Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo

Abstract

BackgroundLong-lasting insecticidal nets (LLIN) are a highly effective means for preventing malaria infection and reducing associated morbidity and mortality. Mass free distribution campaigns have been shown to rapidly increase LLIN ownership and use. Around 3.5 million LLINs were distributed free of charge in the Kasaï Occidental Province in the Democratic Republic of Congo (DRC) in September–October 2014, using two different approaches, a fixed delivery strategy and a door-to-door strategy including hang-up activities.MethodsRepeated community-based cross-sectional surveys were conducted 2 months before and six months after the mass distribution. Descriptive statistics were used to measure changes in key malaria household indicators. LLIN ownership and use were compared between delivery strategies. Univariate and multivariate logistic regression analyses were used to identify factors associated with LLIN use before and after the mass distribution. A comparative financial cost analysis between the fixed delivery and door-to-door distribution strategies was carried out from the provider’s perspective.ResultsHousehold ownership of at least one LLIN increased from 39.4% pre-campaign to 91.4% post-campaign and LLIN universal coverage, measured as the proportion of households with at least one LLIN for every two people increased from 4.1 to 41.1%. Population access to LLIN within the household increased from 22.2 to 80.7%, while overall LLIN use increased from 18.0 to 68.3%. Higher LLIN ownership was achieved with the fixed delivery strategy compared with the door-to-door (92.5% [95% CI 90.2–94.4%] versus 85.2% [95% CI 78.5–90.0%]), while distribution strategy did not have a significant impact on LLIN use (69.6% [95% CI 63.1–75.5%] versus 65.7% [95% CI 52.7–76.7%]). Malaria prevalence among children aged 6–59 months was 44.8% post-campaign. Living in a household with sufficient numbers of LLIN to cover all members was the strongest determinant of LLIN use. The total financial cost per LLIN distributed was 6.58 USD for the fixed distribution strategy and 6.61 USD for the door-to-door strategy.ConclusionsThe mass distribution campaign was effective for rapidly increasing LLIN ownership and use. These gains need to be sustained for long-term reduction in malaria burden. The fixed delivery strategy achieved a higher LLIN coverage at lower delivery cost compared with the door-to-door strategy and seems to be a better distribution strategy in the context of the present study setting.

Access to and use of long-lasting insecticidal nets and factors associated with non-use among communities in malaria-endemic areas of Al Hudaydah governorate in the Tihama region, west of Yemen

“…This finding is similar to a study in Southwestern Ethiopia where half of the population (51.9%) had access to LLINs indicating that there is still a wide access gap in these malaria endemic settings targeted for universal coverage [22]. A much lower proportion of population with access to LLINs has been reported in Congo, 3 years following a mass campaign [23]. In the latter study, in a 2-month pre-distribution survey, the proportion of households with at least one LLIN for every two people was 4.1% and the population with access to a LLIN was 22.2% [23].…”

Lots Quality Assurance Survey (LQAS) as a Strategy to Achieving Quality LLIN Campaigns: The Nigerian Experience

“…where attention needs to be focused on identifying areas where the programme is not working well [2]. The findings of this study are comparable to many expensive, time and resources consuming researches whose results may come out too late to be used to correct the gaps identified.…”

“…The use of LLINs especially in malaria endemic countries is considered as one of the most cost-effective measures towards malaria prevention [1] [2]. This study critically examined the benefits of adopting and scaling up the use of LQAS tool to assess the quality of LLIN campaigns within the shortest possible time to identify post LLIN campaign gaps as done in immunization which will be very helpful in addressing identified gaps promptly.…”

Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

“…Most of the economic studies do not compare the distribution of LLINs through the same mechanisms or channel. Recently, Ntuku et al [6] evaluated a fixed delivery strategy and a door-to-door strategy.…”