Final Report on the Evaluation of Free Insecticide Treated Bednet

Transcrição

Final Report on the Evaluation of Free Insecticide
Treated Bednet Distribution in Sofala and Manica
Provinces, Mozambique, 2005
May 2006
Alexandre Macedo de Oliveira, MD, MSc
Adam Wolkon, MPH
Ramesh Krishnamurthy, PhD, MPH
Centers for Disease Control and Prevention, Atlanta, USA
Mozambican Ministry of Health
Mozambican Red Cross
Canadian Red Cross
1
Table of Contents
Summary ............................................................................................................................. 3
Introduction......................................................................................................................... 5
Objectives ........................................................................................................................... 6
Methods............................................................................................................................... 7
Teams.............................................................................................................................. 7
Definitions....................................................................................................................... 8
Study design and sample size ......................................................................................... 8
Statistical analysis........................................................................................................... 9
Results................................................................................................................................. 9
HH characteristics....................................................................................................... 9
Campaign .................................................................................................................. 10
Children under 5 years old........................................................................................ 11
Pregnant women........................................................................................................ 11
Net specifics.............................................................................................................. 12
ITN ownership, use, and equity ................................................................................ 12
Discussion ......................................................................................................................... 14
Acknowledgments............................................................................................................. 17
References......................................................................................................................... 17
Tables................................................................................................................................ 19
Figures............................................................................................................................... 29
Annex 1. Questionnaire .................................................................................................... 34
Annex 2. Selected districts, enumeration areas, and HHs mapped................................... 46
2
Summary
Long-lasting insecticide treated bednets (LLITNs) were distributed in December
2005 in Sofala and Manica provinces, Mozambique approximately two months after the
second round of the National Polio and Measles Campaign that took place in September
2005. Vouchers were distributed at the time of the immunization campaign, which were
to be redeemed later for an LLITN. We conducted a community-based cross-sectional
survey in these two provinces in February 2006, two months after the distribution of
LLITNs. This survey provided data on ownership and use of insecticide-treated bednets
(ITNs) in those provinces.
Four districts in each province and four enumeration areas (EAs) in each district
were selected using probability proportional to size. Within each EA, 32 households
(HHs) were selected using a simple random sample. We conducted interviews in each of
the selected HHs. Approximately 360,000 LLITNs were distributed as part of this
initiative. Of the selected 1024 HHs, valid interviews were completed for 947 (92.5%)
HHs (440 in Manica and 507 in Sofala). Of the participating HHs, 65.0% in Manica and
63.1% in Sofala reported at least one child less than 5 years of age and 10.2% in Manica
and 10.5% in Sofala reported at least one pregnant woman having slept in the house the
previous night. In Manica, 67.4% of HHs with at least one child under 5 years old
reported they received at least one voucher for an ITN during the registration phase in
September while in Sofala this rate was 69.3%. Of those, 91.0% HHs in Manica and
89.8% in Sofala redeemed at least one of the vouchers and received at least one LLITN.
Pre-campaign HH ownership of at least one bednet of any kind was 20.6% and
35.6% in Manica and Sofala, respectively. In addition, the equity ratio in Manica was
0.10 and in Sofala was 0.71. Post-campaign, 55.1% and 59.6% HHs owned at least one
bednet of any kind in Manica and Sofala, respectively. We found equity ratios of 0.50 in
Manica and 0.92 in Sofala. In addition, 51.5% HHs (equity ratio =0.54) in Manica and
48.5% HHs (equity ratio =0.95) in Sofala reported ownership of at least one ITN.
In Manica and Sofala, 48.1% and 47.6% of HHs respectively reported that they
had at least one ITN hanging in their HH the night before the interview date. However, in
HHs that owned at least one ITN, 89.2% in Manica and 92.4% in Sofala reported to have
3
had at least one ITN hanging the previous night. In both provinces, 60.3% of children
under 5 years old (59.3% in Manica and 61.6% in Sofala) and 39 (39%) of 100 pregnant
women reported sleeping under an ITN the previous night.
The LLITN distribution in Sofala and Manica achieved higher rates of ITN
ownership and use. It achieved the Roll Back Malaria (RBM) target of use by children
under 5 years old when Manica and Sofala provinces are combined. However, the RBM
targets of HH ownership of ITNs, and use by children in Manica alone and pregnant
women in either province were not met. In Manica, the campaign resulted in inequitable
access to ITNs, with the least poor families achieving greater access to ITNs than poorer
families. In addition, more nets were distributed than vouchers. Both of these facts call
into question the utility of voucher-based systems for integration of ITN distribution with
vaccination campaigns. Nonetheless, integration of ITN distribution with vaccination
campaigns presents an opportunity for reaching malaria control goals and should
continue to be considered for large-scale implementation.
4
Introduction
Malaria is endemic throughout most of Mozambique. Approximately 40% of
total outpatient complaints in Mozambique result from malaria and this figure increases
to 60% if only pediatric cases are considered. In addition, malaria is the biggest killer of
young children in Mozambique. Overall, mortality rates among children less than 5 years
old in Mozambique are estimated at 178/1000, resulting in the deaths of an estimated
170,000 children less than 5 years old each year. Malaria is thought to constitute 30% of
this figure, approximately 40,000 children yearly.
In August and September 2005, the Mozambican National Vaccination Campaign
provided measles and polio vaccination and vitamin A to children in Mozambique. Each
intervention was given according to target group ages: 0–59 months for polio, 6–59
months for vitamin A, and 9 months–14 years for measles. The campaign’s first round
happened in August 2005, when children were vaccinated against polio and measles and
received vitamin A. During the second round in September 2005, children received a
second dose of polio vaccine.
Together with the second round of the campaign, vouchers for long-lasting
insecticide-treated bednets (LLITNs) were distributed to mothers or caretakers of
children under 5 years old in the provinces of Sofala (excluding the city of Beira) and
Manica. Vouchers were limited to one per household (HH). A HH was defined as a
woman (or guardian) and her children living together. Pregnant women were not targeted
directly by this campaign. A total of 247,268 vouchers were distributed. Table 1 shows
the number of vouchers distributed by districts in the two provinces.
