Malaria Activity GuideStomp Out Malaria

World Malaria Day Compilation 2012

ContentsMalaria Activity Guide...........................................................................................................................1

Community Activities and Projects........................................................................................................1

How to start a SWAT Malaria club in your community...........................................................................1

How to manage your club......................................................................................................................2

Things to teach your club.......................................................................................................................2

Activities your club can do.....................................................................................................................3

“But I Slept Under My Bed Net!”...........................................................................................................4

Background............................................................................................................................................4

Concept.................................................................................................................................................4

What you will need................................................................................................................................4

Setup.....................................................................................................................................................4

Process...................................................................................................................................................5

Face the Facts........................................................................................................................................5

Concept.................................................................................................................................................6

Process...................................................................................................................................................6

Present your findings.............................................................................................................................6

Things to consider..................................................................................................................................6

Malaria Booth at the Weekly Market.....................................................................................................6

Process...................................................................................................................................................7

Mobilizing the Religious Infrastructure for NightWatch Bed Net Reminders.........................................7

Background............................................................................................................................................7

Process...................................................................................................................................................7

Things to consider..................................................................................................................................8

Net Care Survey; Repair & Modification Project....................................................................................8

Background............................................................................................................................................8

Process...................................................................................................................................................8

Visual Representation of the Cost of Malaria.........................................................................................8

Background............................................................................................................................................8

Process...................................................................................................................................................9

Scavenger hunt......................................................................................................................................9

Find........................................................................................................................................................9

Ask.........................................................................................................................................................9

Tell.......................................................................................................................................................10

Games 10

Bed Nets and Mosquitos ....................................................................................................................10

Background..........................................................................................................................................10

Process.................................................................................................................................................10

Discussion............................................................................................................................................10

Mosquito Mafia...................................................................................................................................11

Background..........................................................................................................................................11

Process.................................................................................................................................................11

Discussion............................................................................................................................................12

Mosquito Net Relay Race (version 1)...................................................................................................12

Materials .............................................................................................................................................12

Process.................................................................................................................................................12

Debrief Questions................................................................................................................................12

Mosquito Net Relay Race (version 2)...................................................................................................12

Materials..............................................................................................................................................12

Process.................................................................................................................................................13

Follow up discussion............................................................................................................................13

Take a Step Forward.............................................................................................................................13

Background..........................................................................................................................................13

Process.................................................................................................................................................13

Discussion............................................................................................................................................14

Skits 14

Transmission, Symptoms, Net Usage, IRS.............................................................................................14

Outlines...............................................................................................................................................14

Discussion............................................................................................................................................14

Net Usage & Malaria Awareness Skit...................................................................................................14

Background..........................................................................................................................................15

“Mad Hatter’s PST Sketch”...................................................................................................................15

Radio 16

Bed Nets = Bling...................................................................................................................................16

Bed Nets Are Beautiful.........................................................................................................................17

Messi Radio Spot.................................................................................................................................17

Pre-Natal Clinic Radio Spot..................................................................................................................18

Surveys18

Malaria Questionnaire: Assessment of Availability and Accessibility to LLINs; Knowledge and Misconceptions around Malaria..........................................................................................................18

General................................................................................................................................................18

Health..................................................................................................................................................19

Nets.....................................................................................................................................................19

Treatment............................................................................................................................................20

IPTp......................................................................................................................................................20

Knowledge...........................................................................................................................................20

House Visit...........................................................................................................................................20

Physical Observation............................................................................................................................20

Knowledge and Attitudes.....................................................................................................................21

Mosquito Net Inspections and Survey.................................................................................................22

Site Supply-Chain Assessment.............................................................................................................22

Background..........................................................................................................................................22

Discussion............................................................................................................................................23

Myths and misconceptions (fununu - gossip, rumors, hearsay)...........................................................23

Kweli au si kweli ..................................................................................................................................23

Murals 24

Appendix A: Vocabulary.......................................................................................................................24

Appendix B : Malaria Facts...................................................................................................................26

Community Activities and Projects

How to start a SWAT Malaria club in your communityRemember: Getting people excited to start a club may be easy, but ensuring that the club is able to sustain itself on its own is very difficult. Be sure to use a counterpart or motivated and well-liked member of a village when getting a malaria club (or any club) started and organized.

Suggested audience: Women’s groups, men’s groups, school clubs, existing community groups

Source: SWAT (Standing With Africa to Terminate Malaria) Malaria Ghana

1. Determine how much time/effort you can commit to a SWAT malaria club in your community2. Establish a meeting location that can comfortably accommodate the club members

1. Location should be central to the range/spread of member residence locations2. Location should have enough seating3. Need to have some way of presenting things (i.e. blackboard, whiteboard, clipchart,

projector, etc..)3. Talk to school classes and promote the club to households, parents and children (why, what,

how, who, where, etc..)4. Create a curriculum/syllabus for the club over several weeks

1. Show the curriculum/syllabus to the people who show some interest in the club. 5. (At the first meeting) Set-up a regular meeting time/schedule that will accommodate and

fulfill the objectives/tasks laid out in the curriculum/syllabus.6. Collect information and profile the strengthens/weaknesses of the club members in order to

allocate and coordinate your efforts accordingly.1. Simple introductory quiz/game will come in handy (maybe at the second meeting, once

word gets out and people really decided whether or not they want to commit)2. May need to modify the curriculum once/if the results of this quiz/game give you some

insight into where and on what to put more emphasis.

How to manage your club1. At every meeting, take attendance (keep on-going record)

1. Might even want to consider taking a picture of the attending group, like a meeting class picture. (before|after) Let the participants have fun with the picture themes.

