Lasting Insecticide Treated Bed Nets Research Articles

Situational Analysis of Malaria Control Following the 2021 Distribution of Long Lasting Insecticide-Treated Bed Nets in the Tiko Health District, South West Region, Cameroon

Malaria is still a major public health concern in Cameroon as more than 20 million people are at risk of the disease. Despite the government’s effort to scale up the distribution of long lasting insecticide-treated bed nets (LLINs), full ownership and optimal use is still limited. In 2021, over a million LLINs were made available for distribution in the South West Region. However, the current situation of malaria has not yet been ascertained following the 2021 mass distribution campaign (MDC). Therefore, the aim of this study was to determine LLIN ownership, coverage, usage and the prevalence of malaria following the 2021 MDC in the Tiko Health District (THD), South West Region of Cameroon. A cross-sectional study was carried from May 1 to 27, 2022 in which a multi-stage sampling technique was used to enroll eligible participants. Data were collected from household heads using questionnaires and capillary blood samples collected from consented household members were used to test for malaria. Data were analyzed using SPSS version 25 at 0.05 significance level. From the 150 households surveyed, 96 (64.0%) owned a mosquito net before the recent MDC. There was an overall significant increase (p p = 0.644) in LLINs ownership between areas where door-to-door (79.5%) and fixed “Hit and Run” (75.8%) strategies were used in the distribution of LLINs in THD. The prevalence of malaria was 10.2%. The regular use of LLINs was significantly associated (p = 0.007) with low malaria prevalence. The 2021 MDC had an impact on malaria prevalence in those who properly used them.

La revue systématique et autres types de revue de la littérature : qu’est-ce que c’est, quand, comment, pourquoi ?

Malaria is difficult to control in central India because of geographical terrain, efficient vectors, and perennial transmission of Plasmodium falciparum and socio-cultural practices of ethnic tribes. The objective was to develop a model to prevent and control malaria in hard to reach areas using existing tools. Baigachak (Tribe population 31,900) situated in Dindori district was undertaken for this study. Intervention measures used are indoor residual spray (IRS), long lasting insecticide treated bed nets (LLINs), prompt diagnosis and treatment along with intensive Information, Education and Communication (IEC) involving school children as agent of change. Door to door rapid fever surveys were carried out in the study area from 2009 to 14 and finger prick blood smears were made from all fever cases and examined under microscope. Mosquitoes were assayed for the presence of sporozoites by enzyme-linked immunosorbent assay (ELISA) technique and sibling species by polymerase chain reaction (PCR). There are two highly efficient vectors i.e. Anopheles culicifacies and An. fluviatilis. In monsoon season of 2009, the man hour density for An. culicifacies was 36.2 which declined to 10.9 during monsoon season of 2010-14 (t = 6.52; p < 0.0001). Epidemiological results revealed that malaria positivity was declined from 27% in 2009–3% in 2014 (Trend chi2 = 57.21; p < 0.0001) and P. falciparum declined from 23.6 to 2.4% (Trend chi2 = 48.33; p < 0.0001). Spleen rate was declined from 47% in 2009–5% in 2014 (χ2 for trend = 6.1; p = 0.0135). Baigachak has achieved a remarkable 89% reduction in malaria. This study confirms that the control strategies undertaken in this study are useful and should be extended at multiple sites for further validation.

