Pathogenesis and immune responses in newborn African green monkeys Cercopithecus aethiops inoculated with simian immunodeficiency virus
Muia-Kiio, Maria Ndunge
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The World Health Organization estimated that 300 - 500 million cases of malaria are reported annually with 90% being from Africa. In search for sustainable malaria control measures studies have shown that the use of insecticide treated bed-nets could be an effective malaria strategy. This information prompted the introduction of the KEMRI/CDC Bed-net project at their study site in Rarieda Division (Bondo District), aimed at the trial of insecticide treated bed nets (ITBNs) in the prevention of malaria in 1997. A randomized controlled trial (RCT) was started in Rarieda Division with a baseline work in 1996 followed by the issuing of insecticide treated bed-nets in 1997. At the beginning of the project, voluntary village bed net committees (VBCs) were formed to help in the promotion of ITBNs' use and maintenance within the community, at the grass root level, in line with the primary health care (PHC) strategy of community participation. They were therefore, expected to closely monitor correct use and maintenance of the ITBNs and to be a link between the community and the project. The nets were issued to 40 of the total 79 villages, randomized by public lottery, to act as intervention villages while the remaining 39 villages were issued with bed-nets two years later and acted as control villages. Thus, the control VBCs started working only after the second intervention, with the second issue of bed nets to the households. However, to sustain the use of ITBNs in the community, a strong active bed-net committee was necessary. This study therefore set out to evaluate the performance of the VBCs' in the promotion of the use of ITBNs during the trial. The main objective of the study was to evaluate the performance of these VBCs as a channel of information, communication and education in the use and maintenance of the insecticide treated bed nets by the community. This study was done in order to determine whether the village bed net committees would be able to promote the use and maintenance of ITBN when the funding ceased. The study used the information collected from VBC and household surveys that was supplemented by focus group discussions with the VBC members. The sample size comprised 115 VBC members with 65 from the Intervention and 50 from the Control villages. There were 598 households with 299 coming from the Intervention and 299 were from the Control villages. The data was collected using structured interviews and analyzed using descriptive statistics and Chi-square test for association using computer Statistical Application Software (SAS). The results of the study indicated that the actual performance of the VBCs was less than the 50% margin and the difference in performance between the VBCs from the intervention and the control villages was not statistically significant. This therefore, indicated that there was not much association between the VBCs and the initial formal orientation given by the project officials as shown by the Chi-square test of association (df=1;>0.05). In conclusion formal orientation of village health workers does not make a difference in their performance. However, it creates unmet expectations. For the sustainability of ITBNs, village bed net committees can be useful if well supervised, supported and given the appropriate knowledge through continuing education.