Abstract
Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.
Highlights
Insecticide treated bednets (ITNs) are one of the most costeffective and widely used malaria interventions [1,2]
Bednet Distribution through public health facilities Bednets were distributed through antenatal clinics (ANC) and immunization clinics at all health facilities
The total number of bednets reported in the census was 13,230, about 64% of the number reported distributed through facilities
Summary
Insecticide treated bednets (ITNs) are one of the most costeffective and widely used malaria interventions [1,2]. Strategies for distributing ITNs differ between countries and between programs and they show a high degree of variability in coverage of households and high-risk groups [7,8]. Unsubsidized ITNs provided through the private retail sector produces the lowest coverage with significant differences between socioeconomics groups. Still other countries have relied on social marketing of ITNs, and have scaled-up distribution through both the health sector and the private retail sector, usually involving a small co-pay [9]. Such cost-sharing schemes with private and public sector subsidies have sustained high coverage [10]. Other studies suggest that a mix of distribution mechanisms can both achieve and maintain high and equitable coverage [9,11,12]
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