Summary

• Mar 2012 was first full month of universal coverage in ALL areas of Ntcheu District
• Initial estimate: Malaria incidence, compared to the same month in the prior year, is 50% lower in Mar 2012, 50% lower in Apr 2012, 45% lower in May 2012, 45% lower in Jun 2012
• The incidence of malaria in July, August and September 2012 were 41%, 47% and 35% lower than in the corresponding months of the prior year.

Notes

• Different malaria diagnostic methods were used pre and post July 2011. Pre July 2011 data were via clinical observation. This diagnostic method can lead to an overstatement of malaria i.e. false positives. Data in July 2011 and after were via use of Rapid Diagnostic Testing Kits ie via blood testing, which is far more accurate.
• Comparing Jul-Nov2010 with Jul-Nov2011 data suggests an average 50% (range 30-70%) over-diagnosis of malaria (false positives) in the Jul-Nov 2010 period. Comparing Dec2010-Jan2011 with Dec 2011-Jan2012 data suggests a much lower over-diagnosis of 0-25%. Anecdotal information from malaria scientists is that over-diagnosis of malaria in the peak malaria season is usually lower than in the off-season as a much higher percentage of people with fever and other malaria like symptoms do indeed have malaria. We are seeking scientific study results on this issue.
• Working assumption: We believe it is reasonable, and perhaps even conservative given the Jan 2011/2012 figures, to estimate the overstatement of malaria in Feb to Jun 2011 as 25% of reported cases. This is the assumption which generates the estimate of a 40-50% reduction in malaria above (‘Initial estimate’)

  Monthly Malaria Case Rate Data

Summary

• 7,646 randomly selected households were visited and 15,735 nets surveyed (6% of the nets distributed) across the 37 health centre catchment areas.
• 90% of the nets were found to be hung and in use. For 10 of the areas the average was 84% (range 78-88%) and for 27 of the areas the average was 95% (range 91-98%).
• This is a high hang-up level.
• 99% of the nets were found to be in 'very good' condition (fewer than 2 holes of up to 2cms in size).
• The condition of the nets when compared with our expectations is: excellent

Additional actions

• Summary: Additional, structured malaria education and hang-up activities have taken place (23-27 Sep 2012) in 10 (of 37) health areas, with the aim of raising the hang-up level in the 10 areas by 10 percentage points (from an average of 84%).
• Detail: Concern Universal (CU) distributed 268,420 LLINs in Ntcheu district, Malawi in Jan and Feb 2012 to achieve universal coverage of a population of 550,000 people. The 6-months Post Distribution Survey showed 90% of the nets distributed were hung. This is a high hang-up level. However, 10 of the 37 areas in the district showed hang-up levels 11 percentage points below that of the other 27 areas (84% vs 95%). Additional, structured malaria education and hang-up activities have taken place in these 10 areas, with the aim of raising the hang-up level in the 10 areas by 10 percentage points. These activities have taken place with full involvement of the local communities. We expect to receive updated hang-up data for these 10 areas by the end of November 2012 and will publish them here. In the 6-months Post Distribution Survey, 7,646 randomly selected households were visited and 15,735 nets surveyed. Survey questions covered net use and net condition for both AMF and non-AMF distributed nets. The survey was carried out by staff from each of the 37 health centres and clinics in Ntcheu, with training and supervision by CU staff. The data was collected on written forms and entered by CU staff into a database to facilitate analysis. The 37 health centre catchment areas had an average hang-up level of 90%. For 10 of the areas the average was 84% (range 78-88%) and for the other 27 areas an average of 95% (range: 91-98%). Whilst these hang-up levels are high, AMF and CU both believed it would be possible to achieve even higher levels of hang-up through a simple post-distribution malaria-education focused intervention. The reason for this additional low-cost intervention was to seek the optimal impact of the nets distributed.

Key data   See the underlying data
Nets Hung	Net Condition	Net condition expectations (14,184 nets)
Other data
Who is covered?	Coverage of sleeping spaces	Coverage + Spare nets

Summary

• 9,250 randomly selected households were visited and 18,580 nets surveyed (7% of the nets distributed) across the 37 health centre catchment areas.
• 85% of the nets were found to be hung and in use. For 21 of the areas the average was 91% (range 84-95%) and for 16 of the areas the average was 78% (range 71-82%).
• This is a high average hang-up level after 12 months, albeit 16 of 37 areas have the potential for higher levels of hang up.
• 89% of the nets were found to be in 'very good' condition (fewer than 2 holes of up to 2cms in size).
• The condition of the nets when compared with our expectations is: excellent

Additional actions

• Summary: (18 Jun 13) Concern Universal are currently liaising with the Ntcheu District Health Officer (DHO) and his team to establish what targeted malaria control interventions might take place in the short term in the light of this information.

12-month Post-Distribution Survey Report (pdf)

Key data   See the underlying data
Nets Hung	Net Condition	Net condition expectations (16,307 nets)
Other data
Who is covered?	Coverage of sleeping spaces	Coverage + Spare nets