Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya
Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya
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DOI：
10.1186/1471-2458-10-137
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发表时间：
2010-03-16
影响因子：
4.5
通讯作者：
Molyneux, Catherine
中科院分区：
文献类型：
--
作者：
Chuma, Jane;Okungu, Vincent;Molyneux, Catherine
背景资料：确保穷人和弱势群体受益于疟疾控制干预措施，仍然是疟疾流行国家面临的一项挑战。直到最近，在大多数国家，驱虫蚊帐的拥有率和使用率都很低，而且不公平，尽管在一些国家，免费发放驱虫蚊帐的工作已纳入大规模疫苗接种运动，覆盖率有所提高。在肯尼亚，2006年通过两次群众运动向5岁以下儿童免费分发了驱虫蚊帐。据报告，在一些地区开展运动后，覆盖率很高，而且公平，但全国范围的覆盖率仍然很低，这表明了解获得服务的障碍仍然很重要。进行这项研究，探讨所有权和使用驱虫蚊帐之间的最贫困的人口之前和之后的群众运动的障碍，以确定提高覆盖率的战略，并提出建议，如何增加覆盖率水平可以持续。方法：这项研究是在肯尼亚的四个疟疾流行区的最贫困地区进行的。多种数据收集方法，包括：横断面调查（n = 708户），24个焦点小组讨论和半结构化访谈70 ITN suppliers.Results：负担能力被报道为一个主要的障碍，但非金融障碍也被证明是重要的决定因素。在需求方面，获得驱虫蚊帐的主要障碍包括：通过干预措施提供的驱虫蚊帐类型与社区偏好不匹配;对疾病原因的看法和信念;供应商的实际位置;对免费提供和分配机构的不信任。供应方面的主要障碍包括：远离制造商;通过干预措施提供的驱虫蚊帐的可接受性有限;排挤商业部门和价格。基础设施，信息和通信发挥了核心作用，在促进或阻碍access.Conclusions：大量的资源已被定向到解决负担能力的障碍，通过提供免费的驱虫蚊帐弱势群体，但这些干预措施的成功在很大程度上取决于其他障碍获得解决的程度。只有加大努力，消除获得服务的非财政障碍，才能实现和维持高覆盖率。
Background: Ensuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets (ITNs) in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained.Methods: The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys (n = 708 households), 24 focus group discussions and semi-structured interviews with 70 ITN suppliers.Results: Affordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access.Conclusions: Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.