The Gambian National Impregnated Bednet Programme: Costs, consequences and net cost-effectiveness

Aikins, Moses; Fox-Rushby, Julia; D’Alessandro, Umberto; Langerock, P.; Cham, K.; New, Laura; Bennett, Steve; Greenwood, Brian; Mills, Anne

doi:10.1016/s0277-9536(97)00145-7

Cited by 46 publications

(42 citation statements)

References 11 publications

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“…3 Moreover, impregnated bed nets also kill other household insects and pests and have a spillover effect, protecting those who do not use them, both in the household and in the community. 9 Because indicators of high socioeconomic status influenced bed net use, there is a need to reduce the price of bed nets so they are affordable by members of lower socioeconomic classes. Measures for reducing prices include bulk purchasing, tax exemption, local tailoring, and instituting community-based distribution and reimpregnation mechanisms.…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing the use of bed nets in Mbarara municipality of Uganda.

Nuwaha¹

2001

Am J Trop Med Hyg

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Abstract. In order to identify independent predictors for bed net use, respondents from 643 households selected randomly from 21 clusters were interviewed in Mbarara municipality, Uganda. Respondents answered questions about demographic characteristics, social economic conditions, causes and transmission of malaria, beliefs about severity and complications of malaria, malaria morbidity and health care-seeking behavior, perceived control of malaria prevention, beliefs about utility of bed nets, perceived susceptibility to malaria, and whether they use bed nets or not. Univariate and multivariate logistic regression analyses were used to identify predictors for bed net use. Fifty-five percent (356 of 643) of the households had bed net users. The independent factors that favored bed net use were as follows: 1) age Ͻ 30 years, 2) ownership of a television, 3) having mosquito nets in ventilators of the house, 4) being a skilled worker or a professional, or owning a major business, 5) living in a permanent house, 6) believing that bed nets prevent malaria, 7) believing that bed nets are worth their cost, 8) not believing that convulsions cannot be cured by modern medicine, and 9) believing that bed nets are not expensive. The strongest predictors of bed net use are living in a permanent house and agreeing that bed nets are worth their cost, with adjusted odds ratios of 4.29 (95% confidence interval, 2.76-6.71) and 3.93 (95% confidence interval, 2.5-26.13), respectively. These data suggest that in order to increase the use of bed nets, the price of bed nets needs to be reduced and educational messages that stress the favorable use of bed nets need to be increased.

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Section: Discussionmentioning

confidence: 99%

“…Insecticide-impregnated bed nets significantly reduce mortality and morbidity, as well as the incidence of severe malaria. [3][4][5][6][7] They are also cost effective, 8,9 and if used widely, they may delay the spread of chloroquine resistance. The use of bed nets is therefore a priority for malaria control in sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing the use of bed nets in Mbarara municipality of Uganda.

Nuwaha¹

2001

Am J Trop Med Hyg

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“…Deployment of impregnated bednets in China and Africa has been successful in reducing malaria morbidity, mortality, or both, [19][20][21] although the resulting decrease in naturally occurring immunity may limit this effect in the medium term. 22 Resistance of the vectors to insecticides is generally increasing.…”

Section: Prevention Of Infectionmentioning

confidence: 99%

Malaria: current status of control, diagnosis, treatment, and a proposed agenda for research and development

Guérin¹,

Olliaro

Nosten

et al. 2002

The Lancet Infectious Diseases

320

201

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“…A societal perspective was used, including costs to both the provider and households. The cost estimates draw on the economic evaluations that accompanied the WHO/TDR trials (Picard et al 1993;Binka et al 1997;Aikins et al 1998;Some 1998), supplemented by additional technical and economic data from other published and unpublished sources and expert consultation. The costing was based on a low income sub-Saharan African country with a per capita GNP less than US $315, and included the cost of the nets, insecticide, staff, sensitization and awareness campaign, transport, other overheads, and community time.…”

Section: Cost Of the Interventionmentioning

confidence: 99%

Rebound mortality and the cost‐effectiveness of malaria control: potential impact of increased mortality in late childhood following the introduction of insecticide treated nets

Coleman¹,

Goodman²,

Mills³

1999

Tropical Med Int Health

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SummaryThe efficacy and relative cost-effectiveness of insecticide-treated nets (ITNs) for the control of malaria in children under 5 years of age have recently been demonstrated by several large-scale trials. However, it has been suggested that long-term use of ITNs in areas of high transmission could lead to mortality rebound in later childhood, which would reduce the cost-effectiveness of the intervention, and at the extreme could lead to negative overall effects. A model is presented in which the cost and disability adjusted life years (DALYs) per child aged 1-119 months were estimated for a sub-Saharan African population with and without an ITN intervention. The rebound rate, defined as the percentage increase in age-specific all-cause mortality and malaria specific-morbidity, was varied to estimate the threshold at which the intervention was no longer costeffective. Rebound was considered over two possible age ranges: 5-9 years and 3-6 years. With mortality and morbidity reductions due to ITNs in children aged 1-59 months and rebound in the 5-9 years age class, one could be reasonably certain that the cost per DALY averted is below $150 up to a rebound rate of 39%. Up to an 84% rebound rate it is highly likely that the intervention will be DALY-averting, that is the DALYs averted by the intervetion outweigh DALYs incurred through rebound effects. These thresholds are sensitive to the age range over which reductions and rebound in morbidity and mortality occur. With reductions confined to children aged 1-35 months and rebound in the 3-6 years age class, the cost per DALY is highly likely to fall below $150 only up to a 2.5% rebound rate, and with a rate in excess of 11% one can no longer be reasonably certain that the intervention is DALY-averting. These rates apply to the whole population. If there is no rebound amongst children who did not comply with the intervention, the actual increases in morbidity and mortality required to reach these thresholds amongst compliers would be much higher. The age range over which rebound occurs is a critical determinant of the thresholds at which one can no longer be reasonably certain that ITNs remain cost-effective in the long term. Based on empirical estimates of age-specific malaria mortality in sub-Saharan Africa, it appears unlikely that this threshold rate would be reached if rebound occurs over the 5-9 years age range. By contrast, if rebound occurs over the ages of 3-6 years, the increase in mortality rates required to reach this threshold falls within the observed range of malaria-specific mortality rates for this age group. It is essential that long-term surveillance is included as part of ITN interventions, with particular attention to the age range over which rebound may occur.

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The Gambian National Impregnated Bednet Programme: Costs, consequences and net cost-effectiveness

Cited by 46 publications

References 11 publications

Factors influencing the use of bed nets in Mbarara municipality of Uganda.

Factors influencing the use of bed nets in Mbarara municipality of Uganda.

Malaria: current status of control, diagnosis, treatment, and a proposed agenda for research and development

Rebound mortality and the cost‐effectiveness of malaria control: potential impact of increased mortality in late childhood following the introduction of insecticide treated nets

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