2. If possible, take video of the meeting - use it to refine your approach for subsequent meetings/sessions.

2. Provide some sort of concession (like candy, treats, prizes, etc..) for participation.1. If you are doing the meeting at/near your home (and you like to cook), you can use the

opportunity to introduce "American" style foods to the members.3. At the end of each meeting, have a closing debriefer (10 minutes max) that will retouch on

the main points of that days meeting/session.1. Use flip-chart throughout the meeting to keep notes (meeting minutes), then rewind

back to the beginning and quickly summarize the meeting based on the notes. 2. Might be good practice to have club members do these debriefings! (offer a prize to the

volunteer debriefer)4. When possible, attempt to co-facilitate sessions with guest presenters (like health-care

workers, nurses, local professionals/successful people, or even other PCVs)

Things to teach your club1. Malaria Science

1. The parasite2. The vector3. The human

2. Malaria Prevention1. Bed Nets2. Insect Repellent3. Clothing4. Behavior

3. Malaria Diagnosis1. Symptoms2. Microscopy3. Rapid Diagnostic Test (RDT)

4. Malaria Treatment

1. ACTs: what kind2. When3. How

NOTE: The following resources may help guide you in educating your club members:

1. Malaria Education Toolkit (MET) (https://docs.google.com/present/view?id=dsfjsrj_270c9h35sfm )

2. WHO Malaria Education Comic Booklet (http://whqlibdoc.who.int/hq/1999/WHO_CDS_CPC_SAT_99.1.pdf)

Activities your club can do1. Take field trips to educational places

1. Make sure to prepare beforehand (have worksheets that aid members in learning from what they experience - like a treasure hunt, give them a list of questions and hold a contest to see who can solve all of the problems)

2. Hold bed net hanging/use contest1. Hold contests in the town center where contestants try to make the best bed net

hanging designs. Also use this opportunity to educate the general community about malaria and proper prevention techniques.

3. Count bed net use within the community1. Split the community into zones and count bed nets:

1. Hung and in use (include the condition of the nets)2. Hung and not in use (include the condition of the nets)3. Stored but used nightly (include the condition of the nets)4. Stored but not used (include the condition of the nets)5. No net

4. Hang, clean, repair, treat bed nets for community5. Make neem cream/lotion

1. May be able to generate some income for the club by selling the neem lotion6. Participate in nearby hang-up campaigns7. Visit neighboring communities and perform peer education at schools (Peer Ed.)

“But I Slept Under My Bed Net!”Suggested audience: Community members; communities pre/during/post bed net distributions

Source: Gambia

BackgroundThis is an activity that helps show why all community members must sleep under their bed nets in order to stop the spread of malaria in a household or community.

ConceptThe main message: protect your neighbors and family against the spread of malaria by making sure that everyone sleeps under a bed net, every night.

What you will need7. Two sleeping mats8. One bed net9. A piece of paper or something else that can be torn easily and passed around

Setup1. Create two sleeping spaces: one mat with a bed net, the other mat without a bed net2. Ask for two community member volunteers from the audience.3. Have one community member lay on the mat under the net and one community member to

lay on the mat without a bed net.

ProcessPart 1

1. Elicit responses from the audience to see if they can tell what is wrong with one of the sleeping area set-ups. (Answer: one of the community members is not sleeping under a bed net.)

2. Have a PCV, counterpart, or local kid act as the mosquito. Make it a point to let the audience know that the mosquito has malaria and is looking for a community member to bite. Put on a good show!

3. Show that the mosquito cannot bite the community member that is sleeping under a bed net. Then move on to the community member that is not sleeping under a net.

4. The community member that is not under a bed net gets bitten and gets infected with malaria. (The mosquito tears off a piece of paper and then passes the larger part of the paper the community member that is not sleeping under a bed net.)

Part 28. Have a different community member volunteer and serve as a new mosquito that does not

have malaria. 9. Have thes community members “wake-up’” and start to move around. 10. The new mosquito bites the community member with malaria. (The community member

with malaria then tears off a piece of the paper and gives the larger piece to the mosquito.)11. The mosquito is now infected with malaria. 12. The mosquito then bites the community member that slept under their bed net and gives

them malaria. (The mosquito tears off a piece of paper and gives the remaining paper to the community member that now has malaria).

Part 313. Have the two community members stand next to the mat where they slept. Show that both

members of the community got malaria regardless of where they slept. 14. Elicit responses about the fact that one community member slept under the bed net but she

still got malaria because the other community member did not. 15. Elicit a response from the audience along the line of something like “you better sleep under

your bed net too because I do not want to get malaria!” The point is to show that unless everyone in a village protects themselves against malaria by sleeping under a mosquito net, everyone in the village is at risk.

Face the FactsSuggested audience: Community leaders, family stake-holders

Source: Ethiopia

ConceptSimply use the official data available in your community to learn about the malaria burden and teach your community about their level of risk of contracting the disease.

Process1. Go to your local health center or hospital, or health bureau with a friend or counterpart.

2. Ask for the number of malaria cases for the last year, (because malaria is seasonal, a shorter time frame might understate the burden). Oftentimes, these stats are displayed on a wall chart.

3. Ask which of the cases were diagnosed clinically or with testing (either by rapid diagnostic test kit or microscope).

4. Interview senior staff or the malaria focal person at the health center or hospital. Ask the following questions to better understand the malaria situation in your site:1. How often do you experience malaria drug stock-outs?2. Is there a problem with patients not taking the entire dose of malaria medication?3. What percentage of the community is at risk of malaria?4. How many households at risk have bed nets?5. Is there a problem with people not wanting to use bed nets?6. What are the future plans to distribute bed nets to households that do not have them?7. Where does malaria rank in the top ten causes of mortality in your community?8. What is the community health system doing to educate about and prevent malaria?

Present your findingsReview what you learned from your visit to the health center or hospital with the community member/counterpart you went with. Plan a presentation for your community that will outline the community’s risk of contracting malaria, how many people get malaria (this point can be very impactful if you include how much treatment and care of one malaria case typically costs then multiply that by how many cases their were. Compare that total to something the community likes and uses daily, e.g. “450,000 fCFA is equal to __ sacks of rice!”). Facilitate a conversation with the community discussing what they already know about malaria and have them brainstorm ways they could prevent the spread of the disease.

