Analysing and recommending options for maintaining universal coverage with long-lasting insecticidal nets: the case of Tanzania in 2011

Malaria Journal

Research

Alex Mkindi¹  Hannah M Koenker²  Renata Mandike³  Nick Brown⁴  Christian Lengeler⁵  Albert Kilian⁶  Joshua O Yukich⁷ 

[1]Booz Allen Hamilton, Dar es Salaam, Tanzania

[2]Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA

[3]National Malaria Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania

[4]National Malaria Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania

[5]Swiss Tropical and Public Health Institute, Basel, Switzerland

[6]A To Z Textile Mills Ltd, Arusha, Tanzania

[7]Swiss Tropical and Public Health Institute, Basel, Switzerland

[8]University of Basel, Basel, Switzerland

[9]Tropical Health LLP, Montagut, Spain

[10]Tulane University, New Orleans, LA, USA

关键词: Long-lasting insecticidal nets;    Malaria;    Schools;    Continuous distribution;    Universal coverage;    Tanzania;    Insecticide-treated nets;    Mass campaign;   

DOI  :  10.1186/1475-2875-12-150

 received in 2013-01-17, accepted in 2013-04-30,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundTanzania achieved universal coverage with long-lasting insecticidal nets (LLINs) in October 2011, after three years of free mass net distribution campaigns and is now faced with the challenge of maintaining high coverage as nets wear out and the population grows. A process of exploring options for a continuous or “Keep-Up” distribution system was initiated in early 2011. This paper presents for the first time a comprehensive national process to review the major considerations, findings and recommendations for the implementation of a new strategy.MethodsStakeholder meetings and site visits were conducted in five locations in Tanzania to garner stakeholder input on the proposed distribution systems. Coverage levels for LLINs and their decline over time were modelled using NetCALC software, taking realistic net decay rates, current demographic profiles and other relevant parameters into consideration. Costs of the different distribution systems were estimated using local data.ResultsLLIN delivery was considered via mass campaigns, Antenatal Care-Expanded Programme on Immunization (ANC/EPI), community-based distribution, schools, the commercial sector and different combinations of the above. Most approaches appeared unlikely to maintain universal coverage when used alone. Mass campaigns, even when combined with a continuation of the Tanzania National Voucher Scheme (TNVS), would produce large temporal fluctuations in coverage levels; over 10 years this strategy would require 63.3 million LLINs and a total cost of $444 million USD. Community mechanisms, while able to deliver the required numbers of LLINs, would require a massive scale-up in monitoring, evaluation and supervision systems to ensure accurate application of identification criteria at the community level. School-based approaches combined with the existing TNVS would reach most Tanzanian households and deliver 65.4 million LLINs over 10 years at a total cost of $449 million USD and ensure continuous coverage. The cost of each strategy was largely driven by the number of LLINs delivered.ConclusionsThe most cost-efficient strategy to maintain universal coverage is one that best optimizes the numbers of LLINs needed over time. A school-based approach using vouchers targeting all students in Standards 1, 3, 5, 7 and Forms 1 and 2 in combination with the TNVS appears to meet best the criteria of effectiveness, equity and efficiency.

【 授权许可】

CC BY   
© Koenker et al.; licensee BioMed Central Ltd. 2013