Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience

Magesa, Stephen; Lengeler, Christian; deSavigny, Don; Miller, Jane; Njau, Ritha; Kramer, Karen L.; Kitua, Andrew Y; Mwita, Alex

doi:10.1186/1475-2875-4-34

Cited by 95 publications

(58 citation statements)

References 23 publications

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“…Much of the essential experience generated by KINET was later integrated into the ITN promotion strategy of the National Malaria Control Programme of Tanzania, which supports private sector distribution through a voucher system that subsidizes purchase by vulnerable priority groups [101]. In the meantime, the preceding KINET pilot in Kilombero has achieved 75 % net use amongst randomly sampled residents of all ages (Killeen et al, unpublished data).…”

Section: Discussionmentioning

confidence: 99%

Preventing Childhood Malaria in Africa by Protecting Adults from Mosquitoes with Insecticide-Treated Nets

et al. 2007

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BackgroundMalaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. Insecticide-treated nets (ITNs) represent a practical means to prevent malaria in Africa, so scaling up coverage to at least 80% of young children and pregnant women by 2010 is integral to the Millennium Development Goals (MDG). Targeting individual protection to vulnerable groups is an accepted priority, but community-level impacts of broader population coverage are largely ignored even though they may be just as important. We therefore estimated coverage thresholds for entire populations at which individual- and community-level protection are equivalent, representing rational targets for ITN coverage beyond vulnerable groups.Methods and FindingsUsing field-parameterized malaria transmission models, we show that high (80% use) but exclusively targeted coverage of young children and pregnant women (representing <20% of the population) will deliver limited protection and equity for these vulnerable groups. In contrast, relatively modest coverage (35%–65% use, with this threshold depending on ecological scenario and net quality) of all adults and children, rather than just vulnerable groups, can achieve equitable community-wide benefits equivalent to or greater than personal protection.ConclusionsCoverage of entire populations will be required to accomplish large reductions of the malaria burden in Africa. While coverage of vulnerable groups should still be prioritized, the equitable and communal benefits of wide-scale ITN use by older children and adults should be explicitly promoted and evaluated by national malaria control programmes. ITN use by the majority of entire populations could protect all children in such communities, even those not actually covered by achieving existing personal protection targets of the MDG, Roll Back Malaria Partnership, or the US President's Malaria Initiative.

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Section: Discussionmentioning

confidence: 99%

Preventing Childhood Malaria in Africa by Protecting Adults from Mosquitoes with Insecticide-Treated Nets

et al. 2007

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“…In Tanzania mainland the responsibility of sustainably and equitably scaling up ITN use lies with the Ministry of Health and Social Welfare (MoHSW). Therefore, the National Insecticide Treated Nets (NATNETS) Programme was established in 2000 under the National Malaria Control Programme (NMCP) of the MoHSW [6,7]. As of late 2012, the programme has worked with numerous partners and been financed by a range of bilateral and multilateral donors.…”

Section: Introductionmentioning

confidence: 99%

Design, implementation and evaluation of a national campaign to deliver 18 million free long-lasting insecticidal nets to uncovered sleeping spaces in Tanzania

Renggli

Mandike

Kramer

et al. 2013

Malar J

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116

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BackgroundSince 2004, the Tanzanian National Voucher Scheme has increased availability and accessibility of insecticide-treated nets (ITNs) to pregnant women and infants by subsidizing the cost of nets purchased. From 2008 to 2010, a mass distribution campaign delivered nine million long-lasting insecticidal nets (LLINs) free-of-charge to children under-five years of age in Tanzania mainland. In 2010 and 2011, a Universal Coverage Campaign (UCC) led by the Ministry of Health and Social Welfare (MoHSW) was implemented to cover all sleeping spaces not yet reached through previous initiatives.MethodsThe UCC was coordinated through a unit within the National Malaria Control Programme. Partners were contracted by the MoHSW to implement different activities in collaboration with local government authorities. Volunteers registered the number of uncovered sleeping spaces in every household in the country. On this basis, LLINs were ordered and delivered to village level, where they were issued over a three-day period in each zone (three regions). Household surveys were conducted in seven districts immediately after the campaign to assess net ownership and use.ResultsThe UCC was chiefly financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria with important contributions from the US President’s Malaria Initiative. A total of 18.2 million LLINs were delivered at an average cost of USD 5.30 per LLIN. Overall, 83% of the expenses were used for LLIN procurement and delivery and 17% for campaign associated activities. Preliminary results of the latest Tanzania HIV Malaria Indicator Survey (2011–12) show that household ownership of at least one ITN increased to 91.5%. ITN use, among children under-five years of age, improved to 72.7% after the campaign. ITN ownership and use data post-campaign indicated high equity across wealth quintiles.ConclusionClose collaboration among the MoHSW, donors, contracted partners, local government authorities and volunteers made it possible to carry out one of the largest LLIN distribution campaigns conducted in Africa to date. Through the strong increase of ITN use, the recent activities of the national ITN programme will likely result in further decline in child mortality rates in Tanzania, helping to achieve Millennium Development Goals 4 and 6.

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“…These perceptions Efforts at up-scaling ITNs at the national level have been tested in Tanzania and else where on promoting and developing a commercial sector for insecticide-treated nets, creating an enabling environment for the distribution and use of ITNs and targeting pregnant women with highly subsidizedtreated nets through a national voucher scheme. Through these efforts, about two million nets and 2.2 million re-treatment kits were distributed in Tanzania in 2004 [28,29]. These evidences imply that up scaling of ITNs at the national level is possible with concerted efforts from all stakeholders and that increasing coverage through a national coordinated significantly affect regular use of ITNs during periods when the mosquito population is low [33].…”

Section: Community Acceptance Of Itnsmentioning

confidence: 92%

Prevention of Malaria Using ITNs: Potential for Achieving the Millennium Development Goals

Binka¹,

Akweongo

2006

CMM

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The use of insecticide treated nets is effective in reducing all cause malaria mortality and morbidity between 17 and 43% in children under five years and provides protection to pregnant women who are most susceptible to malaria. ITNs (Insecticide Treated Nets) are easy to use and require less technical and capital outlay to implement compared with other vector control methods. They are cost-effective, which has led to widespread implementation of ITNs by countries on a large scale. ITN use has however been limited due to the cost outlay households require to make towards the purchase of nets, households' inability to associate the effectiveness of the net with the insecticide leading to low re-treatment rates in most settings and the seasonality associated with the spread of malaria. This chapter provides a review of research on ITN, strategies of improving the availability and effectiveness of the nets and a comparison of ITNs and other malaria preventive methods. The review highlights inequity in ITN use among various socio-economic groups with the poorest being the least to benefit from ITNs even where they are highly subsidized. It discusses the break through in the production of PermaNet to resolve the problem of low re-treatment of nets.

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Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience

Cited by 95 publications

References 23 publications

Preventing Childhood Malaria in Africa by Protecting Adults from Mosquitoes with Insecticide-Treated Nets

Preventing Childhood Malaria in Africa by Protecting Adults from Mosquitoes with Insecticide-Treated Nets

Design, implementation and evaluation of a national campaign to deliver 18 million free long-lasting insecticidal nets to uncovered sleeping spaces in Tanzania

Prevention of Malaria Using ITNs: Potential for Achieving the Millennium Development Goals

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