Things to considerEven at sites where PCVs do not consider malaria to be a major risk, it is oftentimes one of the highest causes of child mortality. In hilly regions, PCVs may not realize that parts of their site may be regions at risk of malaria, even if their own neighborhood is not. PCVs who have not been in site for less than one year may have not experienced the peak malaria season, yet may be in position to help prevent transmission and deaths the following season. Finding out the actual situation in your community is the first step to stomping out malaria.

Malaria Booth at the Weekly MarketSource: Mali

Process1. Become a market lady. Find yourself a place in the market, set up a table, and start selling

knowledge about malaria. 2. For the best effect, hang up a mosquito net over your table. Try to set it up so that people

have to come into the mosquito net to talk with you. 3. Inside the net, set up quick trivia games with malaria facts. Make them multiple-choice to

make things more fun. For example, make a sign/piece of paper that says, “Where does Malaria come from? A) Mangoes B) Mosquitoes C) Dirty laundry.”

4. Along with the words, exercise your artistic skills and draw the corresponding pictures. 5. Other good questions:

1. What time of day can I get malaria? (~10 PM-4AM)

2. What should I do if I have a fever? (go immediately/within 24 hours to the doctor, especially for small children.)

3. What is the biggest killer in [name of site]? (63% of all Malians deaths are malaria related, it is likely similar in your site, but if you have a local health facility, ask them for statistics.)

4. Where do malaria mosquitoes (anopheles) breed? (Clean, still water.) 6. If you want, give small candies or cough drops to people who get 3 or more questions right.

Mobilizing the Religious Infrastructure for NightWatch Bed Net RemindersSource: Ethiopia

BackgroundMalaria No More's Nightwatch program uses celebrities in 30 second radio spots who ask "its 9 pm, are you and your family safe under your mosquito nets tonight?" The program also provides a curriculum developed for students between the ages of 12-14 that focuses on 6 basic malaria facts. Volunteers in Senegal who work with community radio are running the 30 second ads, as well as developing radio sketches that emphasize the 6 facts about malaria introduced in the school curriculum.

In communities where even radios are not common, churches and mosques often are. To the chagrin of sleepy PCVs around Africa, they have loudspeakers. But those loudspeakers could be a great tool for nightly reminders promoting community members to use their bed nets.

Process10. Go to the loudest mosques/churches in your town, and meet with the religious leaders.11. Give them an introductory training on how malaria is affecting their community, explaining

that bed nets are the best method of prevention for malaria.12. Ask for a 9 PM nightly bed net reminder to be announced over the mosque/church

loudspeakers. Provide a script for this short message.13. Continue to work with religious leaders to help prevent malaria among their followers.

Including them in your work shows your gratitude for their help, and respect for your community's beliefs.

Things to considerAre religious institutions willing to relay public health messages, especially those that would not be considered opposed to religious teachings? Religious leaders can be very strong behavior change agents, and oftentimes there is no contradiction between their religious views and what is best for the health of their community.

Net Care Survey; Repair & Modification ProjectSuggested Audience: Net owners

Source: Senegal

BackgroundPeace Corps Volunteers in the first regions of Senegal to have Universal Coverage Bed Net distributions are working with their communities to find out whether or not everyone actually has a bed net. For those who do, volunteers are working on realistic solutions for net repair and maintenance.

ProcessWe are encouraging those involved to gather data about:

14. Where did they get their net, if the purchased it, how much did they pay, 15. How old their net is, 16. Who sleeps under this net (number of people, age, sex), 17. Is the net repaired, if so, how was it done, 18. Is the net circular or a square, 19. Describe each net's condition. It might be useful to develop a standard for net evaluation.

For example, volunteers could come up with 5 descriptions (1 being the best condition, 5 the worst) on a scale, and try to match each net to a number on that scale. Volunteers have developed a net modification for those who have a square net, but prefer the circular type. We are sewing cloth (the durable kind women wear as wrap skirts) along the bottom of the net, where it touches the ground or gets tucked in, in order to make it more durable. A key to doing this is sewing a triangular piece of fabric to each corner so that the net is wide enough at the bottom to better fit around the mattress.

Visual Representation of the Cost of MalariaSuggested Audience: Community members

Source: Senegal

BackgroundA volunteer in one of Senegal's most heavily burdened areas by malaria found that when he told members of his community how many of them died from malaria every year, it didn't seem to have the impact he expected. He learned how much money related to malaria specific illness had been collected at his health post and mentioned it in a conversation. The reaction he got was so strong, that he repeated it in subsequent conversations, and found that it seemed to hit home every time.

ProcessHaving found a statistic that moved his specific community, the volunteer decided to illustrate it publicly. He calculated how many sacks of rice this money could buy in a year and purchased more than 200 of them (empty, and filled with straw). This volunteer plans to line the road leading up to his health post with these rice sacks during the month of April, and use the illustration to drive home just how important prevention is.

Scavenger huntSource: Tanzania

Audience: Students or Malaria Club

Find a number of each of the following. For each ‘find’, ask a question and tell a fact.

Find__ pregnant women__ kids who know how malaria is transmitted__ fathers who sleep under a net__ mothers who have taken SP__ people who have had malaria properly diagnosed and treated in the past month__ people who missed work or school in the past year because they or a family member had malaria

__ people who know someone who died of malaria__ pharmacists who know about malaria drugs

AskWhere does malaria come from?How do you know someone has malaria?How do you treat malaria?Do you know of ways to prevent malaria?(village/community leader) How can you use your power and fame to eliminate malaria?(parents) How do you raise healthy and successful children?(husbands/fathers or girls/women) What can a pregnant mama do to keep herself and baby healthy?

