPX+t77X9nGKSgx9/cLcL4ZnkrSPP03d0HOsTB7Eck53zp8SWNR3H1ME7MomFIo19QSbjGbukUQROxtEZ27PFj61fwvCPNXCYe7C1r6yzP5/A6jtY7d/5ml0hgdsSyDkxz+nbWlCbBJ6PwPxm5n37fBEbUQhcVdDPwpDDt9FmbMr1fJ4zvyqIszaFBsXeqjhEF4XfLAgpciNHITMLUnRc2t+ioD8UW/zqOFZ+bjEK23zctFP2A9nu2dsVu8Q/9xh/ej8Yi65VW/0CwJ6t5B27jACHffaMvMrYam8vs+AqCVxPYOZm5+312tUggeckwJ3Pmc53k+/J9twEflZ6Z8a5Kgwp2Lo4T3KtCrheTwK2C+iiIGx55JChGE7izqSNLxlPm/LooWjM/CXtmoI+9k6JDR+3/Nv6habj37K1pZPx+AdDxroP88h0m/7CvnOj5fOcueRCt7wfWtOyPh8nwLfW+8n+yvk4PyXuQ4Dzos90zpSMcS/cxxutSOAxCFAH5BvJ95I2fzF+jEj08hICNy3o4wCHLoU1B3MXaiQYBTRFRsukyOgCA70kaWxlvgvJqZc1XbxgC9vRk/m2fS7I+NG+nrsePw/Fhswh3TMOeHT84XVOrCte0wf2eO4575GP3d6rqSPvxMhlPd9Xaxw7ncDqsM/qrfHTNSspgdsSyHmac2ueGVvjt7WuNgk8JoF8L/luZj2yNf6YUer1FoGbF/QxxKHbhWOSrH/aochlDcXjKiEj34XHlkwXsUli3tseY/jThSf+zw+i18/nyG7J43P6Qw05fFrpY276i96VDsb4ZSFM2BcKcebQQ888dmff66Zs+0hhPtfznrW0KXuMG+vsjxM4dKj3t3dckxISeD8CfQbM77/PmT5j3s8bNUvgMQjke1jdqfGeOiDzfW8/RmR6eSqBiwv6Uw08qtyqoH7UWPRbAhKQgAQkIAEJSOB5CVjQL/Y2v83yV+zFtEMSkIAEJCABCUhAAhLYDQEL+sVWpJjvfwayEHFIAhKQgAQkIAEJSEACuyBgQb+LbdAJCUhAAhKQgAQkIAEJXEbAgv4ybq6SgAQkIAEJSEACEpDALghY0O9iG3RCAhKQgAQkIAEJSEAClxGwoL+Mm6skIAEJSEACEpCABCSwCwIW9LvYBp2QgAQkIAEJSEACEpDAZQQs6C/j5ioJSEACEpCABCQgAQnsgoAF/S62QSckIAEJSEACEpCABCRwGQEL+su4uUoCEpCABCQgAQlIQAK7IGBBv4tt0AkJSEACEpCABCQgAQlcRuC3gv7Dhw9v/sjAHDAHzAFzwBwwB8wBc8Ac2GcOzLL/t4J+CvguAQlIQAISkIAEJCABCeyXgAX9fvdGzyQgAQlIQAISkIAEJHCUgAX9UUQKSEACEpCABCQgAQlIYL8EblLQ8++rvn37drNIoyt6b6nzZs7dUNGXL1+ujvHz589vHz9+PMur79+///b/lcjYbJ8+ffqf3MrG169f/zef/VrJJEZyJH102u5HgG8p7LNf3djf1b61nM8SuAeB5OHqjOhz5tnvhHtw1sZzE+g7d97r3MWpG2zPReDqgp6DNoXBLROEIuSZD+9bxXhuQU8xn4+exgHQH//UO9/Z+96j5EEXhyu9mbeoh/x9+uwdBzkW2b+M9x4yby+BexPgTExOJj9p5G7y2CYBCRwnsPrleHUPHNekxKMQuLqgp5CncLtV4Bzsz1xo3CrGWWgf24PsVRfdyGcsc2kU/ZN/X7TsPetX61oncsTdvzwwZ/9+BGZRNN/fz7KaJXA6gVl0zPfTNSkpgdclwD3LnT3fX5fM80Z+VUFP0Ze/pPRz4+KvgJ1MSbC8d5vz/ILQclMmB323FJisiw2K04xTvPR4r+35WexGT8aIBdlTCtKsQz497VgsyKWfstHTts8t6Ft3P8dXmBJrz+d5VcS3zFYetAzxpLfdjwB7mvzpvLyfB1qSwGkEODM7T5O/NglI4HQC/csw31LucNtzEvhZYV4QH8UzS5MoM1koIpJMNJKM91ngURTmUKfoQ6YP9eikAI2u2O41Gct820YPerHVeqZ/xNmx5bn1Ekv3me816EFm+sJ49yuZ6d+Msdef+gyH+JiWfhVfbHVMUz/7Dd85j+7sU2za7ksge0exlL6/p/t6ojUJbBPgHCFXD50521qckYAE+IbovXefNyeuKuhT8KXAo3EId8Iw1gUexSNjOaxbT/RR/LbMPNQzlyTFXuZnEbrSHf2s2SqGo7eL27aT9dM2DOiJGzuMxz/0ooMYkek+/s+40c26rRhaz7Hn6EiMtC2dGZ/+sCZ94js0H5nYiR7b/Qnw7WUPju3T/b3TogR+Ekh+Jk/zM8/Rn1I+SUAChwhQL+Q7ovY4JO/c4xL4WcGdGcNWMTqThmTqA5migoI0ayLXbepfyUS+x3MBzCKFXwwit2rzlxJkunBFB3Pp8a/j6vlevzWODji03OoZPxJLflgXW/MXmdX6rTH2qPdgS+dWXNGdufi1xSQyXNJbvjj+vgRmDh3aq/f1RO0S2CbAHcFZl7y1SUAC5xPgzs23dE2dcL5lV9ybwLrKPcELijcO3O47aSgWu3DgsKaAzFqeMd3FLvJto5857FcFffShizXtX54Ty2xduFIEtQw6Kap7Ls/9EWGXHvvHdEQPMqwNC5hiO76ic/px7B1dMEQ+7yudzQXZ9BmPj/jUczzDpHOBOfv3J7D6jrInNgnsjQBnBedees+Nve2S/uydAPd7f0fzrt97DPp3OoGLC/okyCoxSCAKO977MKawyFzaSheFbPopvxVeLoFjBQp6kdsq6FtX4oyP3dCTftV6/Wo+Y8d0RGblH0yxfWlBT1yH9nH6nrhir1vGwgd/eo7nxBGZzgPm7O9DgH3KXpB72RO+w/t4oRUJHCbA+caZwtmR/LVJQAKnE8g3lJ/c2dz3efcePp3hI0n+WqWe6DkH7lZSkEBRt5KdBXoO6nlYk3wUiavC9hQ9q5C6AO7nlk0MFLr40vMURPjXc3lercl4x4r/Wzoi335gA92s24oB+VWPjq1ibsu3+NNrEk/GIr/VuJC35h1/fwJ8h9mrzpu858cmgb0QICdzrqUlXxnrs2cv/uqHBPZIIN8P3w3+cRfPeot5+8cmcNFNnmRIYmw1EinzFBJd8FEscjhzYPPOfJKR4gM9yET39CPvM1Hj5xyLXi4LbPEeve1/3il+80zDZ/xjvPvYadvEwBps895rec76Zo3dZhN/W4a1Wz06EtehNm3Pd7gc8h+WidX25wgkXzrv8WRrnHl7CdyTAOdF8rLb1njL+CwBCfx/Atzx+Y66Ztoal9tzEPj11DwhJorQQ8UgSRMZitgu6NCxlWgkYfouFtGb8fx0sRzX8z7HMp5ilzXpcznM1vOzOKZw7TX40v71PM/TdnOITPxdxcL69O1bnhkjjvTt8xYHdGJz6l350bJtAx9WOjIWZuzzlkzvP77Z357AoWKI7zN7dCyXb++ZGiXwkwBnanJxdTZwjnDu/VzpkwQk0ASoO3J/z3boPpiyvj8WgbML+scKT28lIAEJSEACEpCABCTw3AQs6J97f41OAhKQgAQkIAEJSODJCVjQP/kGG54EJCABCUhAAhKQwHMTsKB/7v01OglIQAISkIAEJCCBJydgQf/kG2x4EpCABCQgAQlIQALPTcCC/rn31+gkIAEJSEACEpCABJ6cgAX9k2+w4UlAAhKQgAQkIAEJPDcBC/rn3l+jk4AEJCABCUhAAhJ4cgIW9E++wYYnAQlIQAISkIAEJPDcBCzon3t/jU4CEpCABCQgAQlI4MkJWNA/+QYbngQkIAEJSEACEpDAcxOwoH/u/TU6CUhAAhKQgAQkIIEnJ2BB/+QbbHgSkIAEJCABCUhAAs9N4LeC/sOHD2/+yMAcMAfMAXPAHDAHzAFzwBzYZw7MX09+K+ingO8SkIAEJCABCUhAAhKQwH4JWNDvd2/0TAISkIAEJCABCUhAAkcJWNAfRaSABCQgAQlIQAISkIAE9kvAgn6/e6NnEpCABCQgAQlIQAISOErAgv4oIgUkIAEJSEACEpCABCSwXwIW9PvdGz2TgAQkIAEJSEACEpDAUQL/DxV4lHFInaSjAAAAAElFTkSuQmCC)
The first theme that emerged from this review was tailor-made content, which refers to creative interventions suitable for the culture, norms and age of the community involved. The studies revealed that the program's content was tailored to each community. Songs, poems, performances, dramatic presentations, and demonstrations were used as mediums to communicate malaria prevention messages. Panter-Brick, C. et al. suggested that intervention initiatives should be designed, implemented, and evaluated from a social ecology perspective [29]. This approach considers the behavioral context such as habits and norms so that the desired change can be effortlessly integrated into the social, cultural, and ecological landscapes of the community. The same study found that using music to encourage the repair and maintenance of mosquito bed nets for malaria control in rural Gambia was successful.
