Recommendations for the distribution of Insecticide-treated nets in Long Term (LLINs)

Introduction:

As part of the response to emergencies and in the fight to prevent malaria and dengue fever, several organizations have in their mandate to intervene in preventing the distribution of mosquito nets. From the Working Group of the Vector Borne disease was designed under the coordination PSI Haiti, the subset distribution of bednets.

To improve the impact of the distributions of mosquito nets and the coordination of public and private stakeholders, policy recommendations were developed taking into account the reality of the camps, priority areas of malaria prevalence and human / material resources .

All these recommendations resulting from the collaboration of key partners distributing mosquito nets under the direction of PSI and in coordination with the "Vector Borne Disease group, the health cluster and MSPP / CNIL.

This document approved by the Ministry of Public Health will be available for distribution and partners are encouraged to implement within their respective mandates and resources.

1. Targeting (common minimum standard of 4 SPHERE standard)
   * = Recommended targeting the entire population

The Anopheles albimanus is responsible for transmitting the parasite that can cause malaria in Haiti begins to bite in the evening around 5-6 pm on that is to say when the majority of beneficiaries are not lying. It's the same for the aedes aegypti, vector of dengue virus, which is fed mainly at dawn and dusk.

Protection against mosquitoes offered by LLINs will therefore truly effective if there is a high coverage over 85% of the population (camp, village, etc. ..) and not only physical protection of individual beneficiaries when sleeping under a mosquito net.

In addition, given the low immunity among the Haitian population (seasonal transmission of malaria, areas of low transmission), any person is at risk of developing severe malaria.

NGOs that have problems in achieving this coverage, will work with other NGOs to maximize their impact.

• Distribution Method

For maximum impact given the behavior specific vectors in Haiti (Anopheles mosquitoes, Aedes, Culex) and gaps in KAP (knowledge, attitudes and practices) of the beneficiaries, the following points are recommended. They aim to get the best use, conservation and efficiency of MILD.

• The nets should be distributed taking into account their specific medical and not as NFIs (non food items)
  
• In addition to the earthquake-affected areas should emphasize the departments of high transmission of malaria (North, Northwest, Nippes, Grand Anse, and South and South East).
  
• The recommended method of distribution is the door to Hook near the homes of beneficiaries. In case this is not possible, the distribution must be made to a central monitoring follow-up visits at random recipients (with attachment if necessary).
  
• The quota is a MILD / shelter (shelter) in the camps of internally displaced people - For the host population, 2 MILD / home undamaged.
  
• The nets should be distributed to beneficiaries without their packaging business. Depending on the resources of organizations, the nets should be distributed with tools hanging (rope, nails, pin feed, etc..)
  
• For purposes of monitoring and evaluation nets will be marked during the distribution (marking on any surface of the screen and not the package) with an indelible mark. Ex NGOs xxx D / M / A
  
• The awareness of beneficiaries must be continued on malaria, the consistent use of the net and his maintenance during this distribution process (before, during). Wherever possible we recommend awareness 1-2 weeks after delivery.
  
• When distributions, filling the data collection tool (1) taking care to comply with all the information requested.
  
• Distributions after sharing the data collection tool (2) on a regular basis with PSI Haiti to ensure better coordination, avoid duplication and thus ensure effective coverage of 85% of the beneficiary population.

Note

Training a day to strengthen the capacity of staff are available through various partners such IFRC, PSI, the MENTOR Initiative.

• Community involvement (see a common standard of SPHERE standard)

Area affected:

The vast majority of camps have a management committee made of residents of the camp or not supervised by an institution. To gain a better acceptance of distribution activities and a lasting impact in terms of net use is recommended:

• Meet the committee and the training on the subject of malaria and use of mosquito nets
  
• Encourage committee members to conduct awareness sessions before and during the distribution of mosquito
  
• Have their active participation in the distribution with a good monitoring system
  
• It is advisable to include in this awareness simplified information on dengue fever and filariasis. In terms of gratuity See paragraph 8

Highly endemic area

For people in areas endemic distribution will be made after consultation with the Health Department involved in using health workers, representatives of NGOs and local associations.

• IEC messages on malaria and LLINs
  
• The camp population must be sensitized before-during and after distribution.
  
• The education materials will be printed in Creole and (brochures - poster) and audio (radio spot)
  
• Awareness may be door to door (eg door to door outreach for the attachment of LLINs, pilot shelter where clients can see how to hang a mosquito net, workshop discussion / demonstration in the queue, etc..)
  