TellShare from the malaria facts (Appendix B)

Games

Bed Nets and Mosquitos (Based on Sharks and Minnows)

Suggested audience: Youth

Source: The Gambia

BackgroundThis game can be used as an icebreaker to have a discussion about malaria knowledge and prevention.

Process1. An area will be needed where players can run around. 2. Each end of the playing area will serve as a base or “bed net.” 3. Two players (or more depending on the amount of players) will be the mosquitoes and will

stand in the middle of the playing area. 4. Remaining players will line up on one side of the playing area under one of the bed nets. 5. When told to do so, all players will run to the other end of the playing area (the other bed

net). 6. The mosquitoes will chase players, and any player that they tag will become infected with

malaria and will join the mosquitoes in the middle to infect/tag other players as they run back-and-forth to each side.

7. Once all players have become infected, the game is finished.

DiscussionA short discussion can be had talking about the fact that when people are not under a bed net at night that they will get malaria. Once someone has malaria, they run the risk of sharing it with their friends and family.

Mosquito MafiaSuggested audience: Youth

Source: The Gambia

BackgroundThis game can be used as an icebreaker to help begin an informal discussion with community members about malaria awareness and prevention. This game is based on a popular game in The Gambia amongst youth. The game played in The Gambia is similar to the game ‘Mafia’ that is played in the U.S.

This game can be used as an ice breaker for a discussion about the importance of sleeping under a bed net.

Process1. Every player will need to receive one card. 2. Cards include: mosquito card, bed net cards, neem cream cards, and no protection cards.

Divide cards accordingly. Let’s say that six people are playing: there would be one mosquito card, two bed net cards, one neem cream card, and two no protection cards.

3. All the cards are handed out. 4. The player that receives the mosquito card is it. 5. The mosquito tries to “bite” the other players. The mosquito selects one player and tries to

“bite” that player. 6. If the selected player is holding a bed net card, than the player cannot be bit because he is

sleeping under a bed net. 7. If the selected player is holding a neem cream card then he is also safe because he has used

protection. 8. If the player is holding a no protection card, then that player is bitten by the player holding

the mosquito card and is infected with malaria. 9. After someone is infected, the round ends. 10. Any player that was not the mosquito or not infected with malaria receives one point. 11. Multiple rounds should be played. 12. Once all of the rounds are completed, the person with the most points is the winner.

DiscussionAfter the game is completed, have a short discussion with the players. Talk about the fact that anyone who sleeps under a mosquito net is will not be bitten by a mosquito. People who do not sleep under a bed net will be bitten by mosquitoes and are not protected against malaria.

Mosquito Net Relay Race (version 1)Source: Mali

Materials 1. 2 or more mosquito nets2. Nails

3. Hammers4. Rope/string/fabric scraps,5. Trees/bed6. Pictures or drawings of correctly installed nets7. Mattresses/mats/mattress-like objects.

ProcessExplain to participants how to install a mosquito net and show them the pictures of correctly installed nets. Divide the group into teams. Each team should have the same materials. Instruct the teams to set up their net as quickly, efficiently, and correctly. To signal that they are done, one team member has to go inside the net and lie down. Criteria for a correctly installed and utilized mosquito net: all edges of the mosquito net are tucked under the mattress, the mosquito net is attached on top somewhere and there is enough space between the net and the person sleeping, the mosquito net is free of gaping holes or gaps where mosquitoes could enter.

Debrief QuestionsWhat is the most effective way to install and use questions a mosquito net and why? How can you make sure that your mosquito net is as effective as possible even when used outside?

Mosquito Net Relay Race (version 2)Source: Burkina Faso

Materials1. Net2. String3. Mattresses4. Strips of bendable wire5. Plastic tubing (1-1.5 meters)

Process1. Students divide into teams (as many nets and mattresses you can get a hold of). Each group

must figure out how to make their net stand properly. Let them know they can use anything… they can go outside and find items to help them. Whichever group is first and hangs net properly (tucked in on all sides) will win.

2. Give students square nets and wire. Tell them to change the net to a circular top net. Have them brainstorm how this is possible and either demonstrate or give solid steps to how it can change. First group to demonstrate this wins.

Follow up discussionIt’s important to hang our nets properly. We can change nets if we are careful about it, but we need to sleep under nets every night. If a net has holes we should sew them up or if it is too old find a new net.

Take a Step ForwardSuggested audience: Youth

Source: The Gambia

BackgroundThis game can be used as an icebreaker to have a discussion about malaria knowledge and prevention.

Process1. Players line up in a single-file line side-by-side facing the leader (a PCV or counterpart). The

leader reads statements, and any player that the comment applies to must take one step forward toward the leader.

2. Examples of Statements are: 1. Know what malaria is2. If you know how to prevent malaria3. If you have a bed net on the place where you sleep4. If you know someone who has suffered from malaria5. If someone in your family has had malaria6. If you have suffered from malaria7. If you know someone who has died from malaria. 8. If you sleep under a bed net every night

3. More statements may be added to the game. 4. The purpose of the game is to begin with general knowledge. Many people have a general knowledge of malaria and how to prevent malaria.5. As people step forward in the knowledge section, point out that most people know something about malaria. 6. Then, when the questions begin to go in a ‘personal experiences’ route, people will step forward showing that they themselves have been affected by malaria or someone that they know has. 7. The questions end with statements about what people do to prevent malaria. Those that use prevention techniques will be stepping forward.

DiscussionLead a discussion about the fact that people know how to prevent malaria, but they often do not take the steps themselves to prevent suffering from malaria. Elicit responses as to why this is the case and how people can work in their communities to begin to work on malaria prevention.

