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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

Number of ITNs by the number of people living in the home. Gray line represents the expected trend of ownership given the number of people and a criterion for universal coverage which assumes at least one net per two people. Blue line (with confidence bands) indicates the observed trend.
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Fig4: Number of ITNs by the number of people living in the home. Gray line represents the expected trend of ownership given the number of people and a criterion for universal coverage which assumes at least one net per two people. Blue line (with confidence bands) indicates the observed trend.

Mentions: Nearly all (97%) of the nets present at households during the second survey were marked Olyset® nets that had been distributed one year earlier, with 99% of these being found in current use inside the dwelling (as opposed to outdoors). About 20% of nets, the vast majority of which were in new condition one year previously, had visible holes (Table 2). Survey teams attempted to assess presence of stored/unused nets and possible diversion of nets for other purposes, but this proved difficult as many diverted nets were present in areas other than the home. ITNs were initially distributed in a manner that would allow for universal coverage, with a goal of providing at least one net per two people in the household. Households with only one or two members were given a single net, three- or four-member households were given two, etc. However, upon follow up, it was found that only 59% of households possessed sufficient nets to satisfy the universal coverage criterion. A graphic comparison of the actual number of nets per resident to the predicted ratio of nets under the universal coverage criterion can be found in Figure 4.Table 2


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)

Number of ITNs by the number of people living in the home. Gray line represents the expected trend of ownership given the number of people and a criterion for universal coverage which assumes at least one net per two people. Blue line (with confidence bands) indicates the observed trend.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Number of ITNs by the number of people living in the home. Gray line represents the expected trend of ownership given the number of people and a criterion for universal coverage which assumes at least one net per two people. Blue line (with confidence bands) indicates the observed trend.
Mentions: Nearly all (97%) of the nets present at households during the second survey were marked Olyset® nets that had been distributed one year earlier, with 99% of these being found in current use inside the dwelling (as opposed to outdoors). About 20% of nets, the vast majority of which were in new condition one year previously, had visible holes (Table 2). Survey teams attempted to assess presence of stored/unused nets and possible diversion of nets for other purposes, but this proved difficult as many diverted nets were present in areas other than the home. ITNs were initially distributed in a manner that would allow for universal coverage, with a goal of providing at least one net per two people in the household. Households with only one or two members were given a single net, three- or four-member households were given two, etc. However, upon follow up, it was found that only 59% of households possessed sufficient nets to satisfy the universal coverage criterion. A graphic comparison of the actual number of nets per resident to the predicted ratio of nets under the universal coverage criterion can be found in Figure 4.Table 2

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