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Insecticide-treated net use before and after mass distribution in a fishing community along Lake Victoria, Kenya: successes and unavoidable pitfalls.

Larson PS, Minakawa N, Dida GO, Njenga SM, Ionides EL, Wilson ML - Malar. J. (2014)

Bottom Line: Household factors such as availability of nets and sleeping arrangements still reduced consistent net use, however.Comprehensive, direct-to-household, mass distribution of ITNs was effective in rapidly scaling up coverage, with use being maintained at a high level at least one year following the intervention.Free distribution of ITNs through direct-to-household distribution method can eliminate important constraints in determining consistent ITN use, thus enhancing the sustainability of effective intervention campaigns.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. anfangen@umich.edu.

ABSTRACT

Background: Insecticide-treated nets (ITNs) have proven instrumental in the successful reduction of malaria incidence in holoendemic regions during the past decade. As distribution of ITNs throughout sub-Saharan Africa (SSA) is being scaled up, maintaining maximal levels of coverage will be necessary to sustain current gains. The effectiveness of mass distribution of ITNs, requires careful analysis of successes and failures if impacts are to be sustained over the long term.

Methods: Mass distribution of ITNs to a rural Kenyan community along Lake Victoria was performed in early 2011. Surveyors collected data on ITN use both before and one year following this distribution. At both times, household representatives were asked to provide a complete accounting of ITNs within the dwelling, the location of each net, and the ages and genders of each person who slept under that net the previous night. Other data on household material possessions, education levels and occupations were recorded. Information on malaria preventative factors such as ceiling nets and indoor residual spraying was noted. Basic information on malaria knowledge and health-seeking behaviours was also collected. Patterns of ITN use before and one year following net distribution were compared using spatial and multi-variable statistical methods. Associations of ITN use with various individual, household, demographic and malaria related factors were tested using logistic regression.

Results: After infancy (<1 year), ITN use sharply declined until the late teenage years then began to rise again, plateauing at 30 years of age. Males were less likely to use ITNs than females. Prior to distribution, socio-economic factors such as parental education and occupation were associated with ITN use. Following distribution, ITN use was similar across social groups. Household factors such as availability of nets and sleeping arrangements still reduced consistent net use, however.

Conclusions: Comprehensive, direct-to-household, mass distribution of ITNs was effective in rapidly scaling up coverage, with use being maintained at a high level at least one year following the intervention. Free distribution of ITNs through direct-to-household distribution method can eliminate important constraints in determining consistent ITN use, thus enhancing the sustainability of effective intervention campaigns.

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Related in: MedlinePlus

Location of study site in the Gembe East area of Mbita District of Nyanza Province, and locations of individual households that were part of the intervention and surveillance.
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Fig1: Location of study site in the Gembe East area of Mbita District of Nyanza Province, and locations of individual households that were part of the intervention and surveillance.

Mentions: The Gembe East area of Mbita District in Nyanza Province (Figure 1) was targeted for a randomized trial of three different types of long-lasting insecticidal nets (LLINs) (Olyset® Net, Olyset® Plus, and ceiling net; Sumitomo Chemical Co. Ltd, Tokyo, Japan) in Jan/Feb 2011 [21, 22]. Teams of community members were employed to visit all households in the distribution area (N = ~4,000), collect old nets (with homeowner consent), and provide each household with new ITNs. Survey teams explained the goals and purpose of the study to adult household representatives and obtained consent. Each household received a number of marked Olyset® LLINs in relation to the number of people reported to regularly sleep in the dwelling, following WHO standards. At the time of distribution, the ages and genders of all people living in the house were noted. For each individual person, survey teams recorded whether they reported sleeping under a net the previous night. Surveyors also noted whether the person slept in a bed room or an open living room and if the person slept on a bed or the floor. This study was approved by the Ethics Committees of the Kenya Medical Research Institute (SSC No. 2131), Nagasaki University (No.10121655-2) and The University of Michigan (HUM00061464).Figure 1


Insecticide-treated net use before and after mass distribution in a fishing community along Lake Victoria, Kenya: successes and unavoidable pitfalls.

