System effectiveness of a targeted free mass distribution of long lasting insecticidal nets in Zanzibar, Tanzania
System effectiveness of a targeted free mass distribution of long lasting insecticidal nets in Zanzibar, Tanzania
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DOI：
10.1186/1475-2875-9-173
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发表时间：
2010-06-18
期刊：
影响因子：
3
通讯作者：
Kallander, Karin
中科院分区：
文献类型：
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作者：
Beer, Netta;Ali, Abdullah S.;Kallander, Karin
背景：驱虫蚊帐(ITN)和长效杀虫蚊帐(LLIN)是预防疟疾的重要手段。尽管人们对其重要性达成了共识，但对于哪种交付策略是分发这些救命干预措施的最佳选择，仍存在不确定性。2005年8月至2006年1月期间，桑给巴尔有针对性地向五岁以下儿童和孕妇大量发放免费LLIN。方法：2006年5月在桑给巴尔的两个区进行了两次横断面调查：奔巴岛的Micheweni(MI)和Unguja岛的North A(NA)。对509名五岁以下儿童的照顾者进行了家庭访谈，调查了他们的社会经济状况、蚊帐分配过程、对蚊帐的看法和使用情况。在所有1至5岁的儿童中，对分配过程中的每一步都进行了无条件和有条件的成功比例评估。结果：MI组和NA组5岁以下儿童在任何类型的治疗蚊帐下睡觉的总比例分别为83.7%(318/380)和91.8%(357/389)。MI组LLIN使用率为56.8%(216/380)，NA组为86.9%(338/389)。总体系统效率在MI中为49%，在NA中为87%，在NA的分销规模扩大中找到了公平。在这两个地区，儿童睡在LLIN下的预测因素是照顾者认为LLIN比传统蚊帐更好(在MI和NA中，OR=2.8p=0.005和2.5p=0.041)，此外还接受LLIN(在MI中OR=4.9p&t；0.001，在NA中OR=30.1p=0.001)。结论：有针对性地免费分配LLIN可以在5岁以下儿童中实现高而公平的床位网覆盖率。然而，为了保持高效率的覆盖面，需要在大规模分发活动之间提供免费分发策略。在大规模分发之前考虑社区的偏好，并通过信息、教育和沟通解决社区关注的问题，可能会改善LLIN的使用。
Background: Insecticide-treated nets (ITN) and long-lasting insecticidal nets (LLIN) are important means of malaria prevention. Although there is consensus regarding their importance, there is uncertainty as to which delivery strategies are optimal for dispensing these life saving interventions. A targeted mass distribution of free LLINs to children under five and pregnant women was implemented in Zanzibar between August 2005 and January 2006. The outcomes of this distribution among children under five were evaluated, four to nine months after implementation.Methods: Two cross-sectional surveys were conducted in May 2006 in two districts of Zanzibar: Micheweni (MI) on Pemba Island and North A (NA) on Unguja Island. Household interviews were conducted with 509 caretakers of under-five children, who were surveyed for socio-economic status, the net distribution process, perceptions and use of bed nets. Each step in the distribution process was assessed in all children one to five years of age for unconditional and conditional proportion of success. System effectiveness (the accumulated proportion of success) and equity effectiveness were calculated, and predictors for LLIN use were identified.Results: The overall proportion of children under five sleeping under any type of treated net was 83.7% (318/380) in MI and 91.8% (357/389) in NA. The LLIN usage was 56.8% (216/380) in MI and 86.9% (338/389) in NA. Overall system effectiveness was 49% in MI and 87% in NA, and equity was found in the distribution scale-up in NA. In both districts, the predicting factor of a child sleeping under an LLIN was caretakers thinking that LLINs are better than conventional nets (OR = 2.8, p = 0.005 in MI and 2.5, p = 0.041 in NA), in addition to receiving an LLIN (OR = 4.9, p < 0.001 in MI and in OR = 30.1, p = 0.001 in NA).Conclusions: Targeted free mass distribution of LLINs can result in high and equitable bed net coverage among children under five. However, in order to sustain high effective coverage, there is need for complimentary distribution strategies between mass distribution campaigns. Considering the community's preferences prior to a mass distribution and addressing the communities concerns through information, education and communication, may improve the LLIN usage.