Impact of a 15-month multi-channel continuous distribution pilot on ITN ownership and access in Eastern Region, Ghana

Abstract

BackgroundInsecticide-treated nets are a key intervention for malaria prevention. While mass distribution can rapidly scale up ITN coverage, multiple channels may be needed to sustain high levels of ITN access and ownership. In Ghana’s Eastern Region, a continuous ITN distribution pilot, started in October 2012, 18–24 months after a mass campaign. The pilot distributed ITNs through antenatal care services (ANC), child welfare clinic services (CWC) through the Expanded Programme on Immunization, and to students in two classes of primary schools.MethodsITN ownership and access were evaluated through two cross-sectional surveys, conducted at baseline in April 2012, 11–15 months after the mass campaign, and at endline in December 2013, after 1 year of continuous distribution. A representative sample was obtained using a multi-stage cluster sampling design. Household heads were interviewed using a structured questionnaire.ResultsHousehold ownership of at least one ITN was 91.3% (95% CI 88.8–93.9) at baseline and was not statistically significant at endline 18 months later at 88.3% (95% CI 84.9–91.0) (p = 0.10). Ownership of at least 1 ITN per two people significantly decreased from 51.3% (95% CI 47.1–55.4) to 40.2% (95% CI 36.4–44.6) (p < 0.01). Population access to an ITN within the household also significantly decreased from 74.5% (95% CI 71.2–77.7) at baseline to 66.4% (95% CI 62.9–69.9) at endline (p < 0.01). The concentration index score for any CD channel was slightly positive (0.10; 95% CI 0.04–0.15).ConclusionThirty-one months after the mass campaign, the 15 months of continuous distribution activities had maintained levels of household ownership at least one ITN, but household ownership of one ITN for every two people and population access to ITN had declined. Ownership and access were higher with the CD programme than without. However, the number of ITNs delivered via ANC, CWC and two primary school classes were insufficient to sustain coverage targets. Future programmes should implement continuous distribution strategies fully within 1 year after a campaign or widen eligibility criteria (such as increase the number of classes) during the first year of implementation to make up for programme delays.

Bio-efficacy, physical integrity, use and attrition of long-lasting insecticidal nets under operational conditions for malaria prevention in Ghana

“…This high ownership of LLINs in households is obviously due to the free mass distribution of LLINs immediately before the study commenced. In the Eastern Region of Ghana, 91.3% ownership was found after thirty-one months post-distribution of LLINs [23]. Based on individual household ownership levels, it is important for the National Malaria Control Programme of Ghana to begin plans for LLINs distributions after a one-year post distribution of free mass campaigns as bed net ownership begins to effectively change after 12 months postdistribution.…”

Measuring quality of facility-based ITN distribution in Ghana

“…Continuous distribution of ITNs through health facilities serves as a primary channel for maintaining ITN access that is achieved through triennial ITN mass distributions and ensuring continuous access to ITNs for pregnant women and children under one year of age. In Ghana, continuous distribution of ITNs through health facilities has been implemented in all districts since 2012 through distribution of ITNs to pregnant women receiving ANC and children receiving the Measles-Rubella Vaccine 2 (MR2) at EPI services (through child welfare clinics [CWCs]) [ 4 ]. There have also been four rounds of mass ITN distribution campaigns since 2010.…”

Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa

“…More countries are beginning to implement CD of nets through schools and communities (through local political/community leaders). School-based distributions have been evaluated in Ghana, Tanzania, and Nigeria [36][37][38][39] and community distribution programmes have been successfully piloted in a number of locations, including Madagascar, South Sudan, and Zanzibar [40,41].…”

“…The financial cost for the community-based CD program was reported to be 19.21 USD (18.81 USD when deflated to 2017 USD) per net distributed. Studies estimating the cost of delivering nets through school-based distribution programs were not identified in the literature, though a small number of studies were identified that evaluated the effects of these systems on net ownership and access [36][37][38][39]. As countries continue to scale up combination delivery systems, they will require information on the costs of these various distribution channels, as well as information about how these costs relate to other outcomes, such as coverage and malaria incidence.…”