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Reaching Talibé Children with Mosquito Nets
A child learning the Koran in a daara in Méouane health post in Tivaouane. Photo Credit: Louis Dasylva, photographer
Despite progress in scaling up malaria control interventions, children in Sub-Saharan Africa are still largely impacted by the disease. Gaps in the distribution of mosquito nets are a contributing factor to children’s vulnerability. In Senegal, among the groups often unreached by formal distribution channels are youth living in religious schools that teach the Koran.
Students who attend these schools, called daaras, are usually boys ages 7 to 15 who are known as Talibé children. Many come from families in rural areas. According to Dr. Amdy Thiam, vector control lead for Senegal’s National Malaria Control Program (NMCP), the number of daaras and the Talibé children that live in them are not well documented. To determine the number of children living in daaras, the NMCP in 2022 used trained community members to launch a census among religious and education leaders in the Thies region, where many of these schools are.
Although Talibé children are eligible to receive insecticide-treated nets (ITNs) during the mass distributions conducted every three years, the 2022 mass campaign excluded the Thies region due to limited government resources. These children are not eligible to access ITNs through other means such as routine distribution at health facilities that target pregnant women and children under five. Nor do daaras have the financial resources to purchase ITNs for their students.
To address this gap, the Abt-led PMI VectorLink Senegal team coordinated with the Ministry of Education, the Ministry of Health and Social Action, and the NMCP on a pilot project to reach Talibé children. The pilot distributed ITNs at no-cost to daaras in the health district of Tivaouane, one of the nine districts in the Thies Region. Tivaouane health district has more than 200 daaras, home to about 50 Talibé children per daara.
“Financial barriers are the main obstacles to vector control through ITNs in most daaras,” said PMI VectorLink Senegal’s Abdul-Aziz Mbaye, who manages ITN distribution for the project. He noted that in the few daaras where ITNs were available, there were not enough. Of the ITNs that were present, many were worn, with holes and insecticide that was likely no longer effective.
Talibés sleeping under an ITN at a Daara in Medine health post in Tivaouane. Photo Credit: Louis Dasylva, photographer
Providing nets to the daaras was the first step. The next challenge was to adapt to the non-traditional sleeping quarters found in most of these schools. In most daaras, there are no regular beds. Children sleep on mattresses or mats on the floor, and three to five children often share one mattress. In some cases, the ITN size was smaller than the dedicated sleeping places. To help address this, VectorLink Senegal provided samples of merged ITNs (made by sewing together two ITNs to increase the size) to cover sleeping places of more than four Talibé children. The daaras can replicate this model using local tailors, but the pilot project showed that less than 20% of daaras merged the ITNs.
Another challenge is that many dormitories also serve as classrooms, with this multipurpose usage a barrier to the consistent use of bed nets. Mbaye shared that “the multiple uses [of rooms] prevent the permanent hanging of ITNs in the sleeping areas. To address this, daaras leadership requested support to acquire materials for the permanent hanging of ITNs in multi-purpose rooms.
To further promote proper and consistent use of ITNs, PMI VectorLink Senegal, the NMCP, regional and district health officials, and daaras’ leadership developed posters in French, Arabic, and the local language, Wolof (written using the Arabic alphabet), and placed them in each daara that received ITNs. The posters focused on the advantages of using ITNs while sleeping, and how to properly hang a net.
Talibé children in front of the poster in Wolof written in Arabic. Photo Credit: Louis Dasylva, photographer
In total, PMI VectorLink Senegal and the NMCP distributed 7,312 ITNs to 237 daaras in August 2022, protecting 12,246 Talibé children. When PMI VectorLink Senegal and the NMCP returned one month later to monitor the hanging of the nets, they found that in the daaras visited (89 percent), 82 percent of the ITNs distributed were hung, and all the Talibé children at those daaras were sleeping under an ITN every night. The project’s close partnership with daaras’ leadership and the involvement of other local education authorities in all aspects of planning and execution led to the successful implementation of the pilot.
Dr. Thiam said that the NMCP will review the lessons learned from the pilot. Abt also identified points for improvement. For example, if there are future distributions (which the NMCP and PMI have yet to decide), the NMCP and its partners should take responsibility for merging ITNs prior to distribution.
This pilot can help fill gaps in access to ITNs and eliminate barriers to proper and consistent use. Advancing equity in access moves Senegal toward its goal of achieving malaria elimination by 2030.
Infectious Diseases & Global Health Security in Sub-Saharan Africa