The Mozambican National Malaria Control Program selected the provinces of
Sofala and Manica because there were no proposals or commitments from donors for
malaria control in these two provinces. Figure 1 shows a map of Mozambique and these
two provinces are indicated. Beira was not included in the distribution because the city
was part of an indoor residual spraying program.
In December 2005, 358,331 LLITNs were distributed. Distribution posts were set
up in the provinces and, upon presentation of vouchers, LLITNs were distributed to HH
members. Table 1 shows the number of LLITNs distributed by districts in those
5
provinces. Of note, many eligible HHs that did not get a voucher in September 2005 also
received a LLITN according to the distribution criteria. To keep track of the LLITN
distribution process and avoid that a given HH would receive more than one bednet, HH
members had their index finger marked when they received an LLITN.
The primary objective of the integrated campaign was to reduce morbidity and
mortality in young children in Mozambique. Studies in Western Kenya showed that
insecticide-treated bednets (ITNs) were effective in averting approximately one in four
infant deaths in areas of intense transmission with high coverage (Phillips-Howard et al,
2003). Prior interventions in Togo, Ghana, and Zambia have shown rapid increase in
ITN ownership and use when free distribution was paired with vaccination campaigns
(Morbidity and Mortality Weekly Report, 2005; Grabowsky et al, 2005a; Grabowsky et
al, 2005b).
We present the preliminary results of the coverage survey conducted in Manica
and Sofala provinces, Mozambique in February 2006. This survey included the
following components: HH information, HH ownership of bednets and ITNs, ITN use
rate by children under 5 years old and pregnant women, and economics. These data will
provide supportive information to the ongoing efforts of the Mozambican Ministry of
Health to control malaria.
Objectives
1. Retrospectively measure pre-campaign HH ownership of bednets of any kind.
2. Measure post-campaign HH ownership of bednets of any kind and ITNs and their
use per Roll Back Malaria (RBM) target groups:
a. HHs;
b. Children under 5 years old;
c. Pregnant women.
3. Assess coverage of above by HH economic status through asset scores.
6
Methods
We conducted the survey from February13 to 24, 2006, approximately two
months after the LLITN distribution (December 2005). We collected information on preand post-campaign HH ownership of bednets and post-campaign ITN ownership and use.
We organized the questionnaire into five parts: HH information, bednet characteristics,
ITN use by children under 5 years old and pregnant women, and economics. A copy of
the questionnaire is attached to this report (Annex 1).
We used personal digital assistants (PDAs) (Dell Axim X50s, Dell, Austin,
Texas) in conjunction with global positioning system units (GPS) (Pharos, Torrance,
California) to conduct this survey. The PDA platform was Pocket PC 2003 SE. We
mapped all HHs in each enumeration area (EA). Descriptive information was collected at
that time to allow return to selected HHs during the navigation process. After mapping,
we chose a simple random sample of HHs among all HHs (rather than of the HHs with at
least one child under 5 years old) as the sampling unit. We then used the PDAs and GPS
devices to navigate to the selected HHs. For these steps, we used a program (GPS Survey
2.0) developed by the U.S. Centers for Disease Control and Prevention (CDC). As
previously mentioned, we included HHs with and without children in the survey.
Interviews were preprogrammed into the PDAs using Visual CE 9.1 (Syware Inc,
Cambridge, Massachusetts). We requested verbal consent from interviewees before the
survey and responses were recorded onto PDAs. All questions had pre-coded answers,
but choices were not read to respondents. Responses could be coded as ‘other’ if the
respondent’s answer did not match any of the existing responses.
Teams
We trained four teams of interviewers. Teams consisted of three to five
interviewers and one supervisor, who were regular employees of Mozambican Red Cross
or Mozambican Ministry of Health, as well as Mozambican Red Cross volunteers. Team
members were fluent in oral and written Portuguese and able to converse in other local
languages. Interviewers and supervisors were trained on the survey and technology from
February 6 to 10, 2006, just prior to the field work. Each team had a vehicle and a driver.
7
Each team went to one of the districts in Manica during the first week of the survey and
the process was repeated for Sofala during the second week.
Once in the field, team members were each accompanied by community members
who served as guides and translators for local languages. Teams mapped each EA in the
morning and gathered around midday for data merging and selection of HHs. Interviews
of selected HHs in that EA were conducted and completed during the afternoon of the
same day, thus work in each EA was finished within one day.
Definitions
For this evaluation, we defined an ITN as either an LLITN or a conventional
bednet that had been treated with insecticide within the previous 6 months. We chose the
cut off of six months because the insecticide most commonly used in Mozambique was
cyfluthrin, which has approximately 6 months of bioactivity on a bednet. Interviewers
were trained to ask to see the bednets, and to ask questions about treatment history, if
appropriate. HH ownership was based on responses from the interviewee. In addition,
we considered a bednet or ITN hung if the interviewee reported that it had been hanging
the previous night.
Study design and sample size
This study was a community-based cross-sectional survey. It used a stratified
three-stage cluster sample design. Four districts in each of the two provinces were
selected using probability proportional to size (PPS) sampling methodology. Then, we
selected four EAs in each district also through PPS. The HH was used as the primary
sampling unit. We selected a simple random sample among all the HHs mapped in each
EA. We used the same definition for HH used during the voucher and LLITN
distribution phases, i.e., a woman and her children living together. If no woman or
children lived in the HH, then the HH was defined by the man. The sampling frame for
the survey was based on the most recent census from the National Institute of Statistics of
Mozambique (1997), which divided the country in EAs. The selected districts and EAs
evaluated in this survey are listed in Annex 2.
8
The main outcome used for the sample-size calculations was the HH ownership of
ITNs after distribution. Sample-size calculations were done using the StatCalc module
(EpiInfo 2000, CDC, Atlanta). The study was designed to have at least 90% power to
estimate the proportion of HHs that received an ITN during the campaign (specified as
65%) within a range of 5% and a design effect of 1.2 per province. In total, 400 HHs
were needed in each province (25 HHs per each of the 16 EA in each province). To
cover for missing data of any cause, we increased the sample size by 25%, so a total
number of 32 HHs per EA were included in the survey.
Statistical analysis
The final data was available in Microsoft Access format. We used EPI Info 2000
(CDC, Atlanta, Georgia), Sudaan 9.0 (Research Triangle Institute, Research Triangle
Park, North Carolina), and SAS (SAS Institute, Cary, North Carolina) to analyze the data.
Statistical analysis accounted for weighting and clustering of data using appropriate
methods. All percentages presented in this report are the result of weighted analysis,
unless otherwise noted.
Population was stratified by economic score calculated according to World Bank
asset scoring for Mozambique based on the 1997 demographics and health survey. We
ordered all HHs surveyed by asset score and divided them into 5 quintiles, starting with
the 20% with the lowest scores going up to the 20% with the highest scores. Economic
equity ratio was calculated as the ratio of proportions in the poorest quintile to the least
poor quintile.
Results
HH characteristics
In Manica, a total of 440 HHs were surveyed. The number of mapped and
interviewed HHs per district is shown in Table 2. The median number of total persons,
children, and pregnant women who slept at the HH the night before was 3 (range: 0–12),
