Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa

Scates, Sara; Finn, Timothy P.; Wisniewski, Janna; Dadi, David; Mandike, Renata; Khamis, Mwinyi; Greer, George; Serbantez, Naomi; Segbaya, Sylvester; Owusu, Prince; Mihigo, Jules; Gerberg, Lilia; Acosta, Ángela; Koenker, Hannah; Yukich, Joshua

doi:10.1186/s12936-020-03164-1

Cited by 30 publications

(28 citation statements)

References 44 publications

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“…There is some evidence of the benefits of housing intervention on the prevention of mosquito-borne pathogens. However, the investments required for the construction of novel housing are markedly higher compared to indoor residual spraying and insecticide-treated bednets that cost less than USD$10 [ 77 ]. The health impact of novel designs in housing can go far beyond that to include decreased indoor mosquito density in tandem with a more comfortable environment for bednets to reduce mosquito-borne diseases, improved air quality, and availability of safe water and latrines to prevent other infectious diseases.…”

Section: Discussionmentioning

confidence: 99%

Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis

Kua

Lee

2021

PLoS ONE

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Background Mosquito-borne diseases remain a significant public health problem in tropical regions. Housing improvements such as screening of doors and windows may be effective in reducing disease transmission, but the impact remains unclear. Objectives To examine whether housing interventions were effective in reducing mosquito densities in homes and the impact on the incidence of mosquito-borne diseases. Methods In this systematic review and meta-analysis, we searched 16 online databases, including NIH PubMed, CINAHL Complete, LILACS, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials for randomized trials published from database inception to June 30, 2020. The primary outcome was the incidence of any mosquito-borne diseases. Secondary outcomes encompassed entomological indicators of the disease transmission. I2 values were used to explore heterogeneity between studies. A random-effects meta-analysis was used to assess the primary and secondary outcomes, with sub-group analyses for type of interventions on home environment, study settings (rural, urban, or mixed), and overall house type (traditional or modern housing), Results The literature search yielded 4,869 articles. After screening, 18 studies were included in the qualitative review, of which nine were included in the meta-analysis. The studies enrolled 7,200 households in Africa and South America, reporting on malaria or dengue only. The type of home environmental interventions included modification to ceilings and ribbons to close eaves, screening doors and windows with nets, insecticide-treated wall linings in homes, nettings over gables and eaves openings, mosquito trapping systems, metal-roofed houses with mosquito screening, gable windows and closed eaves, and prototype houses using southeast Asian designs. Pooled analysis depicted a lower risk of mosquito-borne diseases in the housing intervention group (OR = 0.68; 95% CI = 0.48 to 0.95; P = 0.03). Subgroup analysis depicted housing intervention reduced the risk of malaria in all settings (OR = 0.63; 95% CI = 0.39 to 1.01; P = 0.05). In urban environment, housing intervention was found to decrease the risk of both malaria and dengue infections (OR = 0.52; 95% CI = 0.27 to 0.99; P = 0.05).Meta-analysis of pooled odds ratio showed a significant benefit of improved housing in reducing indoor vector densities of both Aedes and Anopheles (OR = 0.35; 95% CI = 0.23 to 0.54; P<0.001). Conclusions Housing intervention could reduce transmission of malaria and dengue among people living in the homes. Future research should evaluate the protective effect of specific house features and housing improvements associated with urban development.

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Section: Discussionmentioning

confidence: 99%

Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis

Kua

Lee

2021

PLoS ONE

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“…Formal costing following standard practices was conducted during the third and fifth rounds of SNP distribution [19]. SNP3 delivered nearly 500,000 LLINs through schools in three regions at a cost of 9.48 USD per net distributed (1.58 USD per PYP) and SNP5 delivered slightly more than three million LLINs through schools in 14 regions at an economic cost of USD 3.64 per net distributed (USD 0.60 per PYP) in 2017 (including the price of the net).…”