Skits

Transmission, Symptoms, Net Usage, IRS

Outlines1. Transmission – how a mosquito gets malaria2. At a health center using an RDT and finding someone doesn’t have malaria, explaining why

some symptoms seem like malaria when they are not3. Your friend thinks nets are ugly and hot, how can you convince them to sleep under a net?4. A mother doesn’t want to move her belongings out of her house so it can get sprayed, how

can you convince her to accept IRS?

DiscussionDiscuss in more detail some problems with these methods that students have seen or anticipate. Tell them that some countries (USA, Morocco…) have eliminated malaria using these methods so Rwanda can too. Talk about how to manage these and how important each method is (especially combining these methods) to make Rwanda malaria free.

Net Usage & Malaria Awareness SkitSuggested audience: Other PCVs, PCTs; community members during/after net distributions

Source: Mali

BackgroundThe script and You Tube video below were done at Mali’s pre-service training (PST) in December 2011. Though this particular script was written for a Peace Corps Volunteer audience, it can be adapted into local languages and performed for communities as well. If you really like the way you’ve adapted the script, share it with us here. Team Mali’s tip: if your skit rocks, grab some bikes and go on a Tour de Skit with some PCVs and counterparts to perform the skit in surrounding communities.

VIDEO LINK: http://www.youtube.com/watch?feature=player_embedded&v=9_8UFLcoK5I

“Mad Hatter’s PST Sketch”Assitou: HelloCHW: Hi, I’m a community health worker, and we’re passing out free treated mosquito nets! So you should definitely hang this up [pushes two people forward who are the mosquito net]Assitou: What does it do?CHW: It protects you from and kills mosquito nets. Um, you know how to do it right? Hanging this up? I got a lot of stuff to do.Assitou: Uh, yeah.[CHW leaves]Assitou: OMG this is so brand-spanking new I don’t want the children to touch it. I’ll put it here. [places net/two people in corner of room] Narrator: Later that night when Assitou Diara was just sleeping, and her mosquito net was in the corner, not hung up, not being used…[People acting like mosquitos buzz in and bite sleeping Assitou everywhere, buzz over to the wall and hang there saying, “oh I’m so full, I’m going to go sit on her wall now.”]Narrator: A couple days later… maybe a week later…Assitou: [Shivering] oooh! I feel like crap!Narrator: [Standing behind Assitou waving hands] Fever! Chills! Horribleness! Let’s test her – oh! It’s malaria! What could she have done to prevent this?Everyone: [Waves hands singing “do do do do” to signify going back in time while running offstage]CHW: Hi I’m a community health worker, and we’re bringing these new mosquito nets for you, already treated.Assitou: They’re so brand new and beautiful.CHW: Let me help you hang it up!Assitou: Oh, thank you![CHW places two people/net on either side of Assitou’s bed, two ppl/net connect hands over her bed]CHW: Now, be sure to sleep under it every night!

Assitou: And now the mosquitoes won’t get to me!CHW: Mosquitoes won’t get you. Assitou: Oh, wonderful.CHW: It’s great.Assitou: Thank you for your help, inechae (Bombera for “thank you”)Narrator: And that night, while she was sleeping under her hung-up and tucked in mosquito net…[People acting like mosquitos buzz in; 2 people who are the mosquito net karate-chop and kick the mosquitos away]Narrator: And that’s why…Assitou: … [Gets up, stretching] Ahh I feel so healthy right now! Narrator: That’s why you should always…Assitou: … Hang up your mosquito net and sleep under it, every night. [2 people/mosquito net gives a thumbs up]

Radio

Bed Nets = BlingSource: The Gambia

The goal of these scripts is to present malaria prevention in a way that bed nets are cool and if one uses bed nets then they will have a lot of money. [Two actors: both female.] Jainaba: Wow Isatou your dress and hair for the program looks nice. You always have the nicest clothes. Isatou: Thank you friend. I work hard for my money. You must make a lot of money selling at the

market. Jainaba: Business is good, but I can’t work right now because my family keeps suffering from

malaria. I have no money. Isatou: Friend, do you sleep under your bed net? Jainaba: No my bed net is hot and I do not like it. Isatou: Bed nets are not hot and if you do not suffer from malaria you will have so much money to

buy things. My family is healthy and we always look great. We sleep under bed nets. Jainaba: I want nice things too. I’m going to hang all of my bed nets. My family will not suffer from

malaria and I will have so much money I too can buy nice shoes and jewelry. Isatou: Hang up that bed net and we’ll go shopping next month.Jainaba: Thanks friend.

Bed Nets Are BeautifulSource: The GambiaThe goal of these scripts is to present malaria prevention in a way that bed nets are cool and if one uses bed nets then they will have a lot of money.

[Two actors: one male and one female.] Lamin: Hey Fatou, where’s your bed net?Fatou: Lamin, my bed net is so ugly and it’s hot. I threw it under my bed, Lamin: What? Getting malaria is ugly. My girlfriend Sibo got malaria last month. She stayed in bed

for four days and lost weight. Talk about ugly! Fatou: Sibo, the beautiful girl who has all of the nice clothes?

Lamin: Yes! She’s healthy now that she went to the clinic and she’s beautiful because she sleeps under a bed net every night.

Fatou: Lamin get a hammer. Let’s hang my bed net up. I want to be beautiful too.

Messi Radio SpotSource: MaliMessi: Hello folks. This is Lionel Messi. You all wear my jersey every day, why not use my mosquito

net every night? If you want to play like me and the rest of the Barcelona team, make sure you sleep under your mosquito net every night so you can stay healthy. Remember, no one scores with malaria.

Everyone: GOOOOOOOAAAAAAAAAAALLLLLLLLLLLL!

