Abstract
BackgroundAn ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Social marketing techniques were used for product and message development. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at $2.5 per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs.MethodsA post-test only quasi-experimental study design was used to compare intervention and comparison districts. A total of 2,986 respondents were interviewed. Survey respondents were grouped into four socio-economic (SES) categories: low, medium-low, medium and high. Knowledge, access, ownership and use indicators are compared. Concentration index scores are calculated. Interactions between intervention status and SES help determine how different SES groups benefited from the intervention.ResultsAlthough overall use of nets remained relatively low, post-test data show that knowledge, access, ownership and use of mosquito nets was higher in intervention districts. A decline in SES inequity in access to nets occurred in intervention districts, resulting from a disproportionately greater increase in access among the low SES group. Declines in SES inequities in net ownership and use of nets were associated with the intervention. The largest increases in net ownership and use occurred among medium and high SES categories.ConclusionIncreasing access to nets among the poorest respondents in rural areas may not lead to increases in net use unless the price of nets is no longer a barrier to their purchase.
Highlights
An insecticide-treated mosquito nets (ITN) intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures
Widespread coverage of vulnerable populations with insecticide-treated nets is a critical component of the Roll Back Malaria strategy
Hypothesis 2: The intervention contributed to declines in SES inequity in knowledge, access and use of nets The programme impact on equity is assessed using a Concentration Index that calculates the degree of socio-economic inequity on the outcome variables
Summary
An ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at $2.5 per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs. Widespread coverage of vulnerable populations with insecticide-treated nets is a critical component of the Roll Back Malaria strategy. An important gap in knowledge is how ITN interventions influence socio-economic (SES) differences in access, ownership and use of nets [7,2]. Unlike other social marketing interventions that have relied primarily on the retail sector for net distribution [8], this intervention is considered a hybrid because it combines a social marketing approach with distribution of nets through public health facilities. How did different socio-economic groups benefit from the intervention? Was there an overall increase in knowledge, access, ownership and use of ITNs? Were there declines in socio-economic inequities in these outcomes? How did different socio-economic groups benefit from the intervention?
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