The effect of single or repeated home visits on the hanging and use of insecticide-treated mosquito nets following a mass distribution campaign--a cluster randomized, controlled trial.

Albert Kilian,Connie Balayo,Mitra Feldman,Hannah Koenker,Kojo Lokko,Marc Boulay,Matthew Lynch,Ruth A Ashton,Jane Bruce

doi:10.1371/journal.pone.0119078

Albert Kilian, Connie Balayo + Show 7 more

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https://doi.org/10.1371/journal.pone.0119078

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Abstract

BackgroundStudy objective was to evaluate the effectiveness of commonly used post-campaign hang-up visits on the hanging and use of campaign nets.MethodsA cluster-randomized trial was carried out in Uganda following an ITN distribution campaign. Five clusters (parishes, consisting of ∼11 villages each) were randomly selected for each of the three study arms with between 7,534 and 9,401 households per arm. Arm 1 received one hang-up visit, while Arm 2 received two visits by volunteers four and seven months after the campaign. Visits consisted of assistance hanging the net and education on net use. The control arm was only exposed to messages during the campaign itself. Three cross-sectional surveys with a two-stage cluster sampling design, representative of the study populations, were carried out to capture the two key outcome variables of net hanging and ITN use. Sample size was calculated to detect at least a 15 percentage-points change in net use, and was 1811 at endline. The analysis used an intention-to-treat approach.FindingsBoth hanging and use of ITN increased during follow-up in a similar way in all three study arms. The proportion of the population using an ITN the previous night was 64.0% (95% CI 60.8, 67.2), for one additional visit, 68.2% (63.8, 72.2) for two visits and 64.0% (59.4, 68.5) for the control. The proportion of households with all campaign nets hanging increased from 55.7% to 72.5% at endline (p<0.0005 for trend), with no difference between study arms. Financial cost per household visited was estimated as USD 2.33 for the first visit and USD 2.24 for the second.ConclusionsBehavior change communication provided during the campaign or through other channels was sufficient to induce high levels of net hanging and use and additional “hang-up” activities were not cost-effective.

Highlights

Distributions of long-lasting insecticidal nets (LLIN), a sub-category of insecticide-treated nets (ITN), have been widely accepted as one of the key interventions for malaria prevention and mass distribution campaigns as the best approach to achieve a rapid scale-up
Behavior change communication provided during the campaign or through other channels was sufficient to induce high levels of net hanging and use and additional “hang-up” activities were not cost-effective
In the late 2000’s the main hypothesis was that difficulties in hanging the net and lack of knowledge about use were the key barriers to use [9]. This resulted in calls for active support in net hanging and inter-personal communication through home visits after the campaign distribution [1,4,5,9,12] and WHO recommends to include “hang-up” activities by community volunteers as part of LLIN distribution campaigns [13]

Summary

Introduction

Distributions of long-lasting insecticidal nets (LLIN), a sub-category of insecticide-treated nets (ITN), have been widely accepted as one of the key interventions for malaria prevention and mass distribution campaigns as the best approach to achieve a rapid scale-up. In the late 2000’s the main hypothesis was that difficulties in hanging the net and lack of knowledge about use were the key barriers to use [9]. This resulted in calls for active support in net hanging and inter-personal communication through home visits after the campaign distribution [1,4,5,9,12] and WHO recommends to include “hang-up” activities by community volunteers as part of LLIN distribution campaigns [13]. Study objective was to evaluate the effectiveness of commonly used post-campaign hangup visits on the hanging and use of campaign nets

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