Vector Control and Long Lasting Insecticidal Nets



ABSTRACT

Background

Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs.

Methods

A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use.

Results

ITN ownership coverage increased from 10% before the campaigns to 70%-a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among Wealth quintiles (Concentration index 0.02, 95% CI (-0.02 ; 0.05) versus 0.21 95%CI (0.08 ; 0.34) before the campaigns). ITN use (individuals reporting having slept under an ITN the night before the survey visit) among individuals from households owning at least one ITN, was 53.1% with no statistically significant difference between the lowest, second, third and fourth Wealth quintiles and the highest wealth quintile (lowest: odds ratio (OR) 0.87, 95% confidence interval (CI) (0.67 ; 1.13); second: OR 0.85, 95% CI (0.66 ; 1.24); third: OR 1.10 95% CI (0.86 ; 1.4) and fourth OR 0.91 95% CI (0.72 ; 1.15).

Conclusion

The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.

Vector Control and Long Lasting Insecticidal Nets

Background

Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas [1]. However, ITN ownership and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa [2]. With the significant increase in funding in the recent decade, many countries across sub-Saharan Africa are rapidly increasing ITN ownership coverage, that is the percentage of households which own at least one ITN, through several strategies including, social marketing [3,4], free distribution to target groups (through antenatal care (ANC) or immunization campaigns) [5-9], and more recently, free universal population-based distribution campaigns targeting the entire population at risk [3,5,10].

Free distribution campaigns aim at the Roll back Malaria (RBM) goal of universal coverage as opposed to the previous strategies that focused on targeting only pregnant women and children under five. The aim is to achieve the newly agreed-upon Roll Back Malaria (RBM) Partnership target of one ITN for every two people ...