Mass Distribution Of Insecticide-treated Nets Research Articles

Activity-based contracting for optimization of the mass distribution of insecticide-treated nets in the Democratic Republic of Congo: pilot implementation in Kwilu province

BackgroundPromoting the use of insecticide-treated mosquito nets (ITNs) is one of the main strategies for reducing malaria-related morbidity. An innovative activity-based contracting (ABC) approach has been implemented in Kwilu Province, Democratic Republic of Congo to optimize ITN mass distribution campaigns, with payments based on contractually defined programmatic outcomes for key campaign activities following independent verification of results.MethodsThis internal evaluation was carried out using a mixed methods approach combining qualitative and quantitative document and content analysis from a series of three workshops: validation workshops for campaign results at provincial level for the 2021 and 2022 campaigns; internal evaluation workshop for the Kwilu campaign as part of the ABC approach organized by “Santé pour tous en milieu rural” (SANRU) with its sub-contractors; and national campaign evaluation workshop organized by the National Malaria Control Program.ResultsThe pilot campaign with the ABC approach in Kwilu has demonstrated better results than campaigns conducted using the standard, non-ABC, approach: better household coverage (99.9% vs. 97.3%) and improved compliance with ITN allocation to households based on the household size (98. 9% vs. 84.7%); lower loss of ITNs (0.3% vs. 0.5%) with immediate penalties for lost ITNs in the province under the ABC approach; shorter campaign lead times (14 vs. 28 weeks from the start of training to the launch of distribution). This last point is crucial, as it is likely to generate efficiencies and contribute to ensuring timely ITN replacement campaigns.ConclusionThe challenges encountered and the lessons learned in the implementation of the pilot ABC approach in Kwilu could guide future distribution campaigns in the DRC and other African countries that would like to engage in distribution campaigns based on performance-based incentive contracts.

Mass Distribution of Insecticide-Treated Nets: A Qualitative Study on Sumba Island

Background: The distribution of insecticide-treated nets (ITNs) is one of the main forms of malaria control intervention in Sumba Island. Although it has been running for more than a decade, there are still some gaps in the planning and implementation of this program. Aims: This study aims to obtain an overview of the planning and implementation of the mass distribution of ITNs running on Sumba Island, Indonesia. Methods: This study is qualitative research conducted in 2019 in all districts on Sumba Island. Data were collected by conducting in-depth interviews with 53 informants, including those in charge of the program, cross-sectors, and communities selected based on the researcher's considerations. Thematic analysis was used to produce the findings. Results: The study showed a gap between the number of ITNs and the real target, the sources of data on ITNs targets are different, and cross-sector involvement is limited to socialization activities, not maximizing the socialization and education of ITNs to the community. Conclusion: The planning and implementation of the mass distribution of ITNs on Sumba Island have not run optimally at the stages of socialization, logistics management, and distribution to the community. Modification of socialization methods and strengthening of distribution strategies to the community is needed.

Under utilization of long-lasting insecticidal nets (LLINs) is challenging malaria elimination program in Ethiopia: a systematic review and meta-analysis

BackgroundMalaria is one of the most common causes of morbidity and mortality in developing countries including Ethiopia. Mass distribution of insecticide-treated nets and indoor residual spray for high malaria risk groups are the major prevention measures in different countries. Achievement of the malaria elimination plan is highly determined by the level of effective utilization of intervention measures. However, there is scarce information showing the national level of insecticide-treated nets utilization.ObjectiveTo estimate the pooled prevalence of insecticide-treated nets utilization in Ethiopia, 2023.MethodA Systematic Review and Meta-analysis employed to assess the utilization of long-lasting insecticidal nets in Ethiopia. Published articles were searched from Google Scholar, PubMed, Web Sciences, CINAHIL, EMBASE, and Scopus. The collected articles were screened for data extraction and further analysis using preferred reporting items for systematic review and meta-analysis (PRISMA) flow chart. The quality of each study was assessed using the Jonna Briggs Institute (JBI) checklist. The data were extracted using Microsoft Excel and exported to STATA version 17.0 for analysis. The overall pooled prevalence of long-lasting insecticidal nets utilization was determined using a random effects model.ResultOut of 1657 articles reviewed, only 21 of them were eligible for final analysis. All of the included studies were used to estimate the pooled prevalence of long-lasting insecticidal net utilization. The point prevalence of LLIN utilization ranged from 14.23 to 91.9%. The Meta-analysis estimated that the overall pooled prevalence of insecticidal nets utilization among all study participants in Ethiopia was 56.26% (95%CI: 44.04–68.48%). Subgroup analysis revealed that insecticidal nets utilization was relatively highest in the Amhara region [63.0, 95%CI (37.0–89.0%)] and during 2020–2023 [61, 95% CI (53.0–69.0%)].ConclusionLong-lasting insecticidal nets utilization in Ethiopia is lower than the national target plan. Hence, it needs extra follow-up and intervention to enhance its utilization.

