Malaria: Tanzania’s lake, southern zones near...

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(Dar es Salaam, September 4, 2017.) Coverage of mosquito bednets for guarding people against malaria in the lake and southern zones is almost universal. Scientists from Ifakara Health Institute (IHI), Tulane University and National Malaria Control Program (NMCP) evaluating the implementation of the School Nets distribution Program (SNP) have revealed.

The scientists, Dr. Ester Elisaria, Dr. Eveline Geubells, Dr. Joshua Yukich, Charles Festo, Frank Chacky and Logan Stuck, made the bold statement when presenting the findings of the Fourth Round of the evaluations of the program at a stakeholders’ workshop in Dar es Salaam today.

Dr. Elisaria.

The evaluation study was carried out from April-May 2017 in Nachingwea, Mtwara Urban, Sengerema and Chato districts. The four districts benefited from previous bed net distribution campaigns and programs aimed to curb malaria.

The NMCP has been implementing the SNP in Lindi, Mtwara, and Ruvuma regions as a keep-up strategy to maintain universal coverage of the Long Lasting Insecticides treated Nets (LLINs). This push mechanism aims to maintain LLIN coverage through annual distribution of bed nets to school children in specified classes.

Four rounds of school nets distribution have occurred with evaluation surveys conducted after each one. The first two evaluations indicated that the coverage in the southern zone of Tanzania has remained overall high and largely stable.

However, the third-round survey (SNP3) indicated there may have been a slow decline in coverage over time in southern Tanzania where the program was originally implemented. Results from the fourth round show an increased coverage in nets ownership within the southern zone.

We’re almost there

“Ownership of any net was nearly universal and that of at least one LLIN [long lasting insecticidal nets] was high ranging from 83.3% in Nachingwea to 96.6% in Sengerema. The IHI scientists report that over two third of household members in the evaluated districts slept under LLIN the night preceding the survey, adding:

“When the household has enough nets (one LLIN per two people) over 94% of household members slept under LLIN in Mtwara Urban and Nachingwea and a bit lower proportion in Chato (86.1%) and Sengerema (81.9%).” The most frequently stated reasons for not using net were “the nets contain bed bugs” or “no mosquitoes”.

A section of stakeholders listen to IHI scientists presenting SNP4 survey results.

The fourth round of school nets distribution has contributed to 14% and 16% absolute increase in the ownership of at least one LLIN for every two people in Mtwara and Nachingwea district respectively. A small absolute gain was also observed in Chato (8%) and Sengerema (7%).

“The school net distribution program continues to be a major source of nets in Nachingwea and a second contributor in Mtwara. The large increase in LLIN coverage in the southern sites is likely attributed to the increase in a number of nets distributed, increase in target population particularly in Mtwara and existence of parallel intervention targeting pregnant women and infants. The high coverage observed in the Lake Zone was mainly due to Mass Universal Campaigns,” they report.

Underlining the contribution of the SNP, the scientists say, “Without SNP, ownership of LLIN per two people in the household is low in Nachingwea (21.8%) and Mtwara urban (25.3%).

Household bed bugs

After successful implementation of the SNP, the scientists are now calling for a new study to investigate the association between the distributed treated mosquito bed nets with increased household bed bugs particularly in the lake zone.

Background info: About SNP
The distribution of treated bed net has consistently proven to be an efficacious and cost effective strategy for malaria control in Africa. The widespread ownership and use of the nets is necessary to reach desired malaria control targets and improvements in other health and nutrition indicators. Research is needed to explore and evaluate innovative strategies for increasing and sustaining coverage and use of the nets, particularly those which can supplement mass distribution campaigns.

IHI and partners — The National Malaria Control Programme (NMCP) and Tulane University — are implementing the SNP in Lindi, Mtwara, and Ruvuma regions as a keep-up strategy to maintain universal coverage of the LLINs. This push mechanism aims to maintain LLIN coverage through annual distribution of bed nets to school children in specified classes.

Four rounds of SNP distribution have occurred with evaluation surveys conducted following each of them. The first two evaluations indicated that the coverage in the southern zone of Tanzania has remained overall high and largely stable.

However, the third-round survey (SNP3) indicated there may have been a slow decline in coverage over time in southern Tanzania where the program was originally implemented. Results from the fourth round shows an increased coverage in nets ownship within the southern zone

Participants in a group photo.

Therefore, the central goal of the fourth-round evaluation of SNP was to answer the question: “Do the nets issued to school children reach the majority of households and contribute to maintaining the coverage achieved through the earlier mass distribution?”

More specifically, the fourth round hopes to confirm if the downward trend observed in the SNP3 data was indicative of a continued decline in coverage despite the program or if it was due to sampling variation and timing of the survey relative to distribution.

The field work for the evaluation covered a period of sixteen weeks starting April-May 2017 which is approximately nine months since school bed nets were distributed. The evaluation targeted four districts of Tanzania namely Mtwara Urban and Nachingwea in Southern Zone (intervention area); and Sengerema and Chato in Lake Zone (comparison area).

Data were gathered using a cross-sectional survey. Fifteen wards were selected employing probability proportional to size. One hamlet from each ward was selected at random. Twenty-two households were chosen from each hamlet using EPI-type procedure making a total of 1,320 households from 60 clusters selected from all study districts. #

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