1 (range: 0–5), and 0 (range: 0–2), respectively. HHs had a median number of 2 sleeping
spaces (range: 1–6) used the previous night.
9
A total of 507 HHs were surveyed in Sofala province (Table 2). The median
number of total persons, children, and pregnant women sleeping at the HH the night
before was 3 (range: 0–12), 1 (range: 0–3), and 0 (range: 0–2), respectively. HHs had a
median number of 2 sleeping spaces (range: 1–6) used on the night before.
Campaign
Among the 947 HHs interviewed, 48.3% in Manica and 48.2% in Sofala received
at least one voucher at the vaccination post in September 2005. Forty-six HHs received
more than one voucher. Of HHs with or without a child under 5 years old that received at
least one voucher, 88.9% in Manica and Sofala presented at least one of these vouchers
and received a LLITN. The most common reasons for not redeeming the vouchers were
losing the voucher and not knowing when and/or where to redeem it in Manica; and, in
Sofala, those reasons were losing the voucher and lines too long. In Manica, 29 HHs
received at least one campaign LLITN without presenting a voucher, but our analysis
revealed that 26 of these had at least one child under 5 years old living in the HH. In
Sofala, 22 HHs received at least one campaign LLITN without presenting a voucher, but
our analysis revealed that 19 of these had at least one child under 5 years old living in the
HH.
Once we restricted the analysis to the HHs with at least one child under 5 years
old (the target group for this distribution), we observed that 67.4% of HHs in Manica and
69.3% in Sofala had received at least one voucher during the campaign. In addition,
91.0% of HHs that had at least one child under 5 years old and received at least one
voucher redeemed at least one of them in Manica, while in Sofala, this ratio was 89.8%.
Within our sample in Manica, in addition to the 210 LLITNs distributed upon
presentation of a voucher, 28 (11.8%*) LLITNs were distributed without the presentation
of a voucher. In Sofala, 27 (10.7%*) LLITNs were distributed without the presentation of
a voucher in addition to the 225 distributed upon presentation of a voucher.
*
Percentage not weighted.
10
Post-campaign visits by a Mozambican Red Cross volunteer discussing the
importance and benefits of ITN use was conducted in 26.1%* and 57.2%* of HHs in
Manica and Sofala, respectively.
Children under 5 years old
In Manica, a total of 407 children under 5 years old were included in the survey.
The median age of these children was 20 months (range: 1–60) and 207 (50.9%*) were
female. In Sofala, we included a total of 447 children under 5 years old. The median age
of these children was 24 months (range: 1–60) and 233 (52.1%*) were female.
Among all children under 5 years old, 88.7% and 86.6% went to a vaccination
post in September in Manica and Sofala, respectively. Moreover, 59.9% of children
under 5 years old in Manica and 53.3% in Sofala received a voucher. Reasons for not
receiving a voucher are listed in Table 3. Finally, 51.6% and 45.4 % of mothers or
caretakers of children under 5 years old went to the distribution post in November or
December 2005 and received an LLITN from the campaign in Manica and Sofala,
respectively.
Considering the children under 5 years old in Manica and Sofala, 59.3% and
61.6% slept under an ITN the previous night, respectively. Distribution per district is
shown in Table 4. When data from both provinces are combined and weighted, 60.3% of
all children under 5 years old slept under an ITN the previous night.
Pregnant women
A total of 100 pregnant women were included in our survey (46 from Manica and
54 from Sofala). In Manica, 32.6%* slept under an ITN the previous night, while in
Sofala this ratio was 44.4%.* For both provinces combined, this ratio was 39%.* Due to
the small sample of pregnant women, a valid confidence interval for this indicator could
not be calculated.
*
11
Net specifics
Among 440 HHs in Manica, 55.1% (95% confidence interval [CI]: 43.6–66.1)
had at least one bednet of any kind and we collected information on 309 bednets of any
kind. Of these bednets, 279 (90.4%; 95% CI: 82.2–95.0) were ITNs. Among all ITNs,
256 (91.8%*) were campaign LLITNs and 23 (8.2%*) were ITNs of other origin. Among
the 23 noncampaign ITNs, 11 (47.8%*) were LLITNs and 12 (52.2%*) were regular
bednets that were treated with insecticide within the previous 6 months. Two hundred
twenty-six (51.5%; 95% CI: 41.3–61.5) HHs had at least one ITN. Of all ITNs included
in the sample in Manica, 91.0% (95% CI: 85.3–94.6) were reported to have been hanging
the night before the survey.
Among 507 HHs in Sofala, 59.6% (95% CI: 42.4–74.7) had at least one bednet.
We collected information on 369 bednets of any kind. Of those bednets, 279 (75.9%;
95% CI: 70.0–80.8) were ITNs. Among all ITNs, 249 (89.2%*) were campaign LLITNs
and 30 (10.8%*) were ITNs of other origin. Among the 30 noncampaign ITNs in Sofala,
18 (60.0%*) were LLITNs and 12 (40.0%*) were regular bednets that were treated with
insecticide within the previous 6 months. Two hundred forty-three (48.5%; 95% CI:
34.8–62.4) HHs had at least one ITN. Of all ITNs included in the sample in Sofala,
96.6% (95% CI: 92.6–98.5) were reported to have been hanging the night before the
survey.
ITN ownership, use, and equity
In Manica, pre-campaign HH ownership of at least one bednet of any kind was
20.6% (95% CI: 8.0–43.6). In addition, pre-campaign HH ownership was lower in the
poorest quintile (5.7% [95% CI: 1.3–21.8]) compared to the least poor quintile (55.7%
[95% CI: 43.0–67.8]) with an equity ratio of 0.10. Post-campaign HH ownership of at
least one bednet increased to 55.1% (95% CI: 43.6–66.1). Post-campaign HH ownership
in the poorest quintile was 41.2% (95% CI: 19.3–67.4) compared to 82.3% (95% CI:
68.9–90.7) in the least poor quintile with a higher equity ratio (0.50) (Figure 2).
*
12
Pre-campaign HH ownership of at least one bednet of any kind per HH was
35.6% (95% CI: 27.8–44.3) in Sofala. Pre-campaign HH ownership was lower in the
poorest quintile (27.9% [95% CI: 20.3–37.0]) compared to the least poor quintile (39.4%
[95% CI: 27.8–52.2]) with an equity ratio of 0.71. Post-campaign HH ownership of at
least one bednet increased to 59.6% (95% CI: 42.4–74.7). Post-campaign HH ownership
45.2–67.2) in the least poor quintile with a higher equity ratio (0.92). These results are
summarized in Figure 2.
Post-campaign HH ownership of an ITN was 51.5% (95% CI: 41.3–61.5) in
Manica. Post-campaign HH ownership of ITNs in the poorest quintile was 40.3% (95%
CI: 19.9–64.7) compared to 74.3% (95% CI: 62.0–83.8) in the least poor quintile with an
equity ratio of 0.54. Similarly, HH post-campaign ownership of an ITN was 48.5% (95%
CI: 34.8–62.4) in Sofala. Post-campaign HH ownership of ITNs in the poorest quintile
was 42.9% (95% CI: 24.8–63.1) compared to 45.3% (95% CI: 38.3–52.5) in the least
poor quintile with an equity ratio of 0.95. These results are summarized in Table 5 and
Figure 3.
Once we restrict the analysis to bednets distributed during the campaign, we
observed that HH ownership of at least one campaign LLITN was 48.6% (95% CI:
38.1%–59.1) in Manica. In addition, HH ownership of campaign LLITNs in the poorest
quintile was 38.5% (95% CI: 19.4–62.0) compared to 68.0% (95% CI: 56.1–77.9) in the
least poor quintile with an equity ratio of 0.57. In contrast, ownership of a campaign
LLITN was 43.5% (95% CI: 32.2–55.6) in Sofala. HH ownership of campaign LLITNs
30.9–50.6) in the least poor quintile with an equity ratio of 0.99. These results are
summarized in Table 6 and Figure 4. Data on HH ownership of noncampaign ITNs is
summarized in Table 7.
In Manica, 48.1% (95% CI: 36.9–59.5) of HHs reported at least one ITN hanging
the previous night (Table 8). When HHs that owned at least one ITN were considered,
this ratio was 89.2% (95% CI: 84.0–92.9) (Table 9). In Sofala, 47.6% (95% CI: 33.8–
61.7) of HHs reported at least one ITN hanging the previous night and, when HHs that
13
owned at least one ITN were considered, this ratio was 92.4% (95% CI: 85.9–96.0)
(Tables 8 and 9). In addition, 96.5% (95% CI: 93.9–98.0) of HHs that had at least one
campaign LLITN reported to had at least one of them hanging the previous night in
Manica, while in Sofala this ratio was 98.7% (95% CI: 97.4–99.3).
Post-campaign use of ITNs by children under 5 years old was 59.3% (95% CI:
