Knowledge, Attitudes and Practice (KAP) survey of Long-Lasting Insecticide-treated bedNets (LLITNs) in the refugee camps of Kule, Tierkidi and Nguenyyiel, in Gambela, Ethiopia, MSF-OCA catchment area.

Abstract

Ethiopia is a land locked country in east Africa, known for its deep culture and history as well as its struggle with disease outbreaks, drought, malnutrition and major refugee inflex’s. According to UNDP Ethiopia is ranked at 174 in the human development index. Life expectancy at birth is 64.6 years, infant mortality rate is 41.4 (per 1,000 live births), under 5 mortality rate is 59.2 (per 1,000 live births) and deaths from Malaria are 106 (per 100, 000 people). Historically, Gambella region and Itang woreda area are places of ethnic tension between original Agnuak population, Nuers who have arrived in earlier refugee movements 20+ years back, and new Nuer refugees, and Highlanders. All incomers to the area are not refugees, and movement to/from both sides of the South Sudanese border is frequent. Tribal clashes and single incidents take place often; of late the bigger fighting has been less frequent. In Gambella region there are currently 6 camps and 5 reception centers. MSF activities are focused across 3 camps (Kule, Tierkidi and Nguenyyiel) and 1 reception center (Pamdong). While the current refuges crises has been present since early 2014, over the last 18 months more than 130,000 new arrivals have entered Ethiopia, leading to the creation of the latest camp, Nguenyyiel. As of 31st March 2018, official UNHCR data indicates a total South Sudanese population in the region to be 419,259, which now exceeds the local/host population. Key demographics include; 55% of population to be female; 64% to be under 18 years of age; 88% to be women and children. Within this total there are 3,076 unaccompanied minors (0.73%) and 23,238 are separated children (5.5%). It is assumed that also in 2018 the number of unregistered refugees will massively increase due to unwillingness for relocation to other regions creating the need for further extensions or new camps. As all people staying in Gambella camps are not registered with UNHCR, many who seek help with MSF are not officially entitled to it. ARRA health Centres in Tierkidi and Nguenyyiel refuse to treat those without ration card/registration. In case of need of further referral to Gambella hospital, MSF are forced to compromise with the treatment, as those patients are not granted a permit. Across the region, but specifically in the camps served by MSF, we see very high case load of malaria, with major spikes during the rainy season. In 2017, across Kule and Tierkidi camps, MSF treated more than 70,000 people for malaria. Prevention efforts in the camps have been very weak, with limited bed net distribution (last one in 2014) and poorly planned/executed IRS campaigns (Oct 2017—late rain season). MSF will now engage to take on a more active role in prevention and treatment mechanisms including mass bed net distribution, IRS campaigns, use of primaquine (decreased transmission); improved follow up of cases requiring re-treatment as well as participating in a study with the Ethiopian Public health institute looking into the presence of HRP2 gene deletion. PRIMARY OBJECTIVES  To estimate the Long-Lasting Insecticide-Treated bedNets (LLITN) coverage ratio for the total population in the MSF catchment area SECONDARY OBJECTIVES  To describe the population surveyed by sex and age  To measure the LLITN coverage ratio for children under five years of age and pregnant women  To estimate indoor residual spraying (IRS) coverage ratio for the total population in the MSF catchment area  To assess malaria knowledge, attitude and practices in the population including recognition of symptoms, and how to prevent malaria with special focus on LLITN.  To assess knowledge, attitude and practices about malaria treatment.