Project

DUMP, 0

Program Destroying Urban Mosquito Population (DUMP)

Josh Anderson

Hnin Aung

Oladoja Olajide

Western Illinois University

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Summary

The Preventing Malaria Infections (PMI) team has researched, investigated, collaborated,

and taken action to create a program plan that will reduce the number of women of reproductive

age, children, and infants that contract malaria within Ajegunle, Lagos, Nigeria. The topic of

malaria is important to educate and empower the community about because making simple

changes in community members’ negative behaviors can result in positive outcomes. These

negative behaviors aid in mosquito breeding and increasing the chances of contracting malaria.

To reduce malaria, PMI needs to eliminate mosquito breeding locations. PMI has created a

program to address this issue. Destroying Urban Mosquito Populations (DUMP) will provide the

participants with education, training, and resources needed to protect themselves and their

families from malaria. DUMP will start by organizing stakeholders together to establish support

and agreement for the program. Volunteers will carry out the process displaying posters around

the city in four strategic locations. The religious leaders will assist the public health educators in

implementing the educational sessions, after religious services have ended. The impact from

these educational sessions will provide the participants with a better understanding of malaria,

they are able to identify mosquito breeding habitats, and various methods to destroying them.

The demonstration portion of the educational session will take place at the religious leaders’

homes. ‘DUMP in the Street’ is allowing access to materials for the participants within the four

strategic locations of Ajegunle. The overall outcome of DUMP is to decrease the number of

women of reproductive age, children, and infants who contract malaria by 15% within Ajegunle,

Lagos, Nigeria. It is important that the PMI members obtain feedback and adjust DUMP

accordingly to better support the participants. DUMP improvement plans will ensure

sustainability and positive results in the future.

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Program Rationale

Diseases that are spread by mosquitos which infect people are known as vector diseases

(Gubler, 2002). These diseases are extremely dangerous because of their high rate of

contraction, accounting for 17% of all infectious diseases worldwide (WHO, 2016). The most

common vector diseases transmitted by mosquitos is malaria (Ayukekbong, 2014). There are

major geographic, environmental, and climate factors creating the perfect breeding environment

for mosquitoes in Ajegunle, Lagos, Nigeria, such as wet-seasons, high humidity, high heat, and

densely packed urban areas surrounded by large rural regions (Okogun et. al, 2005). Moreover,

within these urban areas, there are manmade objects that hold water such as containers, cans,

tires, barrels, and tops of roofs. (Okogun et. al, 2005). Each of all the above listed provide a safe,

uninhibited environment for mosquitoes to lay 100-300 eggs, per each conception event

(Guzman and Kouri, 2002).

Malaria is a major health issue worldwide, with a 25% contraction rate globally and 31%

contraction rate in Africa (WHO, 2013). Sixty percent of the 350-500 million clinical malaria

cases are found in Africa (Okorosobo et al. 2011). There is a high financial cost associated with

malaria. The expenditure of health care cost is $12 billion according to World Health

Organization (WHO) in 2000 (Okorosobo et al. 2011). The cost for treatment in Nigeria is

majorly out-of-pocket spending (OOPS) which is separated into outpatient department visits

(OPD) and inpatient department (IPD). The average medical cost for malaria treatment per

household was $42.99 for OPD and $23.2 for IPD (Onwujekwe et al. 2013).

In Nigeria, malaria is still a serious health challenge accounting for high mortality rate of

40% and morbidity rate of 60% among adults and children (Umaru, Uyaiabasi, 2015). Although

all individuals are susceptible to contract malaria, several subgroups are at greater risk. The

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subgroup includes women of reproductive age, children and infants. These three subgroups can

be adversely affected by malaria in regards to complications of the disease (Umaru, Uyaiabasi,

2015). Without a stable and healthy young population, the future of this area, Ajegunle, is at

risk. With a disease like malaria, population dynamics will not grow steadily. Currently most

methods of malaria intervention focuses on the treatment and response portion of the disease and

its complications. The Preventing Malaria Infection (PMI) team has a solution to prevent

malaria contraction. By implementing the Destroying Urban Mosquito Populations (DUMP)

program, there will be a reduction of breeding site for mosquitoes within Ajegunle, which will

decrease the number of people infected with malaria.

The best way to control malaria infections is by enacting mosquito abatement techniques.

Two main techniques for mosquito breeding site reduction are behavior modification and

environmental control. At the individual level, behavioral factors that contribute to the breeding

of mosquitoes include; (1) dumping of refuse in the gutter which provide a place for mosquitoes

to breed, (2) storing of water indoors for domestic use without a lid. Behavioral modification

includes; (1) covering containers that are used in holding water for domestic use and dumping

ones that are not (Centers for Disease Control and Prevention, 2012); (2) chemical method

introduction of larvicide into water sources that are unable to be emptied. At the environmental

level, activities that contribute to the growth of mosquitoes include (1) not tending to overgrown

lawns and weeds around the home (World Health Organization, 1982), (2) containers and

impermeable materials around the home provide additional locations for water to collect (World

Health Organization, 1982).

