Strategies for delivering insecticide-treated nets at scale for malaria control: a systematic review
Barbara A Willey, Lucy Smith Paintain, Lindsay Mangham, Josip Car & Joanna Armstrong Schellenberg
Volume 90, Number 9, September 2012, 672-684E
Table 2. Summary of 20 studies on the delivery of insecticide-treated nets (ITNs) at scale in areas with endemicity for Plasmodium falciparum and Plasmodium vivax, by delivery strategya
| Delivery strategy | Country, scale | Evaluation method | Outcome | Equity |
|
|---|---|---|---|---|---|
| Indicator | Outcomeb | ||||
| Continuous | |||||
| Full subsidy; routine health services (ANC clinic) and/or community-based | |||||
| ANC clinics to PW (free) and retail to GP (partial subsidy), implemented 2006 in 24 health centre catchment areas | Burkina Faso, 1 district (Kossi) |
cRCT of SM versus SM and ANC distribution via HH surveys in 2007 (1049 HH) | Comparison area: HH LLIN ownership, 23%; social marketing only Intervention area: HH LLIN ownership, 35%; SM and ANC; P < 0.001 |
Not reported | Not reported |
| From 2001, ANC clinics to PW (free) and HF and CHW to GP (full cost; free after 2003) | Eritrea, national |
2004 NMCP survey in 4 of 6 regions; uncontrolled cross-sectional studyc | HH ITN ownership, 62%; ITN use among children < 5, 59% | Not reported | Not reported |
| ANC clinics to PW (free in Adjumani only) and stand-alone net campaign to children < 5 (free in both districts) in 2007 | Uganda, 2 districts (Adjumani, Jinja) |
HH survey in 2007 (378 HH in the ANC study); no controld | ITN use among children < 5, 94% (ANC study: Adjumani) | Not reported | Not reported |
| Partial subsidy; routine health services (HFs; ANC and/or MCH clinics) and/or retailers and/or community-based | |||||
| From 2002, ANC clinics to PW (partial subsidy via voucher); this followed an integrated campaign to children < 5 (free) earlier in 2002 | Ghana, 1 district (Lawra) |
HH survey in 2006 (475 HH, 674 children < 5); uncontrolled cross-sectional study | After campaign and ANC delivery, 2006: HH ITN ownership, 74%; ITN use among children < 5, 60% | HH asset index; equity ratio | Household ITN ownership: equity ratio, 0.95; ITN use among children < 5: equity ratio, 1.08 |
| From 2000, retail to GP; after 2004, MCH clinics to PW and children < 5 in rural areas (partial subsidy) | Kenya, national |
National survey in 2003; monitoring of net sales for MCH sales in 2005c | 2003: HH ITN ownership, 31%; 24% ITN use in < 5, 24%; 2005: 90% of ITNs sold via MCH | Urban/rural residence | 2003 HH survey: ITN use among children < 5 of 51% in urban areas and 17% in rural areas |
| From 2002, MCH clinics to PW and children < 5; after 2003, to GP by community-based groups (partial subsidy) | Malawi, national |
DHS in 2000 and 2004c | Before campaign, 2000: HH ITN ownership, 13%; ITN use among children < 5, 8% After campaign, 2004: HH ITN ownership, 43%; ITN use among children < 5, 38% |
Not reported | Not reported |
| From 1997, HF, community-based and retailers to GP (partial subsidy) | United Republic of Tanzania, 2 districts (Kilombero, Ulanga) |
Demographic Surveillance System in 1997 (10 313 HH, 240 children < 2), 1998 (646 children < 1), 2000 (101 children < 1); cluster survey in 1999 (757 HH with children < 5) | Before campaign, 1997: HH ITN ownership, 37%; ITN use among children < 2, 10% After campaign, 1998: ITN use among children < 1, 45%; 2000: ITN use among children < 1, 54%; 1999: ITN use among children < 5, 18% |
Not reported | Not reported |
