Abstract
BackgroundContinuous distribution of insecticide-treated nets (ITNs) is thought to be an effective mechanism to maintain ITN ownership and access between or in the absence of mass campaigns, but evidence is limited. A community-based ITN distribution pilot was implemented and evaluated in Toamasina II District, Madagascar, to assess this new channel for continuous ITN distribution.MethodsBeginning 9 months after the December 2012 mass campaign, a community-based distribution pilot ran for an additional 9 months, from September 2013 to June 2014. Households requested ITN coupons from community agents in their village. After verification by the agents, households exchanged the coupon for an ITN at a distribution point. The evaluation was a two-stage cluster survey with a sample size of 1125 households. Counterfactual ITN ownership and access were calculated by excluding ITNs received through the community pilot.ResultsAt the end of the pilot, household ownership of any ITN was 96.5%, population access to ITN was 81.5 and 61.5% of households owned at least 1 ITN for every 2 people. Without the ITNs provided through the community channel, household ownership of any ITN was estimated at 74.6%, population access to an ITN at 55.5%, and households that owned at least 1 ITN for 2 people at only 34.7%, 18 months after the 2012 campaign. Ownership of community-distributed ITNs was higher among the poorest wealth quintiles. Over 80% of respondents felt the community scheme was fair and simple to use.ConclusionsHousehold ITN ownership and population ITN access exceeded RBM targets after the 9-month community distribution pilot. The pilot successfully provided coupons and ITNs to households requesting them, particularly for the least poor wealth quintiles, and the scheme was well-perceived by communities. Further research is needed to determine whether community-based distribution can sustain ITN ownership and access over the long term, how continuous availability of ITNs affects household net replacement behaviour, and whether community-based distribution is cost-effective when combined with mass campaigns, or if used with other continuous channels instead of mass campaigns.
Highlights
Continuous distribution of insecticide-treated nets (ITNs) is thought to be an effective mechanism to maintain ITN ownership and access between or in the absence of mass campaigns, but evidence is limited
In late 2012, through a mass distribution campaign implemented by the National Malaria Control Programme (NMCP) and partners, 5,614,456 nets were distributed in 61 districts in order to achieve universal ITN coverage [25]
Toamasina II District, an area of high malaria endemicity, was selected for the pilot based on its inclusion in the 2012 mass campaign, a population size appropriate for the available number of ITNs for the pilot, nongovernment organization (NGO) presence, and because it includes urban, peri-urban and rural areas as well as a mix of accessible and hard-to-reach communities
Summary
Continuous distribution of insecticide-treated nets (ITNs) is thought to be an effective mechanism to maintain ITN ownership and access between or in the absence of mass campaigns, but evidence is limited. Initial distributions focused on vulnerable pregnant women and children under 5 years old to reduce mortality, using distribution through antenatal and vaccination clinics [1,2,3,4,5], social marketing [6,7,8] and targeted mass campaigns [9,10,11,12,13,14,15,16,17,18]. In late 2012, through a mass distribution campaign implemented by the National Malaria Control Programme (NMCP) and partners, 5,614,456 nets were distributed in 61 districts in order to achieve universal ITN coverage [25]. In order to maintain universal coverage more consistently, other mechanisms of ITN distribution are needed [27]
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