High parasitaemia correlates with malaria episodes and the socioeconomic impact of recurrent malaria infection in high-transmission zone of Nigeria

BackgroundRecurrent malaria infection is a major phenomenon in a hightransmission zone with deplorable health and socioeconomic consequences on individuals and the public. However, the association between parasitaemia, repeated episodes of the infection, and its socioeconomic impact is less studied. Therefore, this study aimed at bridging this research gap by conducting an epidemiological survey in selected malaria-endemic settings of Kwara state, Nigeria.ResultsHigh prevalence and intensity of infection were observed, 56.6% of 572 study participants were infected with average parasitaemia of 3022.25 ± 1001.51 per µl of blood and the majority of heavy infection was due to Plasmodium falciparum. The heavily asymptomatic infected participants were among the younger age group particularly ≤ 20 years, and infection decreases with increasing age. Parasitaemia and the number of episodes of malaria attacks were positively correlated (R2 = 0.2388, p < 0.0001). Highrecurrent malaria was associated with male (p = 0.001), younger age (p = 0.0012), low-income status (p = 0.0004), bush around habitation (0.0014), and unavoidability of preventive strategies and treatment (p < 0.0001) of malaria. Our study further revealed socioeconomic factors as cause and/or consequence of recurrent malaria infection. Low income individuals (aOR 1.948 95%CI 0.945–2.512) and illiterates (aOR 1.920 95%CI 1.470–2.149), those living close to bush (aOR 2.501 95%CI 2.033–3.714) and dumpsite (aOR 2.718 95%CI 1.661–3.118) are at least twice likely to have recurrent infection. The socioeconomic consequence of recurrent malaria episodes includes reduced economic activities, personal savings, and change of lifestyle in adults, while infected children suffered declined academic performance and sports activities.ConclusionsThis study underscores high malaria intensity as a prevalent health problem in our study location and demonstrates a positive correlation between malaria episodes and parasitaemia which can be explored in the clinic for the screening of suitable antimalarial drugs that cure beyond a single infection. Our finding also advocates for mass distribution of insecticide-treated nets, provision of socio-infrastructural amenities such as medical centers, good drainage system and highly subsidized malaria treatment in endemic endemic rural communities

Impact of mass distribution of insecticide-treated nets in Mozambique, 2012 to 2025: Estimates of child lives saved using the Lives Saved Tool.

Malaria was the leading cause of post-neonatal deaths in Mozambique in 2017. The use of insecticide treated nets (ITNs) is recognized as one of the most effective ways to reduce malaria mortality in children. No previous analyses have estimated changes in mortality attributable to the scale-up of ITNs, accounting for provincial differences in mortality rates and coverage of health interventions. Based upon annual provincial ownership coverage of ITNs, the Lives Saved Tool (LiST), a multi-cause mathematical model, estimated under-5 lives saved attributable to increased household ITN coverage in 10 provinces of Mozambique between 2012 and 2018, and projected lives saved from 2019 to 2025 if 2018 coverage levels are sustained. An estimated 14,040 under-5 child deaths were averted between 2012 and 2018. If 2018 coverage levels are maintained until 2025, an additional 33,277 child deaths could be avoided. If coverage reaches at least 85% in all ten provinces by 2022, then a projected 36,063 child lives can be saved. From 2012 to 2018, the estimated number of lives saved was highest in Zambezia and Tete provinces. Increases in ITN coverage can save a substantial number of child lives in Mozambique. Without continued investment, thousands of avoidable child deaths will occur.

The effect of a mass distribution of insecticide-treated nets on insecticide resistance and entomological inoculation rates of Anopheles gambiae s.l. in Bandundu City, Democratic Repub`lic of Congo.

