WASH Cluster – Emergency Training
VC
Vector Control
Module 3D
Net distribution
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Overview
• Understand what LLINs are and which are
tested and approved by WHO
• Understand the procurement, shipping and
storage considerations for LLIN
campaigns
• Understand the main delivery strategies
for emergency settings and how to
achieve and show maximum impact
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LONG LASTING INSECTICIDAL
NETS (LLITNS)
• Nets that have been treated with insecticide
in the factory during production.
• Residual insecticide will continue to be
effective for a period of 3 to 5 years
• LLINs do not need to be retreated
• LLINs are proven to withstand 20 washes
before the insecticide becomes ineffective
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LLITNs
• WHO approved: Permanets
Olyset-nets
Dura-nets
Interceptor nets
NetProtect
• Look for these names on the tags of the
nets.
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WHOPES RECOMMENDED LLINS
SUPPLIER
Sumitomo
Chemical Co.
Ltd.
Vertergaard
Frandsen S.A.
BASF South
Africa PTY Ltd.
Bestnet Europe
Limited
Clarke
Mosquito
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NET
MATERIAL
INSECTICIDES
TREATMENT
PROCESS
Permethrin
Incorporated to
fiber
Deltamethin
Coated
Alphacypermethin
Coated
Deltamethin
Incorporated to
Fiber
Alphacypermethin
Incorporated to
fiber
Polyethylene
Olyset
Polyester
PermaNet
Polyester
Interceptor
Polyethylene
Netprotect
DuraNet
Polyethylene
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Net Characteristics
• Have a look at the differences of the five
WHOPES approved LLINs
• Which one do you prefer?
• Why?
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WHICH LLIN TO USE?
• The characteristics of these nets vary
widely in terms of material, pesticide and
incorporation technology.
• Know your population - field test different
nets. Which nets are going to be best
retained and utilised for there proper use?
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WHAT DOES YOUR TARGET
POPULATION LIKE?
• What texture - each net have different mesh size,
strength, rigidity
• What colour do they like? - Blue, white, green,
pink?? Blue tends to be preferred.
• What shape do they like? - square, round?
• Do they care about durability?
• Do they care about seeing the dying insects?
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WHO IS YOUR TARGET
POPULATION?
• Are you doing a targeted distribution to
pregnant women at ANC?
• Are you covering Children under 5 in a
vaccination campaign?
• Are you doing a general distribution?
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WASH Cluster – Emergency Training
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WHO LLIN POSITION
STATEMENT
Recently, models for delivery of LLINs have
focused on different target groups depending on
the local epidemiological situation:
• in perennial transmission areas: targeted
distribution to vulnerable groups, i.e. pregnant
women and children under five years of age;
•in areas with unstable malaria and limited
populations at high risk: delivery to the total
population within a defined geographic area.
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WHO Global Malaria Programme “Insecticide Treated Mosquito Nets: A position statement” 2007
WASH Cluster – Emergency Training
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WORKPLAN FOR LLIN
CAMPAIGNS
1.
2.
3.
4.
5.
6.
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Assessment
Selection and Training of Workers
Transportation and Storage
Mobilisation and Awareness (IEC / BCC)
Distribution
Supervision and Monitoring
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1. ASSESSMENT
• Done with leaders of the village and health workers to
determine number of LLINs needed and distribution
strategy
• Population, Households, Children under 5, pregnant
women
• Sleeping patterns (number of people per number of
beds / sleeping surfaces), structure of house (wall
height, materials etc.)
• Are there LLINs in the community?? What is
coverage??
• Malaria epidemiological data from health center
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Remember:
Communities
vary greatly in their customs,
WASH Cluster – Emergency
Training
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behaviour and beliefs. Assess this first because it will
determine how LLINs should be delivered are received
and used, or abused!
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2. SELECTION AND TRAINING OF
WORKERS
• All campaign workers (health workers, NGO staff,
community etc.) will be trained in IEC / BCC, distribution
procedures
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• LLIN distribution supervisors also must be
trained in data collection and monitoring
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3. TRANSPORTATION + STORAGE
• When is your distribution - have the LLINs been
ordered - what is lead time on availability in country?
• If not in country, where will LLINs be coming from?
• Air shipment is very expensive so sea freight is
standard, but allow several months?
• Are the LLINs registered already for use in the country
bythe MoH, or not?
• Do you need a MoH letter for tax free import of LLINs
for customs clearnace?
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How will they be transported in country?
Avoid nets being exposed to direct sunlight on open trucks.
This burns away insecticide
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Where will they be stored?
Is it secure?
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Can LLINs be pre-positioned for
distribution?
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MOBILISATION / AWARENESS
(IEC/BCC)
ESSENTIAL!!!!!!!
MUST BE DONE BEFORE DURING AND
AFTER LLITN DISTRIBUTION
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WHY is Community
Education/Mobilisation Essential?
List all the reasons you think IEC is needed
prior to, during and after LLIN distributions?
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WASH Cluster – Emergency Training
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It is relatively easy to physically distribute LLINs.
However, for LLINs to achieve their potential for malaria
prevention all impact is determined by the recipients
behavior:
1.
2.
3.
4.
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LLINs must be retained and not sold
LLINs must be used for sleeping under (no other
applications!)
Those most vulnerable to malaria should be the ones
prioritised to sleep under the LLINs
They must be hung correctly without gaps, and
maintained without holes etc.
