Teta village

Teta Village Malaria Day

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Michael Lessmeier is a rural education volunteer in Central province of Zambia teaching English at Teta Basic School for students in Grades 8 and 9.  Michael observed a high absentee rate of students caused by malaria and decided to work with the community to address this issue.

PCV Michael Lessmeier distributed nets to his community.

First,  Michael met with the local village leader,  Mr. Davis, who is addressed as the headman.  Mr. Davis instructed the neighbor health committee (NHC) volunteers  to complete a census to determine the number of households and bed spaces. Data from the census concluded that many households did not have enough nets for the sleeping spaces.  Michael also surveyed  550 students in grades 3 to 9  and found less than 10% had slept under a bednet  the previous night.

Alarmed by this information, the headman, clinic staff and neighborhood health committee (NHC) members gathered in October to determine the best course of action. They recognized the need not only for more bednets but more education on malaria and prevention. To begin this process Michael submitted a Small Project Assistance grant (SPA) to purchase the 500 nets needed for the village.  Then he worked with NHC members and teachers at Teta school to develop a malaria program.

On November 15th, Michael conducted a workshop  for eight  NHC volunteers on how malaria is transmitted, signs and symptoms, prevention methods and ways to repair a bednet.  One of the teachers from the school assisted in translating the information. The purpose of this training was to have these volunteers teach this information at antenatal clinics and under five clinics.

NHC members demonstrating net repairs.

On November 16th, Teta Malaria Day was held at the health post facility near the school.  Each household in the village was eligible to receive a bednet, and an adult member of the household had to attend the malaria information program in order to receive the net.  The training information was provided in four stations:  transmission, signs and symptoms, prevention and how to properly hang the net. A station for net repair was done by NHC members. A teacher from Teta School conducted these 10 minute sessions in Bemba, the local language.  These information sessions were conducted in groups of 25 people.

When all the information sessions were completed, the nets were distributed to each household member from the census.  The package of each net was opened and given to the household member and an information brochure on malaria was included with each net.

Two members of the neighborhood health committee are also trained in maternal and child care, and affiliated with the  Safe Motherhood Action Group (SMAG) assisted in the day’s events.  These members  conducted brief talks on the importance of attending antenatal and the benefits to for the mother and baby.  Michael also had assistance from other PCVs, Andrew Bernhard, Courtney Gandy and Jennifer Parks in distribution, health information and bed net repairs.

The Teta Village Malaria Day was a great success with 500  families receiving much needed bednets and malaria prevention information.  Mr. Davis, the village headman, said he was “very grateful to Michael and Peace Corps” for helping with malaria prevention.

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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: Training

Zambia rolled out Focus-In-Train-Up (FITU) Pre-Service Training (PST) Malaria 101 Training Sessions the first week of August. Stomp Coordinator, Jane Coleman attended the pre-service training training of trainers (TOT) to explain the new FITU manual and what Peace Corps Headquarters is requiring of all trainings and of Peace Corps Trainees.

68 Community Health Improvement Project (CHIP) Volunteers and Rural Aquaculture Project Volunteers will work with their language teachers on malaria vocabulary in over 10 local languages. Stomp Coordinator, Jane Coleman, and PMI Resident Advisor, Dr. Allen Craig traveled to the CHIP Chipembi PST training site on Saturday, August 3rd, to share with the new trainees about malaria transmission, misconceptions on transmission, and Stomping Out Malaria in Africa and our international partners. The trainees also learned about and discussed  the four pillars of malaria.

34 trainees were present during the first FITU malaria 101. The trainees were very receptive to the malaria training and eager to partake in malaria work once they install at their respective sites. Next Monday, Craig and Jane will return to the training site to conduct a second presentation to the group which will cover more in-depth knowledge about malaria and tangible interventions that PCVs can partake in.

Zambia PMI Resident Advisor Dr. Allen Criag explains the malaria transmission cycle.

Weekly Awesome Zambia: Film Crew Visit

Peace Corps Headquarters sent a film crew to Zambia to learn and highlight what Peace Corps Volunteers, Peace Corps Response Volunteers, and Peace Corps Volunteer Leaders are doing in the field. Peace Corps/Zambia has one of the largest numbers of third-year extension rates and Peace Corps Response Volunteers. Volunteers of all sectors in Zambia are working in malaria prevention. The film crew spent a week traveling around Zambia visiting volunteers in their sites documenting volunteer malaria prevention efforts.

During the week, Jane Coleman, Zambia Stomp Coordinator, arranged the site visits and logistics for the film crew’s trip and traveled with them around the country. Peace Corps Communications Staff Edward Perry and Lee Gillenwater collected great footage that will be used for Peace Corps recruitment and promoting materials next Fall.

The crew and Jane Coleman traveled to Luapula Province to film PCVs David Berger, Brittany McFall, and John Abrams collecting data for the President’s Malaria Initiative (PMI) Net Durability Study. The crew also filmed PCVs Tiffany Saria working with a grassroots soccer organizaion, and Kelsey Simmons and Kelly Finwall working with Safe Motherhood Action Group under the Saving Mothers Giving Life Initiative with USAID. Peace Corps Zambia was thrilled to host the film crew and are excited to see how Peace Corps usages the footage in future promotional materials.

Weekly Awesome Zambia: Natural Mosquito Repellent Production

Natural Mosquito Repellent Production in Zambia: Soaps and Lotions:  Results of the research, design, and development of locally produced repellents in the Appropriate Technology context  in Luapula Province, Zambia

Luapula Province, Zambia is blessed with fertile waterways, seasonal rivers, and an abundance of low lying wetlands. Combined with a reliably warm climate, these factors result in a comparatively high incidence of malaria. In Mansa district alone, there were an estimated 516 cases per 1000 people in 2006 (PSI). The need for locally accessible means of prevention is clear as education and net distribution, while effective in reducing case incidence, are not comprehensive.