| From 2004, ANC clinics to PW (partial subsidy via voucher at retailer) | United Republic of Tanzania, national |
HH survey in 2005 (6199 HH, 5567 children < 5), 2006 (6260 HH, 5815 children < 5), 2007 (6198 HH, 6186 children < 5) | HH ITN ownership, 18% in 2005, 29% in 2006 and 36% in 2007; ITN use among children < 5, 12% in 2005, 21% in 2006 and 26% in 2007 | Asset index | ITN use among children < 5; equity ratio, 0.11 in 2005 and 0.29 in 2007 |
| HF and community volunteers to GP (partial subsidy) from 1998 in 3 intervention districts |
Zambia, 5 districts (Chipata, Lundazi, Chama, Chadiza, Petauka) |
Quasi-experimental study (nonrandomized), HH survey in 2000 (2986) |
Comparison districts: HH ITN ownership, 1.3% Intervention districts: HH ITN ownership, 14%; P < 0.001 |
Asset index |
Comparison districts: concentration index of HH ITN ownership, 0.71 Intervention districts: concentration index of HH ITN ownership, 0.34 |
| Time-limited | |||||
| Full subsidy (free); stand-alone campaign | |||||
| ANC clinics to PW (free) and stand-alone net campaign to children < 5 (free) in 2007 | Uganda, 2 districts (Adjumani, Jinja) |
HH survey in 2007 (Adjumani: 520 HH; Jinja: 547 HH); uncontrolled cross-sectional studyd | After campaign: ITN use among children < 5, 93% in Adjumani and 56% in Jinja | Asset index | ITN use among children under 5: concentration index, 0.08 |
| ITN only campaign to children < 5 and PW (free) 2005–2006 | Zanzibar, 2 districts (Micheweni, North A) |
HH survey in 2006 (Micheweni: 245 HH, 380 children < 5; North A: 264 HH, 389 children < 5); uncontrolled cross-sectional study | After campaign, 2006: ITN use in children < 5, 57% in Micheweni and 87% in North A | Asset index | ITN use among children under 5: equity ratio, 1 in North A and 0.69 in Micheweni |
| Full subsidy (free); integrated with public health campaign | |||||
| Distribution integrated with measles vaccination campaign to children < 5 (free) in 2002 and ANC to PW (partial subsidy via voucher) later in 2002 | Ghana, 1 district (Lawra) |
HH survey in 2003 (475 HH, 674 children < 5) (uncontrolled cross-sectional study) | After campaign, 2003: HH ITN ownership, 90%; ITN use among children < 5, 60% | HH asset index | ITN use among children < 5: equity ratio, 1 (similar across quintiles) |
| Distribution integrated with measles vaccination campaign to children < 5 (free) in 2006 | Kenya, 4 districts (Kwale, Bondo, Greater Kisii, Makueni) |
Before-and-after survey in 2004 (2687 HH, 3719 children < 5), 2006 (2589 HH, 3257 children < 5) | Before campaign, 2004: HH ITN ownership, 24.5%; ITN use among children < 5, 7% After campaign, 2006: HH ITN ownership, 79%; ITN use among children < 5, 67% |
Asset index | HH ITN ownership in 2006: equity ratio, 1.1 (equal across quintiles) v. 1.2 in 2004. |
| Distribution integrated with measles vaccination campaign to children < 5 (free) in 2007 | Madagascar, 59 districts |
HH survey in 2008 (2860 HH, 2369 children < 5); uncontrolled cross-sectional study | After campaign, 2008: HH LLIN ownership, 77%; LLIN use among children < 5, 81% | Asset index | HH LLIN ownership: equity ratio, 1.05 |
| Distribution integrated with polio vaccination campaign to children < 5 (free) in 2005 and 2006 | Niger, national |
HH survey in 2006 (2450 HH); uncontrolled cross-sectional studyd | After campaign, 2006: HH ITN ownership, 65%; ITN use among children < 5, 56% | Asset index | HH ITN ownership: equity ratio, 0.79 |
