Preceed- Procceed framework

1. Health Education program on prevention
of Malaria
Using PRECEED PROCEED Framework
598.Erina Khatri
612.Reshika Rimal

2. Objectives of the presentation
•To share planning of a health education program on prevention
and control of Malaria so as to develop presentation skills.

3. Presentation’s Map
• Introduction: Malaria
• Baseline Information
• Introduction to PRECEDE PROCEED Framework
• PRECEDE
 Social assessment
 Epidemiology Assessment
 Behavioral and Environmental Assessment
 Educational Assessment
 Administrative and Policy assessment
• PROCEED
 Program Design
 Objectives (Different levels)
 Detail Plan of action
 Monitoring and supervision planning
 Plan for Evaluation
• References

4. INTRODUCTION:MALARIA
• Malaria is an infection of liver and RBCs caused by protozoan
parasites belonging to the genus Plasmodium.
• Most commonly transmitted by an infected female Anopheles
mosquito; their bite introduces parasites from the mosquito’s
saliva into a person’s blood.
• Five species of Plasmodium can infect and be spread by
humans viz P. falciparum, P. vivax, P. ovale, P. malariae and P.
knowlesi.
• Incubation period: P. falciparum(9-14 days), P. vivax (12-18
days), P. ovale (18-40 days), P. malariae (16-59 days)

5. INTRODUCTION:MALARIA
The table below shows duration and type of fever for every plasmodium
species:
Species Duration and type of fever
P. falciparum 36-48 hours , Malignant tertian malaria
P. vivax 48 hours, Benign tertian malaria
P. Ovale 48 hours, Ovale tertian malaria
P. malariae 72 hours, Quartan malaria

6. INTRODUCTION:MALARIA
• Clinical manifestation:
Malarial paroxysm consists of three stages:
Cold stage: Feeling of cold and shivering followed by whole body shaking that lasts
15-60 mins, cold ,dry and pale skin.
Hot stage: High fever up to 40-41 C that lasts 2-6 hours, severe headache,
palpitations, tachypnea, flushed and dry skin.
Sweating stage: Profuse sweating for 2-4 hours, feeling of exhaustion.
• Diagnosis:
 Examination of blood.
 Antigen detection test.
• Complications:
 Hemolytic anemia
 Cerebral malaria
 Nephrotic syndrome
 Jaundice
 Relapse

7. BASELINE INFORMATION
From RM profile Joshipur, Kailali
• Total households: 3935
• Total population: 22560 (M=2959, F=2946)
• Literacy rate: 67.08%
• Ethnicity distribution:
Tharu 41.82%
Chhettri 22.61%
Bhramin 10.51%
Kami 7.76%
Others 17.3%

8. Conceptual Framework- PRECEDE /PROCEED Model
Quality of Life
Phase 1
Social
diagnosis
Health
Phase 2
Epidemiological
diagnosis
Health
education
Policy
regulation
organization
Health
Program
Phase 5
Administrative &
policy diagnosis
Output Longer-term
health outcome
Short-term
social impact
Short-term
impact
Process
Input Long-term
social impact
Phase 6
Implementation
Phase 7
Process evaluation
Phase 8
Impact evaluation
Phase 9
Outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 4
Educational
diagnosis
Behavior
Environment
Phase 3
Behavioral &
environmental
diagnosis

9. PRECEED-PROCEED FRAMEWORK OF
MALARIA

10. Phase 1: Social Assessment
 Decreased economic production
 Cost related to treatment (transportation, medicine)
 Reduced interpersonal communication
 School and job absenteeism
 Social insecurity
 Social stigmatization

11.  About 1.5 million people are at risk, of which about 1 million are at highest
risk of getting infected.
 At provincial level, out of 49 risk wards, high risk is at province 7 which
covers 31 risk wards.
 Malarial transmission occurs more during rainy and summer season.
 Among 1128 people infected, 148 are infected by P. falciparum and 980 are
infected by P. vivax.
 Imported cases are higher than indigenous cases due to open boarder with
endemic states of India.
 Annual Parasite Incidence(API) gradually decreased to the lowest level ever
i.e. 0.08/1000 at risk population.
 No. of deaths=3
Phase 2: Epidemiological Assessment

12. Phase 3:Behavioral and Environmental
Assessment
This phase focuses on the systematic identification of health
practices and environmental factors, which seem to be linked to
health problems focused in the epidemiological diagnosis.

