Nigeria
In Nigeria, NetWorks is testing novel approaches for distributing long lasting insecticidal nets (LLIN). NetWorks is also conducting research to understand how climate and behavior can wear out nets. Finally, NetWorks is testing the effect of behavior change communication (BCC) on how households care for their nets and on how long nets last.
Behavior change communication
Field reports increasingly demonstrate that while on average, LLINs last about three years, many do not last as long as intended, in large part because the fabric is susceptible to damage from small children, rodents, over-washing, and general handling. The durability of a net, and how long a household considers it useful can be a key determinant of net use and how often nets need to be replaced.
NetWorks is testing whether a BCC campaign can motivate net users to take better care of their nets and repair holes promptly. Extending net life would in principle provide sustained protection from malaria, and has the potential to increase the return on net investments. NetWorks and its partner, Center for Communication Programs-Nigeria, are using a combination of household visits, community events, and radio programs to promote net care and repair. Evaluation results will be available in mid-2014. Materials from the campaign can be accessed through the online Care and Repair of Mosquito Nets Toolkit.
A music contest in Nigeria addresses net care
This music group, preforming their original song, are winners of a song contest held in Nasarawa State in central Nigeria. Twenty communities competed in the contest as part of an intervention to promote household awareness of the need for care and repair of their malaria nets. The contest is part of a larger pilot intervention, which is using strategic communication to promote these behaviors to increase the useful lifespan of nets. The campaign is airing a series of radio spots and employs community health volunteers to share these messages with community members through local events and house visits.
The song is in Hausa, and translated into English:
Mosquito net is good, care for it to make it last and to prevent us from malaria.
We can sew it and patch it. To care and protect it we can even tie it.
Sew it on time, care and repair your mosquito net to prevent it from spoiling.
NetWorks has led the process of developing a set of indicators to measure behaviour change communication interventions for malaria, through a PMI working group on malaria BCC M&E. The group is nearing completion of a set of guidelines for countries and implementing partners, including indicator definitions, how to use them, and how to integrate questions into household surveys. At the same time, a reporting guideline is being finalized to assist in writing up results of interventions so that the findings are comparable and robust, and presented in a way that builds the evidence base for malaria BCC.
Finally, a series of trainings in planning, monitoring and evaluating malaria BCC programs was developed for program staff and national malaria control program officials. Free online training series on evidence-based malaria behavior change communication
The image above is used in a poster for BCC campaign on net care and repair. Poster caption: "Your mosquito net is like a newborn baby. Handle it with care to make it last and protect your from malaria."
LLIN distribution
High rates of school attendance in Cross Rivers State have created an unparalleled opportunity to reach households with nets. Distributing through schools (link to the Nigeria case study) can be more streamlined than standard campaigns, since many of the necessary elements are in place. Students and their families are already entered into the school registration system, schools have adequate storage facilities, and educators are high motivated to take part in malaria prevention. By distributing nets through both schools and antenatal care, Cross Rivers State can ensure that 75% of households have a net. Between 2012 and 2014, NetWorks will conduct three waves of net distributions in schools in two Local Government Areas (LGAs). The first wave was completed in 2012 and the second and third waves will take place in April 2013 and 2014, respectively.
In Nasarawa and Zamfara states, NetWorks and its partner, Malaria Consortium, are developing systems that help families “pull” nets into their homes when they need them. In these pilots, households seek a net from a community-selected health volunteer, who assesses whether they are eligible for net and provides them with a coupon. Households can use these coupons to obtain a net for free at a health facility (Nasarawa and Zamfara), through a community leader or a place of worship (Zamfara). A full evaluation of the Nasarawa and Cross Rivers distribution efforts will be available in 2014.
NetWorks is also providing technical assistance to the development of net distribution systems throughout much of Nigeria. In 2013, NetWorks trained representatives from 34 of the 36 states and the Federal Capital Territory and members of the federal malaria control program in continuous distribution concepts and the use of a modeling tool called NetCALC. States then drafted state-specific strategies that outlined options for efficient ways to distribute nets and the estimated numbers of nets needed. Case studies and other tools from these pilots can be downloaded from the Continuous Distribution of LLINs for Malaria Control Toolkit. Link to an overview of net distribution approaches.
School distribution in Cross Rivers State, 2012
Research
In addition to the operations research activities described above, NetWorks is also conducting a longitudinal, three-year study that assesses the condition of nets over time in three different climatic zones. The study will compare the proportion of LLINs that are considered to be in good condition between the dry and hot areas of the North (Zamfara), the humid and wet South (Cross Rivers State) and the moderate central area (Nasarawa). The study will provide key information on how long nets last under various field conditions. The second wave of data collection is fielding in March and April 2013, and the final wave, as well as study results, will be available in 2014.