Clients\u2019 satisfaction with preventive services for malaria during pregnancy in Anambra state, Nigeria

BackgroundBurden of Malaria in pregnancy (MIP) is still high despite availability of proven cost-effective interventions. Considerable progress has been made on improving antenatal attendance, but MIP preventive services utilization remains low. Factors responsible for this include dissatisfaction with the services provided. We assessed clients’ satisfaction with preventative services for malaria during pregnancy delivered at antenatal clinics (ANC) in Anambra State Nigeria.MethodWe conducted a cross-sectional study among 284 pregnant women attending ANC using multistage sampling technique. Pre-tested semi-structured interviewer-administered questionnaire was used to collect information on socio-demographics, knowledge of malaria in pregnancy services and satisfaction with services. Responses to questions on satisfaction was on a 5-point Likert scale. A cut off of ≥75% of composite score was used to classify respondents as satisfied. For knowledge, every correct answer was scored 1 and incorrect 0; ≥75% of the composite score was graded as good knowledge. Chi square and logistic regression were used to test for association between client satisfaction and independent variables.ResultsThe mean age of participants is 28 years±4.4 years. Overall, 62.2% were satisfied with quality of preventive services for malaria during pregnancy. However, 64.8 and 57.8% were dissatisfied with cost of healthcare and interpersonal relationship with the health workers (HWs). Majority of the respondents (88.73%) had poor knowledge of malaria preventive services during pregnancy. Type of facility (Adjusted odds ratio [aOR] = 2.11; 95%CI: 1.20–3.71) and knowledge (aOR: 0.41; 95%CI: 0.18–0.90) were independently associated with satisfaction with interpersonal relationship. Type of facility (aOR: 0.47; 95%CI: 0.27–0.80) and employment status (aOR: 3.07; 95%CI: 1.39–6.74) were also independently associated with satisfaction with cost of healthcare.ConclusionA fair proportion of respondents were satisfied with the preventive services for malaria during pregnancy provided even though most were dissatisfied with the cost of assessing care and interpersonal relationship with health workers. Uninterrupted availability of long lasting insecticide treated bed nets and intermittent preventive treatment for malaria at all health facilities, subsidized cost of malaria-related commodities, and incentives for good customer satisfaction ratings may remediate the described barriers to seeking preventative care for malaria during pregnancy.

Efficacy of factory-treated and dip-it-yourself long lasting insecticide-treated bednets against cutaneous leishmaniasis vectors in the sub-Andean region of Colombia: results after two years of use.

BACKGROUND Long lasting insecticide-treated nets (LLINs) may be effective for vector control of cutaneous leishmaniasis (CL). Their efficacy, however, has not been sufficiently evaluated.OBJECTIVE To evaluate the large-scale efficacy of LLINs on Lutzomyia longiflocosa entomological parameters up to two years post-intervention in the sub-Andean region of Colombia.METHODS A matched-triplet cluster-randomised study of 21 rural settlements, matched by pre-intervention L. longiflocosa indoor density was used to compare three interventions: dip it yourself (DIY) lambda-cyhalothrin LLIN, deltamethrin LLIN, and untreated nets (control). Sand fly indoor density, feeding success, and parity were recorded using CDC light trap collections at 1, 6, 12, and 24 months post-intervention.FINDINGS Both LLINs reduced significantly (74-76%) the indoor density and the proportion of fully engorged sand flies up to two years post-intervention without differences between them. Residual lethal effects of both LLINs and the use of all nets remained high throughout the two-year evaluation period.CONCLUSIONS Both LLINs demonstrated high efficacy against L. longiflocosa indoors. Therefore, the deployment of these LLINs could have a significant impact on the reduction of CL transmission in the sub-Andean region. The DIY lambda-cyhalothrin kit may be used to convert untreated nets to LLINs increasing coverage.

Effect of insecticide-treated bed nets on visceral leishmaniasis incidence in Bangladesh. A retrospective cohort analysis.

