Malaria Implementation and Evaluation

Revised Intervention 

A current intervention in the Congo is to provide ITNs to it's people but less than 10% of resources are used on ITNs meaning the presence of ITNs is very little. Even the World Health Organization says that "In most high-burden countries, ITN coverage is still below agreed targets." I would like to have even more ITNs provided than is currently provided. Currently, over 50% of materials are used on insecticides and spray materials. I propose that half of the resources used on insecticides and spray materials be moved to buy and give out ITNs.

Implementation

Contact producers of Long Lasting ITNs and make a deal with them to buy ITNs in bulk for a very small price. After communicating our cause to the Congolese people, spread out all over the Congo and take with us as many ITNs as needed (from what we know of the population) and distribute them to as  many families as we can reach. We will also provide easy to understand pamphlets explaining how to properly use the ITNs (such as not sharing one between communities, etc.) and how to maintain them.

Barriers to implementation are getting the Congolese people to trust in our cause and follow our instructions on use and maintenance of the ITNs. Another barrier is in getting the government to lessen resources in one area of their intervention and move it to fund our intervention.

Communication

Contact various stakeholders and explain out intervention to them. We will also explain the purpose of our intervention and how effective we predict our intervention will be.

Use telephones, the television, radio broadcast stations and the internet to reach those we can and inform them of the intervention and of the places we will be giving out ITNs. For those we couldn't reach electronically, we will create easy to understand posters (made up of words and mostly pictures of illiterate people) to hang in various high risk communities.

Evaluation

Desired Outcomes

• A decrease in the number of Malaria cases.
• A decrease in the number of deaths caused by Malaria.
• Greater awareness of the effectiveness of ITNs in preventing Malaria.
• Congolese people approaching us for free ITNs.

Process Measures

• How many ITNs are bought.
• How many ITNs are distributed.
• What percentage of the population has ITNs.
• How many Congolese people know about the free ITNs and the purpose of our intervention.

Outcome Measure

• If the percentage of resources used for ITNs has increased and the percentage for insecticides and spray materials has decreased.
• Most if not all of the desired outcomes are fulfilled.

References

"WHO Global Malaria Programme: Position Statement on ITNs." World Health Organization. Web. 26 Apr. 2013. <http://www.who.int/malaria/publications/atoz/itnspospaperfinal.pdf>.

Malaria Interventions

Problem Definition
Increasing Malaria cases and deaths in the people of the Democratic Republic of the Congo between 2000 and 2011.

Current Interventions

• Intervention - Key Determinant it addresses
• Educating the public about Malaria - Many people are unaware of Malaria transmission and prevention.
• Insecticide Treated Nets (ITNs) - Anopheles mosquitoes only bite at night. Untreated bed nets are not very effective in keeping away mosquitoes at night. 
• Effectively diagnosing and treating patients with Malaria - Health personnel are usually not trained well enough to treat patients' Malaria symptoms. They also have to deal with huge amounts of patients suffering from other equally dangerous diseases.
• Insecticides and Spray Materials - Malaria can only be contracted from a female Anopheles mosquito.
• Indoor Residual Spraying (IRS) - When done feeding, mosquitoes usually rest on the nearest surface available to them.

My Interventions

Primary - Insecticide Treated Nets (ITNs). Humans are only able to contract Malaria at night but night time is also when people are asleep and their guard is down. Bed nets are only useful to a certain degree since mosquitoes can still get past them. With insecticide treated nets, even when the mosquito has gotten past the net, it will die from the insecticide it's had to get through.

Secondary - Indoor Residual Spraying (IRS). Exophilic Anopheles mosquitoes rest indoors after biting to digest their meal. If the indoor surfaces are sprayed they will eventually die before biting anyone else and spreading the malaria.

Tertiary - Educating the Public about Malaria. Since many do not know how malaria is transmitted and how to prevent it, they do nothing to protect themselves from contracting it. If more people understand these things, they can be better prepared to protects themselves before getting malaria. 

Best Intervention

Insecticide Treated Nets.

• Effectiveness - The CDC reported a 20% reduction in deaths of children from all causes (all causes - the mortality rate from a specified cause (Malaria) for a specific population (children under 5)). So ITNs are highly effective.
• Feasibility - As long as the government and the people understand the effectiveness of ITNs, they would not be against the use of them. Moderately feasible.
• Sustainability - Long lasting ITNs can last up to 3 years. Considering the large number of deaths it could prevent, I would consider it moderately sustainable.
• Cost - The ITNs would be a huge cost to the government since they would be given out to the people freely. However, the CDC stated that a recent study has found that an estimated $3.8 billion could be saved over 10 years if the lifespan of Long Lasting ITNs could go from 3 to 5 years. So I say the costs are moderate.
• Cost Effectiveness - There's a higher chance of not getting Malaria if a person uses and ITN rather than not. High cost effectiveness.
• Political Acceptability - ITNs would cost the government economically but thousands of lives could be saved from them. Moderate political acceptability.
• Social Will - If people understand that ITNs would help more than hurt them, there would be high social will.
• Potential for unintended risks - I can think of no unintended risks that come with ITNs so low potential for unintended risks.
• Potential for unintended benefits - It is likely that the bed nets would protect against other nocturnal bugs that could be carrying other severe diseases for there is a high potential for unintended benefits.

