Vector Control Working Group Update RBM Communication Community of Practice Hannah Koenker In many ways, this group – behavior change communication, social and behavior change, is where malaria control comes together. Dakar, Senegal 27 September 2016

VCWG Workstreams LLIN Priorities – Hannah Koenker/Lena Lorenz LLIN durability and continuous distribution IRS and Insecticide Resistance Management – Dereje Dengela and Mark Hoppé New Tools New Challenges – Fredros Okumu/Mike Reddy Residual and outdoor transmission; new vector control tools Housing and Malaria – Steve Lindsay/Mariana Stephens House screening and closed eaves Integrated Vector Management, Evidence and Capacity – Mike MacDonald Larval Source Management – Silas Mujambere/Ulrike Fillinger

VCWG Activities related to SBC Preferences for ITNs and how these may or may not affect use of ITNs Misuse of ITNS for fishing Outdoor behaviors associated with outdoor malaria transmission SBC in complex operating environments (COE) for malaria prevention and treatment IRS acceptance and compliance with instructions SBC’s role in promoting net care/prevention of net damage Mass campaigns, continuous distribution

Quick Technical Updates

Global Fund Funding Requests Most countries need to develop their funding requests starting this fall, as their grants end in December 2017 SBC needs a seat at these tables

ITN Access and Use Permalink: http://www.vector- works.org/resources/itn- access-and-use/

Ownership, Access, and Use 85 national surveys DHS, MIS, MICS 2005-2015 For 85 surveys.

The Report The ITN Access and Use Report presents ownership, access, and use results for every country, by: Region/Province Wealth Quintile Urban/Rural IRS/no IRS (where available) Provides timing for data collection, rains, and recent mass campaigns Provides observations on the data and programmatic implications

(New and Improved) Since May 2016 it includes results for non-PMI countries 85 surveys in 44 countries Since August we have provided maps for the PMI focus countries

Senegal

Observations The continuous DHS, implemented since 2012, sheds additional light on what initially seems to be a low use:access ratio across surveys. While the mean use:access rates across the surveys are mediocre, especially for a Sahelian country with an entrenched culture of net use, analysis by rainy season (second table) shows a pattern of net use that increases during the early rains and peaks during the late rains (September/October), indicating that net use is likely driven by perceived nuisance biting, and diminishes when mosquitoes are less present. Access and use seem to be higher on the whole in the lower wealth quintiles than in the wealthier ones. As in many other countries, rural residents have higher access and use rates than urban residents. Households receiving IRS had significantly higher ITN ownership in three of the five surveys, including the most recent. This was the case for access and use only in the 2010-2011 survey; the other surveys demonstrated no difference in use or access between the strata. Implications for programming There remains a large gap between ownership and access, indicating that more nets are still needed to meet universal coverage at the household level. SBCC campaigns to increase net use among people with access to a net are still important, particularly for the dry season and most importantly for the early rainy period, where early net use may reduce overall quantities of infectious mosquitoes later on.

Senegal: Seasonal analysis (2014)

Global Trends Of the 85 surveys, 50 (60%) have a strong culture of net use (use:access ratio >0.80) 23 (27%) have a use:access ratio between 0.60 and 0.80 (room for improvement) 12 (13%) have a use:access ratio below 0.60 Nigeria, Zimbabwe, Chad, Namibia, Niger, Swaziland Median use:access is 0.87

Global Trends Strong seasonal influence to use by those with access in many countries (further analysis in process, but seen most clearly in Senegal) No programmatic link between use (or non-use) of ITNs in IRS areas, although our analysis is at national level Wealth quintile either not associated with use:access ratios (40% of surveys), or varying degrees of pro-poor (40%). Pro-rich trends are more common before 2010. Urban/rural: post-2010, 65% of surveys show no difference in use:access ratios, and the remainder are split evenly between urban higher, and rural higher. Use:access ratio improves as access increases (post-2010)

Global Trends Access to ITNs is still insufficient in the majority of countries Highest access reached in any survey is 78.8% following Uganda’s last mass campaign Highest ownership is 90.9% (also Uganda) However, % of households with 1 net for every 2 people was only 53.1%. “Universal coverage” as defined by WHO is extremely difficult to achieve. Highest ever value regionally for universal coverage (1 itn for 2) is in Kigoma in the prelim Tanzania report, 73.4%. Other post-campaign regions do not exceed 60%.

Repurposing of old and expired ITNs “old net” – a net obtained before the current distribution, for example, from the previous campaign. Old nets may still be useful “expired net” – a net that, for whatever reason, is deemed by the household to no longer be useful for sleeping under. Because it’s too torn or too dirty Because it’s no longer needed “repurposing” – using for something else around the home “misuse” – using an ITN for fishing, or repurposing a new net; particularly if the household then doesn’t have enough nets to sleep under

Flowchart for Household Level Messages Is the old net still useful for sleeping under? (household decides) Use expired net for window curtains Use expired net for door curtain Stuff expired net into eaves to reduce mosquito entry Use expired net to patch other nets Put under mattress to reduce biting pests Continue to use the old net. Save the new net until it is needed. Yes No Use the material to prevent mosquito bites in other ways The household makes their own decision about when to use or stop using nets. This advice is meant to inform SBCC messaging, campaign training materials, and other outreach to community leaders and households.

Mosquito Net Fishing Several types Food security Livelihoods Environment Malaria Prevention Several types Subsistence fishing – family uses net to catch fish for protein Small-scale and medium-scale commercial fishing – several or many nets sewn together, used from boats, in traps, or off- shore ITNs are one of many types of illegal fishing gears

Continuous Distribution SBCC Health Facility Community School www.CDtoolkit.org

Variations in preference 50/50: dirt, bamboo walls Strongly conical: cement, stone, brick walls / iron sheet roof Medium conical: thatch, palm, wood roof Overall distribution is 3:1 in each region in Malawi

Variations in preferences 2:1 prefer conical in urban settings; 3 choices are equal in rural settings; rural poor prefer rectangular nets; rural rich prefer conical nets. Urban poor do not care (44% DC). Urban rich 2:1 prefer conical.

New Vector Control Tools