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      Community point distribution of insecticide-treated bed nets and community health worker hang-up visits in rural Zambia: a decision-focused evaluation

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          Abstract

          Background

          In 2013, the Zambian Ministry of Health through its National Malaria Control Programme distributed over two million insecticide-treated bed nets (ITNs) in four provinces using a door-to-door distribution strategy, and more than 6 million ITNs were allocated to be distributed in 2014. This study was commissioned to measure attendance rates at a community point distribution and to examine the impact of follow-up community health worker (CHW) hang-up visits on short and medium-term ITN retention and usage with a view of informing optimal ITN distribution strategy in Zambia.

          Methods

          Households received ITNs at community point distributions conducted in three rural communities in Rufunsa District, Zambia. Households were then randomly allocated into five groups to receive CHW visits to hang any unhung ITNs at different intervals: 1–3, 5–7, 10–12, 15–17 days, and no hang-up visit. Follow-up surveys were conducted among all households at 7–11 weeks after distribution and at 5–6 months after distribution to measure short- and medium-term household retention and usage of ITNs.

          Results

          Of the 560 pre-registered households, 540 (96.4 %) attended the community point distribution. Self-installation of ITNs by households increased over the first 10 days after the community point distribution. Retention levels remained high over time with 90.2 % of distributed ITNs still in the household at 7–11 weeks and 85.7 % at 5–6 months. Retention did not differ between households that received a CHW visit and those that did not. At 7–11 weeks, households had an average of 73.8 % of sleeping spaces covered compared to 80.3 % at 5–6 months. On average, 65.6 % of distributed ITNs were hanging at 7–11 weeks compared to 63.1 % at 5–6 months. While a CHW hang-up visit was associated with increased usage at 7–11 weeks, this difference was no longer apparent at 5–6 months.

          Conclusions

          This evaluation revealed that (1) the community point distributions achieved high attendance rates followed by acceptable rates of short-term and medium-term ITN retention and usage, as compared to reported rates achieved by door-to-door distributions in the recent past, (2) CHW hang-up visits had a modest short-term impact on ITN usage but no medium-term effect, and (3) community point distributions can yield sizeable time savings compared to door-to-door distributions.

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          Most cited references13

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          World Malaria Report: 2010

          WHO WHO (2010)
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            Household Possession and Use of Insecticide-Treated Mosquito Nets in Sierra Leone 6 Months after a National Mass-Distribution Campaign

            Background In November 2010, Sierra Leone distributed over three million long-lasting insecticide-treated nets (LLINs) with the objective of providing protection from malaria to individuals in all households in the country. Methods We conducted a nationally representative survey six months after the mass distribution campaign to evaluate its impact on household insecticide-treated net (ITN) ownership and use. We examined factors associated with household ITN possession and use with logistic regression models. Results The survey included 4,620 households with equal representation in each of the 14 districts. Six months after the campaign, 87.6% of households own at least one ITN, which represents an increase of 137% over the most recent estimate of 37% in 2008. Thirty-six percent of households possess at least one ITN per two household members; rural households were more likely than urban households to have ≥1∶2 ITN to household members, but there was no difference by socio-economic status or household head education. Among individuals in households possessing ≥1 ITN, 76.5% slept under an ITN the night preceding the survey. Individuals in households where the household head had heard malaria messaging, had correct knowledge of malaria transmission, and where at least one ITN was hanging, were more likely to have slept under an ITN. Conclusions The mass distribution campaign was effective at achieving high coverage levels across the population, notably so among rural households where the malaria burden is higher. These important gains in equitable access to malaria prevention will need to be maintained to produce long-term reductions in the malaria burden.
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              Can universal insecticide-treated net campaigns achieve equity in coverage and use? the case of northern Nigeria

              Background Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs. Methods A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use. Results ITN ownership coverage increased from 10% before the campaigns to 70%-a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among wealth quintiles (Concentration index 0.02, 95% CI (-0.02 ; 0.05) versus 0.21 95%CI (0.08 ; 0.34) before the campaigns). ITN use (individuals reporting having slept under an ITN the night before the survey visit) among individuals from households owning at least one ITN, was 53.1% with no statistically significant difference between the lowest, second, third and fourth wealth quintiles and the highest wealth quintile (lowest: odds ratio (OR) 0.87, 95% confidence interval (CI) (0.67 ; 1.13); second: OR 0.85, 95% CI (0.66 ; 1.24); third: OR 1.10 95% CI (0.86 ; 1.4) and fourth OR 0.91 95% CI (0.72 ; 1.15). Conclusion The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.
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                Author and article information

                Contributors
                paul.wang@IDinsight.org
                alison.connor@IDinsight.org
                asjoudeh@gmail.com
                jeff.steinberg18@gmail.com
                ndhlovu.ketty@gmail.com
                madac_mopsiti@yahoo.com
                ntebekabristol@gmail.com
                benjaminchibuye@yahoo.com
                bossbusk@gmail.com
                Journal
                Malar J
                Malar. J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                3 March 2016
                3 March 2016
                2016
                : 15
                : 140
                Affiliations
                [ ]IDinsight, 23B Twin Palm Road, Lusaka, Zambia
                [ ]IDinsight, ADRI 1st Floor, BSIDC Colony, Off Boring Rd., Patna, Bihar 800013 India
                [ ]Ministry of Health, National Malaria Control Centre, Lusaka, Zambia
                [ ]Rufunsa District Health Office, Rufunsa, Zambia
                [ ]World Vision, Plot No. 51/52, Great East Road, P.O. Box 31083, Lusaka, Zambia
                [ ]Clinton Health Access Initiative, 175 Kudu Road, Lusaka, Zambia
                Author information
                http://orcid.org/0000-0002-3541-4890
                Article
                1165
                10.1186/s12936-016-1165-1
                4778329
                26939695
                48406dc9-0ee6-4890-bcd3-418798dbf39a
                © Wang et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 August 2015
                : 11 February 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000278, Department for International Development (GB);
                Award ID: Demand-Driven Evaluations for Decisions (3DE)
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Infectious disease & Microbiology
                malaria prevention,insecticide-treated bed nets,community point distribution

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