Morning folks – I’ve been writing a couple more introspective blogs lately so I thought I’d get back to the meat and bone of volunteer work – projects! I’m narrowing in on today’s project because of it’s importance and because I’m celebrating completing the first of six bi-annual observation visits & the enrolment of 28 households & nets randomly selected. It was nice to break out my old research methods training and put on my walking boots and be an information hound.
So here’re the details. The study is about the durability and Insecticide Persistence in Long-Lasting Insecticide-treated Nets (LLINs) in Zambia. That’s looking after holes and counting burns and rips as well as randomly takin’ a net and sending it to America so they can be cuttin’ it up – for us small folks. Where do I come in? I always wanted to be an RA in college but this is much more exciting! I’m officially a Village Research Assistant working under PMI in collaboration with CDC and Peace Corps.
As part of the process we had a fantastic two day training – you’ll remember my tweets from March @davidnberger – My counterpart and I were trained in random selection (of households), good clinical practices, ethical issues around research, and how to administer questionnaires.
Pretty exciting. Now here are some tough facts about malaria to think about: According to USAID’s Global Health’s official twitter, ” A resistant #malaria strain has emerged along the Thai-Myanmar border, and it may reach #India and #Africa unless contained.”
Meaning that the fears of a resistant hard to treat malaria might be realized sooner than we had hoped, and moving away from curative and putting a greater focus on prevention of infection is essential. “In 2010, #malaria killed ~1794 people per day in #Africa, mostly children #endmalaria #5thBDay.” That 5th birthday tag is USAID’s tagline for this years work. That every child deserves to have a 5th birthday – in deference to high child mortality.
Although the register has some holes and there are recording quality/accuracy issues, in 2010 my clinic reported 4398 cases of malaria treated with anti malarial medication – 2103 were clinical, 2342 were confirmed – 4470 slides/RDT were used. 1124 were cases in children under 1 year. 1422 were cases between 1-5 years, 1852 were 5 years and older. Of those only 1 death at the center during screening/care was recorded from malaria for the entire year.
That last is not an accurate count for the community -instead it is specifically the deaths that occurred at the clinic during screening and or provision of treatment in the clinic ward. Keep in mind that anti – malarial treatment is practiced assembly line style. 30-150 clients come for various maladies – some are tested for malaria, Coartem is dispensed in the proper dosages and the client is sent on their way. There’s usually only one staff member & a casual daily employee – that means unless seizing or unconscious in the screening room, they’re sent home.
I’m still collecting the scraps of 2011’s data. But it will be interesting to graph it and see the net distributions effect on case load, etc through service provision. That brings me to the next point!
Last year in June (’11) my province – Luapula – received a bulk net distribution. My community alone received nearly 5,000 nets.
In 2011 there were 1756 households registered, with an average household consisting of 5.1 people. Two parents and 3 children remaining in the home with a significant number of variation and outliers. Most of my communities homes average 2 sleeping spaces, adults and under 5 years in 1 and children over 5 sharing the others.
That accounts for nearly 3500 of the nets, add in those that had three or even four sleeping spaces and we’ve got a better idea.
I’m not sure on adherence and use rates, but I know that every household inhabited in June of ’11 received a Permanet.
From this study (36 HH visited 28 eligible for enrollment) 1 of 4 houses only used one of the nets they received, 1 in 12 never put it up (still wrapped in its plastic) and 1 in 18 used an older net and had the new net packed away. Only two in the thirty six total households visited for enrollment didn’t use a net at all -one had cut it up and made curtains for their doors and windows, the other used it outside as a chicken coup for new chicks – by getting a sample from communities like mine across distribution areas, we can learn about use, durability, and net longevity better allowing aid organizations to provide efficient distribution schemes. It is serious business – a mosquito net provides a different aspect of protection. Unlike IRS (indoor residual spraying) a net provides the physical barrier as well as the chemical. If preserved and maintained a mosquito net can serve as good protection even after it’s pesticide has been depleted.
On a side note – in a society where households build a gazebo type structure to host visitors, gaining entry to residences and sleeping quarters was – interesting… to say the least. Talk about super awkward.
I’m excited to say that my community, the RHC (rural health clinic) and I have been busy preparing for World Malaria Day on the 25th – we’re planning a football match with a halftime show of role plays and dramas & a pre-game health talk on malaria and prevention.
Check out my BLOG & Twitter page:
www.davidberger.net & DavidNBerger
David N. Berger – Community Health and Improvement Program Volunteer, 2011-2013