Don’t Suarez it!

Matt and I just got back from a National Malaria Control Program (NMCP) meeting. The second such four hour long affair that TAMTAM has attended, the meeting excited me. The meeting consisted of 25 people from the NMCP itself, USAID, and partner NGOs; a very strong group setting out with the ambitious goal of achieving universal insecticide-treated net coverage in Ghana and making good progress toward this goal. It was heartening that we were two of the three people in the room who are not from Ghana. It was also nice to feel like the study we are doing this summer will inform their work.

So, what are we doing this summer? We had a vague idea of what we might do before we arrived; of course, all that changed once we got here.

We will be conducting our study on both registration for bed net distributions and the actual distributions. During registration, community health volunteers survey the number of people, sleeping spaces, and existing effective bed nets in compounds. While this may seem straightforward enough, the devil is where he so often resides – in the details. For instance, many people here live in compounds, which we’ve so far seen range between 4 and 36 people. Sometimes a compound means multiple families live in different rooms of the same building; sometimes a compound means multiple wives and their children live in different rooms of the same building; sometimes a compound means all manner of extended family living in different rooms of the same building. When you are registering people, do you register them by home or by compound? Who should pick up the bed nets during the distribution? Does the veranda count as a sleeping space if people sleep there when it is hot?

We will follow the WHO guidelines of distributing one net per two people (rounding up for odd numbers) up to the number of sleeping spaces, minus the number of existing viable nets. I must mention that this formula is henceforth known as the Constance formula, for she is responsible for developing it at the very meeting we attended this morning. And herein lies the source of this post’s title: “Don’t Suarez it!” As in, don’t take something that’s not yours! (BOO Suarez!) At least he provided a good laugh at the NMCP meeting, though I’d prefer he not have batted Ghana’s ball out of the goal. BOO Suarez!!

Our study is on whether or not offering soap as an incentive for effective bed nets will increase reporting of effective bed nets. This will be an important topic for the NMCP as they undertake campaigns in regions with 30-40% net ownership. With limited funds for nets, they want the nets that they have to go to people who do not already sleep under good nets.

The second phase we are studying is bed net distribution, which you can imagine has as many caveats as registration. One such caveat is whether to do a door-to-door distribution or a point distribution. While this would be an excellent topic to investigate, we are limited to a few thousand nets and the ability to randomly assign people, not whole villages, to different treatments. We will be doing a point distribution, in which people come to one point in the community to pick up their own nets. We will be randomly assigning each compound in which people live not to receive hang-up of their nets, to receive hang-up by community-health workers after 3 days, to receive hang-up by community-health workers after 7 days, or to receive hang-up by community-health workers after 14 days.

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