54.4–63.9) in Manica: 48.4% (95% CI: 26.9–70.5) in the poorest economic quintile and
71.9% (95% CI: 65.6–77.5) in the least poor quintile. The equity ratio for children under
5 years old ITN use was 0.67. Data on children under 5 years old per economic quintile
are summarized in Table 10 and Figure 5. When children who lived in a HH that owned
at least one ITN (251 children) are considered, 96.7% (95% CI: 86.0–99.3) slept under an
ITN the previous night in Manica.
Post-campaign use of ITN by children under 5 years old was 61.6% (95% CI:
41.2–78.6) in Sofala: 54.5% (95% CI: 20.7–84.6) in the poorest economic quintile and
61.6% (95% CI: 54.3–68.3) in the least poor quintile. The equity ratio for children under
5 years old use was 0.88 (Table 10 and Figure 5). When children who lived in a HH that
owned at least one ITN (285 children) are considered, 95.7% (95% CI: 93.7–97.1) slept
under an ITN the previous night in Sofala.
Discussion
This survey was designed to evaluate ITN coverage following the distribution of
free LLITNs in Manica and Sofala provinces. Vouchers were distributed as part of the
second round of polio vaccination and were to be redeemed for LLITNs approximately
two months after the campaign. High coverage with ITNs has been shown to reduce
malaria morbidity and all cause mortality in endemic areas (Phillips-Howard PA et al,
2003). By providing LLITNs to children under 5 years old, the campaign was intended
to increase HH ownership and use of ITNs in these two provinces. Moreover, increasing
ITN ownership among HHs with children under 5 years old may benefit the whole
community. Prior studies have shown that increasing community levels of ITN use to
>50% is beneficial in reducing mosquito populations and malaria (Maxwell CA et al,
2002; Hawley WA et al, 2003).
14
Our survey showed that 88.7% and 86.6% of children under 5 years old in Manica
and Sofala, respectively, went to a vaccination post in September 2005. Additionally,
approximately 50% to 60% of mothers or caretakers of children under 5 years old
received vouchers for LLITNs and indeed redeemed the vouchers for LLITNs at a later
time. Upon comparison of the number of vouchers and LLITNs distributed provided by
registration and vaccination teams, we observed that a high percentage of nets were
distributed even in the absence of a voucher. However, our survey results showed only
10% of nets were received without a voucher. This observation, coupled with the
inequitable post-campaign LLITN observed in Manica, makes us question the value of
distributing vouchers during vaccination campaigns instead of distributing the nets
directly at a later time. However, combining either vouchers distribution with
vaccination campaigns might make microplanning, social mobilization, and logistics
more efficient, thereby saving funds and perhaps ultimately contributing to higher
coverage rates than distributing ITNs directly not connected to a vaccination campaign.
Results of this cross-sectional survey showed that the 2005 campaign to distribute
LLITNs to HHs with children under 5 years old rapidly achieved higher levels of ITN
ownership in Manica and Sofala, Mozambique when compared to pre-campaign figures.
Our data suggest that this was achieved more equitably in Sofala than in Manica. Precampaign HH ownership of bednets were more inequitably distributed in Manica (equity
ratio=0.10) than in Sofala (equity ratio=0.71). Moreover, HH ownership of campaign
LLITNs was also less equitable in Manica than in Sofala, possibly a result of less
effective and equitable distribution efforts in the two provinces.
HH ownership of bednets increased from 20.6% to 55.1% in Manica with
increased equity ratios. In Sofala, HH ownership of bednets increased to around 60%
also with higher equity ratios. Approximately 65% of HHs had at least one child under 5
years old. This proportion is lower than that of Togo (72.8%) or Niger (79.3%) and may
explain why lower community HH ownership of LLITNs was observed in these two
provinces post-campaign when compared to Togo and Niger, since only HHs with
children under 5 years old were targeted for distribution (Wolkon A et al, 2005;
Hochberg N et al, 2005).
15
We were unable to assign the insecticide treatment status of bednets present in the
HH prior to the campaign. However, taking into account the percentages of ITNs among
noncampaign bednets at the time of the survey (43.4% [23 ITNs/53 bednets of any kind]
for Manica province), we can estimate the pre-campaign HH ownership of ITNs to be
8.9% (20.6% x 43.4%) in Manica, lower than what was observed post-campaign. These
findings are consistent with previous studies in the literature, which suggest that
integrated campaigns to distribute ITNs are able to increase HH ownership of ITNs
(Grabowsky M et al, 2005a; Grabowsky M et al, 2005b; MMWR 2005). Similar
reasoning can be done for Sofala province, with higher equity ratios.
In addition, we found high rates of ITN use among HHs that owned at least one
ITN. We also observed that, among HHs that received at least one campaign LLITN,
more than 95% reported at least one of those hanging the previous night. This is higher
compliance than that observed in Togo, where comparable indicators were measured
(Wolkon A et al, 2005). This may be in part attributed to the work done by volunteers
involved in social mobilization, voucher and LLITN distributions, and post-campaign
follow-up visits. It may also partly reflect a self-selection bias since HH members who
made the extra trip to obtain a campaign LLITN may have been more likely to hang it.
Moreover, the survey was conducted late in the rainy season, with possible increase in
mosquito population, a factor known to increase use of bednets.
Regarding use by children under 5 years old (campaign and RBM target group),
we noticed that use rates for both provinces combined is above the 60% RBM target. In
addition, compliance rates (children sleeping under an ITN given at least one ITN in the
HH) were above 95%. In comparison, a survey in Togo during the rainy season, 9
months after the distribution found 69.5% utilization given at least one ITN in the HH
(Wolkon A et al, 2005). Again, this difference may be attributed to increased follow-up
visits and/or mosquito burden.
Given the cross-sectional design of the survey, we were unable to understand how
ITN ownership and use may vary over time. Moreover, our evaluation was focused on
the end results of the campaign, i.e., ITN ownership and use, but provided little
information about improving the overall process of the campaign. Analysis of the
16
campaign itself may yield important lessons for improving future distribution strategies.
In addition, the findings were compared to RBM targets, which are indicators for
countries, rather than country sub-regions as we presented here.
In conclusion, the LLITN distribution in Sofala and Manica appears to have been
an effective strategy to rapidly scale up ITN ownership and use. The figures for HH
ownership of ITNs, although encouraging, are below the RBM targets and efforts to
achieve higher rates should be encouraged. The overall project did achieve the RBM
target for ITN use by children under 5 years old when the provinces were combined, but
only for Sofala when data from each province is analyzed separately. Integration of ITNs
with vaccination campaigns presents an important opportunity for reaching malaria
control goals and should be considered for large-scale implementation.
Acknowledgments
We are grateful to the parents and guardians of the children who participated in
the survey and the many staff members who assisted with this project. This survey has
been a joint international effort that has received support from various individuals and
institutes, to all of whom we are grateful. We are especially indebted to Marcy Erskine
for her energetic support and participation. We would like to thank Jeronimo Zandamela,
Frieda Draisma, Eunice Mucache, and Fernanda Teixeira from the Mozambican Red
Cross for their support. At the Mozambican Ministry of Health, we would like to thank
Teotonio Fumo for his assistance. Finally, we are appreciative to Timothy Freeman from
UNICEF for his assistance.
References
Grabowsky M, Nobiya T, Ahun M, et al. Distributing insecticide-treated bednets during
measles vaccination: a low-cost means of achieving high and equitable coverage. Bull
World Health Organ. Mar 2005;83(3):195-201.
