Rapid Scaling Up of Insecticide-Treated Bed Net Coverage in Africa and Its Relationship with Development Assistance for Health: A Systematic Synthesis of Supply, Distribution, and Household Survey Data
Rapid Scaling Up of Insecticide-Treated Bed Net Coverage in Africa and Its Relationship with Development Assistance for Health: A Systematic Synthesis of Supply, Distribution, and Household Survey Data
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DOI：
10.1371/journal.pmed.1000328
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发表时间：
2010-08-01
期刊：
影响因子：
15.8
通讯作者：
Lim, Stephen S.
中科院分区：
文献类型：
--
作者：
Flaxman, Abraham D.;Fullman, Nancy;Lim, Stephen S.
背景：针对疟疾的卫生发展援助在过去10年中呈指数级增长，其中很大一部分资源用于分发驱虫蚊帐。查明已成功扩大ITN复盖面的国家，并了解DAH的作用，对于在复盖率仍然较低的国家取得进展至关重要。稀疏和不一致的数据来源阻碍了对ITN覆盖范围的可靠估计。方法和主要发现：我们结合了制造商向各国交付ITN的报告、分发给卫生设施和业务合作伙伴的ITN的国家疟疾控制计划(NMCP)报告的数据，以及使用贝叶斯推断的关于ITN分布的确定性分区模型的家庭调查数据。对于非洲44个国家，我们计算了(1)ITN所有权覆盖率，定义为拥有至少一个ITN的家庭的比例；(2)ITN在5岁以下儿童中的使用情况，定义为睡在ITN下的5岁以下儿童的比例。利用回归分析，我们研究了2000至2008年间针对疟疾的累积DAH与同一时期国家一级ITN覆盖率变化之间的关系。1999年，假设所有的ITN都是在疟疾风险人群中拥有和使用的，那么在疟疾风险人群中，5岁以下儿童拥有和使用ITN的平均覆盖率分别为2.2%和1.5%，并且在所有44个国家中的覆盖率都很低。2003年，5岁以下儿童拥有和使用ITN的覆盖率分别为5.1%(95%不确定区间为4.6%至5.7%)和3.7%(2.9%至4.9%)；2006年为17.5%(16.4%至18.8%)和12.9%(10.8%至15.4%)；到2008年分别为32.8%(31.4%至34.4%)和26.6%(22.3%至30.9%)。2008年，4个国家的ITN所有权覆盖率在80%或以上；6个国家的所有权覆盖率在60%至80%之间；9个国家的所有权覆盖率在40%至60%之间；12个国家的所有权覆盖率在20%至40%之间；13个国家的覆盖率低于20%。剔除4个离群点国家，人均1美元的疟疾DAH与ITN家庭覆盖率和5岁以下儿童ITN使用率的显著增加相关，分别为5.3个百分点(3.7至6.9)和4.6个百分点(2.5至6.7)。结论：在一些最贫穷的国家，ITN覆盖率迅速增加，但在大量高危人群中覆盖率仍然很低。针对疟疾的DAH可导致ITN复盖面的改善；资金不足可能是一些国家缺乏进展的一个原因。
Background: Development assistance for health (DAH) targeted at malaria has risen exponentially over the last 10 years, with a large fraction of these resources directed toward the distribution of insecticide-treated bed nets (ITNs). Identifying countries that have been successful in scaling up ITN coverage and understanding the role of DAH is critical for making progress in countries where coverage remains low. Sparse and inconsistent sources of data have prevented robust estimates of the coverage of ITNs over time.Methods and Principal Findings: We combined data from manufacturer reports of ITN deliveries to countries, National Malaria Control Program (NMCP) reports of ITNs distributed to health facilities and operational partners, and household survey data using Bayesian inference on a deterministic compartmental model of ITN distribution. For 44 countries in Africa, we calculated (1) ITN ownership coverage, defined as the proportion of households that own at least one ITN, and (2) ITN use in children under 5 coverage, defined as the proportion of children under the age of 5 years who slept under an ITN. Using regression, we examined the relationship between cumulative DAH targeted at malaria between 2000 and 2008 and the change in national-level ITN coverage over the same time period. In 1999, assuming that all ITNs are owned and used in populations at risk of malaria, mean coverage of ITN ownership and use in children under 5 among populations at risk of malaria were 2.2% and 1.5%, respectively, and were uniformly low across all 44 countries. In 2003, coverage of ITN ownership and use in children under 5 was 5.1% (95% uncertainty interval 4.6% to 5.7%) and 3.7% (2.9% to 4.9%); in 2006 it was 17.5% (16.4% to 18.8%) and 12.9% (10.8% to 15.4%); and by 2008 it was 32.8% (31.4% to 34.4%) and 26.6% (22.3% to 30.9%), respectively. In 2008, four countries had ITN ownership coverage of 80% or greater; six countries were between 60% and 80%; nine countries were between 40% and 60%; 12 countries were between 20% and 40%; and 13 countries had coverage below 20%. Excluding four outlier countries, each US$1 per capita in malaria DAH was associated with a significant increase in ITN household coverage and ITN use in children under 5 coverage of 5.3 percentage points (3.7 to 6.9) and 4.6 percentage points (2.5 to 6.7), respectively.Conclusions: Rapid increases in ITN coverage have occurred in some of the poorest countries, but coverage remains low in large populations at risk. DAH targeted at malaria can lead to improvements in ITN coverage; inadequate financing may be a reason for lack of progress in some countries.