The study by Anderson et al. emphasized tailor-made content to make sure that the song's content was appropriate for the intended audience [28]. Specialists in social anthropology, music, education, and malaria were involved in the song creation. The song was further tested in elementary schools in a malaria high-risk region to see how well it could teach students about malaria prevention. Similarly, in the study by [27], the intervention emphasized the importance of delivering messages that were relevant and applicable to the local context.
The second theme is community engagement and outreach. The studies showed that involving enablers to influence a target group is adequate. Children are commonly treated as a medium to impart malaria knowledge. Besides children, mothers, religious leaders, and community members hand-picked by community leaders were also involved in the intervention as influencers and to disseminate malaria messages. The objective of the message, language, what they need and what they already know about malaria must be pre-identified to avoid redundancy. Contents must be well-researched and rehearsed. These findings are corroborated by a study conducted in South Africa to increase knowledge about malaria among school children [28] and in another study by [27] on the acceptance of malaria messages by primary school children in Ethiopia.
Commonly, both studies employed school-based interventions and used songs in local languages to create awareness on malaria, its symptoms, and prevention behaviors. Both studies reported the usage of songs as an effective communication tool to increase knowledge and promote behavioral change messages. They utilized existing community networks and gatherings to effectively engage the community and promote behavior change toward malaria prevention and control. Similarly, the study by [5] utilized dramatic presentations and songs to engage the community to spread awareness on the importance of Indoor residual spraying (IRS) and minimize insecticide exposure.
The third theme is interpersonal communication. All studies in this review utilized this approach in their intervention programs. The results of the studies proved that this form of communication is more effective than mass communication media when communicating malaria messages among at-risk communities. This approach includes home visits, social support and program monitoring.
For example, a study involving pre and post intervention interviews with Grade 3 learners and their teachers to assess their knowledge of malaria and the impact of the interventions [28]. The teachers were also asked about their observations during the intervention period. Additionally, some parents/caregivers/guardians of the children were interviewed to determine if the children shared their knowledge with them. This interpersonal communication allowed for the exchange of information and insights between the researchers, teachers, learners, and parents, contributing to the evaluation of the intervention's effectiveness and the understanding of knowledge transfer within the community.
This was also similar in a study that utilized facilitators, including natural science teachers and student army leaders, conducted peer-to-peer education sessions to disseminate malaria messages and promote preventive practices to effectively convey information, address concerns, and foster behavior change within the community [27]. [5]studies also utilized interpersonal communication to gather participants. For example, research staff personally invited women who had participated in the VHEMBE birth cohort study and they were encouraged to invite friends, family, and other residents of their villages [5]. This strategy promotes trust which results in better message transmission and behavior change.
A study on preventing unsafe abortion among communities in Nepal used interpersonal communication in the form of dialogue and exchange of information between individuals, seeking to clarify beliefs and understanding. It emphasizes the importance of interpersonal context, including family relationships and social support networks, as entry points for social change. Besides increased knowledge on unsafe abortion, the study reported that the intervention led to an increase in modern family planning use and participants acting as change agents in their communities, disseminating accurate information and behavior change stories [30].
Similarly, a different study demonstrated community engagement and interpersonal communication [26] and further stressed that, in order to increase net use compliance, future malaria programs should consider shifting from the typical mass communication campaign model to community-based interventions involving household visits that incorporate strategies for enhancing community outreach and social support for net use among participants.
Another common strategy was that all four studies were embedded in the SBCC approach and aimed at behavior change ultimately. The use of culturally and age-appropriate songs to disseminate malaria knowledge, implementation of dramatic presentation and song which was carefully curated to suit the culture and norms of the community, involving community members as performers to disseminate the messages, having malaria related performances and demonstrations are some of the clever ways to implement the SBCC strategies. Besides that, two of the studies used children as the change agents to reach out to their families and communities with malaria prevention messages. Children have served as an effective change agent in many other health-related studies [31] which makes it an effective SBCC strategy in the context of these studies. Furthermore, the involvement of community leaders, religious leaders, and teachers to support and promote malaria control messages is also evident in the studies.
Three out of four studies demonstrated monitoring and evaluation which is an integral part of the SBCC approach to evaluate the success of the intervention. Commonly pre-and post-intervention surveys were conducted. The other study assesses the success of the program by analyzing the association between net use and various factors and identifying the factors that influenced net use behavior.