Grabowsky M, Farrell N, Hawley W, et al. Integrating insecticide-treated bednets into a
measles vaccination campaign achieves high, rapid and equitable coverage with direct
and voucher-based methods. Trop Med Int Health. Nov 2005;10(11):1151-1160.
17
Hawley WA, Phillips-Howard PA, ter Kuile FO, et al. Community-wide effects of
permethrin-treated bed nets on child mortality and malaria morbidity in western Kenya.
Am J Trop Med Hyg. Apr 2003;68(4 Suppl):121-127.
Hochberg N, Vanden Eng J, Eliades M J et al. Final Report, Community-Based CrossSectional Coverage Survey One-Month Post Campaign (January 23 – February 17, 2006)
as part of the 2005 Niger Polio/ITN Campaign
Maxwell CA, Msuya E, Sudi M, Njunwa KJ, Carneiro IA, Curtis CF. Effect of
community-wide use of insecticide-treated nets for 3-4 years on malarial morbidity in
Tanzania. Trop Med Int Health. Dec 2002;7(12):1003-1008.
Morbidity and Mortality Weekly Report. Distribution of insecticide-treated bednets
during an integrated nationwide immunization campaign--Togo, West Africa, December
2004. MMWR Morb Mortal Wkly Rep. Oct 7 2005;54(39):994-996.
Phillips-Howard P A., et al. Efficacy of Permethrin-treated bed bednets in the prevention
of mortality in young children in an area of high perennial malaria transmission in
western Kenya. Am. J. Trop. Med. Hyg., 68(Suppl 4), 2003, pp. 23–29.
The World Health Report 2002, statistical Annex WHO.
WHO. African summit on Roll Back Malaria, Abuja, Nigeria, April 25, 2000.
Wolkon A, Vanden Eng J, Terlouw DJ. Final Report, Nine-month post campaign
community-based cross-sectional ITN coverage survey (September 12 – October 5 2005)
as part of the Multidisciplinary evaluation of the impact of the 2004 Togo National
Integrated Child Health campaign, October 2005.
18
Tables
Table 1. Vouchers and long-lasting insecticide-treated bednets (LLITNs) distributed per
district during the vaccination and distribution campaigns in Manica and Sofala
provinces, Mozambique, 2005.
District
Vouchers (n)
LLITNs (n)
Manica
Barue
City of Chimoio
Gondola
Guro
Machaze
Macossa
Manica
Mossurize
Sussendenga
Tambara
11,165
28,005
21,843
6,291
10,219
2,888
18,549
6,947
9,611
6,283
16,689
46,440
43,160
8,551
13,840
3,920
28,691
15,160
17,960
8,040
Subtotal Manica
121,801
202,451
Buzi
Caia
Chemba
Cheringoma
Chibabava
Dondo
Gorongosa
Machanga
Maringue
Marromeu
Muanza
Nhamatanda
11,231
16,727
8,223
5,336
9,877
16,139
9,324
5,825
5,701
12,419
3,867
20,798
12,040
18,400
9,760
5,880
11,840
19,840
15,840
6,040
9,280
13,680
4,280
29,000
Subtotal Sofala
125,467
155,880
247,268
358,331
Sofala
Total
19
Table 2. Households (HHs) mapped and surveyed per district in Manica and Sofala
District
HHs surveyed
Manica
Gondola
Manica
Mossurize
Sussudenga
Subtotal Manica
524
489
650
319
1982
124
94
114
108
440
286
69.4%
68.1%
59.6%
63.0%
65.0%
Sofala
Caia
Chemba
Dondo
Marromeu
682
588
818
673
125
126
128
128
80
75
83
82
64.0%
59.5%
64.8%
64.1%
2761
507
320
63.1%
4743
907
606
66.8%
Subtotal Sofala
Total
*
HHs with at least one
child <5 years old
n
%*
HHs mapped
86
64
68
68
Percentages not weighted.
20
Table 3. Reasons for not receiving vouchers in Manica and Sofala provinces,
Mozambique, 2006.
Manica
Reason
n
%*
No voucher distributed at post
24
22.4%
Another child in HH already received
21
19.6%
Unaware of voucher distribution
13
12.1%
Vouchers out
11
10.3%
Lines too long
5
4.7%
Red Cross volunteer not present
3
2.8%
Unaware voucher was for bednet redemption
2
1.9%
Told had to pay for voucher
2
1.9%
Unaware of importance of bednets
1
0.9%
Other
25
23.4%
Total
107
100.0%
Reason
n
%*
Another child in HH already received
37
27.4%
Unaware voucher was for bednet redemption
10
7.4%
No voucher distributed at post
9
6.7%
Unaware of voucher distribution
9
6.7%
Unaware of importance of bednets
8
5.9%
Vouchers out
5
3.7%
Lines too long
4
3.0%
Red Cross volunteer not present
3
2.2%
Told had to pay for voucher
1
0.7%
Other
49
36.3%
Total
135
100.0%
Sofala
*
Percentages not weighted.
21
Table 4. Percentage of children under 5 years old who slept under an insecticide-treated
bednet (ITN) the previous night per district in Manica and Sofala provinces,
Mozambique, 2006.
%*
95% confidence
interval (CI)
Total
Gondola
64.5%
54.4–73.5
115
Manica
57.5%
22.3–86.5
93
Mossurize
59.8%
41.4–75.9
96
Sussudenga
55.6%
40.3–70.0
103
Subtotal Manica
59.3%
44.7–72.4
407
Caia
46.9%
32.3–62.0
110
Chemba
82.3%
75.0–87.7
108
Dondo
50.5%
44.8–56.3
103
Marromeu
64.4%
35.3–85.7
126
Subtotal Sofala
61.6%
50.1–72.0
447
60.3%
50.6–69.2
854
District
Manica
Sofala
Total
*
Percentages reflect weighted analysis.
22
Table 5. HH ownership of at least one ITN by economic quintile in Manica and Sofala
ITN by group
Post-campaign % (95% CI)*
Manica
All HHs
51.5 (41.3–61.5)
Quintile 1 (poorest quintile) HHs
40.3 (19.9–64.7)
Quintile 2 HHs
54.2 (39.7–68.1)
Quintile 3 HHs
40.9 (25.7–58.1)
Quintile 4 HHs
51.2 (42.6–59.7)
Quintile 5 (least poor quintile)
HHs
74.3 (62.0–83.8)
Equity ratio
0.54
Sofala
All HHs
48.5 (34.8–62.4)
42.9 (24.8–63.1)
Quintile 2 HHs
48.0 (31.3–65.3)
Quintile 3 HHs
55.8 (37.1–72.9)
Quintile 4 HHs
50.0 (24.5–75.5)
HHs
45.3 (38.3–52.5)
Equity ratio
*
0.95
Percentages and 95% confidence intervals reflect weighted analysis.
23
Table 6. HH ownership of at least one campaign LLITN by economic quintile in Manica
and Sofala provinces, Mozambique, 2006.
ITN by group
Manica
All HHs
48.6 (38.1–59.1)
38.5 (19.4–62.0)
Quintile 2 HHs
52.0 (35.5–68.1)
Quintile 3 HHs
38.2 (27.9–49.6)
Quintile 4 HHs
48.8 (38.5–59.2)
HHs
68.0 (56.1–77.9)
Equity ratio
0.57
Sofala
All HHs
43.5 (32.2–55.6)
40.1 (24.5–58.0)
Quintile 2 HHs
45.6 (28.6–63.7)
Quintile 3 HHs
51.6 (35.0–67.8)
Quintile 4 HHs
40.0 (23.6–59.1)
HHs
40.4 (30.9–50.6)
Equity ratio
*
0.99
24
Table 7. HH ownership of at least one ITN not from the campaign by economic quintile
in Manica and Sofala provinces, Mozambique, 2006.
ITN by group
Manica
All HHs
5.0 (1.7–13.3)
1.8 (0.7–4.3)
Quintile 2 HHs
4.0 (1.7–9.1)
Quintile 3 HHs
2.7 (0.3–23.1)
Quintile 4 HHs
6.5 (1.5–23.5)
HHs
11.1 (7.9–15.3)
Equity ratio
0.16
Sofala
All HHs
5.5 (3.0–10.1)
2.8 (0.5–13.8)
Quintile 2 HHs
2.4 (1.0–5.8)
Quintile 3 HHs
4.2 (1.3–13.2)
Quintile 4 HHs
11.0 (3.4–30.6)
HHs
6.5 (2.8–14.4)
Equity ratio
*
0.43
25
Table 8. HHs with at least one ITN hanging the previous night in Manica and Sofala
ITN hanging by group
% (95% CI)*
Manica
All HHs
48.1 (36.9–59.5)
38.5 (19.4–62.0)
Quintile 2 HHs
48.9 (35.0–63.0)
Quintile 3 HHs
34.9 (22.6–49.7)
Quintile 4 HHs
49.1 (37.8–60.5)
HHs
72.9 (57.0–84.5)
Sofala
*
All HHs
47.6 (33.8–61.7)
42.2 (25.0–61.5)
Quintile 2 HHs
46.8 (28.2–66.4)
Quintile 3 HHs
55.8 (37.1–72.9)
Quintile 4 HHs
48.0 (23.7–73.2)
HHs
44.5 (38.3–50.8)
26
Table 9. HHs with at least one ITN hanging the previous night among HHs that had at
least one ITN in Manica and Sofala provinces, Mozambique, 2006.
ITN hung by group
Weighted % (95% CI)*
Manica
All HHs
89.2 (84.0–92.9)
95.6 (93.3–97.2)
Quintile 2 HHs
85.6 (75.7–91.9)
Quintile 3 HHs
81.5 (71.5–88.5)
Quintile 4 HHs
94.1 (69.9–99.1)
HHs
89.3 (84.8–92.6)
Sofala
*
All HHs
92.4 (85.9–96.0)
98.4 (91.1–99.7)
Quintile 2 HHs
87.1 (76.1–93.4)
Quintile 3 HHs
95.1 (83.5–98.7)
Quintile 4 HHs
92.0 (67.2–98.5)
HHs
89.3 (71.7–96.5)
27
Table 10. Children under 5 years old who slept under an ITN the previous night per
economic quintile in Manica and Sofala provinces, Mozambique, 2006.
Children <5 years old under an
ITN on the previous night
Manica
All children <5 years old
Children <5 years old in the
quintile 1 (poorest quintile) HHs
quintile 2 HHs
quintile 3 HHs
quintile 4 HHs
quintile 5 (least poor quintile)
HHs
59.3 (54.4–63.9)
48.4 (26.9–70.5)
64.0 (55.6–71.7)
49.1 (31.8–66.7)
64.3 (37.8–84.2)
71.9 (65.6–77.5)
Equity ratio
0.67
Sofala
All children <5 years old
quintile 1 (poorest quintile) HHs
quintile 2 HHs
quintile 3 HHs
quintile 4 HHs
quintile 5 (least poor quintile)
HHs
61.6 (41.2–78.6)
54.5 (20.7–84.6)
63.8 (33.8–85.8)
70.5 (48.0–86.1)
55.2 (31.7–76.6)
61.6 (54.3–68.3)
Equity ratio
*
0.88
28
Figures
Figure 1. Administrative map of Mozambique.
29
Figure 2. Pre- and post-campaign HH ownership of at least one bednet of any kind by
economic quintile in Manica and Sofala provinces, Mozambique, 2006.*
Manica
% of HH with at least one bednet
100
90
82.3
80
70
50
55.2
55.1
60
Precampaign
Postcampaign
55.7
46.6
41.2
40
30
22.6
16.4
20
10
9.2
5.7
0
1- Poorest
2
3
4
5- Least
poor
Economic quintile
Sofala
% of HH with at least one bednet
100
90
80
60
65.5
65.4
70
58.7
52.2
50
36.2
40
30
35
38.6