The DUMP (Destroying Urban Mosquito Populations) program aims at decreasing the

rate of malaria in Ajegunle, Lagos, Nigeria thorough source reduction. As part of DUMP,

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residences of Ajegunle will actively participate in activities designed to reduce mosquito

breeding areas around their homes and neighborhood. DUMP will be successful because it

utilizes proven methods of malaria control enacted through community participation.

Program Plan Documentation

The program planning model used to design the DUMP Program is MAP-IT. MAP-IT

stands for Mobilize, Assess, Plan, Implement, and Track. The MAP-IT Model uses a linear chain

of events and planning steps to ensure a desired result. The acronym MAP-IT starts with “M”,

for mobilizing key individuals involved from the start to enhance their community and overall

health (USDHHS, 2017). In regards to DUMP, these individuals will be religious leaders and

public health educators. In DUMP, religious leaders, public health educators, PMI team and

volunteers will combine to form a planning committee. After setting up the planning committee

and recruiting the sponsors for DUMP, roles, activities, and responsibilities are created

respectively. In DUMP, the responsibilities include bolstering community participation via

community meetings after religious services, developing and presenting educational events

during community meeting, fundraising and assisting in planning and evaluation. The second

letter of MAP-IT is “A” is in place for access, which consists of the needs assessment for the

community (USDHHS, 2017). During this phase, PMI will work alongside public health

educator from Ajegunle to identify which group of the population has been most negatively

impacted by malaria. Both local data from primary cross-sectional survey and secondary data

from local government agencies will be used. Through analysis of the data, factors contributing

to the health problem of malaria will be identified. DUMP program planning committee will

pinpoint resources available and potential solutions within Ajegunle to address the malaria

problem. The volunteers and additional funds that are to be donated will be confirmed. The third

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letter “P” is plan (Mckenzie, Neiger, Thackeray, 2013). The planning aspect will include events

such as defining goals, creating objectives, establishing a timeline, and securing resources for the

educational component of DUMP. The planning committee developed the goal of DUMP as to

reduce the morbidity and mortality rates of malaria by 25% among reproductive aged women (15

to 44 years), children (1-14 years), and infants (< 1 year) residing in Ajegunle, Lagos, Nigeria,

by the year 2020. The fourth letter of MAP-IT is “I” which stands for implementation

(Mckenzie, Neiger, Thackeray, 2013). During the implementation phase, intervention activities

will be carried out. These includes (1) hanging posters in four strategic locations in Ajegunle; (2)

holding educational sessions at churches and mosques; (3) “DUMP in the Street” days, where the

community will be encouraged to carryout activities learned in the educational sessions. The

final stage of MAP-IT is “T” which means tracking (USDHHS, 2017). This is the evaluation

phase of MAP-IT. Tracking will include events such as; (1) ensuring all the posters are hung up

by the designated due date; (2) number of participants attending educational sessions; (3)

counting the amount of larvicide tablets and water covers taken each week, and (4) incidence and

prevalence of malaria. During DUMP, data will be collected bimonthly, and analyzed upon

completion of DUMP. This information will be shared with stakeholders, providing DUMP

planners with an idea of the effectiveness of DUMP up to the year 2020.

Several health behavioral change theories were used in designing activities for DUMP.

The theories utilized were the Health Belief Model (HBM) and Social Cognitive Theory (SCT).

From HBM, the constructs of perceived barriers and perceived benefits were used. The construct

of perceived barriers was chosen because DUMP is providing free larvicide tablets in the four

strategic locations which is located within one mile of each other. By doing so, the barriers of

cost have been removed (Rosenstock, 1966). Some water sources, like drinking water, cannot be

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removed but they can be protected. DUMP is also providing free bungee cords and plastic

covering for anyone without a lid for their in-home water sources. A mosquito abatement

program in Honduras was successful in promoting the practices of dumping, treating, and

covering through providing education to residents. Thus, removing the barrier of lack of

knowledge which resulted in a drastic reduction of mosquitos that can transmit malaria

(Fernández et. al, 1998). The construct of perceived benefits was chosen because a major health

issue such as malaria can cost the family time, money, and even a life. However, simply

dumping out stagnant water or placing a larvicide tablet into it or placing a lid on the water

source will save the family from the deadly complications of malaria.

From SCT, the construct of self-efficacy will be used in DUMP. Self-efficacy is

confidence in one’s ability to complete a specific task, action, and behavior. Self-efficacy is

important because if an individual feel as though they can successfully complete a task, action or

behavior, they are more likely to attempt it (Bandura, 1977). This situation will be covering their

in-home water source, dispensing larvicide tablets or dumping out water. DUMP will use three

ways to improve self-efficacy (mastery of task, observing others, and verbal reinforcement). A

mastery of task method to improve self-efficacy in DUMP is to demonstrate at the religious

leaders’ homes to practice the steps of identifying water, estimating the size, and placing the

larvicide tablets into the water. Observing others is another way to raise self-efficacy. It is

important that these religious leaders demonstrate how to dispense larvicide tablets and remove

water from around their home because the participants will feel they are all able to complete the

same task. Religious leaders have high social capital among the community and it will set a

positive precedence for others to follow. Verbal reinforcement from religious leaders, neighbors,

and family members will improve the participant’s self-efficacy. Each participant can be held

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accountable and provide personal experiences to each other about dumping, removing,

protecting, or treating water sources around their homes.

