Ghana Field Site: Dzamam

Dzamam is a sub-district of Upper Manya Krobo District. The district was formed just two years ago, after Manya Krobo became too large to adequately distribute resources. The new district is working to develop its own systems and leadership. Its capital is Asesewa, which is about one hour by car from the Eastern Region capital of Koforidua. Dzamam consists of sub-districts and communities which are largely farmers of cassava, maize, and cocoa yam. There are also fishing villages since the Volta River and its tributaries are in the area. Market day is Friday in Asesewa (mini-market on Monday) so that is the busiest transport day- with tro-tros and cars kicking up heaps of dust on the usually quiet roads. It has been a pleasure to get to know this area- with rich soil, lush green mountains during this rainy season, and welcoming people. The useful phrase, “Mo choom ka” or “Thank you very much” in the local Krobo language, has served us well.

Reporting from Ghana

Greetings from beautiful Ghana! Here is a long-awaited update from Accra and beyond. After arrival in early June, the team has been working on three main tasks: 1) Seeking input and context from key malaria stakeholders a policymakers in Ghana , 2) Developing our study design and submitting for ethics approval from the Ghana Health Service, and 3) Identifying and building a relationship with a local partner to implement the study in a field site.

In Accra, the TAMTAM team benefited from the input and expertise of the Ghana National Malaria Control Program, USAID’s malaria control team, and ProMPT (Promoting Malaria Prevention and Treatment), among others. Their insights into current and future malaria activities and learning from past initiatives have greatly informed TAMTAM’s study.

In the context of a point distribution, TAMTAM’s study will examine the rates of net self-installation and leakage over time, as well as the impact on usage of using community health volunteers to hang nets in homes. To support the plans of Ghana’s National Malaria Control Program, our study will be located in the Eastern Region, which is a high priority region list for large-scale mosquito net distributions to achieve full coverage. We are collaborating with one of ProMPT’s local partners, KLO Drivers Alliance based in Asesewa, close to the capital of Eastern Region, called Koforidua. KLO has been working locally on health initiatives for a decade and has networks of volunteers throughout the many communities it serves. Originally, KLO focused on connecting with taxi and public transport drivers as a means to combat the spread of HIV/AIDS. Here is Mr. Sackitey Offei, director of KLO signing an MOU with TAMTAM.

KLO works hand-in-hand with a local health clinic in the sub-district of Dzamam, which will be the base for TAMTAM’s field activities. Located on a quiet dirt road, the clinic employs 4 staff and acts as a hub for the community health volunteers and health initiatives. We have been pleased to meet the committed and capable staff and found their guidance critical to arranging local plans.

We have submitted our tome of documents (above) to the Ghana Health Service Ethics Review Committee for IRB approval. We have identified 7 community health volunteers for our project – at least one for each of the communities we will cover with mosquito nets: Dzamam, Dawatrim, Brepaw, Afuafie, Adwenso, and Takorase. These volunteers will be our hands and feet in the villages where they will collect assess household sizes and population counts, assist in the distribution of mosquito nets and complete follow-up activities such as hang-up and monitoring.

The TAMTAM team is looking forward to putting mosquito nets over at-risk populations very shortly! Many thanks for all the emails and generous support that have come to us here in the field.

Team Uganda: Wrapping up in Ntenjeru and heading North

The TAMTAM Uganda team has focused the last two weeks on managing the data collection efforts in Ntenjeru and on establishing connections with the political, medical, and non-governmental organizations that fight malaria in Uganda.

We have been working hard to go with VHTs on home visits as often as possible to ensure data quality and consistency. The VHTs have done a great job, and it has been very informative for us to be able to see challenges as they occur and fix them in real time. The VHTs are doing one last large push today and tomorrow to finish up the survey and then the collection will be wrapped up in Ntenjeru.

We also spent three days in Kampala meeting with individuals leading governmental and international malaria research and action organizations. We got up-to-date on the current efforts across all the different organizations in Uganda and established connections with individuals leading national research programs. There is currently a nationwide distribution of nets to pregnant women and children under five. After this category of people is covered, the government will then do a “top up” to distribute one net for every two people in every household. We were excited to learn that our results should be ready in time to inform the procedural development for this “top up” distribution. In August, we will be meeting with some of the organizations coordinating this to share our findings and recommendations.

Finally, we have started to plan the follow-up in Gulu. After meeting with our on-the-ground coordinator there, we have been working out the details of the budget and follow-up activities. We look forward to getting started on the training next week.

