Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities

Abstract

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.

Perceptions on the effect of small electric fans on comfort inside bed nets in southern Ghana: a qualitative study

“…Between May 2010 and October 2012, approximately 12.5 million LLINs were distributed in all 10 regions of Ghana through a national universal mass distribution hang-up campaign [7]. Despite universal LLIN coverage [8] only 60% of bed nets within the households that had at least one LLIN were being utilized [7].…”

Large-scale implementation of disease control programmes: a cost-effectiveness analysis of long-lasting insecticide-treated bed net distribution channels in a malaria-endemic area of western Kenya—a study protocol

“…[14][15][16][17][18] However, information is limited on the actual costs of parallel distribution channels in the same context and coverage results that can realistically be achieved from each channel based on financial inputs. 19 In 2013, Kenya devolved responsibility for health service delivery from the central government to 47 county governments as mandated in the 2010 Constitution of Kenya. This major restructuring potentially creates challenges due to inconsistencies in practice, duplicate structures and may hamper malaria control.…”

“…[15][16][17][18][19] To analyse the effectiveness of the distribution channel with regard to the cost and outcome measures, descriptive statistics and a generalised linear regression model will be used because cost data are usually not normally distributed. [15][16][17][18] The analysis will include comparison of the different distribution channels as well as a multilevel analysis focusing on cost categories.…”

“…Similarly, LLINs are intended to last for 3 years in field conditions. 19 25 26 Therefore, capital costs will be expressed as an annual equivalent. Capital inputs that will be annualised are LLINs, vehicles and equipment using 3.5% as a discounting rate.…”

“…Capital inputs that will be annualised are LLINs, vehicles and equipment using 3.5% as a discounting rate. [15][16][17][18][19] Cost-effectiveness will be calculated for each comparison and will be expressed as incremental costeffectiveness ratios (ICERs). Mass campaigns are by far the largest channel by volume and assumed to be the least expensive and most efficient channel for distributing LLINs in Kenya; therefore, the campaign distribution channel will be used as a baseline for the comparative analysis.…”