Free distribution of insecticidal bed nets improves possession and preferential use by households and is equitable: findings from two cross-sectional surveys in thirteen malaria endemic districts of Bangladesh

Abstract

BackgroundBRAC, an indigenous non-governmental development organization (NGO), has been implementing a programme to prevent and control malaria in the 13 malaria-endemic districts of Bangladesh since 2007. One of the critical preventive interventions is the distribution of insecticidal bed nets (long-lasting insecticide-treated nets, LLINs and insecticide-treated ordinary nets, ITNs) to the community free of cost. This study aimed to assess progress in the possession, preferential use, and knowledge on use of the LLIN/ITNs including the programme's avowed pro-poor inclination one and three and half years after intervention began.MethodsA convenient sampling strategy based on malaria endemicity in the districts was adopted. First, thirty upazila (sub-district, with a population around 250,000)s were selected at random, with high prevalent districts contributing more upazilas; second, from each upazila, one (2008) to two (2011) villages (covered by insecticidal bed net distribution programme) were selected. From each village, households that had either one under-five child and/or a pregnant woman were included in the survey, one household being included only once. Data were collected using a pre-tested structured questionnaire.ResultsIn all, 3,760 households in 2008 and 7,895 households in 2011 were surveyed for collecting relevant information. Proportion of households with at least one LLIN, and at least one LLIN/ITN increased (22-59 to 62-67% and 22-64% to 74-76% respectively) over time, including increase in the mean number of LLIN/ITNs per household (≤ 1 to 1 +). The programme achieved > 80% coverage in sleeping under an LLIN/ITN in the case of under-five children and pregnant women, especially in the high-endemic districts. Knowledge regarding critical time of hanging the net also increased over time (7-22 to 44-54%), but remained low. The pro-poor inclination of the programme is reflected in the status of relevant indicators according to self-rated poverty status of the households.ConclusionsThere has been a substantial improvement in possession and usage of insecticidal bed nets especially for the two most vulnerable groups (under-five children and pregnant women), including a reduction of gaps between the high and low endemic districts, and the deficit and non-deficit households during the study period.

The Practice of Jhum Cultivation and its Relationship to Plasmodium falciparum Infection in the Chittagong Hill Districts of Bangladesh

“…These results are also consistent with other reports on bed net use in the Chittagong Hill Districts, which have reported high-bed net use in the area. 23,24 Another possible mechanism that was consistent with the results of this study is that lack of access to care may contribute to higher infection rates in jhum cultivators. Qualitative results found that jhum cultivators delayed treatment until the symptoms became severe because of the distance of jhum sites to the village and perceived need to stay at jhum sites and continue cultivation.…”

Socio-demographic factors influencing knowledge, attitude and practice (KAP) regarding malaria in Bangladesh

“…Although NGOs were supposed to distribute ITNs to every family [14] of the study area some respondents claimed that they had yet to receive any form of bed net (ITNS or LLINS). Many respondents mentioned that a household would receive a single net but this was not sufficient for all of their family members.…”

“…Indeed, the current malaria control strategy in Bangladesh relies mainly on the use of ITNs/LLINs. For several years, this strategy has benefited from a mass campaign promotion [14]. Before the introduction of treated nets, Bangladesh reported as about 50,000 confirmed malaria cases and 450 malaria deaths annually [14].…”

“…For several years, this strategy has benefited from a mass campaign promotion [14]. Before the introduction of treated nets, Bangladesh reported as about 50,000 confirmed malaria cases and 450 malaria deaths annually [14]. After the distribution of ITNs/LLINs, mortality came down from 450 to as low as 37 in the year 2010 [10,14].…”

Distribution of Subsidized Insecticide-treated Bed Nets through a Community Health Committee in Boboye Health District, Niger

“…In Laos, for example, community members including village health volunteers help to carry ITNs from the healthcare facility to the community and to distribute them among households [10]. A similar community-based net distribution system is in place in many countries including Bangladesh, Vietnam, Kenya and Nigeria [11–14]. …”