Multi-country review of ITN routine distribution data: are ANC and EPI channels achieving their potential?

Abstract

Background Routine continuous distribution (CD) of insecticide-treated nets (ITNs) has been an important part of an overall ITN strategy to complement mass campaigns since the early 2000s. The backbone of CD implementation for many sub-Saharan African countries is distribution through antenatal care (ANC) and Expanded Programme for Immunizations (EPI) channels. Performance of these channels is often not monitored closely at the national level, nor is it reviewed globally, unlike the oversight provided to mass campaigns. The question as to why every eligible pregnant woman and child attending these services does not get an ITN remains important and yet, unanswered. Methods ANC and EPI issuing rates from seven countries were reviewed with the aim of conducting a blinded multi-country analysis. Monthly data from January to December 2021 was extracted from each country’s health management information system and analysed jointly with a National Malaria Control Programme (NMCP) focal point. VectorLink CD assessment reports were also reviewed to glean key findings. Results ITN issuing rates varied across countries at ANC (31% to 93%) and EPI (39% to 92%). Across the seven countries, the median ITN issuing rate was 64% at ANC and 78% at EPI. Results varied greatly across months per country at both ANC and EPI. NMCP focal points are aware that mass campaigns often negatively affect implementation of ITN distribution through ANC and EPI, even though global and national guidelines emphasize sustaining CD during campaigns. Concerns were also raised about the standard ITN issuing rate indicator at ANC and even more so at EPI due to the denominator. Findings from CD assessments were similar across countries: ITN stock was inconsistent and sometimes inadequate, and updated guidelines on ITN distribution and utilization and funding for social behaviour change activities were lacking at the facility level. Conclusion The importance of optimizing ANC and EPI routine channels cannot be underscored enough. They are at the frontline to protect the most biologically vulnerable populations, i.e., pregnant women and unborn and young children. Although there are encouraging signs of improvement in issuing rates with some countries reaching optimal rates, further improvements are needed to ensure that every pregnant woman and young child receives the ITN to which they are entitled.

Associations between Household Characteristics and Mosquito Bed Net Utilisation among Under-Five Children in Africa: A Critical Focus on Household Size, Sleeping Rooms, and Demographic Characteristics of Household Heads

“…Despite the usefulness of ITNs as key malaria control tools in SSA, there is reported low usage of ITNs in the region despite relatively high ownership, with barriers such as lack of awareness, poor usage knowledge, inadequate resources, and socio-cultural beliefs hindering the effectiveness of ITN interventions (Orish et al, 2021). Additionally, several factors have been identi ed as barriers or facilitators of ITN ownership and use at the individual and community levels (Miller et al, 2022;Scott et al, 2021;Orish et al, 2021). These include perceptions of malaria and ITNs, availability and affordability of ITNs, and environmental and climatic conditions (Miller et al, 2022;Orish et al, 2021;Scott et al, 2021) Among the factors identi ed, household characteristics may play a signi cant role in in uencing ITN utilisation, especially among children under-ve who are more vulnerable to malaria and depend on their caregivers for protection (Scott et al, 2021;Odufuwa et al, 2020).…”

“…Additionally, several factors have been identi ed as barriers or facilitators of ITN ownership and use at the individual and community levels (Miller et al, 2022;Scott et al, 2021;Orish et al, 2021). These include perceptions of malaria and ITNs, availability and affordability of ITNs, and environmental and climatic conditions (Miller et al, 2022;Orish et al, 2021;Scott et al, 2021) Among the factors identi ed, household characteristics may play a signi cant role in in uencing ITN utilisation, especially among children under-ve who are more vulnerable to malaria and depend on their caregivers for protection (Scott et al, 2021;Odufuwa et al, 2020). However, there is limited evidence on how speci c household characteristics, such as household size, number of sleeping rooms, and the demographic characteristics of household heads, affect ITN utilisation among under-ve children in SSA (Seyoum et al, 2023).…”

Successful implementation of ITN distribution through health facilities in Ghana

“…Even at the global level, there is little public information. For example, a recent multi-country analysis found that the national ITN issuing rates at ANC across seven sub-Saharan countries and EPI for six sub-Saharan countries were 65% and 69%, respectively [ 14 ]. To help fill this knowledge gap, a historical analysis of bed net issuing rates through ANCs and CWCs across six years (2016–2021) was conducted.…”