| Distribution integrated with MDA for LF campaign to PW and children < 5 (free) in 2004 | Nigeria, 2 districts (Kanke, Akwanga) |
HH survey in 2005 (290 HH, 473 children < 5); uncontrolled cross-sectional study | After campaign, 2005: HH ITN ownership, 74%; ITN use among children < 5, 39% | Not reported | Not reported |
| Distribution integrated with measles vaccination campaign to children < 5 (free) in 2004 | Togo, national |
Before-and-after survey in 3 districts in 2004 (Yoto: 495 HH, 718 children < 5; Ogou: 564 HH, 798 children < 5; Tone: 645 HH, children < 5), 2005 (Yoto, 648 HH, 998 children < 5; Ogou: 594 HH, 893 children < 5; Tone: 586 HH, 922 children < 5) | Before campaign, 2004: HH ITN ownership, < 1% in 3 surveyed districts (Yoto, Ogou and Tone) After campaign, 2005: HH ITN ownership, 55%, 59% 70% in Yoto, Ogou and Tone, respectively; ITN use among children < 5, 36%, 44% and 81% in Yoto, Ogou and Tone, respectively |
Asset index | HH ITN ownership in 2005: equity ratio, 1.00, 1.31 and 1.05 in Yoto, Ogou and Tone districts, respectively; 2004: equity ratio, not available |
| Distribution integrated with measles vaccination campaign to children < 5 (free) in 2005 | United Republic of Tanzania, 1 region (Lindi) |
HH survey in 2005 (574 HH, 354 children < 5); uncontrolled cross-sectional study | After campaign, 2005: HH ITN ownership, 37%; ITN use among children < 5, 21.5% | Asset index | HH ITN ownership equity ratio, 0.86 |
| Distribution integrated with measles vaccination campaign to children < 5 (free) and ANC to PW (partial subsidy via voucher at retailer) in 2004–2005 | United Republic of Tanzania, 1 district (Rufiji) |
HH survey in 2006 (1752 HH, 732 children < 5); uncontrolled cross-sectional study | After campaign, 2006: ITN use among children < 5, 40% | Asset index | Overall HH ITN ownership: concentration index, 0.13; free nets campaign: concentration index, 0.02 |
| Distribution integrated with measles vaccination campaign to children < 5 (free) in 2003 | Zambia, 5 districts (Chilubi, Kaputa, Mambwe, Nyimba, Kalalushi) |
HH survey in 2003 (1705 rural HH, 369 urban HH); uncontrolled cross-sectional studye | After campaign, 2003: HH ITN ownership, 88% in rural areas and 82% in urban areas; ITN use among children < 5, 56% in rural areas and 77% in urban areas | Asset index | HH ITN ownership: equity ratio, 0.88 in rural areas and 1.19 in urban areas |
ANC, antenatal care; CHW, community health worker; cRCT, cluster randomized controlled trial; DHS, demographic and health survey; GP, general population; HF, health facility; HH, household; LF, lymphatic filariasis; LLIN, long-lasting insecticidal nets; MCH, maternal and child health; MDA, mass drug administration; NMCP, national malaria control programme; PW, pregnant women; SM, social marketing.
a Studies may appear in more than one category if multiple strategies were used to deliver ITNs at scale or if strategies changed over time.
b For concentration indexes, values of 0 indicate equitable distribution; values > 0 indicate inequitable distribution benefiting the least poor group. For equity ratios, values of 1 indicate equitable distribution; ratios > 1 suggest that the poorest quintiles were favoured.
c Total no. of households included in the study was not reported.
d Total no. of children under 5 included in the study was not reported.
e Denominators for households and children under 5 are equal because the index child (i.e. youngest child in household who was aged ≥ 6 months at time of the campaign) was included in the calculation.