Malaria

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 its importance and because I’m celebrating the completion of the first of six bi-annual observation visits & the enrollment of 28 randomly selected households with nets. It was nice to break out my old research methods training, to put on my walking boots, and be an information hound.

So here are the details:
The study is about the durability and insecticide persistence in Long-Lasting Insecticide-treated Nets (LLINs) in Zambia. That’s looking for holes, counting burns and rips, and randomly takin’ a net and sending it to America.

Where do I come in? I always wanted to be a research assistant (RA) in college but this is much more exciting! I’m officially a Village Research Assistant working under the CDC in collaboration with PMI/USAID. 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 the process of 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. This means it is essential to move away from a curative strategy to put a greater focus on prevention of infection.

USAID Global Health continues: “In 2010, #malaria killed ~1794 people per day in #Africa, mostly children #endmalaria #5thBDay.”
In deference to high child mortality, that 5th birthday hashtag is USAIDGH’s tagline for this year’s work…that every child deserves to have a 5th birthday.

On the ground in Chisunka, we have been analyzing data. 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 number is not an accurate count for the community as a whole, it is documenting 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 on duty. That means people are sent home unless they are seizing or unconscious in the screening room.

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 2011 my province – Luapula – received a bulk net distribution. My community alone received nearly 5000 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 community’s homes average 2 sleeping spaces: Adults and children under 5 years in one space and children over 5 sharing the other.

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 2011 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 2 in the 36 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 coop for new chicks. By getting a sample from communities like mine across distribution areas, we can learn about use, durability, and net-longevity which will better allow 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.

Cheers!