Malaria Think Tank Springs Into Action

Last week the newly formed Peace Corps Uganda Malaria Think Tank held its first meeting! Comprising the Think Tank are Malaria Team members Matt Boddie and Ashley Givan, as well as Community Health Volunteers Sarah Cornett, Kristina Sandfoss, and Chris Peterson.  The Think Tank had the opportunity to sit down with Country Director, Loucine Hayes;  Director of Programming and Training, Paul Sully; and Health Program Specialist, Cotious Tukashaba, to form a strategy that will engage Peace Corps Volunteers in all sectors to fight against malaria.

Capitalizing on the strength and innovation of other Volunteer groups within Peace Corps  Uganda, the Malaria Think Tank will collaborate with the Water and Sanitation for Health, Micro-finance, and Agricultural Think Tanks to exchange information, resources, and plan cross-cutting projects together.  The Think Tank will also work closely with the Technology Committee to make information more readily available to all Volunteers through the Peace Corps Uganda website.

Potential projects of the Malaria Think Tank include: regional malaria trainings, conducting a survey on net use and care at the household level, using Village Savings and Loans Associations as a platform for malaria education, utilizing mobile clinics to deliver education on nets, teaching tailors how to embroider decorative patterns onto nets, carrying out a study on how subsidized nets are adopted in a community, and researching treatment and pesticide resistance at a national level.

The Malaria Think Tank will meet again in January. However, members already communicate on a daily basis. They are enthusiastic about forming partnerships with civil society organizations, local governments, and international organizations.  But most importantly, they are very dedicated to ending malaria in Uganda through its best resource: Peace Corps Volunteers.


Weekly Awesome Senegal: Bed Net Pride Project

By: PCV Sarah Kuech

My name is Sarah Kuech and I am Preventative Health Volunteer in an 800 person village in the Velingara district of Senegal. I came to Senegal in March of 2010. My primary focuses in my village have been analyzing medical records to better understand the needs of the community, and projects on malaria and family planning.

Sarah Kuech's Photo Project

Village women view their peers posing next to their bed nets in photos that posted at the local health post in the Velingara District, Senegal.

Every year, hundreds of people are treated for malaria at my village health post. In 2010, the National Malaria Control Program implemented a universal mosquito net coverage campaign that included my district. However, during the first year of my service, I observed that most people did not sleep under their nets every night. The health post staff – Chief Nurse Marie Theres Sambou, Pharmacist Tentu Sabaly, Local Health Extension Agent Djibi Mballo – and I identified consistent bed net use as a significant problem within our community. In December 2011 when peak malaria season was winding down, we began to brainstorm ideas of how to promote bed net usage through a number of informal and formal meetings. This usually consisted of someone pitching an idea to the group then everyone discussing whether or not it was feasible.

In February 2012, I attended the Stomping Out Malaria in Africa Boot Camp – a ten-day intensive international malaria training in Thies, Senegal. During boot camp, Burkina Faso PCV Bridget Roby presented a malaria photo project that encouraged community members to properly use their bed nets. The idea behind the project is to give community members an incentive to use their bed nets and motivate those without bed nets to acquire one. Community members who are properly using their nets have their photo taken next to their net and the photo is displayed at the local health center. I presented the idea to the local health team and we decided to try the project in our own community.

To begin the project, Djibi Mballo and I visited all 44 households in our community to see who had been properly using their bed nets. If the community member had their bed net hung properly, we took a picture of him/her with the net. If a household did not have a net, Djibi educated them on how they could acquire one from the health post as part of a redistribution campaign. During the campaign, every pregnant woman on her first prenatal visit is eligible for a free net, and every person who pays for a consultation (no matter what their ailment is) is eligible for a 500 CFA (roughly $1) subsidized net.

Sarah Kuech's Photo Project

192 photos of community member with their bed nets are posted at the local health post with the caption below, “We sleep under our nets to protect ourselves from malaria” in the Velingara District, Senegal.

After the pictures were printed, we posted them at the Health Post, along with a sign that reads in the local language, “We sleep under our nets to protect ourselves from malaria.” Anyone who comes to our health post now can see all 192 pictures posted. The people in the pictures are proud to point out their picture to anyone who comes to visit the health post. The project has also created an incentive for those who are not pictured to acquired a new nets for a photo.

