Evaluation of a continuous community-based ITN distribution pilot in Lainya County, South Sudan 2012-2013

Albert Kilian, Lisa Woods Schnurr, Tafadzwa Matova, Richmond Ato Selby, Kojo Lokko, Sean Blaufuss, Miatta Zenabu Gbanya, Ruth Allan, Hannah Koenker, Martin Swaka, George Greer, Megan Fotheringham, Lilia Gerberg, Matthew Lynch

Research output: Contribution to journalArticle

Abstract

Background: Continuous distribution of insecticide-treated nets (ITNs) has now been accepted as one way of sustaining ITN universal coverage. Community-based channels offer an interesting means of delivering ITNs to households to sustain universal ITN coverage. The objective of this study was to provide proof of concept for this channel. Methods: A 9-month, community-based, distribution pilot was implemented beginning 1 year after a mass campaign in Lainya County, South Sudan from 2012 to 2013. Following social mobilization, community members could request an ITN from a net coupon holder. Eligibility criteria included having lost an ITN, giving birth outside of the health facility, or not having enough ITNs for all household members. After verification, households could exchange the coupon for an ITN at a distribution point. The evaluation was a pre/post design using representative household surveys with two-stage cluster sampling and a sample size of 600 households per survey. Results: At endline, 78% of respondents were aware of the scheme and 89% of those also received an ITN through community-based distribution. Population access to ITNs nearly doubled, from 38% at baseline to 66% after the pilot. Household ownership of any ITN and enough ITNs (1 for 2 people) also increased significantly, from 66 to 82% and 19 to 46%, respectively. Community-based distribution was the only source of ITNs for 53.4% of households. The proportion of the population using an ITN last night increased from 22.7% at baseline to 53.9% at endline. A logistic regression model indicates that although behaviour change communication was positively associated with an increase in ITN use, access to enough nets was the greatest determinant of use. Conclusions: ITN access and use improved significantly in the study area during the pilot, coming close to universal coverage targets. This pilot serves as proof of concept for the community-based distribution methodology implemented as a mechanism to sustain ITN universal coverage. Longer periods of implementation should be evaluated to determine whether community-based distribution can successfully maintain ITN coverage beyond the short term, and reach all wealth quintiles equitably.

Original languageEnglish (US)
Article number363
JournalMalaria Journal
Volume16
Issue number1
DOIs
StatePublished - Sep 11 2017

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Insecticides
Universal Coverage
Delivery of Health Care
South Sudan
Logistic Models
Ownership
Health Facilities
Sample Size

Keywords

  • Community-based
  • Insecticide-treated net
  • Insecticide-treated net distribution
  • Malaria
  • South Sudan

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Evaluation of a continuous community-based ITN distribution pilot in Lainya County, South Sudan 2012-2013. / Kilian, Albert; Woods Schnurr, Lisa; Matova, Tafadzwa; Selby, Richmond Ato; Lokko, Kojo; Blaufuss, Sean; Gbanya, Miatta Zenabu; Allan, Ruth; Koenker, Hannah; Swaka, Martin; Greer, George; Fotheringham, Megan; Gerberg, Lilia; Lynch, Matthew.

In: Malaria Journal, Vol. 16, No. 1, 363, 11.09.2017.

Research output: Contribution to journalArticle

Kilian, A, Woods Schnurr, L, Matova, T, Selby, RA, Lokko, K, Blaufuss, S, Gbanya, MZ, Allan, R, Koenker, H, Swaka, M, Greer, G, Fotheringham, M, Gerberg, L & Lynch, M 2017, 'Evaluation of a continuous community-based ITN distribution pilot in Lainya County, South Sudan 2012-2013', Malaria Journal, vol. 16, no. 1, 363. https://doi.org/10.1186/s12936-017-2020-8
Kilian, Albert ; Woods Schnurr, Lisa ; Matova, Tafadzwa ; Selby, Richmond Ato ; Lokko, Kojo ; Blaufuss, Sean ; Gbanya, Miatta Zenabu ; Allan, Ruth ; Koenker, Hannah ; Swaka, Martin ; Greer, George ; Fotheringham, Megan ; Gerberg, Lilia ; Lynch, Matthew. / Evaluation of a continuous community-based ITN distribution pilot in Lainya County, South Sudan 2012-2013. In: Malaria Journal. 2017 ; Vol. 16, No. 1.
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abstract = "Background: Continuous distribution of insecticide-treated nets (ITNs) has now been accepted as one way of sustaining ITN universal coverage. Community-based channels offer an interesting means of delivering ITNs to households to sustain universal ITN coverage. The objective of this study was to provide proof of concept for this channel. Methods: A 9-month, community-based, distribution pilot was implemented beginning 1 year after a mass campaign in Lainya County, South Sudan from 2012 to 2013. Following social mobilization, community members could request an ITN from a net coupon holder. Eligibility criteria included having lost an ITN, giving birth outside of the health facility, or not having enough ITNs for all household members. After verification, households could exchange the coupon for an ITN at a distribution point. The evaluation was a pre/post design using representative household surveys with two-stage cluster sampling and a sample size of 600 households per survey. Results: At endline, 78{\%} of respondents were aware of the scheme and 89{\%} of those also received an ITN through community-based distribution. Population access to ITNs nearly doubled, from 38{\%} at baseline to 66{\%} after the pilot. Household ownership of any ITN and enough ITNs (1 for 2 people) also increased significantly, from 66 to 82{\%} and 19 to 46{\%}, respectively. Community-based distribution was the only source of ITNs for 53.4{\%} of households. The proportion of the population using an ITN last night increased from 22.7{\%} at baseline to 53.9{\%} at endline. A logistic regression model indicates that although behaviour change communication was positively associated with an increase in ITN use, access to enough nets was the greatest determinant of use. Conclusions: ITN access and use improved significantly in the study area during the pilot, coming close to universal coverage targets. This pilot serves as proof of concept for the community-based distribution methodology implemented as a mechanism to sustain ITN universal coverage. Longer periods of implementation should be evaluated to determine whether community-based distribution can successfully maintain ITN coverage beyond the short term, and reach all wealth quintiles equitably.",
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AU - Matova, Tafadzwa

AU - Selby, Richmond Ato

AU - Lokko, Kojo

AU - Blaufuss, Sean

AU - Gbanya, Miatta Zenabu

AU - Allan, Ruth

AU - Koenker, Hannah

AU - Swaka, Martin

AU - Greer, George

AU - Fotheringham, Megan

AU - Gerberg, Lilia

AU - Lynch, Matthew

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KW - Insecticide-treated net

KW - Insecticide-treated net distribution

KW - Malaria

KW - South Sudan

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