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Locations for Social Mobilisation
•
•
•
•
•
•
•
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Mosques, Churches
Schools
Market places
Public Gatherings
Ceremonies
Health centers
Houses
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Key Messages for LLITN
Distribution
• The only cause of malaria is mosquitoes
• Malaria is a very serious disease that can lead to
death
• The most vulnerable groups are children under 5
and pregant women (in malaria endemic areas)
• LLITNs are effective
• Sleep under your LLITN every night
• How to use your LLITN
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Ways to Distribute LLINs
• How many ways can you think of?
• Which method do you think I the most
commonly used?
• Which methods do you think achieve the
best impact?
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Ways to Distribute LLINs
1. House to house distributions
2. Central community distributions to
households
3. Mass distribution linked to vaccination
programmes
4. LLINs distributed in as non food items in
UN and NGO emergency kits
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1. House to House Distribution
Teams to distribute LLINs should be recruited
and trained prior to the arrival of the LLINs in
the distribution site.
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Teams should visit all target communities to get the
community leaders buy in and agree on a date and any
logistics arrangements such as IEC and LLIN delivery sites
in each community
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WASH Cluster – Emergency Training
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On the agreed distribution day the team and nets should
arrive on site as agreed:
• Team of distributors go house to house distributing nets
one per sleeping surface
• The distributor removes net from package.
• Mark the LLIN with an ID number that relates to the
household.
• Use permanent ink for the marking to avoid it being
washed out later on.
• Removing nets from packaging and marking them are
important steps to reduce resale by recipients.
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LLINs should be registered to each household and
the family representative should sign for the LLIN
received.
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• During the distribution / hanging of the net the
washing of the net should be explained again.
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• The person assists in hanging the net. They
bring with them cut rope, hammer and nails to
hang
• All plastic bags must be collected and counted
and returned to the distribution point to ensure
accountability of nets that have gone out.
• The Distributor must explain why they should
sleep under the net and that they should sleep
under it each night.
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2. Central Community Distribution
• All initial set HR and set up arrangements
should be as above.
• However on the day of the distribution the
community is called to the central
distribution site at the agreed time
• Central level IEC drama should be delivered
to explain correct LLIN installation and
usage etc
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• Each household representative is then called
forward one at a time.
• Household details are registered and the LLIN is
signed for by the household representative.
• Mothers are the preferred recipient, but this is not
always possible.
• LLINs are removed from their packaging
• LLINs are marked with the household ID number
allocated, using permanent ink
• Key messages to reinforce understanding of how
to hang and use the LLIN are given again to the
recipient during this process
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Share key messages to reinforce correct use with
each family
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3. SUPERVISION AND MONITORING
• Supervision of the household and community campaigns
should take place through out the entire process.
• Ensure that each household is reached, or visited post
distribution
• Check that LLINs are hung, assist in hanging them where
need,
• Check LLTNs are accounted for, prevention messages are
disseminated
• Map distributions using registration data and village maps
(in the same way as for IRS)
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Mass Distribution / Vaccination
• This method has obvious logistics attractions but
is generally unsuited to emergency settings.
• LLINs are distributed to mothers bringing children
for measles or polio mass vaccination campaigns
• Achieving high distribution numbers in a short time
frame is easy but….
• Achieving high retention and usage is very difficult
and has not worked in most emergencies where
tried.
• List some of the reasons why this may not work?
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Why mass distributions are generally a
poor method
1.
2.
3.
4.
5.
6.
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Time frame for delivery of malaria and LLIN specific IEC
is too short
Understanding of recipients is reduced
Competition with vaccination tasks which generally take
priority
LLINs usually distributed in their packages
Generally no household level contact or follow up to
check if the nets are hung, assist where they are not etc
Usually no coverage or usage data!
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LLINs Emergency Kits Distributions
• In Burma after Cyclone Nargis over 800,000 LLINs were
distributed on mass as non items as part of emergency
survival kits.
• No one knows how many were used.
• Many witnessed piles trod into the ground were they fell,
unappreciated, and never to be used.
• This has happened all over Africa too as LLINs are included
in many UN emergency family kits
• These LLINs are delivered with no IEC, cannot be tracked to
a family or household and abuse and resale rates are
generally expected to be very high!
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WASH Cluster – Emergency Training
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EVALUATING
LLITN Retention + Utilisation
• However LLINs are distributed the coverage and
usage rates achieved should be measured and
reported:
• 3 to 5 months after the distribution a two stage cluster
sample survey should be performed
• Determine the percent of the population who retained
the LLITNs distributed
• Determine the percent of the population who are
correctly utilising their LLITNs (ie have them hanging
over their sleeping areas)
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• If access to health services have remained
stable and the population size has not changed
you can compare morbidity and mortality rates of
malaria for children under 5 and over five at the
health facility level.
• In a holoendemic area you can look at the data
from the months prior and proceeding the
distribution
• In a seasonal malaria area you can compare the
prior year’s data to the present year’s following
the distribution.
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Topping up LLIN Coverage
• Even the best programmes require annual topping up of
LLINs to replace damaged nets and to cover new born
children.
• Establishing free distribution of LLINs to pregnant women
on first visit at antenatal clinic is a very useful way of
topping up coverage
• This helps increase ANC usage and IPT usage.
• Antenatal clinic or other health facility distribution models
are not a substitute for large scale distributions though.
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