MCHINJI 2015 IMPACT ASSESSMENT (IAs) SURVEY FIELD REPORT

INTRODUCTION

Blantyre Institute for Community Ophthalmology (BICO) recently conducted a Trachoma Impact

Assessment survey in Mchinji district in collaboration with the ministry of health (MOH). Between 2008 and

2013, Malawi conducted trachoma baseline surveys looking at both active disease (TF) and trichiasis (TT).

To date 25 out of 28 districts have been mapped, and among these 20 have been found to be endemic for

trachoma, with TF ranging between 5.0 and 29.9 % and TT ranging between 0.0 and 0.9% and mchinji is one

of them. With funding from the Queen Elizabeth Diamond Jubilee Trust, Blantyre Institute for Community

Ophthalmology (BICO) a local NGO dedicated to the prevention of blindness is implementing the SAFE

strategy in 7 districts in Malawi (Chikwawa, Nsanje and Machinga, Dowa, zomba, ntcheu and mchinji).

After 3 years of successful Mass drug Administration (MDA) in Mchinji, BICO in collaboration with the

Ministry of Health undertook an impact assessment survey in 2014 and the (TF) results from all the 3 sub

districts were above 5% threshold (Trachoma still of a public health importance in this district) hence one

more round of MDA was conducted between the month of October and November in 2014. As it is

recommended, after 6 months of MDA an impact assessment survey was conducted in this district in all the

3 subdistricts between 6th June, 2015 to 19th June, 2015. The table below shows the summary of how it was

surveyed;

Table A: EU-Level Data Summary for MCHINJI IAs

EU Total Clusters (24) Total Households

Total Residents

1-9 year olds examined

15+ year olds examined

Last Data received (survey date)

00522 24 959 4,483 1,363 1,601 12/06/2015

00523 24 960 4,301 1,279 1,669 14/06/2015

00524 24 960 4,257 1,166 1,604 18/06/2015

From the table above, a total of 72 clusters were covered an average of 960 households in each EU

(evaluation Unit) meaning 40 households were covered in each cluster. From all the EUs, a minimum of

1166 (1-9) year olds were examined per EU. It took 3 days to finish each EU and data was being uploaded to

server upon completion of each field day, from the table above, the final data for each Impact assessment

survey for Mchinji was from EU=00524 (DHO Nkhwazi) which was finally uploaded on 18/06/2015. The

Impact Assessment results are waiting for approval from the ministry of health and will then be

disseminated to partners and stakeholders.

TRAININGS (RECORDER & GRADER)

The Impact Assessment survey started with a 3 day Grader and Recorder refresher course which took place

in Mangochi district in the Southern region of Malawi. Recorders had a full day of Recorder training in

Blantyre at BICO offices. Trachoma is one of the Neglected Tropical Diseases (NTDs) which is expected to be

eliminated in Malawi by 2018 as there is a manageable backlog. With funding from the Queen Elizabeth

Diamond Jubilee Trust through the Trachoma Elimination programme (TEP) where BICO is one of the

implementing partners (IP), the Ministry of Health (MOH) in collaboration with BICO conducted this survey

in Mchinji district.

The data collection process started with training of recorders on the 21st of May, 2015 prior to the refresher

training in Mangochi. Alvin Chisambi, recorder trainer from BICO trained more than 8 recorders for the survey

with the mentorship and guide from Prof Khumbo Kalua. In total, there were 10 recorders who were trained, 8

for the field and 2 on backup. The group of recorders had time to go through the questionnaires and had to

practice on the LINKs Mobile Application which is used to collect data in the project. Later on, the successful

recorders were allocated to different teams which consisted of grader and driver hence it was three (3) per

team together with the recorder. The graders too had a refresher course from Dr Moyo and Mr Mbewe,

ophthalmology personnel. To familiarise themselves with the application and the community, the teams had

time for field training on the 26th of May, 2015. With this kind of training, the trainers declared the teams fit

for actual field work. The teams started with the GTMP then proceeded to do the Impact assessment after a

short break.Grader trainees went through both classroom and field refresher training which was done by Dr

Moyo and Mr mbewe. The picture below shows one of the session during the classroom refresher training by

Dr Moyo.

Survey Participants; see appendix for names

Dr Moyo; during Grader refresher training

METHODOLOGY

Mchinji district was divided into three (3) sub districts and each sub district had 24 clusters which were

randomly selected. These 3 subdistrict are; Mkanda/Gumba, Ludzi/Kochilila and DHO/Nkhwazi. In total, 72

clusters were selected in all these 3 EUs. These sub districts were assigned EU Ids (see table B)

Households were randomly selected from the village household listing provided by the HSAs. Household

numbers were generated randomly from the village household totals. Teams were selecting households to

survey using these randomly generated numbers from the HSAs household lists.

FIELD WORK (Data Collection)

During field work, as per study design, the graders are supposed to do the trachoma clinical eye lid

examinations of the residents in the selected sampled households. The results of the examinations are coded

into the questionnaire by the recorder who uses the mobile device to capture all the survey data. Below, one

of the graders examine a resident at a household level during the survey

The teams started the data collection process using the Taskforce LINKs mobile Application version 1.3.7 ODK

software on Android devices (mHealth) on 8th June, 2015. The electronic data from the field is uploaded to the

Task Force for Global Health (Impact Links system) server each day of data collection for cleaning and analysis.

The collection and uploading was done simultaneously each day through 8th June, 2015 to 18th June, 2015.