56.6
39.4
Precampaign
Postcampaign
27.9
20
10
0
1- Poorest
2
3
Economic quintile
*
4
5- Least
poor
30
Figure 3. Post-campaign HH ownership of at least one ITN by economic quintile in
Manica and Sofala provinces, Mozambique, 2006.*
Manica
% HH with at least one ITN
100
90
74.3
80
70
54.2
60
50
51.2
40.9
40.3
40
30
20
10
0
1- Poorest
2
3
Economic quintile
4
5- Least
poor
Sofala
100
90
80
70
55.8
60
50
42.9
48
50
45.3
40
30
20
10
0
1- Poorest
*
2
3
Economic quintile
4
5- Least
poor
31
Figure 4. Post-campaign HH ownership of at least one campaign LLITN by economic
quintile in Manica and Sofala provinces, Mozambique, 2006.*
Manica
100
90
80
68
70
52
60
50
40
48.8
38.5
38.2
30
20
10
0
1- Poorest
2
3
Economic quintile
4
5- Least
poor
40
40.4
4
5- Least
poor
Sofala
100
90
80
70
60
50
40.1
51.6
45.6
40
30
20
10
0
1- Poorest
*
2
3
Economic quintile
32
Figure 5. Children under 5 years old who slept under an ITN the previous night by
economic quintile in Manica and Sofala provinces, Mozambique, 2006.*
Manica
% of children under an ITN
100
90
80
71.9
70
60
50
64.3
64
49.1
48.4
40
30
20
10
0
1- Poorest
2
3
Economic quintile
4
5- Least
poor
Sofala
% of children under an ITN
100
90
80
60
70.5
63.8
70
55.2
54.5
61.6
50
40
30
20
10
0
1- Poorest
*
2
3
Economic quintile
4
5- Least
poor
33
Annex 1. Questionnaire used for bednet evaluation, Mozambique, 2006.
MOZAMBIQUE BEDNET SURVEY - DATA DICTIONARY - FEBRUARY 2006
Variable Name
Type
Question (Portuguese)
Question (English)
Perguntas sobre Domicílio
Província
6. Manica
7. Sofala
Household Questions
Province
6. Manica
7. Sofala
Number
Distrito
Manica: 1-Mossurize; 2-Manica;
3- Sussudenga; 4- Gondola.
Sofala: 1-Marromeu; 2Chemba; 3-Dondo; 4-Caia
District
Manica: 1-Mossurize; 2-Manica; 4Sussudenga; 5- Gondola. Sofala:
1-Marromeu; 2-Chemba; 4-Dondo;
5-Caia
EA
Number
Área de enumeração
______ (menu da
randomizacao)
Enumeration area
Options from the randomization
table
District
Text
Comentário para localização
(nome, ponto de referência)
Household location descriptive
comment
Options from the randomization
table (GPS)
Province
Text
District
_____ (menu da randomizacao)
SurveyAutho
Respondent
Number
Number
Bom dia (ou Boa tarde). A
Cruz Vermelha e o Ministério
da Saúde de Moçambique
estão collhendo informação
sobre a campanha de
vacinação e o uso de redes
mosquiteiras. Nós gostaríamos
de fazer algumas perguntas a
você. Isso deve levar mais ou
menos 10 minutos. Você
gostaria de participar?
1. Sim
2. Nao
3. Ninguém na casa
4. Outro motivo para não
entrevistar
Qual a sua posição nessa
família?
1. Pai
2. Mãe
3. Avô/Avó
4. Tio/Tia
5. Um dos filhos
Good day. The Red Cross and the
Ministry of Health in Mozambique
are collecting information on the
vaccination campaign and use of
bednets. We would like to ask you
some questions. This will take
around 10 minutes. Would you like
to take part?
1. Yes
2. No
3. Nobody at home
4. Other reason for not conducting
the interview
What is your role in this family
1. Father
2. Mother
3. Grandparent
4. Uncle/aunt
5. One of the kids
34
6. Sobrinho
7. Cunhado
8.Empregada doméstica
88. Outro
6. Niece
7. Brother in law
8. Maid
88. Other
Number
Quantas pessoas dormiram
nessa casa ontem?
How many people slept at this
house yesterday?
SleepSpaces
Number
Quantas camas/esteiras (ou
outros móveis para dormir)
foram usadas nessa casa
ontem? (Mais de uma pessoa
pode compartilhar a mesma
cama)
How many beds (or other sleeping
spaces) were used to sleep at this
house yesterday? (More than one
person might use the same
sleeping space.)
KidsNum
Number
Quantas crianças com menos
de 5 anos dormiram nesta casa
ontem?
How many kids under 5 yod slept at
this house yesterday?
PregWomen
Number
Quantas mulheres grávidas
dormiram nesta casa ontem?
How many pregnant women slept at
this house yesterday?
PeopLasNight
HaveNets
Number
NumNetsNow
VouchersReceived
Bednet Questions
Do you have at least one bednet at
this house?
1. Yes
2. No
9. Do not know
Você recebeu pelo menos uma
rede mosquiteira durante a
campanha da Cruz Vermelha e
Ministerio da Saude em
novembro/dezembro ?
1. Sim
2. Nao
1. Yes
2. No
Number
Quantas redes mosquiteiras
você tinha na sua casa antes
da campanha em dezembro?
How many bednets you had at the
house before the campaign in
November/December?
Number
Incluindo as redes que você
recebeu em dezembro, quantas
redes mosquiteiras você tem
hoje na sua casa?
Including the bednets distributed in
November, how many nets you
have at your house today?
Number
Quantos auto-colantes as
pessoas da sua casa
receberam na campanha em
setembro?
How many stickers did the people
at your house received in
September?
CurzVerm
NumNetsBefore
Perguntas sobre Redes
Mosquiteiras
Você tem pelo menos uma rede
mosquiteira na sua casa hoje?
1. Sim
2. Nao
9. Nao sei
Did you receive at least one net
from the Red Cross and Ministry of
Health during the campaign last
November/December?
35
VouchersPresented
Number
Check boxes for
these answers
Voucher_lost
Text
Voucher_sold
Text
Voucher_givenaway
Text
Voucher_stolen
Text
Voucher_takeaway
Text
Voucher_knowwhen
Text
Voucher_posttoofar
Text
Voucher_netsout
Text
Voucher_purpose
Text
Voucher_hadtopay
Text
Voucher_toldtopay
Text
Voucher_longlines
Voucher_other
Text
Text
NetWithoutVoucher
NetwithoutVoucher
Num
Number
Number
Quantos colantes você trocou
por rede(s) mosquiteira(s) nos
postos de distribuição em
novembro/dezembro?
Por que nem todos os autocolantes que você recebeu
foram trocados por rede(s)
mosquiteira(s) nos postos de
distribuição em
novembro/dezembro? (Escolha
todas as possiveis)
1. Eu perdi o papel onde estava
o colante
2. Eu vendi o papel com o
colante
3. Eu dei o papel com o colante
para outra pessoa
4. Meu colante foi roubado
5. Eu não sabia que precisava
levar o colante para receber
uma rede
6. Eu não sabia onde ou
quando os postos de
distribuição estavam
funcionando
7. O posto de distribuição era
muito longe da minha casa
8. Não havia mais redes
mosquiteiras em estoque
9. Eu não sei para que servem
as redes mosquiteiras
10. Eu pensei que tinha de
pagar pelas redes mosquiteiras
11. Ao chegar ao posto, as
pessoas me disseram que eu
tinha que pagar pelas redes
mosquiteiras.
12. As filas eram muito grandes
13. Outro
How many stickers did you redeem
at the distribution centers in
exchange to a net?
Why not all the stickers you
received were redeemed for
bednets at the distribution centers
in November December? (all
possible)
1. I lost the sticker
2. I sold the sticker
3. I gave the sticker to somebody
else
4. Someone stole my sticker
5. I did not know I had to present
the sticker to get a net
6. I did not know when the
distribution posts would be working
7. The distribution post was far
away from my house
8. No nets were available in stock
9. I do not know what the nets are
for
10. I thought I had to pay for the
nets
11. When I arrived at the post, the
workers told me I had to pay for the
net
12. The lines were too long
13. Other
Alguém da sua casa recebeu
rede(s) mosquiteiras(s) sem
que alguma criança tivesse
recebido um auto-colante
durante a campanha de
vacinação em setembro?
1. Sim
2. Não
9. Não sei
1. Yes
2. No
9. I do not know
Quantas redes mosquiteiras
foram recebidas sem
How many bednet were received
without presenting a sticker?
Did someone at your home receive
a bednet(s) without a child receiving
a sticker during the vaccination
campaign in September?
36
apresentar um auto-colante?
NetsInHome
Number
Check boxes for
these answers
DecNets_sold
Text
DecNets_givenaway
Text
DecNets_lost
Text
DecNets_stolen
Text
DecNets_damaged
Text
DecNets_thrownawa
y
DecNets_other
DecNets_dontknow
NumNetsHung
Das redes mosquiteiras que
você recebeu em
novembro/dezembro, quantas
ainda estão na sua casa?
O que aconteceu com as redes
mosquiteiras que você recebeu
em novembor/dezembro e que
você não tem mais? (Escolha
todas as possiveis)
1. Eu vendi as redes
mosquiteiras
2 Eu dei as redes mosquiteiras
para outra pessoa
3. Eu perdi as redes
mosquiteiras
4. As redes mosquiteiras foram
roubadas
5. As redes mosquiteiras
estragaram
Of the nets that you received in
November/December, how many
are still at your house?
What happened to the nets that you
received in November/December
and you do not have anymore?
1. I sold the nets
2. I gave the nets to someone else
3. I lost the nets
4. The nets were stolen
5. The nets ruined
Text
6. Eu joguei for a
6. I threw them away
Text
Text
7. Outros
9.Não sei
7. Other
9. I do not know
Number
Considerando todas as redes
