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4 NEEDED LOCAL PERSONNEL/RESOURCES AND LEVEL OF EFFORT Three (3) overall Teams: (A) Demography, Mapping and Data Analysis (B) Socio-Anthropology and community mobilization (C) Environmental/Entomology/Parasitology 4.1 Team A Demography, Mapping and Data Analysis Personnel: (1) Cartographer -20 days (2) Assistant yield mapper/geographer -15 days (3) GIS oriented digitizer for field data -20 days Supplies and Resources: (1) Tracing paper and copying and printing costs (2) Cartographic equipment (3) Digitizer (en route?) (4) Upgraded computer for Atlas GIS software 4.2 Team B Socio-Anthropology and Community Mobilization Personnel: (1) Local Sociologist -30 days (Dr. Ogunlade) (2) Research Assistant (8) -15 days (TBD) (3) Research Assistant (1) -20 days (Ms. F. Akerele) Supplies and Resources: (1) 48 note pads (2) 4 tape recorders (3) 60 90-minute blank cassette tapes (4) 96 batteries (5) 1 box of pens (6) 12 file folders Part I-9
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3.7 Deliverables A. Entomology and Parasitology components. 1. Documentation on methods, techniques and instruments, for future use by CPHs 2. Anopheline (potential) vector breeding and density site maps of the area with delineated ecological characteristics of each situation and amenability to specific sustainable environmental methods of control through CPH involvement. 3. Anopheline mosquito biting pattern inside and outside households and an assessment of the optimal methods of protection of the community from biting contact. 4. Assessment of current situation of malaria in the community through presumptive diagnosis at health facilities and the proportion of parasitemia Plasmodium species prevalence and gametocytaemia levels. 5. An assessment of malaria laboratory diagnostic practices and verification of positivity levels in CPH participating laboratories. 6. Travel and mobility patterns among malaria cases (particularly children under five and pregnant women) and an interpretation of local acquisition of malaria infection. 7. Identification of pointers to CPH. Malaria prevention/control strategy. Part I-8
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B. Parasitological verification 1. CPH laboratory technicians will work closely with the specialized malaria laboratory scientists to carry out parasitemia assessments in all children under five and pregnant women diagnosed as malaria in the health facilities. 2. Parasite species, parasite density and gametocytaemia will be recorded. 3. Jointly with the socioanthropoligical team, A two-week travel history and mobility assessment will be done in all malaria diagnosed cases to determine whether infection was likely acquired within or outside the Lagos area of residence. 3.4 Level of Effort 1. Entomological Team 3 persons + designated CPH members - 30 working days 2. Laboratory Parasitology Team + CPH technicians + trainees - 20-35 working days 3. External Consultant/Senior Entomologist/Parasitologist - 40 working days in Lagos including planning of activities, analysis report-writing time. 3.5 Timeframe and Coverage C Overall duration - 40 working days C Overall field coverage - 3 CPH areas in 3 Ecological/Environmental strata e.g. lagoon water front area; inland non-swampy area; inland swampy area. 3.6 Schedule 1. February 1 -Detailed Mapping activities continue 2. February 27/28 -External Consultant arrives 3. March 2 - 4 -Orientation and preparation for TPM 4. March 4-5 -Team planning meeting - venue TBD 5. March 9th -Start up workshop with CPHs 6. March 10 -Area I Entomological training surveys begin -Sociological training assessments begin -Laboratory and Health facility training and assessment begin simultaneous 7. March 17 -Area I Midterm Review and monitoring workshop 8. March 23 -Review of Area I results 9. March 24 -Area II planning workshop and activities begin 10. March 25 - April 3 -Area II field activities 11. April 6 -Area II review of results 12. April 7-16 -Area III field activities 13. April 17 -Review of Area III results 14. April 20 - 27 -Consolidation of results and preparation of draft report 15. April 23-24 -Preparation of draft Malaria Action Plan 16. April 24 a.m. -Presentation of findings and action plan to CPHs and discussion and feed back 17. April 24 a.m. -Briefing of USAID 18. April 25/26 -External Consultant departs Part I-7

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3 SCOPE OF WORK C: ENTOMOLOGY AND PARASITOLOGY 3.1 Purpose of this activity While the overall activity will address the prevalence, distribution and associated socio-behavioral, and environmental factors related to malaria in the CPH areas, the specific focus of this activity will be on determining the Anopheles mosquito vectors and their distribution and habits as well as the prevalence and history of diagnosed malaria cases and Plasmodium Parasitemia in selected CPH areas. 3.2 Personnel and overall skills required 1. Middle level/senior entomologists/entomological assistants with malaria field experience and training and community survey skills 2. Medical laboratory scientists with special experience in malaria diagnosis and survey methods 3. An environmental biologist with survey and data recording skills 4. Selected members of CPHs who will be trained and will then form part of the team 3.3 Activities/Tasks General (A) A qualified and experienced team leader (external consultant) will be responsible for the planning and coordination of all entomological and parasitological tasks. The field and laboratory teams will be under the overall oversight of the EHP activity manager, Dr. Pandu Wijeyaratne. (B) CPH-designated persons will work closely with both the entomological and parasitological teams after an initial period of training in the basic methods that will be used in the assessments. Building capacity in the CPHs for continuation of these tasks will be an integral function of the overall activity. Specific Tasks: [To be conducted in a pre-determined sampling framework]. A. Entomological Assessments 1. Vector breeding habitats will be mapped and surveys in the area will be carried out. Species identification will be established anc characterized to breeding situations, on a sampling basis, through standard malariometric survey methods. 2. Adult mosquito and human contact assessments will be done in the community to determine anopheline potential vector presence and densities in households and their human contact times. Wherever possible non-intrusive methods, e.g., mechanical light traps and outdoor and indoor biting assessments, will be carried out. Part I-6

