Cost-Sharing Strategies Combining Targeted Public Subsidies With Private-Sector Delivery Achieve High Bednet Coverage and Reduced Malaria Transmission in Kilombero Valley, Southern Tanzania
| Autor: | Rose Nathan, Japheth Kihonda, Maya E. Kotas, N Kasigudi, Thomas J. Smith, FO Okumu, Hassan Ngonyani, Adriana Tami, Salim Abdulla, Christian Lengeler, Valeliana Mayagaya, Gerry F. Killeen, J. D. Charlwood, Hajo Grundmann |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Insecticides
Mosquito Control Time Factors 030231 tropical medicine Tanzania lcsh:Infectious and parasitic diseases 03 medical and health sciences 0302 clinical medicine Malaria transmission Environmental protection parasitic diseases Prevalence medicine Animals Cluster Analysis Humans lcsh:RC109-216 030212 general & internal medicine Socioeconomics Public Sector Surveillance monitoring evaluation Geography biology business.industry Public sector 1. No poverty Bedding and Linens Subsidy medicine.disease biology.organism_classification Private sector Malaria 3. Good health Mosquito control Infectious Diseases Cost sharing Health financing & economics Private Sector business Research Article |
| Zdroj: | BMC infectious diseases, 2007, Vol.7, pp.121 [Peer Reviewed Journal] BMC Infectious Diseases, Vol 7, Iss 1, p 121 (2007) BMC Infectious Diseases |
| Popis: | Background Cost-sharing schemes incorporating modest targeted subsidies have promoted insecticide-treated nets (ITNs) for malaria prevention in the Kilombero Valley, southern Tanzania, since 1996. Here we evaluate resulting changes in bednet coverage and malaria transmission. Methods Bednets were sold through local agents at fixed prices representing a 34% subsidy relative to full delivery cost. A further targeted subsidy of 15% was provided to vulnerable groups through discount vouchers delivered through antenatal clinics and regular immunizations. Continuous entomological surveys (2,376 trap nights) were conducted from October 2001 to September 2003 in 25 randomly-selected population clusters of a demographic surveillance system which monitored net coverage. Results Mean net usage of 75% (11,982/16,086) across all age groups was achieved but now-obsolete technologies available at the time resulted in low insecticide treatment rates. Malaria transmission remained intense but was substantially reduced: Compared with an exceptionally high historical mean EIR of 1481, even non-users of nets were protected (EIR [fold reduction] = 349 infectious bites per person per year [×4]), while the average resident (244 [×6]), users of typical nets (210 [×7]) and users of insecticidal nets (105 [×14]) enjoyed increasing benefits. Conclusion Despite low net treatment levels, community-level protection was equivalent to the personal protection of an ITN. Greater gains for net users and non-users are predicted if more expensive long-lasting ITN technologies can be similarly promoted with correspondingly augmented subsidies. Cost sharing strategies represent an important option for national programmes lacking adequate financing to fully subsidize comprehensive ITN coverage. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|