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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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

Assessing the Feasibility of Continuous Net Distribution in Kenya using Community Based Approach


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


Schematic structure of net replacement process

Schematic structure of net replacement process


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


Summary of study activities

Summary of study activities


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


Time line

Time line


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