Pre-Natal Clinic Radio SpotSource: Mali

[Local language greetings]Ami: Fatimata, did you eat a watermelon or are you expecting?Fatimata: AH! I am expecting, praise God.Ami: Have you seen the midwife yet?Fatimata: Umm… no. I mean, it’s way too far and Allah will provide.Ami: But you go to the market every week and the health center is right next to the market. Why

don’t you go then?Fatimata: But I’m healthy, so why do I need to go?Ami: Well first, they can make sure that you and the baby are healthy. They will also give you

malaria medicine to make sure that you don’t give malaria to the baby. They’ll also give you a mosquito net to sleep under during your pregnancy and to share with your baby once it’s born. You know, everyone in your family should sleep under a mosquito net every night to prevent malaria; if they get infected, they can give you and your baby malaria!

Fatimata: Ohhh… but, Allah will provide!Ami: Allah provided the health center and the mosquito net! Let’s go together after market next

week.Fatimata: Ok, let’s go then.

Surveys

Malaria Questionnaire: Assessment of Availability and Accessibility to LLINs; Knowledge and Misconceptions around Malaria

Source: This toolkit was originally developed by PC Benin. The original has been revised by OPATS for wide use and to include global health indicators. Please revise to align with your programming as needed.

GeneralVolunteer Name:Name of Village:Approximate Population of Village:Males:Females:

Pregnant Women:Children under 5:

HealthHow far is the nearest health facility? What type is it (health center, hospital, maternity)?Are there trained community health workers in your village? If yes, how many, and what activities do they undertake?

NetsAre mosquito nets available at the health facility?Are they sold or given out for free?If sold, how much do they cost?If free, who is eligible to receive mosquito nets?Are mosquito nets always available? If not when and why are there shortages?Where else can mosquito nets be obtained? (NGO distributors, market, boutiques, women’s groups, pharmacies etc.)Are they sold or given out for free? If sold, how much do they cost?Are mosquito nets always available? If not when and why are there shortages?What brands of mosquito nets are available in your village?Which brand is preferred by the population? Why?

TreatmentPer the health center, how many children < 5 years sought malaria treatment during the most recent peak month for the malaria epidemic? What type of malaria medication is available at the health center?What type of malaria medication is available in the village (market, pharmacies, CHW, other, without a prescription etc)?

IPTpPer health center records, what percentage of pregnant women in your community participates in prenatal consultations?On average how many prenatal consultations do pregnant women attend during pregnancy (1 , 2, 3, 4 or more times)?Is IPT (intermittent preventive treatment) for malaria provided at the health center in your village?

KnowledgeAsk health agents what common misconceptions regarding the transmission, prevention or treatment of malaria they encounter, if any?Are they addressing these misconceptions? If so, how?Ask neighbors, work partners and friends about malaria to see if there are any misconceptions regarding malaria that health agents are not aware of: What is malaria?How is malaria transmitted?Is malaria preventable? Is yes, how do you prevent malaria?What treatment is available for malaria?

Where can they receive treatment for malaria?

House VisitSuggested Audience: Head of household

Source: Tanzania

Physical ObservationAt this point don’t ask any questions, simply walk around and directly observe the conditions in the compound:

Do the beds have bed nets? o Which members of the family have them?o What condition are they in? o Are they being used? o At what time of night do people go to bed under the bed nets?

Is any sort of mosquito repellent (lotion or coils) used? Are there potential mosquito breeding areas near the compound?

Knowledge and AttitudesAsk:

How can someone get Malaria? Have members of your family gotten malaria?

o Who?o Was it treated? How?

Where is the nearest health practitioner who can treat malaria (NOTE: this may not be the same as the nearest health facility since in many areas malaria treatment drugs are available through Community Health Workers working out of their homes.)

Do you know of any ways to prevent malaria? How many bed nets does the family own?

o Did they buy them or receive them for free?o Which members of the family get to sleep under them and how is that choice made?o How often do they sleep under them?o In the dry season as well as the rainy season?o For the people who own but are not sleeping under their mosquito net, ask them

why they don’t like to sleep under bed nets. (It may help to get a more honest answer if you ask about a hypothetical 3rd party, i.e.“Do you know anyone who doesn’t sleep under a bed net? Why don’t they?”)

If there are any pregnant members of the family or recent mothers as if they received malaria prevention pills (SP or Fansidar though they will most probably not know the brand - ask if you can see the box)?

o How many doses?

Mosquito Net Inspections and SurveySuggested audience: Net owners

Source: Burkina Faso

1. Are all the edges of the mosquito net tucked under the mattress?

2. Is there enough space between the top of the net and the person sleeping?3. Is the mosquito net free of tears or large holes?4. Are there enough mosquito nets for everyone in the family?

1. Why not?5. How many people live in your house/courtyard?6. Do you routinely use neem cream or mosquito repellent

1. Why or Why not? 7. Do you sleep under a mosquito net when you sleep outside?

1. Why or Why not?

Site Supply-Chain AssessmentSource: Mali

BackgroundMalaria is preventable and 100% treatable, yet thousands of people die of the disease each year. One of the reasons for this is issues with access: access to bed nets, access to testing equipment, access to medicines, and access to medical facilities. The good news is that this isn’t generally a problem in Bamako. That means that the resources to effectively fight against malaria are readily available in Mali. The bad news is that these resources often don’t make their way into the villages.

Here are some easy things that you can do at your site to improve the supply chain:

1. If you have a health facility, check the stock levels of mosquito nets, rapid diagnostic tests, ACTs (malaria medication), and IPTp (malaria medication for pregnant women). Ask questions. If they don’t have any, ask why. Ask when they’re going to get more. Ask if they order them (pull demand) or if they just show up (push demand). Do they show up regularly or once every 5 years? Is money an issue with procuring the above items? If so, are operational costs able to cover procurement costs? If they do have all the items, ask them if there are ever any stock outs (ruptures de stock). Ask when this typically happens and what they do about it.

2. If you don’t have a health facility, identify any non-medical vendors that may be at your site and carrying these items. (For example, some boutiques might have a few mosquito nets stashed away or on your market day someone might come through with a basket full of random medicines, including ACTs. Note that these might not be treated mosquito nets, and the ACTs might not be real or might be expired.)

