Abstract
Malaria accounts for 14% of child deaths in the Democratic Republic of the Congo, and one of the key interventions used to prevent malaria is to distribute insecticide-treated bednets (ITNs), especially long-lasting insecticidal nets (LLINs). The global health community and the Roll Back Malaria initiative have been struggling to achieve universal health coverage using ITNs, and recent studies have reported mixed results about the effects of door-to-door visits and mass distribution campaigns. We aimed to compare LLIN use for those provided by door-to-door hang-up visits and by conventional fixed distribution from distribution centers accompanied by a mass distribution campaign. A cluster randomized control trial was conducted in rural areas of Maniema Province, Democratic Republic of the Congo (DR Congo). Cross-sectional surveys were conducted on 2120 and 2156 households, respectively, with at least one child aged less than five in 76 villages. We assessed the effectiveness of door-to-door hang-up visits on the use of LLINs by exploring the interaction between the “intervention group” and “time” using generalized estimating equation models. Increased LLINs use was observed in all age groups in both arms, but usage differences were not significantly different (relative risk (RR) of LLINs use among children < 5 in the intervention group versus the control group after adjusted for clustering: 1.06, 95% CI: 0.85–1.33). We conclude that the door-to-door hang-up visits are not sufficient to persuade individuals (pregnant woman, children < 5, or all study participants) to use LLINs, although it did appear to be effective for the youngest children in the household.
Highlights
Malaria remains one of the greatest challenges to the global health community; 409,000 people succumbed to the disease worldwide in 2019 despite substantial efforts made during the past two decades [1]
The distribution of insecticide-treated bednets (ITNs), long-lasting insecticidal nets (LLINs), is one of the key interventions used to prevent malaria [4], and it has been reported that the use of ITNs could reduce under-five child deaths by 14–29% [5,6]
In the rural setting of Maniema Province, DR Congo, the door-to-door LLIN hang-up method failed to induce high levels of net use in pregnant woman, children age < 5, or in all study participants, it seemed to be effective for the youngest children
Summary
Malaria remains one of the greatest challenges to the global health community; 409,000 people succumbed to the disease worldwide in 2019 despite substantial efforts made during the past two decades [1]. The Congo is no exception; in 2017, malaria accounted for 14% of child deaths [2]. Apart from its health effects, malaria has enormous economic implications: for example, it reduces labor productivity and increases health expenditures [3]. The distribution of insecticide-treated bednets (ITNs), long-lasting insecticidal nets (LLINs), is one of the key interventions used to prevent malaria [4], and it has been reported that the use of ITNs could reduce under-five child deaths by 14–29% [5,6]. The global health community including the Roll Back Malaria initiative has been struggling to achieve universal ITN coverage [9,10,11]
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