Evaluation of community-based continuous distribution of long-lasting insecticide-treated nets in Toamasina II District, Madagascar.

Autor: de Beyl CZ; Malaria Consortium, London, UK., Kilian A; Tropical Health, LLP, Montagut, Spain., Brown A; Johns Hopkins Center for Communication Programs, Baltimore, MD, USA., Sy-Ar M; Johns Hopkins Center for Communication Programs, Baltimore, MD, USA., Selby RA; Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.; Malaria Consortium, Kampala, Uganda., Randriamanantenasoa F; Catholic Relief Services, Antananarivo, Madagascar., Ranaivosoa J; Catholic Relief Services, Antananarivo, Madagascar., Zigirumugabe S; President's Malaria Initiative, Antananarivo, Madagascar., Gerberg L; President's Malaria Initiative, US Agency for International Development, Washington, DC, USA., Fotheringham M; President's Malaria Initiative, US Agency for International Development, Washington, DC, USA., Lynch M; Johns Hopkins Center for Communication Programs, Baltimore, MD, USA., Koenker H; Johns Hopkins Center for Communication Programs, Baltimore, MD, USA. hkoenker@jhu.edu.
Jazyk: angličtina
Zdroj: Malaria journal [Malar J] 2017 Aug 10; Vol. 16 (1), pp. 327. Date of Electronic Publication: 2017 Aug 10.
DOI: 10.1186/s12936-017-1985-7
Abstrakt: Background: Continuous distribution of insecticide-treated nets (ITNs) is thought to be an effective mechanism to maintain ITN ownership and access between or in the absence of mass campaigns, but evidence is limited. A community-based ITN distribution pilot was implemented and evaluated in Toamasina II District, Madagascar, to assess this new channel for continuous ITN distribution.
Methods: Beginning 9 months after the December 2012 mass campaign, a community-based distribution pilot ran for an additional 9 months, from September 2013 to June 2014. Households requested ITN coupons from community agents in their village. After verification by the agents, households exchanged the coupon for an ITN at a distribution point. The evaluation was a two-stage cluster survey with a sample size of 1125 households. Counterfactual ITN ownership and access were calculated by excluding ITNs received through the community pilot.
Results: At the end of the pilot, household ownership of any ITN was 96.5%, population access to ITN was 81.5 and 61.5% of households owned at least 1 ITN for every 2 people. Without the ITNs provided through the community channel, household ownership of any ITN was estimated at 74.6%, population access to an ITN at 55.5%, and households that owned at least 1 ITN for 2 people at only 34.7%, 18 months after the 2012 campaign. Ownership of community-distributed ITNs was higher among the poorest wealth quintiles. Over 80% of respondents felt the community scheme was fair and simple to use.
Conclusions: Household ITN ownership and population ITN access exceeded RBM targets after the 9-month community distribution pilot. The pilot successfully provided coupons and ITNs to households requesting them, particularly for the least poor wealth quintiles, and the scheme was well-perceived by communities. Further research is needed to determine whether community-based distribution can sustain ITN ownership and access over the long term, how continuous availability of ITNs affects household net replacement behaviour, and whether community-based distribution is cost-effective when combined with mass campaigns, or if used with other continuous channels instead of mass campaigns.
Databáze: MEDLINE