Marcy Erskine, International Federation of Red Cross and Red Crescent Societies; Toju Maleghemi, WHO Cross River State; Iyam Ugot, Special Advisor to the Governor of Cross River State, Community Health
Nigeria’s Cross River State Roll Back Malaria team is tasked with “finding” 500,000 previously distributed bednets to determine how many are still being used and why.
In Nigeria, the Cross River State Government has been a leader in public health, providing free primary health care to pregnant women and children under five* and working to improve health indicators and protect its residents from malaria-related illness and death. In 2008, the State Government, with support from the Canadian Red Cross and USAID, distributed over half a million nets—enough for each child under five attending a vaccination site during an integrated measles campaign.
In 2010, Nigeria’s Cross River State Roll Back Malaria (RBM) team was tasked with “finding” these previously distributed long-lasting insecticide-treated nets (LLINs) to determine how many were still “good” and how many new nets were needed in the next distribution cycle. A “good” net was defined by age: a net distributed in 2008 or later was considered good, while older nets were considered non-viable. The physical condition of the LLIN was not taken into account given the subjective nature of assessing hole size and viability of the net. Given that the estimated lifespan of the distributed nets is three years, it was expected that the majority of the nets distributed in 2008 would still be in use. However, the results of the household census undertaken by Nigeria Red Cross volunteers throughout the State to assess household LLIN needs “found” only 52 percent of the LLINs distributed during the campaign. Similar results have been seen in Senegal, where the National Malaria Control Program (NMCP) is leading a rolling distribution of a similar nature with support from NetWorks.
In Cross River State, the results of the household registration led the State project team to question why such a low number of nets was found and, subsequently, the Nigeria evidence-based health information system (NEHSI) staff were contacted. NEHSI, supported by the International Federation of Red Cross and Red Crescent Societies (IFRC) and the World Health Organization (WHO), conducted a qualitative study to find out what had happened to the previously distributed nets.
The results of the study were of immediate relevance to the net distribution and hanging program currently being rolled out. It was assumed that some people would not be honest about receiving or owning nets from the previous distribution, including ones not yet hung and used, and the survey found that this was actually the case in a number of surveyed households. Another interesting discovery was that more than two-thirds of people surveyed would only sleep under the bednets for about 6–12 months, at which point the nets were considered to be expired or no longer “good” and were either burned or used for another purpose, such as covering a kiosk or screening a window. About half of the survey respondents also believed that once a net had been washed more than twice, it was no longer effective, and nearly one-third of respondents believed that washing the net in cold water would destroy the insecticide and reduce its effectiveness.
This study was relatively inexpensive and easy to implement, and it provided new critical information that is already being used to inform Cross River State’s next phase of mosquito net distributions. It will also be useful to other countries trying to account for nets that are still “good” in households. The study raised concerns about not only the validity of planning net replenishment campaigns based on the age of the net alone, but also the potential difficulties with quantifying net needs when moving from low or moderate to high LLIN coverage based on assumptions of “existing” nets.
In Cross River State, targeted messaging is being developed to encourage residents to use their mosquito nets for the full three years (or longer) and to repair them when they are torn or damaged. A net awareness campaign is being considered to improve knowledge and practice regarding LLIN use, maintenance, and repair. An end process monitoring exercise is currently taking place to ensure that universal coverage has actually been achieved where distribution has taken place. The campaign used a house-to-house distribution and hanging method, with volunteers equipped with hammers, nails, and string in addition to LLINs. The effectiveness of this approach for ensuring LLIN utilization will be assessed later in the year.
In Nigeria as a whole, the progress to date is staggering. The country bears approximately 25 percent of the malaria burden in Africa among its population of 153 million. Under the leadership of the Government and the Federal Ministry of Health, and with support from partners, the country has distributed close to 30 million LLINs and plans to distribute another 28 million this year. Nigeria’s success is reflective of strong leadership, effective partnership, and an excellent coordinating mechanism. In addition to the strong role of the NMCP, State ownership is crucial. Cross River State’s Government has played a key role in the coordination of the current campaign to move from targeted to universal coverage. This qualitative study to “find” previously distributed nets was one of the first of its kind, and provides critical information for Nigeria and other countries seeking to undertake similar activities. The study also demonstrates the importance of regular quantitative and qualitative data collection and analysis to modify project planning.
