Integrating insecticide‐treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher‐based methods

Abstract

SummaryPopulation coverage of insecticide-treated nets (ITNs) in Africa falls well below the Abuja target of 60% while coverage levels achieved during vaccination campaigns in the same populations typically exceed 90%. Household (HH) cost of ITNs is an important barrier to their uptake. We investigated the coverage, equity and cost of linking distribution of free ITNs to a measles vaccination campaign. During a national measles vaccination campaign in Zambia, children in four rural districts were given a free ITN when they received their measles vaccination. In one urban district, children were given a voucher, which could be redeemed for a net at a commercial distribution site. About 1700 HHs were asked whether they received vaccination and an ITN during a measles campaign, as well as questions on assets (e.g. type roofing material or bicycle ownership) to assess HH wealth. Net ownership was calculated for children in each wealth quintile. In the rural areas, ITN coverage among children rose from 16.7% to 81.1% and the equity ratio from 0.32 to 0.88 and in the urban area from 50.7% to 76.2% (equity ratio: 0.66-1.19). The operational cost per ITN delivered was $0.35 in the rural area with direct distribution and $1.89 in the urban areas with voucher distribution. Mass distribution of ITNs through vaccination campaigns achieves rapid, high and equitable coverage at low cost.

Strategies for delivering insecticide-treated nets at scale for malaria control: a systematic review

“…A total of 475 households in Ghana 29,30 and 2074 households in Zambia 49 were surveyed five months and six months, respectively, after ITN delivery campaigns. ITN ownership in Ghana was 90%, whereas ownership in Zambia was 88% in rural areas and 82% in urban areas.…”

“…3 and Table 2). Seven studies provided fully subsidized ITNs through a stand-alone campaign only (in one 41 ) or through an integrated campaign only (in six [42][43][44][47][48][49][50][51]. One study considered the continuous delivery of free ITNs through antenatal clinics.…”

“…Two of the four used a cross-sectional design to evaluate strategies at either the national or district levels. 44,49 The other two used a before-and-after design and also reviewed delivery at the district or national levels. 42,43,47,48 The change in equity index was available only for E r it e a 2 5 U g a n d a : A d ju m a n i 2 7 Z a m b ia : C h ip a t a , L u n d a z i, C h a m a , C h a d iz a , P e t a u k a 2 1 U n it e d R e p u b li c o f T a n z a n ia : n a t io n a l 3 2 -3 5 U n it e d R e p u b li c o f T a n z a n ia : Z a n z ib a r, N o r t h A 4 1 U n it e d R e p u b li c o f T a n z a n ia : Z a n z ib a r, M ic h e w e n i 4 1 K e n y a : K w a le , B o n d o , G r e a t e r K is ii , M a k u e n i 4 2 ,4 3 Z a m b ia : u r b a n ( K a la lu s h i) 4 9 Z a m b ia : r u r a l ( C h il u b i, K a p u t a , M a m b w e , N y im b a ) 4 9 U n it e d R e p u b li c o f T a n z a n ia : L in d i 4 5 K e n y a ( 3 5 d is t r ic t s ) 2 8 G h a n a : L a w r a 2 9 ,3 0 M a la w i 3 ,3 9 ,4 0 U g a n d a : A d ju m a n i 2 7 U g a n d a : J in ja 2 7 M a d a g a s c a r 4 4 U n it e d R e p u b li c o f T a n z a n ia : R u f ij i 4 6 T o g o : T o n e 4 7 ,4 8 T o g o : O g o u 4 7 ,4 8 N ig e r 5 0 N ig e r ia 5 1 T o g o : Y o t o 4 7 ,4 8 G h a n a : L a w r a 2 …”

“…Three studies evaluated the delivery of free ITNs to children under 5 through a campaign integrated with polio or measles vaccination in Niger, in Lindi region of the United Republic of Tanzania, and four rural districts of Zambia (Chilubi, Kaputa, Mambwe and Nyimba). 45,49,50 In the fourth study, the delivery of partially subsidized ITNs to pregnant women via antenatal care clinics in the United Republic of Tanzania was examined. [32][33][34][35] The fifth study reviewed a stand-alone ITN campaign involving distribution of fully subsidized nets to children under 5 in the Micheweni district of Zanzibar.…”

“…The fourth study investigated the Tanzanian National Voucher Scheme and found economic costs of US$ 10.77 per ITN delivered and US$ 6.02 per treated-net-year, with the latter calculation assuming 12-month protection from a treated net. 35 The four studies that evaluated fully subsidized campaigns found financial costs per ITN delivered of US$ 3.71 to US$ 11.79 for those integrated with vaccination campaigns 30,45,49 and US$ 9.48 for a stand-alone campaign. 27 The standalone campaign considered in one of the studies had an economic cost per ITN delivered of US$ 4.76.…”