Abstract
BackgroundContinuous distribution of insecticide-treated nets (ITNs) has now been accepted as one way of sustaining ITN universal coverage. Community-based channels offer an interesting means of delivering ITNs to households to sustain universal ITN coverage. The objective of this study was to provide proof of concept for this channel.MethodsA 9-month, community-based, distribution pilot was implemented beginning 1 year after a mass campaign in Lainya County, South Sudan from 2012 to 2013. Following social mobilization, community members could request an ITN from a net coupon holder. Eligibility criteria included having lost an ITN, giving birth outside of the health facility, or not having enough ITNs for all household members. After verification, households could exchange the coupon for an ITN at a distribution point. The evaluation was a pre/post design using representative household surveys with two-stage cluster sampling and a sample size of 600 households per survey.ResultsAt endline, 78% of respondents were aware of the scheme and 89% of those also received an ITN through community-based distribution. Population access to ITNs nearly doubled, from 38% at baseline to 66% after the pilot. Household ownership of any ITN and enough ITNs (1 for 2 people) also increased significantly, from 66 to 82% and 19 to 46%, respectively. Community-based distribution was the only source of ITNs for 53.4% of households. The proportion of the population using an ITN last night increased from 22.7% at baseline to 53.9% at endline. A logistic regression model indicates that although behaviour change communication was positively associated with an increase in ITN use, access to enough nets was the greatest determinant of use.ConclusionsITN access and use improved significantly in the study area during the pilot, coming close to universal coverage targets. This pilot serves as proof of concept for the community-based distribution methodology implemented as a mechanism to sustain ITN universal coverage. Longer periods of implementation should be evaluated to determine whether community-based distribution can successfully maintain ITN coverage beyond the short term, and reach all wealth quintiles equitably.
Highlights
Continuous distribution of insecticide-treated nets (ITNs) has been accepted as one way of sustaining ITN universal coverage
A 2015 study analysing factors contributing to declines in malaria morbidity between 2010 and 2015 found that 68% of the 40% reduction in malaria incidence could be attributed to ITNs [8]
Continuous distribution of long-lasting insecticidal nets (LLIN) Design The community-based ITN distribution was based on a ‘push–pull’ system, where ITNs were delivered to a hub near the community, here primarily health facilities
Summary
Continuous distribution of insecticide-treated nets (ITNs) has been accepted as one way of sustaining ITN universal coverage. Community-based channels offer an interesting means of delivering ITNs to households to sustain universal ITN coverage. It is not possible to take existing nets into account during mass campaigns [10], meaning that older but still serviceable nets and those distributed through ante-natal care and immunization services are ignored [6]. These attributes of mass campaigns can result in an oversupply of households with nets [11] and thereby reduce the cost-effectiveness of an ITN distribution strategy that includes repeat mass campaigns.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