Larson PS, Minakawa N, Dida GO, Njenga SM, Ionides EL, Wilson ML - Malar. J. (2014)

Location of study site in the Gembe East area of Mbita District of Nyanza Province, and locations of individual households that were part of the intervention and surveillance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289357&req=5

Fig1: Location of study site in the Gembe East area of Mbita District of Nyanza Province, and locations of individual households that were part of the intervention and surveillance.
Mentions: The Gembe East area of Mbita District in Nyanza Province (Figure 1) was targeted for a randomized trial of three different types of long-lasting insecticidal nets (LLINs) (Olyset® Net, Olyset® Plus, and ceiling net; Sumitomo Chemical Co. Ltd, Tokyo, Japan) in Jan/Feb 2011 [21, 22]. Teams of community members were employed to visit all households in the distribution area (N = ~4,000), collect old nets (with homeowner consent), and provide each household with new ITNs. Survey teams explained the goals and purpose of the study to adult household representatives and obtained consent. Each household received a number of marked Olyset® LLINs in relation to the number of people reported to regularly sleep in the dwelling, following WHO standards. At the time of distribution, the ages and genders of all people living in the house were noted. For each individual person, survey teams recorded whether they reported sleeping under a net the previous night. Surveyors also noted whether the person slept in a bed room or an open living room and if the person slept on a bed or the floor. This study was approved by the Ethics Committees of the Kenya Medical Research Institute (SSC No. 2131), Nagasaki University (No.10121655-2) and The University of Michigan (HUM00061464).Figure 1

Bottom Line: Household factors such as availability of nets and sleeping arrangements still reduced consistent net use, however.Comprehensive, direct-to-household, mass distribution of ITNs was effective in rapidly scaling up coverage, with use being maintained at a high level at least one year following the intervention.Free distribution of ITNs through direct-to-household distribution method can eliminate important constraints in determining consistent ITN use, thus enhancing the sustainability of effective intervention campaigns.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. anfangen@umich.edu.

ABSTRACT

Background: Insecticide-treated nets (ITNs) have proven instrumental in the successful reduction of malaria incidence in holoendemic regions during the past decade. As distribution of ITNs throughout sub-Saharan Africa (SSA) is being scaled up, maintaining maximal levels of coverage will be necessary to sustain current gains. The effectiveness of mass distribution of ITNs, requires careful analysis of successes and failures if impacts are to be sustained over the long term.

Methods: Mass distribution of ITNs to a rural Kenyan community along Lake Victoria was performed in early 2011. Surveyors collected data on ITN use both before and one year following this distribution. At both times, household representatives were asked to provide a complete accounting of ITNs within the dwelling, the location of each net, and the ages and genders of each person who slept under that net the previous night. Other data on household material possessions, education levels and occupations were recorded. Information on malaria preventative factors such as ceiling nets and indoor residual spraying was noted. Basic information on malaria knowledge and health-seeking behaviours was also collected. Patterns of ITN use before and one year following net distribution were compared using spatial and multi-variable statistical methods. Associations of ITN use with various individual, household, demographic and malaria related factors were tested using logistic regression.

Results: After infancy (<1 year), ITN use sharply declined until the late teenage years then began to rise again, plateauing at 30 years of age. Males were less likely to use ITNs than females. Prior to distribution, socio-economic factors such as parental education and occupation were associated with ITN use. Following distribution, ITN use was similar across social groups. Household factors such as availability of nets and sleeping arrangements still reduced consistent net use, however.

Conclusions: Comprehensive, direct-to-household, mass distribution of ITNs was effective in rapidly scaling up coverage, with use being maintained at a high level at least one year following the intervention. Free distribution of ITNs through direct-to-household distribution method can eliminate important constraints in determining consistent ITN use, thus enhancing the sustainability of effective intervention campaigns.

Show MeSH
Related in: MedlinePlus