Ownership and usage of mosquito nets after four years of large-scale free distribution in Papua New Guinea

Abstract

BackgroundPapua New Guinea (PNG) is a highly malaria endemic country in the South-West Pacific with a population of approximately 6.6 million (2009). In 2004, the country intensified its malaria control activities with support from the Global Fund. With the aim of achieving 80% ownership and usage, a country-wide campaign distributed two million free long-lasting insecticide-treated nets (LLINs).MethodsIn order to evaluate outcomes of the campaign against programme targets, a country-wide household survey based on stratified multi-stage random sampling was carried out in 17 of the 20 provinces after the campaign in 2008/09. In addition, a before-after assessment was carried out in six purposively selected sentinel sites. A structured questionnaire was administered to the heads of sampled households to elicit net ownership and usage information.ResultsAfter the campaign, 64.6% of households owned a LLIN, 80.1% any type of mosquito net. Overall usage by household members amounted to 32.5% for LLINs and 44.3% for nets in general. Amongst children under five years, 39.5% used a LLIN and 51.8% any type of net, whereas 41.3% of pregnant women used a LLIN and 56.1% any net. Accessibility of villages was the key determinant of net ownership, while usage was mainly determined by ownership. Most (99.5%) of the household members who did not sleep under a net did not have access to a (unused) net in their household. In the sentinel sites, LLIN ownership increased from 9.4% to 88.7%, ownership of any net from 52.7% to 94.1%. Usage of LLINs increased from 5.5% to 55.1%, usage of any net from 37.3% to 66.7%. Among children under five years, usage of LLINs and of nets in general increased from 8.2% to 67.0% and from 44.6% to 76.1%, respectively (all p ≤ 0.001).ConclusionsWhile a single round of free distribution of LLINs significantly increased net ownership, an insufficient number of nets coupled with a heterogeneous distribution led to overall low usage rates. Programme targets were missed mainly as a result of the distribution mechanism itself and operational constraints in this very challenging setting.

Higher Complexity of Infection and Genetic Diversity of Plasmodium vivax Than Plasmodium falciparum Across All Malaria Transmission Zones of Papua New Guinea

“…The highest mean MOI and polyclonality for P. falciparum was recorded in a parasite population from a sentinel site (Morobe: Bulolo, cluster 7), which had been not yet been covered by the free LLIN distribution at the time of the survey. 29 However, there was no difference observed for P. vivax between sentinel sites and other areas that were covered by the free LLIN distribution. This finding is in line with more marked reductions in incidence and prevalence of P. falciparum than P. vivax following the first national distribution of LLIN.…”

“…Some of the results suggest that malaria control initiatives in PNG prior to the survey including LLIN and indoor residual spraying in some areas 29,30 have had a greater impact on P. falciparum. The highest mean MOI and polyclonality for P. falciparum was recorded in a parasite population from a sentinel site (Morobe: Bulolo, cluster 7), which had been not yet been covered by the free LLIN distribution at the time of the survey.…”

“…30 Further details of the survey methodology are published elsewhere. 29,30 We assigned the villages to 27 "geographic clusters" predicted to harbor distinct parasite populations on the basis of topography and predicted human movement ( Figure 1, Supplemental Table 1). Genomic DNA was extracted from whole-blood samples using the QiaAmp DNA Extraction Kit (Qiagen, Chadstone, Victoria, Australia) or the Favorprep TM genomic DNA extraction kit (Favorgen, Ping-Tung, Taiwan).…”

“…[25][26][27][28] From 2004 to 2009, PNG conducted the first country-wide free distribution of long-lasting insecticide treated mosquito nets (LLINs) supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. 29 After the initial roll out of LLIN, a countrywide malaria indicator survey was undertaken to assess malaria prevalence in 49 villages from 16 provinces (of a total of 20), representing all malaria endemic areas of PNG. Additionally, 19 villages were included from six sentinel sites, which had not yet been covered by LLINs.…”

Do ownership of mosquito nets, dwelling characteristics and mothers’ socio-economic status influence malaria morbidity among children under the age of 5 in Cameroon?

“…Similarly, IJOMEH 2015;28(3) 492 The disparities in access to mosquito nets and usage can be explained by free distribution of mosquito nets by the Cameroonian government in order to address the problem of malaria, which is rated above acquired immunodeficiency syndrome (AIDS) and tuberculosis in respect of associated mortality, morbidity and labour days of incapacitation [60]. When compared with other countries, access to mosquito net was lower than that of Papua New Guinea (80.1%) [61]. The findings also emphasized the fact that the ownership of mosquito nets did not automatically translate into their usage [27].…”