Intervention Outline

Mission Statement: The mission of the Destroying Urban Mosquito Populations (DUMP) is to

improve the quality of life of women of reproductive age, children and infants through the

reduction of Malaria within Ajegunle, Lagos, Nigeria.

Goal: To reduce the morbidity and mortality rates of malaria by 25% among reproductive aged

women (15 to 44 years), children (1-14 years), and infants (< 1 year) residing in Ajegunle,

Lagos, Nigeria, by the year 2020.

Objectives

• Process Objective - By March 15, 2018; DUMP volunteers will display five DUMP

posters in each of the four strategic public spaces (20 posters in total) in Ajegunle to

inform the public about the educational sessions and larvicide dispensing dates.

• Impact Objective - Learning (Knowledge level)- After the educational sessions with

respective religious leaders, 80% of the attendees will be able to identify two locations

around their home that contribute to mosquito reproduction.

• Outcome Objective - By August 1, 2020, there will be a 15% decrease in the number of

women of reproductive age, children, and infants who contract malaria within Ajegunle,

Lagos, Nigeria.

Implementation Plan

DUMP is a community-participation based program designed to decrease malaria through

source reduction. Several activities will be conducted to meet the objectives of the DUMP

program. These activities include sensitization about the mosquito lifecycle and how they

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transmit malaria, mosquito breeding locations within Ajegunle, and bi-monthly distribution of

larvicide tablets and water covers to the participants via four strategic locations within Ajegunle,

Lagos, Nigeria. Each activity will provide breeding site reduction among mosquitos and

subsequent transmission of malaria.

DUMP will be implemented as a bimonthly program, which will follow immediately

after both Christians and Muslims religious services. The place of worship for both groups will

be the locations for educational sessions of DUMP. Prior to implementation, a marketing

campaign will occur. Five posters will be hung in each of the four strategic locations by the

volunteers. The activity of hanging posters for DUMP is important to make the community

aware of the educational sessions and the details about the free larvicide tablets and water covers

that will be available to them. Television and radio advertisements will also be made to make the

community aware of DUMP.

DUMP will meet bimonthly for 50 minutes to provide public education about malaria.

DUMP educational session will have two parts. A community educational portion and a

demonstration portion. The community educational portion of DUMP will be 30-minute long,

consisting of the PowerPoint presentation of, Life Cycle of the Mosquito, with videos to depict

the dread of malaria parasite. Moreover, the PowerPoint and video will show how breeding sites

can be eradicated or protected from mosquitoes breeding. During this time, the participants will

be able to identify potential mosquito breeding locations around their homes and environments.

Sensitization of participants regarding mosquito lifecycles and the transmission of malaria is

critical because it will provide positive lasting mitigation effects on the community for years to

come. Brochures will be available at educational session for participants to take home. After the

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30-minute education component, the congregation will then proceed to the religious leaders’

homes for the demonstration portion of the session. This will last approximately 20 minutes.

‘DUMP in the Street’ activity will begin the weekend following the four educational

sessions. The ‘DUMP in the Street’ starts with dispensing of larvicide tablets. Larvicide tablets

will be used by the participants to abate mosquitoes around their homes. The public health

educators and volunteers will be in the four strategic locations on Saturdays from 6 a.m. to 10

a.m. to dispense larvicide tablets and water covers to the participants. The issue of covering

drinking water sources can be solved by providing the participants with plastic covers that will

fit over their in-home water containers. This will prevent mosquitoes from laying their eggs

inside drinking water containers. If the participants have no way to secure the plastic, a bungee

cord will be used to secure the plastic when the container is not in use. Evaluation methods will

be to count the number of materials remaining after each ‘DUMP in the Street’ event. The

detailed implementation plan is provided in Table 1.

The timeline for DUMP spans 40 weeks, and begins with program rationale development

during the first month. Another four weeks are used for a needs assessment, and two weeks for

goal and objective development based on needs assessment. The creation of the intervention,

along with assembly of resources and marketing of the DUMP will occur during week six

through nine. End of the program, the data will be collected bimonthly during DUMP. Data will

be analyzed upon completion of the program, and this information will be shared with

stakeholders. Because DUMP will be implemented again, data and feedback from personnel will

be used for program refinement and plans for the next session will be made. The detailed

timeline can be seen in Table 2.

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DUMP is a 17-week intervention designed to reduce malaria rate through mosquito

abatement. There are key resources and equipment that will be needed to implement DUMP.

Personnel, educational materials, educational session locations and supplies are the main

resources needed. Eight religious leaders (one Christian and one Muslin from each of four

strategic locations within Ajegunle), 20 health sciences students from the College of Medicine at

the University of Lagos will serve as volunteers, and four public health educators (one from each

of four strategic locations) will serve as personnel for DUMP. Free, reliable, interactive and

accurate resources from who.int, unicef.org and nationalgeographic.com will be collected by

PMI and distributed by public health educators. The church or mosque in one of four strategic

locations will serve as the public educational locations. United Bank of Africa will provide four

Dell computer tablets. Grant funds given to PMI will be used to purchase 6000 larvicide tablets,

50 plastics rolls totaling 25,000 feet and 2000 3-inch bungee cords. Detailed information will be

provided in Table 3.