Overall, I felt as though this project achieved its mission of promoting net usage and pride within our community. It also was a great way to reach out to everyone without nets and educate them about how to acquire a new net. The next steps in the project are to evaluate exactly how much more people are using their bed nets and how many more people purchased bed nets due because of the intervention.

Senegal NetWorks Director Joan Schubert

Boot Camp V, Day 4: Behavior Change, HIV/AIDS, and Bed Net Distributions

Burkina Faso Malaria Team

Malaria Team members Emily Engel, Meredith Baker, and Alex Kuznetzov present about malaria in Burkina Faso.

Boot camp attendees took no break on this Saturday and the fourth day of malaria boot camp V. The day was filled with country presentations, a session on behavior change, a presentation about bed nets, and an introduction to HIV/AIDS and malaria.

The morning started off with country presentations from participants from Burkina Faso and Madagascar. The presenters shared about the malaria prevalence in their respective countries, what interventions are underway, and what Peace Corps Volunteers are currently doing to stomp out malaria.

Peace Corps Senegal’s Deputy of Training and Programing (DTP) Vanessa Dickey addressed the challenges of behavior change in communities. She explained how various determinants can influence an individual’s behavior and pointed out that often times, information alone is not enough to influence behavior. Vanessa explained the various stages of change and how different tools are needed at different stages.

Vanessa Dickey, Peace Corps Senegal DPT

PC/Senegal DPT Vanessa Dickey leads a session about behavior change.

Vanessa also presented tools for understanding and strategizing behavior change. She explained how different types of formative research could help you understand behavioral determinants and develop appropriate interventions. Participants broke into groups and conducted their own doer/non-doer barrier analysis based on exercise habits. The groups analyzed their data and developed unique strategies to encourage and influence behavior change within their communities.

Melissa Sharer, the Director of Programing and Training at OGHH, presented after lunch about HIV/AIDS. Many of the countries that Stomp works in also have a high prevalence of HIV/AIDS. Volunteers have to be especially diligent to impress upon malaria prevention in these countries because people living with HIV/AIDS are more at risk to falling victim to severe malaria. Melissa explained the basic science of the disease, transmission, and the most common current interventions. Next week, participants will receive a visit from an expert on HIV/AIDS and malaria co-infection.

Madagascar Malaria Team

Malaria Team Members Raffaele Macri and Lova Rakatoarisoa present about malaria in Madagascar.

Joan Schubert wrapped up the first week of boot camp V with a session about bed net distributions. Joan is the Senegal Director for NetWorks, a program of the Johns Hopkins University Center for Communications Program and serves as the primary implementing partner for bed net distributions in Senegal. Joan walked participants through the steps of organizing a universal distribution and addressed various challenges and strategies. She addressed the key activities that are necessary for successful campaign: advocacy, access, communication, and operational research. She also demonstrated how to transform a square bed net into a circular bed net.

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This was a strong finish to the first week of boot camp V. Participants are ready to enjoy a day off tomorrow at the beach and will come back revitalized and ready for a busy second week on Monday.

El-Hadji-Diop-Boot Camp 5--Day-3

Boot Camp V, Day 3: Community-Based Malaria Prevention, Drug Resistance, and Cost-Benefit Analysis of Free Bednet Distribution

Day three of malaria boot camp V was filled with a field visit to the village of Thieneba Seck in the morning and Skype presentations in the afternoon from two well-known malaria academics.

Boot camp V participants visited the village of Thieneba Seck this morning to talk to community hero El Hadji Momar Diop about his innovative community-led malaria prevention and awareness program. In 1999, El Hadji was working away from his village when he received a phone call stating that his 12-year-old daughter, Amy, had fallen ill. She died before El Hadji could make it home. Amy had contracted malaria.

Dr. Sullian Boot Camp V Day 3

Dr. David Sullivan, MD presents via Skype about malaria diagnosis and treatment and drug resistance.

