Indoor Residual Spraying (IRS) is one of the most effective tools in the fight against malaria. In Zambia, technicians enter dwellings once per year and spray the wall surfaces of buildings with insecticides that kill mosquitos who land on the walls and deter others from entering. Since mosquitoes feed in the evening and at night when humans are indoors, the spraying can greatly reduce the number of bites that occur.
But in rural areas like Zambia’s Luapula and Central Provinces, it is unclear how many dwellings exist, and where those dwellings are located. Without this information, deciding where to spray the insecticides is very difficult, the planners having no way to effectively target IRS to houses in areas of the highest malaria burden. While IRS remains one of the most effective tools for fighting malaria, the pesticides are expensive and must be targeted effectively.
So how to correct for this information gap? How to find out where exactly these dwellings are located so that they can be targeted effectively? Historically, if dwelling enumeration was done, it was done on foot, enumerators visiting villages in person, identifying houses visually and noting the GPS coordinates with a handheld device. It’s not hard to imagine that this method is extremely time-consuming and labor-intensive – especially for a large-scale enumeration. Zambia’s Ministry of Health (MOH), Ministry of Community Development Mother and Child Health (MCDMCH) and Akros technicians found a solution that is at the same time cost-effective and accurate, providing the pinpoint sort of data required for a more effective IRS implementation.
The University of the Western Cape (UWC) School of Public Health in cooperation with The Mauerberger Foundation established an award in 2013 to honor the memory of Jakes Gerwel, the university’s late Vice Chancellor. Before joining the university, Gerwel was Director General in the office of Nelson Mandela’s presidency. Each year the award honors a graduate of the school for the outstanding work he or she has demonstrated in the field of public health.
Anne Mutunda, a Water & Sanitation Health (W.A.S.H.) Surveillance Officer with Akros, is being honored as a nominee for the work she did during her MPH studies at the university. The qualitative study, undertaken in 2012, was initially seen as an exploration of the factors influencing the understanding, experiences and practices of menstrual hygiene among adolescent girls in secondary schools in the Mongu District of Zambia’s Western Province. Mutunda recognized a situation where menstruation has been, and still is a taboo that is dealt with in secrecy, information and knowledge about menstruation and menstrual hygiene among adolescent girls being inadequate as a result.
During the process of the study, however, Mutunda would find that there would need to be a clear focus on the anticipated knowledge gap and the associated traditional cultural factors influencing menstrual hygiene. There was also a strong focus on the socio-economics, both of the girls individually and the schools they attended. The poverty in which they lived meant that the girls had no access to the basic necessities of sanitary towels, instead using torn bits of rags or toilet paper. Even more significantly, a lack of water and sanitation facilities at home and at the schools made even the most basic hygiene practices impossible.
A group of almost 40 secondary school students from Lusaka International Community School (LCIS) recently received a tour of the National Malaria Control Center to learn about malaria and how the Zambian Ministry of Health and its partners are fighting the disease in their country.
“Raise your hand if you or someone you know has had malaria,” said Daniel Bridges, Akros Director of Research. Many hands around the room shot up, the students present all too familiar with the impact the disease can have on an individual. Pupils were then taken through an interactive presentation where they learned about how malaria is spread, how it can be prevented and how it is treated. A couple of the teachers even volunteered to be tested for the parasite (all negative thankfully) so that the students could all see the tests being used for real.
Akros has been awarded a grant from the Malaria Eradication Scientific Alliance (MESA) to continue the push towards malaria elimination in Lusaka, Zambia. The grant of almost USD $200,000 will be used to 1) Develop risk maps of residual transmission and the risk of onward transmission from imported malaria cases and 2) Assess sensitivity of risk maps to target malaria interventions to stop the importation and spread of malaria transmission in Lusaka, Zambia.
Malaria Indicator Surveys conducted in 2010 and 2012 found zero malaria parasite infections among children under the age of five during high transmission season. However, confirmed malaria cases were still reported at health facilities, likely due to small pockets of residual malaria transmission and malaria being transported into Lusaka through people returning to Lusaka from outlying regions. These pockets must be eliminated to achieve zero transmission and imported malaria cases must not be allowed to re-establish transmission once malaria elimination is achieved.