Team Uganda: Out in the field

The Uganda team had a very busy and successful week last week. On Tuesday, seven members of the Volunteer Health Team joined us at the Volset White House for a training on conducting the data collection survey. The day began with breakfast, followed by a review of TAMTAM’s goals, this specific study and the importance of malaria research. After Hummy led everyone through the survey and data entry methodology, the VHTs role-played to practice conducting the survey. We were particularly excited about one VHT who enthusiastically and humorously acted out challenging situations the VHTs might run into, including getting romantic advances during the interview and interviewees using the bed nets for alternate purposes. After 8 hours of training the VHTs stayed late to review with each other and practice additional scenarios.

The TAMTAM team and VHT's during training outside of the White House

Sheryl reviewing training materials with VHTs

With training done, we could now get out in the field to see the impact of the TAMTAM nets first hand. We spent the rest of the week shadowing VHTs on home visits which were very insightful. We observed that most people are correctly using their TAMTAM nets but that some individuals struggled to hang theirs or repair them after tearing. While it is very early in the data collection, it may indicate that education or VHT assistance in installing and maintaining the net can have a significant impact on utilization.

Hummy checking up on a TAMTAM net in a local household

We were also excited to learn that, thanks to the efforts of the VHTs and government educational programs, the majority of net recipients correctly identify how an individual contracts malaria. Understanding how malaria is contracted, and therefore why bed nets are important, should also help increase correct utilization of the nets.

We are now back in Ntenjeru where we will spend the week continuing to shadow the VHTs on home visits as well as working with the health clinic’s records to get a better understanding of how the number of diagnosed malaria cases have changed over the course of the year. We are hoping that with additional layers of data we will be able to look at the impact of net distributions on diagnosed malaria cases.

The team on our walk to the office in the morning. Great views!

Hello from Ghana

Greetings from Accra, Ghana! TAMTAM has teams in Ghana and Uganda right now, and we will be updating this blog with information and stories about our work on TAMTAM’s 2010 summer projects.

Ghana makes the fifth country in which TAMTAM has conducted research or net distributions. For those who are new to the blog or to the organization, please check out our work at our website, and of course, we’re looking forward to telling you about our work throughout the summer.

We currently have a team of six people based in Accra. We are fortunate to have two members of the team, Esther Hsu and Paul Wang, who are officers of TAMTAM and who worked on the Uganda project last year. We also have four new team members: Julia Goldberg, Teague Hopkins, Matthew Raifman, and me, Leah Stern.

Last week, we had a set of very productive meetings, including one at the National Malaria Control Programme (NMCP) where we got a chance to listen to the planning discussions for the next major net distribution campaign in the Eastern Region in Ghana. The discussion included representatives from the President’s Malaria Initiative, ProMPT (Promoting Malaria Prevention and Treatment), and Nets for Life.

The TAMTAM team also met separately with ProMPT, an organization funded by USAID which works in partnership with NMCP, and they shared with us their insights from their work, which seeks to strengthen the NMCP’s work and engage stakeholders in malaria interventions.

We have a very nice office in Osu in downtown Accra in the offices of Deliver, a project of John Snow, Inc (JSI). The folks at Deliver have been wonderfully welcoming and have shared their extensive knowledge with us.

This week, we are looking forward to more meetings to discuss what evaluations would be most useful to policymakers. We’re also working to set up visits to potential local partners.

Stay tuned!

Lusanyuse okulaba mu Uganda! (Welcome to Uganda)

The Uganda TAMTAM has arrived on site in Ntenjeru and hit the ground running! This year’s team consists of Sheryl, who is working on her Master of Science in Epidemiology at the Harvard School of Public Health, Hummy, who is working on her Master in Public Policy at the Harvard Kennedy School of Government, and Laura who just completed her Master’s of Business Administration.

This summer, the team is focused on collecting follow-up data on the 400+ home bed nets that were distributed to last year. The nets were given out through different techniques and the team will evaluate the follow up data to see if techniques resulted in increased utilization. This information will be reported to the government, US health organizations, and other NGOs to improve the methods through which nets are distributed in the future.

We arrived in Uganda on Saturday and after a bumpy ride down to the Volset Foundation's White House we were treated to a delicious dinner by the wonderful women working at the House. On Sunday, we spent the day learning how to do basic tasks, like washing dishes and bathing, without the luxuries of home life and also had the chance to have some fun with the kids that live nearby.

Monday we got right to work going to the Volset Office to meet with two of the Volunteer Health Team members (VHTs) to develop the follow-up survey, schedule dates for training all of the VHTs, and work on training materials. We’ll spend the rest of this week working closely with the VHTs as well as people involved in the initial follow up study last September, to develop the follow-up survey and the training which we will be giving to the VHTs next Tuesday.

We have been warmly welcomed by the community, kids, and VHTs. We’ve been inspired by many of the leaders of the community that we’ve had the pleasure to meet and all the fantastic work they’re doing to improve education, healthcare, community services, and support for the HIV+ community. We’re really excited to be starting off a great summer of working for TAMTAM in Ntenjeru!