BackgroundVisceral leishmaniasis (VL) is a parasitic disease, transmitted by the sand fly species Phlebotomus argentipes in the Indian sub-continent. Effective vector control is highly desirable to reduce vector density and human and vector contact in the endemic communities with the aim to curtail disease transmission. We evaluated the effect of long lasting insecticide treated bed nets (LLIN) and bed nets impregnated with slow-release insecticide tablet K-O TAB 1-2-3 (jointly insecticide-treated nets or ITN) on VL incidence in a highly endemic sub-district (upazila) in Bangladesh.MethodsSeveral distributions of LLIN or K-O TAB 1-2-3 for self-impregnation of bed nets at home took place in Fulbaria upazila, Mymensigh district from 2004 to 2008 under three research projects, respectively funded by CDC, Atlanta, USA (2004) and WHO-TDR, Geneva, Switzerland (2006 & 2008). We included all households (n = 8142) in the 20 villages that had benefited in the past from one of these interventions (1295 donated LLIN and 11,918 local bed nets impregnated with K-O TAB 1-2-3) in the “exposed cohort”. We recruited a “non-exposed cohort” in villages with contemporaneously similar incidence rates who had not received such vector control interventions (7729 HHs from nine villages). In both cohorts, we visited all families house to house and ascertained any VL cases for the 3 year period before and after the intervention. We evaluated the incidence rate (IR) of VL in both cohorts as primary endpoint, applying the difference-in-differences method.ResultsThe study identified 1011 VL cases (IR 140.47/10,000 per year [py]) before the intervention, of which 534 and 477 cases in the intervention and control areas respectively. The IR was 144.13/10,000 py (534/37050) and 136.59/10,000 py (477/34923) in the intervention and control areas respectively, with no significant difference (p = 0.3901) before the intervention. After the intervention, a total of 555 cases (IR 77.11/10,000 py) were identified of which 178 (IR 48.04/10,000 py) in the intervention and 377 (107.95/10,000 py) in the control area. The intervention area had a significant lower IR than the control area during follow up, rate difference = –59.91, p<0.0001. The IR during follow up was significantly reduced by 96.09/10,000 py in the intervention area (p<0.0001) and 28.63/10,000 py in control area (p<0.0001) compared to baseline. There was a strong and significant overall effect of the ITN intervention, δ = –67.45, p <0.0001. Sex (OR = 1.36, p<0.0001) and age (OR = 0.99, p<0.0001) also had a significant effect on VL incidence. Male had a higher risk of VL than female and one year increase in age decreased the likelihood of VL by about 0.92%. Two third of the VL incidence occurred in the age range 2 to 30 years (median age of VL patients was 17 years).ConclusionVL incidence rate was significantly lower in the ITN intervention cohort compared to control in Bangladesh. Some bias due to more intense screen-and-treat activities or other interventions in the intervention area cannot be ruled out. Nonetheless, given their feasibility and sustainability, ITNs should be considered for integrated vector control during the maintenance phase of the VL elimination programme.

Reduction of Malaria Vector Mosquitoes in a Large Scale Intervention Trial in Rural Burkina Faso Using &lt;i&gt;Bti&lt;/i&gt; Based Larval Source Management

Background: Malaria remains one of the most important causes of morbidity and death in Sub-Saharan Africa. Along with early diagnosis and treatment of malaria cases and intermittent preventive treatment in pregnancy (IPTp), vector control is an important tool in the reduction of new cases. Alongside the use of long lasting insecticide treated bed nets (LLINs) and indoor residual spraying (IRS), targeting the vector larvae with biological larvicides such as Bacillus thuringiensis israelensis (Bti) is gaining importance as a means of reducing the number of mosquito larvae before they emerge to their adult stage. With this study, we present data corroborating the entomological impact of such an intervention in a rural African environment. Methods: The study extended over two years and researched the impact of biological larviciding with Bti on malaria mosquitoes that were caught indoors and outdoors of houses using light traps. We calculated the achieved reductions in female Anopheles mosquitoes for two different larviciding choices using a regression model. Findings: In villages that received selective treatment of the most productive breeding sites, the number of female Anopheles spp. dropped by 61% (95% CI: 54%-66%) compared to the pre-intervention period. In villages in which all breeding sites were treated, the number of female Anopheles spp. was reduced by 70% (95% CI: 64%-74%) compared to the pre-intervention period. Interpretation: We showed that malaria vector abundance can be dramatically reduced through larviciding of breeding habitats and that, in many geographical settings, they are a viable addition to current malaria control measures. Trial Registration Information: The study was registered under the trial id PACTR201611001721299 on the Pan African Clinical Trials Registry.. Funding Statement: This work was financed by Manfred Lautenschlager foundation, Wiesloch, Germany. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the ethics committees of the University of Heidelberg under the certificate number S-438/2013 and additionally presented to and granted by the national ethics board of Burkina Faso in Ouagadougou and the local ethics committee at the research site in Nouna. We collected aggregated collective informed consent for the spraying activities for each village.