Grader; examining a resident during survey

Mchinji 3 sub districts took 11 days of actual data collection with a break after every 3 days between the

districts. As per revised survey guidelines, teams were supposed to cover a total of 40 households per day

per cluster. With 8 teams in the field, with an expectation of 8 clusters and 320 households to be done per

day, teams were to cover 960 households and 24 clusters in 3 days in a single EU. All the Evaluation Units

(EUs) Mkanda/Gumba (00522)Ludzi/Kochilila (00523) and DHO/Nkhwazi(00524) had 24 clusters with a total

of 72 clusters in all the EUs.

Table B: Summary of Households Covered as reported by field teams:

District Sub District Evaluation Unit-ID (EU)

Clusters Households Covered(40)

MCHINJI Mkanda/Gumba 00522 24 40*24=960

MCHINJI Ludzi/Kochilila 00523 24 40*24=960

MCHINJI DHO/Nkhwazi 00524 24 40*24=960

The above table B shows that all teams managed to visit and interview 40 households per day. In total

960*3=2880 households were covered and a total of 72 clusters were covered in all the 3 Evaluation Units

(EU) as reported by field teams.

From table B, it is shown that the summaries teams were giving each day to the supervisor is 99.9% correct

with what was being really corrected and uploaded on the server. When we compare Table A (actual

Recorder; collecting Household data during survey

analysis) and table B, only 1 household less from what was reported by teams in EU=00522. This show that

teams were able to finish 40 households per cluster per day.

FINDINGS

The findings (clinical examinations, TFs and TT) of this Impact Assessment (IAs) survey are yet to be

released by the Ministry of health and BICO as the analysed data is still awaiting Ministry of health

approval. Tables A and B above just gives a summary of the total number of households covered per cluster

per Evaluation Unit (EU) and the residents who were examined during the survey. The results of this survey

will be very important in the history of trachoma for the people of Mchinji as they will determine the way

forward in the Mass Drug treatment as now Mchinji has had 4 rounds of MDA.

CHALLENGES

Household sampling was a problem due to problems in household listing by the HSAs as they provided

different information as submitted initially. Most HSAs did not give actual number of households on the

ground. Teams were trained on how to sample if this challenge arises.

The crashing of Motorola mobile android devices which were being used for data collection during the

survey brought some major challenges. This is because most of these gadgets are old and need replacing

but still they helped to complete the Impact assessment survey in Mchinji with no major challenges.

Logistical challenges when vehicles had breakdown but survey teams had vehicles on backup

CONCLUSION

The Impact assessment (IAs) survey conducted in Mchinji, the second of its kind following the first which

was done in 2014 with funding from the Queen Elizabeth Diamond Jubilee Trustthrough Trachoma

Elimination Programme in Malawi was successfully done by Ministry of Health and Blantyre Institute for

Community Ophthalmology (BICO) one of the implementing partners (IPs) doing “A” of the SAFE strategy.

With teams of graders having a refresher course and recorders having been fully trained before going to

the field. Field work lasted as planned and everything went on well as planned. With the main challenge

being HSAs household listing not tallying with what was submitted to DHO and crashing of the application,

teams still managed to complete the Impact Assessment (IAs) survey successfully.

RECOMMENDATION

Consider replacing or repairing the android devices being used in the surveys as they appear to be old as

most of them have developed cracks on the screens.

Survey planning was well done and should be continued as clusters were well selected starting with had to

reach areas and finishing with the base where teams were putting up. This made the teams easier to get to

hard to reach areas.

Keep on having vehicles, recorders and graders on backup as this helps a lot when there is a breakdown or

when a recorder or grader get sick or withdraws.

Appendix:

Survey Participants and Roles

Number NAME ROLE

1 Prof Khumbo Kalua Survey Coordinator BICO

2 Mr Michael Masika Supervisor MOH

3 Dr Moyo Trainer MOH

4 Frank Mbewe Trainer/Grader MOH

5 Alvin Chisambi Trainer/Data Manager BICO

6 Florence Kalua Survey Logistics BICO

7 Ranneck Singano Survey Logistics/driver BICO

8 Hendrix Likongwe Grader MOH

9 Isaac Luhanga Grader MOH

10 Josen Chizala Grader-backup MOH

11 Madalitso Nyangulu Grader MOH

12 Maggie Nsenzama Grader MOH

13 Thandi Banda Grader-backup MOH

14 Voreen Chiziwe Grader MOH

15 H. Juta Grader MOH

16 Elijah Phiri Grader MOH

17 George Mphasa Grader MOH

18 Gomezgani Nyasulu Recorder BICO

19 Annie Mwafulilwa Recorder-backup BICO

20 Patrick Chasauka Recorder BICO

21 Melody Sakala Recorder-backup BICO

22 Madalitso Jamali Recorder BICO

23 Lesley Mulaga Recorder BICO

24 Slyviah Zulu Recorder BICO

25 Chikondi Chikoti Chalera Recorder BICO

26 Jesica Sipanala Recorder BICO

27 Emily Lungu - backup Recorder BICO

28 Salomie Mumderanji Balakasi Recorder-backup BICO

29 J. Banda Driver MoH

30 P. D. Phiri Driver MoH

31 W. Maonga Driver MoH

32 A. Mafunga Driver MoH

33 L. Bale-backup Driver MoH

34 L. Chinula Driver MoH

35 Brazio Banda Driver MoH

36 Chester Phiri-backup Driver BICO