El Hadji wanted to fight back at the disease that took his daughter’s life. He began to talk to other members in the community and learned that five other village children and many pregnant women had also fatally fallen victim to malaria that year. El Hadji called community leaders together to ask questions about what this misunderstood disease was, what caused it, and how the community could stop it. After talking with local health workers, El Hadji and the men and women of Thieneba Seck implemented an aggressive campaign to fight back against malaria. The villagers sought to eliminate mosquito-breeding sites, put together a program to ensure that everyone was using their mosquito nets properly, and started an intense education campaign for school children. After years of work, Thieneba Seck and the surrounding area are now malaria-free. Today, the boot camp participants had the opportunity to learn about El Hadji’s malaria story and ask questions about how he mobilized his community and the community’s strategies for remaining malaria-free.

After lunch, Dr. David Sullivan, MD, Associate Professor Johns Hopkins Bloomberg School of Public Health, presented via Skype about malaria diagnosis and treatment and drug resistance. Dr. Sullivan discussed the multiple methods to diagnose malaria and various drug regimens. Participants learned about how different drugs work at different stages of the parasitic life cycle. Dr. Sullivan clarified any misconceptions about drug resistance and why some drugs become ineffective.

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Dr. Dupas Boot Camp V Day 3

Standford Professor Dr. Pascaline Dupas shares her research about distributing free bed nets in Kenya.

Following Dr. Sullivan, Stanford Professor Dr. Pascaline Dupas joined the group via Skype to discuss her research regarding the benefits and costs of distributing free bed nets versus subsidized bed nets in Kenya. Participants explored the relationship between cost and demand for subsidized health goods. She touched on the importance of using operational research to contribute to effective public policy and health practices. She also shared some insight about doing field research and challenges she had to overcome.

PCVL Mike Toso and Stomp Program Manager Matt McLaughlin finished off the day’s sessions with a crash course in electronic tools. Malaria Team Members are now equipped with the knowledge to effectively share their materials and stories with each other and the public. Tomorrow is another full day of presentations and hands-on activities.

Weekly Awesome Burkina Faso: Promoting Good Bed Net Usage to a Low Literate Audience

The pictures in card board box help explain good bed net practices to low-literate audiences.

Clarissa Pape is a health volunteer posted in the eastern region of Burkina Faso. Upon arriving in her village in December 2011, she noticed that most people in her community had mosquito nets, but many were not properly using the nets. She noticed that some people did not hang their nets properly, many nets had small holes that could be easily repaired, and some nets were used for completely different usages such as fencing or covering vegetables.

Since April 2012, Clarissa has focused much of her work on researching mosquito net use in her community and educating the population about proper net use. Her village suffers from a low literacy rate. In order to overcome this obstacle, Clarissa created visual aids to be used as a survey tool. She constructed two boxes: one box with a picture of somebody sleeping under a mosquito net and one box with a picture of somebody sleeping without a mosquito net. Clarissa asks women to place a stone in either box depending on how they slept the night before. Then, Clarissa and her counterpart discuss malaria transmission, prevention techniques, and treatment strategies.

Clarissa has seen a difference in the general use of mosquito nets in her village. While she is not yet ready to release her evaluation of the project, she is believes the general culture of bed net usage in her village has begun to shift. She notices that more people taking care of their bed nets and using them properly. She plans to continue her study and education campaign in the future.

Clarisse Pape’s counterpart walks around with the visual aids during an education session about malaria and bed net usage.

Weekly Awesome Zambia: Research Update

Jane Coleman cutting up nets to send to the CDC for insecticide testing

I am an Individual Investigator for the PMI “Durability and Insecticide Persistence in Long-Lasting Insecticide-Treated Nets (LLINs) Study”, in conjunction with the Center for Disease Control and Prevention, Population Services International’s Malaria and Child Survival Program, and Peace Corps.  Peace Corps and PMI Zambia have a very strong relationship and the enthusiasm and collaboration between the two has allowed Stomp Zambia to grow quickly, and has made my work truly enjoyable. To my knowledge, we are the first Peace Corps country to be involved in a CDC/PMI research study regarding malaria control and LLINs.

