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LONG LASTING INSECTICIDES TREATED NETS UNIVERSAL COVERAGE : THE SENEGALESE EXPERIENCE

LONG LASTING INSECTICIDES TREATED NETS UNIVERSAL COVERAGE : THE SENEGALESE EXPERIENCE.

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LONG LASTING INSECTICIDES TREATED NETS UNIVERSAL COVERAGE : THE SENEGALESE EXPERIENCE

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  1. LONG LASTING INSECTICIDES TREATED NETS UNIVERSAL COVERAGE : THE SENEGALESE EXPERIENCE Mamadou Lamine Diouf1, Mike Toso2, Celine Ziegers de Beyl3, Hannah Koenker3, Joan Schubert3, Debbie Gueye4, Mame Birame Diouf4, Youssoufa Lo3, Mady Ba1 , Pape Moussa Thior1, Ousmane Faye5, Julie Thwing4, Medoune Ndiop1, OulèyeBèye1, 1 Senegal Ministry of Health and Social Action: National Malaria Control Program 2 American Peace Corps /Senegal 3NetWorks project for John Hopkins University, Baltimore 4 PMI/USAID/Senegal 5 Entomolgy Service, Univdersity Cheikh Anta Diop Dakar ASTMH 62nd annual meeting, Washington November 15, 2013

  2. OUTLINE • CONTEXT • EVOLUTION OF ITN DISTRIBUTION STRATEGIES • UC DISTRIBUTION ROLL OUT • EVALUATION METHODOLGY • RESULTS • DISCUSSIONS • MAINTAIN UC • NEXT STEPS

  3. CONTEXT • Great progress from 2005 to 2010 in malaria control • scale up of malaria prevention and treatment interventions • decrease in all cause child mortality of 40% 2005 to 2010 • National Strategic Plan 2011-2015: Ambitious objectives for pre elimination • Sustain gains/Improve performances • Short timeframe to achieve MDGs • Intensify activities and innovative strategies

  4. EVOLUTION OF ITN DISTRIBUTION STRATEGIES • 2002-2007: combination of Untargeted/targeted subsidized distribution in health facilities and community based organizations • 2008: subnational free distribution targeting under 5 years old through integrated campaigns • 2009: nationwide free distribution targeting under 5 years old through integrated campaign • 2009-2010: pilot universal coverage development in 2 districts based on sleeping spaces (by Peace Corps) • 2010-2013: staged nationwide rolling LLINs UC distribution (completed in march 2013)

  5. UC DISTRIBUTION ROLL OUT • Universal coverage defined by the NMCP as one LLIN per sleeping space(1/1.8) • Senegal strategy includes a household census of people, sleeping spaces and existing nets ingood conditions • Door to door census conducted by community volunteers • Coupon given to household/redemption with net • Coordinating committee at each level (national, regional, district, village, etc.) • Strong partnership on funding and on field implementation • Training, monitoring, supply and communication activities • Procurement and supply system dedicated to UC • Evaluation after each phase to improve next phase

  6. UC DISTRIBUTION ROLL OUT (2)

  7. Evaluation - survey methodology • Cross sectional cluster sample household survey • Conducted in the six phase 1 and phase 2 regions during early rainy season 2011 • Survey conducted one year after phase 1 and 6 months after phase 2 • 60 clusters x 26 households per cluster = 1560 households • Questionnaire included questions on household demographics, census, distribution, sleeping space, and net use

  8. RESULTS: Household characteristics Large HH size with many sleeping spaces Improvements were seen from phase 1 to phase 2 in terms of households visited and LLINs received 42% of households had ≥ 1 ITN / SS Campaign net retention 95%, but pre-existing retention 49%

  9. RESULTS: Net use >80% of campaign ITNs hanging In all HH, 71% of sleeping spaces and 69% of people were protected by an ITN In HH achieving UC (1 ITN/SS), 90% were protected 72% of children under 5 years and 74% of pregnant women slept under an ITN

  10. Supporting data from DHS surveys Data from the classic DHS in 2010 and the first year of the continuous DHS in 2012 South and most of center covered by 2010 DHS High ownership in south and center (use higher in south) Remainder of center and north done by the time of the 2012 DHS High ownership and use in north and center, falling in south

  11. DISCUSSIONS • Universal coverage mass distributions greatly improved coverage and use compared to non-UC regions • Sleeping spaces census • Definition of SS • Household acces by volunteers • Low retention rate of prexisting nets • Nets hidden by people • Nets supply • Accuracy of LLINs quantification • Effective supply chain (transportation and storage) • Intensive effort requiring significant involvement at all levels

  12. HOW TO MAINTAIN UC? • Universal coverage mass distributions greatly improved coverage and use compared to non-UC regions • UC mass campaign is labor intensive, costly and cannot be rolled annually in the same regions • Multi-channel Routine distribution to maintain high coverage (piloted in 2 regions) • Distribution through health facilities • Distribution of LLINs through antenatal consultations (free) • Distribution of LLINs through general health consultations (subsidized) • Distribution through community-based organizations (subsidized) • Distribution through primary schools (free) • Distribution through the private sector (subsidized)

  13. NEXT STEPS • Restart universal coverage with the same chronology to replace the nets distributed 3 years ago • Scale up Routine Multi-channel countrywide • Reinforce communication and sensitization to encourage use year-round and by all household members (Three T)

  14. Ministère de la Santé et de l’Action Sociale THANKS FOR YOUR ATTENTION

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