Thank you to Solomon Shewit!

TAMTAM would like to recognize 13-year old Solomon Shewit from Falls Church, VA. We are inspired by Solomon's desire to fight malaria and his creativity in organizing events. Solomon wrote to us in an email:

"I found it very heartbreaking that in Africa, and even in my country, Ethiopia, so many people are dying from malaria because they cannot get a hold of a mosquito net, but here in the United States, getting hold of these mosquito nets is not an issue for most people. I realized that with malaria, there is so much that I can do to help, and after searching for an organization to send money for mosquito nets, I thought that TAMTAM, Together Against Malaria, was perfect." -Solomon Shewit

Solomon shared with us plans to hold various events such as bake sales, concerts, and Ethiopian food services. We have just received Solomon's contribution to TAMTAM which will provide hundreds of mosquito nets in sub-Saharan Africa.

Thank you, Solomon, from the whole TAMTAM team! We will put your kind donation to good use!

And now to hang the nets…

Curious neighbors say hello during a home visit...

Volunteer Richard and a happy owner of a newly installed mosquito net.

Volunteer Abraham of Takorase after demonstrating the hanging of the mosquito net to the household.

As part of TAMTAM’s operational research, we are again testing the impact of using community health volunteers to hang mosquito nets for households on net usage. At the same time, we are also observing the rate at which households will install nets on their own and whether or not the nets make it home after a fixed point distribution. These questions were all suggested by malaria policymakers in Ghana. We hope to deliver useful findings for them through our work these past few months.

The community health workers are now visiting homes to install mosquito nets and collect other information. They have been trained to hang nets in different types of rooms, over beds and mats, and armed with supplies such as flashlights, nails, and hammers.

We look forward to hearing that households not only own but also use their mosquito nets to cover their entire family.

Nets are in the communities at Ghana site!

Happy kids with nets.

Meeting the local health officials before the net distribution.

Crowds waiting for nets at Adwenso.

Calling household names at Afuafie.

Assembly line to prepare nets for households.

Supply pack included with each net: strings, hooks, nails, and care instructions.

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Going home with baby and nets.

Managing the distribution table in Dzamam.

Going home...

After two action-packed days, nearly 2000 nets have been distributed for free to communities in Dzamam sub-district. Five separate distributions were supported by the community health volunteers, the local health clinic, KLO Drivers’ Alliance, and the TAMTAM team. The tro-tro van which carried our 2,000 nets and team members traveled many kilometers over challenging terrain to reach the communities. The distributions occurred at central community hubs: a health clinic, two churches, and two schools. Each distribution began with a malaria message to the gathered community by Mr. Sackitey Offei, the leader of KLO. The message covered basic malaria prevention information and proper care (mild soap, no sun exposure, minimal washing) and use of the mosquito nets including a hang-up demonstration. Following the message, household heads were called by name from the pre-registration list and given the mosquito nets allocated to their household. TAMTAM’s mosquito nets, WHO-certified Permanets manufactured by Vestergaard-Frandsen, were prepared by opening the package and cutting a hole in the tag to mark TAMTAM nets. Hooks, strings, and an instructional cartoon were included in the distributed packs. Nets were opened to ensure they could not be sold and so that households were know to use the nets immediately instead of saving them for the future. It was quite an assembly line with all hands on deck to assemble thousands of nets for distribution.

At the end of the distributions, we were satisfied to know that six communities, or 3,700 people in 585 households were protected by TAMTAM mosquito nets. It was especially rewarding to see mothers and small children and pregnant women taking home nets. Thank you to KLO Drivers Alliance for their preparation and facilitation of the entire project. The staff members of the Dzamam health clinic (Barbara, Wahab, Eudia, and Abigail) have been very helpful- from shuttling us to distant villages on their Ghana Health Service motor bikes, coordinating collection of data from volunteers, and storing our supplies. They are all nurses and technicians assigned to this rural site, far from their homes and where they must learn the new language of Krobo. Once again, we have been inspired by local partners and found their participation critical to the success of our work.

Photos from Pre-Registration in Dzamam

Father and son visited during a household pre-registration visit.

Volunteer Abraham checking one of the few existing mosquito nets. This household owns one but it is too old to have effective insecticide.

Grandma and baby while their house is visited by a volunteer

Volunteer Joseph registers a household in Adwenso

Training Volunteers in Ghana

Photos- Top: Volunteers, KLO, Dzamam clinic and TAMTAM teams after training; Middle: Volunteers ready for instructions; Bottom: Discussing details during training.

The community health volunteers for TAMTAM’s project in the Dzamam sub-district gathered at the church across from the health clinic. During the one day training, the volunteers learned how to pre-register their communities so that TAMTAM could distribute enough mosquito nets for universal coverage. As defined by the National Malaria Control Program’s standards, universal coverage for a household is one net for every two people, up to the number of sleeping spaces, and less the household’s current effective nets. Our volunteers went into their communities to return this information for each of their households. They were also prepared with tools such as clipboards, inkpads, pens, and flashlights to help them accurately obtain the data needed. During training, volunteers were able to practice administering the pre-registration survey. They problem solved potentially challenging situations through role playing and discussing together.

After training, the seven volunteers (Richard, Christian, Felix, Nicholas, Abraham, Joseph, and Joseph) conducted pre-registration in their respective communities of Brepaw, Dawatrim, Dzamam, Adwenso, Takorsae, and Afuafie. TAMTAM members were available to work with the volunteers during their first few household visits to ensure that there were no difficulties. In total, 3800 people in about 600 households were registered for TAMTAM’s project.

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!