Best practices for an insecticide-treated bed net distribution programme in sub-Saharan eastern Africa

Alexis R Sexton

doi:10.1186/1475-2875-10-157

Abstract

Insecticide-treated bed nets are the preeminent malaria control means; though there is no consensus as to a best practice for large-scale insecticide-treated bed net distribution. In order to determine the paramount distribution method, this review assessed literature on recent insecticide treated bed net distribution programmes throughout sub-Saharan Eastern Africa. Inclusion criteria were that the study had taken place in sub-Saharan Eastern Africa, targeted malaria prevention and control, and occurred between 1996 and 2007. Forty-two studies were identified and reviewed. The results indicate that distribution frameworks varied greatly; and consequently so did outcomes of insecticide-treated bed net use. Studies revealed consistent inequities between urban and rural populations; which were most effectively alleviated through a free insecticide-treated bed net delivery and distribution framework. However, cost sharing through subsidies was shown to increase programme sustainability, which may lead to more long-term coverage. Thus, distribution should employ a catch up/keep up programme strategy. The catch-up programme rapidly scales up coverage, while the keep-up programme maintains coverage levels. Future directions for malaria should include progress toward distribution of long-lasting insecticide-treated nets.

Highlights

Malaria is a re-emerging infectious disease contributing to more deaths in present day than in decades prior [1,2,3,4]
Insecticide-treated bed nets (ITNs) remain a highly effective tool in the fight against malaria [1,5,6,7,8,9,10,11,12,13,14,15,16] when used correctly [4,17,18,19,20,21,22,23]
Mosquitoes need to be recognized as the sole cause of malaria, prompting a belief that ITNs are a complete defense against transmission and disease

Summary

Introduction

Malaria is a re-emerging infectious disease contributing to more deaths in present day than in decades prior [1,2,3,4]. When existing resource opportunities are exploited, distribution costs generally decrease greatly, increasing overall programme sustainability [42]. Between one half and two-thirds of the population obtain nets through the commercial sector with no subsidy (it should be noted that the least poor purchase the unsubsidized ITNs more frequently than the poorer populations) [15,25,30], showing that it may be a sustainable framework and an important aspect of ITN distribution and coverage [13,47].

Results

Conclusion