Evidence of Insecticide Resistance to Pyrethroids and Bendiocarb in Anopheles funestus from Tsararano, Marovoay District, Madagascar.

Introduction In Madagascar, malaria control relies on the countrywide use of long lasting insecticide treated bed nets (LLINs) and on indoor residual spraying (IRS) in the central highland area as well as a small area on the eastern coast. We tested insecticide resistance mechanisms of Anopheles funestus from Tsararano, a malaria endemic village in the coastal health district of Marovoay. Methods Insecticide susceptibility bioassays were done in July 2017 on first-generation Anopheles funestus (F1) to assess (i) the susceptibility to permethrin (0.05%), deltamethrin (0.05%), DDT (4%), malathion (5%), fenitrothion (1%), and bendiocarb (0.1%); (ii) the effect of preexposure to the piperonyl butoxide (PBO) synergist; and (iii) the enzymatic activities of cytochrome P450, esterases, and glutathione S-transferases (GST). Results Our results demonstrated that An. funestus was phenotypically resistant to pyrethroids and bendiocarb, with a mortality rate (MR) of 33.6% (95%CI: 24.5-43.7%) and 86% (95%CI: 77.6-92.1%), respectively. In contrast, An. funestus were 100% susceptible to DDT and organophosphates (malathion and fenitrothion). Preexposure of An. funestus to PBO synergist significantly restored the susceptibility to bendiocarb (MR=100%) and increased the MR in the pyrethroid group, from 96% (95%CI: 90.0-98.9%) to 100% for deltamethrin and permethrin, respectively (χ2 = 43, df = 3, P< 0.0001). Enzymatic activities of cytochrome P450 and α-esterases were significantly elevated among An. funestus compared with the IPM reference strain (Mann-Whitney U= 30, P<0.0001; U = 145.5, P <0.0001, respectively). No significant differences of β-esterases activities compared to the IPM reference strain were observed (Mann-Whitney U = 392.5, P = 0.08). Conclusion In Tsararano, despite the absence of an IRS programme, there is evidence of high levels of insecticide resistance to pyrethroids and bendiocarb in An.

Malaria control in a tribal area of central India using existing tools

Malaria is difficult to control in central India because of geographical terrain, efficient vectors, and perennial transmission of Plasmodium falciparum and socio-cultural practices of ethnic tribes. The objective was to develop a model to prevent and control malaria in hard to reach areas using existing tools. Baigachak (Tribe population 31,900) situated in Dindori district was undertaken for this study. Intervention measures used are indoor residual spray (IRS), long lasting insecticide treated bed nets (LLINs), prompt diagnosis and treatment along with intensive Information, Education and Communication (IEC) involving school children as agent of change. Door to door rapid fever surveys were carried out in the study area from 2009 to 14 and finger prick blood smears were made from all fever cases and examined under microscope. Mosquitoes were assayed for the presence of sporozoites by enzyme-linked immunosorbent assay (ELISA) technique and sibling species by polymerase chain reaction (PCR). There are two highly efficient vectors i.e. Anopheles culicifacies and An. fluviatilis. In monsoon season of 2009, the man hour density for An. culicifacies was 36.2 which declined to 10.9 during monsoon season of 2010-14 (t = 6.52; p < 0.0001). Epidemiological results revealed that malaria positivity was declined from 27% in 2009–3% in 2014 (Trend chi2 = 57.21; p < 0.0001) and P. falciparum declined from 23.6 to 2.4% (Trend chi2 = 48.33; p < 0.0001). Spleen rate was declined from 47% in 2009–5% in 2014 (χ2 for trend = 6.1; p = 0.0135). Baigachak has achieved a remarkable 89% reduction in malaria. This study confirms that the control strategies undertaken in this study are useful and should be extended at multiple sites for further validation.