13. Behavioral Assessment
Positive Behaviors Negative Behaviors
Proper use of LLINs/ITNs Ignorance in use of LLINs/ITNs
Practice of indoor residual spraying Sleeping outdoors
Prompt practice of using mustard oil Cultural beliefs in use of traditional and
ineffective method of treatment.
Burning dung and hay mixture(Guitha), and
egg covers to keep mosquitoes away.
No practice of using full sleeves clothes
while working outdoors.

14. Environmental Assessment
• Toilet coverage : 94%
• Field contaminated with feces : 17%
• Disposal system : Burning ( 85%), Pit disposal (11%)
• Raising domestic animals near the household.
• Standing water in irrigation ditches and burrow pits which
provide breeding place for mosquitoes
• Water pollution

15. Behavioral Prioritization
Prioritized behavior for health education intervention program : Practice of
using LLIN/ITNs
Score : very high 5, high 4, neither high nor low 3, low 2, very low 1
Behaviour Importance Changeability Total score
1.Practice of using
LLIN/ITNs
5 4 9
2.Practice of Indoor
residual spraying
4 3 7
3.Practice of using
Mustard oil
2 4 6
4.Filling the burrow
pits containing stagnant
water
3 3 6
5.Rearing of livestock
near household
3 2 5

16. Phase 4: Educational Diagnosis
Predisposing Factors:
• Knowledge on malaria: 66%
• Knowledge on mode of transmission of malaria: 74%
• Knowledge on preventive measures of malaria: 42%
• Knowledge on LLINs: 40%
• Availability of LLINs: Government health institution(40%),
Private hospital and clinic (35%) and No idea(25%)
• Charge for LLINs: Free of cost (52%), Need to buy (24%) and
No idea(24%)

17. Reinforcing Factors:
• Education on proper use of LLINs not integrated effectively.
• Uneven distribution of LLINs among people (especially
pregnant women).
• Using LLINs to protect domestic animals rather than family
members.
Enabling Factors:
• Unmet need for LLINs : 53%
• Availability and accessibility of LLINs: Poor due to
unawareness
• Poor stock out response regarding LLINs.
• Programs on LLINs by various NGOs/INGOs: Focused on
pregnant women and children but not followed up properly.

18. Phase 5:Administrative and Policy
Assessment
• Program Supported and Priority by :
 National malaria strategic plan, 2014-2025
- Goal: Malaria free Nepal by 2026
 National health policy and plan, 2071
 Inclusion in SDGs.
- Goal 3, Target 3.3
 Roll back malaria initiatives, 1998 (WHO)
 National malaria eradication program, 1958
 Malaria control project, 1954 (USAID)
 VBDTRC (Vector born disease Training and Research Center )
under MOHP.

19. Phase 6:Program Design and
Implementation
Overall Goal
Improve health related Quality of Life of people attributed by
Malaria in Joshipur Rural municipality of Kailali District.
General Objective
Reduce incidence of Malaria to half of the baseline after two
months of Health Education Program on proper use of
LLINs/ITNs in Joshipur Rural Municipality.

20. Behavioral objectives
• To promote the use of LLINs up to 90% among the people
of Joshipur Rural Municipality after 2 months of health
education program on proper use of LLINs/ITNs.

21. Educational objectives
• To aware local people regarding malaria and LLIN use.
• To develop knowledge and skills regarding LLIN use and
maintenance.

22. Organizational and Policy objectives
• To strengthen programmatic technical and managerial
capacities for LLIN distribution.

23. Resource assessment
Resources Source
IEC materials USAID Kathmandu, District
health office
Human resource Local health facility, local
clubs, FCHVs
Funding USAID Kathmandu, Joshipur
rural municipality office
Infrastructure Local municipality

24. Program Design

25. Title: Health Education on proper use of LLIN Nets
Duration: May 1- May 10
Location: Joshipur Rural Municipality, Kailali
Objectives Activities Indicators/
Targets
Means of
verification
Overall Goal
Improve health related
Quality of Life
attributed by Malaria in
Joshipur RM of Kailali
District
Health education
program on proper use
of LLINs/ITNs
HDI, HPI PCI, Literacy
rate, Life
expectancy
Program Objective
Reduce incidence of
malaria by half after two
months of Health
Education Program in
that Rural municipality
Health education
program on proper use
of LLINs/ITNS
Malaria
Incidence, Case
Finding Rate
HMIS, Surveys

26. Continued….
Objectives Activities Indicators/
Targets
Means of
verification
Educational Objectives
To aware local people
regarding malaria and
LLIN use
Meeting and
discussions on LLIN
use and malaria with
health workers and
FCHVs.
100% of the
participants
could mention
the links or
benefits of
LLIN use to
prevent
malaria.
Post meeting
questions
Health education
program in community
by health worker and
FCHVs.
80% of local
people could
explain
benefits of
LLIN use to
prevent
malaria.
Evaluation
forms

