In 2015, VectorWorks led the U.S. President’s Malaria Initiative’s (PMI’s) effort to standardize long-lasting insecticide-treated net (LLIN) durability monitoring protocols. Since then, the project has implemented durability studies in eight countries. Investigators in these countries embarked on three-year prospective studies to examine the impact of behavioral and environmental factors on how long LLINs last in field conditions, along a standard timeline. The research team collects baseline data within 6 months of a mass campaign and then follows up at 12, 24, and 36 months after distribution.
PMI VectorWorks partners with the Liberia National Malaria Control Program (NMCP) and University of Liberia Pacific Institute for Research and Evaluation (UL-PIRE) to implement durability monitoring in Liberia. The UL-PIRE is chiefly responsible for fieldwork, including baseline data collection. In July 2018, VectorWorks facilitated a training to strengthen the capacity of UL-PIRE and the NMCP to implement durability monitoring fieldwork. At the beginning of the training, the participants took a pre-test and the average score was 10.5 points out of a possible 40.
The LLIN durability monitoring comprises both specialized skills and general skills, which translate well to non-durability monitoring activities. During four days, Dr. Albert Kilian of Tropical Health LLP, a VectorWorks’ partner, demonstrated the techniques and skills needed to be proficient in the field. This included net hole counting using an android-based application, randomly selecting households, locating and storing global positioning system coordinates for household identification at follow up, and administering the household survey. Participants worked through a series of presentations and practical scenarios to increase their knowledge and skills.
Leo Harris, a student at UL-PIRE, is an experienced data collector working with the university. Despite his experience with data collection, he had not administered household malaria surveys and had little technical knowledge of malaria. At the beginning of the training, he was unfamiliar with the durability monitoring methodology and said, “On Monday, I thought what are we doing? Everything seemed big. On the second day, I started to enjoy the training. Now that we have completed the training—everything seems so simple.” Leo admits to being a seasonal LLIN user in the past, but now he thinks that the training has changed how and when he might use a net in the future, using a net more consistently.
Victor S. Koko, a monitoring and evaluation officer at the Liberia NMCP, was really impressed with the growth of the training team during the week, adding, “The training was very interesting and I’m proud to be a part of this team.” Victor was heavily involved in the training and felt the training was a real eye opener. “At first I thought, ‘what are we doing counting holes,’ but it is very interesting and the activity will have significant programmatic impact for decision making. You can’t take data from other countries and use it here [Liberia]; you must contextualize it here.” Many participants shared this outlook, and it was reflected in the post-training test. The median score increased by 35 percentage points from pre-training to post-training.
After the baseline training, the UL-PIRE team, with representatives from the NMCP, began baseline fieldwork in Lofa and Grand Gedeh counties. In total, 377 households were enrolled in the study and will be followed through 2021. VectorWorks, UL-PIRE, and the NMCP will reconvene in early 2019 for a refresher training and for the first round of follow up. During the study, VectorWorks expects to achieve two major outcomes: (1) high-quality LLIN durability data that will assist the NMCP in LLIN distribution decision making, and (2) capacity strengthening that will enable the NMCP and local research institutions—like UL-PIRE—to monitor LLINs locally.
“I learned so many new things from the training: The counting of holes on a mosquito net, identifying the categories/size of holes on a net, the kinds/types of nets, how to take care of a net, the types of anopheles mosquitoes and how they transmit the malaria parasite, etc., ” said Leo M. Harris of the UL-PIRE Africa Center
Liberia is just one example of VectorWorks’s durability monitoring portfolio. Over the next 12 months, VectorWorks will complete durability studies in Burma, Democratic Republic of the Congo, Ghana, Mozambique, Nigeria, and Tanzania (Zanzibar). Like UL-PIRE and the Liberia NMCP, local research institutions and national malaria control programs are at the core of each study; and they are making a significant contribution to malaria decision making in their respective countries.
Sean Blaufuss is a program officer at Johns Hopkins Center for Communication Programs working on the VectorWorks project.