Mozambique FELTP fellows evaluate impact of malaria bed net campaign

Four Mozambican epidemiologists-in-training spent a month walking up to ten kilometers a day to make sure that one of the most effective malaria control interventions was reaching the poorest Mozambicans. Malaria is the leading cause of death in Mozambique, and insecticide-treated bed nets are one of the key malaria control measures. Since 2007, the U.S. President’s Malaria Initiative (PMI) has supported the Mozambican Ministry of Health and the National Malaria Control Program (NMCP) in efforts to reduce the burden of malaria in the country, not only through distribution of bed nets, but other key components as well: indoor residual spraying, diagnostic testing and treatment with effective antimalarials, and intermittent preventive therapy for pregnant women.

In 2013, with PMI support, the NMCP launched a universal bed net distribution campaign in six districts in Nampula Province, located in the northern region of Mozambique. The goal was to provide access to a bed net to the entire population living in the 250,000 households within the target area. The definition of “universal” varies somewhat by country; in Mozambique it means one bed net for every sleeping space. Mass distribution campaigns meant to achieve universal coverage are ambitious, complex, multi-step activities. They involve visiting all households in the distribution area to perform a census, determining how many bed nets to distribute per household, and organizing the logistics of delivering hundreds of thousands of bed nets to remote areas. It is therefore important to evaluate their performance and determine how successful they were in achieving their goal so that lessons learned can inform planning for the next campaign. And for the NMCP, it is important to document how increased bed net ownership and use made possible by campaigns affect malaria transmission.

To address these questions, I developed an evaluation protocol, in collaboration with Geraldo Chambe, a resident in the Mozambique Field Epidemiology and Laboratory Training Program (FELTP), a CDC training program that builds in-country capacity in the areas of epidemiology and laboratory skills.  PMI supports FELTPs in 12 of 19 target countries in Africa.

During the evaluation, randomly selected households in two of the target districts were visited within two weeks following the bed net distribution campaign.  Geraldo Chambe and three other FELTP residents each led a survey team. Teams worked long days in the field, visiting up to nine houses per day during the peak of the hot, dry season. At each household, the interviewer administered a brief questionnaire in the local language, visually inspected bed net placement and condition, took a blood sample to test for malaria, and gave treatment to any member of the household who tested positive. In one year, the districts will be revisited to assess whether greater access to bed nets has changed malaria prevalence in the area, as well as to assess the condition and use of bed nets distributed during the 2013 campaign.

The FELTP, NMCP, and EIS field team worked jointly to successfully implement the evaluation. It was a win/win all around.  The NMCP drew on the FELTP residents’ epidemiology and local language skills.  And the residents obtained field experience. According to James Colborn, PMI’s CDC Resident Advisor to Mozambique, “The project provided an excellent synergy between EIS and FELTP, while addressing an important malaria-related operational research need.”  Added CDC FELTP Resident Advisor Tim Doyle, “This provided a great field service learning opportunity for our residents. We hope this will also lead to greater capacity within the Ministry of Health to conduct such impact evaluations in the future.”

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