The study design and concept came from research conducted in 2010 regarding high parasitemia levels in children in two provinces in Zambia.  In February 2011, approximately 2 million nets were purchased and distributed among the two provinces.  However, through observation and research studies, the international development and public health community realized that some mosquito nets are not lasting as long as the manufacture forecast them to last.  Therefore, the National Malaria Control Program in Zambia was seeking to collect data on bed net longevity.   Under the direction of NMCP, PMI and Peace Corps/Zambia launched a bed net longevity study to assess the durability of the bed nets being distributed through the country. The study utilizes 38 Peace Corps Volunteers and their 38 local Counterparts as Village Research Assistants. Each PCV and his/her counter visit 25 households (totaling a sample size of 1,000 nets) to conduct a survey which was developed from the WHO approved questionnaires on the durability and insecticide persistence of the two type nets (Permanents and Olyset). The results will help to better forecast when future mass net distributions are needed.

PCV Mateyo Bonham cutting out pieces of a used bed net to send to the CDC for insecticide testing

The training and first round of data collection happened in March and April of 2012. The data collection period is expected to continue through April 2014. Currently, I am analyzing the data from the questionnaires and working with PMI and the CDC on testing the insecticide levels on the 38 nets we collected from the households (we replaced the nets we took for the study). We hope to write an abstract and share the results within a few months of the first round of findings.

Weekly Awesome Zambia: Chikakla Bed Net Distribution

U.S. Peace Corps Volunteers and partners distributed over 550 mosquito nets to six villages at the Chikakala Rural Health Center Catchment, Mpika district, on Saturday, July 7th, 2012. Health Peace Corps Volunteer, Barbara Smith, with Mrs. Maureen Mwape of the Rural Health Center and Mr. Patrick Mwape an Environmental Health Technician with the clinic hosted the event. This project was funded by a Small Project Assistance (SPA) grant, a project of the U.S. Agency for International Development (USAID).  PCV Barbara Smith collaborated with the Zambia Stomp Malaria Team and Vestergaard Frandsen to purchase 700 discounted nets.

The primary goal of this distribution to fill the gap of households who did not receive enough nets during the 2011 distribution, which consisted of about 1500 bednets. Without enough resources to fund 1500 bednets, Barbara decided to narrow down the focus of the second distribution. Barbara learned that children where the most vulnerable group in her area. During the first quarter of 2012, there were 1083 positive RDT for malaria and 60% of those were children. Therefore, this distribution targeted households with children under five who did not have bed nets.

The 12 Neighbor Health Committees conducted village inspections to determine how many people live in each household, how many children under five inhabit each household, and how many usable bed nets each household owns. Barbara compared these inspections to the 2011 census to verify the accuracy and to determine which villages would be eligible to receive bed nets. In the next couple weeks, Barbara and her community counterpart, Mr. Peter Musengaa , will conduct follow-up home visits in each village to evaluate whether or not the recipients are accurately using their bed nets.

The event was a huge success. Local media including the Zampost from Kabwe and the Mpika radio station covered the event. Six villages were covered in the distribution: Chisengo, Masongo, Kabenga, Chakopo, Chinjele and Mikuba. Over 550 bed nets were distributed and the remaining bed nets will be distributed at antenatal and children under five clinic visits. The village headmen, volunteers from the Neighbor Health Committees, Sub Chief Masongo, and Sub Chief Katema all played an instrumental role in the in the success of the distribution. Notable guests included Mr. Patrick Muma, the Mpika District Public Health Officer, Mrs. Rose Mwaba, Mpika District Nurse, and Ms. Jane Coleman, the Malaria Coordinator for Peace Corps Zambia. Peace Corps Volunteers Kristin Turner, Valerie Booth, and Kristen Buck assisted in distribution efforts throughout the day.

[quote style=”2″]”We are thankful for the assistance Peace Corps has provided in health education and malaria prevention” – Sub Chief Masongo[/quote]

The day also aimed to educate the population about malaria prevention and proper bed net hanging and repair techniques. Students from the Chikakala Basic School and members of the Twatasha Women’s Group performed dramas and songs about malaria and how to protect yourself from contracting the disease.  HIV/AIDS education and prevention was also a focus of the event. Volunteers distributed information regarding Voluntary Counseling and Testing (VCT) for HIV/AIDS. Free testing facilities were also available to the public.  Overall, 45 community members were tested.

Stomp Zambia and our partners hope that this distribution has filled in some of the gaps from last year’s distribution shortage. The project will serve as a learning tool for future malaria projects and distributions. This event has also motivated PCVs to participate in the bednet distributions in their own sites.