Microfinance against malaria: impact of Freedom from Hunger's malaria education when delivered by rural banks in Ghana

A community randomized pre-test/post-test design was used to compare the knowledge and behaviors of microfinance clients receiving malaria education (n = 213) to those receiving diarrhea education (n = 223) and to non-client controls (n = 268). Comparisons assessed differences at follow-up as well as within-group changes over time. At follow-up, malaria clients had significantly better malaria knowledge than comparison groups: 48.4% of malaria clients were able to identify groups most vulnerable to malaria compared with 39.2% of diarrhea clients (P = 0.044) and 37.7% of non-clients (P = 0.024). Malaria clients were more likely than diarrhea clients (P = 0.024) (P < 0.001) and non-clients (P = 0.028) (P = 0.004) to report that insecticide-treated nets (ITNs) provide the best protection against malaria, and to agree that pregnant women should use ITNs, respectively. Between baseline and follow-up, malaria clients were most likely to: improve in knowledge of malaria complications during pregnancy; to own at least one bed net; and to report at least one child or woman of reproductive age sleeping under a bed net. Malaria clients also experienced the greatest increases in ITN ownership/use (9% vs. 2.9% and 6.7% among diarrhea clients and non-clients). Results indicate that, although significant barriers to malaria control remain, a malaria education program provided by microfinance institutions can effectively contribute to community and national malaria initiatives.