CDI Module 7: CDI in LLIN Distribution and Use

©Jhpiego Corporation

The Johns Hopkins University

A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services

Module 7 Objectives

By the end of this module, learners will: Explain how to obtain and safely maintain stocks

of long-lasting insecticide-treated nets (LLINs) Estimate LLIN needs based on community census Discuss the need to educate community members

on the importance of sleeping under LLINs every night (especially children and pregnant women)

Discuss the need to encourage pregnant women to collect and use LLINs as soon as they realize they are pregnant

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More Objectives

By the end of this module, learners will: Outline the process of teaching community

members how to use the nets Outline follow-up procedures for facility staff and

community-directed distributors (CDDs) to encourage continued LLIN use

Discuss the importance of making sure that all women of reproductive age have and use an LLIN so that they will be protected from the beginning of their next pregnancy

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Comparison of Treated and Untreated Nets

Action Untreated Nets

LLINs/ITNs

Protection against malaria Provides some levels of protection

Provides high levels

of protection

Kill and repel mosquitoes No Yes

Reduce number of mosquitoes inside/outside net

No Yes

Kill other insects (e.g., lice, roaches, bedbugs)

No Yes

Safe for pregnant women, young children and infants

Yes Yes

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Net Program Stages

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Catch-up:Make sure everyone gets a net

Hang-up:People hang and use the nets

Keep-up:Replace old nets, give nets to new people

Procuring and Maintaining LLIN Stocks

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Modes of LLIN Distribution

In some places nets are distributed through mass distribution campaigns

In some places LLINs are also made available through routine services like antenatal care (ANC)

In either case, we must estimate needs for nets—building from household, to village, to local government area (LGA)/municipal levels

We need to identify different providers and sources of LLINs and ensure coordination to meet all coverage needs

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Community Net Stocks

Communities need to obtain and safely maintain stocks of LLINs based on community census estimates

Community distributors will approach the health facility with a community register, based on the community census, and will receive LLINs for their communities

The community distributors will sensitize and inform community members on the availability of the commodity through mechanisms agreed upon by the community

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Who Gets LLINs?

Generally our goal is at least one net for every two people in a household Net need can also be estimated by the number of

sleeping spaces in a home

The CDDs will ensure that all under-five children, pregnant women and women of reproductive age living in their community receive LLINs

Other household members should get nets, but if supplies are limited, priority should go to children and pregnant women

Replacement and Keeping Up

After mass distribution, we may discover that not all households received the required number of nets

Therefore, we need to maintain supplies to fill gaps We also need to maintain supplies to meet the needs

of newly pregnant women and people who migrate into the community

In some cases, we may need to account for the fact that people have two residences (e.g., town and farm)

Supplies are also needed to replace lost, torn nets

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Methods for Filling Gaps and Keeping Up

Frontline health facilities need to keep a supply of nets after campaigns have taken place

CDDs may also keep supplies of nets for newcomers and newly pregnant women

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Community Health Education on LLIN Benefits

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Health Education Beginswith the Community

Although health workers know malaria is carried by mosquitoes, and therefore, LLINs will prevent malaria: Community members

may have other ideas (as we see to the right)

We must be respectful of local beliefs when we explain net use

According to some local beliefs, malaria may be caused by: Red cooking oil Too much alcohol Too much work Over-exposure to sun

What do people in your area think?

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Inform Community Membersof LLIN Benefits

LLINs: Repel and kill mosquitoes Prevent physical contact

with mosquitoes Repel and kill other

insects (e.g., lice, ticks, bedbugs and cockroaches)

When most people use nets, mosquitoes are reduced throughout the community

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Educate Community Members on Protecting Vulnerable Groups

If possible, everyone should use an LLIN, but give priority to pregnant women, infants and children

LLINs are safe for pregnant mothers, young children and infants

Advise pregnant women to use the net as soon as possible as soon as they know they are pregnant— teach them how to use the nets

Ideally all women of reproductive age (15–45 years) should sleep under an LLIN so they are already protected if they become pregnant

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Inform Community Membersabout LLIN Benefits

Prevents mosquito bites Helps people sleep better Protects children from malaria Protects pregnant women against malaria, resulting

in less: Anemia Prematurity and low birth weight Risk of maternal and newborn death Retarded fetal growth

Promotes growth and development of the fetus and newborn

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Education about Benefits

Inform community members that LLIN use will benefit the community by: Decreasing cost of treating

frequent malaria Reducing number of sick

children and adults, thus helping Children to grow up healthy Adults to remain productive

Lowering the number of deaths in the community

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Inform Community Membersabout LLIN Logistics

Let people know how they can obtain nets: Routine health services (e.g., ANC) Campaigns—in some cases they may need to obtain a

voucher first Commercial sales

Inform people where they can obtain LLINs: The community distributors in their community The health facility providing service to their community Shops, markets, pharmacies, etc.

Discuss LLIN logistics that apply to your area

Education on Proper LLIN Use

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Educate Women

Women play important roles in keeping household members healthy, so remind women: That it is not enough to collect the net; they must use

it too To expose the net for 24 hours before use (but NOT in

direct sunlight) To hang the net above the bed or sleeping mat—

using rope, net hangers or sticks at the four edges of the net

To tuck the net under the mattress or sleeping mat To use the net every night, all year round

Demonstration and Return Demonstrationon Net Hanging

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Net Hanging Demonstrationin a Village Hall

Discuss where you can organize net demonstrations

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Hanging a Net Properly in the VillageCan Be Challenging

23Discuss net hanging challenges in your area

CDDs Visit the People

CDDs should: Visit pregnant women and

children’s caregivers and remind them that pregnant women and children should sleep under nets regularly

Teach pregnant women and children’s caregivers how to care for the nets

Make rounds to ensure nets are hung properly and all sleeping spaces are covered

Ensure that women sleep under the net regularly during pregnancy

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Teach People How to Use and Care for Nets

Handle the nets gently to avoid tearing them Fold/tie up the net during the day to avoid damage Regularly inspect the net for holes; repair holes, if

found LLINs last for three to five years or 20 washes, but

may expire sooner if washed too often Wash only when very dirty, no more than a few times a year Wash nets with gentle soap, NOT detergent Dry nets in the shade—no sun because it will destroy the

chemical

Keep LLINs away from smoke, fire, direct sunlight

Correct Net Use

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Net Misuse

Net used for goal post Net used for kiosk

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More Net Misuse

Net used for door curtain Net used to cover vegetable garden

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Discussion

What different sources of LLINs are available in your communities?

Share the different examples of net misuse you have seen and suggest what can be done

What challenges do you know that make promotion of net use difficult? Any household factors? Any health system factors? What can the community do about such challenges?

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Summary

We need to address net procurement and distribution during campaigns and for follow-up

People need to be educated about the benefits of using nets

Net distribution is not finished until all nets are hung properly and used regularly

CDDs have an important role in: Helping people handle nets Monitoring the actual household situation, and Reminding people to use nets correctly

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