• Whenever possible, each beneficiary will receive a screen printed educational materials on malaria and use of the net.

The key messages of awareness:

• THE CAUSE OF MALARIA (role of the mosquito)
  
• GRAVITY OF THE DISEASE (malarial coma --- dead!)
  
• GROUPS AT RISK: can reach everyone, especially the most vulnerable (person immune deficient, malnourished, pregnant women, child - 5 years, persons traveling to areas of low transmission to high transmission area)
  
• THE MEANS OF PREVENTION
  
  a. Consistent use of LLINs
  b. Clean environment (prevent puddling and eliminate any potential container)
  
• ROLE LLINs
  
  a. Physical barrier (to prevent mosquito mesh to pass but are large enough to allow good aeration).
  b. Deterrent or repellent (insecticide)

- USE LLIN (latch-wash-care information)

• The MILD when hooked to touch the ground or return under the layer
  
• The MILD day and night should remain attached and well-deployed to play its role repellent
  
• Possible side effects may be experienced (hives, itching, digestive disorders). These disorders are transient and we recommend washing hands after handling the net.
  
• Washing with plain soap and water every four months and extend the shade
  
• Keep out of reach of fire (candle-light - stove )

How to get education materials specific to MILD?

PSI / Haiti has IEC materials already approved by the Directorate of Health Promotion and Protection of the Environment is a cell of the Ministry of Public Health and Population. These materials are available in limited quantities partners. The models can be shared for printing after permission of the management of PSI Haiti.

NB No changes may be made to the various models without the written permission of the management of PSI Haiti

• Initial assessment (see Standard 2 of common SPHERE standard)

In conjunction with the camp committee, an initial assessment of the camp must be made to have data on:

• the number of families involved
• number of shelters
• access areas
• the storage nets in the distribution
• health status and hygienic.

A micro-planning should include awareness of the committee, the date of initial awareness of the inhabitants of the camp by the committee, the evaluation of possible pre-positioning / MILD storage on site, the definition of the distribution strategy and followed to the letter of notification to the mayor and the police.

• Follow-up (minimum common standard No. 5)

Monitoring the distribution must include awareness of users / Managers, messages on the maintenance and conservation of nets (mosquito nets are hung they always?).

The Recommendation is to empower the committee of such monitoring. In areas of high endemicity the assistance of health workers may be requested.

• Rating (common minimum standard SPER No. 6)

An assessment of the distribution must be made by the organization distributes. A key indicator of this assessment is the knowledge of users on the vector and the means to protect themselves against the vector and the change in attitude to sleep on a screen. (See also standard on an anti-SPHERE vector. These data will be compared with epidemiological data to see if the result from the decreased incidence of malaria has been achieved.

Note

The post distribution monitoring tools / training are available (Contact The MENTOR Initiative)

• Contribution / Gratuity

To carry out the activities, volunteer work is encouraged. However, given the reality of the camps and the availability of funds to the institution, a system of 'cash for work "can be established. The amount allocated per person will understand between 300 and 500 Gourdes per working day and will be at the discretion of the institution. No meals or transportation costs would be awarded. but the icy water in sufficient quantity for each day of activity will be made available Team Distribution / hooking.

• Coordination of actors

PSI / Haiti provides coordination and supervision of distribution activities nets. In this capacity he is asked all organizations that want to distribute, and / or distribute mosquito nets to coordinate their efforts to avoid duplication of activities.

Organizations must submit to PSI following information:

• Date, place and population distributions made sites
  
• Date - location-and population distributions provided sites.
  
• Number and type of nets distributed and characteristics of beneficiaries (general population, pregnant women, families with children under 5 years e)
  
• Constraints / Recommendations
  
• Tracking provided
  

To provide supervision during and / or after distribution to PSI Haiti, in each geographical department, a field coordinator who can with good planning framework for the institution making the distribution.

Also with the updated distributions already made in the PSI may limit its budget achieve mass awareness activities around the site with 2 vehicles with sound.

The information gathered will be updated regularly and communicated to the National Programme for Control of Malaria and clusters.

NB Meet the actual needs (common standard 3)

During a visit to the camp to distribute mosquito nets an assessment of unmet needs (health-food-health etc. ..) must be made and the organization must facilitate decision-committee contact with organizations that can help .