NetWorks is dedicated to advancing the field of malaria prevention through operations research and formative research activities. The project uses the results of this research to understand results, improve implementation strategies and feed new information into decision-making.
In the first year, NetWorks led research in net quantification for planning, using analysis from 15 Demographic and Health Surveys to show that using a 2 people per net algorithm to calculate procurement needs is insufficient to reach universal coverage operationally, due to the number of households that have odd numbers of inhabitants. A planning ratio of 1.6-1.8 people per net takes into account the odd-numbered households, as well as population estimates that are outdated or otherwise insufficient, due to shifting seasonal laborer populations and other issues.
NetWorks is also addressing the issue of how to take into account nets that are already in the field, due to prior distributions and/or social marketing efforts. The Senegal universal coverage activities are one method of accounting for existing nets, and we have completed a large-scale evaluation of this innovative strategy. The evaluation is in the process of being finalized and gives some encouragnig results.
In order to look further into the dynamics of household net allocation and use, and to understand the gap between distribution and sleeping space coverage, NetWorks launched the first phase of Senegal Culture of Net Use study in January 2012. This longitudinal study collected in-depth qualitative and quantitative data on net use, net allocation, net condition, and care and repair of nets. Over an 18 month period, households will be visited up to four times to understand how these factors and decisions change over time. A phase one report outlining major findings is available. Data collection for the second phase of this study was conducted in August 2012 and analysis is underway. This study design has been replicated on a smaller scale in Uganda in order to add to the knowledge base and provide a site in East Africa for comparison.
In Nigeria, NetWorks implemented a study evaluating the integrated net distribution campaign that UNICEF carried out in Sokoto State, comparing its results with that of a stand-alone net distribution campaign in a neighboring state. NetWorks is also designing and implementing post-campaign evaluations of pilot routine distributions in Nasarawa and Cross River states, which target community distribution and school-based distribution respectively.
Furthermore, NetWorks launched a net care and repair BCC campaign in Nasarawa State Nigeria to understand the feasibility of increasing the useable life of a net through net care and repair behaviors. The research team conducted qualitative formative research to understand existing net care and repair behaviors as well as motivations and barriers for implementing these practices. Results from this assessment were shared and utilized during the campaign design workshop. Additionally, the campaign will be evaluated using a quasi-experimental design with baseline and endline surveys conducted in the target district as well as a control district. The baseline survey has been conducted and the follow-up surveys will occur in March 2013 and March 2014. These surveys include a quantitative durability assessment, which is used to assess the condition of nets in both sites within Nasarawa state. Additionally, the same survey will be administered in Zamfara state and Cross River state in order to understand the durability of nets in three ecological zones in Nigeria. The care and repair study and intervention will also be replicated in Uganda.
In Uganda, NetWorks evaluated a Hang-Up campaign using a cluster randomized, controlled community intervention design to assess the impact of household visits by volunteers on net use. This evaluation found a limited effect of hang-up visits on net hanging and use. NetWorks also launched the aforementioned Culture of Net Use study in March 2012 and a final report has been completed. The second phase of the qualitative, longitudinal study will take place in early January 2013. NetWorks plans to launch a net care and repair BCC campaign in February in Serere district, eastern Uganda to understand the feasibility of increasing the useable life of nets through net care and repair behaviors in addition to motivations and barriers for implementing these practices. In addition, this will provide a comparison to the care and repair BCC campaign and research in Nigeria. Results from the formative research in Nasarawa State showed that net care and repair behaviors are at a base level of knowledge and awareness. As such, a midterm qualitative assessment on net care and repair will be conducted in early March 2013 in the intervention district, Serere, and the control district, Kaliro. This assessment will be conducted several months after the campaign launch, to provide ample time for any changes in net care and repair behaviors resulting from the campaign to take hold. Similar to Nigeria, the campaign will be evaluated using a quasi-experimental design with baseline and endline surveys conducted in the target district as well as the control district. The baseline survey has been conducted in November 2012 and the follow-up survey will occur in April 2014.
In Tanzania, NetWorks has conducted formative research in Kagera and Zanzibar on messaging to encourage community members to use nets in the context of reduced malaria transmission settings. Kagera and Zanzibar have been especially successful in reducing their incidence of malaria through IRS (indoor residual spraying), and distribution and promotion of nets. This research included focus groups of net users and non-users and will investigate the differences in knowledge, attitudes, and experiences between these two groups. Data collection has been completed and analysis is underway. Data from these focus groups will be used to design messages encouraging net use in low transmission settings, where the perceived risk of malaria may be low.
In addition, NetWorks conducted a mixed methods evaluation of the Community Change Agent (CCA) program in Tanzania. This program uses community health workers to promote net use and provide information about malaria and proper use of nets. The evaluation consisted of quantitative and qualitative inquiry among both the CCAs themselves as well as community members. The data has been collected and is being analyzed to understand the role of CCAs and other communication channels in promoting net use in Tanzania.
NetWorks is a project funded by USAID in partnership with Johns Hopkins Bloomberg School of Public Health.