A review of 10 days with TAMTAM in Gulu

children caring for children: a legacy of the LRA in Gulu?

The evidence of two decades of LRA terror both stares you in the face and bubbles under the surface in Gulu. (The Lord's Resistance Army is a group that murdered many in Northern Uganda and abducted children to make child soldiers and sex slaves, now working in Sudan)


IDP camp in Gulu town

Many have horrific stories full of fear from personal experiences during the LRA terrors. IDP (internally displaced peoples) camps are seen everywhere tightly packed for group safety, in Gulu town and on the roads around Gulu town, schools were closed and health declined.



Today, many NGOs still operate in the area and the health networks are sufficiently developed - each village nominates a person to be its health information volunteer; this person is trained, sometimes to do immunizations, or talk about malaria, etc. TAMTAM worked closely with some wonderful Village Health Teams (VHTs) and youth leaders to disperse 1300 bednets to a very needy population, still struggling to return to a life of normalcy and independence.

A photo tour of TAMTAM's work in Gulu...

TAMTAM's bednets: the best in the biz! Nets are coated with insecticide that lasts 3 years, and net holes are small to prevent mosquitoes from entry. Note the different colors of rope, corresponding to the different distribution interventions

VHTs receive malaria training from Doctor Samuel and learn about bednet distribution interventions TAMTAM hopes to test at KAIROS health and community development center

The distribution of nets took place in community meeting places, often under a large tree, in a school yard or in the market. The village would gather and men and women would inevitably separate themselves.

In one site, 300 people packed in an open air community space to pick up nets. It was overflowing with people!

Here, Goretti, a VHT gives one of 4 intervention messages

A woman and child take their new bednet

five women begin what may be a long walk home with their bednets. We learned as we did home installations of bednets that some villagers travel from an hour away to a bednet distribution site.

After the nets are distributed, Thomas, Albert and Charles, several village health team members divide up the home installation lists by location: some will head into the IDP camps to do up to 30 installations in 2 days, while others will see 5 homes deep in the bush over 2 days.

inside a home, two children play while a new bednet is being installed by a VHT.

So that's a quick tour of TAMTAM's work in Gulu. 1,300 bednets distributed. Not too bad for 10 days' work. Many thanks to our dedicated VHTs, youth leaders and the staff at KAIROS!

Operation Gulu: Distribution and Installation Complete

Villagers wait patiently for their names at the Pageya parish distribution

After 9 days in Gulu District, the TAMTAM team has dropped down in all 6 parishes of the Koro Sub-county. With the leadership and guidance of Mr. Christopher and Dr. Beatrice from Kairos, much travel and coordination with 14 youth leaders and Village Health Team members, and the facilitation of local government officials, brand new nets have reached over 1,300 households. It has been an exciting time for the team, to see our many data files come to life as thousands of people gathered to receive nets. Our nets went out with malaria information and specific messaging about proper care and installation. With this distribution in Gulu, we also hope to learn about the effect of certain messaging on the use of the net in homes. The final follow-up phase will begin in early September, spearheaded by Ash.

LEFT: Curious neighbors watch a net installation, RIGHT: Village health worker, Alfred, installs a new TAMTAM net

We have learned a lot in Gulu and look forward to working there in the future. A job well done by all of our partners and cheers to all the kind people we met. In the meantime, plans are being hatched for a distribution through Kairos health clinic's weekly immunisation day...

TAMTAM team (Paul, Ash, Eric, Jasmine, Esther) with the distribution and installation team (Mr. Christopher, Youth leaders Chris, Samuel, and Goretti, and Village Health Worker Alfred).

Ash and Jeff on the ground!

Both Ash Gupta and Jeff Grosz have arrived in Uganda as of today! The team is excited to welcome them to the TAMTAM team. Ash was put to work immediately and has made the rounds at Ntenjeru and now here in Gulu. Jeff has been here for mere hours- his travel is to come! We also bid a fond farewell to Meredith and Lekha- you will be missed in Uganda!

Day 1 of distribution: Labwoch Parish

Today we started our distributions in Labwoch Parish. We were both eager to get the nets out, and a bit apprehensive about the problems that might arise. Would people come from the villages to the meeting? Would many expect nets who were not assigned to nets? Was there something we hadn’t anticipated?

The first sign of trouble was our incredibly late start – a sign of trouble, fortunately, only for those uninitiated with African time. As we readied ourselves, people kept arriving and when they did, waited patiently. Speeches were made on malaria and bed net care, on self-reliance, and then nets (and a large net transport bag too) were distributed.

Following distribution, some stayed to argue their cases for receiving a net and a protocol was decided. Extra nets went to pregnant women, families with young children, the sick, and the elderly. Once established, few could argue the logic and those that did not receive a net left with without complaint. We gave out 132 nets today and can count the day a huge success!!