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trained in interviewing techniques to enable them to ask these questions in a nonthreatening way. C. Health Education and Action Planning Selected CPH members will participate as assistant FGD recorders in order that they learn how FGDs are conducted and so that they have first-hand access to the information generated from and about their communities. They will assist in the revision of written notes taken during the FGDs and also develop a simple results summary for future use in planning. Subsequent to the FGDs in each CPH, the CPH recorders as a group will meet together and compare their summary data sheets and discuss the implications for planning appropriate health education and action programmes in their areas. 2.4 Resources FGDs - lists of participating organizations in each CPH are already available for use in selecting FGD participants. Meeting locations will be provided by the CPHs, such as halls belonging to CPH member organizations. Additional materials that should be purchased or assigned include: 48 note pads 4 tape recorders 60 90-minute blank cassette tapes 96 batteries 1 box of pens 12 file folders Observations - Street maps with busy shopping/market intersections denoted will be used to start off observations. Checklists will be printed - approximate sample size of approximately 80 stores per CPH. 2.5 Level of Effort C 1 senior level social scientist/health educator for 20 working days (Dr. W. Brieger based in Ibadan, Nigeria.) C 1 middle level social scientist (local hire) for 30 working days (Dr. Ogunlade of University of Lagos working in a private capacity.) C 8 research assistants (local hire) for 15 days each 2.6 Products 1. Instruments and methodologies for use in future MRAs in the CPH communities include a FGD Guide, an observation checklist and a brief survey on mobility included with parasitological examination. 2. Planning process guidelines for CPHs to utilise FGD and observational data to plan educational and action programmes. Part I-5
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2.2 Personnel 1. Senior and middle level social scientist/health educators with experience in social and intervention research in malaria and/or other tropical diseases and in the use of rapid and qualitative methods. 2. Research assistants with training in social and related sciences and experience in conducting field studies, especially in the conduct of focus group discussions (FGDs). 3. Selected members of CPHs in order that they gain knowledge and skills needed to gather information needed to understand malaria in their own communities and to plan for appropriate malaria control activities. 2.3 Activities/Tasks 1. General There are three general tasks for the social/anthropological component of the Malaria Rapid Assessment (MRA) in Lagos. (a) to identify community beliefs, perceptions and behaviours concerning the recognition of malaria and its vector and community responses to these, (b) Jointly with the Parasitology/Entomology team, to determine travel history and mobility patterns and disease perceptions associated with the parasitological findings of the overall study, and (c) to utilise these findings to aid the CPHs in developing more appropriate educational and environmental interventions against malaria. 2. Specific Tasks A. Community Perceptions and Behaviours 1) Focus Group Discussions will be organised in each of the selected CPH communities in each of the three ecological zones to be studied. FGDs will be stratified by gender and major resident ethnic group for adults, with two FGDs being conducted for each gender/ethnic combination in each CPH, yielding a minimum of 8 adult FGDs per community. In addition there will be two FGDs per CPH held among secondary school students who live and attend school in the community. FGDs will identify local beliefs, perceptions, and other factors affecting human behaviour regarding malaria recognition, treatment and prevention. Particular focus will be on perceptions about mosquito breeding, including recognition of mosquito larvae and ideas about human activities (environmental, travel) that may influence malaria transmission). 2) Observational Studies will be conducted in each of the selected communities to determine what vector control products are available for sale (nets, sprays, etc.), their prices, and positioning in the shops. CPH members will play a major role in data collection in order to pass on skills to the community. B. Mobility and Disease Perception Integrated into the parasitological investigations will be a few basic interview questions that are aimed at determining the recent travel (within 2 weeks) behaviour of persons who complained of fever and whose blood film examination was positive. All persons examined will be asked (or the mothers for small children) to name the type of fever that they believe is affecting them and how they distinguished this from other locally (culturally) known fevers. Staff conducting the parasitological investigations will be Part I-4

