Evaluation of long-lasting insecticidal net distribution through schools in Southern Tanzania

Abstract

Universal coverage with effective vector control remains the mainstay of malaria vector control in sub-Saharan Africa Tanzania has utilized a number of mechanisms for the maintenance of long-lasting insecticidal net (LLIN) coverage over time. Schools have been identified as one potential channel for continuous distribution of LLIN. This research aims to evaluate an annual school based LLIN distribution programme in Tanzania which began in 2013, called the School Net Programme (SNP). Following each of the first four rounds of SNP distribution, a household survey was conducted in intervention and comparison districts in Southern and Lake zones of Tanzania (N = 5083 households). Measures of ownership, access, and use were compared between intervention and comparison districts. Determinants of reach were assessed in intervention districts. Population access to an LLIN increased from 63.1% (95% CI: 58.8, 67.5) to 76.5% (95% CI: 72.9, 80.0) in the intervention districts between the first and last surveys. Access also rose in the comparison districts from 51.4% (95% CI: 46.9, 55.9) to 79.8% (95% CI: 77.3, 82.0) following a mass distribution and implementation of school-based distribution during the study period. LLIN use increased in intervention districts from 44.9% (95% CI: 40.5, 49.3) to 65.6% (95% CI: 59.4, 71.8) and from 57.2% (95% CI: 49.7, 64.7) to 77.4% (95% CI: 69.3, 85.5) specifically amongst primary school-aged children. Households reached by the SNP were wealthier households with children enrolled in school. The SNP in Tanzania was able to maintain population level LLIN ownership, use, and access in the absence of a mass distribution. The SNP successfully reached households which housed school-aged children. Alternative delivery strategies may need to be considered to reach households without children enrolled in school which experienced less benefit from the program.

Annual distributions of insecticide-treated nets to schoolchildren and other key populations to maintain higher ITN access than with mass campaigns: a modelling study for mainland Tanzania

“…These findings are supported by retrospective research in Tanzania that found that continuous distribution at quantities equal to population × 20–25% led to higher ITN access in household surveys than when quantified at lower levels (Koenker et al in review). School distribution in Tanzania has previously been demonstrated to maintain population ITN access and use in the absence of mass campaigns [ 4 , 13 ].…”

LLIN Evaluation in Uganda Project (LLINEUP2)—Factors associated with coverage and use of long‑lasting insecticidal nets following the 2020–21 national mass distribution campaign: a cross-sectional survey of 12 districts

“…Strategies such as school-based interventions aiming to improve LLIN coverage and use in older children are gaining traction. In Tanzania, a study to evaluate a school-based LLIN distribution programme found that LLIN use increased from 57 to 77% among primary school children [ 38 ]. Targeting school-aged children, who can serve as agents of change, can also improve LLIN use within households [ 39 ].…”

Annual distributions of insecticide-treated nets to schoolchildren and other key populations to maintain higher ITN access than with mass campaigns: a modeling study for mainland Tanzania

“…School distribution in Tanzania has previously been demonstrated to maintain population ITN access and use in the absence of mass campaigns [4,13].…”