The impact of mass distribution of long lasting insecticide-treated bed-nets on the malaria parasite burden in the Buea Health District in South-West Cameroon: a hospital based chart review of patient\u2019s laboratory records

BackgroundMalaria remains a leading cause of illness and deaths in Cameroon. The use of long lasting insecticide treated bed nets (LLITN) is the most effective method to reduce the burden of malaria. The aim of this study was to determine the impact of the mass distribution of LLITN on the hospital prevalence of malaria (prevalence of malaria in patients with a presumptive diagnosis of malaria), in the Buea Health District in the South-West Region of Cameroon.MethodsA hospital-based chart review of records of malaria confirmatory test results in health facilities of the Buea Health District from January 2011 through December 2013. Data were extracted with the help of a grid, then analyzed with EPIinfo version 6 and Microsoft Excel 2010. Chi square test was used to compare prevalence and ANOVA was used to compare mean parasitaemia.ResultsA total of 17,268 records were reviewed, 3545[20.5% (19.9–21.1)] confirmed malaria positive with mean trophozoite count of 2735.3 ± 23,323.5 trophozoite/µl of blood. Prevalence was higher in males 1497 [23.5% (22.4–24.5)] than females 2047 [18.8% (18.1–19.6)], p < 0.01. Significant evidence of a reduction in the prevalence of malaria was found in under-fives in 2012 (p = 0.03).ConclusionsUniversal coverage with LLITN failed to guarantee effective control of malaria in the Buea Health District, as expected. Continuous and appropriate use of LLITN is indispensable, in addition to periodic sensitization, booster campaigns of LLITN distribution and evaluation research for effective prevention and control of malaria.

Insecticide resistance in Anopheles arabiensis in Sudan: temporal trends and underlying mechanisms.

BackgroundMalaria vector control in Sudan relies mainly on indoor residual spraying (IRS) and the use of long lasting insecticide treated bed nets (LLINs). Monitoring insecticide resistance in the main Sudanese malaria vector, Anopheles arabiensis, is essential for planning and implementing an effective vector control program in this country.MethodsWHO susceptibility tests were used to monitor resistance to insecticides from all four WHO-approved classes of insecticide at four sentinel sites in Gezira state over a three year period. Insecticide resistance mechanisms were studied using PCR and microarray analyses.ResultsWHO susceptibility tests showed that Anopheles arabiensis from all sites were fully susceptible to bendiocarb and fenitrothion for the duration of the study (2008–2011). However, resistance to DDT and pyrethroids was detected at three sites, with strong seasonal variations evident at all sites. The 1014 F kdr allele was significantly associated with resistance to pyrethroids and DDT (P < 0.001) with extremely high effects sizes (OR > 7 in allelic tests). The 1014S allele was not detected in any of the populations tested. Microarray analysis of the permethrin-resistant population of An. arabiensis from Wad Medani identified a number of metabolic genes that were significantly over-transcribed in the field-collected resistant samples when compared to the susceptible Sudanese An. arabiensis Dongola strain. These included CYP6M2 and CYP6P3, two genes previously implicated in pyrethroid resistance in Anopheles gambiae s.s, and the epsilon-class glutathione-S-transferase, GSTe4.ConclusionsThese data suggest that both target-site mechanisms and metabolic mechanisms play an important role in conferring pyrethroid resistance in An. arabiensis from Sudan. Identification in An. arabiensis of candidate loci that have been implicated in the resistance phenotype in An. gambiae requires further investigation to confirm the role of these genes.