Introductioninsecticide-treated nets (ITNs) remain the mainstay of malaria vector control in the Democratic Republic of Congo. However, insecticide resistance of malaria vectors threatens their effectiveness. Entomological inoculation rates and insecticide susceptibility in Anopheles gambiae s.l. were evaluated before and after mass distribution of ITNs in Bandundu City for possible occurrence of resistance.Methodsa cross-sectional study was conducted from 15th July 2015 to 15th June 2016. Adult mosquitoes were collected using pyrethrum spray catches and human landing catches and identified to species level and tested for the presence of sporozoites. Bioassays were carried out before and after distribution of ITNs to assess the susceptibility of adult mosquitoes to insecticides. Synergist bioassays were also conducted and target site mutations assessed using Polymerase chain reaction (PCR).Resultsa total of 1754 female An. gambiae s.l. were collected before and after deployment of ITNs. Fewer mosquitoes were collected after the distribution of ITNs. However, there was no significant difference in sporozoite rates or the overall entomological inoculation rate before and after the distribution of ITNs. Test-mosquitoes were resistant to deltamethrin, permethrin, and Dichlorodiphenyltrichloroethane but susceptible to bendiocarb. Pre-exposure of mosquitoes to Piperonyl butoxide increased their mortality after exposure to permethrin and deltamethrin. The frequency of the Kinase insert domain receptor (kdr)-West gene increased from 92 to 99% before and after the distribution of nets, respectively.Conclusionseasonal impacts could be a limiting factor in the analysis of these data; however, the lack of decrease in transmission after the distribution of new nets could be explained by the high-level of resistance to pyrethroid.

Primary Healthcare on Utilization of Insecticide Treated Nets among Pregnant Mothers and Carers of Children in South –South Nigeria

One of the strategies of Primary Health Care (PHC) is the use of insecticide treated nets (ITNs) against malaria among pregnant mothers and care givers of children under five years. The agency for PHC in Nigeria is the National Primary Health Care Development Agency (NPHCDA). The objective of this narrative review is to identify the role of PHC providers in promoting the use of ITNs among pregnant mothers and care givers of children under five years. Method was by review of 30 published literatures on PHC; as it relates to use of ITNs. Findings indicate that most pregnant mothers and care-givers of children under five years in Nigeria are aware that the best option to prevent malaria infection is by use of ITNs. Healthcare providers participate in mass distribution of ITNs. There is increase nets ownership in households. Supervisory guidance influences use of ITNs. However, there is evidence of slow uptake of ITNs due to resistance to behavioural change. Also, the knowledge of pregnant women concerning ITNs use was good, but the attitudes and practices were poor. The implication is that health promotion need to be enhanced among both PHC workers and community leaders on use of ITNs. Primary healthcare workers may need to be motivated to do their job in terms of promoting the use of ITNs among pregnant mothers and carers of children under five years.

Intensity of pyrethroid resistance in Anopheles gambiae before and after a mass distribution of insecticide-treated nets in Kinshasa and in 11 provinces of the Democratic Republic of Congo

BackgroundBetween 2011 and 2018, an estimated 134.8 million pyrethroid-treated long-lasting insecticidal nets (LLINs) were distributed nationwide in the Democratic Republic of Congo (DRC) for malaria control. Pyrethroid resistance has developed in DRC in recent years, but the intensity of resistance and impact on LLIN efficacy was not known. Therefore, the intensity of resistance of Anopheles gambiae sensu lato (s.l.) to permethrin and deltamethrin was monitored before and after a mass distribution of LLINs in Kinshasa in December 2016, and in 6 other sites across the country in 2017 and 11 sites in 2018.MethodsIn Kinshasa, CDC bottle bioassays using 1, 2, 5, and 10 times the diagnostic dose of permethrin and deltamethrin were conducted using An. gambiae s.l. collected as larvae and reared to adults. Bioassays were conducted in four sites in Kinshasa province 6 months before a mass distribution of deltamethrin-treated LLINs and then two, six, and 10 months after the distribution. One site in neighbouring Kongo Central province was used as a control (no mass campaign of LLIN distribution during the study). Nationwide intensity assays were conducted in six sites in 2017 using CDC bottle bioassays and in 11 sites in 2018 using WHO intensity assays. A sub-sample of An. gambiae s.l. was tested by PCR to determine species composition and frequency of kdr-1014F and 1014S alleles.ResultsIn June 2016, before LLIN distribution, permethrin resistance intensity was high in Kinshasa; the mean mortality rate was 43% at the 5× concentration and 73% at the 10× concentration. Bioassays at 3 time points after LLIN distribution showed considerable variation by site and time and there was no consistent evidence for an increase in pyrethroid resistance intensity compared to the neighbouring control site. Tests of An. gambiae s.l. in 6 sites across the country in 2017 and 11 sites in 2018 showed all populations were resistant to the diagnostic doses of 3 pyrethroids. In 2018, the intensity of resistance varied by site, but was generally moderate for all three pyrethroids, with survivors at ×5 the diagnostic dose. Anopheles gambiae sensu stricto (s.s.) was the most common species identified across 11 sites in DRC, but in Kinshasa, An. gambiae s.s. (91%) and Anopheles coluzzii (8%) were sympatric.ConclusionsModerate or high intensity pyrethroid resistance was detected nationwide in DRC and is a serious threat to sustained malaria control with pyrethroid LLINs. Next generation nets (PBO nets or bi-treated nets) should be considered for mass distribution.

