Edson Mwebesa, Delight Mawufemor Agbi, Daniel Thoya Iha, Lameck Ondieki Agasa and Ann Mwangi

Malaria Journal

Background: Malaria remains a global public health issue, with almost 2.5 million cases and more than 0.6 million deaths each year, of which women and children remain disproportionately affected. Insecticide-treated nets (ITNs) are a cornerstone of malaria prevention in endemic malaria regions. Malaria messages (MM) are intended for positive and measurable social, attitude, and behavioural change towards malaria prevention uptake. However, their impact on insecticide-treated nets (ITNs) use has not been sufficiently investigated through rigorous statistical approaches. This study investigated the effect of MM on ITN use among women and children under five years in Uganda using Propensity Score Matched Analysis (PSMA).Methods The study utilized the Uganda Malaria Indicator Survey (UMIS) 2018 -19 data. Women (n = 8868) and children (n = 6915) datasets were extracted from Individual Women’s and Children’s Data, respectively. The children’s dataset included data on interviewed women (caregivers), household indicators and under-five children’s data, while the women’s dataset contains records of every eligible woman in selected households. Propensity score-matched analysis (PSMA) was utilized to identify the effect of the MM (intervention) on ITN use (outcome) among women of reproductive age and children under five in Uganda.

Results: The results revealed that 69.3 [95% CI: 67.2, 71.2] of the women and 71.8 [95% CI: 69.1, 74.4] of the children

under five years slept under a mosquito bed net the night preceding the survey. The results further revealed a significant and positive effect of exposure to malaria messages on ITN use among exposed women [Average Treatment

Effect of the Treated (ATT) = 5.1%, 95% CI: 1.5–8.9%] and under-five children of exposed women [ATT = 4.3%, 95% CI:

1.0–7.6%].

Conclusion: Effective and relevant behavioural change communications, such as malaria messages, are an effective way of influencing the use of ITN. Such an intervention may reduce malaria endemicity, morbidity, and mortality

in Uganda.

2025-11-10

Edson Mwebesa, Delight Agbi, Daniel Iha, Dan Kogei, Lameck Agasa, Gregory Kerich & Ann Mwangi

Malaria Journal

Abstract

Introduction: Malaria 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 ofmmosquito 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.

Methods: We conducted a secondary analysis of nationally representative data from the 2018 – 2019 Uganda Malaria Indicator Survey (UMIS), restricted to 3,488 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.

Results: Of the 3,488 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.

Conclusion: Among 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.

2026-01-25

Delight Mawufemor Agbi, Edson Mwebesa, Abraham Isiaka Jimmy, Salako Kolawolé Valère, Gregory Kibet Kerich

BMC Pregnancy Childbirth

2026-02-24

Delight Mawufemor Agbi, Gideon Ikemdinachi Nwankwo, Courage Venunye Mawuko, Daniel Thoya Iha, Josias Ounsinli Djossou & Edson Mwebesa

BMC Women's Health

Women's decision-making autonomy is widely recognized as an important determinant of maternal health behaviors such as the timing of antenatal care (ANC) initiation in low- and middle-income countries. However, empirical evidence from Ghana on this relationship, particularly using causal inference approaches, remains limited. This study investigates the effect of women's decision-making autonomy on the early initiation of ANC visits in Ghana. Data were sourced from the 2022 Ghana Demographic and Health Survey (GDHS), including 4,314 women aged 15-49 years with a birth in the preceding three years

before the survey. Autonomy was measured as a composite index from household decision-making participation. Propensity Score Matching (PSM) was used to match women with High and None/Low autonomy, based on covariates like age, education, wealth, and residence. The average treatment effect on the treated (ATT) was estimated to assess the impact of high autonomy on early ANC initiation (within the first trimester), compared to the counterfactual

scenario in which the same women lacked such autonomy. Among the women included in the study, 25.3% reported high decision-making autonomy, and 66.4% initiated ANC early. Women with high autonomy were more likely to

be older (30-49 years), educated (secondary or higher), married, employed, Christian, insured, urban residents, and from wealthier households. After matching on socio-demographic covariates, no statistically significant effect of high autonomy on early ANC initiation was observed [-0.029; 95% CI: -0.081 to 0.022]. Women’s decision-making autonomy, when measured through household

decision-making participation and within the Ghanaian context, does not independently drive early ANC initiation, suggesting that broader structural and contextual barriers may constrain the translation of autonomy into early care-seeking.

2026-03-03