Abstract
BackgroundInsecticide-treated nets (ITN) are one of the most effective measures for preventing malaria. Mass distribution campaigns are being used to rapidly increase net coverage in at-risk populations. This study had two purposes: to evaluate the impact of a universal coverage campaign (UCC) of long-lasting insecticidal nets (LLINs) on LLIN ownership and usage, and to identify factors that may be associated with inadequate coverage.MethodsIn 2011 two cross-sectional household surveys were conducted in 50 clusters in Muleba district, north-west Tanzania. Prior to the UCC 3,246 households were surveyed and 2,499 afterwards. Data on bed net ownership and usage, demographics of household members and household characteristics including factors related to socio-economic status were gathered, using an adapted version of the standard Malaria Indicator Survey. Specific questions relating to the UCC process were asked.ResultsThe proportion of households with at least one ITN increased from 62.6% (95% Confidence Interval (CI) = 60.9-64.2) before the UCC to 90.8% (95% CI = 89.0-92.3) afterwards. ITN usage in all residents rose from 40.8% to 55.7%. After the UCC 58.4% (95% CI = 54.7-62.1) of households had sufficient ITNs to cover all their sleeping places. Households with children under five years (OR = 2.4, 95% CI = 1.9-2.9) and small households (OR = 1.9, 95% CI = 1.5-2.4) were most likely to reach universal coverage. Poverty was not associated with net coverage. Eighty percent of households surveyed received LLINs from the campaign.ConclusionsThe UCC in Muleba district of Tanzania was equitable, greatly improving LLIN ownership and, more moderately, usage. However, the goal of universal coverage in terms of the adequate provision of nets was not achieved. Multiple, continuous delivery systems and education activities are required to maintain and improve bed net ownership and usage.
Highlights
Insecticide-treated nets (ITN) are one of the most effective measures for preventing malaria
The strategy is based on a combination of distribution mechanisms targeting different groups in the population: 1) starting in 2004 a publicprivate partnership continues to provide subsidized ITNs to pregnant women through discounted vouchers issued at antenatal clinics (TNVS) [9]; 2) between 2009 and 2010 a national mass campaign (U5CC) distributed 8.7 million long-lasting insecticidal nets (LLINs) free of charge to families with children under five years of age to quickly scale up ownership and usage in this group [10]; 3) in 2011 a Universal Coverage Campaign (UCC) distributed 17.6 million LLINs to ensure that all sleeping places are covered by an ITN and to increase ITN usage to 80% in the general population [11]
Intra-household saturation coverage and usage The proportion of households with at least one ITN increased from 62.6% before the universal coverage campaign (UCC) to 90.8% afterwards (Table 1) and the mean number of ITNs owned per household almost doubled to 2.1
Summary
Insecticide-treated nets (ITN) are one of the most effective measures for preventing malaria. The strategy is based on a combination of distribution mechanisms targeting different groups in the population: 1) starting in 2004 a publicprivate partnership continues to provide subsidized ITNs to pregnant women through discounted vouchers issued at antenatal clinics (TNVS) [9]; 2) between 2009 and 2010 a national mass campaign (U5CC) distributed 8.7 million long-lasting insecticidal nets (LLINs) free of charge to families with children under five years of age to quickly scale up ownership and usage in this group [10]; 3) in 2011 a Universal Coverage Campaign (UCC) distributed 17.6 million LLINs to ensure that all sleeping places are covered by an ITN and to increase ITN usage to 80% in the general population [11]. In April 2011 the district, supported by Mennonite Economic Development Associates (MEDA), completed the UCC distributing 144,000 LLINs (Olyset, Sumitomo) to the population of Muleba
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