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Table 1: Detailed Implementation Plan Christians Muslims Week 5 and Week 7 1. Educational program (30

mins) - Learning about the life-cycle

of mosquitoes. - How to identify mosquito

breeding sites around their homes and environments.

- Ways to prevent mosquitoes from breeding in the house and environment.

2. Activities (20 mins) - Moving from the church to

the religious leaders’ homes (5 mins).

- Religious leader demonstrates how to use the larvicide tablets on water sources that are in the environment and how to properly cover water for domestic use (15 mins)

1. Educational program (30 mins)

- Learning about the life-cycle of mosquitoes.

- How to identify mosquito breeding sites around their homes and environments.

- Ways to prevent mosquitoes from breeding in the house and environment.

2. Activities (20 mins) - Moving from the mosque to

the religious leaders’ homes (5 mins).

- Religious leader demonstrates how to use the larvicide tablets on water sources that are in the environment and how to properly cover water for domestic use (15 mins)

DUMP IN THE STREETS Week 9 , 11, 13, 15, 17, 19, 21 1. Public health educators and volunteers will report to the four

strategic locations by 5.30 a.m. - One public health educator and five volunteers will be in each

strategic location. 2. Distribution of source reduction materials (larvicide tablets and

coverlids-plastics and cords) to the participants commences at 6 a.m. and wraps up at 10 a.m.

3. Collection of data on the remaining stock (10-11 a.m.)

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Table 2: TIMELINE FOR DUMP TASK WEEK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Formative evaluation

X X X X X X X X X X X X X X

Develop program plan

X

X

X

X

Assess needs

X

X

X

X

Goals and Objectives

X X

Creating intervention

X X X

Order supplies

X X X X

Program marketing

X X X

Program Starts

X

Education events

X X

Dump in streets

X X X X X X X

Collect data

X X X X X X X X X X X X X X X X

Summative Evaluation

X X X X X X X X X X X

Analysis of data

X X X

Fixing program problems

X

X

X

Review of result with stakeholders

X

X

X

Plan for next event

X X X X

Follow-up long term evaluation

X

X

X

X

X

X

X

X

X

X

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Table 3: Projected Budget for DUMP Name of Item Total Amount Expenditures Cost

Revenue and Support Contributions from sponsors:

Dell Computer Tablets 4 tablets $150 X 4 $ 600.00 Grant $15,000.00

Expenditures Supplies Variable Cost-BT Mosquito Dunks (Pet Solutions)

6,000 tablets(20 tablets per pack)

300 pack ($16.99 per pack) $ 5,100.00

Variable Cost-2 Mil Poly Tubing Roll - 40” X500’ Model# S-14492 (Uline)

50 Rolls

50 Rolls ($80 per roll)

$ 4,000.00

Variable Cost-Bungee Cord 36” (Blue) (Uline)

2000 Cords(10 cords per pack

200 packs ($17 per pack) $ 3,400.00

Advertising on Radio and TV for ‘DUMP in the Streets’

$ 1,000.00

Printing-Brochures and posters $ 1,500.00 Total Expenses $15,000.00

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Evaluation

Evaluation involves making judgement or assessing the value DUMP has added to the

community of Ajegunle, Lagos, Nigeria. In the course of evaluating the DUMP program, the

PMI team and stakeholders will meet to determine if the participants understood the need for

enacting source reduction, implementing of the use of larvicide tablets, and the covering of

domestic water to reduce mosquito breeding sites, and thus potentially decrease morbidity and

mortality associated with malaria. In order to achieve this, process, impact, and outcome

evaluation will be done by the PMI, made up of Josh Anderson, Hnin Aung, and Oladoja

Olajide.

The most threating vector disease that mosquitoes transmit is malaria. Malaria is

preventable, yet it is a leading cause of death among women of reproductive age, children and

infants within Ajegunle. Current programs seek to prepare or recover from malaria events, but

few programs focus on the mitigation or prevention aspects of malaria control. The DUMP

program seeks to reduce the number of malaria cases among women of reproductive age,

children, and infants.

The overall goal of the DUMP program is to reduce the morbidity and mortality rate of

malaria by 15% among women of reproductive age (15-44 years), children (1-14 years), and

infants (<1 year) of Ajegunle in Lagos, Nigeria, by the year 2020. The success of the program

will be assessed by implementing various health theories to change the individual, and

environmental contributing factors to malaria.

Our objectives are as follows: (1) Process Objective: By March 15, 2018, DUMP

volunteers will display 20 DUMP posters around public spaces in Ajegunle to inform public

about the malaria and ‘DUMP in the Street’; (2) Impact/Learning Objective: After the

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educational sessions with respective religious leaders, 80% of attendee will be able to identify

two locations around their home that contribute to mosquito reproduction; and (3) Outcome

Objective: By August 1, 2020, there will be a 15% decrease in the number of women, children

and infants who contract malaria within Ajegunle.

Forty individuals will be needed to implement DUMP from the beginning until the end,

which includes eight religious leaders, four health educators and 28 health education students.

The educational programs will be done immediately following religious services thereby using

churches or mosques as the intervention sites. Activities to be conducted during DUMP include

(1) displaying posters in the four strategic locations within Ajegunle, (2) four educational

sessions informing the participants about mosquito breeding sites and prevention methods, (3)

‘DUMP in the Street’ will consist of distributing larvicide tablets and water covers for domestic

water within the four strategic locations of Ajegunle.

