BackgroundBetween May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana. The campaign included pre-registration of persons and sleeping places, door-to-door distribution of LLINs with ‘hang-up’ activities by volunteers and post-distribution ‘keep-up’ behaviour change communication activities. Hang-up activities were included to encourage high and sustained use.MethodsThe cost and cost-effectiveness of the LLIN Campaign were evaluated using a before-after design in three regions: Brong Ahafo, Central and Western. The incremental cost effectiveness of the ‘hang-up’ component was estimated using reported variation in the implementation of hang-up activities and LLIN use. Economic costs were estimated from a societal perspective assuming LLINs would be replaced after three years, and included the time of unpaid volunteers and household contributions given to volunteers.ResultsAcross the three regions, 3.6 million campaign LLINs were distributed, and 45.5% of households reported the LLINs received were hung-up by a volunteer. The financial cost of the campaign was USD 6.51 per LLIN delivered. The average annual economic cost was USD 2.90 per LLIN delivered and USD 6,619 per additional child death averted by the campaign. The cost-effectiveness of the campaign was sensitive to the price, lifespan and protective efficacy of LLINs.Hang-up activities constituted 7% of the annual economic cost, though the additional financial cost was modest given the use of volunteers. LLIN use was greater in households in which one or more campaign LLINs were hung by a volunteer (OR = 1.57; 95% CI = 1.09, 2.27; p = 0.02). The additional economic cost of the hang-up activities was USD 0.23 per LLIN delivered, and achieved a net saving per LLIN used and per death averted.ConclusionIn this campaign, hang-up activities were estimated to be net saving if hang-up increased LLIN use by 10% or more. This suggests hang-up activities can make a LLIN campaign more cost-effective.

The Ghana Health Service plans to eliminate blinding trachoma by 2010 and has implemented the SAFE strategy since 2001. The programme impact was assessed in all endemic districts. A two-stage, cluster random sample of 720 households was selected in each of 18 endemic districts in Upper West and Northern Regions. All eligible residents were examined for trachoma signs. Household environmental risk factors were assessed. In total, 74,225 persons from 12,679 households were examined. Prevalence of trachomatous inflammation-follicular in 1-9 year-old children was 0.84% (95% CI 0.63-1.05, range of point estimates by district 0.14-2.81%) and prevalence of trichiasis in adults aged > or = 15 years was 0.31% (95% CI 0.24-0.38, range by district 0.00-1.07%). An estimated 4950 persons have trichiasis, of whom 72.6% are aged > or = 60 years and 71.4% are women. Latrines were observed in 11.6% of households and 79.2% of interview respondents reported use of an improved water source. Active trachoma is no longer a public health problem in Ghana after successful implementation of the SAFE strategy. The programme should maintain health education, advocate for improved water and sanitation and focus on providing surgery. Surveillance activities are needed to ensure sustained control.

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Trachoma is not a disease of public health importance in the UER of Ghana despite being in a trachoma endemic zone and sharing the necessary risk factors for the disease.