References

"Insecticide Treated Bed Nets." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2012. Web. 19 Apr. 2013. <http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html>.

Rhee, Michelle. "Use of Insecticide-treated Nets (ITNs) following a Malaria Education Intervention in Piron, Mali: A Control Trial with Systematic Allocation of Households." Malaria Journal 4.35 (2005): n. pag. Print.

Malaria Intervention and Stakeholders

Problem Definition

Increasing Malaria cases and deaths in the women and children of the Democratic Republic of the Congo from 2005 to 2011.

Intervention

After using the Strategy Decision Matrix, I have determined that the best course of action was to increase provisions of Insecticide Treated Nets (ITNs) to the people of the Congo. In 2011, over 50% of expenditures went toward insecticides and spray materials while a very small percentage was spent on ITNs. While the number of deaths and cases has become steady from 2005 to 2011, these numbers are till increasing. The CDC has stated that "ITNs have been shown to reduce the death of children under 5 years from all causes by about 20%." About half of the expenditures used towards insecticides and spray materials will be allocated to ITNs. Women and children, as the most vulnerable population, will be shown preference when ITNs are given out.

Stakeholders

Those involved in the Program Operations: 

• Aid organizations like the CDC, WHO, UNICEF, and more who may provide resources (money, ITNs, etc.) to move the program forward.
• Government - In shaping policies to regulate the allocation of ITNs
• The people involved in developing the intervention

Those who the Program affects:

• The women and children who would be using the ITNs
• The different organizations who would be spending their money

Those interested in the evaluation results: 

• The government of the Congo
• The people who developed the intervention
• The Aid organizations (WHO, CDC, etc.) to update their information on Malaria treatments and such.

The stakeholders that may oppose my intervention in the Congo's government and some of the AID organizations. These stakeholders would probably disagree with spending so much money on ITNs since they are generally more expensive than insecticides and spray materials and also because they're not very long lasting. In response to this, I would demonstrate to them the uses of the Long Lasting Insecticidal Mosquito Nets that several companies have developed. I would also help them understand that I expect the ITNs to have a greater effect on the number of cases of Malaria victims.

References

"Insecticide Treated Bed Nets." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2012. Web. 12 Apr. 2013. <http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html>.

World Malaria Report 2012. Publication no. 119. World Health Organization, 2012. Web. 12 Apr. 2013. <http://www.who.int/malaria/publications/country-profiles/profile_cod_en.pdf>.

Public Health Topic: Malaria Determinants

Increasing Malaria cases and deaths in the Democratic Republic of the Congo.


Environmental Determinants
One of the many determinants of Malaria is water. The mosquitoes that transmit the Malaria virus need water to breed so in most places where a body of water can be found, there is a chance that that water carries Anopheles Mosquito Larvae. One more environmental determinant of Malaria is geography. There is a higher prevalence of Malaria in people who live further from towns and closer to rural areas.

Biological Determinants
Infants and children, pregnant women, non-immune, and HIV/AIDS positive people are at the highest risk of being infected with Malaria due to their weak immune systems.

Social and Cultural Determinants
Males are also at a higher risk than women of being infected Malaria. Thais may be due in part to gender and societal norms like males being expected to work to take care of their families.

Economic Determinants
Certain things like bed nets, treated or not, greatly help in warding off Mosquitoes. If many people cannot afford bed nets, their risk in being affected with Malaria rises.

Behavioral Determinants
It was found that individual use of bed nets was highly effective while community use greatly decreased the effectiveness. So communities that chose to share their bed net(s) have a higher chance of infection that in people who chose to use bed nets individually.

References

"Gender Health and Malaria." World Health Organization. N.p., June 2007. Web. 05 Apr. 2013. <http://www.who.int/gender/documents/gender_health_malaria.pdf>.

Messina, Jane P. "Population, Behavioural and Environmental Drivers of Malaria Prevalence in the Democratic Republic of Congo." Malaria Journal. Malaria Journal, 9 June 2011. Web. 05 Apr. 2013. <http://www.malariajournal.com/content/10/1/161>.

Rogier, Christophe. "Environmental Determinant of Malaria Cases among Travellers." Malaria Journal. Malaria Journal, 4 Mar. 2013. Web. 05 Apr. 2013. <http://www.malariajournal.com/content/12/1/87>.