Stakeholders include (1) officials from Ajeromi Ifelodun Local Government (AJIF), (2)

program planning committee, (3) women of reproductive age (15-44 years), children (1-14

years), and infants (< 1 year), and (4) religious leaders from both Christian churches and Muslim

mosques, (5) public health educators/volunteers.

Officials from Ajeromi Ifelodun Local Government (AJIF) will be involved in: (1) a

Memorandums of Understanding (MOU) which will provide an outline between the AJIF and

the PMI team. Issues such as timeframes, participation, data collection, analyzing, and

presentation of data will be listed in the contract. A cooperative effort needs to be publicized

between the AJIF and PMI. Moreover, this will provide transparency in reporting process

regarding legal and ethical issues. The evaluation plan is consistent with the protocols listed. (2)

Process evaluation, permission will be obtained from AJIF to display posters around Ajegunle,

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also providing information as to the best locations to do so. (3) Impact evaluation, results

regarding the program’s findings will be given to AJIF for them to review, ensuring that

participant’s needs were met. (4) Outcome evaluation, final report of DUMP program will be

given. AJIF officials hold a stake in the success of DUMP, it is beneficial for the community that

they are on board with these types of evaluation. Meetings will be scheduled to review the

various sections mentioned in the evaluations. Program planning committee will oversee the

evaluation sessions. Specific aspects they will be responsible for include: (1) Memorandums of

Understanding (MOU)s, where all the details of methods, timeframe, where, when, what and

how activities will be conducted. (2) Process evaluation, where the detailed record of activities,

costs, events and problems will be checked and managed by the program committee members.

(3) Impact evaluation, where their feedback about which portion of the program is going well

and which should be changed will be asked to each member of the planning committee. (4)

Outcome evaluation, to review program’s effects on participants and community, determine if

activities of the program need to be improved, to prepare and distribute findings, to

compare/contrast DUMP with other similar programs. Committee members should be engaged in

the evaluation because it will help to perpetualize DUMP for the future. Women of reproductive

age, children, and infants are the target population and a part of the evaluation process. It is

imperative that DUMP receives feedback from the participants during the evaluation. The

feedback will provide the PMI team with tools to assess DUMP and improve the quality.

Moreover, the evaluation input from the target population will help to determine the

effectiveness of DUMP. A final report (outcome evaluation) of the program will be provided to

the participants. Religious leaders from both Christian churches and Muslim mosques assist in

(1) process evaluation, where the detailed record of activities, events and problems within the

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housing of the DUMP educational component will be checked and managed; (2) outcome

evaluation, to review program’s effects on participants and community, determine if activities of

the program need to be improved, to prepare and distribute findings, to compare/contrast DUMP

with other similar programs.

Public health educators and volunteers will be involved in process evaluation, obtaining

their input is necessary from an administrative and coordinator level to strengthen the program

activities. These specific areas to focus on include event coordination process, problem at

events, unintended costs, program’s progress, and their suggestions of which program activities

should be continued and which modifications should be made. During the staff training session,

the PMI team members will ask public health educators and volunteers regarding this

information. The results will be shared with the public health educators and volunteers upon the

completion of the program.

The types of evaluation to be used in the DUMP program include process, impact, and

outcome evaluation. These evaluations have been chosen by the PMI team to (1) correspond with

MAP-IT, (2) provide ways to evaluate immediate and long-term effect of the program, and (3)

DUMP will use the information from the participants, coordinators, and volunteers to refine and

produce a better program in the future implementation phases. In process evaluation, the PMI

team has already geographically mapped the four strategic locations that are available to

accommodate five posters each that will be hung within each of these locations. The number and

location of each poster can be altered based on the feedback from the participants regarding

which posters were most effective. Information about where the participants saw the posters will

be captured during the pretest of the educational portion of DUMP. The impact evaluation will

measure the behavioral and environmental modification immediately after DUMP. This will be

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used to determine if the participants were able to identify, remove, treat, or cover at least two

locations around their home that contribute to mosquito reproduction. Long-term impacts for

malaria contraction cases, morbidity and mortality measurements, with an emphasis on

improving quality of life, health status will be outcome evaluation.

PMI will use a participatory approach for the process evaluations. For the impact and

outcome evaluations, we will use conventional approach based on the types of activities,

resources, and time frame within the DUMP program. The participatory approach will allow the

DUMP program to gather firsthand information about the community, the implementation

methods, and the outcome. The conventional approach is necessary for the needs assessment,

data collection and interpretation, and for formal evaluation methods.

DUMP will use a non-experimental design to implement pre-test/post-tests for the

program. This was chosen because we do not have a control group and we are not sure about the

future funding and participants for the program.

The methods used to collect data for the DUMP program are quantitative methods.

Process, impact, and outcome question can be found on Table 4. These specific types of

methods include pre-test/post-tests and observations. The pre-test/post-tests will measure the

impact of the educational programs held by the religious leaders. The observational methods of

data collection will be used in the process objectives to count the number or posters hung and to

count the number of larvicide tablets given at the four strategic locations within Ajegunle.