27. Objectives Activities Indicators/Targets Means of
Verification
To develop
knowledge and
skills regarding
use of LLIN and
its maintenance
Discussion and
training on proper
use and
maintenance of
LLINs
95% of the
participants
would be able to
recall steps of
cleaning LLINs.
Post discussion
questions

28. Detail plan of Action

29. Activities Contents Target
group
Methods
and medias
Responsible
persons
Venue Date/
Time
Meeting and
discussions
on LLIN use
and malaria
with local
people,
health
workers and
FCHVs.
Introduction to
malaria and
LLINs,
benefits of
using LLINs
FCHVs
and Health
workers
Group
discussion/
Flip chart
Electronic
medias
Program
coordinator
(BPH graduate)
Divyajy
oti
school,
Hall,Jos
hipur
RM.
2019
May
4,
10
am- 2
pm
Health
education
program in
community
by health
worker and
FCHVs.
Introduction to
LLINs and
malaria,
benefits of
using LLINs
Communit
y
people(spe
cially
targeting
pregnant
women
and family
with U5
children
Counselling
Group
discussion/
Flip chart
Poster
HP Incharge
FCHVs of
respective
wards.
Divyajy
oti
school
hall,josh
ipurr
RM
2019
May 6
– May
8,
12pm-
3pm
Discussion
and Training
Steps of
hanging,
Communit
y
Flip charts
and Posters
Program
coordinator
Divyajy
oti
2019
May

30. Activities Contents Target
group
Methods
and
medias
Responsible
persons
Venue Date/
Time
Radio
Program
and Media
outcasting
Signs and
symptoms
of malaria
and proper
use of
LLIN nets.
All the
commun
ity
people
Short
messages
Bph graduate
and AHW
Radio
Kailali
2019
May
9-
May
11,
6am
Advocate on
improving
stock-out
response
Briefing on
unmet need
of LLIN
DPHO,
HP
incharge
Discussion
s
Bph graduate
and FCHVs
Health
post
2019
May
12
Integrated
school
health
program
Introductio
n to
malaria, its
symptoms
and
School
children
of grade
6-10
Lectures
and
discussion
s, posters
HP incharge,
BPH
graduate
Divyaj
yoti
School
2019
May
14

31. Risk Management
Risks Risk Management
The willingness of the
community may decrease
during the program
Community will be involved in all stages of the
program: planning, implementation and evaluation
Time management of local
people
Program will be conducted in off time.
Health risks for pregnant
women
Prior consent from family to participate in
programs

32. Plan for Supervision and
monitoring of the program
• There will be one monitoring and evaluation sub-committee for the
program.
• The members will be one Rural Municipality Secretary, one BPH graduate,
one target group representative and one HP representative.
• The focal person for the program monitors and advise where required, and
will ensure that there is good accountability and also act as process
facilitator.
• The Monitoring committee will monitor in line with log framework of the
program. The committee will monitor the program one time a month.
• Each monitoring will produce a report and the monitoring findings will be
utilized to modify and strengthen the health education program.

33. Plan for Evaluation of the
Program

34. Phase 7: Process Evaluation
Evaluation of implementation of detail plan of action and
educational objectives and indicators
It includes
• Number of students and mothers trained and educated
• Number of materials and resources used
• Number of radio programs
• Number of trainings conducted
• Number of discussions sessions conducted

35. Phase 8: Impact Evaluation
Evaluation of behavioral objectives and indicators
It includes:
• Percentage of households who uses LLINs.
• Percentage of Mother’s and Children with knowledge of
signs ,symptoms and preventive measures of malaria.
• Percentage of women who received LLINs during
pregnancy from health facility.

36. Phase 9: Outcome Evaluation
Evaluation of epidemiological and social indicators and
objectives.
It includes
Prevalence of Malaria in young aged children and pregnant
women
Educational level of mothers
Improved learning abilities of children and less school
absenteesim.

37. References
Annual report 2072/2073
MOHP/NHEICC. Formative Research on BCC/IEC
Program on Health, National Health Education
Information and Communication Center, Kathmandu,
Nepal 2067/68
NPC/CBS, Nepal Living Standard Survey 2003/04,
Center Bureau of Statistics 2068(2011)
MOEP, Nepal Population Report 2011
A TEXT BOOK OF HEALTH PROMOTION AND
EDUCATION (Shiv prasad Sapkota and Durga Prasad
Pahari)
WWW.GOOGLE.COM

39. THANK YOU
Buying LLIN is
cheaper than
treating Malaria!!