3. Identify the closest place to your site that has these items available. Brainstorm ways of getting these items from Point A to Point B. This could be done by identifying potential local vendors in the form of established boutique owners or a relais (CHW) and connecting them with the supplier. Is there regular transportation between the two points? Would the driver be willing to transport items? This doesn’t have to be a big operation. In some cases it is a student that travels between the two sites each day to attend classes.

DiscussionSource: Tanzania

Myths and misconceptions (fununu - gossip, rumors, hearsay)1. Malaria inatokana maembe, jua, kubadilisha mazingira, umelogwa.

Malaria comes from mangoes, the sun, change of environment, being cursed.

2. Degedege inasababishwa na uchawi.

Convulsions are caused by magic.

3. Mbu anaweza ueneza ugonjwa wa UKIMWI.

Mosquitoes can spread AIDS.

4. Mwanaume anapungukiwa au anakosa nguvu za kiume akilala ndani ya chandarua chenye vuatilifu/dawa.

Men become impotent if they sleep under treated mosquito nets.

5. Magonjwa ya ngozi yanasababishwa na chandarua chenye vuatilifu/dawa.

Skin infections are caused by treated mosquito nets.

6. Utakufa taratibu ukilala kwenye chandarua chenye vuatilifu/dawa kila siku.

You will die slowly if you sleep under a treated mosquito net every day.

Kweli au si kweli (from the Pata Pata guide – for kids)

1. Vimelea vya malaria huwa vinasambazwa na aina yoyote ya mbu.

2. Malaria kali inaweza kusababisha degedege kwa watoto wadogo.

3. Wachawi na waganga wanaweza pia kusababisha degedege na kutibu degedege.

4. Vimelea vya malaria vinaitwa vimelea vya plasmodiamu.

5. Malaria inasababishwa na mbu wanaokaa juani na kwenye maembe mabichi.

6. Mbu wanapenda kuzaliana kwenye majani ya mti.

7. Wanaume watu wazima wapo kwenye hatari zaidi ya kuungua malaria kwa sababu wao ni wakubwa sana.

8. Unaweza kulala kwenye chandarua kama utalala kwenye godoro na au kama utalala kwenye mkeka.

9. Vyandarua vilivyowekwa dawa ni hatari kwa watoto wachanga na watoto wadogo.

10. Kulala kwenye chandarua sio salama kwa kujikinga dhidi ya malaria kwa sababu unaweza kuumwa na mbu wakati wa mchana au jioni.

Kweli : 2, 4, 8 Si kweli :

1. ni mbu jike aina anofelesi tu ndiye husambaza vimelea vya malaria3. degedege ni dalili kuonyesha kwamba kuna tatizo kwenye ubongo kilichosababishwa na ugonjwa,

na haraka unatakiwa upata matibabu kwenye kituo cha afya.5. ni vimelea vya plasmodiamu vienezavyo na mbu wa anopholesi vinasababisha malaria6. wanahitaji maji yaliyotuama kwa mayai na lava kukua7. watoto wadogo na wanawake wajawazito wapo kwenye hatari zaidi ya kuugua malaria kwa

sababu miili yao haina kinga ya kutosha kupambana na vimelea vya malaria.9. dawa inayowekwa kwenye vyandarua ni maalumu kwa ajili ya kuulia mbu aina anofelesi na ni

salama kwa watu wote hata kwa watoto10. kwa sababu mbu wa anofelesi aenezae vimelea vya malaria huuma mara nyingi wakati wa usiku.

Murals

Appendix A: VocabularyUncomplicated malaria

Malaria isiyo kali Transmission Uambukizaji

Severe malaria Malaria iliyo kali Mosquito Mbu

Cerebral malaria Malaria iliyopanda kichwani Bite Kuuma

Plasmodium Vijidudu vya malaria, vimelea vya malaria

Between sunset and sunrise

Kati ya machweo na mapambazuko

Parasites Vimelea (ki/vi) Lay eggs Kutaga mayai

Red blood cells Seli za damu nyekundu Mature Kukomaa

Vector Wadudu wadhurifu Stagnant water Maji yaliotuama

Symptoms Dalili Stomach ache Kuumwa na tumbo

Signs Ishara Nausea Kuchafuka moyo

Fever Joto la homa, kusikia joto Vomit Kutapika

Chills Kusikia baridi Convulsions Degedege

Shiver Tetemeka Loss of appetite Kukosa hamu ya kula

Weakness Udhaifu Diarrhea Harisha

Fatigue Uchovu Dizziness Kizunguzungu

Headache Kuumwa na kichwa Unconsciuosness Poteza ufahamu

Ache Mchonyoto, maumivu Blood loss Upungufu wa damu

Prevent KuzuiaPrevention UzuiajiLong lasting insecticide treated nets (LLINs) Vyandarua vilivyotiwa viuatilifu vya muda mrefuIndoor residual spraying (IRS) Kupulizia viuatilifu kwenye makazi au katika kuta za

nyumba au dawa ya ukoko

Put screens in windows and doorways and other open areas

Kuweka wavu katika madirisha, milango na sehemu nyingine zenye uwazi

Prophylaxis Tiba ya kuzuia maradhi

Pregnancy Ujauzito Anemia Upungufu wa damu

Pregnant mother Mjamzito Afterbirth Kondo ya nyuma

Antenatal Clinic Kliniki kwa wajawazito Maternal mortality

Kupoteza maisha wakati wa kujifungua

Blood loss Upungufu wa damu Infant mortality Vifo vya watoto wachanga

Physically weak Dhaifu Low birthweight Mtoto njiti

Traditional birth attendant Mkunga wa jadi

Treat Tibu Diagnosis Utambuzi, ubainishaji wa

ugonjwaMedical treatment Matibabu, utibabu Laboratory Maabara

Drug Dawa Blood sample Sampuli ya damu

Dose Dozi Rapid diagnostic test (RDT)

