VC3D VC WASH Cluster – Emergency Training 1 Vector Control Module 3D Net distribution.

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VCWASH Cluster – Emergency Training

Vector ControlModule 3D

Net distribution

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Overview• Understand what LLINs are and which are

tested and approved by WHO

• Understand the procurement, shipping and storage considerations for LLIN campaigns

• Understand the main delivery strategies for emergency settings and how to achieve and show maximum impact

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LONG LASTING INSECTICIDAL NETS (LLITNS)

• Nets that have been treated with insecticide in the factory during production.

• Residual insecticide will continue to be effective for a period of 3 to 5 years

• LLINs do not need to be retreated

• LLINs are proven to withstand 20 washes before the insecticide becomes ineffective

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LLITNs• WHO approved: Permanets

Olyset-nets

Dura-nets

Interceptor nets

NetProtect

• Look for these names on the tags of the nets.

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WHOPES RECOMMENDED LLINSSUPPLIER NET MATERIAL INSECTICIDES

TREATMENT

PROCESS

Sumitomo Chemical Co.

Ltd.Olyset

PolyethylenePermethrin

Incorporated to fiber

Vertergaard Frandsen S.A. PermaNet

PolyesterDeltamethin Coated

BASF South Africa PTY Ltd. Interceptor

PolyesterAlphacypermethin Coated

Bestnet Europe Limited Netprotect

PolyethyleneDeltamethin

Incorporated to Fiber

Clarke Mosquito

DuraNetPolyethylene

AlphacypermethinIncorporated to

fiber

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Net Characteristics

• Have a look at the differences of the five WHOPES approved LLINs

• Which one do you prefer?

• Why?

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WHICH LLIN TO USE?

• The characteristics of these nets vary widely in terms of material, pesticide and incorporation technology.

• Know your population - field test different nets. Which nets are going to be best retained and utilised for there proper use?

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WHAT DOES YOUR TARGET POPULATION LIKE?

• What texture - each net have different mesh size, strength, rigidity

• What colour do they like? - Blue, white, green, pink?? Blue tends to be preferred.

• What shape do they like? - square, round?• Do they care about durability?• Do they care about seeing the dying insects?

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WHO IS YOUR TARGET POPULATION?

• Are you doing a targeted distribution to pregnant women at ANC?

• Are you covering Children under 5 in a vaccination campaign?

• Are you doing a general distribution?

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WHO LLIN POSITION STATEMENT

Recently, models for delivery of LLINs havefocused on different target groups depending on the local epidemiological situation:• in perennial transmission areas: targeted distribution to vulnerable groups, i.e. pregnant women and children under five years of age;•in areas with unstable malaria and limited populations at high risk: delivery to the total population within a defined geographic area.

WHO Global Malaria Programme “Insecticide Treated Mosquito Nets: A position statement” 2007

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WORKPLAN FOR LLIN CAMPAIGNS

1. Assessment

2. Selection and Training of Workers

3. Transportation and Storage

4. Mobilisation and Awareness (IEC / BCC)

5. Distribution

6. Supervision and Monitoring

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1. ASSESSMENT• Done with leaders of the village and health workers to

determine number of LLINs needed and distribution strategy

• Population, Households, Children under 5, pregnant women

• Sleeping patterns (number of people per number of beds / sleeping surfaces), structure of house (wall height, materials etc.)

• Are there LLINs in the community?? What is coverage??

• Malaria epidemiological data from health center

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VCWASH Cluster – Emergency TrainingRemember: Communities vary greatly in their customs, behaviour and beliefs. Assess this first because it will determine how LLINs should be delivered are received and used, or abused!

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2. SELECTION AND TRAINING OF WORKERS

• All campaign workers (health workers, NGO staff, community etc.) will be trained in IEC / BCC, distribution procedures

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• LLIN distribution supervisors also must be trained in data collection and monitoring

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3. TRANSPORTATION + STORAGE

• When is your distribution - have the LLINs been ordered - what is lead time on availability in country?

• If not in country, where will LLINs be coming from? • Air shipment is very expensive so sea freight is

standard, but allow several months?• Are the LLINs registered already for use in the country

bythe MoH, or not?• Do you need a MoH letter for tax free import of LLINs

for customs clearnace?

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Avoid nets being exposed to direct sunlight on open trucks. Avoid nets being exposed to direct sunlight on open trucks. This burns away insecticideThis burns away insecticide

How will they be transported in country?

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Where will they be stored? Is it secure?

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Can LLINs be pre-positioned for distribution?

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MOBILISATION / AWARENESS (IEC/BCC)

ESSENTIAL!!!!!!!MUST BE DONE BEFORE DURING AND

AFTER LLITN DISTRIBUTION

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WHY is Community Education/Mobilisation Essential?

List all the reasons you think IEC is needed prior to, during and after LLIN distributions?

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It is relatively easy to physically distribute LLINs. However, for LLINs to achieve their potential for malaria

prevention all impact is determined by the recipients behavior:

1. LLINs must be retained and not sold 2. LLINs must be used for sleeping under (no other

applications!)3. Those most vulnerable to malaria should be the ones

prioritised to sleep under the LLINs4. They must be hung correctly without gaps, and

maintained without holes etc.