* This is the overall health policy in Nigeria, but is not yet implemented by all states.
http://www.macepalearningcommunity.org/newsletter_nigeriabednet.htm
Nigeria’s Cross River State Roll Back Malaria team is tasked with “finding” 500,000 previously distributed bednets to determine how many are still being used and why.
In Nigeria, the Cross River State Government has been a leader in public health, providing free primary health care to pregnant women and children under five* and working to improve health indicators and protect its residents from malaria-related illness and death. In 2008, the State Government, with support from the Canadian Red Cross and USAID, distributed over half a million nets—enough for each child under five attending a vaccination site during an integrated measles campaign.
In 2010, Nigeria’s Cross River State Roll Back Malaria (RBM) team was tasked with “finding” these previously distributed long-lasting insecticide-treated nets (LLINs) to determine how many were still “good” and how many new nets were needed in the next distribution cycle. A “good” net was defined by age: a net distributed in 2008 or later was considered good, while older nets were considered non-viable. The physical condition of the LLIN was not taken into account given the subjective nature of assessing hole size and viability of the net. Given that the estimated lifespan of the distributed nets is three years, it was expected that the majority of the nets distributed in 2008 would still be in use. However, the results of the household census undertaken by Nigeria Red Cross volunteers throughout the State to assess household LLIN needs “found” only 52 percent of the LLINs distributed during the campaign. Similar results have been seen in Senegal, where the National Malaria Control Program (NMCP) is leading a rolling distribution of a similar nature with support from NetWorks.
In Cross River State, the results of the household registration led the State project team to question why such a low number of nets was found and, subsequently, the Nigeria evidence-based health information system (NEHSI) staff were contacted. NEHSI, supported by the International Federation of Red Cross and Red Crescent Societies (IFRC) and the World Health Organization (WHO), conducted a qualitative study to find out what had happened to the previously distributed nets.
The results of the study were of immediate relevance to the net distribution and hanging program currently being rolled out. It was assumed that some people would not be honest about receiving or owning nets from the previous distribution, including ones not yet hung and used, and the survey found that this was actually the case in a number of surveyed households. Another interesting discovery was that more than two-thirds of people surveyed would only sleep under the bednets for about 6–12 months, at which point the nets were considered to be expired or no longer “good” and were either burned or used for another purpose, such as covering a kiosk or screening a window. About half of the survey respondents also believed that once a net had been washed more than twice, it was no longer effective, and nearly one-third of respondents believed that washing the net in cold water would destroy the insecticide and reduce its effectiveness.
This study was relatively inexpensive and easy to implement, and it provided new critical information that is already being used to inform Cross River State’s next phase of mosquito net distributions. It will also be useful to other countries trying to account for nets that are still “good” in households. The study raised concerns about not only the validity of planning net replenishment campaigns based on the age of the net alone, but also the potential difficulties with quantifying net needs when moving from low or moderate to high LLIN coverage based on assumptions of “existing” nets.
In Cross River State, targeted messaging is being developed to encourage residents to use their mosquito nets for the full three years (or longer) and to repair them when they are torn or damaged. A net awareness campaign is being considered to improve knowledge and practice regarding LLIN use, maintenance, and repair. An end process monitoring exercise is currently taking place to ensure that universal coverage has actually been achieved where distribution has taken place. The campaign used a house-to-house distribution and hanging method, with volunteers equipped with hammers, nails, and string in addition to LLINs. The effectiveness of this approach for ensuring LLIN utilization will be assessed later in the year.
In Nigeria as a whole, the progress to date is staggering. The country bears approximately 25 percent of the malaria burden in Africa among its population of 153 million. Under the leadership of the Government and the Federal Ministry of Health, and with support from partners, the country has distributed close to 30 million LLINs and plans to distribute another 28 million this year. Nigeria’s success is reflective of strong leadership, effective partnership, and an excellent coordinating mechanism. In addition to the strong role of the NMCP, State ownership is crucial. Cross River State’s Government has played a key role in the coordination of the current campaign to move from targeted to universal coverage. This qualitative study to “find” previously distributed nets was one of the first of its kind, and provides critical information for Nigeria and other countries seeking to undertake similar activities. The study also demonstrates the importance of regular quantitative and qualitative data collection and analysis to modify project planning.
* This is the overall health policy in Nigeria, but is not yet implemented by all states.
http://www.macepalearningcommunity.org/newsletter_nigeriabednet.htm
No comments:
Post a Comment