Kenya (2014): Malaria TRaC Study among Populations Living in Malarial Zones in Kenya

In the last decade, the Government of Kenya (GoK) has emphasized malaria programming with a bid at reducing the infant mortality, and malaria related maternal mortality. PS Kenya has developed an evidence-based programmes aimed at enhancing use of insecticide treated mosquito nets through support of routine net distribution, mass media campaign, and interpersonal campaigns. In order to inform this campaign, PS Kenya, with funding from the DfID plans to implement a national household survey among residents of malarial zones in Kenya. This study design highlights the objectives of the survey, the methodological approach, the ethical consideration, and the data collection tools proposed for the study. We aim in this study to provide national level monitoring data on net ownership, and net usage. Specifically this survey will determine the factors associated with net ownership and use among the target populations, the trends in uptake of nets compared to other national level surveys, the association of exposure to mass media and interpersonal communication with ownership of LLINs with use of LLINs. The investigators propose a cross sectional study design that adopts quantitative approaches to data collection. The investigators propose to implement the study between May and June 2014. The study will include a national sample of 6002 households distributed based on the square root allocation method to the different malarial zones. The investigators will get an additional sample in IPC implementation areas to bring the sample for this area to 2320 to enable conclusion around IPC intervention. The survey proposes a two-stage cluster sampling design. The study will use a sampling frame based on the NASSEP V developed by the Kenya National Bureau of Statistics. Using 298 enumeration areas (EA), the interviewers will include, without replacement, 28 households per. The investigators propose the inclusion of respondents aged 18-49 years who give written, informed, and voluntary consent to participate in the survey. The interviewers will collect data using mobile phones through the open data kit system. The investigators anticipate that an interview will take between 30 -45 minutes with the interviewers conducting an average of seven interviews per day. SPSS version 21 will aid the analysis for this study. Net use defined as sleeping under an insecticide treated net the night preceding the survey, will be determined through frequencies and proportions, segmented by the malarial zones, age, and gender categories. The study considers net ownership at two levels: ownership of at least one net in a household and universal coverage (owner ship of 1 net for every 2 people in the household). The behavioral factors, based on Leikert Scales, will be assessed using Analysis of Variance to determine possible association to the behavior. The evaluation of the IPC’s association with behavior will be determined using coarsened exact matching to increase comparison accuracy. The influence will then be assessed based on analysis of variance. The investigators will present the findings from this survey in PS Kenya’s dashboard and study specific report. The investigators will share the report with the donor, the GoK through the MCU, and other stakeholders in malaria prevention. Insights from the report will inform malaria programming in Kenya.

近十年来，肯尼亚政府（Government of Kenya, GoK）始终将疟疾防控工作作为核心议题，致力于降低婴儿死亡率以及与疟疾相关的孕产妇死亡率。肯尼亚PS Kenya制定了循证项目，通过支持常规蚊帐分发、大众媒体宣传及人际传播宣传，提升经杀虫剂处理蚊帐（insecticide treated mosquito nets, ITNs）的使用普及率。为给本次宣传活动提供决策依据，在英国国际发展部（Department for International Development, DfID）的资助下，肯尼亚PS Kenya计划在肯尼亚疟疾流行区居民中开展一项全国家庭调查。本研究方案详细阐述了本次调查的研究目标、方法学路径、伦理考量及拟采用的数据收集工具。本研究旨在提供全国层面的蚊帐拥有率与使用率监测数据。具体而言，本次调查将明确目标人群中与蚊帐拥有及使用相关的影响因素、相较于其他全国性调查的蚊帐普及率变化趋势，以及大众媒体与人际传播接触情况与长效驱虫蚊帐（Long-Lasting Insecticidal Nets, LLINs）拥有及使用之间的关联。研究人员采用横断面研究设计，以定量方法开展数据收集工作。本研究计划于2014年5月至6月间实施。本次调查将纳入全国范围内的6002户家庭作为样本，依据平方根分配法将样本分配至各个疟疾流行区。研究人员将在感染预防与控制（Infection Prevention and Control, IPC）实施区域额外采集样本，使该区域的样本量达到2320户，以便能够针对IPC干预措施得出可靠结论。本次调查采用两阶段整群抽样设计。本调查将以肯尼亚国家统计局制定的NASSEP V抽样框架作为抽样依据。调查人员将以298个枚举区（Enumeration Area, EA）为基础，每个枚举区不放回抽取28户家庭。研究人员拟纳入18至49岁的受访对象，且该对象需签署书面知情同意书，自愿参与本次调查。调查人员将通过移动设备搭载开放数据工具包（Open Data Kit, ODK）系统收集数据。研究人员预计每例访谈耗时30至45分钟，调查人员日均完成约7例访谈。本研究将采用SPSS 21版本（Statistical Product and Service Solutions 21）开展数据分析工作。将“蚊帐使用率”定义为调查前一晚睡在经杀虫剂处理蚊帐下的情况，通过按疟疾流行区、年龄及性别分组的频率与占比来统计该指标。本研究从两个维度定义蚊帐拥有率：一是家庭至少拥有1顶蚊帐，二是全民覆盖（即每2名家庭成员拥有1顶蚊帐）。基于李克特量表（Likert Scale，原文拼写为Leikert，应为标准Likert）的行为因素将通过方差分析进行评估，以明确其与相关行为的潜在关联。为提升对比准确性，将采用粗化精确匹配法（coarsened exact matching, CEM）评估IPC干预与相关行为之间的关联。随后将通过方差分析评估其影响效应。研究人员将在PS Kenya的可视化仪表盘以及本研究专项报告中展示本次调查的结果。研究人员将向资助方、通过疟疾控制单元（Malaria Control Unit, MCU）对接的肯尼亚政府，以及其他疟疾防控利益相关方分享该报告。本报告的研究结论将为肯尼亚的疟疾防控工作提供决策参考。