da sua casa, quantas redes
mosquiteiras foram penduradas
sobre as camas/esteiras (ou
outros móveis para dormir)
ontem à noite?
Considering all the nets in the
house, how many nets were hung
over the beds or other sleeping
spaces yesterday night?
Check boxes for
these answers
NotHung_notimport
ant
Text
NotHung_purpose
Text
NotHung_habit
Text
NotHung_toohot
Text
NotHung_cantsleep
Text
NotHung_nospace
Text
Se tem rede(s) mosquiteira(s)
que não pendurou, por que
você não pendurou essa(s)
rede(s) mosquiteira(s)?
(Escolha todas as possíveis)
– Eu não acho que é
importante
– Eu não sei para que a rede
serve
– Eu não tenho hábito
– Fica muito quente debaixo da
rede
– É incomodo para dormir
Já havia rede(s) mosquiteira(s)
em todas a(s)
cama(s)/esteira(s)
If you have nets that were not
hanged, why did you not hang
them? (Choose all possible)
I do not think they are important
I do not know what the nets are for
I am not used to them
It gets hot under the net
It is uncomfortable to sleep
There were already bednets over all
beds (sleeping spaces)
37
NotHung_dontlike
Text
NotHung_getsdirty
Text
NotHung_makeugly
Text
NotHung_other
Text
– Meu marido ou outro membro
da família não gosta
– A rede fica suja logo e eu não
gosto
– A rede (cor por exemplo)
deixa minha casa feia
– Outro
Mensagem: Se o entrevistador
puder ver a(s) rede(s), a
determinação do tipo de rede
deve ser feita por ele.
Perguntas sobre Redes
Mosquiteiras
Have the counter 'Rede 1 de N'
NetHungProp
Number
Essa rede foi pendurada sobre
uma cama/esteira
1. Sim
2. Nao
9. Nao sei
DistDec
NetAge
WhereBuy
Number
Number
Number
Anote se a rede vista
corresponde ao modelo
distribuído em novembro/
1. Sim
2. Nao
9. Nao sei
My husband or another family
member do not like
The net gets dirty and I do not like
The net makes my house ugly
Other
If the interviewer can see the nets,
he/she should be the one
classifying the net.'
Questions on Mosquito Bednet
Details
Net N out of NN
Was this net given by the Red
Cross and MOH in
November/December?
1. Yes
2. No
9. Do not know
Check if the net was of the same
kind of the campaign model.
1. Yes
2. No
9. Do not know
Se a rede não tiver sido dada
pela Cruz Vermelha e
Ministério da Saúde, há
quantos meses ou anos você
tem essa rede mosquiteira?
1. Menos de 6 meses
2. De 6 a 11 meses
3. De 1 a 2 anos
4. Mais de 2 anos
9. Não sei
1. Less than 6 months
2. 6--11 months
3. 12--24 months
4. More than 24 months
9. I do not know
Onde você comprou (ou
recebeu) essa rede
mosquiteira?
1. PSI
2. HAI
3. Loja comercial
4. Centro de saude
5. Outro serviço/Não sei
If the net is not of the same kind
distributed, where did you buy /
receive this net?
1. PSI
2. HAI
3. Commercial store
4. Health center
5. Other / DNK
If the net was not given by the Red
Cross, for how long do you have
this net?
38
NetTreated
Number
Essa rede mosquiteira é do tipo
que possui tratamento
permanente com insecticida?
(Marcas possíveis de esse tipo:
Permanet, Olyset Net, Serena
Net)
1. Sim
2. Não
9. Nao sei
preTreated
LastTreated
Number
Number
NetSeen
Number
NumPeopleSlept
Number
Check boxes for
these answers
ChildOneYear
Text
ChildTwoYears
Text
ChildFiveYears
Text
ChildFourteen
PregnantWoman
Text
Text
WomanSlept
Text
ManSlept
Text
Essa rede mosquiteira foi
tratada com insecticida quando
você a comprou ou recebeu?
1. Sim
2. Nao
9. Nao sei
Is this net the kind that is
permanently impregnated with
insecticide?
1. Yes (Possible brands Permanet,
Olyset)
2. No
9. Do not know
Was this net treated with insecticide
when you bought or received it?
1. Yes
2. No
9. Do not know
Quando foi o último tratamento
com insecticida desta rede?
1. Apenas quando a recebi ou
comprei
2. Menos de 6 meses
3. De 6 a 11 meses
4. Mais de 12 meses
5. Nunca
9. Não sei
2. Less than 6 months
3. 6--11 months
4. More than 12 months
5. Never
9. Do not know
Essa rede mosquiteira foi vista
pelo entrevistador?
1. Sim
2. Não
Was this net seen by the
interviewer?
1. Yes
2. No
Quantas pessoas dormiram
debaixo desta rede ontem?
How many people slept under this
net yesterday?
Quem eram essas pessoas?
Who were they?
_ Criança(s) com menos de um
ano
_ Criança(s) de 1 ano a 2 anos
e 11 meses
_ Criança(s) de 3 anos a 4
anos e 11 meses
_ Criança(s) de 5 a 14 anos
_ Mulher(es) grávida(s)
_ Mulher(es) com mais de 14
anos nao grávida(s)
_ Homem(ns) com mais de 14
anos
When was the last insecticide
treatment
1. Only when bought
_ Child <1 yod
_ Child 1 to 2 years- and 11
months-old
_ Child 3 to 4 years- and 11
months-old
_ Child 5 to 14 yod
_ Pregnant woman
_ Woman >14 yod not pregnant
_ Man >14 yod
39
NetTreatedFinal
Number
Você gostaria de dar
informação sobre uma outra
rede mosquiteira?
1. Sim
2. Nao
MoreNets
SeptVisit
Essa rede será chamada:
Number
Perguntas sobre a Campanha
Pelo menos uma das crianças
que moram nesta casa foram a
um posto fixo ou móvel para a
segunda volta da vacinação em
setembro de 2005?
1. Sim, posto fixo
2. Sim, posto móvel
3. Nao fui ao posto
4. Não há criança com menos
de 5
9. Não sei
camp_television
camp_radio
Text
Text
camp_sanitary
Text
camp_school
camp_volunteer
Text
Text
camp_socialmob
Text
camp_parent
camp_religiouslead
er
Text
Como você soube da
campanha? (Escolha todas
possíveis)
– Televisão
– Rádio
– Informação na unidade
sanitária
– Informação na escola
– Voluntário da Cruz Vermelha
– Mobilizador social (não da
Cruz Vermelha)
– Parente
Text
– Líder religioso (Igreja, outros)
camp_commleader
Text
Check boxes for
these answers
camp_commmembe
r
camp_journal
Text
Text
camp_pamphlet
Text
camp_dk
camp_other
Text
Text
childvaccination
Number
– Líder comunitário (político,
chefe, outro)
– Vizinho ou membro da
comunidade
– Jornal
– Faixa ou panfleto de
divulgação
– Nao sabia da campanha
– Outro
Todas as crianças com menos
de 5 anos desta casa foram ao
posto de vacinação em
setembro?
1. Sim
2. Nao
3. Nao ha criancas na casa
This bednet will be called
Would you like to enter data about
another net?
1. Yes
2. No
Campaign Questions
In September, did you go to a fix or
mobile post for vaccination?
1. September fix
2. September mobile
3. I did not go to the post
4. There are no children under 5
yod
9. Do not know
How did you learn about the
campaign?
TV
Radio
At the health center
At school
Red Cross volunteer
Social mobilization (not from RC)
Relative
Religious mentor
Community leader
Neighbor or community member
Newspaper
Banner
I did not know about the campaign
Other
Did all the children who leave in this
house went to a vaccination post in
September?
1. Yes
2. No
3. No children in the house
40
Check boxes for
these answers
NotVac_dontknow
NotVac_busy
Text
Text
NotVac_nothome
Text
NotVac_vacaway
Text
NotVac_childsick
NotVac_locunknow
n
NotVac_noauth
Text
NotVac_noneedvac
Text
NotVac_noneednet
Text
NotVac_confdate
Text
NotVac_noconv
Text
NotVac_notregistere
d
NotVac_linetoolong
NotVac_relmotives
NotVac_vacc_dk
NotVac_brigade
NotVac_vacc_other
childAge
AgeBase
ChildGender
9. Nao sei
9. Do not know
Por que algumas crianças
menores de 5 anos que moram
na casa não foram ao posto de
vacinação,? (Escolha todas as
respostas possiveis)
Why some children under 5 who
live in this house did not go to the
vaccination post (all that apply)
I did not know about the campaign
I was too busy
Text
Eu não sabia da campanha
Eu estava muito ocupado (a)
Eu não estava em casa ou fora
do país durante a campanha
O posto de vacinação era muito
longe
Criança estava doente
Text
Eu não sabia aonde ir
I did not know where to go
Parentes não deram
autorização
Criança não precisa de vacina
contra sarampo ou polio
Criança não precisa de rede(s)
mosquiteira(s)
Eu estava confusa sobre a
data
O horário do posto não era
conveniente
Eu não sabia que o registro era
para redes mosquiteiras
As filas eram muito longas
Motivos religiosos
Eu não sei explicar o motivo
Eu atrasei
Outra
The relatives did not give
authorization
The child does not need measles,
polio vaccines
Text
Text
Text
Text
Text
Number
Number
Number
Perguntas sobre Crianças
Quantos anos a criança tem
(meses)? (Peca para ver o
cartao de registro)
I was abroad during the campaign
The vaccination post was too far
away
The child was sick
The child does not need nets
I was confused about the dates
The vaccination post hours were
not convenient
I did not know about the net
registration
The lines were too long
Religious reasons
I can not explain
I was late
Other
Child Question
How old is this child (months) (ask
to see any document)
A idade foi calculada com base
