System effectiveness of a targeted free mass distribution of long lasting insecticidal nets in Zanzibar, Tanzania

Malaria Journal

Research

Don de Savigny¹  Karin Källander²  Netta Beer³  Anders Björkman⁴  Mahdi Ramsan⁵  Abdul-wahiyd H Al-mafazy⁶  Rahila S Omari⁶  Ali K Abass⁶  Abdullah S Ali⁶ 

[1] Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland and University of Basel, Basel, Switzerland;Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden;Makerere University School of Public Health, Kampala, Uganda;Malaria Consortium Africa, Kampala, Uganda;Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden;Malaria Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden;Malaria Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden;Research Triangle Institute (RTI), Dar-es-Salaam, Tanzania;Zanzibar Malaria Control Programme (ZMCP), Ministry of Health, Zanzibar, Tanzania;

关键词: Malaria;    Distribution Point;    Focus Group Discussion;    Voucher Scheme;    LLIN Distribution;   

DOI  :  10.1186/1475-2875-9-173

 received in 2010-01-07, accepted in 2010-06-18,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundInsecticide-treated nets (ITN) and long-lasting insecticidal nets (LLIN) are important means of malaria prevention. Although there is consensus regarding their importance, there is uncertainty as to which delivery strategies are optimal for dispensing these life saving interventions. A targeted mass distribution of free LLINs to children under five and pregnant women was implemented in Zanzibar between August 2005 and January 2006. The outcomes of this distribution among children under five were evaluated, four to nine months after implementation.MethodsTwo cross-sectional surveys were conducted in May 2006 in two districts of Zanzibar: Micheweni (MI) on Pemba Island and North A (NA) on Unguja Island. Household interviews were conducted with 509 caretakers of under-five children, who were surveyed for socio-economic status, the net distribution process, perceptions and use of bed nets. Each step in the distribution process was assessed in all children one to five years of age for unconditional and conditional proportion of success. System effectiveness (the accumulated proportion of success) and equity effectiveness were calculated, and predictors for LLIN use were identified.ResultsThe overall proportion of children under five sleeping under any type of treated net was 83.7% (318/380) in MI and 91.8% (357/389) in NA. The LLIN usage was 56.8% (216/380) in MI and 86.9% (338/389) in NA. Overall system effectiveness was 49% in MI and 87% in NA, and equity was found in the distribution scale-up in NA. In both districts, the predicting factor of a child sleeping under an LLIN was caretakers thinking that LLINs are better than conventional nets (OR = 2.8, p = 0.005 in MI and 2.5, p = 0.041 in NA), in addition to receiving an LLIN (OR = 4.9, p < 0.001 in MI and in OR = 30.1, p = 0.001 in NA).ConclusionsTargeted free mass distribution of LLINs can result in high and equitable bed net coverage among children under five. However, in order to sustain high effective coverage, there is need for complimentary distribution strategies between mass distribution campaigns. Considering the community's preferences prior to a mass distribution and addressing the communities concerns through information, education and communication, may improve the LLIN usage.

【 授权许可】

CC BY   
© Beer et al; licensee BioMed Central Ltd. 2010