Section: Cost Snpmentioning

confidence: 99%

Sustaining LLIN coverage with continuous distribution: the school net programme in Tanzania

Yukich

Stuck

Scates

et al. 2020

Malar J

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Most malaria-endemic countries have struggled in the past decade to establish effective national-scale continuous distribution mechanisms for long-lasting insecticidal nets (LLINs). Since the implementation of the Tanzania National Voucher Scheme in 2004 and mass-distribution campaigns in 2009-2011 and 2015-2016, Tanzania has been committed to finding new and innovative ways of achieving and maintaining universal bed net coverage. Planning for the School Net Programme (SNP) began in 2011 and in 2013, the country piloted a SNP in three regions. Nets were distributed annually to children attending schools in selected primary and secondary grades. Intra-family redistribution was assumed, and hence the family as a whole, rather than just the children themselves, were the targeted beneficiaries. The programme has since expanded to 14 regions and has seen six rounds of annual distribution. In its fifth year, 3 million nets were distributed at a cost of USD 3.64 per net and USD 0.60 per person-year of protection (including the net). ITN access and use were maintained at a high level (~ 50-75%) over the first 4 years of distribution within selected evaluation areas, even in the absence of a mass distribution event. Net distribution through primary schools has proven to be a feasible and effective strategy for maintaining consistently high coverage in Tanzania.

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“…Households in these areas appear more dependent on mass distribution campaigns as the primary source of LLINs. In these more remote communities, school-based distributions may sustain higher and more equitable coverage [ 17 , 18 , 38 ]. Uganda also has an established network of CHWs, many of whom already perform evaluation and management of uncomplicated malaria in their homes, who could be leveraged to identify households without adequate LLINs [ 39 – 41 ].…”

Section: Discussionmentioning

confidence: 99%

Malaria prevalence and long-lasting insecticidal net use in rural western Uganda: results of a cross-sectional survey conducted in an area of highly variable malaria transmission intensity

Côte

Goel

Muhindo

et al. 2021

Malar J

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Background Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution approaches and tailored messaging campaigns. Methods A cross-sectional survey of 2190 households was conducted in a single sub-county of western Uganda that experiences highly variable malaria transmission intensity. The survey was carried out approximately 3 years after the most recent mass distribution campaign. At each household, study staff documented reported LLIN use and source among children 2 to 10 years of age and performed a malaria rapid diagnostic test. Elevation and distance to the nearest health facility was estimated for each household. Associations between parasite prevalence and LLIN use were estimated from log binomial regression models with elevation and distance to clinic being the primary variables of interest. Results Overall, 6.8% (148 of 2170) of children age 2–10 years of age had a positive RDT result, yielding a weighted estimate of 5.8% (95% confidence interval [CI] 5.4–6.2%). There was substantial variability in the positivity rates among villages, with the highest elevation villages having lower prevalence than lowest-elevation villages (p < .001). Only 64.7% (95% CI 64.0–65.5%) of children were reported to have slept under a LLIN the previous night. Compared to those living < 1 km from a health centre, households at ≥ 2 km were less likely to report the child sleeping under a LLIN (RR 0.86, 95% CI 0.83–0.89, p < .001). Households located farther from a health centre received a higher proportion of LLINs from government distributions compared to households living closer to health centres. Conclusions LLIN use and sourcing was correlated with household elevation and estimated distance to the nearest health facility. The findings suggest that current facility-based distribution strategies are limited in their reach. More frequent mass distribution campaigns and complementary approaches are likely required to maintain universal LLIN coverage and high rates of use among children in rural Uganda.

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Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa

Cited by 30 publications

References 44 publications

Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis

Randomized trials of housing interventions to prevent malaria and Aedes-transmitted diseases: A systematic review and meta-analysis

Sustaining LLIN coverage with continuous distribution: the school net programme in Tanzania

Malaria prevalence and long-lasting insecticidal net use in rural western Uganda: results of a cross-sectional survey conducted in an area of highly variable malaria transmission intensity

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