em informação escrita (cartão
de vacinação e controle do
peso ou registo de nascimento)
ou verbal (estimativa)?
1. Informação escrita
2. Informação verbal
1. Written info
2. Estimative
Qual o sexo dessa criança ?
1. Masculino
2. Feminino
What is the child sex?
1. Male
2. Female
Was the age based on written
information (birth certificate) or
estimative (verbal information)?
41
MomSchool
Text
number
SeptVacc
Number
Check boxes for
these answers
reason_measles
Text
reason_polio
Text
reason_net
Text
reason_previll
Text
reason_orient
Text
reason_dk
reason_other
Text
Text
VoucherPosted
NoVoucherReason
Number
Até que classe de escola a mãe
dessa criança estudou (classe
em anos)?
What is the level of education of this
child's mom (years of school)?
A criança foi levada ao posto
de vacinação em setembro?
1. Sim
2. Nao
9. Não sei
Was this child brought to the
vaccination post in September?
1. Yes
2. No
9. Do not know
Por que a criança foi levada ao
posto de vacinação em
setembro? (Escolha todas
possíveis)
– Para receber vacina contra
sarampo
– Para receber vacina contra
polio
– Para receber uma rede ou
para fazer o registro de rede
– Para proteger meu filho (a)
contra doenças
– Porque fui orientado (a) pelo
líder da comunidade, amigo,
parente ou outra pessoa
– Eu não sei
– Outro
A criança teve colante (para
rede mosquiteira) afixado no
cartão de vacinação ou outro
documento durante a
campanha de setembro?
1. Sim
2. Nao
9. Nao sei
Por que a crianca nao recebeu
o auto-colante para uma rede
mosquiteira durante a
campanha?
1. Nao havia autocolantes
2. Os autocolantes haviam
acabado
3. A Cruz Vermelha nao estava
4. Outra crianca da casa havia
recebido
5. Nao sabia sobre autocolantes
6. Nao sabia que os autocolantes eram para redes
Why was the child brought to the
vaccination post in September? (All
that apply)
To get measles vaccine
To get polio vaccine
To register for a net or get a net
To protect him/her against diseases
Because I was told to do so by a
community leader, relative, or
someone else
I do not know
Other
Did the child receive a sticker on
his/her vaccination card during the
campaign in September?
1. Yes
2. No
9. Do not know
Why the child did not get a sticker
during the campaign?
1. No more stickers
2. The stickers were over
3. Red Cross was not there
4. Another child from the house got
one
5. I did not know about the stickers
6. I did not know the stickers were
for the nets
42
7. Nao sabia da importancia
das redes
8. Me disseram que eu tinha de
pagar
9. As filas eram muito grandes
99. Outro
VisitPost
childsleepnet
sleepnetnum
Number
Number
Number
Em Novembro/Dezembro de
2005, você, ou outro membro
da família, foi ao posto de
distribuição para receber a rede
mosquiteira)
1. Sim
2. Nao
9. Nao sei
Essa criança dormiu debaixo
de uma rede mosquiteira ontem
à noite?
1. Sim
2. Nao
9. Nao sei
Qual rede mosquiteira?
Opcões vindas do próprio ques
More Children
@var(15)
SleepUnderNet
PregWomenNet
Number
Number
Text
Você gostaria de dar
informação sobre uma outra
criança?
1. Sim
2. Nao
Perguntas sobre Gestantes
Essa mulher gravida dormiu
debaixo de uma rede
mosquiteira ontem à noite?
1. Sim
2. Nao
9. Nao sei
Qual rede mosquiteira?
– Opcoes vindas do inventario
de redes
Pode ainda dar informação
sobre uma outra mulher
grávida?
1. Sim
2. Nao
7. I do not know about the
importance of the nets
8. People told me I had to pay
9. The lines were too long
99. Other
In November/ December, you or
another family member went to a
distribution post to receveive a
bednet?
1. Yes
2. No
9. Do not know
Did this child sleep under a net
yesterday night?
1. Yes
2. No
9. Do not know
Which net?
Options coming from the net
inventory
Would you like to enter data of
another child?
1. Yes
2. No
Pregnant Woman Question
Did this pregnant woman slept
under a net yesterday night?
1. Yes
2. No
9. Do not know
Which net?
Options from the net inventory
Would you like to give information
on another pregnant woman?
1. Yes
2. No
43
WaterSource
BathType
Number
Number
Indicadores Econômicos
Qual é a principal fonte de água
para beber das pessoas que
moram nesta casa? (Escolha
apenas 1)
1. Água canalizada dentro da
própria casa ou quintal
2. Água canalizada dentro da
casa do vizinho
3. Água canalizada pública ou
fontenária
4. Água de poço no próprio
quintal
5. Água de poço no quintal do
vizinho
6. Água de poço público
7. Agua de caminhao
8. Água de rio, lago ou outra
fonte de superfície
9. Água de chuva
99. Outra
Que tipo de banho há na sua
casa? (Escolha apenas 1)
1. Retrete com autoclismo
proprio
2. Retrete com autoclismo
comunitario
3. Latrina tradicional
4. Latrina
5. Mato
6.Outro
BathUse
Number
A casa de banho é utilizada só
pela família ou por outras
pessoas também?
1. Só família
2. Outras pessoas também
Na sua casa há (Leia cada uma
das opções)
Check boxes for
these answers
Electricity
Radio
Television
Telephone
Refrigerator
Text
Text
Text
Text
Text
–
–
–
–
–
Eletricidade
Rádio
Televisor
Telefone fixo
Geladeira/ congelador
NumRooms
Number
Quantos quartos ou divisões da
casa usam para dormir?
Economic Indicators
What is the drinking water source
for this house?
1. In house piped water
2. Piper water at neighbor's
3. Piped public well
4. Well at the backyard
5. Well at neighbor's
6. Public well
7. Truck
8. River, lake or other surface water
9. Rain
99. Other
What is the type toilet facility used
by members of your house?
(Choose only one)
1. Flushing toilet
2. Toilet without flushing
3. Traditional latrine
4. Latrine
5. Bush or field
6. Other
Is the bathroom used only by family
members or by others as well?
1. Only family
2. Others as well
Do you have in your house? (Read
each option and choose all
possible)
Electricity
Radio
TV
Phone
Refrigerator/ freezer
How many divisions are used for
sleeping?
44
FloorType
Number
Qual é o material mais comum
do piso da sua casa? (Escolha
apenas 1)
1. Chão de terra batida
2. Chão de madeira rudimentar
3. Chão de adobe
4. Chão de parquet ou madeira
encerada
5. Ladrilho ou tijolo
6. Cimento
7. Outro
Alguma das pessoas que
moram nessa casa possuem o
seu próprio? (Leia cada uma
das opções)
– Bicicleta
– Motorizada
– Carro
What is the type of flooring of your
house? (Choose only one)
1. Dirt
2. Rustic wood (unfinished)
3. Adobe
4. Finished wood
5. Brick or tile
6. Cement
7. Other
Does anybody in this house have?
(Read each option and choose all
possible)
Bicycle
Motorcycle
Car
Text
Text
Text
Familywork
Number
Os membros da sua família
trabalham em terra de sua
própria posse?
Do the members of your family work
on their own land?
HealthPostMin
Number
Quanto tempo você leva
caminhando até o posto de
saúde mais próximo? (minutos)
How long does it take for you to get
to the nearest health post? (in
minutes)
RedCrossVisit
Esta casa recebeu a visita de
um voluntario da Cruz
Vermelha depois da campanha
de distribuicao falando sobre o
uso ou importancia das redes?
1. Sim
2. Nao
9. Nao sei
Bicycle
Motorcycle
Car
Did their house receive the visit of a
volunteer from the Red Cross
talking about the bednets or its
importance?
1. Yes
2. No
9. Don't know
45
Annex 2. Selected districts, enumeration areas, and HHs mapped in Manica and Sofala
Manica
Households
Mapped
Sofala
Households
Mapped
Mossurize
Muzoco
Magecuana/Metecuana
Jelhe /Jeche
Chinguno
171
203
123
128
Marromeu
Bairo 1 de maio
Regulo Cundue Alto
Bairro Kenneth Kaunda
Bairo S. Muthenba
243
90
201
139
Manica
Machipanda
Chitundo
Bairro Chitio
Josina Machel
107
172
71
141
Chemba
Regulo Sanhabuzi
Gero
Regulo Cado-a
Regulo Cado-b
98
163
214
113
Sussudenga
16 de Junho
Chitchira
Machote
Serracao
102
100
62
55
Dondo
Mafambisse Sede
Bairro Censito-a
Bairro Censito-b
Bairro Mafarinha
178
204
166
270
Gondola
Dongo
Revue
Chipindaumue
Mutipate
173
117
134
100
Caia
Regulo Muanalaro
Tang-Tang
Regulo Murema
Regulo Muanalaro
185
227
80
190
46

Final Report on the Evaluation of Free Insecticide Treated Bednet

Transcrição

Documentos relacionados

Sentinela - Zelia Fonseca

Auxiliary verb: can 1. Unscramble the words to form questions. a

ISSN1936-5071 PROGRESSION THROUGH SCHOOL AND

English: “My advice: If you have to leave a city that you love, leave it

Folder PDF - Premier Algarve Rentals

Property Sheet PDF - Signature Properties Solutions

Press Release Aláfia – Corpura Who started all that? Was it Jorge

GetData Recover My Files Professional 4.9.4.1296

AKC Lecture Series: Spring Semester 2012 A luta continua / La

the library - Mairo Vergara

Property Sheet PDF - Signature Properties Solutions