Malaria Hotspots Drive Hypoendemic Transmission in the Chittagong Hill Districts of Bangladesh

BackgroundMalaria is endemic in 13 of 64 districts of Bangladesh, representing a population at risk of about 27 million people. The highest rates of malaria in Bangladesh occur in the Chittagong Hill Districts, and Plasmodium falciparum (predominately chloroquine resistant) is the most prevalent species.MethodsThe objective of this research was to describe the epidemiology of symptomatic P. falciparum malaria in an area of Bangladesh following the introduction of a national malaria control program. We carried out surveillance for symptomatic malaria due to P. falciparum in two demographically defined unions of the Chittagong Hill Districts in Bangladesh, bordering western Myanmar, between October 2009 and May 2012. The association between sociodemographics and temporal and climate factors with symptomatic P. falciparum infection over two years of surveillance data was assessed. Risk factors for infection were determined using a multivariate regression model.Results472 cases of symptomatic P. falciparum malaria cases were identified among 23,372 residents during the study period. Greater than 85% of cases occurred during the rainy season from May to October, and cases were highly clustered geographically within these two unions with more than 80% of infections occurring in areas that contain approximately one-third of the total population. Risk factors statistically associated with infection in a multivariate logistic regression model were living in the areas of high incidence, young age, and having an occupation including jhum cultivation and/or daily labor. Use of long lasting insecticide-treated bed nets was high (89.3%), but its use was not associated with decreased incidence of infection.ConclusionHere we show that P. falciparum malaria continues to be hypoendemic in the Chittagong Hill Districts of Bangladesh, is highly seasonal, and is much more common in certain geographically limited hot spots and among certain occupations.

Impact of a decade-long anti-malaria crusade in a West African community

ObjectiveTo assess the rate of utilization of long lasting insecticide treated bed nets (LLINs) which is one of the cardinal components of the program, a decade-long antimalarial campaign under the roll back malaria (RBM) initiative. MethodsThe study was carried out between October and December 2009 and cross-sectional in nature involving adult women in Otukpo town and environs. Households were selected using systematic sampling methods where all the adult women in each household were interviewed. Relevant information such as age, marital status, occupation, utilization of LLINs and reasons for non-utilization were obtained. Data obtained were analysed using analysis of variance (ANOVA) and regression coefficient. ResultsAlmost 100% (3 154) of the respondents could associate malaria fever with mosquito bite although other causes were also mentioned. The overall any bed net utilization in Otukpo town was found to be 58.3% (1 849). LLINs utilization was found to be 23.3% (739). 35.0% (1 110) used untreated bed nets while 41.7% (1 322) had no bed net. Positive predictors for LLINs utilization were increasing educational levels, increasing wealth index and presence of an under five child, while lower wealth index and cultural beliefs negatively contributed to LLINs utilization. ConclusionsThe RBM program in the community has failed to yield the desired results. Efforts should be intensified towards addressing the socioeconomic, cultural, literary and logistic factors in order to reach this goal.

Effectiveness of intermittent preventive treatment with sulphadoxine-pyrimethamine and insecticide treated nets on the prevention of malaria in pregnancy in non-malarial endemic area in Kenya

