KAP Survey to evaluate success of post-flooding distribution of ITNs in Gaza Province

Emergency ITN Distribution and Retreatment, Mozambique

1 Introduction

Mosquito net use in Mozambique has historically been very low and knowledge of insecticide treatment of nets was virtually non-existent prior to 2000. Previous malaria KAP surveys indicate that in rural areas, knowledge of the role of mosquitoes in malaria transmission was less than 30%. Pregnant women were not recognised as an at-risk group.

Following the extensive flooding that affected southern Mozambique during February 2000, the Ministry of Health, in collaboration with UNICEF and several NGO partners (SCF-USA, WVI, LWF, ADPP, Oxfam, Concern, Merlin, World Relief), distributed 200,000 ITNs to flood-affected families in conjunction with participatory communication for malaria. These nets were distributed free of charge.

2 Methodology
2.1 IDP camps, Manhiça district

A total of 1,227 white, family sized ITNs and 432 green single-sized ITNs were distributed in eight accommodation camps. Each family received either one white net or two green nets. Immediately prior to each distribution in the camps, a theatre group performed a sanitation and hygiene/malaria play to inform camp inhabitants how to prevent diarrhoeal diseases and malaria. Six months after the initial distribution a KAP survey was held to determine if the nets had been kept by the families who had received them, if the target groups were using the nets, etc. A sample of 195 houses was selected for interview and a total of 214 households were visited.

2.2 Re-settlement camps, Gaza province

Following the Manhiça distribution, which demonstrated that ITNs did not immediately leak into the market place, approximately 200,000 ITNs were distributed to flood-affected families and 189,000 individuals participated in participatory communication activities. Ten months after the initial distribution, the participatory communication sessions were repeated, nets were re-treated and a KAP survey was carried out in the communities that received nets to determine recipient acceptance of ITNs and the effectiveness of the participatory processes. 528 individuals were interviewed from 5 districts.

3 Results

NGO partner	District	Number of ITNs distributed	Population protected	No. reached with malaria CCD
World Vision	Xai-Xai District	20,320	60,960	36,000
SCF	Xai-Xai City	2,564	7,692	4,500
SCF	Chibuto District	18,344	55,032	32,500
SCF/ADPP	Bilene District	29,700	89,100	52,500
SCF	Massangena	6,000	18,000	10,500
LWF	Guija	26,662	79,986	47,000
LWF	Mabalane	3,300	9,900	6,000
Oxfam	Chokwe Town	25,000	60,000	-
Oxfam	Chokwe District	60,000	147,000	-
TOTALS		191,890	575,670	189,000

· In Gaza, almost 100% of interviewees stated that they knew of the existence of malaria and 91% of respondents cited mosquitoes as a means of transmission. This compares with only 43% of interviewees in Manhiça who mentioned mosquitoes. The difference in knowledge regarding the mechanism of malaria transmission is statistically significant (Chi-sq=195, P<<0.0001).

· 98% of interviewees in Gaza reported that they still possessed their net. 96% ownership was confirmed by direct observation by the interviewer. In Manhiça district, 80% of the population were using their nets 6 months after the distribution.

· Of the nets observed by interviewers in Gaza, 94% were classified as being in good condition, compared with 80% in Manhiça. Significantly more nets in Gaza were in good condition compared with Manhiça, despite the Gaza nets being four months older (Chi-sq=21, P<0.0001).

· 95% of respondents in Gaza stated that they slept under their net every night, compared with 80% in Manhiça. In Gaza, 89% of respondents stated that children slept under the net, either alone or with one or both parents. In Manhiça 62% of those who used their nets reported that children slept in them.

· Children were identified as an at-risk group for malaria by 89% of males and 85% of females who attended the participatory sessions in Gaza. Fewer individuals (59% males and 57% females) who attended the sessions identified pregnant women as an at-risk group. This proportion is still considerably higher than that observed in a pre-intervention study in rural Zambézia province, where not one single interviewee identified pregnant women as being at risk of malaria. In Manhiça 61% identified children as being at risk, but only 5% identified pregnant women. Significantly more interviewees identified children as an at-risk group in Gaza, compared with Manhiça (Chi-sq=55, P<<0.0001)

· In Gaza, 93% of respondents stated that it was possible to protect oneself against malaria through use of ITNs. In Manhiça only 15% of respondents stated that ITNs were a method for malaria prevention, the most commonly cited method being use of antimalarial drugs (54.0%).

Comparison of impact in relation to the use of participatory approaches (PA) and drama	Baseline	Using PA After 1 year (%)	Drama After 6 months (%)
% of respondents citing mosquitoes as a means of transmission of malaria	30	91	43
% of respondents still possessing the net	-	98 stated 97 observed	80
% on nets in good condition	-	94	80
% of respondents sleeping under the net every night	-	95	80
% of respondents saying children sleep under the net either alone or with both parents	-	89	62
% of respondents identifying children as an at risk group	-	87	61
% of respondents identifying pregnant women as an at risk group	0	58	5
% of respondents saying its possible to protect oneself against malaria using an ITN	1	93	15

4 Conclusions

· The high levels of net retention and the low numbers of damaged nets observed in the populations exposed to participatory processes are encouraging and suggests that free net distributions can be successful when combined with a good quality education package.

· It would appear from these results that individuals who were exposed to participatory processes as opposed to theatre sessions were more likely to have retained key messages concerning malaria, illustrating the benefits of this kind of approach.

· We have clearly demonstrated that ITNs distributed in post-emergency situations are retained, used correctly and appreciated by populations, especially if the distribution is accompanied by a good quality participatory learning package.

5 The future

ITNs were also distributed to flood affected families in northern Mozambique following extensive flooding in 2001. In Tete province, Mutarrara district, 20,000 ITNs were distributed along with hygiene and sanitation kits, with participatory education on malaria, hygiene and sanitation and nutrition, to families receiving supplementary feeding. One year post intervention, over 90% ITN retention was recorded.