| Summary: | A research report submitted to the Faculty of Health Science in
partial fulfillment of the requirements for the degree of Master
of Science (MSc) in Epidemiology - Implementation Science.
November, 2017. === Introduction
TheWorld Health Organization (WHO) reported an estimated global 3.3 billion people still
living at risk of malaria in 2015. In the world, only 15 countries bear approximately 80%
of malaria related deaths. The Sub-Saharan Africa (SSA) alone accounts for 90% of malaria
related deaths. The use of Long-Lasting Insecticidal Net (LLIN) for malaria prevention is a
cost-effective intervention. WHO recommends LLIN universal coverage, defined as at least
one LLIN for every two people in the household. In SSA and other Low and Middle Income
Countries (LMICs), governments and multilateral partners have committed to fully subsidize
and provide LLIN for free through mass distribution campaigns. However, LLIN mass
distribution has not necessarily led to reduced malaria incidence and related deaths because
of its non-use or missed. In Burundi, LLIN is provided free of charge through mass
distribution at community level and to pregnant women coming for antenatal care or
delivery and childhood immunization. Despite LLIN ownership, Burundi malaria report
for 2014 says that only 49% of people sleep under LLIN and only 82% of LLIN are used
for their purpose. This has impeded efforts to control malaria and also led to financial
wastage. Our study sought to improve LLIN use in Kayange community of north-western
Burundi by using the Model For Improvement (MFI).
Objective
This study assessed the level of LLIN ownership and use in Kayange community of northwestern
Burundi with an aim of building on drivers of LLIN non-use in order to identify
and test improvement actions by using the MFI.
Methods
A one group pre-test post-test study design was conducted. LLIN ownership and use was
assessed for four weeks before intervention and for another four weeks after intervention.
The study was conducted on 96 households in Kayange community of north-western Burundi.
The intervention consisted of testing four different weekly small change actions by
using the MFI. The first change action consisted of the demonstration of how to mount
LLIN and this was conducted at the community yard. The second change action consisted
of selecting one watchdog in each household who was tasked of checking and reminding
household members to mount LLIN before sleeping. The third change action consisted of
conducting two community reminders every week. Reminders were done by a town-crier.
The fourth change action consisted of a combination of the last two actions. Data was
collected for each week. Descriptive analysis was performed on socio-demographic data
and factors associated with LLIN non-use and misuse were summarized using frequency
v
tables. Each outcome indicator was calculated each week and plotted on a run chart.
Results
Of the 96 households, 83 (87%) households owned at least one LLIN. However, only 40
(42%) households owned at least one LLIN for every two people. After intervention, the number
of LLIN used increased from 32 to 75% (134% increase) and the number of persons
(general population) sleeping under LLIN from 35 to 73% (108% increase). The number
of children under 5 years sleeping under LLIN increased from 31 to 76% (145% increase)
and the number of pregnant women who slept under LLIN from 43 to 73% (69% increase).
Also, the averages of the number of nights in each week that the general population slept
under LLIN increased from 2.13 to 5.11 (140% increase), children under 5 years slept under
LLIN from 1.68 to 4.78 (184% increase) and pregnant women slept under LLIN from 1.56 to
4.47 (186% increase).
Conclusion
In conclusion, our intervention led to significant increase of all outcome indicators. Drivers
of success included community collaboration, an enabling context, and support from
stakeholders. Small tests of change at community level have potential of achieving improved
outcomes. It is essential to gain collaboration and support from stakeholders and
also engage the community. === LG2018
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