Using geo-coding to quantify community needs for Zambia s Indoor Residual Spraying (IRS) program

Transcription

1 Using geo-coding to quantify community needs for Zambia s Indoor Residual Spraying (IRS) program Brian Chirwa Information Officer, Health Services and Systems Program (HSSP), Abt Associates Inc.

2 Background Malaria in Zambia Estimated to account for more than 45% of clinical consultations and a quarter of childhood deaths 4.3 million suspected cases and 50,000 deaths annually Incidence rate of 408 per 1,000 people 6,452 reported deaths in children under 5, (2006 Zambia HMIS)

3 Background From 2006/07 transmission season the USAID-funded Health Services and Systems Program (HSSP) has been assisting the National Malaria Control Program in implementation of IRS activities and operations. Support includes: National Strategy development, coordination, and management of IRS District planning Pesticide safe storage and handling Training and supervision of district managers and spray operators Implementation of IRS activities in target districts Monitoring, information management, and applied research for IRS Procurement of personal protective equipment (PPEs)

4 Background Indoor Residual Spraying is one of the primary malaria prevention strategies implemented in Zambia: Currently supported in 15 districts Objective is coverage target of 85% of eligible population in target districts Roughly 700,000 households covered (2007/2008 spray season)

5 Zambia s 15 IRS Districts CHILILABOMBWE CHINGOLA MUFULIRA KALULUSHI SOLWEZI KITWE LUANSHYA NDOLA KABWE LUSAKA CHONGWE KAFUE MAZABUKA KAZUNGULA LIVINGSTONE

6 IRS Program Expansion Originally in 5 districts in 2001 Expanded to 15 districts by 2007 Covering about 24% of the vulnerable population living in suburban/ peri-urban communities Collectively these districts represent roughly 34% and 33% of the total population and total households, respectively Planned expansion to 36 of the Nation s 72 districts by the end of 2008

7 Design Geocoding of IRS-targeted households using hand-held, personal-digital assistants (PDAs) introduced into the spray program in 2007 Provides accurate information on communities in each district: Number of structures that exist/ require spraying Type of structures Numbers of population associated with structures Availability of other resources (such as bed nets) found in structures

8 Design Consensus among key partners resulted in financial and technical support for initial enumeration training of IRS national and district focal points Training included: Use of PDAs Basic methods in GIS GPS units and related equipment WHO s Healthmapper software program Benefits of using such an information system for the collection of data for IRS activities

9 Tools Hardware PDAs (Dell Axim X51s and HP ipaq 2495s) Windows Mobile 5 Equipped with US GlobalSat SiRF Star III compact flash GPS units Software Malaria Branch, Centers for Disease Control and Prevention (CDC), Atlanta, USA (A. Frolov) Developed in Visual Basic using SQL Mobile Used extensively for household listing and survey-based field sampling Program data includes: Information on the number of household inhabitants Number of rooms per structure Plastered (formal) Unplastered (informal) Number of mosquito nets available Household geo-coordinates with unique identifying number

10 Training of Enumerators Local communities recommend eligible candidates Nominated candidates attend training Training session is carried out over 2-3 days Geocoding field exercises are conducted Training includes downloading of data to the computer and charging PDAs

11 Training of Enumerators Enumerators practice using PDAs before beginning field exercises

12 Training of Enumerators Mock interviews are an important component of the enumerator training course

13 Training of Enumerators Practical training in the field is conducted before final teams of enumerators are selected

14 Results and Outcomes 43 district level personnel trained as master trainers Over 400 volunteers from 11 districts trained as enumerators* IRS supervisors trained in program management and data handling * Enumerators are community volunteers and their efforts are considered community contributions. However, they are provided with transportation cost refunds and lunch allowances.

15 Results and Outcomes

16 Results and Outcomes IRS areas and structures have been mapped and geo-coded in 11 districts (out of 15)

17 Results and Outcomes

18 Results and Outcomes The GIS program has proven to be an important tool for national and district level planning for IRS activities, including: Quantification of insecticide requirements Anticipated number of spray operators to be trained Vehicles needed to conduct IRS operations and access communities Equipment necessary to carry out full coverage in each district

19 Next Steps Remaining 4 districts of 15 pilot districts will be mapped and geo-coded before the 2008 spray season Additional 7 new districts (of 21 expansion districts) will be geo-coded before 2008 spray season (remaining 14 will be completed in 2009) Training of Master trainers for 7 new districts has already been conducted, new enumerators will be trained as part of the roll-out

20 Challenges Need for periodical update of geo-coded structures based on population changes (every 3-5 years) Communication in the field is challenging, as teams are spread over large areas and sometimes need to be shifted Steep learning curve for supervisors on PDA and GIS use, especially as they are not full-time staff Future use and integration of GPS/GIS data for planning, monitoring, and evaluation of other health interventions

21 Conclusions GPS/GIS is an important tool for accurate and timely quantification and monitoring of IRS-related health needs and activity planning at the community level To successfully introduce these programs, substantial time and support should be invested in developing capacity of national and district level personnel to introduce, monitor, and update the system

22 Thank You! Partners: Ministry of Health National Malaria Control Centre Malaria Control and Evaluation Partnership in Africa Co-Authors: Chandana Mendis (HSSP) Christopher Lungu (MACEPA) Chadwick Sikaala (NMCC) Dayton Masuka (HSSP) John Miller (MACEPA) Simon Smith (Abt Associates Inc.)