RDT

ACT (artemesin combination therapy)

Dawa mseto, ALU Respiratory illness Ugonjwa unaohusiana na upumuaji

Traditional medicine Dawa za kienyeji Traditional healer Mganga wa kienyeji

Harms Madhara (n/n)

Disability Ulemavu

Death Kifo

Presence Kuhudhuria

Absence Kutohudhuria

Economy Uchumi

Misguided belief (myth)

Imani potofu

Appendix B : Malaria Facts(from CDC website, read more online – sites listed on the Malaria Links document)

Malaria in the United States By 1951, malaria was considered eliminated from the United States. On average, 1500 cases of malaria are reported every year in the United States, even though

malaria has been eradicated in this country since the early 1950's. First- and second-generation immigrants from malaria-endemic countries returning to their

"home" countries to visit friends and relatives tend not to use appropriate malaria prevention measures and thus are more likely to become infected with malaria.

Between 1957 and 2009, in the United States, 63 outbreaks of locally transmitted mosquito-borne malaria have occurred; in such outbreaks, local mosquitoes become infected by biting

persons carrying malaria parasites (acquired in endemic areas) and then transmit malaria to local residents.

Of the species of Anopheles mosquitoes found in the United States, the three species that were responsible for malaria transmission prior to elimination (Anopheles quadrimaculatus in the east, An. freeborni in the west, and An. albimanus in the Caribbean) are still widely prevalent; thus there is a constant risk that malaria could be reintroduced in the United States.

During 1963-2009, 96 cases of transfusion-transmitted malaria were reported in the United States; approximately two thirds of these cases could have been prevented if the implicated donors had been deferred according to established guidelines.

Malaria Worldwide 3.3 billion people (half the world’s population) live in areas at risk of malaria transmission in

109 countries and territories. 35 countries (30 in sub-Saharan Africa and 5 in Asia) account for 98% of global malaria

deaths. WHO estimates that in 2008 malaria caused 190 - 311 million clinical episodes, and 708,000 -

1,003,000 deaths. 89% of the malaria deaths worldwide occur in Africa. Malaria is the 5th cause of death from infectious diseases worldwide (after respiratory

infections, HIV/AIDS, diarrheal diseases, and tuberculosis). Malaria is the 2nd leading cause of death from infectious diseases in Africa, after HIV/AIDS.

Malaria History As early as 2700 BC Chinese medical writings described the symptoms of malaria. Malaria parasite was discovered by Charles Louis Alphonse Laveran, a French army surgeon

stationed in Constantine, Algeria. On August 20th, 1897, Ronald Ross, a British officer in the Indian Medical Service, was the

first to demonstrate that malaria parasites could be transmitted from infected patients to mosquitoes.

The construction of the Panama Canal was made possible only after yellow fever and malaria were controlled in the area. In 1906, there were over 26,000 employees working on the Canal. Of these, over 21,000 were hospitalized for malaria at some time during their work

Chloroquine was discovered by a German, Hans Andersag, in 1934 at Bayer I.G. Farbenindustrie A.G. laboratories in Eberfeld, Germany.

Dichloro-diphenyl-trichloroethane, DDT, available since 1943 was sprayed in over 6.5 million homes

The Communicable Disease Center, CDC’s origin (July 1, 1946) stemmed from Malaria Control in War Areas (MCWA) which used DDT as its primary weapon against mosquitoes.

Biology, Pathology, Epidemiology Among the malaria species that infect humans, Plasmodium vivax and P. ovale can develop

dormant liver stages that can reactivate after symptomless intervals of up to 2 (P. vivax) to 4 years (P. ovale).

Pregnant women have increased susceptibility to Plasmodium falciparum malaria; in malaria-endemic countries, P. falciparum contributes to 8-14% of low birth weight, which in turn decreases the chance of a baby’s survival.

After a single sporozoite (the parasite form inoculated by the female mosquito) ofPlasmodium falciparum invades a liver cell, the parasite grows in 6 days and produces 30,000-40,000 daughter cells (merozoites), which are released into the blood when the liver cell ruptures. In the blood, after a single merozoite invades a red blood cell, the parasite grows in 48 hours and produces 8-24 daughter cells, which are released into the blood when the red blood cell ruptures.

Under the microscope, Plasmodium knowlesi can resemble either P. falciparum or P. malariae. Thus PCR (polymerase chain reaction) is often required to confirm infection.

Other Facts

Four Nobel prizes have been awarded for work associated with malaria: to Sir Ronald Ross (1902), Charles Louis Alphonse Laveran (1907), Julius Wagner-Jauregg (1927), and Paul Hermann Muller (1948).

Two important currently used antimalarial drugs are derived from plants whose medicinal values had been noted for centuries: artemisinin from the Qinghao plant (Artemisia annua, China, 4th century) and quinine from the cinchona tree (South America, 17th century).

Tanzania Facts (from supportthemission.org) Malaria is the #1 child killer in Tanzania 1 in 5 children <5 years old die of malaria related diseases Average no. of births/ woman = 5 ie. By average, all mom’s experience 1 death of a child.

80,000 children die annually 58% of kids under age 5 have fever and receive antimalarial drugs Tanzania has the 3rd largest population (38mill) on earth at risk for malaria The use of ITN (insecticide treated nets) can reduce child mortality by >40%. Tanzania’s 3 factories are the largest ITN producers in Africa >32% of households across Tanzania currently use ITNs Malaria is the leading cause of inpatient and outpatient consultation and = 30% of the

nations health care burden. Approximately half the population is affected with malaria One Tanzanian, nearly always a child dies of malaria every 5 minutes. Mothers have anemia,

premature births and tiny babies because of it. Parents and children get severe permanent brain damage from it. An many people die from HIV/Aids and other diseases that are made worse by malaria.