Domestic Larval Control Practices and Malaria Prevalence among Under-Five Children in Burkina Faso.

IntroductionLarval source management has contributed to malaria decline over the past years. However, little is known about the impact of larval control practices undertaken at the household level on malaria transmission.MethodsThe study was conducted in Kaya health district after the 2010 mass distribution of insecticide treated-nets and the initiation of malaria awareness campaigns in Burkina Faso. The aim was to (i) estimate the level of domestic larval control practices (cleaning of the house and its surroundings, eradication of larval sources, and elimination of hollow objects that might collect water); (ii) identify key determinants; and (iii) explore the structural relationships between these practices, participation in awareness-raising activities and mothers’ knowledge/attitudes/practices, and malaria prevalence among under-five children.ResultsOverall, 2004 households were surveyed and 1,705 under-five children were examined. Half of the mothers undertook at least one action to control larval proliferation. Mothers who had gone to school had better knowledge about malaria and were more likely to undertake domestic larval control practices. Living in highly exposed rural areas significantly decreased the odds of undertaking larval control actions. Mothers’ participation in malaria information sessions increased the adoption of vector control actions and bednet use. Malaria prevalence was statistically lower among children in households where mothers had undertaken at least one vector control action or used bed-nets. There was a 0.16 standard deviation decrease in malaria prevalence for every standard deviation increase in vector control practices. The effect of bednet use on malaria prevalence was of the same magnitude.ConclusionCleaning the house and its surroundings, eradicating breeding sites, and eliminating hollow objects that might collect water play a substantial role in preventing malaria among under-five. There is a need for national malaria control programs to include or reinforce training activities for community health workers aimed at promoting domestic larval control practices.

Malaria transmission in Tripura: Disease distribution & determinants.

Background & objectives:Malaria is a major public health problem in Tripura and focal disease outbreaks are of frequent occurrence. The State is co-endemic for both Plasmodium falciparum and P. vivax and transmission is perennial and persistent. The present study was aimed to review data on disease distribution to prioritize high-risk districts, and to study seasonal prevalence of disease vectors and their bionomical characteristics to help formulate vector species-specific interventions for malaria control.Methods:Data on malaria morbidity in the State were reviewed retrospectively (2008-2012) for understanding disease distribution and transmission dynamics. Cross-sectional mass blood surveys were conducted in malaria endemic villages of South Tripura district to ascertain the prevalence of malaria and proportions of parasite species. Mosquito collections were made in human dwellings of malaria endemic villages aiming at vector incrimination and to study relative abundance, resting and feeding preferences, and their present susceptibility status to DDT.Results:The study showed that malaria was widely prevalent and P. falciparum was the predominant infection (>90%), the remaining were P. vivax cases. The disease distribution, however, was uneven with large concentration of cases in districts of South Tripura and Dhalai coinciding with vast forest cover and tribal populations. Both Anopheles minimus s.s. and An. baimaii were recorded to be prevalent and observed to be highly anthropophagic and susceptible to DDT. Of these, An. minimus was incriminated (sporozoite infection rate 4.92%), and its bionomical characteristics revealed this species to be largely indoor resting and endophagic.Interpretation & conclusions:For effective control of malaria in the State, it is recommended that diseases surveillance should be robust, and vector control interventions including DDT spray coverage, mass distribution of insecticide-treated nets/long-lasting insecticidal nets should be intensified prioritizing population groups most at risk to avert impending disease outbreaks and spread of drug-resistant malaria.

Evaluation of universal coverage of insecticide-treated nets in western Kenya: field surveys.

