Design, implementation and evaluation of a national campaign to distribute nine million free LLINs to children under five years of age in Tanzania

Abstract

BackgroundAfter a national voucher scheme in 2004 provided pregnant women and infants with highly subsidized insecticide-treated nets (ITNs), use among children under five years (U5s) in mainland Tanzania increased from 16% in 2004 to 26.2% in 2007. In 2008, the Ministry of Health and Social Welfare planned a catch-up campaign to rapidly and equitably deliver a free long-lasting insecticidal net (LLIN) to every child under five years in Tanzania.MethodsThe ITN Cell, a unit within the National Malaria Control Programme (NMCP), coordinated the campaign on behalf of the Ministry of Health and Social Welfare. Government contractors trained and facilitated local government officials to supervise village-level volunteers on a registration of all U5s and the distribution and issuing of LLINs. The registration results formed the basis for the LLIN order and delivery to village level. Caregivers brought their registration coupons to village issuing posts during a three-day period where they received LLINs for their U5s. Household surveys in five districts assessed ITN ownership and use immediately after the campaign.ResultsNine donors contributed to the national campaign that purchased and distributed 9.0 million LLINs at an average cost of $7.07 per LLIN, including all campaign-associated activities. The campaign covered all eight zones of mainland Tanzania, the first region being covered separately during an integrated measles immunization/malaria LLIN distribution in August 2008, and was implemented one zone at a time from March 2009 until May 2010. ITN ownership at household level increased from Tanzania's 2008 national average of 45.7% to 63.4%, with significant regional variations. ITN use among U5s increased from 28.8% to 64.1%, a 2.2-fold increase, with increases ranging from 22.1-38.3% percentage points in different regions.ConclusionA national-level LLIN distribution strategy that fully engaged local government authorities helped avoid additional burden on the healthcare system. Distribution costs per net were comparable to other public health interventions. Particularly among rural residents, ITN ownership and use increased significantly for the intended beneficiaries. The upcoming universal LLIN distribution and further behaviour change communication will further improve ITN ownership and use in 2010-2011.

A rapid, low-cost methodology for longitudinal evaluation of insecticide treated bednet distributions: a pilot survey coupling bednet usage with malaria prevalence at the household level

“…Furthermore, our survey was conducted in only one village while the postintervention monitoring program surveyed a total of 4500 households randomly selected from 150 villages in 5 representative districts. 10 Our methodology would be expected to yield an even lower per-household cost if the evaluation was expanded to include more households because greater quantities of supplies such as the rapid antigen tests and the malaria treatment can be obtained at a lower unit price. This methodology can be replicated and scaled up into a cluster design to survey a larger proportion of the population.…”

“…Following the NMCP's distribution of LLINs to households with children under five, an English academic institute and an evaluation contractor conducted a household survey of ITN usage in selected areas, 10 compared to baseline data from the last national survey completed in 2008. 11 Although the post-inter- vention monitoring program measured household ownership and usage of bednets after the intervention, no data were collected about malaria prevalence in the households and communities where the survey took place.…”

“…Total expenditure on monitoring during the Under 5 Coverage Campaign was 106,000 USD which paid for survey of 4500 households (24.44 USD per household). 10 In 2007, researchers from Mount Sinai School of Medicine in New York developed a plan for a rapid yet detailed assessment of the progress of the NMCP's malaria control program in one village while limiting on-site personnel to medical students, local nurses, and local lay people. Researchers assessed baseline malaria prevalence and bednet usage at the household level and repeated the study annually to investigate changes in these parameters following two phases of malaria control measures implemented by the NMCP.…”

The Impact of Mass Bed Net Distribution Programs on Politics: Evidence from Tanzania

“…One month after distribution, the Red Cross (or district health staff in areas where the Red Cross was not active) followed up at households with a campaign to encourage correct bed net use. Over 8.7 million nets were issued, and the total program cost was $63 million (Bonner et al, 2011).…”

“…ITN distribution programs in Tanzania started out with relatively small-scale pilots in the late 1990s in several districts, which were seen as highly effective in reducing malaria-related mortality and morbidity (Schellenberg et al, 2001). In 2004, a national voucher scheme was created (Njau et al, 2009) unteers, who registered all households and then distributed the nets (Bonner et al, 2011). The nets themselves were manufactured by A to Z Textiles Ltd., a domestic Tanzanian manufacturing firm.…”