ABSTRACT
SETTING: St John's District, Grand Bassa County, Liberia. OBJECTIVES: In households with children aged <5 years, to examine the coverage and use of long-lasting insecticide-treated bed nets (LLINs), factors associated with non-use and the characteristics and conditions of bed nets. DESIGN: Cross-sectional study involving interviews with mothers and visual inspection of LLINs. RESULTS: Of 663 households visited, 492 (74%) had no LLIN and 135 (20%) had one LLIN. Of 171 households with LLINs, these were consistently used by 73 (43%) children. The main reasons for inconsistent use included LLINs being old or damaged, and LLINs generating too much heat for 20-30% of children. Visual inspection of LLINs in 130 households showed that 98% of LLINs were white, 20% were not hung above the child's sleeping place, 30% had holes, 84% were double-bed sized and 82% had been washed in the previous 6 months. CONCLUSION: Despite reports of 100% LLIN coverage in St John's District, this study showed that only a quarter of households had an LLIN, over half of the children used LLINs inconsistently and the LLINs had several deficiencies. More surveys should be conducted to determine the true coverage of LLINs in Liberia, and measures must be taken to improve the use of LLINs.
ABSTRACT
Reported are findings from an evaluation of a community-based strategy employing local chiefs and traditional midwives as extenders of the Ministry vaccination team for the purpose of increasing vaccination completion in Liberia, West Africa. The intervention strategy-a training workshop and two subsequent supervisory visits-was selected from among those generated in Stage 1 of a three-stage operational research design. Evaluation of the intervention was carried out after an eight-month follow-up period. Visits to intervention and control villages, for the purpose of interviewing chiefs, traditional midwives (TMs) nand mothers of children under one year of age, were the means by which data were gathered. Both process and outcome indicators were identified as means of assessing the effectiveness of the strategy. Vaccination rosters and holding of a town meeting were used as evidence of the former. A vaccination coverage survey using a cluster sample methodology was used to evaluate differences in vaccination coverage. Results showed that knowledge about vaccination, treatment of side effects and the importance of the RTH Card was greater among chiefs/TMs and mothers in the intervention districts than in control districts. Coverage rates for fully immunized children were greater in the intervention districts (56% intervention vs. 45% control). When stratified by type of leadership, coverage rates were higher in intervention districts where TMs rather than chiefs served as vaccination team extenders, although chiefs were more effective than controls. As a result of this study, the Ministry of Health has decided to extend this activity into other counties and to add additional information on other PHC messages.