BackgroundMass distribution of insecticide-treated nets (ITNs) is a cost-effective way to achieve universal coverage, but maintaining this coverage is more difficult. In addition to commonly used indicators, evaluation of universal coverage should include coverage of effective nets and changes in coverage over time.MethodsLongitudinal and cross-sectional household ITN surveys were carried out from 2010 to 2013 in six locations representing a variety of settings across western Kenya. Five indicators were used to evaluate the current status of universal coverage: 1) ITN ownership – proportion of households that own at least one ITN, 2) access index – ratio of the number of family members over the number of ITNs owned by that household, 3) operational coverage – proportion of the at-risk population potentially covered by ITNs, assuming one ITN for every two people, 4) effective coverage – population coverage of effective ITNs, and 5) usage – proportion of the population that used ITNs the previous night.ResultsITN ownership and operational coverage increased substantially from 2010 to 2013, but this increase was mostly due to the 2011 mass distribution campaign. In 2013, household ITN ownership was on average 84.4% (95% CI [78.4, 90.5]) across the six study areas, and operational coverage was 83.2% (95% CI [72.5, 93.8]). The ITN access rate was 59.1% (95% CI [56.6, 61.7]), and 40.8% (95% CI [38.3, 43.4]) of the people at risk needed more nets to achieve universal coverage. About 88.5% (95% CI [86.1, 90.9]) of the ITNs were below three years old and 16.5% (95% CI [12.1, 20.9]) of the ITNs had hole(s). The estimated effective long-lasting insecticide-treated net (LLIN) coverage was 70.5% (95 CI [58.7, 82.3]). Approximately 18.4% (95% CI [15.5, 21.4]) of the ITNs were shared by more than three persons, and the population ITN usage rate was about 75-87%. The reason for not using ITNs was almost exclusively “net not available”.ConclusionCurrent methods of delivering ITNs, i.e., one mass campaign every five years and regular distribution of ITNs from health center can barely maintain the current effective coverage. Inaccessibility and loss of physical integrity of ITNs are major hindrances to achieving and maintaining universal coverage.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-351) contains supplementary material, which is available to authorized users.

Effect of bednets and indoor residual spraying on spatio-temporal clustering of malaria in a village in south Ethiopia: a longitudinal study.

BackgroundUnderstanding the spatio-temporal pattern of malaria transmission where prevention and control measures are in place will help to fine-tune strategies. The objective of this study was to assess the effect of mass distribution of bednets and indoor residual spraying (IRS) with insecticides on the spatio-temporal clustering of malaria in one malaria endemic village in south Ethiopia.MethodsA longitudinal study was conducted from April 2009 to April 2011. The average population was 6631 in 1346 locations. We used active and passive searches for malaria cases for 101 weeks. SatScan v9.1.1 was used to identify statistically significant retrospective space–time clusters. A discrete Poisson based model was applied with the aim of identifying areas with high rates. PASW Statistics 18 was used to build generalized Poisson loglinear model.ResultsThe total number of both types of malaria episodes was 622, giving 45.1 episodes per 1000 persons per year; among these, episodes of Plasmodium falciparum and vivax infection numbered 316 (22.9 per 1000 per year) and 306 (22.2 per 1000 per year), respectively. IRS with Dichlorodiphenyltrichloroethane (DDT) and later with Deltamethrin and free mass distribution of insecticide-treated nets (ITNs) were carried out during the study period. There was space–time clustering of malaria episodes at a household level. The spatio-temporal clustering of malaria was not influenced by free mass distribution of ITNs; however, the time-span of the spatio-temporal clustering of malaria cases ended after IRS with Deltamethrin. The presence of clusters on the south-east edge of the village was consistent with the finding of an increasing risk of acquiring malaria infection for individuals who lived closer to the identified vector breeding site.ConclusionThe risk of getting malaria infection varied significantly within one village. Free mass distribution of ITNs did not influence the spatio-temporal clustering of malaria, but IRS might have eliminated malaria clustering.

Integrating insecticide‐treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher‐based methods

Population coverage of insecticide-treated nets (ITNs) in Africa falls well below the Abuja target of 60% while coverage levels achieved during vaccination campaigns in the same populations typically exceed 90%. Household (HH) cost of ITNs is an important barrier to their uptake. We investigated the coverage, equity and cost of linking distribution of free ITNs to a measles vaccination campaign. During a national measles vaccination campaign in Zambia, children in four rural districts were given a free ITN when they received their measles vaccination. In one urban district, children were given a voucher, which could be redeemed for a net at a commercial distribution site. About 1700 HHs were asked whether they received vaccination and an ITN during a measles campaign, as well as questions on assets (e.g. type roofing material or bicycle ownership) to assess HH wealth. Net ownership was calculated for children in each wealth quintile. In the rural areas, ITN coverage among children rose from 16.7% to 81.1% and the equity ratio from 0.32 to 0.88 and in the urban area from 50.7% to 76.2% (equity ratio: 0.66-1.19). The operational cost per ITN delivered was dollar 0.35 in the rural area with direct distribution and $1.89 in the urban areas with voucher distribution. Mass distribution of ITNs through vaccination campaigns achieves rapid, high and equitable coverage at low cost.