LONG LASTING INSECTICIDES TREATED NETS UNIVERSAL COVERAGE : THE SENEGALESE EXPERIENCE
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Transcript of LONG LASTING INSECTICIDES TREATED NETS UNIVERSAL COVERAGE : THE SENEGALESE EXPERIENCE
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LONG LASTING INSECTICIDES TREATED NETS UNIVERSAL
COVERAGE : THE SENEGALESE EXPERIENCE
Mamadou Lamine Diouf1, Mike Toso2, Celine Ziegers de Beyl3, Hannah Koenker3, Joan Schubert3, Debbie Gueye4, Mame Birame Diouf4, Youssoufa Lo3, Mady Ba1 , Pape Moussa Thior1, Ousmane Faye5, Julie Thwing4, Medoune Ndiop1, Oulèye Bèye1,
1 Senegal Ministry of Health and Social Action: National Malaria Control Program2 American Peace Corps /Senegal
3 NetWorks project for John Hopkins University, Baltimore4 PMI/USAID/Senegal
5 Entomolgy Service, Univdersity Cheikh Anta Diop Dakar
ASTMH 62nd annual meeting, Washington November 15, 2013
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OUTLINE• CONTEXT• EVOLUTION OF ITN DISTRIBUTION STRATEGIES• UC DISTRIBUTION ROLL OUT• EVALUATION METHODOLGY• RESULTS• DISCUSSIONS• MAINTAIN UC• NEXT STEPS
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CONTEXT
• Great progress from 2005 to 2010 in malaria control – scale up of malaria prevention and
treatment interventions – decrease in all cause child mortality of
40% 2005 to 2010 National Strategic Plan 2011-
2015: Ambitious objectives for pre elimination
Sustain gains/Improve performances
Short timeframe to achieve MDGs Intensify activities and innovative
strategies
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EVOLUTION OF ITN DISTRIBUTION STRATEGIES
2002-2007: combination of Untargeted/targeted subsidized distribution in health facilities and community based organizations
2008: subnational free distribution targeting under 5 years old through integrated campaigns
2009: nationwide free distribution targeting under 5 years old through integrated campaign
2009-2010: pilot universal coverage development in 2 districts based on sleeping spaces (by Peace Corps)
2010-2013: staged nationwide rolling LLINs UC distribution (completed in march 2013)
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UC DISTRIBUTION ROLL OUT
Universal coverage defined by the NMCP as one LLIN per sleeping space (1/1.8)
Senegal strategy includes a household census of people, sleeping spaces and existing nets in good conditions
Door to door census conducted by community volunteers
Coupon given to household/redemption with net Coordinating committee at each level (national,
regional, district, village, etc.) Strong partnership on funding and on field
implementation Training, monitoring, supply and communication
activities Procurement and supply system dedicated to UC Evaluation after each phase to improve next
phase
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UC DISTRIBUTION ROLL OUT (2)
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Evaluation - survey methodology
• Cross sectional cluster sample household survey• Conducted in the six phase 1 and phase 2 regions
during early rainy season 2011• Survey conducted one year after phase 1 and 6
months after phase 2• 60 clusters x 26 households per cluster = 1560
households• Questionnaire included questions on household
demographics, census, distribution, sleeping space, and net use
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RESULTS: Household characteristics
Household (HH) characteristics
Phase Total
1st 2nd
Mean people per HH 11.6 10.9 11.2
Mean sleeping spaces (SS) per HH*
6.4 6.2 6.3
HH visited by a census team
85% 95% 91%
HH that received at least one LLIN
84% 94% 89%
HH ownership of ≥ 1 ITN / SS post-campaign
33% 51% 42%
Retention of campaign nets
93% 97% 95%
Retention of pre-existing nets
46% 51% 49%
• Large HH size with many sleeping spaces
• Improvements were seen from phase 1 to phase 2 in terms of households visited and LLINs received
• 42% of households had ≥ 1 ITN / SS
• Campaign net retention 95%, but pre-existing retention 49%
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RESULTS: Net useUse indicators Phase Total
1st 2nd
Among HH with ≥ 1 ITN, % with ≥ 1 ITN hanging
90% 94% 92%
% of HH with all ITNs hanging
71% 60% 65%
% of campaign ITNs hanging
86% 80% 83%
% of SS protected by ITN (all HH)
65% 76% 71%
% of population using an ITN in all HH
62% 75% 69%
% of population using ITN in HH with ≥ 1 ITN/SS
92% 89% 90%
% of children < 5 under ITN
64% 80% 72%
% of pregnant women under ITN
65% 80% 74%
• >80% of campaign ITNs hanging
• In all HH, 71% of sleeping spaces and 69% of people were protected by an ITN
• In HH achieving UC (1 ITN/SS), 90% were protected
• 72% of children under 5 years and 74% of pregnant women slept under an ITN
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Supporting data from DHS surveys
2010 DHS
2012 DHS*
HH ownership of ≥ 1 ITN
63% 73%
Dakar 37% 24%
North 66% 83%
Center 79% 80%
South 88% 70%
ITN use by general population
29% 41%
Dakar 14% 24%
North 46% 61%
Center 37% 48%
South 50% 40%
• Data from the classic DHS in 2010 and the first year of the continuous DHS in 2012
• South and most of center covered by 2010 DHS• High ownership in
south and center (use higher in south)
• Remainder of center and north done by the time of the 2012 DHS• High ownership and use
in north and center, falling in south
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DISCUSSIONS• Universal coverage mass distributions greatly improved
coverage and use compared to non-UC regions • Sleeping spaces census – Definition of SS– Household acces by volunteers– Low retention rate of prexisting nets– Nets hidden by people
• Nets supply– Accuracy of LLINs quantification– Effective supply chain (transportation and storage)
• Intensive effort requiring significant involvement at all levels
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HOW TO MAINTAIN UC? • Universal coverage mass distributions greatly improved
coverage and use compared to non-UC regions • UC mass campaign is labor intensive, costly and cannot
be rolled annually in the same regions• Multi-channel Routine distribution to maintain high
coverage (piloted in 2 regions)– Distribution through health facilities
• Distribution of LLINs through antenatal consultations (free) • Distribution of LLINs through general health consultations
(subsidized)– Distribution through community-based organizations
(subsidized)– Distribution through primary schools (free)– Distribution through the private sector (subsidized)
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NEXT STEPS• Restart universal coverage with the same
chronology to replace the nets distributed 3 years ago
• Scale up Routine Multi-channel countrywide• Reinforce communication and sensitization to
encourage use year-round and by all household members (Three T)
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THANKS FOR YOUR ATTENTION
Ministère de la Santé et de l’Action Sociale