Zambia continues to work toward the ambitious goal of eliminating malaria in five zones by 2015. To make this goal a reality, myriad partners are working together on every level from the molecular to the administrative to the on-the-ground Community Health Workers (CHWs). These CHWs are responsible for visiting houses of those who present with active malaria cases at the clinic level and then testing the neighbors in the immediate area through a program Akros helped pilot called Reactive Case Detection. Often the distance to these active cases is significant despite the large number of CHWs, and visiting every case on foot can be an overwhelming and at times unachievable task.
So last week, the Government Republic of Zambia in partnership with PATH-MACEPA, Akros and World Bicycle Relief distributed over 1,100 bicycles to community health workers across seven districts in Zambia’s southern province. The distribution ceremonies took place from February 10 – 14 and were attended by village chiefs and leaders, ministry officials and partner organizations. The ceremonies included dramas, dancing, and an official handover of each and every bicycle to the very excited CHWs.
Akros has received the last major shipment of equipment for the newly installed molecular container lab at the Zambia National Malaria Control Centre (NMCC) through our collaborators at the Harvard School of Public Health. This lab will enable in-country technicians to perform a wide range of molecular investigations including genotypic analysis of malaria parasites and mosquito specimens, and it came at a fraction of the cost of traditionally constructed laboratories.
“For the first time, Zambia NMCC will have the resources and the throughput to perform genotypic analysis in-country,” said Dan Bridges, Director of Research for Akros. “This will expose Zambian scientists to new techniques, paradigms and enable the NMCC to remain at the forefront of understanding malaria.”
One long standing and successful deployment has been driven by a Malaria program run by the National Malaria Control Center in Zambia. The system is used for mobile reporting from health workers at health clinics and voluntary community health workers in the villages, with each of the two user groups reporting on key data that is relevant for their tasks and responsibilities. The project uses the DHIS Mobile Java clients for aggregate reporting, connected to a national DHIS2 instance that is also available for other projects and programs to share. The project supplies low cost mobile phones and prepaid SIM cards for health workers to report with, and the client uses mobile data (GPRS) to send information to the DHIS2 server.
UNICEF and the Zambia Ministry of Local Government and Housing (MLGH) retained Akros last year to revitalize its Community-Led Total Sanitation (CLTS) intervention among rural Zambian villages. The intervention uses a combination of techniques to persuade community members to use latrines. If people use latrines instead of simply defecating in the open, then fecal-based contamination decreases. When latrines are regularly used, communities see a sharp decrease in Cholera, food poisoning, diarrhea, and other illnesses.
To date, WASH surveillance in Zambia has been slow, inaccurate and incomplete. This made it extremely difficult to target the WASH interventions effectively, and to assess whether these actions were having any real impact. UNICEF and MLGH asked Akros to help in August of 2013.
Akros has been retained by UNICEF and Praekelt Foundation to lead the design and rapid deployment of a community-level WASH surveillance system in Zambia. The project will scale to a total of twenty districts in the coming months, and will provide real-time data on WASH-indicators at the village level to MLGH and UNICEF stakeholders. This project builds on Akros prior successes in rapidly scaling up similar community-level surveillance packages with the Zambian Ministry of Health and PATH/MACEPA. Learn more here.
“This surveillance system will provide unprecedented empowerment to the environmental health technicians and community champions supporting progress toward open-defecation free status in their catchment areas”, said Benjamin Winters, Country Director for Akros in Zambia. “Without good, timely information, it is nearly impossible to know where or how to focus interventions. We are drastically changing the game here.”
In collaboration with University of Oslo developers, Akros has customized a curriculum for Advanced System Configuration (System Configuration II). This course will address many of the administrative tools available to DHIS2 implementers through the GUI, and builds on the foundation created in System Configuration I. Click here to see a full listing of Akros DHIS2 offerings.
The DHIS2 surveillance suite is rapidly building a large user base in Africa, India and other developing regions. It is flexible and highly customizable, integrating a robust mobile phone surveillance module, clean data visualization tools and vast integration capabilities with reporting engines and other database applications. In addition to System Configuration II, Akros offers several other end-user and system administration courses. See dhis2training.com for more details.