Multi-country comparison of delivery strategies for mass campaigns to achieve universal coverage with insecticide-treated nets: what works best?

Abstract

BackgroundThe use of insecticide-treated nets (ITNs) is widely recognized as one of the main interventions to prevent malaria. High ITN coverage is needed to reduce transmission. Mass distribution campaigns are the fastest way to rapidly scale up ITN coverage. However, the best strategy to distribute ITNs to ensure household coverage targets are met is still under debate. This paper presents results from 14 post-campaign surveys in five African countries to assess whether the campaign strategy used had any effect on distribution outcome.MethodsData from 13,901 households and 14 campaigns from Ghana, Nigeria, Senegal, South Sudan and Uganda, were obtained through representative cross-sectional questionnaire surveys, conducted three to 16 months after ITN distribution. All evaluations used a multi-stage sampling approach and similar methods for data collection. Key outcomes examined were the proportion of households having received a net from the campaign and the proportion of households with one net for every two people.ResultsHousehold registration rates proved to be the most important determinant of a household receiving any net from the campaign (adjusted odds ratio [OR] 74.8; 95 % confidence interval [CI]: 55.3–101.1) or had enough ITNs for all household members (adjusted OR 19.1; 95 % CI: 55.34–101.05). Factors that positively influenced registration were larger household size (adjusted OR 1.7; 95 % CI: 1.5–2.1) and families with children under five (adjusted OR 1.4; 95 % CI: 1.2–1.6). Urban residence was negatively associated with receipt of a net from the campaign (adjusted OR 0.73; 95 % CI: 0.58–0.92). Registration was equitable in most campaigns except for Uganda and South Sudan, where the poorest wealth quintiles were less likely to have been reached. After adjusting for other factors, delivery strategy (house-to-house vs. fixed point) and distribution approach (integrated versus stand-alone) did not show a systematic impact on registration or owning any ITN. Campaigns that used a universal coverage allocation strategy were more effective in increasing the proportion of households with enough ITNs than campaigns that used a fixed number of ITNs. Registering based on counting usual sleeping spaces resulted in higher levels of households with one net per two people among those receiving any campaign net (adjusted OR 1.6; 95 % CI: 1.07–2.48) than campaigns that registered based on the number of household members.ConclusionAll of the campaigns, irrespective of strategy, successfully increased ownership of at least one ITN. Delivery method and distribution approach were not associated with receipt of at least one ITN from the campaign. Rather, the key determining factor for receipt of at least one ITN from the campaign was a successful registration process, which depends on the ability of community volunteers to reach households during the exercise. Universal coverage campaigns, especially those that used a sleeping space allocation strategy, were more effective in increasing the proportion of households with...

Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo

“…However, among those households reached by either strategy, the net allocation method (which differed by strategy) did not influence whether a household had sufficient LLIN for one per two people. A multi country comparison of LLIN delivery strategies based on 14 surveys from five African countries did not find a significant association between delivery strategy and ownership of a net from the campaign but found a positive association between sleeping space allocation and enough LLIN in the household [28]. …”

Evaluation of a continuous community-based ITN distribution pilot in Lainya County, South Sudan 2012–2013

“…This resulted in a pro-rich gradient especially for the indicator for ‘enough’ ITNs for all household members (concentration index 0.14). Although the inequity was moderate compared to other observations on ITNs or immunization coverage from African countries [ 25 ], it was significant enough to raise concern and in contrast to the high level of equity generally found following mass campaigns [ 3 , 7 ]. Future interventions should establish additional social mobilization targeted especially at this group to ensure they are empowered to request sufficient numbers of ITNs to protect their families keeping in mind, however, that this is likely to further increase cost.…”

“…Following the 2007 launch of the new WHO universal coverage strategy for ITNs [ 6 ], campaigns changed from being mostly targeted to young children and pregnant women to mass campaigns for the entire population at risk. From 2008 to 2016 more than one billion ITNs have been delivered to African countries and distributed using a variety of approaches to mass campaign organization which in general were successful in rapidly and equitably scaling up ITN coverage if properly managed and implemented [ 7 ]. A 2015 study analysing factors contributing to declines in malaria morbidity between 2010 and 2015 found that 68% of the 40% reduction in malaria incidence could be attributed to ITNs [ 8 ].…”

Digital Insecticide-treated nets (ITNs) mass distribution campaign in the particular context of covid-19 pandemic in Benin: lessons learned and challenges

“…Fixed point distribution was used during the pilot phase, but this approach is not suited to the context of the covid-19 pandemic in terms of compliance with barrier measures. A multi country comparison of ITN delivery strategies based on 14 surveys from ve African countries did not nd a signi cant association between delivery strategy and ownership of a net from the campaign [17][18][19][20][21].…”