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2 SCOPE OF WORK B: SOCIOLOGY/ ANTHROPOLOGY 2.1 Purpose of this Activity The formation of CPHs has encouraged well established community-based organizations, which do not ordinarily provide health services, to mobilize to improve the health status of their community s children. Immediately upon their formation, community action programs were initiated in target neighbourhoods. One example is the establishment of preventive measures against malaria, perceived as an important problem in the area. CPH members use environmental sanitation days in their neighbourhoods to clean up raw sewage B what they presumed to be a breeding area for mosquitoes, and by extension, a cause of the malaria they perceive their communities. No systematic effort has been instituted to define or describe the malaria problem in the community, i.e. if it truly is malaria, and if it is indigenous, (contracted locally) or imported (contracted when people visit rural areas) Nor has there been a systematic effort to survey malaria vectors and associated environmental factors in these communities. Each CPH developed a work plan which included this objective: Reduce the number of children and pregnant mothers getting sick from malaria (in the community, and/or among the organizational members of the CPH) and reduce the number dying despite contact with partner health facilities. One of the interventions used by the CPHs against malaria has been environmental sanitation, especially the clearing of gutters in the neighbourhoods. BASICS provided a set of equipment to each CPH to undertake this activity. CPHs have engaged in environmental clean-up both as a special campaign activity as well as a regularly scheduled intervention. Admittedly, cleaning of refuse from the streets and backed-up open gutters along these streets is not likely to address the problem of the breeding of anopheline mosquitoes. The effort may have little impact on the transmission of malaria, although other mosquitoes may be affected. This activity underscores the fact that local people, and even local health workers, may not distinguish among the types of mosquitoes and among the types of fevers that their children suffer. From the foregoing, a need becomes evident, that assuming malaria is a major cause of urban child morbidity, it is not only necessary to learn about the breeding of mosquitoes from an entomological perspective and the prevalence of malaria from a parasitological viewpoint, but also to understand how the communities perceive both the vectors and the disease. The social/anthropological component of this rapid assessment will gather information about local beliefs, perceptions and behaviours that can form the basis of community, particularly CPH, efforts at designing and implementing culturally and environmentally appropriate health education and community action against malaria. Part I-3
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1.5 Level of Effort 1. An experienced cartographer/town planner for 20 working days. (Mr. Ogunleye J.F., a senior lecturer in The Polytechnic, Ibadan, Nigeria) 2. An assistant field mapper; a geographer/town planner for 15 days (local hire) 3. A specialist in GIS who will digitize all maps, for 20 days (local hire) 1.6 Supplies and Resources 1. Tracing paper, copying, and printing 2. Cartographic equipment 3. Digitizer (en route) 4. Updated computer for all GIS software Part I-2
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1 SCOPE OF WORK A: DEMOGRAPHY AND MAPPING 1.1 Purpose of this Activity In order to determine accurately the association between the distribution of malaria-carrying mosquitoes and environmental variables, and in order to determine a link between endemicity of the disease and the quality of the environment, detailed mapping of each CPH area will have to be carried out. 1.2 Personnel and Overall Skills Required (A) A qualified cartographer/town planner will be responsible for the detailed survey and updating of those maps already drawn. He will have an assistant who is a geographer, familiar with town planning. (B) A specialist in Geographic Information Systems (GIS) will be responsible for digitizing all the maps produced by the cartographer/town planner. 1.3 Tasks The cartographer and his assistant will do the following: 1. Carry out a detailed survey of the project CPA areas a. noting and recording all swamps, lakes, streams, rivers, and other water areas b. noting and recording all markets, health facilities, and the diagnostic laboratories c. sketching all the housing areas, open areas, and road networks 2. Mapping all the entomological information produced by the other teams 3. The GIS specialist will be responsible for linking all the data with the GIS 1.4 Products/Deliverables Their assignments will be to produce maps of the following: 1. Distribution of all swamps, streams, rivers, and other water surfaces in all the project s CPA areas. 2. Distribution of markets, health facilities, and all laboratories in the affected CPA areas 3. Housing areas, open or undeveloped areas, and road networks 4. GIS maps of 1-3 above. All these activities will be coordinated by BASICS M&EPO, and all consultants will work under his supervision. Part I-1
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Figure 4 (B) ESTIMATED POPULATION OF CPHs - Lagos. (Census Estimate for 1992) Calculation done using the population figures and the proportion of land occupied by each of the CPHs. (1992) CPHs OLD LGA Total LGA Population CPH/LGA Proportion CPH total Proportion CPH Density/ sq.km. Under One Population Under 5’s Pop Women 15-44 JASCPH Mushin 1,016,452 20% 203,290 46,000 8,376 41,878 46,061 AJCPH Ojo 1,042,162 14.5% 151,114 36,000 6,226 31,129 34,242 AMCPH Ojo 1,042,152 2.47% 25,741 37,000 1,061 5,303 5,833 LCPH Mainland 895,689 22.46% 201,261 29,000 8,292 41,460 45,606 LICPH Lagos Island 169,283 23.0% 38,935 37,000 1,604 8,021 8,823 MCPH Mainland 895,689 2.24% 20,063 29,000 827 4,133 4,546 TOTAL 5,061,437 Average= 14.1 Range=2. 24-23.0 440,404 26,386 131,924 145,111 Part I-xi
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