Outcome objective will be measured by using secondary sources of data that are provided by the

government officials and the local hospitals. Random sampling can be used to gather a

representation of the target population. Moreover, a Z-test will be used to compare the groups of

people who participated in the DUMP program with those who did not. The members of the

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planning committee are able to interpret and analyze the statistical data from DUMP, if

assistance is needed, the planning members have colleagues will provide assistance pro bono.

The data will be read by one member of the committee and entered by another into the computer

system. Both members will check the accuracy of the data to ensure non-sampling errors do not

occur. Confidentiality will not be an issue as all the evaluations and data are anonymous. The

only information available will be aggregated data. The data will be kept on a secure cloud

server within PMI’s Google Team Drive. With Google Team Drive data and information can be

shared securely with committee members. Moreover, edits, dates, times, and other information

about document changes can be tracked and recorded.

The planning committee consists of, the PMI team, AJIF local government officials,

religious leaders, public health educators, and the volunteers. Data collected bimonthly will be

shared among the planning committee. When there is need for a change of plan all the program

planning committee will make decisions on what actions are needed. Response, input,

suggestions, and new ideas will be collected from stakeholders, participants, and funders of

DUMP. Table 5 will contain DUMP’s work plan.

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Table 4: Examples of Specific Questions to be asked during Evaluation EVALUATION QUESTIONS How Collected From Whom Collected Process Evaluation Were all the posters ready for distribution at the time the program commenced?

Checklist (counting number of posters hung)

Program planners and volunteers.

Did all the volunteers show up at the allotted time?

Checklist by attendance log book.

Program planners

Were all the poster hung up at the allotted time?

Checklist , count of remaining posters if available

Program planners

Impact Evaluation How many participants understood the need for reduction in mosquito breeding site?

Self-report survey, post evaluation

Participants, religious leaders, program planners

Did the practice of mosquito breeding source reduction continue after DUMP program has ended?

Self-report survey, post evaluation

Participants and program planners

Was there a reduction in breeding sites inside and outside the homes

Self-report survey Participants

Outcome Evaluation How many morbidity and mortality rate due to malaria was recorded by local government within the last 3 years

Secondary data Local government officials, program planners

How often did the target population visit the hospital for malaria treatment within the last 3 years?

Secondary data Local government officials, program planners

DUMP, 21

Table 5: Work Plan for DUMP Evaluation Persons(s) Responsible Timeframe

Staffing Evaluation Coordinator Program Manager Week Formative Evaluation/Context Evaluation DUMP is designed using MAP-IT model, health belief model and social cognitive theory. The PMI team will evaluate the barriers of the target population. Providing free materials and accessibility to those materials to the target population and program will be evaluated during the program. The volunteers are given five posters for the four strategic locations around Ajegunle. There posters are in place to inform the community about the educational sessions and DUMP in the streets activities.

The evaluation coordinator along with program planning committee will collect information about posters, radio, and television promotions that provided the best advertisements for DUMP

Week 6-13

Summative Evaluation Pre/posttest surveys regarding mosquitoes and malaria will be conducted after each educational session by the public health educators. Post program surveys will be available during the last two sessions of DUMP in the streets.

Community health educators will conduct pre/posttest of the educational sessions. DUMP program committee members will work alongside the PMI team to interpret and analyze the statistics from the DUMP program.

Week 10-26

Engaging Stakeholders Program planning committee. PMI team members and planning

committee Week 1-8

Religious leaders Public health educators and volunteers assisting with DUMP.

PMI team members and evaluation coordinator

Week 4

Target population attends church and DUMP educational following service.

PMI team members and planning committee

Week 10-13

Focusing the Evaluation An impact evaluation will provide PMI and the planning committee with feedback from the participants

PMI team members and evaluation coordinator

Week 6-13

Memorandums of Understanding (MOU)s between religious leaders, AJIF, and DUMP

PMI team members and evaluation coordinator

Week 5

Gathering Credible Evidence Provide a hazards and vulnerability assessment for the participants in Ajegunle

PMI team members Week 2-5

Process evaluation PMI team members and evaluation coordinator

Week 7-9

Impact Evaluation: distribute surveys and collect data

PMI team members and evaluation coordinator

Week 10-14

DUMP, 22

Larvicide dispensing Public health educators Week 14-20 Using Evaluation Results

Getting feedback from the participants and the analyzed data will be used in the presentation of evaluation that will be discussed during the bimonthly meetings. This evaluation report will also be sent to the sponsors

Evaluation Coordinator Week 30

Implementation of changes made from after action report and improvement plans

Week 31-32

DUMP, 23

References

Ayukekbong, J.A. (2014). Dengue virus in Nigeria: Current status and future

perspective. British Journal of Virology, 1(3), 106-111. doi:

10.1016/j.virusres.2014.07.023.

Bandura, A. (1977) Self-efficacy: Toward a unifying theory of behavioral change. Psychological

Review, 84(2), 191-215.

Centers for Disease Control and Prevention (CDC; 2012). Larval control and other vector

control interventions. (2012, November 9). Centers for Disease Control and Prevention.

(CDC) Retrieved February 03, 2017, from

https://www.cdc.gov/malaria/malaria_worldwide/reduction/vector_control.html.