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Locations for Social Mobilisation

• Mosques, Churches

• Schools

• Market places

• Public Gatherings

• Ceremonies

• Health centers

• Houses

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Key Messages for LLITN Distribution

• The only cause of malaria is mosquitoes• Malaria is a very serious disease that can lead to

death• The most vulnerable groups are children under 5

and pregant women (in malaria endemic areas)• LLITNs are effective• Sleep under your LLITN every night• How to use your LLITN

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Ways to Distribute LLINs

• How many ways can you think of?

• Which method do you think I the most commonly used?

• Which methods do you think achieve the best impact?

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Ways to Distribute LLINs

1. House to house distributions

2. Central community distributions to households

3. Mass distribution linked to vaccination programmes

4. LLINs distributed in as non food items in UN and NGO emergency kits

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1. House to House DistributionTeams to distribute LLINs should be recruited and trained prior to the arrival of the LLINs in the distribution site.

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Teams should visit all target communities to get the community leaders buy in and agree on a date and any logistics arrangements such as IEC and LLIN delivery sites in each community

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On the agreed distribution day the team and nets should arrive on site as agreed:

• Team of distributors go house to house distributing nets one per sleeping surface

• The distributor removes net from package.

• Mark the LLIN with an ID number that relates to the household.

• Use permanent ink for the marking to avoid it being washed out later on.

• Removing nets from packaging and marking them are important steps to reduce resale by recipients.

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LLINs should be registered to each household and the family representative should sign for the LLIN received.

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• During the distribution / hanging of the net the washing of the net should be explained again.

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• The person assists in hanging the net. They bring with them cut rope, hammer and nails to hang

• All plastic bags must be collected and counted and returned to the distribution point to ensure accountability of nets that have gone out.

• The Distributor must explain why they should sleep under the net and that they should sleep under it each night.

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2. Central Community Distribution

• All initial set HR and set up arrangements should be as above.

• However on the day of the distribution the community is called to the central distribution site at the agreed time

• Central level IEC drama should be delivered to explain correct LLIN installation and usage etc

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• Each household representative is then called forward one at a time.

• Household details are registered and the LLIN is signed for by the household representative.

• Mothers are the preferred recipient, but this is not always possible.

• LLINs are removed from their packaging • LLINs are marked with the household ID number

allocated, using permanent ink• Key messages to reinforce understanding of how

to hang and use the LLIN are given again to the recipient during this process

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Share key messages to reinforce correct use with each family

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3. SUPERVISION AND MONITORING

• Supervision of the household and community campaigns should take place through out the entire process.

• Ensure that each household is reached, or visited post distribution

• Check that LLINs are hung, assist in hanging them where need,

• Check LLTNs are accounted for, prevention messages are disseminated

• Map distributions using registration data and village maps (in the same way as for IRS)

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Mass Distribution / Vaccination

• This method has obvious logistics attractions but is generally unsuited to emergency settings.

• LLINs are distributed to mothers bringing children for measles or polio mass vaccination campaigns

• Achieving high distribution numbers in a short time frame is easy but….

• Achieving high retention and usage is very difficult and has not worked in most emergencies where tried.

• List some of the reasons why this may not work?

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Why mass distributions are generally a poor method

1. Time frame for delivery of malaria and LLIN specific IEC is too short

2. Understanding of recipients is reduced

3. Competition with vaccination tasks which generally take priority

4. LLINs usually distributed in their packages

5. Generally no household level contact or follow up to check if the nets are hung, assist where they are not etc

6. Usually no coverage or usage data!

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LLINs Emergency Kits Distributions• In Burma after Cyclone Nargis over 800,000 LLINs were

distributed on mass as non items as part of emergency survival kits.

• No one knows how many were used. • Many witnessed piles trod into the ground were they fell,

unappreciated, and never to be used. • This has happened all over Africa too as LLINs are included

in many UN emergency family kits • These LLINs are delivered with no IEC, cannot be tracked to

a family or household and abuse and resale rates are generally expected to be very high!

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EVALUATINGLLITN Retention + Utilisation

• However LLINs are distributed the coverage and usage rates achieved should be measured and reported:

• 3 to 5 months after the distribution a two stage cluster sample survey should be performed

• Determine the percent of the population who retained the LLITNs distributed

• Determine the percent of the population who are correctly utilising their LLITNs (ie have them hanging over their sleeping areas)

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• If access to health services have remained stable and the population size has not changed you can compare morbidity and mortality rates of malaria for children under 5 and over five at the health facility level.

• In a holoendemic area you can look at the data from the months prior and proceeding the distribution

• In a seasonal malaria area you can compare the prior year’s data to the present year’s following the distribution.

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Topping up LLIN Coverage

• Even the best programmes require annual topping up of LLINs to replace damaged nets and to cover new born children.

• Establishing free distribution of LLINs to pregnant women on first visit at antenatal clinic is a very useful way of topping up coverage

• This helps increase ANC usage and IPT usage.

• Antenatal clinic or other health facility distribution models are not a substitute for large scale distributions though.

VC3D VC WASH Cluster – Emergency Training 1 Vector Control Module 3D Net distribution.

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