Smith Paintain L., Awini E., Addei S., Kukula V., Nikoi C., Sarpong D., Kwesi Manyei A., Yayemain D., Rusamira E., Agborson J., Baffoe-Wilmot A., Bart-Plange C., Chatterjee A., Gyapong M., Mangham-Jefferies L.
Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; UNICEF Offices, 4-8th Rangoon Close, Accra-North, Ghana; National Malaria Control Programme, Ghana Health Service, PO Box KB493, Accra, Greater Accra, Ghana; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
Smith Paintain, L., Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Awini, E., Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; Addei, S., Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; Kukula, V., Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; Nikoi, C., Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; Sarpong, D., Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; Kwesi Manyei, A., Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; Yayemain, D., UNICEF Offices, 4-8th Rangoon Close, Accra-North, Ghana; Rusamira, E., UNICEF Offices, 4-8th Rangoon Close, Accra-North, Ghana; Agborson, J., UNICEF Offices, 4-8th Rangoon Close, Accra-North, Ghana; Baffoe-Wilmot, A., National Malaria Control Programme, Ghana Health Service, PO Box KB493, Accra, Greater Accra, Ghana; Bart-Plange, C., National Malaria Control Programme, Ghana Health Service, PO Box KB493, Accra, Greater Accra, Ghana; Chatterjee, A., UNICEF Offices, 4-8th Rangoon Close, Accra-North, Ghana; Gyapong, M., Dodowa Health Research Centre, Dangme West District, Dodowa, Ghana; Mangham-Jefferies, L., Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
Background: Between May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana. The campaign included pre-registration of persons and sleeping places, door-to-door distribution of LLINs with 'hang-up' activities by volunteers and post-distribution 'keep-up' behaviour change communication activities. Hang-up activities were included to encourage high and sustained use. Methods. The cost and cost-effectiveness of the LLIN Campaign were evaluated using a before-after design in three regions: Brong Ahafo, Central and Western. The incremental cost effectiveness of the 'hang-up' component was estimated using reported variation in the implementation of hang-up activities and LLIN use. Economic costs were estimated from a societal perspective assuming LLINs would be replaced after three years, and included the time of unpaid volunteers and household contributions given to volunteers. Results: Across the three regions, 3.6 million campaign LLINs were distributed, and 45.5% of households reported the LLINs received were hung-up by a volunteer. The financial cost of the campaign was USD 6.51 per LLIN delivered. The average annual economic cost was USD 2.90 per LLIN delivered and USD 6,619 per additional child death averted by the campaign. The cost-effectiveness of the campaign was sensitive to the price, lifespan and protective efficacy of LLINs.Hang-up activities constituted 7% of the annual economic cost, though the additional financial cost was modest given the use of volunteers. LLIN use was greater in households in which one or more campaign LLINs were hung by a volunteer (OR = 1.57; 95% CI = 1.09, 2.27; p = 0.02). The additional economic cost of the hang-up activities was USD 0.23 per LLIN delivered, and achieved a net saving per LLIN used and per death averted. Conclusion: In this campaign, hang-up activities were estimated to be net saving if hang-up increased LLIN use by 10% or more. This suggests hang-up activities can make a LLIN campaign more cost-effective. © 2014 Smith Paintain et al.; licensee BioMed Central Ltd.