Fernández, E., Leontsini, E., Sherman, C., Chan, A., Reyes, C., Lozano, R., . . . Winch, P.

(1998). Trial of a community-based intervention to decrease infestation of Aedes aegypti

mosquitoes in cement washbasins in El Progreso, Honduras. Acta Tropica,70 (2), 171-

183. doi:10.1016/s0001-706x(98)00033-3

Gubler, D. J. (2002). The global emergence/resurgence of arboviral diseases as public health

problems. Archives of Medical Research, 33, 330-342.

Guzman, M. G., and G. Kouri (2002). Dengue: An update the lancet infectious diseases, Lancet

Infectious Disease Journal, 2, 33-42.

Jain, D. (2015). Life Cycle of Mosquito (With Diagram). Retrieved January 27, 2017, from

http://www.biologydiscussion.com/experiments/life-cycle-of-mosquito-with-

diagram/1754.

DUMP, 24

Mckenzie, J. F., Neiger, B. L., & Thackeray, R. (2013). Planning, implementing & evaluating

health promotion programs: a primer. Boston: Pearson Education.

Okogun, G. R., Anosike, J. C., Okere, A. N., & Nwoke, B. E. (2005). Ecology of mosquitoes of

midwestern Nigeria. Journal of Vector Borne Diseases, 42(1), 1-8.

Okorosobo T., Okorosobo F., Mwabu G., Orem J.N., Kirigia J.M. (2011) Economic burden of

malaria in six countries of Africa. European Journal of Business and Management, 3.

PLoS ONE, 3 (6) 42-63.

Onwujekwe, O., Uguru, N., Etiaba, E., Chikezie, I., Uzochukwu, B., & Adjagba, A. (2013). The

economic burden of malaria on households and the health system in Enugu State

southeast Nigeria. PLoS ONE, 8 (11). doi: 10.1371/journal.pone.0078362.

Rosenstock, I.M. (1966). Why people use health services. Milbank Memorial Fund Quarterly,

44, 94-124

Umaru, M. L., Uyaiabasi, G. N. (2015). Prevalence of Malaria in Patients Attending the

General Hospital Makarfi, Makarfi Kaduna – State, North-Western Nigeria. American

Journal of Infectious Diseases and Microbiology, 3(1), 1-5.

U.S. Department of Health and Human Services (USDHHS). (2017). MAP-IT: A guide to using

Healthy People 2020 in your community. Retrieved April 28, 2017, from

https://www.healthypeople.gov/2020/tools-and-resources/Program-Planning

World Health Organization. (WHO: 1982). Manual on environmental management for mosquito

control with special emphasis on malaria vectors. Retrieved February 18, 2017, from

http://apps.who.int/iris/handle/10665/37329

DUMP, 25

World Health Organization. (WHO; 2013). Malaria report. Retrieved February 18, 2017,

from http://www.who.int/malaria/publications/world_malaria_report_2013/en/

World Health Organization. (WHO; 2016). Vector-borne diseases. Retrieved January 27, 2017,

from http://www.who.int/mediacentre/factsheets/fs387/en/

DUMP, 26

Appendices Program: DUMP Logic Model Situation: The women of reproductive age, children and infants of Ajegunle, Lagos, Nigeria suffer from malaria which is a disease that is spread by mosquitoes. Malaria can cause severe sickness and even death. Malaria is also preventable through proper mosquito mitigation and prevention efforts. DUMP will provide larvicide tablets and materials to public health educators. The public health educators will be conducting mosquito educational sessions and demonstrating proven mosquito abatement techniques to subsequently reduce malaria within Ajegunle.

Inputs Outputs Outcomes -- Impact Activities Participation Short Medium Long

Funding / Grant $15,000 UBA donations Equipment Larvicide tablets 6,000 Materials Bungee cords 2,000 Plastic roll 50 rolls Volunteers 4 Public health educator 8 Religious leaders 20 Student volunteers

Support, facilitate and be a member of DUMP within Ajegunle, Nigeria. Deliver prevention education programs Carry out educational programs within the churches and mosques. Promote initiative via posters around the Ajegunle Engage target population within Ajegunle to build relationships.

Infants (0-365 years)

Children (0-14 years)

Mothers (15-44 years)

2 Public officials

4 Public health educators

8 Religious leaders

20 Student volunteers

Increased awareness of need to eliminate malaria in Ajegunle Increased knowledge about effects and consequences of malaria in Ajegunle Increased commitment from, women of reproductive age and children to participate in activities aimed at reducing malaria in Ajegunle Increased communication between religious leaders, healthcare officials, and the target population.

Decrease standing water on target populations’ property.

Increased community cooperation of water source removal.

Increase the number of target population to participate in DUMP.

Increased supply of mosquito abatement resources within Ajegunle.

Decrease stigma of larvicide.

Continued weekly water dumping activity.

Assumptions: Ajegunle will come together to reduce rates of malaria, funding will be secured, and computer tablets will be donated by UBA.

External Factors: Majority of residents in Ajegunle are poor, uneducated, and hold a negative view of the use of larvicides.

DUMP, 27

Detailed Implementation Plan Christians Muslims Week 5 and Week 7 1. Educational program (30

mins) - Learning about the life-cycle

of mosquitoes. - How to identify mosquito

breeding sites around their homes and environments.

