Evaluation of a national universal coverage campaign of long-lasting insecticidal nets in a rural district in north-west Tanzania
Department of Infectious Disease Epidemiology, London School of Tropical Medicine and Hygiene, Keppel Street, London, United Kingdom; Department of Disease Control, London School of Tropical Medicine and Hygiene, Keppel Street, London, United Kingdom; National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; MRC Tropical Epidemiology Group, London School of Tropical Medicine and Hygiene, Keppel Street, London, United Kingdom
Background: Insecticide-treated nets (ITN) are one of the most effective measures for preventing malaria. Mass distribution campaigns are being used to rapidly increase net coverage in at-risk populations. This study had two purposes: to evaluate the impact of a universal coverage campaign (UCC) of long-lasting insecticidal nets (LLINs) on LLIN ownership and usage, and to identify factors that may be associated with inadequate coverage. Methods: In 2011 two cross-sectional household surveys were conducted in 50 clusters in Muleba district, north-west Tanzania. Prior to the UCC 3,246 households were surveyed and 2,499 afterwards. Data on bed net ownership and usage, demographics of household members and household characteristics including factors related to socio-economic status were gathered, using an adapted version of the standard Malaria Indicator Survey. Specific questions relating to the UCC process were asked. Results: The proportion of households with at least one ITN increased from 62.6% (95% Confidence Interval (CI) = 60.9-64.2) before the UCC to 90.8% (95% CI = 89.0-92.3) afterwards. ITN usage in all residents rose from 40.8% to 55.7%. After the UCC 58.4% (95% CI = 54.7-62.1) of households had sufficient ITNs to cover all their sleeping places. Households with children under five years (OR = 2.4, 95% CI = 1.9-2.9) and small households (OR = 1.9, 95% CI = 1.5-2.4) were most likely to reach universal coverage. Poverty was not associated with net coverage. Eighty percent of households surveyed received LLINs from the campaign. Conclusions: The UCC in Muleba district of Tanzania was equitable, greatly improving LLIN ownership and, more moderately, usage. However, the goal of universal coverage in terms of the adequate provision of nets was not achieved. Multiple, continuous delivery systems and education activities are required to maintain and improve bed net ownership and usage. © 2012 West et al.; licensee BioMed Central Ltd.
adolescent; adult; article; bed net; child; cross-sectional study; demography; health program; household; human; infant; major clinical study; malaria control; poverty; preschool child; questionnaire; rural area; school child; social status; Tanzania; universal coverage campaign; Adolescent; Adult; Child; Child, Preschool; Cross-Sectional Studies; Family Characteristics; Female; Health Services Research; Humans; Infant; Insecticide-Treated Bednets; Malaria; Male; Mosquito Control; Ownership; Pregnancy; Rural Population; Tanzania; Universal Coverage