Review on LLIN distribution campaign during the COVID-19 pandemic

written by Dr Herdiana H. Basri, M.Kes, M.Epi - National Professional Officer (Malaria)

LLINs are effective at preventing malaria as they form a physical and chemical barrier against mosquitoes. When mosquitoes try to bite someone sleeping under a LLIN, the netting blocks them, while the insecticide coating kills them.

Fig. 1. LLIN over the mattress in a villager’s house in Indonesia’s West Sumba district. © NIHRD, 2021

The review was conducted in six out of 47 districts with moderate or high malaria endemicity. Batubara and Sorong municipality represented 23 moderate endemic districts, while Tembrauw, Mappi, Boven Digul, and West Sumba represented 24 high endemic districts. The review team consisted of NMCP, National Institute of Health Research and Development (NIHRD), as well as staff of provincial and district health offices. The review team visited 2880 selected households and interviewed their members applying standardised questionnaires. The team also observed LLIN usage within households and conducted in-depth interviews with the primary health centre (PHC) and District Health Office staff involved in the LLIN distribution campaign.

From August 2020 to April 2021, NMCP distributed 3.4 million LLIN using a mass campaign method for high endemic villages and a focal campaign method for moderate and low endemic districts. As of November 2021, 2.8 million (83.48%) out of 3.4 million LLINs had been received by  beneficiaries. Papua province reported that 69% of LLINs were distributed to the community. Some districts have not distributed all LLINs due to security issues or large-scale mobility restrictions. Following WHO’s recommendation, implementing a mass campaign method has been modified into door-to-door distribution during the COVID-19 pandemic.

Findings show that the proportion of ownership of a minimum of one LLIN per two people was 63.8%, while the proportion of people sleeping under a LLIN in a household was 89.8%, with 95% for children under five years of age and 91.6% for pregnant women.

Fig. 2. Team from NIHRD, NMCP and local malaria cadres interviewed household members and observed the LLIN at a villager’s house in Tembrauw district, Indonesia. ©NIHRD, 2021

The main reasons for not sleeping under LLINs differed among districts. In West Sumba, Boven Digul, and Sorong municipality, respondents reported that they felt uncomfortable and/or hotter. Insufficient LLINs for all household members or not having a LLIN were found to be the main reasons in Mappi, Tembrauw, and Batubara districts. The smaller felt size and the type of LLIN fabric (Polyethylene) that had changed from previous distributions were further reasons cited in Tembrauw, West Sumba, Boven Digul, and Mappi districts.

The review team has finalized the analysis of LLIN distribution campaign. The review result will be used to inform NMCP for the next LLIN campaign strategy and innovation in 2022-2023. 

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