assessing the feasibility of continuous net distribution in kenya using community based approach
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Assessing the Feasibility of Continuous Net Distribution in Kenya using Community Based Approach. Background. Malaria control strategies are based on four principles Early diagnosis and treatment Use of effective medicines

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Presentation Transcript
background
Background
  • Malaria control strategies are based on four principles
    • Early diagnosis and treatment
    • Use of effective medicines
    • Sustainable preventive measures such as vector control- use of long-lasting insecticidal nets (LLINs)/IRS
    • Detection, containment and prevention of epidemics
approaches to increasing net coverage
Approaches to increasing net coverage
  • Use of LLINs have potential of saving half a million child deaths each year
  • Sustained coverage and use of LLINs remains low
  • Efforts to increase coverage include:
    • Social marketing
    • Catch-up -provision of free nets through clinics/ vaccination campaigns
    • Keep-up-combined strategy through provision of nets routinely to pregnant-women and children through public health clinics or commercial outlets/vouchers
why a community approach
Why a community approach?
  • Shift from vulnerable populations to universal coverage
  • Universal coverage- ratio of at least one LLIN for every two household members
  • Sustaining universal coverage require innovative ways
  • Continuous distribution systems are crucial to maintaining universal coverage
  • Operational studies indicate the potential of using a community based model of sustaining universal coverage
null hypothesis
Null Hypothesis
  • Community based distribution of nets have no effect in sustaining universal coverage
general objective
General Objective
  • To test the feasibility of sustaining universal coverage achieved during the mass net distribution through community based distribution
specific objectives
Specific Objectives
  • To estimate the current number of nets per household in settings where mass distribution was implemented in 2011
  • To identify the number of nets in the household that need replacement
  • To pilot and document the feasibility of using community based LLIN distribution schemes in maintaining universal coverage
  • To assess whether community based redistribution schemes achieve higher utilization rates
proposed intervention components
Proposed intervention components

Component 1: Establishment of HH registers

  • CHWs under the supervision of CHEWS will develop a baseline village register containing HH details

Component 2: Training of CHW/CHEW

  • Identification of CHWs & CHEWS
  • Training and sensitization on continuous LLINs distribution, their expected roles and responsibilities
proposed intervention components1
Proposed intervention components

Component three: Need determination

  • LLIN need determination at Household level
  • HHH approaches CHW for verification
  • CHW gives a coupon to HHH to redeem a net from facility

Component four: Advocacy and IEC strategies

  • PHTs to conduct community awareness programs and integrate messages into health talks
  • Use of active district ITN advocacy/ information, education and communication (IEC) groups
evaluation approach
Evaluation approach

What do you want to measure?

How sure do you want to be?

study design
Study design
  • Quasi experimental utilizing a plausibility assessment of a before and after study with a control.
  • Mixed methods-
    • Quantitative- to assess the number of nets within the HH/ replacement, utilization of nets
    • Qualitative -to assess the feasibility of using community based approaches to distribute the nets
project sites
Project sites
  • Project site : selected community units in Samia District of Busia County
  • Selection criteria :
    • Communities with a functional community health unit
    • similar malaria epidemiological profile,
    • Geographical buffer of about 20 km apart;
    • Has had mass net distribution taking place,
    • Malaria endemic with a prevalence of above 38%.
  • The district will be divided into intervention and control sites.
sample size determination
Sample size determination
  • Expected effect: 10-20%,
  • Cluster design approach-using a design effect of 2
  • 95% confidence interval and 80% power,
  • Estimated universal coverage 59.6% in western Kenya (Post Mass Net Evaluation report)
  • Estimated sample size will be 876 per arm giving an estimated sample size of 1752 HHs in the two study sites
data analysis
Data analysis
  • Quantitative data from the HHs survey will be collected using android enabled phones/PDAs and submitted to a central server each day.
  • Data verification, cleaning and analysis will be conducted using STATA version 11
  • Using USAID- Tool kit to track community –NetCalc version 2 to estimate coverage
  • Qualitative data will be stored and managed using Nvivo10
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