- Ways to prevent mosquitoes from breeding in the house and environment.

2. Activities (20 mins) - Moving from the church to

the religious leaders’ homes (5 mins).

- Religious leader demonstrates how to use the larvicide tablets on water sources that are in the environment and how to properly cover water for domestic use (15 mins)

1. Educational program (30 mins)

- Learning about the life-cycle of mosquitoes.

- How to identify mosquito breeding sites around their homes and environments.

- Ways to prevent mosquitoes from breeding in the house and environment.

2. Activities (20 mins) - Moving from the mosque to

the religious leaders’ homes (5 mins).

- Religious leader demonstrates how to use the larvicide tablets on water sources that are in the environment and how to properly cover water for domestic use (15 mins)

DUMP IN THE STREETS Week 9 , 11, 13, 15, 17, 19, 21 1. Public health educators and volunteers will report to the four

strategic locations by 5.30 a.m. - One public health educator and five volunteers will be in each

strategic location. 2. Distribution of source reduction materials (larvicide tablets and

coverlids-plastics and cords) to the participants commences at 6 a.m. and wraps up at 10 a.m.

3. Collection of data on the remaining stock (10-11 a.m.)

DUMP, 28

TIMELINE FOR DUMP TASK WEEK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Formative evaluation

X X X X X X X X X X X X X X

Develop program plan

X

X

X

X

Assess needs

X

X

X

X

Goals and Objectives

X X

Creating intervention

X X X

Order supplies

X X X X

Program marketing

X X X

Program Starts

X

Education events

X X

Dump in streets

X X X X X X X

Collect data

X X X X X X X X X X X X X X X X

Summative Evaluation

X X X X X X X X X X X

Analysis of data

X X X

Fixing program problems

X

X

X

Review of result with stakeholders

X

X

X

Plan for next event

X X X X

Follow-up long term evaluation

X

X

X

X

X

X

X

X

X

X

DUMP, 29

Projected Budget for DUMP Name of Item Total Amount Expenditures Cost

Revenue and Support Contributions from sponsors:

Dell Computer Tablets 4 tablets $150 X 4 $ 600.00 Grant $15,000.00

Expenditures Supplies Variable Cost-BT Mosquito Dunks (Pet Solutions)

6,000 tablets(20 tablets per pack)

300 pack ($16.99 per pack) $ 5,100.00

Variable Cost-2 Mil Poly Tubing Roll - 40” X500’ Model# S-14492 (Uline)

50 Rolls

50 Rolls ($80 per roll)

$ 4,000.00

Variable Cost-Bungee Cord 36” (Blue) (Uline)

2000 Cords(10 cords per pack

200 packs ($17 per pack) $ 3,400.00

Advertising on Radio and TV for ‘DUMP in the Streets’

$ 1,000.00

Printing-Brochures and posters $ 1,500.00 Total Expenses $15,000.00

DUMP, 30

Work Plan for DUMP Evaluation Persons(s) Responsible Timeframe

Staffing Evaluation Coordinator Program Manager Week Formative Evaluation/Context Evaluation DUMP is designed using MAP-IT model, health belief model and social cognitive theory. The PMI team will evaluate the barriers of the target population. Providing free materials and accessibility to those materials to the target population and program will be evaluated during the program. The volunteers are given five posters for the four strategic locations around Ajegunle. There posters are in place to inform the community about the educational sessions and DUMP in the streets activities.

The evaluation coordinator along with program planning committee will collect information about posters, radio, and television promotions that provided the best advertisements for DUMP

Week 6-13

Summative Evaluation Pre/posttest surveys regarding mosquitoes and malaria will be conducted after each educational session by the public health educators. Post program surveys will be available during the last two sessions of DUMP in the streets.

Community health educators will conduct pre/posttest of the educational sessions. DUMP program committee members will work alongside the PMI team to interpret and analyze the statistics from the DUMP program.

Week 10-26

Engaging Stakeholders Program planning committee. PMI team members and planning

committee Week 1-8

Religious leaders Public health educators and volunteers assisting with DUMP.

PMI team members and evaluation coordinator

Week 4

Target population attends church and DUMP educational following service.

PMI team members and planning committee

Week 10-13

Focusing the Evaluation An impact evaluation will provide PMI and the planning committee with feedback from the participants

PMI team members and evaluation coordinator

Week 6-13

Memorandums of Understanding (MOU)s between religious leaders, AJIF, and DUMP

PMI team members and evaluation coordinator

Week 5

Gathering Credible Evidence Provide a hazards and vulnerability assessment for the participants in Ajegunle

PMI team members Week 2-5

Process evaluation PMI team members and evaluation coordinator

Week 7-9

Impact Evaluation: distribute surveys and collect data

PMI team members and evaluation coordinator

Week 10-14

DUMP, 31

Larvicide dispensing Public health educators Week 14-20 Using Evaluation Results

Getting feedback from the participants and the analyzed data will be used in the presentation of evaluation that will be discussed during the bimonthly meetings. This evaluation report will also be sent to the sponsors

Evaluation Coordinator Week 30

Implementation of changes made from after action report and improvement plans

Week 31-32