A team of two Peace Corps Volunteers and two Host Country National Counterparts from rural communities developed, produced and tested various methods for the prevention of malaria via application of natural soaps and lotions at an Appropriate Technology Workshop held in Mansa, Luapula Province, Zambia, 22/05/2012 – 27/05/2012. The team developed the idea for their products by setting a series of design requirements to ensure that the repellents would be affordable, accessible, culturally compatible, and effective. This was accomplished through researching ICE materials and interviews with HCNs that live in the affected communities.

[heading style=”1″]Lotion Production Results:[/heading]
The team found that lotion production in particular has a strong cultural precedent in the Luapula area. Palm oil is used in the Lake Bangweulu area in the eastern part of the province as a moisturizing lotion for the skin and as a cooking fuel. Palm is so ubiquitous in this region that prices are well below the market value of any other oil, estimated at ZMK 8,000 (US$ 1.60) per 2.5 Liters of raw product. This accessibility makes palm oil an excellent candidate for use in natural production.

Neem leaves were used to give the lotion a repellent quality. Neem trees grow well in the Mansa area but are not very common throughout the region. The team used a recipe that used shea butter as a base and chose to replace this ingredient with palm oil to make the lotion more locally applicable (Neem Cream Recipe: A Natural Mosquito Repellent, Olga Samborska & Nyima Camara, PC/Gambia). The neem leaves were boiled and the resulting tea was mixed with soap shavings and palm oil to produce an attractive orange lotion. This product was very popular with HCN counterparts attending the workshop and has a high degree of cultural compatibility. Many of the HCN counterparts suggested adding glycerin solution to the lotion, a practice widespread in Zambia, to provide more cosmetic properties.

Testing results were mixed. Several PCVs used the lotion in the evenings to see how effective a repellent it is but not clear control was established and feedback was too varied to adequately process. The lotion needs to be tested for resiliency and effectiveness with captive mosquitoes under close observation for an accurate assessment. These conditions were not possible to meet at the Provincial Resource Center in Mansa and should be considered in the future.

[heading style=”1″]Soap Production Results:[/heading]
The design team found that soap production is cultural compatible and feasible in rural Luapula but is not prevalent. Basic recipes use raw plant oil, caustic soda, water, and a mould to manufacture solid bars of soap and are easily demonstrated. The use of caustic soda is questionable as the substance is relatively hazardous and only available in more urban markets. Caustic soda is affordable, however, with an estimated cost of ZMK 11,000 (US$ 2.20) per kilogram; a cost of about ZMK 2,000 (US$ 0.40) per kilogram of soap. This ingredient may be replaced with a local soda produced from potash in the future and further testing is necessary.

The team tested citronella production methods that used citrus rind from orange and lemon as well as lemongrass using hot water extraction. This proved to be rather difficult as it was not possible to easily decant the resulting citronella oil from the water. The team decided that using bruised orange peel and lemongrass would be easier to accomplish in the rural setting and applied this technique to an existing recipe for jatropha oil soap (The Jatropha Manual: A Guide to the Integrated Exploitation of the Jatropha Plant in Zambia, Reinhard Henning, bagani GbR) to take advantage of jatropha’s repellent qualities. Caustic soda and water were mixed to produce a lye solution that was then mixed with jatropha oil, orange peel, and lemongrass. The resulting mixture was poured into bamboo moulds lined with old plastic bags and left to harden. Jatropha is found in many places in Luapula but is not prevalent and oil production is not widespread. The oil also proved to be so strong in odor that the resulting soap smelled a bit like diesel fuel when combined with orange peel and lemongrass. These factors do not make jatropha oil a good candidate for adoption of this soap in rural communities. The team suggested mixing palm and sunflower oils, found easily in Luapula, for use in soap production in place of jatropha. The workshop did not allow adequate time to test this idea and participants expressed interest in continuing to experiment in their respective communities.

[heading style=”1″]Malaria Prevention as Appropriate Technology[/heading]
The Appropriate Technology context allows for the kind of grassroots brainstorming, research, and development necessary to create sustainable solutions to the malaria repellent question. Abandoning the “one-size-fits-all” demonstration model in favor of tapping local knowledge, skills, and resources produced a wealth of empirical experience that can be used for future development. The team presented their findings and prototype products at a showcase on the final day of the workshop, leading to dissemination and sharing of knowledge through conversation and practical demonstration from HCN to HCN and PCV to PCV. The flexible and adaptive nature of AT will continue to provide interesting solutions to the malaria prevention question as PCVs and HCNs continue to research, design, and develop their ideas into practical methodology.

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.

PMI/STOMP Net Durability in the Stage of Net Cutting and Data Entry

Zambia Stomp has been working with PMI for a year now on a Net Durability Study with the CDC.  The sample size is 500 Olyset and 500 Perma nets to be study over the course of 2 years.

38 Peace Corps Volunteers and 38 Counterparts were all trained to be Village Research Assistants by the PMI Resident Advisor, Dr. Allen Craig and the Stomp Coordinator, Jane Coleman.

After the training, the new researchers went into their  villages to visited 25 households collecting information on the durability of the net and the level of insecticide on it.  After collecting the questionnaires and 38 randomly selected nets, the Stomp Coordinator and another Response Volunteer working at Society For Family Health have been inputting the 1,000 questionnaires in Epi Info as well as cutting up the nets to match CDC and WHO protocol in order to send them to the CDC for further testing!

 

It has been exciting and the fun has just begun.  Stomp Zambia will share the results has they come forth in a few months.

 

Stomp Malaria Coordinator

Jane Coleman