Background: Malaria prevention strategies have significantly reduced the prevalence of malaria in pregnant women in several studies done in malaria endemic regions. Objective: To determine the effectiveness of Intermittent preventive treatment with sulphadoxine-pyrimethamine and Insecticide treated nets on the prevention of malaria in pregnancy in a non-malaria endemic area. Design: Comparative study. Setting: Kapsabet District Hospital in Nandi County. Subjects: One hundred and fourty three non-randomised pregnant women were followed through the Antenatal clinic before 28 weeks gestation until delivery and compared with records of 600 pregnant women ( non-intervention arm), who attended ANC and delivered at the hospital. Results: The incidence of malaria infection in pregnancy was 21% in the non-intervention group compared with 8% in the intervention group, (p-value 0.000). The incidence of low birth weight was 12.5% in the non-intervention group compared with 5.6% in the intervention group (p-value 0.018); with a reduction of low birth weight by 50% in the intervention group. The incidence of Still births was 6% in the non-intervention group and 1.4% in the intervention group (p-value 0.025). There were two (0.3%) cases of maternal mortality in the non-intervention group and no mortality in the intervention group which was statistically not significant but clinically significant. Conclusion: The use of intermittent preventive treatment with sulphadoxinepyrimethamine and Insecticide Treated Nets is effective in prevention of malaria in pregnancy in non-malaria endemic region and is associated with reduction of adverse pregnancy outcome. There is therefore a need of up scaling the use of sulphadoxinepyrimethamine during pregnancy, and availing subsidised long lasting insecticide treated bed nets to pregnant women countrywide.

Possession and Usage of Insecticidal Bed Nets among the People of Uganda: Is BRAC Uganda Health Programme Pursuing a Pro-Poor Path?

BackgroundThe use of insecticidal bed nets is found to be an effective public health tool for control of malaria, especially for under-five children and pregnant women. BRAC, an indigenous Bangladeshi non-governmental development organization, started working in the East African state of Uganda in June 2006. As part of its efforts to improve the health and well-being of its participants, BRAC Uganda has been distributing long lasting insecticide-treated bed nets (LLIN) at a subsidized price through health volunteers since February 2008. This study was conducted in March-April 2009 to examine how equitable the programme had been in consistence with BRAC Uganda's pro-poor policy.Methodology/Principal FindingsInformation on possession of LLINs and relevant knowledge on its proper use and maintenance was collected from households either with an under-five child and/or a pregnant woman. The sample included three villages from each of the 10 branch offices where BRAC Uganda's community-based health programme was operating. Data were collected by trained enumerators through face-to-face interviews using a hand-held personal digital assistant (PDA). Findings reveal that the study population had superficial knowledge on malaria and its transmission, including the use and maintenance of LLINs. The households' rate of possession of bed nets (41–59%), and the proportion of under-five children (17–19%) and pregnant women (25–27%) who reported sleeping under an LLIN were not encouraging. Inequity was observed in the number of LLINs possessed by the households, in the knowledge on its use and maintenance, and between the two programme areas.Conclusions/SignificanceThe BRAC Uganda's LLINs distribution at a subsidized price appeared to be inadequate and inequitable, and BRAC's knowledge dissemination is insufficient for initiating preventive actions such as proper use of LLINs to interrupt malaria transmission. Findings contribute to the on-going debate on LLINs distribution in Africa and make a strong case for its free distribution.

Free distribution of insecticide treated bed nets to pregnant women in Kinshasa: an effective way to achieve 80% use by women and their newborns

To determine whether long lasting insecticide treated bed nets (LLINs) distributed free of charge to pregnant women at their first antenatal clinic visit in Kinshasa, DRC are used from the time of distribution to delivery and 6 months after delivery. Women were enrolled into a cohort study at their first antenatal care (ANC) visit and provided LLINs free of charge. Reported use of these nets was then measured at the time of delivery (n = 328) and in a random sample of women (n = 100) 6 months post-delivery using an interviewer administered, structured questionnaire. At baseline, only 25% of women reported having slept under a bed net the night before the interview. At the time of delivery, after being provided an LLIN for free, this increased to 79%. Six months post-delivery (n = 100), 80% of women reported sleeping under a net with a child under the age of 5 the night before the interview. Freely distributed bed nets are acceptable, feasible and result in high usage. Free distribution of bed nets during antenatal clinic visits may be a highly effective way to rapidly increase the use of bed nets among both pregnant women and their newborn infants in areas with high levels of ANC attendance.